Influence of attachment bonding protocol on precision of the attachment in aligner treatments

Weckmann, Julia; Scharf, Sven; Graf, Isabelle; Schwarze, Jörg; Keilig, Ludger; Bourauel, Christoph; Braumann, Bert

doi:10.1007/s00056-019-00204-7

Cited by 30 publications

(27 citation statements)

References 18 publications

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“…On top of that, the inclusion of resin-based attachments to aligner therapy in an attempt to guide tooth movement and orchestrate tooth displacement more effectively, has become almost universal among the users of such treatment alternatives [42,43]. Apparently, the inclusion of such auxiliaries to a full-case orthodontic treatment with aligners gives rise to certain emerging issues: first, the inclusion of additional adhesive/resin based materials, of variable number, size and scheme or shape, which present themselves as "extensions" to natural dentition bounds, are possibly likely to demonstrate estrogenic activity through BPA/monomer release in the oral cavity.…”

Section: Findings In Contextmentioning

confidence: 99%

Safety Considerations for Thermoplastic-Type Appliances Used as Orthodontic Aligners or Retainers. A Systematic Review and Meta-Analysis of Clinical and In-Vitro Research

et al. 2020

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Use of thermoplastic material in orthodontics, either as aligner or as retainer appliances, is common practice and is likely to increase in the years to come. However, no systematic assessment on safety considerations of these adjuncts has been implemented up to date. The aim of this systematic review was to collectively appraise the existing evidence from both clinical and laboratory studies, on whether these appliances are associated with any estrogenic/cytotoxic effects or bisphenol-A (BPA) and monomer leaching. Eight electronic databases were searched with no limits in December 22, 2019, for published and unpublished research. Eligibility criteria comprised of studies of any design, describing use of any type of thermoplastic aligner. Study selection, data extraction and risk of bias (RoB) assessment was done independently, either in duplicate or confirmed by a second reviewer. Random effects meta-analyses of weighted mean differences (WMD) with associated 95% Confidence Intervals (CIs) were planned. Quality of the evidence was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 58 articles were initially identified, while 5 were included in qualitative synthesis and 2 of those contributed to the quantitative syntheses. Four studies were in-vitro, while one was a randomized controlled trial; all assessed some type of orthodontic aligner or retainer, either as-received or retrieved. Risk of bias recordings ranged between unclear and high for all studies. Proliferation induction capacity of thermoplastic appliances’ eluents on MCF-7 cells failed to be confirmed compared to beta-estradiol (2 studies: 5% v/v, WMD: −182.08; 95% CI: −198.83, −165.33; p-value < 0.001; and 20% v/v, WMD: −184.53; 95% CI: −206.17, −162.88; p-value < 0.001). No cytotoxic activity was detected as well. In addition, although evidence from in-vitro studies was indicative of no traceable detection of BPA or other monomers, the findings from a single clinical trial were allied to increased levels of BPA in whole stimulated saliva, after up to 30 days of thermoplastic retainer usage, compared to standard Hawley retainer. The quality of the evidence overall was low to medium. Current data from in-vitro research are indicative of an absence of an estrogenic or cytotoxic effect of thermoplastic aligners or retainers. Regarding BPA or monomer release, evidence from clinical and laboratory studies appear inconsistent.

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Section: Findings In Contextmentioning

confidence: 99%

Safety Considerations for Thermoplastic-Type Appliances Used as Orthodontic Aligners or Retainers. A Systematic Review and Meta-Analysis of Clinical and In-Vitro Research

et al. 2020

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“… 6 As previously discussed, aligner usage for treatment of malocclusions currently involves increasingly frequent adoption of composite grips bonded to tooth enamel, sometimes more than 1 per tooth, as attachments of various sizes and shapes, with nonnegligible dimensions, varying within the range of 2-5 mm and also width or thickness that may exceed 1 mm. 6 , 8 These adjuncts target to the achievement of modes of tooth movement, either rotational or translational, within all 3 planes of space, which would otherwise be non- manageable with the early phase plain thermoplastic aligner usage, that do not necessitate enamel involvement. 86 This compares to the thin layer of composites used as a layer of “sandwich-type” pattern between the bracket base and the enamel surface in a conventional case fixed appliance treatment, with an average estimated thickness of 150 to 250 μm; one may evidently cognize that the bulk and thickness of the attachment grips in aligner therapy is implicated in 2 conditions: first, the occurrence of an excessive amount of composite polymerized material within the oral cavity, allowing for the potential risk of BPA release or monomer leaching, depending on the number and shape or size; second, grinding procedures for attachment removal may prove extremely exhaustive and timely, bearing an increasing risk of excessive production of aerosolized composite dust.…”

Section: Composite Grinding and Particulate Productionmentioning

confidence: 99%

“…6,7 This is particularly striking if one considers that most orthodontists and/or other clinicians utilizing aligner methods to straighten teeth and treat malocclusions have adopted wide application of these adjuncts in everyday practice. 8,9 With regard to bonding strategies, the conventional acid-etching stage may be employed with the use of a gel etchant of very thick consistency, a gel of lower viscosity, or a liquid etchant (Fig 1). Implications for the first alternative are rather straightforward, as it might require a considerably higher pressure of water flow to be rinsed off, as well as a longer rinsing period; but practically, there is more.…”

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confidence: 99%

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Minimizing the aerosol-generating procedures in orthodontics in the era of a pandemic: Current evidence on the reduction of hazardous effects for the treatment team and patients

Eliades

Koletsi

2020

American Journal of Orthodontics and Dentofacial Orthopedics

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The purpose of this critical review is to list the sources of aerosol production during orthodontic standard procedure, analyze the constituent components of aerosol and their dependency on modes of grinding, the presence of water and type of bur, and suggest a method to minimize the quantity and detrimental characteristics of the particles comprising the solid matter of aerosol. Minimization of water-spray syringe utilization for rinsing is suggested on bonding related procedures, while temporal conditions as represented by seasonal epidemics should be considered for the decision of intervention scheme provided as a preprocedural mouth rinse, in an attempt to reduce the load of aerosolized pathogens. In normal conditions, chlorhexidine 0.2%, preferably under elevated temperature state should be prioritized for reducing bacterial counts. In the presence of oxidation vulnerable viruses within the community, substitute strategies might be represented by the use of povidone iodine 0.2%-1%, or hydrogen peroxide 1%. After debonding, extensive material grinding, as well as aligner related attachment clean-up, should involve the use of carbide tungsten burs under water cooling conditions for cutting efficiency enhancement, duration restriction of the procedure, as well as reduction of aerosolized nanoparticles. In this respect, selection strategies of malocclusions eligible for aligner treatment should be reconsidered and future perspectives may entail careful and more restricted utilization of attachment grips. For more limited clean-up procedures, such as grinding of minimal amounts of adhesive remnants, or individualized bracket debonding in the course of treatment, handinstruments for remnant removal might well represent an effective strategy. Efforts to minimize the use of rotary instrumentation in orthodontic settings might also lead the way for future solutions. Measures of self-protection for the treatment team should never be neglected. Dressing gowns and facemasks with filter protection layers, appropriate ventilation and fresh air flow within the operating room comprise significant links to the overall picture of practice management. Risk management considerations should be constant, but also updated as new material applications come into play, while being grounded on the best available evidence.

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“…Allerdings wurde beim Kleben der Attachments mit KFO-Komposit (mittlere Viskosität) signifikant mehr Material-Überschuss festgestellt als im Vergleich zu einem Flowable-Komposit (niedrige Viskosität). Weckmann et al [51] untersuchten den Einfluss des Befestigungsmodus auf die Attachment-Übertragung. Sie konnten zeigen, dass die Art der Übertragung einen Einfluss hat.…”

Section: Aligner-attachmentsunclassified

Befestigungsmöglichkeiten von Brackets und Attachments in der Kieferorthopädie

Jungbauer

Liebermann

Kieschnick

et al. 2020

Informationen aus Orthodontie & Kieferorthopädie

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ZusammenfassungSowohl für die Befestigung von Brackets als auch von Aligner-Attachments stehen verschiedene Materialien und Strategien zur Auswahl. Die Vorbereitung der Schmelz-Oberfläche für die adhäsive Befestigung kann mit Phosphorsäure im Etch and Rinse-Verfahren oder mittels diverser selbstätzender Adhäsive vorgenommen werden. Die Materialien zur Befestigung unterscheiden sich hinsichtlich der Monomermatrix, der Füllkörper und deren Anteile sowie ihres Initiatiorsystems. Brackets können direkt oder indirekt adhäsiv befestigt werden. Attachments für die Behandlung mit Alignern können ein- oder zweiphasig auf die entsprechenden Zähne aufgebracht werden. Ziel dieses Artikels ist es, anhand der aktuellen Literatur einen Überblick über die verschiedenen Materialien und Befestigungsstrategien zu geben.

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Influence of attachment bonding protocol on precision of the attachment in aligner treatments

Cited by 30 publications

References 18 publications

Safety Considerations for Thermoplastic-Type Appliances Used as Orthodontic Aligners or Retainers. A Systematic Review and Meta-Analysis of Clinical and In-Vitro Research

Safety Considerations for Thermoplastic-Type Appliances Used as Orthodontic Aligners or Retainers. A Systematic Review and Meta-Analysis of Clinical and In-Vitro Research

Minimizing the aerosol-generating procedures in orthodontics in the era of a pandemic: Current evidence on the reduction of hazardous effects for the treatment team and patients

Befestigungsmöglichkeiten von Brackets und Attachments in der Kieferorthopädie

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