Iosif Sifakakis

Release of bisphenol-A from a light-cured adhesive bonded to lingual fixed retainers

INTRODUCTION Our aim was to quantitatively determine the bisphenol-A (BPA) released from a light-cured orthodontic adhesive used to bond lingual fixed retainers. METHODS Eighteen recently extracted premolars, divided into 3 groups of 6 teeth each, were embedded in plaster in an arch shape. A light-cured adhesive (Transbond XT, 3M Unitek, Monrovia, Calif) was bonded to a .0195-in, 3-strand heat-treated twist flex wire (Wildcat, GAC International, Bohemia, NY) adjusted to the lingual surface of the teeth, and the arches were immersed in doubled-distilled water for 10, 20, and 30 days. The concentration of BPA in the 3 eluents was investigated with gas chromatography-mass spectroscopy; all assays were performed in triplicate, and the results were averaged. RESULTS Measurable amounts of BPA were identified for all groups, with the highest found in the immersion media of the 1-month groups (2.9 μg/L), whereas the control (tooth storage solution) had 0.16 μg/L. CONCLUSIONS The BPA released from a light-cured adhesive used to bond lingual fixed retainers might be assigned to the application mode of the material that differs from conventional use. Further testing including estrogenicity assays will assess the potential estrogenic action of this application. Composite restorative resins should replace orthodontic adhesives that were not intended to function with their surfaces in the oral cavity; alternatively, canine-bonded fixed retainers might reduce the amount of adhesive used.

BPA qualtitative and quantitative assessment associated with orthodontic bonding in vivo

OBJECTIVE To assess the in vivo amount of BPA released from a visible light-cured orthodontic adhesive, immediately after bracket bonding. METHODS 20 orthodontic patients were recruited after obtaining informed consent. All patients received 24 orthodontic brackets in both dental arches. In Group A (11 patients), 25 ml of tap water were used for mouth rinsing, whereas in Group B (9 patients) a simulated mouth rinse formulation was used: a mixture of 20 ml de-ionized water plus 5 ml absolute ethanol. Rinsing solutions were collected before, immediately after placing the orthodontic appliances and after washing out the oral cavity and were then stored in glass tubes. Rinsing was performed in a single phase for 60s with the entire volume of each liquid. The BPA analysis was performed by gas chromatography-mass spectrometry. RESULTS An increase in BPA concentration immediately after the 1st post-bonding rinse was observed, for both rinsing media, which was reduced after the 2nd post-bonding rinse. Water exhibited higher levels of BPA concentration than water/ethanol after 1st and 2nd post-bonding rinses. Two-way mixed Repeated Measures ANOVA showed that the primary null hypothesis declaring mean BPA concentration to be equal across rinsing medium and rinsing status was rejected (p-value <0.001). The main effects of the rinsing medium and status, as well as their interaction were found to be statistically significant (p-values 0.048, <0.001 and 0.011 respectively). SIGNIFICANCE A significant pattern of increase of BPA concentration, followed by a decrease that reached the initial values was observed. The amount of BPA was relatively low and far below the reference limits of tolerable daily intake.

In-vitro assessment of the forces generated by lingual fixed retainers

INTRODUCTION The aim of this article was to assess the effect of wire adaptation on the lingual surfaces of mandibular anterior teeth with 3 types of lingual retainers on the development of vertical and labiolingual forces. METHODS Ten retainers (canine to canine) were constructed from each of the following wires: Wildcat 0.0195-in heat-treated 3-strand twist-flex wire (GAC, Bohemia, NY); Penta-one 0.0215-in 6-strand as received; and Penta-one 0.0215-in 6-strand after heat treatment at 350°C for 4 minutes (both, Masel Orthodontics, Carlsbad, Calif). The retainers were bonded on each tooth of an acrylic resin model, and the model was installed in the Orthodontic Measurement and Simulation System. The vertical and labiolingual forces generated were measured for wire displacements up to 0.2 mm in 0.02-mm increments. RESULTS Wire displacement of 0.2 mm exerted forces as high as 1 N on the teeth. In the vertical direction, the highest force levels were recorded for the as-received Penta-one 0.0215-in and the lowest from its heat-treated counterpart. In the horizontal plane, the as-received Penta-one 0.0215-in exerted the highest forces. CONCLUSIONS The forces recorded from the lingual retainer wires during 0.2-mm simulated intrusion-extrusion and buccal-lingual movements might generate high forces that exceed 1 N and be large enough to produce unwanted tooth movement during retention. The only significant determinant of the generated forces was the amount of wire displacement and not the type of wire used in this study.

A comparative assessment of torque generated by lingual and conventional brackets

The aim of this study was to assess the effect of bracket type on the labiopalatal moments generated by lingual and conventional brackets. Incognito™ lingual brackets (3M Unitek), STb™ lingual brackets (Light Lingual System; ORMCO), In-Ovation L lingual brackets (DENTSPLY GAC), and conventional 0.018 inch slot brackets (Gemini; 3M Unitek) were bonded on identical maxillary acrylic resin models with levelled and aligned teeth. Each model was mounted on the orthodontic measurement and simulation system and 10 0.0175 × 0.0175 TMA wires were used for each bracket type. The wire was ligated with elastomerics into the Incognito, STb, and conventional brackets and each measurement was repeated once after religation. A 15 degrees buccal root torque (+15 degrees) and then a 15 degrees palatal root torque (-15 degrees) were gradually applied to the right central incisor bracket. After each activation, the bracket returned to its initial position and the moments in the sagittal plane were recorded during these rotations of the bracket. One-way analysis of variance with post hoc multiple comparisons (Tukey test at 0.05 error rate) was conducted to assess the effect on bracket type on the generated moments. The magnitude of maximum moment at +15 degrees ranged 8.8, 8.2, 7.1, and 5.8 Nmm for the Incognito, STb, conventional Gemini, and the In-Ovation L brackets, respectively; similar values were recorded at -15 degrees: 8.6, 8.1, 7.0, and 5.7 Nmm, respectively. The recorded differences of maximum moments were statistically significant, except between the Incognito and STb brackets. Additionally, the torque angles were evaluated at which the crown torque fell well below the minimum levels of 5.0 Nmm, as well as the moment/torque ratio at the last part of the activation/deactivation curve, between 10 and 15 degrees. The lowest torque expression was observed at the self-ligating lingual brackets, followed by the conventional brackets. The Incognito and STb lingual brackets generated the highest moments.

Torque expression of 0.018 and 0.022 inch conventional brackets

The aim of this study was to assess the effect of the moments generated with low- and high-torque brackets. Four different bracket prescription-slot combinations of the same bracket type (Mini Diamond® Twin) were evaluated: high-torque 0.018 and 0.022 inch and low-torque 0.018 and 0.022 inch. These brackets were bonded on identical maxillary acrylic resin models with levelled and aligned teeth and each model was mounted on the orthodontic measurement and simulation system (OMSS). Ten specimens of 0.017 × 0.025 inch and ten 0.019 × 0.025 inch stainless steel archwires (ORMCO) were evaluated in the low- and high-torque 0.018 inch and 0.022 inch brackets, respectively. The wires were ligated with elastomerics into the brackets and each measurement was repeated once after religation. Two-way analysis of variance and t-test were conducted to compare the generated moments between wires at low- and high-torque brackets separately. The maximum moment generated by the 0.017 × 0.025 inch stainless steel archwire in the 0.018 inch brackets at +15 degrees ranged from 14.33 and 12.95 Nmm for the high- and low-torque brackets, respectively. The measured torque in the 0.022 inch brackets with the 0.019 × 0.025 inch stainless steel archwire was 9.32 and 6.48 Nmm, respectively. The recorded differences of maximum moments between the high- and low-torque series were statistically significant. High-torque brackets produced higher moments compared with low-torque brackets. Additionally, in both high- and low-torque configurations, the thicker 0.019 × 0.025 inch steel archwire in the 0.022 inch slot system generated lower moments in comparison with the 0.017 × 0.025 inch steel archwire in the 0.018 inch slot system.

Torque efficiency of different archwires in 0.018- and 0.022-inch conventional brackets

OBJECTIVE To compare the archwires inserted during the final stages of the orthodontic treatment with the generated moments at 0.018- and 0.022-inch brackets. MATERIALS AND METHODS The same bracket type, in terms of prescription, was evaluated in both slot dimensions. The brackets were bonded on two identical maxillary acrylic resin models, and each model was mounted on the orthodontic measurement and simulation system. Ten 0.017 × 0.025-inch TMA and ten 0.017 × 0.025-inch stainless steel archwires were evaluated in the 0.018-inch brackets. In the 0.022-inch brackets, ten 0.019 × 0.025-inch TMA and ten 0.019 × 0.025-inch stainless steel archwires were measured. A 15° buccal root torque (+15°) and then a 15° palatal root torque (-15°) were gradually applied to the right central incisor bracket, and the moments were recorded at these positions. A t-test was conducted to compare the generated moments between wires within the 0.018- and 0.022-inch bracket groups separately. RESULTS The 0.017 × 0.025-inch archwire in the 0.018-inch brackets generated mean moments of 9.25 Nmm and 14.2 Nmm for the TMA and stainless steel archwires, respectively. The measured moments in the 0.022-inch brackets with the 0.019 × 0.025-inch TMA and stainless steel archwires were 6.6 Nmm and 9.3 Nmm, respectively. CONCLUSION The 0.017 × 0.025-inch stainless steel and β-Ti archwires in the 0.018-inch slot generated higher moments than the 0.019 × 0.025-inch archwires because of lower torque play. This difference is exaggerated in steel archwires, in comparison with the β-Ti, because of differences in stiffness. The differences of maximum moments between the archwires of the same cross-section but different alloys were statistically significant at both slot dimensions.

Stability and relapse after orthodontic treatment of deep bite cases—a long-term follow-up study

The purpose of this long-term follow-up study was twofold-firstly, to assess prevalence of relapse after treatment of deep bite malocclusion and secondly, to identify risk factors that predispose patients with deep bite malocclusion to relapse. Sixty-one former patients with overbite more than 50% incisor overlap before treatment were successfully recalled. Clinical data, morphometrical measurements on plaster casts before treatment, after treatment and at long-term follow-up, as well as cephalometric measurements before and after treatment were collected. The median follow-up period was 11.9 years. Patients were treated by various treatment modalities, and the majority of patients received at least a lower fixed retainer and an upper removable bite plate during retention. Relapse was defined as increase in incisor overlap from below 50% after treatment to equal or more than 50% incisor overlap at long-term follow-up. Ten per cent of the patients showed relapse to equal or larger than 50% incisor overlap, and their amount of overbite increase was low. Among all cases with deep bite at follow-up, gingival contact and palatal impingement were more prevalent in partially corrected noncompliant cases than in relapse cases. In this sample, prevalence and amount of relapse were too low to identify risk factors of relapse.

Residual stress analysis of fixed retainer wires after in vitro loading: can mastication-induced stresses produce an unfavorable effect?

Abstract The aim of the present study was to compare four different types of fixed canine-to-canine retainer regarding the maximum and residual force system generated on a canine during the intrusive in vitro loading of the rest of the anterior teeth. Retainers constructed from Ortho-FlexTech gold chain 0.038×0.016-inch (rectangular, 0.96×0.40 mm²), Tru-Chrome® 7-strand twisted 0.027-inch (round, 0.68 mm diameter) steel wire, and Wildcat 0.0175-inch (round, 0.44 mm) and 0.0215-inch (round, 0.55 mm) 3-strand Twistflex steel wire bonded on the anterior teeth of an acrylic resin model, installed in the Orthodontic Measurement and Simulation System. The force system on the canine was recorded during the loading of the anterior teeth as well as the residual force system at the same tooth after the unloading. During maximum loading, the gold chain exerted the lowest and the 0.0215-inch archwire the highest force and moment magnitude. Residual forces and moments were exerted on the canine after the unloading in all retainer types, i.e., the evaluated fixed retainers were not passive after in vitro vertical loading. The lowest magnitude was measured in gold chain retainers and the highest in cases of the high formable/low yield strength 0.027-inch archwire. This fact may explain the unexpected movements of teeth bonded on fixed retainers detected long-term in vivo.

A comparative assessment of the forces and moments generated with various maxillary incisor intrusion biomechanics

The aim of this study was to comparatively evaluate the intrusive forces and buccolingual torquing moments generated during anterior maxillary intrusion using different maxillary incisor intrusion mechanics. Five wire specimens were used for each of the following intrusive arches: blue Elgiloy utility arch 0.016 x 0.016 inch, TMA utility arch 0.017 x 0.025 inch, Burstone TMA intrusion arch 0.017 x 0.025 inch, and reverse curve of Spee NiTi 0.016 x 0.022 inch. The wires were inserted on bracketed dental arches constructed on maxillary Frasaco models, segmented mesially to the maxillary canines. Simulated intrusion from 0.0 to 3 mm was performed using the orthodontic measurement and simulation system (OMSS), and forces and moments were recorded in the sagittal plane at 0.1 mm vertical displacement increments. All measurements were repeated five times for each specimen and values recorded at 1.5 mm for all wires were used for statistical evaluations. The results were analysed with one-way analysis of variance with forces and moments serving as the dependent variables and wire type as the independent variable. Post hoc multiple comparisons were performed using the Tukey test (0.05 error rate). Comparison of the two major intrusion techniques for the maxillary anterior teeth, segmented and bioprogressive, revealed that the Burstone TMA 0.017 x 0.025 inch intrusion arch exerted the lowest force on the incisors (0.99 N), followed by the TMA utility 0.017 x 0.025 inch (1.33 N) and the blue Elgiloy 0.016 x 0.016 inch utility (1.43 N). The highest force was recorded for the reverse curve of Spee NiTi and exceeded the value of 9 N. The lowest buccolingual moments were recorded with the Burstone intrusion arch (2.47 Nmm), whereas the highest was registered for the utility arch constructed with a 0.017 x 0.025 inch TMA wire (7.31 Nmm).

Forces and Moments Generated with Various Incisor Intrusion Systems on Maxillary and Mandibular Anterior Teeth

OBJECTIVE To evaluate the comparative intrusive forces and torquing moments in the sagittal plane generated during anterior intrusion using different incisor intrusion mechanics in the maxillary and mandibular anterior teeth. MATERIALS AND METHODS Five wire specimens were used for each of the following intrusive arches: non-heat-treated, 0.016 x 0.016-inch blue Elgiloy utility arch, 0.017 x 0.025-inch TMA utility arch, and 0.017 x 0.025-inch TMA Burstone intrusion arch. The wires were constructed according to the specifications given by their inventors and were inserted on bracketed dental arches on Frasaco models, segmented mesial to the canines. Simulated intrusion from 0.0-1.5 mm was performed on the Orthodontic Measurement and Simulation System (OMSS), and forces and moments were recorded at 0.1 mm vertical displacement increments. All measurements were repeated five times for each specimen, and maximum values recorded at 1.5 mm for all wires were used for all statistical evaluations. The data were analyzed with two-way analysis of variance (ANOVA) with forces and moments serving as the dependent variables, separately, and wire type and jaw as the independent variables. Post hoc multiple comparisons were performed using the Tukey test (.05 error rate). RESULTS The 0.017 x 0.025-inch TMA Burstone intrusion arch exerted the lowest intrusive forces, followed by the 0.017 x 0.025-inch TMA utility and the 0.016 x 0.016-inch blue Elgiloy utility arch. The lowest anterior moment in the sagittal plane in this experiment was generated from the 0.017 x 0.025-inch TMA Burstone intrusion arch. CONCLUSIONS The intrusive forces, as well as the generated moments, were always higher in the mandible, where significant differences were observed among the configurations tested.