Plaque Accumulation in Adolescent Orthodontic Patients

:
Bonded Versus Banded Teeth
Abstract
Fitin Aloufi, BDS, MS, MSD Diplomate, American Board of Periodontology Diplomate, American Board of Orthodontics Security Forces Hospital, Dental Department Riyadh Colleges of Dentistry and Pharmacy Saudi Arabia Sebastian G. Ciancio, DDS* Distinguished Service Professor and Chair Department of Periodontics and Endodontics, School of Dental Medicine Director, Center for Dental Studies University at Buffalo, State University of New York Buffalo, NY Othman Shibly, DDS, MS Diplomate, American Board of Periodontology Coordinator, International Advanced Dental Education Director, Preventive Dentistry Associate Director, Center for Dental Studies University at Buffalo, State University of New York Buffalo, NY Mohammad S. Al-zahrani, BDS, MSD, PhD Associate Professor Division of Periodontics King Abdulaziz University Jeddah, Saudi Arabia *Corresponding author

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laque accumulation on bonded (BN) versus banded (BA) teeth was com-

pared in 252 teeth in 9 healthy adolescents, 11 to 15 years of age, who were undergoing orthodontic treatment with fixed appliances. Plaque

index was measured on BN and BA teeth. The measurements were taken at 3 time intervals: 0, 28, and 48 days. At the end of the study, plaque accumulation was found to be significantly higher around BA compared with BN molars.

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rthodontic bands, brackets, and wires are impediments to brushing and flossing, frequently facilitating the accumulation of plaque biofilm that jeopardizes gingival and periodontal health. Studies have demonstrated an increase in plaque biofilm deposits and putative periodontal pathogens after placement of orthodontic appliances, leading to increased bleeding and probing depth.1-7 Furthermore, periodontal pathogens in orthodontic patients were reduced within 3 months of appliance removal.8 Bacterial plaque as a biofilm is recognized as the principal cause of caries and periodontal disease.9 Dental plaque removal by professional prophylaxis and maintenance through personal oral hygiene is key to prevention of caries and periodontal disease and continued satisfactory maintenance of oral health.10 Therefore, it is important for both the patient and the clinician to establish a personalized oral hygiene regimen to achieve and maintain optimal plaque control during orthodontic treatment. Two earlier studies examined the effect of type of fixed orthodontic appliance on plaque accumulation.2,4 Both compared the periodontal health of BN and BA molars and demonstrated greater inflammation around BA compared with BN molars. With advances in the orthodontic field, however, there is a need to update studies of this issue. The objective of the present study is to bring the data up to date on the accumulation of plaque biofilm on BA versus BN teeth.

Study Design
The study was conducted with 9 adolescent patients (11 to 15 years of age) in the Department of Orthodontics, School of Dental Medicine, UniDental Learning / June 2010 1

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Table 1 Plaques Scores on Banded (BA) and Bonded (BN) Teeth

BA BN

T1 (Day 0) 3.1 ± 0.08 2.9 ± 0.07

T2 (28 days) 2.3 ± 0.18 2.3 ± 0.10

T3 (48 days) 2.7 ± 0.13 2.2 ± 0.12*

*Differences between groups statistically significant, P < 0.05.

versity at Buffalo, State University of New York. The protocol was reviewed and approved by the university’s Institutional Review Board. Written informed consent was obtained from the parents before enrolling their children in the study. All patients brushed using a manual soft-bristled toothbrush and fluoridated toothpaste according to instructions given at the start of their orthodontic treatment. The research included a total of 252 teeth; 180 were BN and 72 were BA. The plaque index was scored by 1 calibrated, experienced examiner on all buccal surfaces at 3 visits: 0, 28, and 48 days. Only the facial and facial interproximal surfaces were scored because the purpose of the study was to compare plaque biofilm accumulation around both BN and bracketed teeth. Because orthodontic bonding is placed only on the buccal aspects of teeth, these surfaces were used for comparison of biofilm accumulation on both BN and bracketed surfaces. In practice, it is expected that this index would be used on the facial aspects of teeth and a traditional aspect on the lingual surfaces of teeth. Plaque biofilm was disclosed with a disclosing solution (sodium fluorescein) with disclosing light) and scored according to the Quigley-Hein plaque index.11 A student test was used to compare the plaque accumulation between BA teeth and BN teeth. The significance level was set at P≤ .05.

Figure 1 — Schematic representation of the bonded bracket Index (BBI)

Grade I: Grade II:

Plaque present on the bracket only Plaque present on the bracket and the immediate adjacent tooth surface Grade III: Plaque present on the bracket and continuous to the interproximal surface Grade IV: A continuous layer of plaque extending from the bracket to the gingival margin.

Discussion
The present study demonstrated that BA teeth had more plaque biofilm accumulation compared with BN teeth at 6 weeks. This finding was in agreement with a previous study that examined the plaque accumulation and periodontal status of patients during orthodontic treatment.2 The results suggest that BA teeth are more retentive of plaque and therefore more difficult to keep plaque free compared with BN teeth. A possible reason for this finding could be because of the overhanging margins of the orthodontic bands that make plaque removal more difficult. Patients who might be at higher risk of periodontal disease because of systemic factors, history of chronic periodontitis, poor oral hygiene, or smoking/tobacco use may benefit from bonding as opposed to banding the teeth. In the study, a new index was introduced (BBI) to help monitor plaque biofilm control throughout the orthodontic treatment. The BBI will allow clinicians to better determine the effectiveness of the orthodontic patient’s

Results
The plaque biofilm score for BA teeth at baseline was 3.1 ± 0.08, and for BN teeth was 2.9 ± 0.07 (Table 1). At 4 weeks, the plaque scores for BA and BN were 2.3 ± 0.18 and 2.3 ± 0.10, respectively. At 6 weeks, a significantly greater plaque accumulation was found on BA teeth (2.7 ± 0.13) compared with BN teeth (2.2 ± 0.12 (P < 0.05). To help monitor plaque biofilm control throughout the orthodontic treatment, the following new index, the Bonded Bracket Index (BBI), was introduced (Figure 1):

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oral hygiene measures. Also, it provides more valuable information in terms of the amount of plaque accumulation on and around the bracket. This information may be important relative to the need for use of plaque-control products during orthodontic therapy to diminish adverse effects on both the adjacent gingival tissue and the tooth surface around the bracket. This index can also be used as a tool to visually demonstrate plaque biofilm for those patients with poor plaque control as a motivational aid to improve their oral hygiene. BBI scores could be recorded at each patient’s visit during orthodontic therapy to serve as a definitive measure of the distribution of plaque around bonded brackets.

2. Alexander SA. Effects of orthodontic attachments on the gingival health of permanent second molars. Am J Orthod Dentofacial Orthop. 1991;100:337-340. 3. Atack NE, Sandy JR, Addy M. Periodontal and microbiological changes associated with the placement of orthodontic appliances. A review. J Periodontol. 1996;67:78-85. 4. Boyd RL, Baumrind S. Periodontal considerations in the use of bonds or bands on molars in adolescents and adults. Angle Orthod. 1992;62:117-126. 5. Sadowsky C, BeGole EA. Long-term effects of orthodontic treatment on periodontal health. Am J Orthod. 1981;80: 156-172. 6. Naranjo AA, Triviño ML, Jaramillo A, et al. Changes in the subgingival microbiota and periodontal parameters before and 3 months after bracket placement. Am J Orthod Dentofacial Orthop. 2006;130:275.e17-22. 7. Ristic M, Vlahovic Svabic M, Sasic M, Zelic O. Clinical and microbiological effects of fixed orthodontic appliances on periodontal tissues in adolescents. Orthod Craniofac Res. 2007;10:187-195. 8. Choi DS, Cha BK, Jost-Brinkmann PG, et al. Microbiologic changes in subgingival plaque after removal of fixed orthodontic appliances. Angle Orthod. 2009;79:1149-1155. 9. Loesche W. Dental caries and periodontitis: contrasting two infections that have medical implications. Infect Dis Clin North Am. 2007;21:471-502. 10. Ximénez-Fyvie LA, Haffajee AD, Som S, et al. The effect of repeated professional supragingival plaque removal on the composition of the supra- and subgingival microbiota. J Clin Periodontol. 2000;27:637-647. 11. Quigley GA, Hein JW. Comparative cleansing efficiency of manual and power brushing. J Am Dent Assoc. 1962;65: 26-29.

Conclusion
This study demonstrated that BA teeth had more plaque accumulation compared with BN teeth at 6 weeks. This finding was in agreement with a previous study that examined the plaque accumulation and periodontal status of patients during orthodontic treatment.4 The findings suggest that BA teeth are more retentive of plaque and therefore more difficult to keep plaque free compared with BN teeth. Patients who might be at higher risk of periodontal disease as a result of systemic factors, history of chronic periodontitis, poor oral hygiene, or smoking/tobacco use habit may benefit from bonding as opposed to banding the teeth.

References
1. Lee SM, Yoo SY, Kim HS, et al. Prevalence of putative periodontopathogens in subgingival dental plaques from gingivitis lesions in Korean orthodontic patients. J Microbiol. 2005;43:260-265.

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