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Long-term evaluation of metal ion release in orthodontic patients using fluoridated oral hygiene agents: An in vivo study

  • Prasad Chitra
    Correspondence
    Corresponding author. Doctoral Fellow, Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics, Army College of Dental Sciences, Secunderabad, Telangana 500087, India.
    Affiliations
    Doctoral Fellow, Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics, Army College of Dental Sciences, Secunderabad, Telangana, India
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  • Govinakovi Shivamurthy Prashantha
    Affiliations
    Professor, Department of Orthodontics and Dentofacial Orthopaedics, M.S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
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  • Arun Rao
    Affiliations
    Professor, Department of Mechanical Engineering, M.S. Ramaiah University of Applied Sciences, Bengaluru, Karnataka, India
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      Highlights

      • Nickel and chromium ions are released into gingival crevicular fluid during orthodontic treatment.
      • Fluorides cause greater amounts of metal release due to their corrosive effects on metals.
      • Maximum levels of nickel and titanium are noticed 30 days after commencing treatment.
      • Fluoride agents should be used with caution in orthodontic patients undergoing treatment with metal fixed appliances.

      Abstract

      Objective

      To investigate levels of nickel and chromium in gingival crevicular fluid from subjects undergoing orthodontic treatment with and without using fluoridated toothpaste and mouthwash over a 6-month period.

      Materials and methods

      Sixty subjects divided into two groups of 30 each served as the experimental group with and without using fluoride agents for oral hygiene care along with fixed appliance treatment. Gingival crevicular fluid was collected in fluoridated and nonfluoridated groups before, and at 7 days, 30 days, and 6 months after commencing orthodontic treatment. Levels of nickel, chromium, titanium, and manganese were evaluated using inductively coupled plasma mass spectrometry.

      Results

      No changes in metal levels at any time were observed in the untreated control group. Nickel levels were elevated to 101.78 μg/L in the fluoridated group at 30 days posttreatment, indicating heavy leaching from nickel-titanium archwires (Friedman P < 0.001). Results returned to baseline in both groups at 6 months. Mean differences for chromium, titanium, and manganese ion release were not statistically significant at 30 days. Titanium showed elevated levels at 30 days in both tested groups, but levels were lesser than nickel.

      Conclusions

      Archwires are susceptible to corrosion when exposed to fluoride agents during orthodontic therapy causing release of metal ions into the mouth with the possibility of systemic absorption. Long-term consequences of metal ion release into the oral cavity require further investigation.

      Keywords

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