Gracia Costa Lopes, Gilson Kazuo Watinaga, Antonio Sergio Guimaraes, Lidia Audrey Rocha Valadas, Juliana Ramacciato
What did the authors aim to do in this study?
The main aim of this study was to compare the intensity, location, and short-term impact of the periodontal discomfort or pain, as well as the related functional parameters of bite force and masticatory efficiency, between self-ligating and conventional orthodontic appliances.
How did the authors evaluate?
This randomized controlled clinical study included a sample of twenty patients aged 15 to 25 years with good general & oral health, without caries or periodontal disease, with permanent dentition and in whom orthodontic treatment was indicated. All patients included in the present study had a Class I malocclusion and were evaluated by two of the researchers. Straight-wire systems were used, and orthodontic devices were randomly bonded with self ligating brackets on one side and conventional bracket on the contralateral side. The measurements recorded before bracket insertion were used as controls. All brackets were metallic with a similar appearance in order to avoid bias. The conventional appliances had elastomeric ties without esthetic discomfort for the patient. Samples for substance P (SP) level, the pressure-related pain threshold, maximal bite force, and masticatory performance were measured at two timepoints: T1 (before the first activation) and T2 (24 hours after the first activation). The primary outcome was the pain, and the secondary outcome was the pressure.
Collection of gingival fluid from the gingival sulcus for measurement of SP level was performed from the maxilla according to the Offenbacher method. All teeth were first gently washed with water, and the side of the procedure was isolated for minimizing salivary contamination. An endodontic paper cone was then inserted about 1 mm inside the gingival sulcus and was kept there for 1 minute. The volume of fluid absorbed by the paper cone was measured using Periotron 8000, which was calibrated with human serum. The protein concentration was evaluated using the Bradford method, with bovine serum albumin used as a standard. The levels of SP were measured using the enzyme linked immunosorbent assay method (ELISA). Periodontal pain evaluation was performed using a calibrated mechanical algometer, which allowed measurement of the pressure related pain threshold in each tooth.
What did the authors find?
The study concluded that there was no significant difference in the measurement of substance P between the two devices. However, for the self-ligating brackets, the mean in the second assessment (after 24 hours from the first activation) was significantly lower than in the first (before the brackets were installed). There was also no significant difference between the conventional or self-ligating brackets with regard to the time required to reach pain, as measured by the algometer. It was also noted that with both brackets there was a significant decrease in the time required to reach pain in the second assessment compared to the first, both in the incisor and premolar regions. Similar results were observed for pressure measurements by the algometer. There was no significant difference between the brackets, and both brackets showed a significant decrease in pressure threshold.
What did the authors conclude?
There was no difference between conventional and self-ligating appliances in the parameters of pain, substance P, and pressure.
The results of this study suggest that functional aspects, such as pain and discomfort, should not be considered when making a therapeutic decision regarding the use of self-ligating vs conventional orthodontic appliances.
What do we think about it?
From the inception of orthodontic therapy, numerous advancements have always been brought about in order to increase the efficiency & outcome of the treatment. This was also done to provide as little discomfort as possible for the patient too. As a part of this process, the normal braces have always been tied to the archwire with either ligatures or elastomeric ties. But this had major disadvantages such as loss of ties, inconsistency in the strength of the material, and, consequently, lack of control over the dental materials, extending the chair side time. So, the self ligating braces were developed to overcome these defects & also to provide lesser friction & allow better sliding mechanics with high efficiency. So, this study was done to actually compare & correlate all the advantages that the self ligating braces have over the regular braces. Although the study had limitations such as the comparison between the brackets was done in the same arch with the same wire passing through both the types of brackets. This may have possibly caused differences in the forces released. But apart from these, the study is still reliable to prove that only based on the factors of pain & discomfort, the type of brackets should not be preferred.
Lopes GC, Watinaga GK, Guimarães AS, Rocha Valadas LA, Ramacciato J. Self-ligating brackets do not reduce discomfort or pain when compared to conventional orthodontic appliances in Class I patients: a clinical study. Angle Orthod. 2023 Jul 1;93(4):398-402.
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