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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 7  |  Issue : 1  |  Page : 8-13

Cleanliness drive: Straight wire appliance or Begg's appliance???


1 Department of Orthodontics and Dentofacial Orthopaedics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
2 Department of Orthodontics and Dentofacial Orthopaedics, PMNM Dental College, Bagalkot, Karnataka, India

Date of Web Publication30-Jun-2017

Correspondence Address:
Sanjeev Vasudev Jakati
Department of Orthodontics and Dentofacial Orthopaedics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Wanadongri Sangam Road, Hingna, Nagpur - 441 110, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmd.ijmd_65_16

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  Abstract 

Context: Plaque is a major etiological factor in causation of periodontal disease. Orthodontic appliances are known to accumulate plaque owing to their complex configuration.
Aim: The aim of this study was to evaluate difference in plaque accumulation both quantitatively and qualitatively, and oral hygiene maintenance, between Begg's and Straight Wire appliances.
Subjects and Methods: Eighty patients (40 of Begs and 40 of MBT) aged between 13 and 23 years were subjected to oral prophylaxis to bring the plaque score to zero before the start of study and were asked to report every 2 weeks to identify the microbial shift in plaque sample. The disclosing solution was applied on labial and lingual tooth surfaces and plaque was scored with the help of Quigly and Heins index. The plaque samples were collected in 2 ml of saline containing test tubes. Data were analyzed using IBM-SPSS software version 22. P<0.005 was considered statistically significant level.
Results and Conclusion: Significant difference between Beggs group and MBT group for variables V1 (plaque index) and V2 (spirochetes count) at each time point existed. Furthermore, MBT group patients showed an increase in plaque index value at each point. In spite of maintaining same environment, plaque accumulation and spirochetes are more in Straight Wire appliance than Begg's.

Keywords: Begg technique; oral hygiene; plaque; spirochetes; Straight Wire technique


How to cite this article:
Jakati SV, Gogineni R, Aley MS, Atram HK, Chachada AD. Cleanliness drive: Straight wire appliance or Begg's appliance???. Indian J Multidiscip Dent 2017;7:8-13

How to cite this URL:
Jakati SV, Gogineni R, Aley MS, Atram HK, Chachada AD. Cleanliness drive: Straight wire appliance or Begg's appliance???. Indian J Multidiscip Dent [serial online] 2017 [cited 2017 Dec 11];7:8-13. Available from: http://www.ijmdent.com/text.asp?2017/7/1/8/209279


  Introduction Top


Oral hygiene is the most important issues in patients undergoing orthodontic treatment. Although long-term reports concerning the health of periodontal tissues of orthodontic patients are controversial,[1] oral hygiene measures are always instituted because bands, brackets, ligature wires, and elastics encourage accumulation of microbial flora and food residues, which, in time, cause periodontal diseases and caries. Although mechanical cleaning of tooth surfaces can be accomplished in various forms such as tooth brushes and waterjets;[2],[3] teeth brushing (manual/powered) is routinely advised to prevent or at least minimize these hazards.

The management of oral hygiene in patients undergoing orthodontic treatment has concentrated on effects of different oral-hygiene regimes which include different types of brushes, brushing techniques, toothpastes, and fluoride aids [4] and on efficacy of various oral-hygiene aids in plaque control and reduction of gingival inflammation.[2],[3] Manual tooth brushing, oldest methods of plaque removal, remains the mainstay of oral hygiene and plaque control. It is used as the standard or control against which other methods of plaque removal are assessed.[2],[3]

Chlorhexidine mouthwashes as an adjunct to tooth brushing [5] have been effective in control of gingival inflammation although prolonged use causes problems with staining. Prebrushing rinses show no difference in effect on plaque accumulation or gingival health.[6] Fluoride mouthrinses reduce the extent of enamel decalcification and gingival inflammation during orthodontic treatment.[4],[7] Mechanical aids such as electric toothbrushes as compared with manual tooth brushing on oral hygiene in orthodontic patients found to be a significant improvement.[2],[3]

Oral hygiene maintenance is greatly complicated following the placement of fixed orthodontic appliances. Failure to manage plaque removal leads to loss of tooth support and carious lesions. If the orthodontist succeeds in making the patient hygiene minded, possible periodontal damage during treatment is, no doubt, compensated for in the long run. When hygiene is neglected, more damage is initiated during the treatment and patient being little motivated or able to control his periodontal situation, long-term benefits of orthodontic treatment might be questioned. It is conceded that greater plaque-retentive nature of orthodontic appliances aids in plaque accumulation at gingival margin and thus contributes to incidence and severity of gingival inflammation.

Begg and Straight Wire are commonly used orthodontic appliances, with different bracket sizes, configurations, and mechanisms of tooth movements. In view of difference in brackets and techniques, it is possible that there is a difference in plaque accumulation and oral hygiene maintenance. Hence, this study was conducted to evaluate difference in plaque accumulation both quantitatively and qualitatively,[8] and oral hygiene maintenance, between Begg's and Straight Wire appliances.


  Subjects and Methods Top


Eighty patients (40 each of Beggs and MBT) between ages of 13 years and 23 years were selected.

Subjects with following inclusion criteria were chosen:

  1. Subjects with no oral habits and no systemic or biochemical diseases
  2. Those who were not under any drug coverage
  3. Females who were neither on contraceptive pills nor were pregnant
  4. At least 24 teeth present at the time of study
  5. Those who were undergoing treatment with fixed appliance with no history of previous orthodontic treatment
  6. Period from the time of initiation of treatment was not more than 1 year
  7. Teeth were banded or bonded
  8. Individuals who used orthodontic toothbrushes and had no gingival inflammation.


Subjects who had poorly fitting crowns, large carious lesions, and unfinished restorations were excluded as these favored plaque accumulation and can introduce bias in the sample.

Procedure

Before commencement of the study, purpose of the same was explained to each of subjects and their commitment to adhere to the method was solicited.

At the initial visit, a swab of tincture iodine was applied on teeth and the patient was asked to rinse. Stained plaques were demonstrated to patient with aid of a mirror. Teeth were thoroughly scaled and polished and plaque scores were reduced to zero before the commencement of the study. STIM orthodontic toothbrushes were used. A nontherapeutic toothpaste was recommended and patients were asked to discontinue any medicated toothpaste, they have been using at least 15 days before trial.

Modified bass tooth brushing technique was explained to subject. Patients take at least a period of 6 weeks to get used to Modified Bass technique and practice it regularly to maintain a stable oral hygiene status. Hence, after 6 weeks of training, only those who demonstrated proper technique were selected. Tooth brushing time was five minutes twice daily.[9] The patient was asked to brush at same time every day with light pressure and quadrant-wise to standardize the procedure.

Pooled plaques' samples were collected with a sterile curette surface and stored in test tubes containing 1–2 ml of sterile saline solution [Figure 1]a and [Figure 1]b. Test tubes were stored in an ice container and studied under dark field microscope within a time frame of one hour. Subjects were given tincture iodine applied with cotton on tooth surface for a minute and were asked to rinse once with water. Stained plaque [Figure 2],[Figure 3],[Figure 4] was recorded using bonded bracket index and plaques demonstrated to patients. Patients were sent back with reinforced tooth brushing instructions. Subjects were directed to report every 2 weeks for the collection of plaques samples. Patients were recalled every 2 weeks for up to 8 weeks and samples collected by same operator under identical conditions and subjected to same methodology and studied.
Figure 1: (a and b) Armamentarium required in the study

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Figure 2: Plaque sample in Begg's technique

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Figure 3: Plaque sample in MBT technique

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Figure 4: Collection of plaque sample

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Dark field or phase contrast microscopy [Figure 5] was used to detect bacterial morphotypes, determine motility, and identify spirochetes [8] and to assess percentage of motile rods/spirochetes in plaque sample [Figure 6]a and [Figure 6]b. Plaque index was recorded by same investigator throughout the period of study to reduce interexaminer bias.
Figure 5: Dark field microscope

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Figure 6: (a and b) Plaque sample and spirochetes viewed in microscope

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Quigley-Hein index was used in evaluation of amount of microbial plaque on whole crown surface and is scored in following manner.

  • 0: No microbial plaque
  • 1: Spots of microbial plaque at gingival border
  • 2: Prominent microbial plaque at gingival border
  • 3: Microbial plaque covers a third of tooth surface near gingiva
  • 4: Two-third of tooth surface is covered with microbial plaque
  • 5: More than two-third of tooth surface is covered with microbial plaque.


Bonded bracket index was developed and used to determine amount of microbial plaque accumulation on teeth with bracket and scored as:

  • 0: No plaque
  • 1: Plaque only on brackets
  • 2: Plaque on bracket and tooth surface but not spreading toward gingival
  • 3: Plaque on bracket and tooth surface spreading to papilla
  • 4: Plaque on bracket and tooth surface, part of gingival is covered with plaque
  • 5: Plaque on bracket, tooth surface and gingival is totally covered with plaque.



  Results Top


Data were analyzed using IBM SPSS Statistics version 22.0 (USA). Students' paired t-test was employed to test differences of variables V1 (plaque index) and V2 (spirochetes count) at each time points within each study groups. Student's independent t-test was employed to compare mean values of V1 (plaque index) and V2 (spirochetes count) at different time points between two independent groups. P< 0.05 was considered statistically significant level [Table 1],[Table 2],[Table 3].
Table 1: Mean and standard deviation for variables V1 and V2 at different time points

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Table 2: Test of significance for difference in V1 (plaque index) at different time points within each study group

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Table 3: Test of significance for difference of V2 (spirochetes count) at each time point within each study group

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We can conclude that there is a significant difference between Group I and II for variables V1 and V2 at each time point. Furthermore, Group II patients are showing a significant increase in plaque index value at each point. Hence, V1 is a better index, which is less in Group I patients.


  Discussion Top


Orthodontic treatment is dependent on biological response of periodontal tissues. An important factor which contributes to periodontal disease is plaque formation. Plaque is a dynamic entity being constantly removed by brushing, but it builds up in areas of stagnation. Dental plaque consists of Gram-positive cocci such as St. Sangius and Streptococcus mutans, Gram-negative cocci such as  Neisseria More Details, Gram-positive rods such as Actinomyces israeli and Corynebacterium, Gram-negative rods such as Bacteroides melaninogenicus and Bacteroides Intermedius, Spirochetes such as Treponema Microdentium and Treponema ovale.[3],[9],[10],[11]

Commonly used fixed orthodontic appliances are Begg's and Straight Wire. Begg's bracket occupies less area on tooth surface and round wires are used in this technique. Straight Wire appliances bracket configuration and slot size are larger. Round and rectangular wires are fixed to brackets with modules and these areas could cause increased plaque accumulation.

Evaluation of quality of plaque in patient undergoing treatment with Straight Wire appliances and Begg's appliances has earlier as per the findings of the current authors have not been reported anywhere till date. The sample in this study consisted of patients from the Department of Orthodontics from our college. The results can thus be interpreted only for subjects included (in specific) and in general population for population of current study, i.e., Nagpur and its surrounding villages only.

Raybin (1943) defined disclosing agent as “a solution which when applied to teeth makes visible by staining, roughness, and foreign matter on the teeth.” In our study, it was used to identify bacterial plaque deposits for instruction, evaluation, and research. Iodine solution (21 ml of tincture Iodine in 15 ml of water) is formally most classic disclosing solution, widely used and very effective, but has a drawback that its flavor is unpleasant.

This disclosing solution was applied on labial and lingual surfaces of teeth and plaque was scored with the help of Quigly and Heins index. Other indices such as Green and Vermillon, Loe, and Sillness were restricted to study tooth surfaces but are not indicated when banded or bonded teeth are concerned.

Modified bass technique has proved effective for subjects with a healthy oral cavity and is appropriate for subjects with gingivitis since it removes plaque from vulnerable gingival areas.

All eighty subjects were subjected to oral prophylaxis to bring plaque score to zero before start of experiment and were asked to report every 2 weeks to identify microbial shift in plaque sample. Plaque samples were collected in 2 ml of saline containing test tubes and were kept in ice containers to bring down room temperatures to body temperatures and also at higher temperatures motility of spirochetes is lost. Organisms usually found were mature, smooth surface dental plaque and between 7th and 14th day and onward spirochetes [9],[10],[11] were found.

Dark field microscope studies have been widely used to successfully differentiate population of percentage of spirochetes and other motile bacteria. Healthy patient sites manifest a flora, predominantly Gram-positive cocci with scanty motile forms and spirochetes.[9],[10],[11] Dark field microscope has distinct advantage that a reflected light is used (as against transmitted light in ordinary microscope) to improve contrast. Contrast gives an increased resolution so that slender organisms such as spirochetes, their motility and morphology can be seen.

These techniques demonstrated that number and proportion of bacteria morphotypes varied in periodontal health when compared with diseased sites. Hence by studying the bacterial morphotypes, periodontal condition can be assessed. This was made use of to compare periodontal condition, in two different orthodontic techniques.

Summary

Configuration of Straight Wire brackets is greatly responsible for increase in plaque accumulation in Straight Wire appliance when compared with Begg's appliance. It is possible that increase in size of bracket encroaches upon tooth and gingival causing inflammation resulting in gingivitis and increase in spirochetes also.

While studying, increase in plaque proportion of spirochetes, there is significant difference between the groups. Subjects in Group II showing greater increase in proportion of spirochetes than Group I suggest that in subjects with Straight Wire appliance there is a greater shift towards pathogenic flora than Begg's appliance, the possible reason being, as the complexity in design of appliance increases the rate of plaque accumulation also increases which leads to more amount of acidogenic secretions from the bacterial flora which in turn causes more periodontal destruction and more faster tendency towards development of a pathogenic flora.(If it is not properly removed/disturbed by brushing techniques or other similar methods).

After 6 weeks, due to constant and periodical oral hygiene procedures ability to maintain oral hygiene improves and reduces plaque accumulation. However, over 8-week period, plaque accumulation was more in Straight Wire appliance than Begg's.


  Conclusion Top


In spite of maintaining same environment plaque accumulation and spirochetes are more in Straight Wire appliance than Begg's. Hence, it is required that for those having Straight Wire appliance, oral hygiene instructions should be more strictly enforced and periodic oral prophylaxis must be resorted to prevent initiation of periodontal disease.

Financial support and sponsorship

This study was supported by Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Poison AM, Subtelny JD, Meitner SW, Sonmrers EW, Iker HP, Reed BE. Long-term periodontal status after orthodontic treatment. Am J Orthod Dentofacial Orthop 1988;93:51-8.  Back to cited text no. 1
    
2.
Jackson CL. Comparison between electric toothbrushing and manual toothbrushing, with and without oral irrigation, for oral hygiene of orthodontic patients. Am J Orthod Dentofacial Orthop 1991;99:15-20.  Back to cited text no. 2
    
3.
Wilcoxon DB, Ackerman RJ Jr., Killoy WJ, Love JW, Sakumura JS, Tira DE. The effectiveness of a counterrotational-action power toothbrush on plaque control in orthodontic patients. Am J Orthod Dentofacial Orthop 1991;99:7-14.  Back to cited text no. 3
    
4.
Dénes J, Gábris K. Results of a 3-year oral hygiene programme, including amine fluoride products, in patients treated with fixed orthodontic appliances. Eur J Orthod 1991;13:129-33.  Back to cited text no. 4
    
5.
Brightman LJ, Terezhalmy GT, Greenwell H, Jacobs M, Enlow DH. The effects of a 0.12% chlorhexidine gluconate mouthrinse on orthodontic patients aged 11 through 17 with established gingivitis. Am J Orthod Dentofacial Orthop 1991;100:324-9.  Back to cited text no. 5
    
6.
Pontier JP, Pine C, Jackson DL, DiDonato AK, Close J, Moore PA. Efficacy of a pre-brushing rinse for orthodontic patients. Clin Prev Dent 1990;12:12-7.  Back to cited text no. 6
    
7.
Boyd RL, Chun YS. Eighteen-month evaluation of the effects of a 0.4% stannous fluoride gel on gingivitis in orthodontic patients. Am J Orthod Dentofacial Orthop 1994;105:35-41.  Back to cited text no. 7
    
8.
Butler BL, Morejon O, Low SB. Assessment of plaque accumulation. JADA 1996;127:1763-6.  Back to cited text no. 8
    
9.
Hamp SE, Lundström F, Nyman S. Periodontal conditions in adolescents subjected to multiband orthodontic treatment with controlled oral hygiene. Eur J Orthod 1982;4:77-86.  Back to cited text no. 9
    
10.
Davies TM, Shaw WG, Worthington HV. Effect of orthodontic treatment on Plaque and gingivitis. Am J Orthod 1991;99:155-60.  Back to cited text no. 10
    
11.
Iyer VS. Reaction of the gingival to orthodontic force. A critical study. J Periodontol 1962;33:26-9.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Introduction
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