Does chlorhexidine in different formulations interfere with the force of orthodontic elastics?

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1 Originl Article Does chlorhexidine in different formultions interfere with the force of orthodontic elstics? Mtheus Melo Pithon ; Dndr Andrde Sntn b ;Kássio Henrique Sous b ; Is Mr Andrde Oliveir Fris b ABSTRACT Objective: To evlute the effects of different concentrtions of chlorhexidine on the decline in force of orthodontic elstics. Mterils nd Methods: In lbortory study, five groups of smples were tested, with one control group represented by distilled wter (group 1) nd four experimentl groups: 0.12% mnipulted chlorhexidine (group 2), 0.2% mnipulted chlorhexidine (group 3), 0.12% chlorhexidine gluconte bsed orl solution (0.12% Periogrd; group 4), nd 0.2% Clenform mouthwsh (formul nd ction; group 5). The test groups were submersed in rtificil sliv t 37uC. Templtes were used nd submerged in the chlorhexidine solutions for 30 seconds twice dy. Force ws mesured with digitl dynmometer t six different time intervls: 0, 1, 7, 14, 21, nd 28 dys. Results: No sttisticl differences were found mong the groups in the initil period, t 24 hours, nd t 7 dys (P..05). There were sttisticl differences between groups 2 nd 5 t 14 dys of the experiment nd between group 1 nd the others t 28 dys. In the initil period, the force ws sttisticlly higher thn it ws t ny of the other periods of the experiment (P,.05). Conclusion: In the present study, chlorhexidine showed no significnt influence on the force degrdtion of the chin elstics tested. (Angle Orthod. 0000;00: ) KEY WORDS: Degrdtion; Elstomeric chins; Chlorhexidine INTRODUCTION Use of n orthodontic pplince demnds tht the werer tke specil cre becuse the presence of this device in the orl cvity leds to greter ccumultion of bcteril plque round brckets nd bnds. 1,2 Considering tht deficient orl hygiene generlly is reson why it is difficult to chieve successful orthodontic tretment, it is necessry for the dentist to implement n individulized model of progrm of preventive eduction for ech ptient. 3 In individuls who cnnot or re unble to perform good orl Professor of Orthodontics, Southwest Bhi Stte University UESB, Deprtment of Helth, Jequié, Bhi, Brzil. b Dentl student, Southwest Bhi Stte University UESB, Bhi, Brzil. Corresponding uthor: Dr Mtheus Melo Pithon, Av. Otávio Sntos, 395, sl 705, Centro Odontomédico Dr. Altmirndo d Cost Lim, Birro Recreio, CEP , Vitóri d Conquist, Bhi, Brzil (e-mil: mtheuspithon@gmil.com) Accepted: July Submitted: June Published Online: August 28, 2012 G 0000 by The EH Angle Eduction nd Reserch Foundtion, Inc. hygiene, in ddition to mechnicl control, it is importnt to implement chemicl plque control. Among the ntiseptics for orl use, chlorhexidine is one of the most powerful nd most studied ntimicrobil gents. 4 6 Orthodontic movement comes from the ppliction of force on dentl unit by mens of ccessories, such s brckets, springs, bnds, wires, nd elstics. 7,8 Elstic devices re importnt sources for trnsmission of force to teeth but re not considered idel becuse the force they generte diminishes s function of the time of ctivtion, orl medium, nd other fctors relted to diet. 9 The ction of chlorhexidine on the mechnicl properties of these elstics, such s the force degrdtion over the course of time, hs hrdly been discussed in the literture. Therefore, the im of this study ws to determine the effects of different concentrtions of chlorhexidine on the decline in force of these elstics. MATERIALS AND METHODS A lbortory study ws conducted to test the degrdtion of orthodontic chin elstics under the DOI: /

2 2 PITHON, SANTANA, SOUSA, FARIAS influence of chlorhexidine. Five groups of smples were tested, nd ech of these groups ws composed of totl of 18 orthodontic chin elstics. The smples evluted were distilled wter (control group; group 1), 0.12% mnipulted chlorhexidine (group 2), 0.2% mnipulted chlorhexidine (group 3), 0.12% Periogrd (Colgte, São Pulo, SP, Brzil; group 4), nd 0.2% Clenform mouthwsh (Fórmul e Ação, São Pulo, Brzil; group 5). In nother five receptcles, one for ech group mentioned bove, rtificil sliv ws reserved for immersion of the smples. To fbricte the personlized templtes, polyvinyl chloride (PVC) tubes were used, in which smll orifices were mde to insert the supporting rods for the orthodontic chin elstics. Self-polymerizing crylic resin ws injected into the PVC tube to fix the rods. The orifices were seprted by horizontl men distnce of 0.5 cm. On the test specimen, the elstics were put into plce nd stretched long verticl distnce of 23.5 mm. The elstics used were of the short-spcing type from Morelli (Sorocb, Brzil). As they re presented in single continuous chin, the elstomeric chins were cut to stndrd, so tht totl of five links were left free, with two links being responsible for fixtion onto the templte (Figure 1). The templtes enbled the elstomeric chin to be immersed in the rtificil sliv solution during the 28 dys the lbortory study lsted. The devices contining the ctivted elstic segments were kept immersed in rtificil sliv from Splbor (São Pulo, Brzil) t controlled temperture of uC, idel for reproducing conditions in the orl cvity. This temperture ws controlled by mens of thermostt nd digitl thermometer (Splbor). The chin elstics were removed from the receptcle contining rtificil sliv nd were dipped in the corresponding chlorhexidine solutions, leving them immersed for 30 seconds twice dy with n intervl of 12 hours between immersions. In the moments immeditely before mesurements, the devices were removed from the receptcle, force mesurements were tken, nd they were then replced in the receptcles. Six force mesurements were tken during the experimentl period t the following time intervls: initil (0), 1, 7, 14, 21, nd 28 dys. These mesurements were tken with digitl dynmometer (Instrutherm DD-300, São Pulo, Brzil; Figure 1). The chin elstics were removed from the templtes nd plced on the dynmometer, previously clibrted with regrd to the distnce of 23.5 mm of the templtes. This gurnteed greter relibility of the dt obtined. After ech mesurement, the force mesurer ws restrted, nd the vlues were noted on control sheet. After ll of the groups hd been mesured, the elstics were fixed on their respective templtes nd inserted in the receptcles of rtificil sliv, which were put into the oven (Splbor). The level of sliv in the receptcle ws verified every dy, so tht the elstics would be covered by this solution t ll times. Sttisticl nlyses were performed with the progrm SPSS 13.0 (SPSS Inc, Chicgo, Ill). Descriptive sttisticl nlysis including men nd stndrd devition were clculted for the groups evluted. The vlues for the quntity of force relesed were submitted to the nlysis of vrince to determine whether there were sttisticl differences mong the groups, nd fterwrd, the Tukey test ws performed. RESULTS When the groups were compred with one nother in the sme period, no sttisticl differences mong the groups were found in the initil, 24-hour, nd 7-dy time intervls (P..05). There were sttisticl differences between groups 2 nd 5 t 14 dys of the experiment nd between group 1 nd the others t 28 dys (Tble 1). When dopting the men vlues, it my be observed tht t the end of the 28 dys, the control group hd lower force vlue thn the chlorhexidine test groups. Among these, the two 0.12% chlorhexidine groups obtined the highest vlues of decline in force. When the groups were evluted individully compring the fctor time, the force ws sttisticlly higher in the initil period thn tht of ll the other experimentl periods (P,.05; Tble 2). DISCUSSION Orthodontic ccessories dhered to the tooth surfces mke it difficult to perform orl hygiene nd ct s dditionl bcteril plque retiners, leding to enmel deminerliztion of enmel, cusing white stins, dentl cries, nd gingivitis. 1 In dentistry, chlorhexidine cts in preventive mnner in the reduction of bcteril plque, such s in physiclly hndicpped persons with motor limittions, mentlly retrded nd geritric ptients, nd ptients using orthodontic pplinces. 3,6 It is synthetic ntimicrobil gent tht presents high level of ctivity without, however, hving the secondry effects tht most ntimicrobil gents hve. 10,11 In orthodontic ptients, in ddition to the fctor time, exposure to wter, ltertions in temperture, nd enzymes nd other chemicl substnces, such s chlorhexidine, my hve significnt influence on the mount of force relesed by orthodontic elstics. 12 For this reson, it is impertive to know the ction of chlorhexidine on this mteril to enble sfe nd stisfctory orthodontic tretment.

3 CHLORHEXIDINE AND FORCE OF ELASTICS 3 Figure 1. () Test specimen with stretched chin elstics. (b) Test specimen dipped in rtificil sliv. (c) Digitl dynmometer (Instrutherm DD-300), mesurement of chin elstic. Most orthodontic ccessories used for pplying forces nd performing movement do not provide stble force. With the vrition of time, the intensity of force initilly used diminishes, nd thereby tooth movement is compromised nd cn be reduced or even interrupted. Elstic mterils present this peculirity, clled force degrdtion. 13 Yers go, Bty et l. 14 nd De Genov et l. 15 evluted the behvior of elstics over period of 3 weeks. Here, the period of 4 weeks ws selected becuse it coincides with the time intervl frequently occurring between orthodontic consulttions, the sme period observed by Mott et l. 16 Moreover, conducting this test in vitro genertes initil results in the interction between mteril nd the biologic tissue in short nd timely mnner, reducing the need for tests in nimls. 17 When evluted in humid medium, the force degrdtion relesed by synthetic elstic mterils is significntly greter thn it is when this is done in dry environment 18,19 ; therefore, the chin elstic segments were kept immersed in rtificil sliv. Becuse it

4 4 PITHON, SANTANA, SOUSA, FARIAS Tble 1. Men Vlues (kgf), Stndrd Devition, nd Sttisticl Anlysis (Comprison Between Groups by Time) of the Groups Evluted Group Initil Men (SD) Stt 24 h, Men (SD) Stt 7 d, Men (SD) (0.64) 22 P (0.67) 22 P (0.57) 23 P P P P P P (0.55) 23 P (0.59) 23 P (0.38) 24 P P P P (0.58) 24 P (0.46) 24 P (0.37) 25 P P (0.63) 25 P (0.52) 25 P (0.54) (0.60) 3.72 (0.50) 3.37 (0.37) Groups: (1) control destilled wter, (2) 0.12% chlorhexidine, (3) 0.2% chlorhexidine, (4) 0.12% periogrd, (5) 0.2% Clenform mouthwsh. concerns simultion of the orl cvity, the temperture t which the elstics ws mintined ws uC, s this is the body temperture nd lso becuse it is known tht temperture prticiptes in the force degrdtion relesed by the elstics. 20 Another fctor tht influences mechnicl behvior is the size of chin elstics described s short, medium, or long s well s their configurtion. 21 In this study, the short chin elstic, without spces between the links, ws dopted, since this mintin higher percentge of force over the course of time. 9 In this study, the results demonstrted tht when using elstics with the short configurtion, groups 3 nd 5 (0.2% chlorhexidine) mintined higher percentge of force during the course of 28 dys in comprison with groups 2 nd 4 (0.12% chlorhexidine), which underwent greter force degrdtion in the sme period of time. This impliction rises from the ction of 0.12% chlorhexidine on the force degrdtion of the elstics t its highest vlues of force t the end of the study, when compred with the composition of 0.2% of the smples. It ws lso observed tht the control group hd its lowest vlue of force in comprison with the test groups t the end of the 28 dys. Although there ws difference in the vlues mong the groups, the results obtined point out tht chlorhexidine does not hve significnt influence on the force degrdtion of the chin elstics (Tble 1). Giok et l. 22 evluted the relxtion of force of ltex elstics during period of 24 hours of extension nd to do this estimted the extension necessry to chieve the relted force. It ws concluded tht extension of the elstic to chieve the relted force vries between 2.7 nd 5 times the originl length. 22 In this study, the ltex elstics showed force of relxtion on the order of 25%, which consists of component with n elevted initil decline nd ltent prt with reduced rte. Most of the relxtion occurred within the first 3 to 5 hours fter extension, irrespective of the mnufcturer, size, or level of force of the elstic. In the present study, the lrge mount of Tble 2. Comprisons Between the Groups Individully t Different Times of Evlution (kgf) 1 Stt 2 Stt 3 Initil 4.71 (0.64) 24h-P 5.000* 4.96 (0.55) 24-P 5.000* 4.75 (0.58) 7d-P 5.000* 7d-P 5.000* 14d-P 5.000* 14d-P 5.000* 21d-P 5.000* 21d-P 5.000* 28d-P 5.000* 28d-P 5.000* 24 h 3.85 (0.67) 7d-P (0.59) 7d-P (0.46) 14d-P d-P d-P 5.030* 21d-P 5.025* 28d-P 5.000* 28d-P 5.006* 7 d 3.62 (0.57) 14d-P (0.38) 14d-P (0.37) 21d-P d-P d-P d-P d 3.5 (0.36) 21d-P (0.44) 21d-P (0.38) 28d-P 5.000* 28d-P d 3.3 (0.28) 28d-P 5.000* 3.37 (0.54) 28d-P (0.50) 28 d 2.52 (0.57) 3.5 (0.32) 3.06 (0.47) Groups: (1) control destilltion wter, (2) chlorhexidine 0.12%, (3) chlorhexidine 0.2%, (4) Periogrd 0.12%, (5) Clenform mouthwsh 0.2%.

5 CHLORHEXIDINE AND FORCE OF ELASTICS 5 Tble 1. Stt 14 d, Men (SD) Stt 21 d, Men (SD) Stt 28 d, Men (SD) Stt 22 P (0.36) 22 P (0.28) 22 P (0.57) 22 P 5.000* 23 P P P P 5.003* 24 P P P P 5.000* 25 P P P P P (0.44) 23 P (0.54) 23 P (0.32) 23 P P P P P P P 5.009* 25 P P P (0.38) 24 P (0.50) 24 P (0.47) 24 P P P P P P (0.32) 25 P (0.35) 25 P (0.35) 25 P (0.27) 3.1 (0.54) 3.04 (0.44) Groups: (1) control destilled wter, (2) 0.12% chlorhexidine, (3) 0.2% chlorhexidine, (4) 0.12% periogrd, (5) 0.2% Clenform mouthwsh. Extended decline in force within the first 24 hours ws followed by minly consistent levels of force up to 4 weeks. In the times fter the initil moment, the intensity of force vried discretely within ech group t the different times. Right from the first hour, the elstics of ll the groups presented sttisticlly lower vlues when compred with the respective vlues of force initilly relesed, corroborting the findings of previous studies. Therefore, knowledge of the ltertions in the mechnicl properties of chin elstics when elongted nd exposed to the ction of chlorhexidine is necessry to combine these ccessories with the use of this solution. Nevertheless, this interction hd no significnt influence on the force degrdtion of the elstics. CONCLUSIONS N Chlorhexidine does not ct significntly on the force degrdtion of orthodontic chin elstics. N The two 0.12% chlorhexidine groups obtined the highest vlues of decline in elstic force. REFERENCES 1. Ai H, Lu HF, Ling HY, et l. Influences of brcket bonding on mutns streptococcus in plque detected by rel time fluorescence-quntittive polymerse chin rection. Chin Med J (Engl). 2005;118: dos Sntos RL, Pithon MM, Vitsmn DS, Arujo MT, de Souz MM, Nojim MG. Long-term fluoride relese from resin-reinforced orthodontic cements following rechrge with fluoride solution. Brz Dent J. 2010;21: Oltrmri-Nvrro PV, Titrelli JM, Mrsicno JA, et l. Effectiveness of 0.50% nd 0.75% chlorhexidine dentifrices in orthodontic ptients: double-blind nd rndomized controlled tril. Am J Orthod Dentofcil Orthop. 2009;136: Du MQ, Ti BJ, Jing H, Lo EC, Fn MW, Bin Z. A two-yer rndomized clinicl tril of chlorhexidine vrnish on dentl cries in Chinese preschool children. J Dent Res. 2006;85: Lobo PL, de Crvlho CB, Fonsec SG, et l. Sodium fluoride nd chlorhexidine effect in the inhibition of mutns streptococci in children with dentl cries: rndomized, double-blind clinicl tril. Orl Microbiol Immunol. 2008;23: Ribeiro LG, Hshizume LN, Mltz M. Effect of different 1% chlorhexidine vrnish regimens on mutns streptococci Tble 2. Stt 4 Stt 5 Stt 24-P 5.000* 4.78 (0.63) 24-P 5.000* 4.4 (0.60) 24-P 5.001* 7d-P 5.000* 7d-P 5.000* 7d-P 5.000* 14d-P 5.000* 14d-P 5.000* 14d-P 5.000* 21d-P 5.000* 21d-P 5.000* 21d-P 5.000* 28d-P 5.000* 28d-P 5.000* 28d-P 5.000* 7d-P (0.52) 7d-P (0.50) 7d-P d-P d-P d-P d-P d-P d-P 5.002* 28d-P 5.008* 28d-P 5.001* 28d-P 5.001* 14d-P (0.54) 14d-P (0.37) 14d-P d-P d-P d-P d-P 5.023* 28d-P d-P d-P (0.32) 21d-P (0.27) 21d-P d-P d-P d-P d-P (0.35) 28d-P (0.54) 28d-P (0.35) 3.04 (0.44) Extended

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