Biofilm formation following chitosan-based varnish or chlorhexidine-fluoride varnish application in patients undergoing fixed orthodontic treatment: a double blinded randomised controlled trial

Abstract

Background Orthodontic treatment poses an increased risk of plaque accumulation and demineralisation of enamel leading to white spot lesion around the brackets. This parallel arm trial aims to assess the degree of bacterial plaque formation adjacent to orthodontic brackets, following the application of a chitosan-based varnish or chlorhexidene-fluoride varnish. Methods A total of 200 teeth from 20 patients undergoing fixed orthodontic therapy were assessed and biofilm formation around the brackets were recorded using the Bonded Bracket Index (Plaque index) at baseline and weekly for 6 weeks. The bacterial count and plaque pH at corresponding weekly intervals were also recorded. Following bracket bonding, the patients were cluster randomised to receive chitosan-based varnish-CHS (UNO Gel Bioschell, Germiphene corp., Brantford, Canada) or chlorhexidine-fluoride varnish-CFV (Cervitec F, Ivoclar Vivadent, Schaan, Liechtenstein) every week on the representative teeth respectively. BBI proportions were compared between groups at all time intervals using Chi square test. Mean plaque bacterial count and plaque pH were compared using Mann Whitney U test and Tukey’s HSD test respectively. Results Baseline characteristics were similar between the groups: Mean age was CHS = 23 and CFV = 21; male to female ratio was CHS = 5/5, CFV = 7/3. At the end of 6 weeks, chitosan-based varnish performed equal to chlorhexidine-fluoride varnish (P > 0.05) with 98% and 95% of teeth with acceptable scores respectively. The plaque bacterial count significantly reduced at 6 weeks for both varnish compared to the baseline; The value for CHS was 0.43 ± 0.4 × 104 and CFV was 0.77 ± 0.64 × 104 CFU (P < 0.05), with no difference between both the varnishes. Both varnishes had no effect on the plaque pH that remained neutral. Conclusion This trial showed that both chitosan-based varnish and chlorhexidine-fluoride varnish reduced bacterial count, while the plaque pH remained neutral over a period of six weeks in patients undergoing fixed orthodontic therapy. The anti-plaque effects of the natural biopolymeric chitosan-based varnish was similar to that of chlorhexidine-fluoride varnish, a known chemotherapeutic agent. Registration: This trial protocol was registered with https://www.ctri.nic.in (CTRI/2019/05/018896). (Date of registration 02/05/2019). Protocol: The protocol was not published before trial commencement.

Chitosan Superabsorbent Biopolymers in Sanitary and Hygiene Applications

“…It effectively inhibited plaque formation by forming flocs as the bridges (bridges formed between positively charged chains that attach to the microbial wall) become effective, thus inhibiting S. mutans. The activity of CS was compared to chlorhexidine fluoride varnish, which is known as a chemotherapeutic agent and was found to be similar [76]. The electrostatic interaction between the positively charged CS molecules and the microbe surface negatively charged is the most widely acknowledged mechanism for microbial inhibitions [77].…”

Increased demand for orthodontic treatments during the COVID-19 pandemic: a commentary

“…Fixed orthodontic appliances remain the prevailing orthodontic treatment for most malocclusions. 38 Systematic reviews on lingual braces have concluded that these appliances did not survive the drawback of intraoral irritation and increased difficulty with speaking and eating. 39 Whereas there is relatively little development of the lingual appliances used in everyday orthodontics, CAT seems to be an area of constant improvement and increasing demand.…”

Changes in the Color and Brightness of White Spots Associated with Orthodontic Treatment 6 Months after the Application of Infiltrative Resins: Systematic Review and Meta-Analysis

“…Fixed multibracket orthodontics is the most widely used system in orthodontic treatments, whether by conventional, low friction or lingual brackets. Despite its multiple advantages in solving cases of dental malocclusions, it can also be associated with adverse side effects such as the appearance of lesions in the enamel, facilitated by the accumulation of plaque and oral bacteria in the bracket, the adhesive or the surface of the enamel itself [ 1 , 2 , 3 ].…”

“…The intra treatment methods have included varnishes or toothpastes with chlorhexidine or fluorine [ 3 , 20 , 21 ], adhesives of brackets with or without bioactive fluorinated ceramic [ 22 ] use of nanoplatinum particles in sealants around the brackets, mouthwashes, pastes and dental adhesive [ 23 , 24 , 25 ], organoselenium sealants [ 26 ], etc. None of these methods seems to have a superior efficacy over the others in preventing the appearance of white spots during orthodontic treatment [ 5 , 25 ].…”