Comparative evaluation of salivary bisphenol A levels in patients wearing vacuum-formed and Hawley retainers: An in-vivo study

Raghavan, Akila Srinivasan; Sathyanarayana, Haritha Pottipalli; Kailasam, Vignesh; Padmanabhan, Sridevi

doi:10.1016/j.ajodo.2016.07.022

Cited by 37 publications

(58 citation statements)

References 39 publications

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“…A total number of 58 results were initially retrieved after application of electronic search strategies. After duplicate exclusion and screening first by title and subsequently by abstract, eleven articles were left for full-text assessment, leaving 5 to be included in the qualitative synthesis [5][6][7]28,29]. Of these, 2 contributed to meta-analyses for different outcomes [5,6] (Figure 1).…”

Section: Search Detailsmentioning

confidence: 99%

“…Studies presented a variable origin background, with authorship affiliation to Europe, Asia, the United States as well as the United Arab Emirates. The first study in the field dates back to 2004 [29], while in the last five years only two research papers described the results of safety considerations regarding thermoplastic appliances used for orthodontic purposes either in the course of treatment or in the retention phase [6,7].…”

Section: Study Design and Characteristicsmentioning

confidence: 99%

“…Only one study presented a clinical trial design (randomized controlled trial, RCT) [7], while the remaining 4 examined outcomes on in-vitro tested materials in the laboratory [5,6,28,29]. Three studies tested on both as-received (or-pretreatment) and retrieved (after use) material [6,7,29], while 2 only on newly received aligners [5,28]. Sample sizes for aligner units ranged from 6 to 45, while when aligners' eluents were examined for cell response or monomer/BPA leaching, the respective contributing units were effectively larger, constituting up to 96 eluent samples from respective micro-wells examined.…”

Section: Study Design and Characteristicsmentioning

confidence: 99%

“…BPA leaching was also the reported outcome for the study of Kotyk 2014 [28], which reported on a wide range of dental materials including thermoplastic retainers. The primary outcome of the sole clinical trial included in this review was whole stimulated saliva BPA levels after the use of three-types of retainers including a thermoplastic vacuum formed one, after a consecutive time-points of 1 day, 7 days and 30 days of aligner use [7].…”

Section: Study Design and Characteristicsmentioning

confidence: 99%

“…Sporadic reports, mainly in vitro, have examined potential cytotoxic effects of these appliances [5,6]. Recently, an in-vivo study on retainers has documented increased levels of bisphenol-A (BPA) release in saliva of patients using vacuum-formed thermoplastic adjuncts during the retention phase, compared to the use of classic Hawley-type appliances [7]. Thermoplastic orthodontic adjuncts as retainers cannot be considered inferior to the classic type-Hawley retainers at present and in view of the available evidence on certain perspectives, such as stability or attainment of proper oral hygiene [8].…”

Section: Introductionmentioning

confidence: 99%

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Safety Considerations for Thermoplastic-Type Appliances Used as Orthodontic Aligners or Retainers. A Systematic Review and Meta-Analysis of Clinical and In-Vitro Research

et al. 2020

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Use of thermoplastic material in orthodontics, either as aligner or as retainer appliances, is common practice and is likely to increase in the years to come. However, no systematic assessment on safety considerations of these adjuncts has been implemented up to date. The aim of this systematic review was to collectively appraise the existing evidence from both clinical and laboratory studies, on whether these appliances are associated with any estrogenic/cytotoxic effects or bisphenol-A (BPA) and monomer leaching. Eight electronic databases were searched with no limits in December 22, 2019, for published and unpublished research. Eligibility criteria comprised of studies of any design, describing use of any type of thermoplastic aligner. Study selection, data extraction and risk of bias (RoB) assessment was done independently, either in duplicate or confirmed by a second reviewer. Random effects meta-analyses of weighted mean differences (WMD) with associated 95% Confidence Intervals (CIs) were planned. Quality of the evidence was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 58 articles were initially identified, while 5 were included in qualitative synthesis and 2 of those contributed to the quantitative syntheses. Four studies were in-vitro, while one was a randomized controlled trial; all assessed some type of orthodontic aligner or retainer, either as-received or retrieved. Risk of bias recordings ranged between unclear and high for all studies. Proliferation induction capacity of thermoplastic appliances’ eluents on MCF-7 cells failed to be confirmed compared to beta-estradiol (2 studies: 5% v/v, WMD: −182.08; 95% CI: −198.83, −165.33; p-value < 0.001; and 20% v/v, WMD: −184.53; 95% CI: −206.17, −162.88; p-value < 0.001). No cytotoxic activity was detected as well. In addition, although evidence from in-vitro studies was indicative of no traceable detection of BPA or other monomers, the findings from a single clinical trial were allied to increased levels of BPA in whole stimulated saliva, after up to 30 days of thermoplastic retainer usage, compared to standard Hawley retainer. The quality of the evidence overall was low to medium. Current data from in-vitro research are indicative of an absence of an estrogenic or cytotoxic effect of thermoplastic aligners or retainers. Regarding BPA or monomer release, evidence from clinical and laboratory studies appear inconsistent.

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