Salivary Levels of Eluents During Invisalign™ Treatment with Attachments: an in Vivo Investigation

Overview

Journal Prog Orthod

Publisher Springer

Specialty Dentistry

Date 2024 Jun 2

PMID 38825612

Authors

Larissa Stocker

Sevasti-Kiriaki Zervou

Spyridon N Papageorgiou

Stephania Karakousoglou

Theodoros Triantis

Anastasia Hiskia

George Eliades

Theodore Eliades

Affiliations

Soon will be listed here.

Abstract

Background: The aim of the present study was to investigate qualitatively and quantitatively the elution of substances from polyester-urethane (Invisalign™) aligners and resin composite attachments (Tetric EvoFlow) in vivo.

Methods: Patients (n = 11) treated with the aligners and attachments (16 per patient, without other composite restorations) for an average of 20 months, who were planned for attachment removed were enrolled in the study. Patients were instructed to rinse with 50 mL of distilled water upon entry and the rinsing solution was collected (before removal). Then, the attachments were removed with low-speed tungsten carbide burs for adhesive residue removal, a thorough water rinsing was performed immediately after the grinding process to discard grinding particle residues, and subsequently, after a second water-rinsing the solution was collected for analysis (after removal). The rinsing solutions were analyzed for targeted (LC-MS/MS: Bis-GMA, DCDMA, UDMA, BPA) and untargeted (LC-HRMS: screening of leached species and their degradation products) compounds.

Results: Targeted analysis revealed a significant reduction in BPA after attachment removal (4 times lower). Bis-GMA, DCDMA, UDMA were below the detection limit before removal but were all detectable after removal with Bis-GMA and UDMA at quantifiable levels. Untargeted analysis reviled the presence of mono-methacrylate transformation products of Bis-GMA (Bis-GMA-M1) and UDMA (UDMA-M1), UDMA without methacrylate moieties (UDMA-M2), and 4-(dimethylamino) benzoic acid (DMAB), the degradation product of the photo-initiator ethyl-4-(dimethylamino) benzoate (EDMAB), all after attachment removal. Several amino acids and endogenous metabolites were also found both before and after removal.

Conclusions: Elevated levels of BPA were traced instantaneously in patients treated with Invisalign™ and flowable resin composite attachments for the testing period. BPA was reduced after attachment removal, but residual monomers and resin degradation products were found after removal. Alternative resin formulations and attachment materials may be utilized to reduce eluents.

References

Kang Y, Kim J, Kim J, Won P, Nam J . Release of bisphenol A from resin composite used to bond orthodontic lingual retainers. Am J Orthod Dentofacial Orthop. 2011; 140(6):779-89. DOI: 10.1016/j.ajodo.2011.04.022. View

Raghavan A, Sathyanarayana H, Kailasam V, Padmanabhan S . Comparative evaluation of salivary bisphenol A levels in patients wearing vacuum-formed and Hawley retainers: An in-vivo study. Am J Orthod Dentofacial Orthop. 2017; 151(3):471-476. DOI: 10.1016/j.ajodo.2016.07.022. View

Botta A, Duarte Jr S, Paulin Filho P, Gheno S, Powers J . Surface roughness of enamel and four resin composites. Am J Dent. 2010; 22(5):252-4. View

Kloukos D, Sifakakis I, Voutsa D, Doulis I, Eliades G, Katsaros C . BPA qualtitative and quantitative assessment associated with orthodontic bonding in vivo. Dent Mater. 2015; 31(8):887-94. DOI: 10.1016/j.dental.2015.04.020. View

Papageorgiou S, Koletsi D, Iliadi A, Peltomaki T, Eliades T . Treatment outcome with orthodontic aligners and fixed appliances: a systematic review with meta-analyses. Eur J Orthod. 2019; 42(3):331-343. DOI: 10.1093/ejo/cjz094. View

Pivonello C, Muscogiuri G, Nardone A, Garifalos F, Provvisiero D, Verde N . Bisphenol A: an emerging threat to female fertility. Reprod Biol Endocrinol. 2020; 18(1):22. PMC: 7071611. DOI: 10.1186/s12958-019-0558-8. View

Lofroth M, Ghasemimehr M, Falk A, Vult von Steyern P . Bisphenol A in dental materials - existence, leakage and biological effects. Heliyon. 2019; 5(5):e01711. PMC: 6538958. DOI: 10.1016/j.heliyon.2019.e01711. View

Ke Y, Zhu Y, Zhu M . A comparison of treatment effectiveness between clear aligner and fixed appliance therapies. BMC Oral Health. 2019; 19(1):24. PMC: 6343314. DOI: 10.1186/s12903-018-0695-z. View

Schymanski E, Jeon J, Gulde R, Fenner K, Ruff M, Singer H . Identifying small molecules via high resolution mass spectrometry: communicating confidence. Environ Sci Technol. 2014; 48(4):2097-8. DOI: 10.1021/es5002105. View

10.

Prins G, Tang W, Belmonte J, Ho S . Perinatal exposure to oestradiol and bisphenol A alters the prostate epigenome and increases susceptibility to carcinogenesis. Basic Clin Pharmacol Toxicol. 2008; 102(2):134-8. PMC: 2819392. DOI: 10.1111/j.1742-7843.2007.00166.x. View

11.

Eliades T, Gioni V, Kletsas D, Athanasiou A, Eliades G . Oestrogenicity of orthodontic adhesive resins. Eur J Orthod. 2007; 29(4):404-7. DOI: 10.1093/ejo/cjm040. View

12.

Eliades T, Hiskia A, Eliades G, Athanasiou A . Assessment of bisphenol-A release from orthodontic adhesives. Am J Orthod Dentofacial Orthop. 2007; 131(1):72-5. DOI: 10.1016/j.ajodo.2006.08.013. View

13.

Alonso-Magdalena P, Morimoto S, Ripoll C, Fuentes E, Nadal A . The estrogenic effect of bisphenol A disrupts pancreatic beta-cell function in vivo and induces insulin resistance. Environ Health Perspect. 2006; 114(1):106-12. PMC: 1332664. DOI: 10.1289/ehp.8451. View

14.

Moreira M, Matos L, de Souza I, Valim Brigante T, Queiroz M, Romano F . Bisphenol A release from orthodontic adhesives measured in vitro and in vivo with gas chromatography. Am J Orthod Dentofacial Orthop. 2017; 151(3):477-483. DOI: 10.1016/j.ajodo.2016.07.019. View

15.

Sifakakis I, Zinelis S, Eliades G, Koletsi D, Eliades T . Enamel gloss changes induced by orthodontic bonding. J Orthod. 2018; 45(4):269-274. DOI: 10.1080/14653125.2018.1542266. View

16.

Al Naqbi S, Pratsinis H, Kletsas D, Eliades T, Athanasiou A . In Vitro Assessment of Cytotoxicity and Estrogenicity of Vivera® Retainers. J Contemp Dent Pract. 2018; 19(10):1163-1168. View

17.

Willi A, Patcas R, Zervou S, Panayi N, Schatzle M, Eliades G . Leaching from a 3D-printed aligner resin. Eur J Orthod. 2022; 45(3):244-249. DOI: 10.1093/ejo/cjac056. View

18.

Janiszewska-Olszowska J, Tomkowski R, Tandecka K, Stepien P, Szatkiewicz T, Sporniak-Tutak K . Effect of orthodontic debonding and residual adhesive removal on 3D enamel microroughness. PeerJ. 2016; 4:e2558. PMC: 5068349. DOI: 10.7717/peerj.2558. View

19.

Mubarak M, Omolaoye T, Nabeeh Al Smady M, Zaki M, Du Plessis S . Bisphenol A and Male Infertility: Role of Oxidative Stress. Adv Exp Med Biol. 2022; 1391:119-135. DOI: 10.1007/978-3-031-12966-7_8. View

20.

Ayyanan A, Laribi O, Schuepbach-Mallepell S, Schrick C, Gutierrez M, Tanos T . Perinatal exposure to bisphenol a increases adult mammary gland progesterone response and cell number. Mol Endocrinol. 2011; 25(11):1915-23. PMC: 5417179. DOI: 10.1210/me.2011-1129. View