|Year : 2023 | Volume
| Issue : 1 | Page : 55
Comparative evaluation and influence of various staining agents on color stability and fluorescence of different esthetic orthodontic wires: An in vitro study
Katragadda Saveri1, Madhukar R Rachala2, Arun K Dasari2, Vankre Mallikarjun2, Sakam Nikhil2, Dhana P Gurram3
1 Department of Orthodontics, Drs. Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Vijayawada, Andhra Pradesh, India
2 Department of Orthodontics, SVS Institute of Dental Sciences, Mahabubnagar, Telangana, India
3 Department of Conservative Dentistry and Endodontics, Drs. Sudha and Nageswara Rao Siddhartha Institute of Dental Sciences, Vijayawada, Andhra Pradesh, India
|Date of Submission||27-Dec-2022|
|Date of Decision||14-Feb-2023|
|Date of Acceptance||14-Apr-2023|
|Date of Web Publication||04-Sep-2023|
Arun K Dasari
Department of Orthodontics, SVS Institute of Dental Sciences, Mahabubnagar, Telangana - 509 002
Source of Support: None, Conflict of Interest: None
OBJECTIVES: This study aimed to compare and evaluate the effect of three staining solutions on the color stability of three different brands of esthetic archwires using a spectrophotometer and also to compare the fluorescence of esthetic archwires with extracted human teeth.
MATERIALS AND METHODS: A total of 84 nickel–titanium (NiTi)-coated esthetic archwires with the same cross section and size (0.016 × 0.022″) were included. All samples were divided into four groups of 21 each, that is, group 1: artificial saliva (AS), group 2: coffee (C) solution, group 3: turmeric (T) solution, and group 4: chlorhexidine (CH) mouth rinse; each group was subdivided into three subgroups of seven each (Opal Classic (OC), Libral Rabbit Force (LRF), and Ortho Organizers (OO)). The baseline value (T0) was measured before immersion in the staining solution and then immersed in the staining solution for 21 days. The color measurements were recorded at different time intervals on the 7th, 14th, and 21st days using a spectrophotometer. The fluorescence of archwires is tested in a dark atmosphere using a fluorescent black lamp. The data obtained were analyzed using descriptive statistics, analysis of variance (ANOVA), and post hoc Bonferroni test.
RESULTS: A significant amount of color change in all three brands of archwires from day 0 to day 21 (p < 0.005) was observed, except for OC in the CH mouth rinse group (p = 0.230). The fluorescence of OO matches with the natural teeth.
CONCLUSION: LRF showed the highest overall color change followed by OO and OC. Turmeric is the most chromogenic agent, followed by Coffee and CH mouth rinse.
Keywords: Coated wires, color stability, fluorescence, spectrophotometer
|How to cite this article:|
Saveri K, Rachala MR, Dasari AK, Mallikarjun V, Nikhil S, Gurram DP. Comparative evaluation and influence of various staining agents on color stability and fluorescence of different esthetic orthodontic wires: An in vitro study. J Orthodont Sci 2023;12:55
|How to cite this URL:|
Saveri K, Rachala MR, Dasari AK, Mallikarjun V, Nikhil S, Gurram DP. Comparative evaluation and influence of various staining agents on color stability and fluorescence of different esthetic orthodontic wires: An in vitro study. J Orthodont Sci [serial online] 2023 [cited 2023 Oct 3];12:55. Available from: https://www.jorthodsci.org/text.asp?2023/12/1/55/385062
| Introduction|| |
The increased esthetic demands from orthodontic patients are mainly due to an increase in the number of adult patients seeking orthodontic treatment. In today's era of esthetic dentistry where invisible orthodontics is in demand, metal brackets and wires are almost completely replaced by ceramic brackets and esthetic archwires.
Esthetic archwire materials are basically a composite of two materials, which can be broadly classified into two major groups, that is, ceramic–polymer composite archwire and coated esthetic archwire. Discoloration of orthodontic materials may be due to intrinsic factors such as water sorption, incomplete polymerization of adhesives or resins, matrix composition of the material, and content and size of reinforcement particles, brands, and tone, or extrinsic factors such as ingestion of colored food materials such as coffee, tea, colas, mouthwash, nicotine, and lipstick. Numerous studies have focused on the color stability of esthetic orthodontic appliances such as brackets, and ligatures.,
Fluorescence is an optical property inherent in the natural tooth when irradiated by ultraviolet (UV) light. Sound teeth generate maximum visible fluorescence emission in the blue-violet spectrum by an excitation wavelength of UV or near UV light of approximately 400 nm. Thus, esthetic archwires ideally should have comparable fluorescence properties to those of natural teeth.
Despite the well-known color stability of orthodontic appliances such as brackets and ligatures, the color stability of such esthetic orthodontic wires is poorly understood and the effect of different staining solutions such as coffee (C) and turmeric (T) solutions, which are regularly taken as part of the Indian subcontinent diet, and the effect of mouth rinse, which is usually prescribed during orthodontic mechanotherapy, are not studied extensively. As already mentioned, having an ideal fluorescence is also essential for an ideal esthetic archwire despite the amount of light the patient is exposed to whether daylight or UV light. The comparison of fluorescence of extracted human teeth and coated wires has not been studied extensively.
So, this study was undertaken to evaluate the influence of various staining agents (coffee (C), turmeric (T), and chlorhexidine (CH) mouth rinse) on the color stability and fluorescence of different brands (Opal Classic (OC), Libral Rabbit Force (LRF), and Ortho Organizers (OO)) of esthetic orthodontic wires at different time intervals (0th, 7th, 14th, and 21st days).
| Materials and Methods|| |
The study was carried out after obtaining the Institutional Ethical Committee approval SVSIDS/ORTHO/3/2017, Mahabubnagar, Telangana, India date of 5th Dec 2017. A sample of 84 nickel–titanium (NiTi)-coated esthetic archwires of three different brands, that is, Opal Classic (OC), Libral Rabbit Force (LRF), and Ortho Organizers (OO) with the same cross section and size of 0.016 × 0.022”, were included [Table 1]. All the wires were stored in artificial saliva (AS) for 24 hrs before grouping, and color measurements were noted using a spectrophotometer (VITA Easyshade Guide). All the samples were divided into four groups of 21 each, that is, group 1: AS, group 2: C solution, group 3: T solution, and group 4: CH mouth rinse. Each group is further divided into three subgroups (seven each) based on three different brands, that is, subgroup A (OC), subgroup B (LRF), and subgroup C (OO). The color measurements of all the samples were carried out using a spectrophotometer.
Staining solution preparation
The Coffee solution was prepared by adding 15 gms of Coffee powder to 500 ml of boiling water, and once the powder was completely dissolved, it was filtered and allowed to cool down to room temperature. The Turmeric solution 0.1% (w/v) was prepared by adding 1 gm of T powder into 1000 ml of water, and commercially available CH mouth rinse was used.
Color measurements were done using a spectrophotometer, that is, VITA Easyshade Guide [Figure 1]. All the wires were stored in AS for 24 hrs and dried using blotting paper, and color measurements were recorded as T0. Later, the samples were placed in containers with their respective staining solutions [Figure 2]. All the samples were removed at time intervals of the 7th, 14th, and 21st days of immersion, rinsed with distilled water, and dried using blotting paper. Color measurements were repeated after their respective time intervals and recorded as T1, T2, and T3.
Before performing the measurements, the spectrophotometer was calibrated according to the manufacturer's instructions. Seven measurements of each brand were recorded, and the average value of each sample was taken for the calculation. Color changes were characterized using the Commission Internationale de I'Eclairage L*a*b* color space (CIE L*a*b*). Because visual color assessment is subjective, the color systems are quantitative systems with rectangular coordinates that allow an objective color measurement. These systems adequately represent the visual perception of color differences. Total color differences are expressed by the formula Δ E* = ([ΔL*]2 + [Δa*]2 + [Δb*]2) 1/2, where ΔL*, Δa*, and Δb* are differences in L*, a*, and b* values before (T0) and after immersion at each time interval (T1, T2, and T3). To relate the amount of color change (ΔE*) to a clinical environment, the data were converted to National Bureau of Standards (NBS) units; that is, NBS units = ΔE* × 0.92. The definitions of color changes quantified by NBS units were used [Table 2].
|Table 2: Critical marks of color change according to the National Bureau Standards|
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The samples were randomly arranged in a dark atmosphere devoid of natural light. A fluorescent black lamp was positioned 15 cm above the samples. To observe the fluorescence, each specimen was placed on the labial surface of a human central incisor. Two observers independently classified the samples according to the fluorescence levels as high, medium, and low [Figure 3]a and [Figure 3]b.
All the data were analyzed using IBM Statistical Package for the Social Sciences (SPSS) software (version 23.0). Descriptive statistics such as frequency analysis and percentage analysis were used for categorical variables, whereas mean and standard deviation were used for continuous variables. A paired-samples t-test is used to find the significant difference between the bivariate samples in paired groups. The probability value of 0.05 was considered statistically significant. For intergroup comparison, one-way analysis of variance (ANOVA) was used, and for intragroup comparison, repeated-measures ANOVA was used. ANOVA and post hoc Bonferroni tests were used to determine the level of significance between groups and within groups for various time periods.
| Results|| |
In the AS group, a significant difference was observed between the groups and within the groups at all time periods. The C solution group showed a statistically significant difference between the groups only at T1, and the CH group showed a significant difference between the groups at T1, T2, and T3. In the T solution group, there was no statistically significant difference between and within the groups at any time period [Figure 4], [Figure 5], [Figure 6]. When comparisons were made regarding the color change in all subgroups between T0 and T3 showed a statistically significant change except for OC in the CH mouth rinse group [Figure 7], [Table 3].
To determine the perceivable change by humans, all the recorded values were converted into NBS units and were standardized. In the C solution group, the total changes in NBS units were 1.64, 9.34, and 9.08 for OC, LRF, and OO, respectively. In the T solution group, the total changes in NBS units were 2.557, 9.476, and 9.31 for OC, LRF, and OO, respectively. In the CH mouth rinse group, the total changes in NBS units were 0.717, 2.714, and 4.2 for OC, LRF, and OO, respectively [Table 4].
The fluorescence of all three brands of esthetic wires was evaluated by two observers separately, and the values were calibrated as high, medium, and low. OO showed medium fluorescence, whereas OC and LRF showed high fluorescence compared with human teeth [Table 5].
| Discussion|| |
Invisible orthodontic appliances such as clear aligners, lingual bracket systems, and ceramic brackets in combination with esthetic archwires are preferred by adult patients seeking orthodontic treatment. Clear aligners and lingual brackets are occupying only 10% of the orthodontic market in the Indian subcontinent due to the main drawbacks such as cost and their inability to treat complicated cases.
The coated esthetic wire should have optimal biocompatibility, frictional properties, color stability, force deflection, and surface coating. When force deflection was evaluated by Abaas et al., coated wires had similar bending properties compared with uncoated wires. The main disadvantage of coated esthetic wires is loss of coating and change in color. Ideally, the color of esthetic archwires should resemble the natural teeth and esthetic brackets. However, the color of natural teeth may vary according to the color measurement protocols, race, gender, and age., In addition to the color differences, the color stability of coated archwires during orthodontic treatment is also clinically important.
Spectrophotometers are used to eliminate the subjective interpretation of visual color comparison. Color changes were characterized using the CIE L*a*b* color space. The perceptibility of color differences was evaluated using ΔE* values., However, the criteria for perceptibility adopted by each author were different. This magnitude of the color difference is based on the human perception of color; color differences greater than 1 ΔE unit are visually detectable by 50% of human observers. To overcome such differences and disagreements, the NBS rating system is frequently used to determine the degree of color difference and offers absolute criteria by which Δ E* values can be converted to definitions with clinical significance.
Few studies evaluated the color stability of esthetic wires using coffee as a staining agent, which was said to be most chromogenic, but till date there was no strong evidence on the color stability of esthetic wires using turmeric and mouthwashes.
A pairwise comparison of each subgroup in C shows that there is a statistically significant change in all the brands (OC, LRF, and OO) from T0 to T3. Coffee may stain both by adsorption and by absorption of its colorants onto/into the organic phase of the coating and also depends on the saturation capacity of the resins for color absorption. Similar results were seen in studies conducted by Silva et al., Deepika et al., and Prabhakar et al. When perceivable changes were evaluated by NBS units for the individual group in the C solution, both OO and LRF wires showed an extremely marked color difference.
The second staining agent used was turmeric (T), which is stated as the most chromogenic agent by Singh and Aggarwal. T is an extensively used Indian spice with both edible and therapeutic functions. Its major color constituent is an oleoresin called curcumin. The overall highest color change was in the T solution. Abass and Alhuwaizi evaluated the staining properties of clear elastic modules and found that turmeric caused more color change when compared to coffee and tea. When perceivable, a paired-samples t-test showed that there is a statistically significant discoloration seen in all subgroups; that is, all brands from T0 to T3 changes were evaluated by NBS units for individual subgroup in the T solution. Extremely marked changes were seen in both OO and LRF.
Despite the increased use of mouth rinses, research comparing color changes associated with the use of mouth rinses in esthetic archwires is limited. The increase in the stain of dental materials when immersed in mouthwash was due to the diffusion and adsorption of mouthwash molecule to the surface of the material. Al-Attar et al. evaluated the staining property of mouth rinses on esthetic brackets and concluded that CH mouth rinse has the highest staining capacity when compared to other mouth rinses. In our study, minimal changes were seen in the mouth rinse. A paired-samples t-test showed that there is a statistically significant discoloration seen in all subgroups, that is, all brands from T0 to T3 except for OC. NBS values show that overall changes were marked in LRF. Overall, the results of our study showed that T is the most chromogenic agent, followed by C and CH mouth rinse. LRF showed the highest color change followed by OO and OC.
There are minimal studies regarding the fluorescence of esthetic archwires. Silva et al. evaluated the fluorescence of esthetic wires with the natural tooth and found that coated wires had low fluorescence when compared to the bovine tooth. In our study, among three different brands of esthetic wires, only OO had similar fluorescence, that is, medium fluorescence when compared with human teeth. The other two brands, that is, OC and LRF, showed high fluorescence than human teeth. Further studies on different types of staining solutions and various archwires can be carried out.
| Conclusion|| |
The conclusions drawn from this study were as follows:
- LRF showed the highest overall color change followed by OO and OC.
- Turmeric is the most chromogenic agent, followed by coffee and CH mouth rinse.
- Most of the archwires showed an overall significant color change from T0 to T3.
- The fluorescence of the OO archwire matches with a human tooth, and LRF and OC have high fluorescence.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]