Effects of Fixed Orthodontic Appliances on Salivary Conditions

Yumi Lindawati

, Erliera Sufarnap

, Wihda Munawwarah

Departement of Oral Biology Faculty of Dentistry, Universitas Sumatera Utara, Jl. Alumni No. 2 Campus USU Padang

Bulan, Medan, Indonesia 20155

Keywords: Edgewise, Straight Wire, Fixed Orthodontic, Saliva.

Abstract: Fixed orthodontic can increase salivary flow rate because of its mechanical stimuli and as the body’s

physiological response that regard as a foreign in the body. The aim of this research is to know the effects of

the fixed orthodontic techniques to salivary flow rate and calcium. This study used observational analytic

with cross sectional design using samples of saliva stimulated from 66 young subjects (18-25 years old),

divided into groups of controls, edgewise technique and straight wire technique. The subjects obtained by

consecutive sampling method based on inclusion and exclusion criteria. The salivary flow rate and saliva’s

calcium had significantly difference (p=0.001) for all groups. Salivary flow rate and calcium showed

significant differences between subjects with fixed orthodontic of edgewise technique and straight wire

technique (p <0.05). This study concludes that fixed orthodontic with edgewise technique and straight wire

technique influences the salivary flow rate and calcium. Mechanical stimulation process in patients with

edgewise technique is higher than straight wire technique.

1 INTRODUCTION

Fixed orthodontic appliance is a device placed on

the surface of teeth which cannot be removed by

the patient (Coburne and DiBiase, 2010). Both

fixed and removable orthodontic appliances are

widely used in orthodontic treatment with the

increasing knowledge of the importance of oral and

dental health. Thus, fixed orthodontic appliances

are more widely used than removable orthodontic

appliances (Lau and Wong, 2006). Orthodontic

treatment may also cause changes in the oral cavity,

such as bacterial concentration, salivary buffer

capacity, salivary acidity (pH), salivary protein

level and salivary flow rate (Carillo, 2010). Many

techniques of fixed orthodontic treatment are to be

developed to overcome the previous techniques

technical weaknesses. The fixed orthodontic

treatment technique that is still used in the

Orthodontic clinic in Dentistry Hospital (RSGM),

University of Sumatera Utara, such are edgewise,

straight- wire technique and self-ligature bracket

technique.

The use of fixed orthodontic appliances increase

salivary flow rate as a form of physiological

response of the body by recognizing the fixed

orthodontic appliance as a foreign object in the oral

cavity. The placement of fixed orthodontic appliance

improves the mechanical stimulation process in the

oral cavity (Carillo, 2010).

Saliva is a complex liquid produced in the oral

cavity by several salivary glands which consists of

water and other contents. Based on the function,

saliva has several properties such as lubricating,

cleansing, neutralizing, and protecting the oral

cavity against demineralization. This protective

function of saliva is strongly related to the salivary

flow, composition, pH, buffer capacity, and ionic

arrangement of salivary proteins (Teixeira, 2012),

(Motamayel, 2013). Based on the description,

researchers are interested to observe the salivary

flow rate and saliva’s calcium in fixed orthodontic

patients with edgewise and straight wire techniques.

So that we will know the effect of fixed orthodontic

in salivary conditions.

2 MATERIAL AND METHOD

This is an observational analytic study with cross

sectional design and this study has obtained

permission from the health research ethics

committee of the Faculty of Medicine, University of

Lindawati, Y., Sufarnap, E. and Munawwarah, W.

Effects of Fixed Orthodontic Appliances on Salivary Conditions.

DOI: 10.5220/0010075804910494

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

491-494

ISBN: 978-989-758-449-7

491

Sumatera Utara. Samples of stimulated saliva

collected from 66 young subjects (18-25 years old)

with spitting method. This research was conducted

on April 2018 to August 2018 at Orthodontic

Residency’s clinic, RSGM, University of Sumatera

Utara. The population of this study were patients

from the clinic. This research consist of a control

group and two study groups, with edgewise and

straight wire techniques of fixed orthodontic

appliances. Subjects that match the inclusive criteria

were obtained as many as 22 people in each group.

General inclusive criteria: 18-25 years old, male and

female. Inclusive criteria of control group: without

orthodontic appliances. Inclusive criteria for

experimental group: subjects with fixed orthodontic

appliances; edgewise and straight wire placement

technique, and patients with 4-6mm crowding.

Exclusive criteria: smokers, alcohol drinkers, intake

of medications, systemic diseases, women that

undergoes menstruation, pregnancy, breastfeeding,

dental caries, and patient with prosthesis.

Saliva collection was done at 09.00-12.00 WIB

by spitting method. Saliva was collected in mouth

with closed lip position, then was spitted into a

salivary pot every 1 minute. The saliva collection

performed for 5 minutes. Subjects were initially

instructed to rest for 1 minute, then every 1-minute

subjects were asked to spit the accumulated saliva

into a measuring cup. The total amount of saliva

collected then divided by the collection time of 5

minutes to obtain the salivary flow rate ml/min.

Saliva’s calcium data was obtained by using Atomic

Absorption Spectrophotometer (SAA) at the

Pharmaceutical Research Laboratory of University

of Sumatera Utara.

3 RESULT

This research was conducted to observe the effect of

fixed orthodontic placement technique on salivary

flow rate and saliva’s calcium at Orthodontic Clinic,

Faculty of Dentistry, University of Sumatera Utara

using consecutive sampling method. All the data

were then processed and analyzed by Annova and

Spearman Test.

Table 1 shows the distribution of salivary flow

rate on control group, subjects with edgewise and

straight wire fixed orthodontic placement

techniques. The minimum salivary flow rate in the

control group is 0.60 ml/min with maximum rate of

2.00 ml/min. In the edgewise placement technique

group, the minimum salivary flow rate is 1.60

ml/min with maximum rate of 5.20 ml/min, while in

the straight wire placement technique group the

minimum salivary flow rate is 0.60 ml/min with the

maximum rate of 2.00 ml/min. There is a significant

difference of salivary flow rate between study

groups (group with edgewise and straight wire

placement technique) (p=0.001).

Table 1. Distribution of salivary flow rate on control

group, edgewise and straight wire placement

technique.

Salivary Flow Rate

(

ml/minute

)

Min

Max

Median

Control 0,60

2,00

1,00 0,001

Edgewise 1,60

5,20

2,60

Straight

wire

0,60

2,00

1,20

*significance p<0,05

Table 2 shows the distribution of saliva’s

calcium in control group, subjects with edgewise

and straight wire fixed orthodontic techniques. The

minimum saliva’s calcium value in the control group

is 0.00 m mol/l while the maximal value is 0.90 m

mol/l. In the edgewise placement technique group,

the minimum salivary calcium value is 0.90 m mol/l

while the maximum value is 2.10 m mol/l. In the

straight wire placement technique group, the

minimum salivary calcium value is 0.30 m mol/l

while the maximum value is 1.50 m mol/l. The test

shows that saliva’s calcium has a value of p=0.001

which indicates that there is a significant difference

between the study groups (group with edgewise and

straight wire placement technique) (p <0,05).

Table 2. Distribution of salivary calcium on control

group, edgewise and straight wire placement technique

Saliva’s calcium (m mol/l) p

Min Max Median

Control 0,00 0,90 0,60 0,001*

Edgewise 0,90 2,10 1,30

Straight

wire

0,30 1,50 0,90

*significance p<0,05

Table 3 shows the relationship between salivary

flow rate with saliva’s calcium. Spearman’s test of

correlation showed a significant relationship

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

492

(p=0,001) with r value of 0.835 which indicates a

perfect relationship between salivary flow rate and

saliva’s calcium.

Table 3. Relationship of salivary flow rate with saliva’s

calcium.

*significance p<0,05

4 DISCUSSION

Fixed orthodontic treatment can be done with

several techniques such as edgewise and straight

wire techniques to obtain an ideal occlusion.

Orthodontic treatment can cause environmental

changes in the oral cavity, such as changes in saliva.

Aim of this study is to observe the effect of fixed

orthodontic placement technique on the flow rate,

and saliva’s calcium. Table 1 shows the distribution

of salivary flow rates in the control group, subjects

with edgewise and straight wire fixed orthodontic

placement techniques. The results showed a

significant difference in the three study groups with

the highest salivary flow rate is on the edgewise

fixed orthodontic placement technique group. The

placement of fixed orthodontic appliances in a

malocclusion patient improves the mechanical

stimulation process in the oral cavity. After the

placement of orthodontic appliances, the body will

start to recognize the placed appliances as a foreign

object and causes stimulation that increases the

salivary flow rate (Carillo, 2010). In Edgewise

technique, a wider bracket is usually used.

A study by Crincoli on frictional forces in some

brackets found that conventional brackets produce

frictional forces 5-6 times higher than other brackets

(Singh, 2007), (Crincoli, 2013). The presence of

large frictional force of edgewise and the use of

wide bracket causes a larger pressure and also the

bracket used on the edgewise technique has multiple

loops which cause discomfort feeling to the patients,

thus increases the salivary flow rate (Rasyid, 2014).

Changes occurring in the oral cavity are considered

as physiological responses to mechanical stimulation

due to the high pressure caused by the edgewise

technique while the straight-wire technique causes

the salivary flow rate, pH and saliva’s calcium to be

lower due to the negated wire bending (Samawi,

2011).

Salivary secretions may be enhanced by two

types of salivary reflexes, simple salivary reflex

(unconditioned) and acquired salivary reflex

(conditioned). In fixed orthodontic appliance users

there is an increase in salivary flow rate through

simple or unconditioned saliva reflex that occur

through a chemoreceptor or pressure receptor. This

pressure may come from the fixed orthodontic

appliance placement. When the appliances are

activated, the receptors initiate an impulse in the

afferent nerve fibers that carry information to the

salivary centre in the medulla brainstem. The

salivary centre then sends an impulse to the salivary

glands through the extrinsic autonomic nerves to

stimulates the parasympathetic nervous system that

plays a major role in salivary secretion that causes

much and enzyme-rich dilute saliva secretion. The

presence of brackets and wires in the teeth

encourage the saliva secretion in the absence of food

due to manipulation of pressure receptors located in

the mouth (Sherwood, 2011). The nerves responsible

for saliva secretion include facial and glosso

pharyngeal nerves. Facial nerve is directly related to

sublingual and sub mandibular salivary glands,

while the glosso pharyngeal nerve is directly related

to the parotid gland (Neil, 2007).

Table 2 shows the distribution of saliva’s

calcium in the control group, subjects with of

edgewise and straight wire fixed orthodontic

placement techniques. The results showed a

significant difference between the three study groups

with the highest saliva’s calcium value in the

edgewise fixed orthodontic placement technique.

Studies by Bhavsar, state that saliva’s calcium is

higher in patients undergoing orthodontic treatment

compared to patients without orthodontic treatment.

The results of this study lead to the fact that saliva’s

calcium value is affected by changes in the oral

environment due to orthodontic brackets in the oral

cavity.

Increased salivary calcium concentration is

due to dental demineralization and fixed orthodontic

treatment. The presence of great pressure and

friction in edgewise techniques leads to an increase

in salivary flow rate and salivary calcium ions. The

concentration of calcium ions depends on the pH

and salivary flow rate. Saliva containing calcium

acts as an important source of ions. Thus the balance

between re mineralization and demineralization

depends on the concentration of saliva’s calcium

(Bhavsar, 2017).

Table 3 shows the relationship between salivary

flow rate and saliva’s calcium. The results showed a

significant correlation between salivary flow rate

and saliva’s calcium. The results showed that the

Variable

(r)

Salivary Flow Rate 0, 83 0,001*

Saliva’s calcium

Effects of Fixed Orthodontic Appliances on Salivary Conditions

493

higher the pressure of fixed orthodontic placed, the

greater the saliva secretion will be and it will

increases the amount of calcium ions in the saliva,

with r value of 0.83 which means that the increase of

calcium in saliva is related perfectly with the

salivary flow rate. The results showed a perfect

relationship between saliva secretion and the amount

of calcium ion in the saliva which also means that

the calcium ions level in saliva are affected by the

saliva flow rate. As reported by Indriana, increased

salivary flow rate affects the amount of calcium ion

concentration in saliva (Indriana, 2011).

5 CONCLUSION

A fixed orthodontic placement with both edgewise

and straight wire techniques affect the salivary flow

rate and saliva’s calcium. There were significant

differences of salivary flow rate and saliva’s calcium

level between control and study groups (p <0.05). It

can be concluded that fixed orthodontics appliances

affects the condition of the patient's saliva

ACKNOWLEDGMENTS

This research was conducted with the aid of

TALENTA funds from the Research Institute of

University of Sumatera Utara in 2018 with contract

number 2590/UN5.1. R/PPM/2018.

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