Changes in the oral environment after placement of lingual and labial orthodontic appliances

BACKGROUND: This study compared the oral hygiene and caries risk of patients treated with labial and lingual orthodontic appliances throughout a prospective evaluation of the status of the oral environment before and after bracket placement. METHODS: A total of 20 orthodontic patients aged 19 to 23 years were included in the study and were divided into two groups: 10 patients wore Roth labial appliance (American Orthodontics, Sheboygan, WI, USA) and 10 patients wore STb lingual appliance (Ormco Corporation, Glendora, CA, USA). Plaque index (PI), gingival bleeding index (GBI), salivary flow rate, saliva buffer capacity, salivary pH, and Streptococcus mutans and Lactobacillus counts in saliva were determined at three time points: before orthodontic appliance placement (T0), 4 weeks after bonding (T1), and 8 weeks after bonding (T2). After appliance placement, all patients were periodically educated to the oral hygiene procedures. Wilcoxon rank and Mann-Whitney U tests were used to determine intragroup and intergroup differences as regards qualitative data. To compare quantitative data between the groups, chi-square and Fisher's exact tests were undertaken, while intragroup differences were tested with McNemar test. The level of statistical significance was set at p < 0.05. RESULTS: Statistical analysis of the data obtained revealed a statistically significant difference between the data of T0 and T1 and the data of T0 and T2 of the PI scores and between T0 and T2 of the GBI scores in the group treated with the lingual appliance. The GBI value increased significantly between T0 and T1 but decreased significantly between T1 and T2 (p < 0.01) in the group treated with labial appliance. S. mutans counts increased significantly between T0 and T2 in the saliva samples of patients treated with lingual appliance. No statistically significant differences were found between S. mutans and Lactobacillus counts at the three terms of saliva collection in patients treated with labial appliance. No statistically significant differences were found between the two groups at the three time points as regards the salivary flow rate and saliva buffer capacity. CONCLUSIONS: Lingual and labial orthodontic appliances showed a different potential in modifying the investigated clinical parameters: patients wearing STb lingual orthodontic appliance had more plaque retention 4 and 8 weeks after bonding, while there were more gingival inflammation and more S. mutans counts 8 weeks after bonding. No differences were found between the two groups as regards the Lactobacillus counts, the salivary flow rate, and saliva buffer capacity.