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1. Oral Micro Flora Changes
During Orthodontic Therapy
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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2. DO THESE ORTHODONTIC APPLIANCES
BRING ABOUT CHANGES IN
?
NORMAL MICROFLORA

3.  IN HEALTHY ORAL CAVITY MICRO
ORGANISMS CO EXIST IN A BALANCED
STATE
 QUANTITATIVE CHANGES

4. WITH ORTHODONTIC TREATMENT
 Oral hygiene maintenance difficult
 > plaque
 > bacteria
 < Ph
 Transient MICROBACTERIAL SHIFT

5. REMOVABLE ORTHODONTIC
APPLIANCES
 > Candida albicans
 > Streptococcus
 > Lactobacillus
 > Actinomyces
 > Bacteriodes

6. Effect of orthodontic therapy with fixed
and removable appliances on
microbial flora
 Petti ,Barbato etal
In fixed
 > Actinobacillus Actinomycetemcomitans
 > Porphyromonas gingivalis
 < Gram +ve cocci

7. Oral Micro Flora Changes During
Fixed Orthodontic Therapy
 Banding
 Bonding
 Bracket materials
 Methods of ligation
 Debonding and debanding

8. Banding
 Mechanical irritation (Lundstrom etal 1980)
 Chemical irritation
 Food impaction ,plaque accumulation and
composition (Lang Kiel , Anderhalden 1983)
 Pseudopockets favor growth of
periodontopathic microorganisms (Kenny ,
Ash 1969 ; Loesche etal 1983 )

9.  Many studies reviewed only clinical
parameters and indices
 Few seem to review specific
microflora associated with clinical
change

10. Bloom and Brown (1964)
 Generalized
> in all bacterial counts
 Statistically significant
Lactobacillus count
> in
 Samples taken from saliva not from
specific areas around bands

11.  Most studies examined supragingival
plaque
 Ogaard ,Rolla etal (1988)
 > Streptococci mutans ,Lactobacilli
under orthodontic bands caused white
spot lesions

12.  Inflamation seen around bands in patients
with excellent supragingival plaque control
 Need to examine specific subgingival plaque
associated with bands
 Banding cause “ MICROFLORA SHIFT”

13. Muller ,Flores de Jacoby (1982)
 > spirochetes ,motile microorganisms
Diamanti ,Kipoiti (1987)
 > total subgingival flora
 > black pigmented bacteriodes
 > bacteriodes intermedius
 > actinomyces odontolyticus species
 < facultative anerobes

14. Huser ,Baehni Lang (1990)
 > carbohydrates , < Ph
 > plaque accumalation
 > gingival inflamation
 > spirochetes ,motile rods
 Shift to more anerobic flora
 > fusobacterium , > spirilla
 > filamentous organisms
 > bacteriodes intermedius

< cocci

15. Banding v/s Bonding
Scinclair etal (1987)
 Gingivitis more on bonded incisors than
banded molars, marked on labial surface
Reasons
 Orthodontic attachments on labial surface
 Rough surfaced bonding material

16. Banding v/s Bonding
Robert Boyd,Sheldon Baumrind (1992)
 > plaque accumalation
 Gingival inflamation in interproximal
sites of banded molars

17. Banded molars
Bonded molars

18. Bacterial colonization assosiated
with fixed orthodontic appliances a
SEM study
Warat etal (2001)
 Excess bonding composite is a critical site
Reasons
 Roughness
 Distinct gap at composite enamel interface

19. SURFACE TEXTURE OF COMPOSITE
IMMEDIATELY AFTER BONDING
COARSE FILLER PARTICLE

20. PLAQUE DEVELOPMENT AFTER 1 WEEK
SCATTERED COCCI

21. PLAQUE DEVELOPMENT AFTER 2 WEEKS
AGGREGATES OF
COCCI

22. Corncobs consisting of cocci attached to
central filament

23. PLAQUE DEVELOPMENT AFTER 3 WEEKS
Mature
plaque

24. Gap along the edge of composite

25. Bracket materials
 Eliades etal studied the wettability of
metallic ,plastic ,ceramic orthodontic
brackets invitro study
Metallic brackets
 Highest critical surface tension
 > Potential of adhesion of
microorganisms

26. Microbial profile on metallic and
ceramic bracket
 Anhowry etal(2001)
 No significant difference in levels of
streptococcus mutans and lactobacillus
between 2 bracket materials also between
anterior and posterior brackets
Metallic (posterior brackets)
 Treponima denticola
 Actinobacillus actinomycetemcomitans
 Streptococcus anginosus

27. Metallic (anterior and posterior)
 Fusobacterium nucleatum
 Eubacterium nodatum
Ceramic (anterior)
 Campylobacter showae
 Selenomonas noxia
Ceramic (anterior and posterior)
 Eskenella corrodens

28. LIGATION
Stainless steel wire v/s Elastomeric ring
Turkkhraman ,Sayin (1991)
Brackets ligated with elastomeric ring
 > plaque
 > Streptococci mutans ,Lactobacilli

> bleeding on probing

29. Archwire ligation
 Warat etal (2001) SEM study
Brackets ligated with elastomeric ring
 > plaque
 Has more irregular surface

30. stainless steel wire
elastomeric ring

31. stainless steel wire
elastomeric ring

32. Clinical and microbiologic changes
after removal of orthodontic
appliances
 Sallum etal(2004)
 The removal of orthodontic appliances,




coupled with professional prophylaxis and
proper instruction in oral hygiene
< Bacteroides forsythus
< Actinobacillus actinomycetemcomitans
< plaque index
< bleeding on probing

33. Conclusion
 Transient microbial shift
 Pretreatment levels reached after removal
 Prevent iatrogenic causes
 Emphasis on oral hygiene maintenance

34.  > interproximal loss of attachment
for banded maxillary molar than
bonded maxillary molar
Reasons
 Mechanical irritation
 Plaque removal difficult

35. Thank you