METHOD AND SYSTEM FOR PRODUCTION OF ANTI-MICROBIAL ORTHODONTIC ELASTOMERIC LIGATURES

Abstract

A method for production of anti-microbial orthodontic elastomeric ligatures is disclosed. The elastomeric ligatures are coated with an anti-microbial solution layer by layer. The coating solution comprising an anti-bacterial agent, a polymer and a solvent in the following ratio: 2 g anti-microbial agent, 4 g polymer and 200 mL solvent. The hypo-allergic latex-free orthodontic elastomeric ligatures with an internal diameter of 0.045 inches and external diameter of 0.115 inches are rinsed in distilled water, dried at 60° C. and sprayed with the anti-bacterial solution two times and dried for five minute. This process is repeated for five times and the elastomeric ligatures are dried at room temperature for 1 h.

Claims

1. A method for production of anti-microbial orthodontic elastomeric ligatures, comprising the steps of: a) preparing a coating solution by mixing an anti-bacterial agent, a polymer and a solvent by a ratio of 2 g anti-microbial agent, 4 g polymer and 200 mL solvent; b) selecting a hypo-allergic latex-free orthodontic elastomeric ligatures with an internal diameter of 0.045 inches and external diameter of 0.115 inches; c) rinsing said hypo-allergic latex-free orthodontic elastomeric ligature in distilled water and drying at 60° C.; d) spraying the anti-microbial solution on the hypo-allergic latex-free orthodontic elastomeric ligature two times and drying for five minutes; e) repeating step (d) five times, and f) drying the elastomeric ligature at room temperature for 1 h.

2. The method of claim 1, wherein the anti-bacterial agent is chlorhexidine (CHX) diacetate.

3. The method of claim 1, wherein the polymer is ethyl cellulose.

4. The method of claim 1, wherein the solvent is dichloromethane.

5. A method of preparing an anti-microbial solution, comprising the steps of: a) dissolving ethyl cellulose as a polymer in dichloromethane solvent using a stirrer for 24 h, and b) adding chlorhexidine (CHX) diacetate as an antibacterial agent.

6. The method of claim 5, wherein the ratio of each agent comprising 2 g CHX diacetate+4 g ethyl cellulose+200 mL dichloromethane.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0023] Embodiments herein will hereinafter be described in conjunction with the appended drawings provided to illustrate and not to limit the scope of the claims, wherein like designations denote like elements, and in which:

[0024] FIG. 1 is a representation of various parts of an orthodontic brace;

[0025] FIG. 2 is a schematic representation of the structural formula of Chlorhexidine (CHX) as an antibacterial agent being used for the coating solution of the present invention;

[0026] FIG. 3 shows the preparation of the coating solution as an antibacterial agent for the orthodontic ligatures according to the present invention;

[0027] FIG. 4 is an illustration of elastomeric ligatures made of Hypo-allergic latex-free orthodontic elastomeric ligatures to which the coating of the present invention is applied;

[0028] FIG. 5 shows the process of collecting salvia of a patient in a sterile syringe for transferring into micro-tube for S. mutans count;

[0029] FIG. 6 shows the preparation of the culture medium for the sample processing;

[0030] FIG. 7 shows the culture medium poured into sterile plates after mixing the solution;

[0031] FIG. 8 shows the samples placed into the incubator for centrifuging, and

[0032] FIG. 9 shows the blue colonies of S. mutans after the completion of incubation period and staining.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

[0033] As shown in FIG. 1 orthodontic appliance 100 is comprised of orthodontic wires 20 secured on brackets 30 and bands 50 that are bonded onto tooth enamel and are held in position by elastomeric ligature ties 10. Composite and adhesive are used for bracket bonding. The wire 20 is fastened to all of the brackets 30 and creates force to move teeth into proper alignment. Brackets 30 are connected to the bands or directly bonded on the teeth and hold the wire 20 in place. The wire 20 is held to each bracket with a ligature 10. Elastic hooks and rubber bands 40 help move teeth toward their final position.

[0034] These appliances encourage colonization of microorganisms around the brackets 30 and elastomeric ligature ties 10. The most common microorganisms that can colonize and cause white spot lesions (WSL) and dental caries on enamel surface are gram-positive Streptococcus mutans (S. mutans). When poor oral hygiene is maintained after fixed orthodontic appliance placement, this can result in formation of WSLs and periodontitis. Development of WSLs is due to prolonged plaque accumulation, which causes the decalcification of enamel. WSLs, if left untreated can progress to dental caries.

[0035] Prevention of microbial buildup is a preferred alternative to treatment. Chlorhexidine (CHX) is an antimicrobial agent which belongs to the biguanide class of drugs that is efficacious against gram-negative, gram-positive bacteria and yeasts. As a broad-spectrum antimicrobial and antifungal agent, CHX does not promote the development of bacterial resistance and it is widely used in medicine and in dentistry, as a mouth rinse in the form of CHX digluconate. FIG. 2 shows the chemical structure of CHX digluconate.

[0036] According to FIG. 3 for the preparation of the coating solution CHX diacetate (Sigma Aldrich, St. Louis, Mo., USA) was used as antibacterial agent and ethyl cellulose (N100; Sigma Aldrich, St. Louis, Mo., USA) was used as polymer to prepare the coating solution. The polymer volume was 2% of the solution, and dichloromethane (Duksan Pure Chemicals) was used as solvent in the following ratio: 2 g CHX diacetate+4 g ethyl cellulose+200 mL dichloromethane. First, ethyl cellulose was completely dissolved in dichloromethane solvent using a stirrer for 24 h. Next, CHX diacetate was added to the solution.

[0037] According to FIG. 4 for the preparation of elastomeric ligatures, Hypo-allergic latex-free orthodontic elastomeric ligatures with an internal diameter of 0.045 inch and external diameter of 0.115 inch were rinsed in distilled water and dried at 60° C. The coating solution was sprayed on the ligatures five times. Each time, each side of the wire was sprayed twice. After the first spray, the ligature was dried for 5 min and then it was sprayed again. Next, elastomeric ligatures were dried at room temperature for 1 h, and three rings of each type of ligature (CHX-releasing and conventional ligatures) were cultured to ensure absence of S. mutans.

[0038] The present system and method is tested by using elastomeric ligatures prepared with the method of the present invention in a number of orthodontic patients. A double-blind clinical trial was used to evaluate 30 orthodontic patients between 14 to 25 years, who were randomly divided into two groups. CHX-releasing elastomeric ligatures were used in the test group while the conventional elastomeric ligatures were used for the control group. Saliva samples were collected at baseline, and 7, 14, 21 and 28 days after the intervention. Plaque samples were also collected at baseline and after 28 days. Elastomeric ligatures were collected in both groups after 28 days. The collected samples were cultured to count the number of S. mutans. Data were analyzed using the Mann-Whitney and Wilcoxon tests.

[0039] The result was that the salivary count of S. mutans was significantly lower in the test group at 7, 14, 21 and 28 days (P<0.05). The S. mutans count on the surface of CHX-releasing ligatures was significantly lower than that on the surface of conventional ligatures (P<0.05). However, no significant difference was noted in S. mutans count in plaque samples between the two groups (P>0.05). The salivary level of S. mutans significantly decreased during the course of study in the test group. In conclusion, CHX-releasing elastomeric ligatures can significantly decrease the salivary count of S. mutans in orthodontic patients.

[0040] In this double-blind clinical trial, sample size was calculated to be 15 in each group considering the minimum difference of 30% between the two groups, 80% study power and 95% confidence interval. A total of 30 patients between 14 to 25 years were selected who required fixed orthodontic treatment. The patients were selected using convenience sampling and received oral hygiene instructions. They were requested to brush their teeth twice a day. They were also asked to floss their teeth. All patients used a toothpaste containing 0.3% sodium fluoride during the study period. The patients were requested to refrain from eating and drinking for 2 h prior to sampling. They were also requested not to use mouthwash during the study period.

[0041] The inclusion criteria were (I) presence of all natural teeth, (II) requiring fixed orthodontic treatment, (III) no smoking, (IV) absence of extensive dental restorations or fixed partial dentures, (V) no antibiotic use during the study period and the 2 months prior to the onset of study, (VI) absence of periodontal disease prior to treatment onset, (VII) high motivation for oral hygiene maintenance, (VIII) no use of mouthwash during the study period, (IX) no restoration on the buccal surface of the teeth and (X) normal anatomical shape and height of teeth.

[0042] The exclusion criteria were (I) systemic disease or medication intake, (II) history of previous orthodontic treatment, (III) history of CHX use for 1 week or longer in the past 2 months, (IV) presence of active carious lesions, and (V) low saliva flow. The selected 30 patients were randomly divided into test and control groups (n=15).

[0043] According to FIG. 5 in clinical procedure, in the first visit, baseline saliva samples were collected from both the test and control group patients. The patients were requested not to eat or drink for 2 h prior to sampling. The patients were requested to sit on a dental chair for 5 min, and 0.5 mL of unstimulated saliva was collected using a sterile syringe and transferred into a micro-tube to determine the salivary count of S. mutans. Immediately after saliva collection, dental plaque sample was obtained from the second premolar site bilaterally using a sterile periodontal probe.

[0044] FIGS. 6 to 9 show the procedure of the sampling implemented in this clinical trial. The plaque sample was transferred into a micro-tube containing 1 mL saline. After sampling, the teeth underwent professional cleaning and the brackets were bonded. Roth brackets with a slot size of 0.022×0.028 inch were used in all patients. A minimum of 20 brackets were used for patients. The same type of composite and adhesive was used for bracket bonding in all patients.

[0045] CHX-releasing ligatures were used for patients in the test group while conventional ligatures were used for control patients. The ligatures had similar color coding in both groups. Thus, the patients were blinded to the type of ligatures. The samples were placed next to dry ice and were sent to a microbiology lab in less than 2 h. Saliva samples were collected again at 7, 14, 21 and 28 days after placement of ligatures. On day 28, dental plaque samples were also collected in addition to saliva samples from the same site. Also, elastomeric ligatures were removed from the oral cavity using a sterile explorer and placed in 1 mL of saline and sent to the microbiology lab.

[0046] According to FIG. 7 to prepare the Mitis Salivarius Agar culture medium (Quelab, UK), 90 g of culture medium powder and 200 g of sucrose (Merck, Darmstadt, Germany) were dissolved in 1 L of distilled water and autoclave-sterilized at 110° C. and 15 ibs/in.sup.2 pressure for 15 min. After cooling to 50° C., 1 mL/L of 1% potassium tellurite (Merck, Darmstadt, Germany) and 0.2 μ/mL of bacitracin stock solution (previously sterilized by a syringe filter) were added to the culture medium. After mixing, 25 mL of culture medium was poured into sterile plates.

[0047] Samples transferred to the microbiology lab were centrifuged and 10 serial dilutions were prepared using sterile serum. Of each dilution, 0.1 unit/mL was streak-cultured on Mitis Salivarius Agar culture medium. The culture plates were then incubated at 37° C. for 48 h. To ensure that the counted colonies were S. mutans colonies, they were Gram-stained and catalase and Voges-Proskauer tests were also performed. Gram-staining revealed chains of Gram-positive cocci.

[0048] The bacteria could not break down hydrogen peroxide and the catalase test result was negative. The Voges-Proskauer test result was positive and color change was observed. Thus, after the completion of incubation period and staining, the prominent, granulated, blue colonies of S. mutans were counted. In order to obtain the total number of bacteria present in the original sample, the number of counted colonies at each concentration was multiplied by the inverse of the dilution factor. Number of colony forming units per milliliter (CFUs/mL)=number of colonies/(transferred volume×dilution factor) OR number of colonies×inverse of the dilution factor (10.sup.−4)×inverse of the transferred volume (0.1 mL)

[0049] Data were analyzed using SPSS version 25 (SPSS Inc., Ill., USA). Normality of the data was evaluated using the Kolmogorov-Smirnov test. The Mann Whitney test was used to compare the salivary colony count between the two groups at different time points. The Friedman test was used to compare the colony count in the saliva samples separately in each group at 7, 14, 21 and 28 days. The Wilcoxon test was used to analyze the difference in salivary colony count at different time points. The Mann Whitney test was applied to compare the bacterial colony count in plaque samples between the two groups at different time points. The Wilcoxon test was applied to analyze the difference in bacterial count in plaque samples in each group at different time points. The bacterial colony count on elastomeric ligature samples was compared between the two groups at different time points using the Mann Whitney test.

[0050] Tables 1, 2 and 3 show the salivary count of S. mutans. The Kolmogorov-Smirnov test revealed that data were not normally distributed in the test and control groups (P<0.05). Thus, non-parametric tests were applied for data analysis.

TABLE-US-00001 TABLE 1 Salivary count of S. mutans at baseline and at 7, 14, 21 and 28 days after the intervention Control group Test group Time point Mean Std. deviation Mean Std. deviation P value Baseline 1.08 0.49 1 0.55 0.78  7 days 1.07 0.42 0.69 0.48 0.037 14 days 1.14 0.47 0.39 0.32 <0.001 21 days 1.13 0.55 0.21 0.21 <0.001 28 days 1.23 0.61 0.13 0.12 <0.001 *The mean and std. deviation values are based on 10.sup.5 CFUs.

[0051] Table 1 presents the salivary count of S. mutans at baseline and at 7, 14, 21 and 28 days after the intervention. The Mann-Whitney test revealed no significant difference in salivary count of S. mutans between the test and control groups at baseline (P=0.78). However, the salivary count of S. mutans started to increase in the control group and started to decrease in the test group during the course of study. The salivary count of S. mutans was significantly lower in the test group at 7, 14, 21 and 28 days (P<0.05).

[0052] Friedman test was then applied within-group comparisons. It revealed no significant difference in salivary count of S. mutans in the control group during the one-month study period (P=0.061). However, this difference was significant in the test group (P<0.001). Wilcoxon test was then applied to analyze the difference in salivary count of S. mutans at different time points in the two groups. In the control group, the difference in this regard was not significant between different time points (P>0.05, Table 2). However, a significant reduction in S. mutans colony count was noted over time in the test group.

TABLE-US-00002 TABLE 2 Results of Wilcoxon test for pairwise comparisons of salivary S. mutans colony count at different time points Time Control group Test group Baseline-7 days 0.865 0.001  7 days-14 days 0.363 0.001 14 days-21 days 0.691 0.001 21 days-28 days 0.105 0.004 Baseline-28 days 0.088 0.001

[0053] Table 3 shows the S. mutans count in dental plaque samples collected at baseline and at 28 days (Table 3). The Mann Whitney test was used to compare the plaque S. mutans count of the two groups, which revealed no significant difference between the test and control groups in this respect (P>0.05). Wilcoxon test revealed no significant increase in colony count in dental plaque at 28 days compared with baseline in the control group (P=0.910). In the test group, no significant reduction was noted in S. mutans colony count at 28 days compared with baseline (P=0.081).

TABLE-US-00003 TABLE 3 S. mutans colony count in dental plaque samples collected at baseline and at 28 days Control group Test group Mean Std. deviation Mean Std. deviation P value Baseline 1.1 0.47 1 0.54 0.425 28 days 1.11 0.51 0.97 0.54 0.400 *The mean and std. deviation values are based 10.sup.5 CFUs.

[0054] The mean count of S. mutans on elastomeric ligature samples was 0.51±0.48 (×10.sup.5) CFUs in the test and 1.02±0.50 (×10.sup.5) CFUs in the control group at 28 days. The Mann Whitney test revealed a significant difference in this respect between the two groups (P=0.003).

[0055] The results showed that the salivary count of S. mutans was significantly lower in the test group at 7, 14, 21 and 28 days (P<0.05). The S. mutans count on the surface of CHX-releasing ligatures was significantly lower than that on the surface of conventional ligatures (P<0.05). However, no significant difference was noted in S. mutans count in plaque samples between the two groups (P>0.05). The salivary level of S. mutans significantly decreased during the course of study in the test group.

[0056] In this clinical study, the patients were asked not to use fluoride- or CHX-containing gels or mouthwashes during the study period to prevent their confounding effects on the results. None of the patients showed any side effect related to the use of CHX, which is probably due to the use of relatively low concentration of CHX in the coating.

[0057] The foregoing is considered as illustrative only of the principles of the invention. Further, since numerous modifications and changes will readily occur to those skilled in the art, it is not desired to limit the invention to the exact construction and operation shown and described, and accordingly, all suitable modifications and equivalents may be resorted to, falling within the scope of the invention.

[0058] With respect to the above description, it is to be realized that the optimum relationships for the parts of the invention in regard to size, shape, form, materials, function and manner of operation, assembly and use are deemed readily apparent and obvious to those skilled in the art, and all equivalent relationships to those illustrated in the drawings and described in the specification are intended to be encompassed by the present invention.

REFERENCES

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