Efficacy of a Copper–Calcium–Hydroxide Solution in Reducing Microbial Plaque on Orthodontic Clear Aligners: A Case Report

Abstract

The aim of this study was to investigate the ability of a copper–calcium–hydroxide-based compound to remove microbial plaque naturally produced onto orthodontic clear aligners. A commercially available dental paste, named Cupral, based on copper–calcium–hydroxide, was used. A healthy volunteer (female, 32 years old), undergoing orthodontic treatment with thermoplastic clear aligners was enrolled. By conventional/confocal microscopy and colony-forming unit (CFU) assay, 2-week used aligners were examined for microbial plaque, prior and following exposure to Cupral. Confocal microscopy revealed abundant plaque irregularly distributed onto the aligner surface. Following Cupral treatment, a drastic decrease occurred in plaque thickness and matrix presence. As assessed by the CFU assay, total microbial load approached 10⁹ CFUs/aligner, with slight differences in aerobiosis and anaerobiosis culture conditions; six macroscopically different types of colonies were detected and identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Following Cupral treatment, microbial load dropped to undetectable levels, irrespectively of the conditions considered. Exposure of clear aligners to Cupral results in the elimination of contaminating microorganisms; the antimicrobial activity is retained up to 1.25% concentration. Overall, our data describe a novel use of Cupral, a copper–calcium–hydroxide-based compound, in daily hygiene practices with promising results.

Keywords

clear aligners - copper–calcium–hydroxide - orthodontic therapy - microbial plaque

• References

• 1 Keim RG, Gottlieb EL, Nelson AH, Vogels III DS. 2007 JCO orthodontic practice study. Part 1: trends. J Clin Orthod 2007; 41 (10) 617-626
• 2 Gomes SC, Varela CC, da Veiga SL, Rösing CK, Oppermann RV. Periodontal conditions in subjects following orthodontic therapy. A preliminary study. Eur J Orthod 2007; 29 (05) 477-481
• 3 van Gastel J, Quirynen M, Teughels W, Coucke W, Carels C. Longitudinal changes in microbiology and clinical periodontal variables after placement of fixed orthodontic appliances. J Periodontol 2008; 79 (11) 2078-2086
• 4 Meto A, Blasi E, Colombari B, Tragaj E, Meto A. Endodontic treatment of apical resorptions due to fixed orthodontic treatments. Int Dent J 2017; 67 (01) 135-198
• 5 Abusleme L, Dupuy AK, Dutzan N. et al. The subgingival microbiome in health and periodontitis and its relationship with community biomass and inflammation. ISME J 2013; 7 (05) 1016-1025
• 6 Li L, Finnegan MB, Özkan S. et al. In vitro study of biofilm formation and effectiveness of antimicrobial treatment on various dental material surfaces. Mol Oral Microbiol 2010; 25 (06) 384-390
• 7 Enaia M, Bock N, Ruf S. White-spot lesions during multibracket appliance treatment: a challenge for clinical excellence. Am J Orthod Dentofacial Orthop 2011; 140 (01) e17-e24
• 8 Richter AE, Arruda AO, Peters MC, Sohn W. Incidence of caries lesions among patients treated with comprehensive orthodontics. Am J Orthod Dentofacial Orthop 2011; 139 (05) 657-664
• 9 Ahn SJ, Lim BS, Lee SJ. Prevalence of cariogenic streptococci on incisor brackets detected by polymerase chain reaction. Am J Orthod Dentofacial Orthop 2007; 131 (06) 736-741
• 10 Low B, Lee W, Seneviratne CJ, Samaranayake LP, Hägg U. Ultrastructure and morphology of biofilms on thermoplastic orthodontic appliances in ‘fast’ and ‘slow’ plaque formers. Eur J Orthod 2011; 33 (05) 577-583
• 11 Harradine NW. Self-ligating brackets: where are we now?. J Orthod 2003; 30 (03) 262-273
• 12 Lagravère MO, Flores-Mir C. The treatment effects of Invisalign orthodontic aligners: a systematic review. J Am Dent Assoc 2005; 136 (12) 1724-1729
• 13 Fischman SL. Current status of indices of plaque. J Clin Periodontol 1986; 13 (05) 371-374,379–380
• 14 Marsh PD, Martin MV. Oral Microbiology. 4th ed.. Oxford: Wright; 1992
• 15 Knappwost A. Das Depotophorese-Verfahren mit Kupfer-Calciumhydroid, die zur systematischen ausheilung fuhrende alternative in der endodontie. ZWR der Zahnarzt 1993; 9: 618-623
• 16 Meto A, Colombari B, Sala A. et al. Antimicrobial and antibiofilm efficacy of a copper/calcium hydroxide-based endodontic paste against Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans . Dent Mater J 2019; 38 (04) 591-603
• 17 Meto A, Meto A. Histological observation of copper sulfide in vitro of extracted teeth. Asian Acad Res Assoc 2016; 3 (03) 103-111
• 18 Meto A, Meto A, Tepedino M. Radiological results of apical cystic granuloma treated with Cupral. Int Dent J 2013; 63 (01) 1-98
• 19 Abbate GM, Caria MP, Montanari P. et al. Periodontal health in teenagers treated with removable aligners and fixed orthodontic appliances. J Orofac Orthop 2015; 76 (03) 240-250
• 20 Listgarten MA. Structure of the microbial flora associated with periodontal health and disease in man. A light and electron microscopic study. J Periodontol 1976; 47 (01) 1-18
• 21 Sakamoto M, Rôças IN, Siqueira Jr JF, Benno Y. Molecular analysis of bacteria in asymptomatic and symptomatic endodontic infections. Oral Microbiol Immunol 2006; 21 (02) 112-122
• 22 Chang CS, Al-Awadi S, Ready D, Noar J. An assessment of the effectiveness of mechanical and chemical cleaning of Essix orthodontic retainer. J Orthod 2014; 41 (02) 110-117