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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1588-1590  

Assessment of nickel and chromium level in gingival crevicular fluid in patients undergoing orthodontic treatment with or without fluoridated tooth paste


1 Department of Orthodontics and Dentofacial Orthopedics, Vananchal Dental College and Hospital, Garhwa, Jharkhand, India
2 Med Care Hospital, Gaya, Bihar, India

Date of Submission31-Mar-2021
Date of Acceptance01-May-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Amrita Pritam
Department of Orthodontics and Dentofacial Orthopedics, Vananchal Dental College and Hospital, Pharatiya, Garhwa, Jharkhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_302_21

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   Abstract 


Background: Release of metallic ions, especially nickel and chromium, present in orthodontic fixed appliance attachments such as brackets and archwires has been a basis of concern in current years. The present study was conducted to assess nickel and chromium level in gingival crevicular fluid in patients undergoing orthodontic treatment. Materials and Methods: Forty patients undergoing fixed orthodontic treatment were divided into 2 groups of 20 each. Group I was fixed orthodontic treatment group and was given nonfluoridated toothpaste and Group II was fixed orthodontic treatment group and was given fluoridated toothpaste. The assessment of salivary nickel and chromium levels was done using inductively coupled plasma mass spectrometry. Results: In group I, there were 6 male and 14 female and in group II 7 males and 13 females. The mean nickel level (ng/ml) before treatment in group I was 0.49 and in group II was 0.52, on 7th day was 0.52 and 0.54, on 30th day was 13.4 and 100.2, and on 6th month was 0.54 and 0.52 in Group I and II, respectively. The mean chromium level (ng/ml) before treatment in Group I was 0.48 and in Group II was 0.52, on 7th day was 0.52 and 0.53, on 30th day was 40.6 and 62.4 and on 6th month was 4.9 and 0.52 in Group I and II, respectively. The difference was significant (P < 0.05). Conclusion: The release of metal ions such as nickel and chromium was more with fluoridated toothpaste as compared to nonfluoridated toothpaste in patients undergoing fixed orthodontics.

Keywords: Chromium, nickel, orthodontic


How to cite this article:
Pritam A, Priyadarshini A, Hussain K, Kumar A, Kumar N, Malakar A. Assessment of nickel and chromium level in gingival crevicular fluid in patients undergoing orthodontic treatment with or without fluoridated tooth paste. J Pharm Bioall Sci 2021;13, Suppl S2:1588-90

How to cite this URL:
Pritam A, Priyadarshini A, Hussain K, Kumar A, Kumar N, Malakar A. Assessment of nickel and chromium level in gingival crevicular fluid in patients undergoing orthodontic treatment with or without fluoridated tooth paste. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 10];13, Suppl S2:1588-90. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1588/330079




   Introduction Top


Release of metallic ions, especially nickel and chromium, present in orthodontic fixed appliance attachments like brackets and archwires has been a reason of concern in recent years.[1] Although metals used in the mouth have decent biocompatibility and corrosion resistance, they occasionally lose their stable surface oxide layer, leading to leaching of metallic ions when exposed to the intraoral environment causing allergies, hypersensitivity, and alterations in cellular morphology and characteristics.[2] Fluorides prescribed for use during orthodontic treatment have a harmful effect of promoting leaching of ions by creating an acidic environment. Studies comparing in vitro and in vivo orthodontic appliance metal ion leaching have shown variable results. Substantial increase in metallic ions released in vitro has been observed.[3]

Fixed orthodontic appliances including brackets and arches are generally made of stainless steel and nickel–titanium (NiTi) alloys and therefore, have corrosion potential in the oral environment. The amount of nickel as the main component of contemporary orthodontic appliances may vary from 8% in stainless steel to more than 50% in NiTi alloys. Stainless steel alloys include 17%–22% of chromium.[4]

Nickel-containing alloys exist in a wide variety of appliances and auxiliary devices used in orthodontics, with a content of up to 55% by weight.[5] Likewise, the in vivo release of nickel ions varies greatly from 0.5 to 105.7 μg/l, according to the alloy type, body fluid, temperature, mechanical stress, or pH.[6] In general, orthodontic materials are considered to be highly biocompatible. The systemic absorption of leached metal ions usually can be definitively measured using available biomarkers that include blood, hair, urine, saliva, and gingival crevicular fluid (GCF).[7] The present study was conducted to assess nickel and chromium level in GCF in patients undergoing orthodontic treatment.


   Materials and Methods Top


The present study was conducted among 40 patients undergoing fixed orthodontic treatment of both genders. All were informed regarding the study and written consent was obtained.

Data such as name, age, gender, etc., were recorded. Patients were divided into two groups of 20 each. Group I was fixed orthodontic treatment group and was given nonfluoridated toothpaste and Group II was fixed orthodontic treatment group and was given fluoridated toothpaste. Brackets were bonded using light-cured composite resin and only NiTi archwires were sequentially used to eliminate confounders. Each wire was used for 2 months before replacement with the next.

Samples of GCF were obtained from both the groups before appliance placement, at 1 week, 1 month, and 6 months after appliance placement. The assessment of salivary nickel and chromium levels was done using inductively coupled plasma mass spectrometry. Results were subjected to statistical analysis. P <0.05 was considered statistically significant.


   Results Top


[Table 1] shows that in group I, there were 6 males and 14 females and in group II 7 males and 13 females.
Table 1: Distribution of patients

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[Table 2] shows that mean nickel level (ng/ml) before treatment in Group I was 0.49 and in Group II was 0.52, on 7th day was 0.52 and 0.54, on 30th day was 13.4 and 100.2 and on 6th month was 0.54 and 0.52 in group I and II, respectively. The difference was significant (P < 0.05).
Table 2: Assessment of nickel level

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[Table 3] shows that mean chromium level (ng/ml) before treatment in Group I was 0.48 and in Group II was 0.52, on 7th day was 0.52 and 0.53, on 30th day was 40.6 and 62.4 and on 6th month was 4.9 and 0.52 in Group I and II, respectively. The difference was significant (P < 0.05).
Table 3: Assessment of chromium level

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   Discussion Top


Nickel and chromium ions discharged from fixed orthodontic appliances can act as allergens or may have serious biological adverse effects. Allergic reactions are the predominant side effects, owing to the unavoidable release of nickel ions as a by-product of intraoral corrosion.[8] This has caused concerns among orthodontic patients, their parents, and orthodontists, owing to the possible association of orthodontic treatment with the prevalence of nickel hypersensitivity.[9] However, previous in vitro and in vivo evidence indicates that oral nickel intake, especially prior to cutaneous sensitization, may favor the induction of oral tolerance to nickel.[10] Moreover, they are cytotoxic, mutagenic, and carcinogenic in small quantities in the range of nanograms. Evaluation of the level of trace elements in patients using orthodontic appliances is a priority. Both nickel and chromium ions can cause hypersensitivity reactions in some people. In addition, nickel and chromium can cause dermatitis and asthma.[11] The present study was conducted to assess nickel and chromium level in GCF in patients undergoing orthodontic treatment.

In the present study, in Group I, there were 6 male and 14 female and in Group II 7 males and 13 females. Chitra et al.[12] conducted a study in which 60 subjects divided into two groups of 30 each served as the experimental group with and without using fluoride agents for oral hygiene care along with fixed appliance treatment. GCF was collected in fluoridated and nonfluoridated groups before, and at 7 days, 30 days, and 6 months after commencing orthodontic treatment. Levels of nickel, chromium, titanium, and manganese were assessed using inductively coupled plasma mass spectrometry. No changes in metal levels at any time were detected in the untreated control group. Nickel levels were raised to 101.78 mg/L in the fluoridated group at 30 days posttreatment, demonstrating heavy leaching from NiTi archwires. Results returned to baseline in both groups at 6 months. Mean differences for chromium, titanium, and manganese ion release were not statistically significant at 30 days. Titanium showed higher levels at 30 days in both tested groups, but levels were lesser than nickel.

We found that mean nickel level (ng/ml) before treatment in Group I was 0.49 and in group II was 0.52, on 7th day was 0.52 and 0.54, on 30th day was 13.4 and 100.2 and on 6th month was 0.54 and 0.52 in Group I and II respectively. The mean chromium level (ng/ml) before treatment in Group I was 0.48 and in Group II was 0.52, on 7th day was 0.52 and 0.53, on 30th day was 40.6 and 62.4 and on 6th month was 4.9 and 0.52 in Group I and II respectively. Ağaoğlu et al.[13] determined if there is any significant change in these concentrations during any period of the treatment time. Saliva and blood samples were collected from 100 patients ranging in age from 12 to 33 years. Twenty samples from each group were obtained. In the first group, saliva and blood samples were collected before insertion of the fixed appliances. In the 2nd, 3rd, 4th, and 5th groups, samples were collected at 1 week, 1 month, 1 year, and 2 years after appliance insertion. In the serum, there were statistically significant increases in ion concentration in the 2nd-year groups. In saliva samples, nickel and chromium reached their highest levels in the 1st month and decreased to their initial level in the rest of the groups. It can be concluded that fixed orthodontic appliances release measurable amount of nickel and chromium when placed in the mouth, but this increase does not reach toxic levels for nickel and chromium in the saliva and serum.

Amini et al.[14] conducted a study in which patients were divided into two groups and level of nickel was determined by atomic absorption spectrophotometry. Nickel concentration value (mg/L) in first group before starting of treatment was 0.097 ± 0.071. An upsurge in the level of nickel was followed by decrease 4 and 8 weeks after applying the archwire (0.208 ± 0.112) and (0.077 ± 0.056 mg/L) respectively. Nickel levels in saliva of the second group showed minimal variation and ranged from 0.061 ± 0.044 mg/L to 0.083 ± 0.054 throughout the study. It may be concluded that there could be a release of nickel from the appliances used in the first group but it does not reach toxic level in saliva.


   Conclusion Top


Authors found that release of metal ions such as nickel and chromium was more with fluoridated toothpaste as compared to nonfluoridated toothpaste in patients undergoing fixed orthodontics.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Tzannetou S, Efstratiadis S, Nicolay O, Grbic J, Lamster I. Comparison of levels of inflammatory mediators IL-1beta and beta G in gingival crevicular fluid from molars, premolars and incisors during rapid palatal expansion. Am J Orthod Dentofacial Orthop 2008;133:699e707.  Back to cited text no. 1
    
2.
Watanabe I, Watanabe E. Surface changes induced by fluoride prophylactic agents on titanium-based orthodontic wires. Am J Orthod Dentofacial Orthop 2003;123:653-6.  Back to cited text no. 2
    
3.
Beline T, Garcia CS, Ogawa ES, Marques IS, Matos AO, Sukotjo C, et al. Surface treatment influences electrochemical stability of cpTi exposed to mouthwashes. Mater Sci Eng C Mater Biol Appl 2016;59:1079-88.  Back to cited text no. 3
    
4.
Katić V, Mandić V, Ježek D, Baršić G, Špalj S. Influence of various fluoride agents on working properties and surface characteristics of uncoated, rhodium coated and nitrified nickel-titanium orthodontic wires. Acta Odontol Scand 2015;73:241-9.  Back to cited text no. 4
    
5.
Ramadan AA. Effect of nickel and chromium on gingival tissues during orthodontic treatment: Longituinal study. World J Orthod 2004;5:230-5.  Back to cited text no. 5
    
6.
Kerosuo H, Kanerva L. Systemic contact dermatitis caused by nickel in a stainless steel orthodontic appliance. Contact Dermatitis 1997;36:112-3.  Back to cited text no. 6
    
7.
Talic NF, Alnahwi HH, Al-Faraj AS. Nickel and chromium levels in the saliva of a Saudi sample treated with fixed orthodontic appliances. Saudi Dent J 2013;25:129-33.  Back to cited text no. 7
    
8.
Lindsten R, Kurol J. Orthodontic appliances in relation to nickel hypersensitivity. A review. J Orofac Orthop 1997;58:100-8.  Back to cited text no. 8
    
9.
Temesvári E, Rácz I. Nickel sensitivity from dental prosthesis. Contact Dermatitis 1988;18:50-1.  Back to cited text no. 9
    
10.
Rahilly G, Price N. Nickel allergy and orthodontics. J Orthod 2003;30:171-4.  Back to cited text no. 10
    
11.
Staerkjaer L, Menné T. Nickel allergy and orthodontic treatment. Eur J Orthod 1990;12:284-9.  Back to cited text no. 11
    
12.
Chitra P, Prashantha GS, Rao A. Long-term evaluation of metal ion release in orthodontic patients using fluoridated oral hygiene agents: An in vivo study. J World Fed Orthod 2019;8:107-11.  Back to cited text no. 12
    
13.
Ağaoğlu G, Arun T, Izgi B, Yarat A. Nickel and chromium levels in the saliva and serum of patients with fixed orthodontic appliances. Angle Orthod 2001;71:375-9.  Back to cited text no. 13
    
14.
Amini F, Harandi S, Mollaei M, Rakhshan V. Effects of fixed orthodontic treatment using conventional versus metal-injection molding brackets on salivary nickel and chromium levels: A double-blind randomized clinical trial. Eur J Orthod 2015;37:522-30.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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