Comparative analysis of long-term biofilm formation on metal and ceramic brackets

Abstract

Objective: To test the null hypothesis that stainless steel and ceramic brackets show no differences in biofilm adhesion.

Materials and methods: Twenty adolescents (6 boys, 14 girls) who had received fixed orthodontic therapy for 18.9 ± 3.2 months were divided into a metal and a ceramic bracket group. Thirty brackets per group were taken from central incisors, canines, and second premolars and quantitatively analyzed for biofilm coverage with the Rutherford backscattering detection method. Five micrographs were obtained per bracket with views from the buccal, mesial, distal, gingival, and occlusal aspects, resulting in a total of 300 images. Biofilm formation between groups was compared using the Mann-Whitney U-test (α = .05).

Results: Total biofilm formation was 12.5% ± 5.7% (3.3 ± 1.6 mm(2)) of the surface on metal and 5.6% ± 2.4% (1.5 ± 0.6 mm(2)) on ceramic brackets. Differences between groups were statistically significant (P < .05). A pairwise comparison of biofilm formation revealed significantly lower biofilm formation on ceramic brackets with respect to intraoral location (central incisor, canine, second premolar) and bracket surface (buccal, mesial, distal).

Conclusions: The hypothesis was rejected. The results indicate that ceramic brackets exhibit less long-term biofilm accumulation than metal brackets.

Figure 1

Verification of the biofilm as an organic material by use of (A) SEM and (B) EDX.

Figure 2

Total relative biofilm formation on stainless steel and ceramic brackets in a box-plot presentation.

Figure 3a–C

Representative micrographs of a stainless steel bracket with perspectives from (A) buccal, (B) proximal, and (C) gingival views. Dark areas represent biofilm-covered surfaces.

Figure 4a–C

Micrographs taken from the (A) buccal, (B) proximal, and (C) gingival views showing less biofilm formation on a ceramic bracket.