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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1. NAME OF THE CANDIDATE:
AND ADDRESS
DR. PAVITHRA BAI M
DEPARTMENT OF ORTHODONTICS
& DENTOFACIAL ORTHOPAEDICS,
P.M.N.M. DENTAL COLLEGE &
HOSPITAL, BAGALKOT-587101
KARNATAKA.
2. NAME OF THE INSTITUTION:
P.M.N.M. DENTAL COLLEGE &
HOSPITAL, BAGALKOT-587101
KARNATAKA
3. COURSE OF STUDY AND
SUBJECT:
MASTER OF DENTAL SURGERY
(M.D.S.) IN ORTHODONTICS &
DENTOFACIAL ORTHOPAEDICS.
4. DATE OF ADMISSION:
28-04-2009
5. TITLE OF THE TOPIC:
COMPARISON OF 5 DIFFERENT TYPES OF LIGATION PROCEDURE FOR
MICROBIAL COLONIZATION: AN IN-VIVO STUDY
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6. BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY
The placement of a fixed appliance often impedes the maintenance of good oral hygiene
for the orthodontic patient. Components of the fixed appliance create new retention areas for
streptococcus mutans and lactobacilli and impede access to areas for optimal cleaning, which in
turn increases the incidence of enamel demineralization and gingival inflammation.
Currently in the search for more practical and efficient orthodontic accessories, elastomeric
rings have been suggested as a material of choice to secure the archwires to brackets instead of
metallic ligatures.
In the literature it is evident that elastomeric rings exhibited a great number of micro
organisms in the plaque around the bracket than the steel ligatures.
Recently newer elastomeric ligatures were introduced to combat the existing problem of
plaque accumulation around the brackets. The manufacturers claim that these modified ligatures
reduce the dental biofilm formation, decrease the enamel demineralization and improve the
enamel remineralization around the bracket base.
Reports in literature regarding the efficacy of these elastomers in reducing microbial
adhesion remain controversial and hence a need for this study exists.
This in-vivo study attempts to evaluate the association of 5 different elastomeric ligatures:
the coated super slick, safe-t-ties, sili ties for streptococcus mutans and lactobacilli by using
microbial culture techniques. The non-coated elastomeric ligatures from the same two
manufactures will be kept as a control.
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6.2 REVIEW OF LITERATURE
Fixed orthodontic appliances increase plaque accumulation, bacterial colonization and
resultant enamel decalcification.1,2,4
Forsberg et al observed greater microbial colonization on teeth ligated to the archwire
with elastomeric rings compared with teeth ligated with steel wires.3
A scanning electron microscopic study was done to evaluate the bacterial colonization
associated with fixed orthodontic appliances. The authors concluded that the method of ligation
does not appear to influence the bacterial morphotypes on both composite and enamel surfaces.5
Studying the different techniques of ligations, it was found that a greater number of
microbes were seen in teeth ligated with elastomers rather than with stainless steel ligatures. But
the differences were not statistically significant and the authors suggested that they could be
ignored.6
A study was done to evaluate the contamination of super slick ligatures for streptococcal
mutans. This in-vivo study concluded that there was no clinical evidence that Super Slick
elastomeric rings are effective in reducing bacterial biofilm formation on their surfaces.7
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OBJECTIVE OF THE STUDY:
1. To evaluate and compare the 5 different types of ligation procedures for microbial
colonization of streptococcus mutans and lactobacilli.
2. To evaluate the efficiency of the protective coating on the elastomeric ligatures in
controlling microbial colonization.
7. MATERIALS & METHODS:
7.1 SOURCE OF DATA:
20 middle class patients(10 males and 10 females), aged 12-25 years, undergoing fixed
orthodontic treatment will be randomly selected from orthodontic post graduate clinic,
Department of Orthodontics and Dentofacial Orthopaedics, P.M.N.M.Dental College and
Hospital, Bagalkot.
Materials that will be used:
1. Super slick elastomeric rings (TP Orthodontics)
2. Sili ties elastomeric rings (GAC International)
3. Safe-T-Tie ( Cerum ortho,OrthoOrganizers )
4. Non-coated Elastomeric-rings (GAC International)
5. Non-coated elastomeric rings (TP Orthodontics)
An informed consent will be obtained from all subjects.
7.2 METHOD OF COLLECTION OF DATA:
Upper and lower arches will be divided into 4 quadrants from molar to midline. Five
different elastomers, coated super slick and non coated from TP Orthodontics, coated sili ties and
non coated from GAC International, safe-t-tie from Ortho Organizers will be placed from the
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central incisors to 1st molars selected randomly and from patient to patient. Patients will be
recalled 1 month after placement of ligatures.
Ligatures will be carefully removed without disturbing the plaque around the brackets.
Using a periodontal probe plaque will be collected around the brackets and around ligatures. The
plaque will be transported to the lab by mixing it into the transport medium which contains 10 ml
of thioglycollate medium with Hemin and vitamin K (1:1000 dilutions). The samples will be then
inoculated on media to evaluate for Streptococcus mutans and lactobacilli and cultured. Colonies
will be counted with a stereomicroscope with reflected light.
INCLUSION/ EXCLUSION CRITERIA FOR COLLECTION OF DATA:
Patients who will be using antimicrobial mouthwashes, has any systemic disease, had
used antibiotics within the previous 3 months of the study, or had brackets bonded with glass
ionomer cements will be excluded from the trial. The volunteers will not be asked to follow any
specific dietary, tooth brushing, and mouth-rinsing protocols, but they will be asked to maintain
the eating habits and the oral hygiene measures recommended by the orthodontics postgraduate
clinic for patients with fixed orthodontic appliances.7 All patients will be right handed brushers,
and will undergo thorough oral prophylaxis at the start of the study.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO
BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMAL? IF SO PLEASE
DESCRIBE BRIEFLY.
NO.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION?
YES
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8. LIST OF REFERENCES:
1. Scheie AA, Arneberg P, Krogstad O. Effect of orthodontic treatment on prevalence of
streptococcus mutans in plaque and saliva. Scand J Dent Res.1984;92:211-217
2. Rosenbloom RG, Tinanoff N. Salivary streptococcus mutans levels in patients before,
during, and after orthodontic treatment. Am J Orthod Dentofac Orthop.1991;100:
35-37
3. Forsberg CM, Brattstrom V, Malmberg E, Nord CE. Ligatures wires and elastomeric
rings: two methods of ligation and their association with microbial colonization of
streptococcus mutans and lactobacilli. Eur J orthod.1991;13:416-420
4. Chang HS, Walsh LJ, Freer TJ. The effect of orthodontic treatment on salivary flow, pH,
buffer capacity and levels of mutans streptococci and lactobacilli. Aust J Orthod.
1999;15:229-34
5. Sukontapatipark W, El-Agroudi MA, Selliseth NJ,Thunold K,Selvig KA. Bacterial
colonization associated with fixed orthodontic appliances. A scanning electron
microscopy study. Eur J Orthod.2001;23:475-484
6. Turkkahraman H, Sayin MO, Bozkurt FY, Yetkin Z, Kaya S, Onal S. Angle orthod.
2005;75:231-236
7. Magno AFF, Enoki C, Ito IY, Matsumoto MAN, Faria G, Nelson-Filho P. Am J Orthod
Dentofacial Orthop.2008;133:S104-109
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9. SIGNATURE OF THE CANDIDATE:
10.REMARKS OF THE GUIDE:
11. NAME & DESIGNATION
Dr. ANNA C.VAZ
OF GUIDE:
PROFESSOR & HEAD,
DEPT. OF ORTHODONTICS,
P.M.N.M. DENTAL COLLEGE &
HOSPITAL,
BAGALKOT, KARNATAKA.
12. SIGNATURE OF GUIDE & HOD:
12.1 SIGNATURE OF CO-GUIDE:
12.2 REMARKS OF THE CHAIRMAN & PRINCIPAL:
12.3 SIGNATURE OF PRINCIPAL:
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