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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 3  |  Page : 209-214

An overview of nanotechnological advances in orthodontics


Department of Orthodontics and Dentofacial Orthopedics, SDS, Sharda University, Greater Noida, Uttar Pradesh, India

Date of Submission24-Aug-2020
Date of Decision19-Nov-2020
Date of Acceptance11-Jan-2021
Date of Web Publication12-Jul-2021

Correspondence Address:
Madhurima Nanda
Department of Orthodontics and Dentofacial Orthopedics, SDS, Sharda University, Greater Noida - 201 301, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_145_20

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  Abstract 


Nanotechnology is the field of science dealing with the manipulation of the matter at the nanoscale level. The science of nanotechnology has emerged as a promising concept in all fields of medicine including dentistry and its scope is increasing everyday. It has also gained relevance in the field of orthodontics owing to its wide range of applications ranging from nanocoatings in archwires and brackets, orthodontic bonding, antimicrobial properties, atomic force microscopy to some future applications such as shape memory polymers, mandibular growth stimulation with gene therapy, acceleration of orthodontic movement, and use as biomechanical sensors. The enormous range of application of nanotechnology in orthodontics demands an intensive research into its current and future usages. This article aims to review and discuss the various applications and its potential usage in orthodontics.

Keywords: Nanoadhesives, nanocoatings, nanoparticles, nanotechnology, orthodontics


How to cite this article:
Nanda M, Bagga DK, Agrawal P, Tiwari S, Singh A, Shahi PK. An overview of nanotechnological advances in orthodontics. Indian J Dent Sci 2021;13:209-14

How to cite this URL:
Nanda M, Bagga DK, Agrawal P, Tiwari S, Singh A, Shahi PK. An overview of nanotechnological advances in orthodontics. Indian J Dent Sci [serial online] 2021 [cited 2021 Sep 20];13:209-14. Available from: http://www.ijds.in/text.asp?2021/13/3/209/321171




  Introduction Top


The human qualities of interest, miracle, and inventiveness are as old as humankind. For a long time, individuals globally have been saddling their interest into request and the procedure of logical technique. Science is the fuel for the motor of innovation. Furthermore, thus the fuel for progress, this article plans to feature the accomplishment of the science and innovation of scaling down, for example, nanotechnology in orthodontic applications.

The term “nano” means “dwarf” in Greek. A nanometer is one-billionth of a meter. Nanoscale includes the measurements between 1 and 100 nm.[1] Nanotechnology refers to the field of applied science and research dealing with the study and control of materials and phenomenon at atomic, molecular, and macromolecular scale.


  Historical Perspective Top


The history of nanotechnology dates back to 600 BC when the carbon nanotubes and cementile nanowires found in the microstructure of wootz steel were exported globally. In the 9th century, they were used in Mesopotamia by artisans for creating a glittering effect on pots. The glitter occurred as a result of the luster created due to the metallic film containing silver and copper.[2]

Richard Zsigmondy, the 1925 Nobel Prize Laureate in chemistry was the first to propose the concept of a “nanometer.” He coined the term nanometer precisely for characterizing the particle size, and he was the first to measure the size of particles such as gold colloids using a microscope.[3] The term “nanotechnology” was first used by Taniguchi[4] in 1974, but it was not extensively known until popularized by Eric Drexler in his book “Engines of Creation”. First portrayed in 1959 by physicist Feynman,[5] who considered it to be an unavoidable improvement in the advancement of science, nanotechnology has been a piece of standard logical hypothesis with potential clinical and dental applications since the mid-1990s. It is found to be a useful tool in the health and research. It can be defined as the design, characterization, production, and application of structures, devices, and systems by controlled manipulation of size and shape at the nanometer scale (atomic, molecular, and macromolecular scales) that produces structures, devices, and systems with at least one novel/superior characteristic or property.

In 1986, Gerd Binnig and Heinrich Rohrer were awarded Nobel Prize for developing scanning tunneling microscope. The first atomic force microscope was introduced by Binnig, Calvin Quate, and Christoph Gerber in 1986. Harry Kroto, Richard Smalley, and Robert Curn won Nobel Prize for the discovery of fullerenes. In 1991, Sumio Iijima discovered carbon nanotubes.[2]

The use of nanotechnology in the commercial products began in early 2000s with nanoparticles such as titanium dioxide, zinc oxide, and silver nanoparticles.

The mass properties of the materials change with the extension of nano ingredients. The reason behind the alteration in the properties of the material at the nanoscale can be credited to two reasons:

In the first place, because of the bigger surface region of the nanomaterials when compared with a similar mass of material delivered in a bigger structure, the nanomaterials act in an all the more artificially responsive way influencing their quality or electrical properties.

Second, quantum impacts show all the more commanding conduct of issue at the nanoscale – especially at the lower end – influencing the optical, electrical, and attractive conduct of materials. Materials can be created that are nanoscale in one measurement, in two measurements or in every one of the three measurements.[6]

Two different ways to deliver nonmaterial are as follows:[7]

  1. Top-down approach: It begins with a mass material and afterward breaking it into smaller pieces utilizing mechanical, compound, or other types of energy
  2. Bottom-up approach: It blends the material from nuclear or sub-atomic species by means of concoction responses, taking into account the precursor particles to develop in size.



  Applications in Orthodontics Top


Its applications in orthodontics include, as nanocoatings in archwires and brackets, in orthodontic bonding, as antimicrobial agents, as enamel remineralizing agents, to promote mandibular growth stimulation, investigation of a nanofabricated ultrasound device to minimize iatrogenic root resorption, and use of nanomechanical sensors for real-time orthodontic forces and moments measurement.

Nanocoatings in archwires and brackets

Frictional forces in orthodontics have consistently been an issue of concern. High frictional forces diminish the treatment effectiveness as well as lead to more slow movements and expanded treatment time. Along these lines, extensive research has been done to decide different techniques for limiting friction. To overcome such frictional forces, nanoparticles-based dry lubricant coatings are being utilized in wires and brackets.[8] Inorganic fullerene such as nanoparticles[9] in the form of tungsten sulfide is a potent dry lubricant used as coatings on stainless steel wires. One such study was conducted by Redlich et al.[10] in which stainless steel wires and brackets were coated with nickel–phosphorous electro less film impregnated with inorganic fullerene-like nanoparticles of tungsten disulfide IF-WS[2] which are potent dry lubricants. The incorporation of cobalt and fullerene composite coatings, such as WS2 nanoparticles, into Ni–W–P alloy coatings has resulted in a lower coefficient of friction. Studies in which frictional forces were compared between coated and uncoated wires have shown a reduction in frictional forces by 51%–60% when coated arch wires were used. The coefficient of friction was also found to be reduced significantly.

Other materials, such as carbone nitrile (CoNX)[11], have been suggested considering possible toxicity of WS2. Coatings of zinc oxide (ZnO)[12], inorganic fullerenes such as Moybdenum disulfide,[13] and diamond-like coatings, as well as nitro carburizing[14], have all been proposed. These coatings also improved the corrosion resistance of the wire.

In 2012, UC3M developed a novel material for manufacturing orthodontic brackets that contained hard alumina nanoparticles embedded in polysulfone.[15] This material has shown reduced frictional and mechanical resistance, improved strength, and biocompatibility. Studies using brackets with nanoparticles coatings with a thin film of nitrogen (N2)-doped titanium dioxide (TiO2) nanoparticles have shown an antimicrobial effect against the oral bacteria. Because of the nitrogen doping and modifications, TiO2 displays catalytic activity inducing the production of hydroxyl radicals, superoxide ions, peroxyl radicals & H2O2.[16] These radicals are capable of reacting with biological molecules through a series of oxidation reactions damaging their biological structure and exhibiting antimicrobial activity. The results have shown antimicrobial activity of 95%, 91%, 69%, and 99% against Streptococcus mutans, Lactobacillus acidophilus, Actinomyces viscus, and Candida albicans, respectively. Reduced antimicrobial activity can prevent enamel demineralization and gingivitis during orthodontic treatment.

Nanoparticles in adhesives

Bonding systems form an integral part of successful orthodontic treatment. There has been a continuous evolution in the bonding materials and the methods since the advent of acid etch technique by Buonocore in 1955. Researches have been in quest of adhesive systems which have improved adhesion resistance, good remineralizing properties, and are least damaging to the enamel surface.

Composites and glass ionomer cements (GICs) are the two adhesive agents used primarily for securing bands and brackets to teeth surfaces. Nanoparticles can be used as orthodontic adhesives with improved mechanical properties and reduced risk of enamel damage. There are two class of materials nanoclusters (composites) and nanomers (glass ionomers).[17],[18] Further, the nanocomposites are of two types: Nanofills-containing nanometer-sized particles (1–100 nm) all through the resin matrix with no large primary particles included nanohybrids consisting of larger particles (400–500 nm) with added nanometer-sized particles.[19] Because of the diminished size of filler particles, these are able to permeate the resin tags, an expanded filler load can be accomplished bringing about decreased polymerization shrinkage, improved mechanical properties. Similarly, a great peripheral seal to dentin and polish can be accomplished. The other advantages include excellent optical properties, easy handling characteristics, and superior polishability. Furthermore, addition of nanofillers results in diminished surface roughness, thus reducing the odds of bacterial adhesion.

The use of GIC in orthodontics for band cementation is popular because of its flouride-releasing potential.[20] The mechanical behavior of conventional GIC was enhanced by adding polyacids including nanohydroxy and flouroapatite, as well as N-vinyl pyrrolidone. Furthermore, the compressive strength, diametral tensile strength, and biaxial flexural strength were found to be greater than conventional GIC.[21] Recently, a resin-modified GIC composed of nanofillers flouroaluminislicate glass and other nanofillers clusters was introduced with high mechanical properties and high fluoride release.[22],[23]

In a study conducted by Uysal et al.,[24] when the bond strengths of nanocomposites and nano-ionomers were compared with conventional adhesives, it was found that they achieved the SBS ranges under clinical acceptability ranges but were still inferior as compared to the conventional adhesives. When Bishara et al.[25] compared the shear bond strength of a nano hybrid restorative material, Grandio (Voco, Germany), to that of a traditional adhesive material (Transbond XT; 3M Unitek), they found that nano filled composite material could potentially be used for orthodontic bonding if its consistency could be made more flowable to adhere to the bracket base.

In contrast, another study compared the shear bond strength between conventional (Transbond XT) and nanocomposites and found higher bond strengths with nanocomposites. Studies were also done in which silver hydroxyapatite nano were added to Transbond XT in different concentrations of 1%, 5%, and 10% cone and changed the shear bond strength suggesting an optimum concentration of nanoparticles to achieve highest strength.[26]

Nanoparticles as antimicrobial agents

White spot lesions are an undesirable consequence of orthodontic treatment which occurs as a result of demineralization of enamel surfaces around brackets or bands. These mostly occur as a result of poor oral hygiene of the patient leading to bacterial accumulation which causes demineralization of the tooth surfaces resulting in caries or gingival inflammation.

Various studies have been done in past to find out suitable methods for the prevention and treatment of these lesions. The use of nanoparticles as antimicrobial agents is gaining relevance in dentistry. Owing to their surface to volume ratio, they are able to react more closely with the microbial membrane and provide an increased surface area for antimicrobial activity. The unique physiochemical properties of the nanoparticles along with its antimicrobial effect have resulted in the upsurge in the research on nanoparticles and their potential application as antimicrobials.[27]

There are two main mechanisms of incorporating the biomaterials antimicrobial effects of nanoparticles in orthodontics, by combining them with materials such as composites, glass ionomers, or use them as coatings on the surfaces.[28],[29]

The various nanoparticles which are found to have antimicrobial effects include Chitosan, Zno, silver, titanium oxide, and copper oxide.

Chitosan

A hydrophilic biopolymer mechanically acquired by N-deacetylation of chitin, can be applied as an antimicrobial agent. Mirhashemi et al.[30] in a study demonstrated that Chitosan whenever added to composite in blend with zinc oxide in a concentration of 10% composite resulted in decrease in biofilm creation.

Silver nanoparticles

For centuries, silver has been used to treat wounds and burns and is known to have an antimicrobial effect. The addition of silver nanoparticles to orthodontic adhesives has shown a significant reduction in the Streptococci adhesion to the composites.[31] Silver has also been added to primer of Transbond XT in varied concentrations (1%, 5%, and 10%), and it was found that desirable effects were seen at the concentrations of 1% and 5% whereas increasing the concentration to 10% resulted in impaired physical properties.[32]

Nanosilver has been coated to orthodontic brackets, and it was seen that these coatings resulted in less adherence of plaque, thus reducing the demineralization and occurrence of white spot lesions.[33]

Copper

Nanoparticles in the form of copper oxide have also been added to orthodontic adhesives. Toodehzaeim[34] showed CuO nanoparticles when added to Transbond XT in the concentration of 0.01%, 0.55%, and 1% by weight resulted in reduced S. mutans growth, and it was suggested that increasing the concentration had an improved antimicrobial effect.

Enamel remineralizing agents

Nanoparticles have been shown to be effective not only as demineralizing agents but also as remineralizing agents for enamel. Medeiros et al.[35] in their study found that calcium nanophosphate crystals can prevent enamel erosion by forming a protective layer over it. Due to their large surface area and increased wettability of the calcium nanophosphate crystals, there is an improved bioactivity.

Nanoparticle delivery from elastomeric ligatures

Elastomeric ligatures containing nanoparticles can serve as a scaffold for the release of anticariogenic, anti-inflammatory, and antibacterial nanoparticles. They can serve as a source of fluoride release. Local delivery of therapeutic nanoparticles at areas of enamel decalcification, biofilm formation, and gingivitis might be highly beneficial.

Nanoindentation and atomic force microscopy

It has been demonstrated in studies that the surface qualities of the orthodontic arch wire can affect their performance and the biocompatibility. Hence, in order to achieve an optimal biologic response for effective tooth movement, frictional forces should be kept to a minimum. The surface characteristics of orthodontic arch wires may be measured using several methods, including laser spectroscopy, contact-surface profilometry, and atomic force microscopy (AFM).[36] A nanoindenter coupled with AFM is used to evaluate nano-scale surface characteristics of biomaterials.

The main advantage of AFM is the production of three-dimensional images in the real space with a very high resolution. The sample does not have to undergo any kind of specialized treatment to provide the quantitative values for the parameters investigated. However, there are few drawbacks associated with AFM such as the small size of scans obtained and the low speed of scanning which can impede the complete analysis of the sample.

The nanoindenter's sharp cantilever tip (radius 10 nm) scans across the sample surface at very low distances (0.2-10 nm probe-sample separation) to reconstruct a three-dimensional surface topography. A typical AFM may achieve resolutions of 1mm laterally and 0.07 nm vertically. Nanoindentation studies may also assess mechanical characteristics like as hardness, elastic modulus, yield strength, fracture toughness, scratch hardness, and wear properties. AFM may also be used to inspect the surface properties of stainless steel, nickel titanium, beta titanium wires, and orthodontic brackets.


  Future Applications of Nanotechnology in Orthodontics Top


Shape memory polymers

There has been a recent surge in the demand of esthetic orthodontic wires to complement esthetic brackets. Shape memory polymer (SMP) is a class of smart materials which exhibits an ability to fix in the briefly programmed shape and to recover the original shape upon exposure to external stimuli such as heat, light, or magnetic field.[37],[38] SMP can be used in both fixed and removable orthodontic appliances. In orthodontics, SMP components can be in front edge over the shape memory alloys. These polymers can be developed to have a wide range of transition temperatures depending on their application.[37] As a result, they can provide lighter and constant forces which can be less painful for the patient. They can be framed into specialized designs and are more esthetic than the metal attachments. Their production cost is also low. Most important, a new approach and rationale for orthodontic treatment with SMP can result in simpler and more effective treatment. In terms of orthodontic biomaterial research, more research into shape memory polymers to produce esthetic orthodontic wires has a lot of promise.

Biological MEMS/NEMS

Biological MEMS (BioMEMS) or biomedical microelectromechanical systems are an emerging field developed as a subset of MEMS devices for the applications in biomedical research and medical microdevices. The (bioMEMS) comprises of micromachined devices usually on silicon substrates, including gears, motors, and actuators with linear and rotary motion for the applications to biological systems.[39],[40],[41]

BioMems are revolutionizing the field of medicine. The main areas of applications in the clinical field are diagnostic (using implantable sensors) or therapeutics (drug delivery microchips). Nanoelectromechanical frameworks (NEMS) are nanoscale devices that combine electrical and mechanical functionality. It has been claimed that using electricity to complement these mechanical forces can speed up orthodontic tooth movement.[42],[43] When placed on the gingiva near to the alveolar bone, an enzymatic microbattery may serve as a possible electrical force hotspot for speeding orthodontic tooth movement.[43],[44] This device is non-osseointegrated and can utilize glucose for the fuel. Nonetheless, there are a few problems to be addressed, such as soft tissue biocompatibility and the influence of food with varying temperatures and pH on the performance of a microfabricated protein battery. It is quite possible that over the next few years MEMS/NEMS based system can be used to enhance orthodontic tooth movement.[19]

Nanolipus devices

Low–intensity pulsed Ultrasound (LIPUS) devices are a type of mechanical energy that is transferred as acoustic pressure waves through and into biological tissues at frequencies above the human hearing limit.[45] LIPUS has been reported to be effective in promoting wound healing, enhancing bone growth,[46] bone healing after fracture,[47] reducing root resorption and in accelerating tooth movement. It has proven to be effective in stimulating mandibular growth in animals as well as in humans.[48],[49] In a recent randomized controlled trial conducted by Bialy et al.,[50] the effect of lipus was evaluated on tooth movement and root resorption in orthodontic patients, and it was found to be effective in accelerating tooth movement and also minimizing root resorption. Another retrospective clinical trial by Kaur et al.[51] has shown a clinically significant reduction in orthodontic treatment duration in patients using Invisalign clear aligners. Therefore, LIPUS can be considered as a potentially useful tool in orthodontics and future research should be continued to understand its applications in orthodontics.

Nanomechanical sensors

In orthodontics, it is important to understand the force moment system to predict the course of tooth movement and minimize the traumatic effects. Based on this, the concepts of nanomechanical sensors were introduced. These sensors can be incorporated in the bracket base and can provide a real-time feedback about the forces allowing the orthodontist to adjust the applied force within the biological limits for efficient tooth movement.[52],[53]

Nanotechnology and gene therapy in orthodontics

Mandibular underdevelopment can be caused by a complex interplay of hereditary and environmental factors that is difficult to control. Bite jumping appliances have been shown to have the ability to stimulate development. But there have been studies questioning the long term clinical significance of these functional appliances in enhancing mandibular growth.

Like other fields of medicine, nanotechnology is also gaining importance regarding its role in mandibular growth. The role of the specific vascular growth inducting genes in mandibular growth has been mentioned.[54],[55] Further clinical trials are required to understand the role of gene therapy in orthodontics and also to ensure its safety and efficacy.

Temporary anchorage devices

Temporary anchorage devices (TADs) have become increasingly popular among orthodontists as they aid in the augmentation of anchorage. At present, TADs are manufactured with a smooth surface to avoid osseointegration, but contrary to this, implant failure can occur as a result of lack of osseointegration. Hence, TADs which can provide an initial osseointegration and can be removed easily will be ideal for orthodontic anchorage. Titanium nanocoatings are being studied that can form an interfacial layer between the bone and TADs and thus can enhance initial osseointegration required for its success.[19]

Nanorobots in orthodontics

Freitas[56] in 2000 suggested that nanorobots can be utilized in dentistry to aid in performing certain functions such as oral anesthesia, drug delivery, nanorobotic dentifrices, and tooth movements. The nanorobots can navigate through human tissues, perceive and modify their environment using preprogrammed instructions guided by an onboard nanocomputer. Orthodontic nanorobots could allow rapid and painless repositioning of teeth within minutes to hours by directly manipulating the periodontal tissues.[56]


  Conclusion Top


Despite the fact that nanotechnology's application in orthodontics is still in its early phases, it has a tremendous promise in the field due to its vast variety of applications. Overall, if all present efforts succeed in clinical application at a fair cost to the orthodontist and patients, nanotechnology will play a major role in orthodontic therapy in the future.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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