The Effects of Using Water Flosser Versus Interdental Brush on Gingival Health in Patients With Mandibular Bonded Retainer

After the removal of orthodontic appliances, retention is one of the most important aspects of orthodontic therapy Removable and fixed retainers are examples of retention appliances that have been introduced. Since their inception in 1970, bonded fixed retainers have become more popular. Fixed retainers have benefits of demanding minimal patient compliance, being unnoticeable, ensuring safe and efficient permanent retention. However; some disadvantages of fixed retainers have also been noted, including increased chair side time, technique sensitivity, possible detrimental effects on periodontal tissues, the risk for tooth displacement due to wire distortion and frequent bond failures. Fixed retainers have benefits of demanding minimal patient compliance, being unnoticeable, ensuring safe and efficient permanent retention. However; some disadvantages of fixed retainers have also been noted, including increased chair side time, technique sensitivity, possible detrimental effects on periodontal tissues, the risk for tooth displacement due to wire distortion and frequent bond failures.

Despite all the disadvantages of fixed retainers, this type of retainer has become increasingly popular and at the same time raises concerns among dentists about possible periodontal health issues. It is stated that fixed retainers are conducive for plaque retention which cause gingivitis and periodontitis. A study on fixed retainers also concluded that long-term fixed retainer wear leads to increased calculus accumulations, marginal recession, and probing depths. These effects are due to long-term tissue irritation caused by the fixed retainer and bacterial build up around it. Bonding of the retainer to each tooth may limit toothbrush access to interdental areas, decreasing the ability of floss to glide smoothly across the teeth, resulting in a decrease in overall oral hygiene maintenance of patients.

One of those cleaning devices is a water flosser, which is effective in cleaning inaccessible areas which present commonly in patients with fixed retainers and can be used to improve their gingival health. To the best of our knowledge, there has been no previous research on this subject. Therefore, the goal of this randomized controlled trial is to compare the effects of water flosser versus interdental brush in improving gingival health in patients with mandibular permanent retainers by detecting differences in debris accumulation, plaque and calculus formation, and signs of gingival inflammation such as gingival bleeding.

RATIONALE:

With the increasing usage of bonded retainers in orthodontic treatment, the concerns about their effects on periodontal health are also increasing.14 Fixed retainers' applications in orthodontics without proper interdental cleaning aids may result in inadequate oral hygiene. Therefore, it is crucial to determine effective aids that not only improve the periodontal health but also prove to be simple and efficient to use for the patients. Moreover, to the best of our knowledge, no previous study has compared the effects of water flosser and interdental brush usage on oral hygiene maintenance in patients with fixed bonded retainers. .

Inclusion criteria

• Patients undergoing fixed orthodontic treatment requiring bonded retention
• All patients who will sign the informed consent form

Exclusion criteria

• • Patients with systemic diseases or multiple co-morbid such as diabetes, blood dyscrasias, etc.

• Patients with any previous history of periodontal surgery
• Patients with uncontrolled periodontal disease
• Pregnant women or lactating mothers