RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 1. / NAME OF THE CANDIDATE AND ADDRESS (IN BLOCK LETTERS) /

:

/

Dr. PARVEZ CHOHAN

POST GRADUATE STUDENT
DEPARTMENT OF ORTHODONTICS & DENTOFACIAL ORTHOPAEDICS.
DAYANANDA SAGAR COLLEGE OF DENTAL SCIENCES,
BANGALORE – 560078
2. / NAME OF THE INSTITUTION / : / DAYANANDA SAGAR COLLEGE OF DENTAL SCIENCES,
BANGALORE – 560078
3. / COURSE OF STUDY AND SUBJECT / : / MASTER OF DENTAL SURGERY (M.D.S.)
ORTHODONTICS & DENTOFACIAL ORTHOPAEDICS
4. / DATE OF ADMISSION TO COURSE / : / 31st MAY 2011
5. / TITLE OF THE TOPIC
EFFECTS OF COMMONLY USED MOUTHWASHES ON FORCE DEGRADATION OF ORTHODONTIC ELASTOMERIC CHAINS – AN IN-VITRO STUDY.
6. /
BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY
In the field of orthodontics, synthetic elastomeric chains have been introduced since last 20 years. They are used to generate light continuous forces for correcting rotations, consolidating spaces and retracting canines. They are inexpensive, easily applied and relatively hygienic and require little or no patient cooperation.
However, force degradation of these materials has been a clinical problem. Elastomeric chains, however, are not without their disadvantages. When exposed to an oral environment, they absorb water, saliva and other liquid like beverages which permanently stain and suffer breakdown of internal bonds leading to permanent deformation. They also experience rapid loss of force due to stress relaxation, resulting in a gradual loss of effectiveness.
In recent years, orthodontic patients have become more oral health conscious and have started using mouthwashes prescribed routinely by dental practitioners and those available commercially.
Therefore, this study aims at accessing the effects of these mouth washes on the intra oral Elastomeric Chains.
6.2 REVIEW OF LITERATURE
1.  A prospective laboratory study was completed to test the effect of alcohol on force decay of elastomeric chains in vitro in order to determine if increasing alcohol concentrations results in an increased amount of elastomeric chain force decay.
There were no significant differences among groups at the initial time point
Statistically significant effects of time on force decay were seen in all groups. All test groups showed significantly more force decay than the control group. Only a few statistically significant differences were observed when comparing force decay among the
test groups. Alcohol causes an increase in force decay of elastomeric chain over time. A
concentration dependence of alcohol on force decay of chains was not observed.1
2.  A study was designed to determine the force degradation of elastomeric chains (Dentaurum) at different time intervals in different media (air, distill water, Biofresh mouthwash and artificial saliva) and to compare the effect of wet and dry conditions on the force relaxation. The results showed that the mean percent force remaining of elastics is affected by stretching, water absorption, chemicals and times and the amount of loss in dry condition is less than in wet environments and especially in biofresh mouthwash more than the neutral saliva. The elastomeric chains are greatly affected by stretching, moisture and time.2
3.  A study was done to evaluate the force decay patterns of three commercially available elastomeric products— Ormco Power Chain ll, Rocky Mountain Energy Chain, and TP Elast-O Chain— in a simulated oral environment.
Thermal-cycled samples experienced less force decay over a 21-day period than samples
stored at 37°C.
Furthermore, statistical analysis confirmed that there was a high significant difference
(p< 0.01) between the mean force exerted by short modules and long modules for each
material. Overall, module producing higher initial forces (short modules) underwent less
force decay after 21 days than did modules producing lower initial force value long
modules).3
4.  A study was to evaluate the effects of pre stretching on time-dependant force decay of synthetic elastomeric chains. Five-unit (12.5 mm) and six-unit (15.5 mm) modules (Generation II, Ormco, Glendora, Calif) were prestretched 100% for 1 hour, 24 hours, 2 weeks, and 4 weeks in 37°C distilled water.
The rates and patterns of force decay from 1 hour to 4 weeks were quite similar between
the control and the prestretched modules of both the 5- and 6-unit groups. The effects of
prestretching on force decay of elastomeric chains were noted mainly in the first hour.
Thus, the clinical value of pre stretching a synthetic elastomeric chain is questionable.4
5.  A study aimed to analyze the force degradation of four commercial brands of orthodontic elastics chain (Morelli, Ormco, TP, and Unitek) over 21 days. The elastics chains were stretched and maintained at a standardized distance equivalent to a force of 150 g. The amount of force generated by the elastics chains were measured by using a dynamometer (ZEUZAN 300 g) at intervals of 30 minutes, 7, 14, and 21 days.
Unitek chains displayed the highest percentage of force degradation, while TP exhibited the smallest percentage of force degradation and showed the greatest stability at all intervals tested.5
6.  A study was done which states that saliva plays an important role in acquired pellicle formation on tooth surfaces, crystal growth homeostasis, bacterial adhesion, plaque formation, and—because of its lubricating effect in maintaining mucosal integrity of the oral and upper gastrointestinal mucosal surfaces. It also plays an important role in physico-chemical defense, antimicrobial defense, and wound healing. Many saliva
constituents including proteins, carbohydrates, lipids, and ions interact under fine regulation to fulfill these important tasks. Local and systemic disorders may disturb and interrupt these complex balanced functions, which can lead to mucosal and tooth damages. In other cases, systemic disorders induce salivary changes without any significant local effects.
6.3 AIMS AND OBJECTIVES OF THE STUDY
Ø  To assess if commonly used mouth washes have any effect on force degradation of different Elastomeric chains.
Ø  To study the behavior of each of the Elastomeric chains when exposed to different mouthwashes.
Ø  To ascertain the favorable mouthwash for orthodontic patients that would have the least effect on the force applied by the Elastomeric chains.
Ø  To ascertain the favorable Elastomeric chain that could withstand the mouthwashes without degrading easily.
7. /
MATERIAL & METHODS:
7.1  SOURCE OF DATA
1.  Three elastomeric products will be selected for evaluation, they are :
3M Unitek Alastic Chain
Ortho Organizers Elastomeric Chain
American Technology Maximum Power Chain
2.  Four mouthwashes will be selected for evaluation, they are :
Amflor Oral Rinse
Colgate Phos - Flur Rinse
Hiora Mouth Wash
Listerine
3.  A rectangular acrylic platform of 18 cm x 5 cm x 1 cm will be fabricated comprising of two rows of stainless steel jigs (made with 0.040 mm stainless steel wire), each row comprises of 15 jigs, both rows separated 20 mm apart and the elastomeric chains will be stretched across the rows.
4.  The whole assembly is completely immersed in the respective baths in an enamel tray.
7.2 METHOD OF COLLECTION OF DATA (INCLUDING SAMPLING PROCEDURE, IF ANY)
Material used will be as follows:
1.  3M Unitek Alastic chain (Product A)
2.  Ortho Organizers Elastomeric Chain (Product B)
3.  American Technology Maximum Power Chain (Product C)
4.  Artificial saliva (0.4 NaCl, 1.21g KCl, 0.78g NaH2Po4. 2H2O, 0.005g
Na2S.9H2O, 1g CO(NH2)2 and 1000ml of distilled / deionized water.
Then add 10N sodium hydroxide).
5.  Mouthwashes :
a)  Amflor Oral Rinse containing Amine Fluoride which is an Organic
Fluoride manufactured by Group Pharmaceutical Limited, India.
b)  Colgate Phos - Flur Rinse containing Sodium Fluoride, Acidulated Phosphate
manufactured by Vita Biopharma Private Limited, India.
c)  Hiora Mouth Wash containing Ocimum Sanctum, Syzygium Aromatic manufactured
by Himalaya Drug Company, India.
d)  Listerine containing Menthol,Ethyl Alcohol, Thymol, Methyl Salicylate manufactured by Lambert Pharmacal Company, India
Equipments used in the study will be:
1. Universal Testing Machine.
2. Metric Vernier caliper.
3. Electronic force gauge.
Short elastomeric chains of three different brands are examined, to compare their force efficiency, when they are exposed to different mouthwashes.
Since the dimension of lumen varies for each brand, elastomeric chains with five links each which approximately ranges from 11-12 mm in length when unstretched are used in this study.
To simulate canine retraction, each of these elastomeric chains will be stretched up to 20 mm and their initial force is recorded.3
The sample comprises of five links of each of the three leading brands of polyurethane elastomeric chains which are mounted on a platform comprising stainless steel jigs.
The force levels of these elastomeric chains are tested on immediate loading on the jig and then in a control media of artificial saliva at 37°C (simulating the oral temperature) and after 30 minutes, 1st day, 7th day, 14th day and 21st day respectively (since the elastomeric chains are usually changed every 20 days).1
Likewise, four similar jig assemblies will be fabricated and used for the experimental groups.
The experimental groups of elastomeric chains will be exposed to different mouthwashes used which are commonly prescribed by dental practitioners or commercially available in the market, twice daily for one minute in the presence of artificial saliva.
The ratio of mouthwash to saliva will be maintained at 20:1, as studies have shown that 1 ml of saliva is usually retained in the oral cavity for one minute and manufacturer of all leading mouthwashes recommend 20 ml quantity of mouthwash to be swirled in the mouth for one minute twice daily.6
Control group :
Group A – Elastomeric chains exposed only to artificial saliva for 21 days.
Experimental group :
Group B – Elastomeric chains exposed to Amflor Oral Rinse for 21 days.
Group C – Elastomeric chains exposed to Colgate Phos - Flur Rinse for 21 days.
Group D – Elastomeric chains exposed to Hiora Mouth Wash for 21 days.
Group E – Elastomeric chains exposed to Listerine for 21 days.
Force levels of all the elastomeric chains will be checked 30 minutes after immediate loading and subsequently checked twice daily with an interval of 9 hrs on the 1st day, 7th day, 14th day and 21st day respectively.1
After the 21st day, the data will be analyzed statistically and the influence of different mouthwashes on different elastomeric chains will be inferred.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
No.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN
CASE OF 7.3?
Not applicable.
8. /
LIST OF REFERENCES
1.  Larrabee. T, Yao Liu. S, Eckert. G,Stewart. K. The effects of varying alcohol concentrations commonly found in mouth rinses on the force decay of elastomeric chain. Angle Orthod. 2012;82:894–899.
2.  Al-Kassar. S. The Force Degradation of Elastic Chain in Different Environments and for Different Intervals (An In Vitro Study). Al–Rafidain Dent J. 2011; 11(2):231-237.
3.  De Genova DC, McInnes-Ledoux P, Weinberg R, Shaye R. Force degradation of orthodontic elastomeric chains – a product comparison study. Am J Orthod 1985;87:377-
84..
4.  Kim .K, Chung. C, Kwnagchul Choy .K, Lee. J, Vanarsdalld. R. Effects of prestretching on force degradation of synthetic elastomeric chains. Am J Orthod Dentofacial Orthop October 2005.
5.  Silva.L, Kochenborger.C, Marchioro.M. Force degradation in orthodontic elastic chains. Rev. odonto ciênc. 2009;24(3):274-278.
6.  Fablan.T, Fejerdy.P. Saliva in health and disease. Wiley Encyc. Chemical Biology 2007.
9 /
SIGNATURE OF CANDIDATE
/
10 /
REMARKS OF THE GUIDE
/
11 / NAMES AND DESIGNATION OF (IN BLOCK LETTERS)
11.1 GUIDE:
11.2 SIGNATURE:
11.3 CO-GUIDE (IF ANY) :
11.4 SIGNATURE:
11.5 HEAD OF THE
DEPARTMENT:
11.6 SIGNATURE: / Dr. Hemanth.M
Professor
Department of Orthodontics and Dentofacial
Orthopaedics.
Dayananda Sagar College of Dental Sciences,
Bangalore - 560078
Dr. Hareesha K.B
Professor
Department of Orthodontics and Dentofacial
Orthopaedics.
Dayananda Sagar College of Dental Sciences,
Bangalore - 560078.
Dr. G.S. Patil
Professor and H.O.D
Department of Orthodontics and Dentofacial
Orthopaedics.
Dayananda Sagar College of Dental Sciences,
Bangalore - 560078.
12 /
12.1 REMARKS OF THE
CHAIRMAN & PRINCIPAL
12.2 SIGNATURE / Dr. H.P. Raghuveer
Professor and H.O.D
Department of Oral Surgery.
Dayananda Sagar College of Dental Sciences,
Bangalore - 560078

4