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. 2020 Nov 12:1-7.
doi: 10.1038/s41415-020-2280-5. Online ahead of print.

Quantitative analysis of particulate matter release during orthodontic procedures: a pilot study

Ahmed Riaz Din  1 , Annika Hindocha  2 , Tulsi Patel  2 , Sanjana Sudarshan  3 , Neil Cagney  4 , Amine Koched  5 , Jens-Dominik Mueller  3 , Noha Seoudi  6 , Claire Morgan  7 , Shakeel Shahdad  8 , Padhraig S Fleming  9
Affiliations

Quantitative analysis of particulate matter release during orthodontic procedures: a pilot study

Ahmed Riaz Din et al. Br Dent J. .

Abstract

Introduction Transmission of SARS-CoV-2 through aerosol has been suggested, particularly in the presence of highly concentrated aerosols in enclosed environments. It is accepted that aerosols are produced during a range of dental procedures, posing potential risks to both dental practitioners and patients. There has been little agreement concerning aerosol transmission associated with orthodontics and associated mitigation.Methods Orthodontic procedures were simulated in a closed side-surgery using a dental manikin on an acrylic model using composite-based adhesive. Adhesive removal representing debonding was undertaken using a 1:1 contra-angle handpiece (W&H Synea Vision WK-56 LT, Bürmoos, Austria) and fast handpiece with variation in air and water flow. The removal of acid etch was also simulated with the use of combined 3-in-1 air-water syringe. An optical particle sizer (OPS 3330, TSI Inc., Minnesota, USA) and a portable scanning mobility particle sizer (NanoScan SMPS Nanoparticle Sizer 3910, TSI Inc., Minnesota, USA) were both used to assess particulate matter ranging in dimension from 0.08 to 10 μm.Results Standard debonding procedure (involving air but no water) was associated with clear increase in the 'very small' and 'small' (0.26-0.9 μm) particles but only for a short period. Debonding procedures without supplementary air coolant appeared to produce similar levels of aerosol to standard debonding. Debonding in association with water tended to produce large increases in aerosol levels, producing particles of all sizes throughout the experiment. The use of water and a fast handpiece led to the most significant increase in particles. Combined use of the 3-in-1 air-water syringe did not result in any detectable increase in the aerosol levels.Conclusions Particulate matter was released during orthodontic debonding, although the concentration and volume was markedly less than that associated with the use of a fast handpiece. No increase in particulates was associated with prolonged use of a 3-in-1 air-water syringe. Particulate levels reduced to baseline levels over a short period (approximately five minutes). Further research within alternative, open environments and without air exchange systems is required.

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Figures

Fig. 1
Fig. 1
a) Experimental model to simulate debonding with the location of adhesive demarcated. b) Adhesive was placed on the tooth surface with pressure to expel the excess adhesive using molar tubes and brackets as appropriate covered in a petroleum jelly layer. c) An even layer (approx. 1 mm) of composite-based adhesive remained on each tooth surface. d) Models of each arch were secured in place using silicone transfer jigs
Fig. 2
Fig. 2
Working principle of the instruments. a) NanoScan 3910. b) OPS 3330. Images are courtesy of TSI Incorporated, Shoreview, MN (USA) and protected by copyright
Fig. 3
Fig. 3
Variation in the measured concentrations of aerosols during each experiment. The rows correspond to the different procedures: a) standard debond; b) debond without air coolant; c) debond with water; d) repair of two teeth using standard debond approach (with air only); e) repair of two teeth; and f) debond using the fast handpiece. The columns show the concentrations for various size ranges of aerosols: i) very small; ii) small; iii) medium; and iv) large. The grey shaded regions indicate the time during which the procedure took place and the colours indicate the different repeated measurements, as shown in Table 2. Note that the y-axis scale is different for the fast handpiece procedures (row f)
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