Plaque Accumulation

in Adolescent
Orthodontic Patients:
Bonded Versus Banded Teeth

Abstract
P
laque accumulation on bonded (BN) versus banded (BA) teeth was com-
pared in 252 teeth in 9 healthy adolescents, 11 to 15 years of age, who
were undergoing orthodontic treatment with fixed appliances. Plaque
Fitin Aloufi, BDS, MS, MSD
Diplomate, American Board index was measured on BN and BA teeth. The measurements were taken at 3
of Periodontology time intervals: 0, 28, and 48 days. At the end of the study, plaque accumulation
Diplomate, American Board was found to be significantly higher around BA compared with BN molars.
of Orthodontics
Security Forces Hospital,
Dental Department

Riyadh Colleges of Dentistry and Pharmacy
Saudi Arabia
Sebastian G. Ciancio, DDS*
Distinguished Service
Professor and Chair
Department of Periodontics
and Endodontics, School of
Dental Medicine
Director, Center for Dental Studies
University at Buffalo, State University of
New York
Buffalo, NY
Othman Shibly, DDS, MS
Diplomate, American Board
of Periodontology
Coordinator, International
Advanced Dental Education
Director, Preventive
Dentistry
Associate Director, Center for Dental Studies
University at Buffalo, State University of
New York
Buffalo, NY
Mohammad S. Al-zahrani,
BDS, MSD, PhD
Associate Professor
Division of Periodontics
King Abdulaziz University
Jeddah, Saudi Arabia
*Corresponding author
O
rthodontic bands, brackets, and wires are impediments to brush-
ing and flossing, frequently facilitating the accumulation of
plaque biofilm that jeopardizes gingival and periodontal health.
Studies have demonstrated an increase in plaque biofilm deposits and pu-
tative periodontal pathogens after placement of orthodontic appliances,
leading to increased bleeding and probing depth.1-7 Furthermore, peri-
odontal pathogens in orthodontic patients were reduced within 3 months
of appliance removal.8
Bacterial plaque as a biofilm is recognized as the principal cause of
caries and periodontal disease.9 Dental plaque removal by professional pro-
phylaxis and maintenance through personal oral hygiene is key to preven-
tion of caries and periodontal disease and continued satisfactory
maintenance of oral health.10 Therefore, it is important for both the pa-
tient and the clinician to establish a personalized oral hygiene regimen to
achieve and maintain optimal plaque control during orthodontic treatment.
Two earlier studies examined the effect of type of fixed orthodontic ap-
pliance on plaque accumulation.2,4 Both compared the periodontal health
of BN and BA molars and demonstrated greater inflammation around BA
compared with BN molars. With advances in the orthodontic field, how-
ever, there is a need to update studies of this issue. The objective of the
present study is to bring the data up to date on the accumulation of plaque
biofilm on BA versus BN teeth.
Study Design
The study was conducted with 9 adolescent patients (11 to 15 years of
age) in the Department of Orthodontics, School of Dental Medicine, Uni-

Vol. 4, No. 6 (Suppl 1) Dental Learning / June 2010 1

 Table 1 Plaques Scores on Banded (BA) and Bonded (BN) Teeth
T1 (Day 0) T2 (28 days) T3 (48 days)
BA 3.1 ± 0.08 2.3 ± 0.18 2.7 ± 0.13
BN 2.9 ± 0.07 2.3 ± 0.10 2.2 ± 0.12*
*Differences between groups statistically significant, P < 0.05.
versity at Buffalo, State University of New York. The pro-
tocol was reviewed and approved by the university’s In-
stitutional Review Board. Written informed consent was
obtained from the parents before enrolling their children
in the study. All patients brushed using a manual soft-bris-
tled toothbrush and fluoridated toothpaste according to
instructions given at the start of their orthodontic treat-
ment. The research included a total of 252 teeth; 180 were
BN and 72 were BA. The plaque index was scored by 1
calibrated, experienced examiner on all buccal surfaces at
3 visits: 0, 28, and 48 days. Only the facial and facial in-
terproximal surfaces were scored because the purpose of
the study was to compare plaque biofilm accumulation
around both BN and bracketed teeth. Because orthodon-
tic bonding is placed only on the buccal aspects of teeth,
these surfaces were used for comparison of biofilm accu-
mulation on both BN and bracketed surfaces. In practice,
it is expected that this index would be used on the facial
aspects of teeth and a traditional aspect on the lingual sur-
faces of teeth. Plaque biofilm was disclosed with a dis-
closing solution (sodium fluorescein) with disclosing light)
and scored according to the Quigley-Hein plaque index.11
A student test was used to compare the plaque accumula-
tion between BA teeth and BN teeth. The significance level
was set at P≤ .05.
Results
The plaque biofilm score for BA teeth at baseline was
3.1 ± 0.08, and for BN teeth was 2.9 ± 0.07 (Table 1). At
4 weeks, the plaque scores for BA and BN were 2.3 ± 0.18
and 2.3 ± 0.10, respectively. At 6 weeks, a significantly
greater plaque accumulation was found on BA teeth (2.7
± 0.13) compared with BN teeth (2.2 ± 0.12 (P < 0.05). To
help monitor plaque biofilm control throughout the or-
thodontic treatment, the following new index, the Bonded
Bracket Index (BBI), was introduced (Figure 1):
2 Dental Learning / June 2010
Figure 1 — Schematic representation of the bonded bracket
Index (BBI)
Grade I: Plaque present on the bracket only
Grade II: Plaque present on the bracket and the imme-
diate adjacent tooth surface
Grade III: Plaque present on the bracket and continuous
to the interproximal surface
Grade IV: A continuous layer of plaque extending from
the bracket to the gingival margin.
Discussion
The present study demonstrated that BA teeth had
more plaque biofilm accumulation compared with BN
teeth at 6 weeks. This finding was in agreement with a
previous study that examined the plaque accumulation
and periodontal status of patients during orthodontic
treatment.2 The results suggest that BA teeth are more re-
tentive of plaque and therefore more difficult to keep
plaque free compared with BN teeth. A possible reason
for this finding could be because of the overhanging mar-
gins of the orthodontic bands that make plaque removal
more difficult. Patients who might be at higher risk of pe-
riodontal disease because of systemic factors, history of
chronic periodontitis, poor oral hygiene, or smoking/to-
bacco use may benefit from bonding as opposed to band-
ing the teeth.
In the study, a new index was introduced (BBI) to help
monitor plaque biofilm control throughout the ortho-
dontic treatment. The BBI will allow clinicians to better
determine the effectiveness of the orthodontic patient’s
Vol. 4, No. 6 (Suppl 1)
oral hygiene measures. Also, it provides more valuable in-
formation in terms of the amount of plaque accumulation
on and around the bracket. This information may be im-
portant relative to the need for use of plaque-control prod-
ucts during orthodontic therapy to diminish adverse
effects on both the adjacent gingival tissue and the tooth
surface around the bracket. This index can also be used as
a tool to visually demonstrate plaque biofilm for those pa-
tients with poor plaque control as a motivational aid to
improve their oral hygiene. BBI scores could be recorded
at each patient’s visit during orthodontic therapy to serve
as a definitive measure of the distribution of plaque
around bonded brackets.
Conclusion
This study demonstrated that BA teeth had more
plaque accumulation compared with BN teeth at 6 weeks.
This finding was in agreement with a previous study that
examined the plaque accumulation and periodontal sta-
tus of patients during orthodontic treatment.4 The find-
ings suggest that BA teeth are more retentive of plaque
and therefore more difficult to keep plaque free compared
with BN teeth. Patients who might be at higher risk of pe-
riodontal disease as a result of systemic factors, history of
chronic periodontitis, poor oral hygiene, or smoking/to-
bacco use habit may benefit from bonding as opposed to
banding the teeth.
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