Original Research Article DOI: 10.18231/2455-6785.2017.0020 Indian Journal of Orthodontics and Dentofacial Research, April-June 2017;3(2):98-102 98 Evaluations of Saliva for Nickel release from Conventional Stainless Steel and Nickel free Orthodontic brackets- An Atomic Absorption Spectrophotometric (AAS) study Rahul Krishan Sharma 1,* , Azhar Malik 2 , Akshay Gupta 3 , Kamal Nabhi 4 , Dipika Sharma 5 1 Senior Lecturer, Dept. of Orthodontics & Dentofacial Orthopaedics, Daswani Dental College & Hospital, Kota, Rajasthan, 2 Associate Professor, 4 Clinician, Dept. of Endodontics, 3 Professor & HOD, Dept. of Orthodontics, Indira Gandhi Govt. Dental College, Jammu & Kashmir, 5 PG Student, Dept. of Prosthodontics, Institute of Dental Studies & Technologies, Uttar Pradesh *Corresponding Author: Email: drrahul.sharmahdc@gmail.com Abstract Introduction: Nickel, which is a potent allergen, is used as a key metallurgical ingredient for manufacturing orthodontic brackets. The study aims at extracting nickel levels in patient’s saliva at different time interval. Methods: A total of twenty patients, ten bonded with conventional 3M Stainless steel brackets (group A) and another ten with nickel free brackets(group B). Group B was further divided into two groups of five each, based on different manufacturing companies viz Classic orthodontic and d-tech orthodontics. Three samples of stimulated saliva were collected from each patient at the following intervals: before placement of appliance, one hour after placement and a week after the appliance is being placed. The sample were then analysed with an atomic absorption spectrophotometer for amount of nickel release. Results: Study revealed that the nickel release in 3M stainless brackets in first hour of the bracket placement was very high compared to pre- treatment nickel level. Gradually the release was found to decrease when it was measured after one week. In the second group comprising nickel free brackets by Classic orthodontics the release of nickel gradually increased from the time the appliance was placed in the oral cavity over a period of one week. Third group having d- tech nickel free orthodontic brackets the release in nickel was found to be significantly on higher side after one hour of the appliance placement which eventually decreased over a period of one week. Conclusions: The final outcome of the present study revealed that manufacturing companies and extended time interval has a profound effect on nickel release from simulated fixed orthodontic appliance. Nickel free brackets used in the study though claim to be absolutely nickel free but some amount of nickel was found in them also. Keywords: Nickel, Atomic Absorption Spectrophotometer Introduction The biocompatibility of dental alloy has been investigated over the past twenty year. However, studies on these issues have given rise to questions without answers confirming the need to learn more about the biocompatibility of these materials. Since this process has not been fully explained, orthodontist may be confused in the selection of biologically safe appliance for their patients. (1) A large variety of metallic alloys are routinely used in dentistry. Gold was used in orthodontics for fabrication of the accessories until the 1930s and 1940s. In 1929, stainless steel was used for the first time to replace gold. Orthodontic bands, brackets and wires are universally made of austenitic steel containing approximately 8-12% nickel and 17- 22% chromium. (2) Nickel in particular is the most common cause of contact dermatitis in women. (2,3) In addition to the allergic issues, carcinogenic, mutagenic and cytotoxic effects have been assigned to nickel and to lesser extent chromium. (4) The literature shows that nickel is potentially allergic and capable of provoking type IV delayed hypersensitivity reactions that presents signs in the oral cavity including gingival overgrowth, angular cheilitis and labial desquamation. (5) In vitro experiments on cultured human gingival fibroblast showed that ions released from implanted nickel- chromium alloys can cause altered cellular functions. (6) At present, orthodontic bands, brackets and arch wires are primarily made of stainless steel, containing 18% chromium and 8% nickel. Nickel titanium (NiTi) arch wires contain more than 50% nickel. Orthodontic alloys emit electro galvanic currents with saliva as the medium, leading to a release of metal ions. This discharge of nickel ions might be potentially hazardous for the patients undergoing orthodontic treatment. (7,8) It has been reported that 4.5% to 28.5% of the population has nickel hypersentivity, with a higher prevalence in females (9,10) and the frequency of sensitivity increases in patient who have sustained prosthodontics or orthodontic treatments, especially when nickel- containing alloys are used. This study was conducted with the aim to evaluate the nickel release from conventional stainless steel and nickel free brackets and between the nickel free brackets of different manufacturers at different time intervals. Materials and Method The study was conducted in the Department of Orthodontics and Dentofacial Orthopaedics of Darshan Dental College and Hospital Udaipur, India and a total of twenty patients were included in the study.