{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T12:23:18Z","timestamp":1789906998691,"version":"4.0.1"},"reference-count":48,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To examine the ability of a removable thermoplastic appliance (RTA) to adsorb hygienic solutions and inhibit bacterial growth and to examine the efficacy of three hygiene protocols in reducing bacterial biofilm adherence to RTA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      Solution adsorption and bacterial growth inhibition were examined\n                      <jats:italic>in vitro<\/jats:italic>\n                      using paper vs RTA discs. Subsequently, 11 patients treated with RTA (mean age, 29.1 \u00b1 4.7\u00a0years) were assigned into a sequence of three hygiene protocols: regular RTA brushing (baseline), immersion RTAs in chlorhexidine mouthwash (CHX), and using a vibrating bath with cleaning solution (VBC). For each patient, 12 upper RTAs were examined (2 baseline RTAs, 5 CHX RTAs, and 5 VBC RTAs), for a total of 132 RTAs. All RTAs were stained with gentian violet, and biofilm presence was measured using a photodensitometer.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The RTA discs did not adsorb CHX or cleaning solution. The later agent did not show antibacterial features. Baseline RTAs showed significant biofilm adherence (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001) on the posterior palatal side of the aligner and on the anterior incisal edge. CHX and VBC hygienic protocols significantly (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001) reduced baseline biofilm adherence by 16% and 50%, respectively. Hygienic improvement was maintained over 140\u00a0days when CHX and VBC were used. However, VBC was three times more efficient than CHX.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>This study highly recommends the use of a VBC protocol. Biofilm deposits on the RTA, especially on incisal edges and attachment dimples, could lead to inadequate tooth\/RTA and attachment\/RTA overlap and consequently impair tooth alignment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/012413-75.1","type":"journal-article","created":{"date-parts":[[2013,6,20]],"date-time":"2013-06-20T15:55:29Z","timestamp":1371743729000},"page":"161-170","source":"Crossref","is-referenced-by-count":40,"title":["Efficacy of three hygienic protocols in reducing biofilm adherence to removable thermoplastic appliance"],"prefix":"10.2319","volume":"84","author":[{"given":"Nir","family":"Shpack","sequence":"first","affiliation":[{"name":"Lecturer, Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronit Bar-Ness","family":"Greenstein","sequence":"additional","affiliation":[{"name":"Senior Lecturer, Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Gazit","sequence":"additional","affiliation":[{"name":"Postgraduate student, Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Sarig","sequence":"additional","affiliation":[{"name":"Instructor, Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Dan","family":"Vardimon","sequence":"additional","affiliation":[{"name":"Professor and Head, Department of Orthodontics, The Maurice and Gabriela Goldschleger School of Dental Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-84-1-161-b01","series-title":"Dent Mater J","first-page":"954","article-title":"Preparation and characterization of thermoplastic materials for invisible orthodontics","volume":"30","author":"Zhang\n              N,","year":"2011","unstructured":"Zhang\n              N, \n            \n              Bai\n              Y, \n            \n              Ding\n              X, \n            \n              Zhang\n              Y. \n          \n          Preparation and characterization of thermoplastic materials for invisible orthodontics. Dent Mater J. 2011;30:954\u2013959."},{"key":"i0003-3219-84-1-161-b02","series-title":"Am J Orthod Dentofacial Orthop","first-page":"725","article-title":"Structural conformation and leaching from in vitro aged and retrieved Invisalign appliances","volume":"126","author":"Schuster\n              S,","year":"2004","unstructured":"Schuster\n              S, \n            \n              Eliades\n              G, \n            \n              Zinelis\n              S, \n            \n              Eliades\n              T, \n            \n              Bradley\n              TG. \n          \n          Structural conformation and leaching from in vitro aged and retrieved Invisalign appliances. Am J Orthod Dentofacial Orthop. 2004;126:725\u2013728."},{"key":"i0003-3219-84-1-161-b03","series-title":"Am J Orthod Dentofacial Orthop","first-page":"403","article-title":"Intraoral aging of orthodontic materials: the picture we miss and its clinical relevance","volume":"127","author":"Eliades\n              T,","year":"2005","unstructured":"Eliades\n              T, \n            \n              Bourauel\n              C. \n          \n          Intraoral aging of orthodontic materials: the picture we miss and its clinical relevance. Am J Orthod Dentofacial Orthop. 2005;127:403\u2013412."},{"key":"i0003-3219-84-1-161-b04","series-title":"J Bacteriol","first-page":"3247","article-title":"Adhere today, here tomorrow: oral bacterial adherence","volume":"175","author":"Kolenbrander\n              PE,","year":"1993","unstructured":"Kolenbrander\n              PE, \n            \n              London\n              J. \n          \n          Adhere today, here tomorrow: oral bacterial adherence. J Bacteriol. 1993;175:3247\u20133252."},{"key":"i0003-3219-84-1-161-b05","series-title":"Acta Odontol Scand","first-page":"39","article-title":"Clinical adhesiveness of selected dental materials: an in-vivo study","volume":"39","author":"Jendresen\n              MD,","year":"1981","unstructured":"Jendresen\n              MD, \n            \n              Glantz\n              PO. \n          \n          Clinical adhesiveness of selected dental materials: an in-vivo study. Acta Odontol Scand. 1981;39:39\u201345."},{"key":"i0003-3219-84-1-161-b06","series-title":"J Prosthet Dent","first-page":"592","article-title":"Retention of oral microorganisms on cobalt-chromium alloy and dental acrylic resin with different surface finishes","volume":"80","author":"Taylor\n              R,","year":"1998","unstructured":"Taylor\n              R, \n            \n              Maryan\n              C, \n            \n              Verran\n              J. \n          \n          Retention of oral microorganisms on cobalt-chromium alloy and dental acrylic resin with different surface finishes. 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J Appl Bacteriol. 1987;62:129\u2013138."},{"key":"i0003-3219-84-1-161-b08","series-title":"Am J Orthod Dentofac Orthop","first-page":"598","article-title":"Influence of thermoplastic retainers on Streptococcus mutans and Lactobacillus adhesion","volume":"141","author":"T\u00fcrk\u00f6z\n              C,","year":"2012","unstructured":"T\u00fcrk\u00f6z\n              C, \n            \n              Canig\u00fcr Bavbek\n              N, \n            \n              Kale Varlik\n              S, \n            \n              Ak\u00e7a\n              G. \n          \n          Influence of thermoplastic retainers on Streptococcus mutans and Lactobacillus adhesion. Am J Orthod Dentofac Orthop. 2012;141:598\u2013603."},{"key":"i0003-3219-84-1-161-b09","series-title":"J Clin Periodontol","first-page":"1025","article-title":"Predominant cultivable supragingival plaque in Chinese \u201crapid\u201d and \u201cslow\u201d plaque formers","volume":"23","author":"Zee\n              KY,","year":"1996","unstructured":"Zee\n              KY, \n            \n              Samaranayake\n              LP, \n            \n              Attstrom\n              R. \n          \n          Predominant cultivable supragingival plaque in Chinese \u201crapid\u201d and \u201cslow\u201d plaque formers. J Clin Periodontol. 1996;23:1025\u20131031."},{"key":"i0003-3219-84-1-161-b10","series-title":"Eur J Orthod","first-page":"577","article-title":"Ultrastructure and morphology of biofilms on thermoplastic orthodontic appliances in \u2018fast\u2019 and \u2018slow\u2019 plaque formers","volume":"33","author":"Low\n              B,","year":"2011","unstructured":"Low\n              B, \n            \n              Lee\n              W, \n            \n              Seneviratne\n              CJ, \n            \n              Samaranayake\n              LP, \n            \n              H\u00e4gg\n              U. \n          \n          Ultrastructure and morphology of biofilms on thermoplastic orthodontic appliances in \u2018fast\u2019 and \u2018slow\u2019 plaque formers. Eur J Orthod. 2011;33:577\u2013583."},{"key":"i0003-3219-84-1-161-b11","series-title":"Aust Orthod J","first-page":"34","article-title":"Short-term chemical and physical changes in Invisalign appliances","volume":"25","author":"Gracco\n              A,","year":"2009","unstructured":"Gracco\n              A, \n            \n              Mazzoli\n              A, \n            \n              Favoni\n              O, \n            et al. \n          Short-term chemical and physical changes in Invisalign appliances. 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Eur J Oral Sci. 2007;115:7\u201314."},{"issue":"suppl S16","key":"i0003-3219-84-1-161-b13","series-title":"J Periodontal Res Suppl","first-page":"74","article-title":"Chlorhexidine digluconate: an agent for chemical plaque control and prevention of gingival inflammation","volume":"21","author":"Lang\n              NP,","year":"1986","unstructured":"Lang\n              NP, \n            \n              Brecx\n              MC. \n          \n          Chlorhexidine digluconate: an agent for chemical plaque control and prevention of gingival inflammation. J Periodontal Res Suppl. 1986;21(suppl S16):74\u201389."},{"key":"i0003-3219-84-1-161-b14","series-title":"J Dent Res","first-page":"1194","article-title":"Long-term effects of Meridol\u00ae and chlorhexidine mouthrinses on plaque, gingivitis, staining, and bacterial vitality","volume":"72","author":"Brecx\n              MC,","year":"1993","unstructured":"Brecx\n              MC, \n            \n              Macdonald\n              LL, \n            \n              Legary\n              K, \n            \n              Cheang\n              M, \n            \n              Forgay\n              MGE. \n          \n          Long-term effects of Meridol\u00ae and chlorhexidine mouthrinses on plaque, gingivitis, staining, and bacterial vitality. J Dent Res. 1993;72:1194\u20131197."},{"key":"i0003-3219-84-1-161-b15","series-title":"Gerodontology","article-title":"Survival of microorganisms on complete dentures following ultrasonic cleaning combined with immersion in peroxide-based cleanser solution","author":"Nishi\n              Y,","unstructured":"Nishi\n              Y, \n            \n              Seto\n              K, \n            \n              Kamashita\n              Y, \n            \n              Kaji\n              A, \n            \n              Kurono\n              A, \n            \n              Nagaoka\n              E. \n          \n          Survival of microorganisms on complete dentures following ultrasonic cleaning combined with immersion in peroxide-based cleanser solution. Gerodontology. Published online: December 5, 2012 (doi:10.1111\/ger.12027)."},{"key":"i0003-3219-84-1-161-b16","series-title":"J Periodontol","first-page":"1194","article-title":"Interaction of chlorhexidine with smooth and rough types of titanium surfaces","volume":"77","author":"Kozlovsky\n              A,","year":"2006","unstructured":"Kozlovsky\n              A, \n            \n              Artzi\n              Z, \n            \n              Moses\n              O, \n            \n              Kamin-Belsky\n              N, \n            \n              Bar-Ness Greenstein\n              R. \n          \n          Interaction of chlorhexidine with smooth and rough types of titanium surfaces. J Periodontol. 2006;77:1194\u20131200."},{"key":"i0003-3219-84-1-161-b17","series-title":"J Periodont Res","first-page":"92","article-title":"Interactions of chlorhexidine with salivary films adsorbed at solid\/liquid and air\/fluid interfaces","volume":"28","author":"Freitas\n              LB,","year":"1993","unstructured":"Freitas\n              LB, \n            \n              Vassilakos\n              N, \n            \n              Arnebrant\n              T. \n          \n          Interactions of chlorhexidine with salivary films adsorbed at solid\/liquid and air\/fluid interfaces. 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Biotech Histochem. 1996;71:145\u2013151."},{"key":"i0003-3219-84-1-161-b19","series-title":"Antimicrob Agents Chemother","first-page":"1461","article-title":"Analysis of the effects of chlorhexidine on oral biofilm vitality and structure based on viability profiling and an indicator of membrane integrity","volume":"48","author":"Hope\n              CK,","year":"2004","unstructured":"Hope\n              CK, \n            \n              Wilson\n              M. \n          \n          Analysis of the effects of chlorhexidine on oral biofilm vitality and structure based on viability profiling and an indicator of membrane integrity. 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Dent Mater J. 2010;29:446\u2013453."},{"key":"i0003-3219-84-1-161-b23","series-title":"J Periodontol","first-page":"2127","article-title":"The effect of 0.12% chlorhexidine gluconate rinsing on previously plaque-free and plaque-covered surfaces: a randomized, controlled clinical trial","volume":"78","author":"Zanatta\n              FB,","year":"2007","unstructured":"Zanatta\n              FB, \n            \n              Antoniazzi\n              RP, \n            \n              R\u00f6sing\n              CK. \n          \n          The effect of 0.12% chlorhexidine gluconate rinsing on previously plaque-free and plaque-covered surfaces: a randomized, controlled clinical trial. 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Dent Mater J. 2011;30:954\u2013959."},{"key":"i0003-3219-84-1-161-b02","series-title":"Am J Orthod Dentofacial Orthop","first-page":"725","article-title":"Structural conformation and leaching from in vitro aged and retrieved Invisalign appliances","volume":"126","author":"Schuster\n              S,","year":"2004","unstructured":"Schuster\n              S, \n            \n              Eliades\n              G, \n            \n              Zinelis\n              S, \n            \n              Eliades\n              T, \n            \n              Bradley\n              TG. \n          \n          Structural conformation and leaching from in vitro aged and retrieved Invisalign appliances. Am J Orthod Dentofacial Orthop. 2004;126:725\u2013728."},{"key":"i0003-3219-84-1-161-b03","series-title":"Am J Orthod Dentofacial Orthop","first-page":"403","article-title":"Intraoral aging of orthodontic materials: the picture we miss and its clinical relevance","volume":"127","author":"Eliades\n              T,","year":"2005","unstructured":"Eliades\n              T, \n            \n              Bourauel\n              C. \n          \n          Intraoral aging of orthodontic materials: the picture we miss and its clinical relevance. Am J Orthod Dentofacial Orthop. 2005;127:403\u2013412."},{"key":"i0003-3219-84-1-161-b04","series-title":"J Bacteriol","first-page":"3247","article-title":"Adhere today, here tomorrow: oral bacterial adherence","volume":"175","author":"Kolenbrander\n              PE,","year":"1993","unstructured":"Kolenbrander\n              PE, \n            \n              London\n              J. \n          \n          Adhere today, here tomorrow: oral bacterial adherence. J Bacteriol. 1993;175:3247\u20133252."},{"key":"i0003-3219-84-1-161-b05","series-title":"Acta Odontol Scand","first-page":"39","article-title":"Clinical adhesiveness of selected dental materials: an in-vivo study","volume":"39","author":"Jendresen\n              MD,","year":"1981","unstructured":"Jendresen\n              MD, \n            \n              Glantz\n              PO. \n          \n          Clinical adhesiveness of selected dental materials: an in-vivo study. 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J Appl Bacteriol. 1987;62:129\u2013138."},{"key":"i0003-3219-84-1-161-b08","series-title":"Am J Orthod Dentofac Orthop","first-page":"598","article-title":"Influence of thermoplastic retainers on Streptococcus mutans and Lactobacillus adhesion","volume":"141","author":"T\u00fcrk\u00f6z\n              C,","year":"2012","unstructured":"T\u00fcrk\u00f6z\n              C, \n            \n              Canig\u00fcr Bavbek\n              N, \n            \n              Kale Varlik\n              S, \n            \n              Ak\u00e7a\n              G. \n          \n          Influence of thermoplastic retainers on Streptococcus mutans and Lactobacillus adhesion. Am J Orthod Dentofac Orthop. 2012;141:598\u2013603."},{"key":"i0003-3219-84-1-161-b09","series-title":"J Clin Periodontol","first-page":"1025","article-title":"Predominant cultivable supragingival plaque in Chinese \u201crapid\u201d and \u201cslow\u201d plaque formers","volume":"23","author":"Zee\n              KY,","year":"1996","unstructured":"Zee\n              KY, \n            \n              Samaranayake\n              LP, \n            \n              Attstrom\n              R. \n          \n          Predominant cultivable supragingival plaque in Chinese \u201crapid\u201d and \u201cslow\u201d plaque formers. J Clin Periodontol. 1996;23:1025\u20131031."},{"key":"i0003-3219-84-1-161-b10","series-title":"Eur J Orthod","first-page":"577","article-title":"Ultrastructure and morphology of biofilms on thermoplastic orthodontic appliances in \u2018fast\u2019 and \u2018slow\u2019 plaque formers","volume":"33","author":"Low\n              B,","year":"2011","unstructured":"Low\n              B, \n            \n              Lee\n              W, \n            \n              Seneviratne\n              CJ, \n            \n              Samaranayake\n              LP, \n            \n              H\u00e4gg\n              U. \n          \n          Ultrastructure and morphology of biofilms on thermoplastic orthodontic appliances in \u2018fast\u2019 and \u2018slow\u2019 plaque formers. Eur J Orthod. 2011;33:577\u2013583."},{"key":"i0003-3219-84-1-161-b11","series-title":"Aust Orthod J","first-page":"34","article-title":"Short-term chemical and physical changes in Invisalign appliances","volume":"25","author":"Gracco\n              A,","year":"2009","unstructured":"Gracco\n              A, \n            \n              Mazzoli\n              A, \n            \n              Favoni\n              O, \n            et al. \n          Short-term chemical and physical changes in Invisalign appliances. 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Eur J Oral Sci. 2007;115:7\u201314."},{"issue":"suppl S16","key":"i0003-3219-84-1-161-b13","series-title":"J Periodontal Res Suppl","first-page":"74","article-title":"Chlorhexidine digluconate: an agent for chemical plaque control and prevention of gingival inflammation","volume":"21","author":"Lang\n              NP,","year":"1986","unstructured":"Lang\n              NP, \n            \n              Brecx\n              MC. \n          \n          Chlorhexidine digluconate: an agent for chemical plaque control and prevention of gingival inflammation. J Periodontal Res Suppl. 1986;21(suppl S16):74\u201389."},{"key":"i0003-3219-84-1-161-b14","series-title":"J Dent Res","first-page":"1194","article-title":"Long-term effects of Meridol\u00ae and chlorhexidine mouthrinses on plaque, gingivitis, staining, and bacterial vitality","volume":"72","author":"Brecx\n              MC,","year":"1993","unstructured":"Brecx\n              MC, \n            \n              Macdonald\n              LL, \n            \n              Legary\n              K, \n            \n              Cheang\n              M, \n            \n              Forgay\n              MGE. \n          \n          Long-term effects of Meridol\u00ae and chlorhexidine mouthrinses on plaque, gingivitis, staining, and bacterial vitality. J Dent Res. 1993;72:1194\u20131197."},{"key":"i0003-3219-84-1-161-b15","series-title":"Gerodontology","article-title":"Survival of microorganisms on complete dentures following ultrasonic cleaning combined with immersion in peroxide-based cleanser solution","author":"Nishi\n              Y,","unstructured":"Nishi\n              Y, \n            \n              Seto\n              K, \n            \n              Kamashita\n              Y, \n            \n              Kaji\n              A, \n            \n              Kurono\n              A, \n            \n              Nagaoka\n              E. \n          \n          Survival of microorganisms on complete dentures following ultrasonic cleaning combined with immersion in peroxide-based cleanser solution. Gerodontology. Published online: December 5, 2012 (doi:10.1111\/ger.12027)."},{"key":"i0003-3219-84-1-161-b16","series-title":"J Periodontol","first-page":"1194","article-title":"Interaction of chlorhexidine with smooth and rough types of titanium surfaces","volume":"77","author":"Kozlovsky\n              A,","year":"2006","unstructured":"Kozlovsky\n              A, \n            \n              Artzi\n              Z, \n            \n              Moses\n              O, \n            \n              Kamin-Belsky\n              N, \n            \n              Bar-Ness Greenstein\n              R. \n          \n          Interaction of chlorhexidine with smooth and rough types of titanium surfaces. 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