UNIVERSIDADE ESTADUAL PAULISTA
“JÚLIO DE MESQUITA FILHO”
Instituto de Ciência e Tecnologia
Campus de São José dos Campos
ORIGINAL ARTICLE DOI: https://doi.org/10.4322/bds.2024.e4142
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Braz Dent Sci 2024 Apr/June;27 (2): e4142
This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Changes in epithelial cells adjacent to orthodontic devices
Alterações nas células epiteliais adjacentes a dispositivos ortodônticos
Zena Hekmat ALTAEE1 , Ahlam Thabet BDAIWI1 , Laith Hamood Aswad AL-SALMANY1 , Bushra Zubair KHALAF2
1 - University Of Anbar, College of Dentistry, Ramadi, Anbar, Iraq.
2 - Histopathology of Baghdad Medical City, Baghdad, Iraq.
How to cite: Altaee ZH, Bdaiwi AT, Al Salmany LHA, Khalaf BZ. Changes in epithelial cells adjacent to orthodontic device. Braz Dent Sci.
2024;27(2):e4142. https://doi.org/10.4322/bds.2024.e4142
ABSTRACT
Objective: The majority of oral lesions in the epithelial tissue are caused by local irritation so the purpose of
this study is to compare between the patients have xed orthodontic device and patients without orthodontic
device and to perform cytomorphometric and cytological examinations of the oral mucosa epithelium close to
metal brackets and band areas. Material and Methods: The study comprises 40 participants, divided into two
distinct groups: a control group of 20 patient without xed orthodontic appliance and the second group is 20
patients with xed orthodontic appliance. Smears were collected from the oral mucosa adjacent to the orthodontic
bracket and adjacent to the band area in the orthodontic patients while cell collection from non-orthodontic
patients taken from buccal mucosa then the smears stained and analyzed using an alight microscope. Results:
This study shows a signicant difference in Nuclear area,cytoplasmic area and nuclear cytoplasmic area ratio
between control, bracket and molar area, showing alteration change in the cell of the epithelial tissue adjacent
to molar band then bracket area and appearance of type II inammatory smears, according to Papanicolau
classication especially in band area. Conclusion: Metal brackets and molar band cause cytomorphometric and
cytomorphological changes adjacent oral mucosa cells.
KEYWORDS
Epithelial cell; Fixed appliances; Oral mucosa; Orthodontic appliance; Papanicolau Classication.
RESUMO
Objetivo: A maioria das lesões orais nos tecidos epiteliais são causadas por uma irritação local, deste modo,
o objetivo deste estudo é comparar pacientes que usam aparelhos ortodônticos xos e pacientes sem aparelho
ortodôntico xos e realizar exames citomormétricos e citológicos do epitélio da mucosa próximo às áreas das
bandas e brackets metálicos. Material e Métodos: O estudo foi composto por 40 participantes, divididos em
dois grupos distintos, um grupo controle com 20 pacientes sem aparelho ortodôntico xo e o segundo grupo
com 20 pacientes com aparelho ortodôntico xo. Foram coletados esfregaços da mucosa oral adjacente aos
brackets e bandas ortodônticos dos pacientes com aparelho, enquanto a coleta das células dos pacientes que não
usavam aparelho foi colhida da mucosa bucal. Em seguida, os esfregaços foram corados e analisados usando
um microscópio ótico. Resultados: Este estudo mostrou uma diferença signicativa na área nuclear, na área
citoplasmática e na área citoplasmático nuclear proporcionais entre o controle, área do bracket e área de banda
molar, apresentando alterações nas células do tecido epitelial adjacente à banda molar e à área do bracket e
aparecimento de esfregaços inamatórios do tipo II, de acordo com a classicação de Papanicolau, especialmente
na área de banda. Conclusão: Brackets metálicos e bandas nos molares causam mudanças citomorfométrica e
citomorfológica nas células da mucosa oral adjacente.
PALAVRAS-CHAVE:
Celula epitelial; Aparelhos xos; Mucosa bucal; Aparelho ortodôntico; Classicação Papanicolau.
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Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
INTRODUCTION
The epithelial layer is the layer that covers
the oral mucosa in the oral cavity [1]. Therefore,
maintaining the integrity of the mucous membrane
is crucial for oral health. However, Epithelial
cells can undergo alterations caused by oral
cavity disease, infections, traumatic agents, or
metabolic circumstances, leading to various clinical
changes [2,3]. When undergoing treatment with a
xed orthodontic appliance, attaching additional
components such as brackets, arches, and molar
bands is essential. These accessories, which attach
to the oral mucosa, may cause irritation, ulceration,
hematomas, and erosions, which can cause
discomfort and pain to the orthodontic patient [3-6].
Most oral sores arise due to localized irritation
and do not warrant worry [3,7]. Infrequently, they
may serve as an initial indication of more severe
oral problems. Typically, oral lesions are mainly
caused by trauma like a trauma from orthodontic
appliance that does not t properly, is not smooth
or cracked denature or may be a sharp tooth
surface which may affect the nearby soft tissues.
Oral tissues can undergo signicant alterations at
a deeper level due to acute stress [3].
Additionally, the orthodontic device promotes
plaque buildup and alters the microbial population
in the mouth, which has a detrimental impact
on the oral epithelial tissue surrounding the
xed orthodontic appliance [8,9]. Orthodontic
treatments should aim to correct dental or /and
skeletal discrepancies without tissue damage.
Nevertheless, there are a restricted number of
researches that have investigated the alterations
to epithelial cells caused by the friction produced
by xed orthodontic appliances [3,9,10].
Therefore, the purpose of this study was to
examine the differences between patients who
were receiving orthodontic treatment and those
who were not. In addition, the purpose of the
study was to conduct cytomorphometric and
cytological exams in order to carry out extensive
investigations of the oral mucosa epithelium
in the vicinity of metal brackets that were
equipped with stainless steel wires and the area
surrounding the molar band.
MATERIAL AND METHODS
The experimental protocol for the current
study received approval from the Human Research
Ethics Committee at Anbar University number 116
in 11/8/2023. The present study was conducted
with 40 subjects aged 18 to 35 years with good
oral hygiene. The participants were selected
from a private dental clinic and separated into
two groups. In the control group, 20 patients
without xed orthodontic appliances came to
the clinic for different reasons. The second group
is 20 patients with xed orthodontic appliances
exclusion criteria included patient with history
of any lesion in the oral cavity ,smoking, any
systemic disease and bad oral hygiene patients.
The xed appliances include a metallic bracket
(Roth bracket slot 0.22 and stainless wire ) and
an orthodontic band on the rst molar.
Oral exfoliated cells were obtained from
buccal mucosa by liquid exfoliation cytology.
Initially, the mouth of the patient should be
washed with water to get rid of any excess debris
that may be present in the oral cavity.
Subsequently, samples were obtained from two
regions: The rst is the oral mucosa area adjacent
to the orthodontic bracket and wire, while the
second is the oral mucosa adjacent to the band
area. While cell collection from non-orthodontic
patients takes from buccal mucosa adjacent to the
upper rst premolar and rst molar region.
The squamous epithelial cells were collected
using cytobrush by gently scraping and rolling
the mucosa region onto glass slides, which were
then promptly xed in 99.9% pure alcohol for
20 minutes. The smears were subsequently
stained with the standard Papanicolaou stain and
examined using Japan’s Olympus Corporation
light microscope. A single observer conducted the
cytological examination. teen random cytological
smear from each group were reexamined by the
observer after period of time.
The smears were categorized using the
Papanicolaou classication system{{. Class 0:
Insufcient or inadequate material for analysis.
Class I: The smear is normal. Class II: The smear
is normal but shows signs of inammation. Class
III: The smear shows dysplastic alterations,
indicating suspicion. Class IV: The smear strongly
suggests malignancy but is not conclusive. Class
V: The smear is malignant
Statistical analysis
In this study, the results were expressed as
the mean ± SD was made using SPSS version 25.
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Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
So, the ANOVA and ,Chi sequre was used to
compare between variables .when Anova analysis
showed a signicant different between groups we
used Tukey test (Post Hoc) to determine which
groups differed from other groups ,probability
value of less than 0.05 and 0.01 were accepted
as signicant.
RESULT
The current study’s results indicated statisti-
cally signicant differences in the average nuclear
area values across different areas in this investiga-
tion The average values and associated standard
deviations for all the variables under investigation
are displayed in (Table I). Table II show that the
epithelial cells close to band area exhibited the
most signicant decrease in a nuclear area rela-
tive to the other sites examined. this decrease was
statistically signicant at a signicance level of
p<0.05.and the control area is more signicant
increase in nuclear area than other sites . Addi-
tionally, the mean values of the cytoplasmic area
exhibited a statistically signicant increase in the
band area more than two other sites while control
area was lesser signicant different than other two
sites. Also a statistically signicant difference was
observed between the mean Nuclear cytoplasmic
area ratio (NA/CA) ratio values at (p<0.05) so
the control area was the more Nuclear cytoplasmic
area ratio (NA/CA) than molar and Bracket site
while the band site was the lesser one. Table III
shows a higher number of nucleated cells in the
supercial layer of the oral mucosa region that
is in touch with the xed orthodontic device. A
nucleated supercial layer is also present near the
bracket and molar band area. However, no such
layer is observed in the control area.
The smears were categorized using the
Papanicolaou classication system. There was
a signicant increase(P≤0.01) in the of class I
in the control area, while class II type smear
(inammatory). Show higher in contact with the
molar band and less in bracket area as shown in
the (Table IV). (Figure 1) shows the epithelial
cell’s class ll (inflammation) adjacent to the
orthodontic device of neutrophils, perinuclear
halo pycnotic nucleus and binucleation as
characteristic of inammation.
Table I - Cytological measurement in epithelium cells from different site
Variable
Control Bracket Band
P value
Mean S.D Mean S.D Mean S.D
NA* 149.3 7.9 141.2 ±6.5 135.3 ±6.7 0.042
CA* * 3668 ±102.7 4396 ±137.4 6533 ±215.1 0.025
NA /CA *** 0.04 ±0.005 0.03 ±0.002 0.02 ±0.001 0.032
*nuclear area; **cytoplasmic area; ***nuclear cytoplasmic area ratio; S.D: Std. Deviation.
Table II - Comparison between difference groups in NA, CA and NA/CA by Tukey test (Post Hoc)
Group Control *Bracket Control *Band Band *Bracket
NA 0.0345* 0.026* 0.0125*
CA 0.0124* 0.0002* 0.0144*
NA/ CA 0.0507* 0.0001* 0.0419*
A significant different at * P≤0.05
Table III - Type of predominant cell from the different regions of the oral smears
Region
Enucleated
superficial cells
Nucleated
superficial cells
Intermediated
layer cells
Basal
layer cells Total
N % N % N % N %
Bracket area 3 15 9 45 8 40 0 0 20
Band area 4 20 10 50 6 30 0 0 20
Control 0 0 14 70 6 30 0 0 20
Total 7 11.6 33 55 20 33.3 0 0 60
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Changes in epithelial cells adjacent to orthodontic devices
Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
DISCUSSION
The current study investigated 10,250 oral
epithelial cell (60 slides) from patients by mean
cytological and cytomorphological analysis.
Our study ndings conrmed that metallic
brackets and molar bands can cause irritation
to the epithelial cells and create alterations, this
agree with Pereira et al. research [8]. As show
in the (Tables I, II) the insertion of orthodontic
brackets and band for orthodontic treatment
resulted in a reduction in the size of the nucleus,
an increase in the cytoplasm, and a decrease in
the ratio of the nucleus to the cytoplasm of the
oral epithelial cells located next to the band then
brackets area . Increase cytoplasmic area facilitate
increase synthesis of proteins to adaptation of
the tissue to the changes due to inammation
adjacent to orthodontic device [11].
Shabana et al. [12], agree this phenomenon as
well, conrming that cells exposed to orthodontic
devices had an enlargement of unaffected cells.
The smears obtained from exfoliative cytology,
from (Table III), typically show a deciency of
basal cell layer of intact oral epithelium. This
shows that this method does not eradicate cells
from the underlying layers of the epithelium.
The quantitative investigation revealed that
a majority of cells in the supercial layer of the
Table IV - Classification of smears by papanicolaou system
Papanicolaou
classification Bracket area % Band area % Control area % p value
Class 1 8 40 5 25 18 90 0.0001 **
Class II 12 60 15 75 2 10 0.0001 **
Class III 0 0 0 0 0 0 NS
Class IV 0 0 0 0 0 0 NS
Class V 0 0 0 0 0 0 NS
Total 20 100 20 100 20 100
**(P≤0.01) significant different
Figure 1 - High-power view showing different cellular changes in oral epithelia in class II classification from band and bracket areas. (A), show
cell with perinuclear halo. (B), show Pycnotic nucleus. (C), infiltration of neutrophils. (D), Cell with Binucleation.
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Altaee ZH et al.
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Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
oral mucosa were affected by friction occur with
the site of band tube. This phenomenon may arise
due to the thickening of the cornea layer, resulting
in a higher prevalence of supercial cells. This
is agree with the ndings of Kwon et al. [13].
Additionally, it was discovered that prolonged
irritation leads to increased cells of the supercial
layer due to the process of keratinization and the
excessive growth of the oral mucosa.
Regarding the Papanicolaou’s classifica-
tion [14], in Table IV, the classication in the
bracket area was as follows: 40% class I and
60% class II; in the area of orthodontic bands:
25% class I and 75% class II. For the control
group, 90% were class I and only 10% were class
II. Therefore, inammation was associated, in
decreasing order, with the orthodontic band area,
followed by the bracket area and, more discreetly,
in the mucosa of patients in the control group.
The presence of brackets and molar tubes
can cause detrimental effect to the epithelial
cells. These physical agents can hurt the epithelial
cell and the neighboring epithelial cell near
the molar band [9]. This is may be due to the
challenges ineffectively cleaning of this particular
location in band area, leading to plaque buildup.
Consequently, the presence of plaque bacteria
might trigger inammation (due to Prescence of
acidic
streptococcus mutans
in the plaque[10].
Ramaesh
et al
., [15], demonstrated through
cytomorphometric analysis that dysplastic lesions
and spinocellular carcinomas display a gradual
reduction in cytoplasm width when compared
to normal cells, accompanied by a gradual loss
in nucleus size. Our investigation found no
changes in the morphological features of smear
cells collected from the mucosa neighboring the
orthodontic device. The ndings of this study are
consistent with previous research [8,16] that has
proven that cellular alterations in the oral mucosa
resulting from friction with orthodontic devices
do not lead to malignant transformation (with
a 0% occurrence of class III, , and V). Studies
have demonstrated that attaching orthodontic
appliances to the oral mucosa cannot produce
cytotoxicity or genotoxicity [17-19].
Berstein and Miller [20], shown normal
cell morphology is characterized by copious
cytoplasm and a small, concentrated singular
nucleus. However, in this study, the area where
the orthodontic device is placed, specically the
band area, exhibits some degree of dysplasia
and morphological changes as show in
(Figure 1 A, B, C, D).
Biopsy is widely regarded as the gold-
standard method of evaluating mucosal diseases.
However, the noninvasive technique of exfoliative
cytology is sensitive for detecting cellular
alterations in healthy mucosa. Exfoliative
cytology evaluations can serve as a para-clinical
method for assessing cellular damage before
the manifestation of clinical symptoms. An
orthodontic device is a physical agent that
irritates the oral mucosa. A more significant
number of keratinized cells and inammatory
cell in the mucosa can be attributed to the friction
experienced in the area close to the orthodontic
device [9]. The ions liberated by stainless steel
orthodontic device have a genotoxic effect due
to corrosion of the metal in the orthodontic
appliance on oral mucosa cells. However, this
impact can be undone due to the presence
of cellular DNA repair mechanisms [21,22].
So, the orthodontist should emphasize of the
important oral hygiene to the patient to prevent
further inammation which occur due to plaque
accumulation associated with device [21] and
check any signs of inammation or sharp edge
and make adjustments. And the orthodontic
device should be fabricated with least alteration
to the epithelium tissue as much as possible.
CONCLUSION
Metal brackets and molar bands cause
cytomorphometric and cytomorphological changes
in tissue adjacent to orthodontic devices, especially
adjacent molar bands, which show inammatory
change in type II inammation smears according
to the Papanicolaau classication. The orthodontic
appliance induces inflammation, however
malignant change was not observed. As a result,
the orthodontist must pay attention to the patient’s
careful cleanliness of their teeth and orthodontic
device to prevent any inammation that could
worsen the condition.
Author’s Contributions
ZHA: Conceptualization, Methodology,
writing- original draft, preparation, Visualization
and supervision. ATB: Sample collection,
Validation and investigation. LHAAS: Writing
-Review and Editing, Software, Data curation and
formal analysis. BZK: Cytological study.
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Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
Conict of Interest
No conict of interest of this article.
Funding
None.
Regulatory Statement
This study was conducted in accordance with
all the provisions of the local human subjects
oversight committee guidelines and policies of:
University Of Anbar, Ethical Approval Committee.
The approval code for this study is: 116 at
8/11/2023.
REFERENCES
1. Wolff A, Ship JA, Tylenda CA, Fox PC, Baum BJ. Oral mucosal
appearance is unchanged in healthy, different-aged persons.
Oral Surg Oral Med Oral Pathol. 1991;71(5):569-72. http://doi.
org/10.1016/0030-4220(91)90364-I. PMid:2047098.
2. Sognnaes RF, Albright JT. Electron microscopy of the epithelial
lining of the human oral mucosa. Oral Surg Oral Med Oral
Pathol. 1958;11(6):662-73. http://doi.org/10.1016/0030-
4220(58)90014-8. PMid:13553320.
3. de Arruda EP, Trevilatto PC, Camargo ES, Woyceichoski IEC, Naval
Machado MA, Vieira I,etal. Preclinical alterations of oral epithelial
cells in contact with orthodontic appliances. Biomedical Papers.
2011;155(3):299-303. http://doi.org/10.5507/bp.2011.043.
PMid:22286817.
4. Kluemper GT, Hiser DG, Rayens MK, Jay MJ. Efficacy of a wax
containing benzocaine in the relief of oral mucosal pain caused
by orthodontic appliances. Am J Orthod Dentofacial Orthop.
2002;122(4):359-65. http://doi.org/10.1067/mod.2002.126405.
PMid:12411880.
5. Kvam E, Bondevik O, Gjerdet NR. Traumatic ulcers and pain in adults
during orthodontic treatment. Community Dent Oral Epidemiol.
1989;17(3):154-7. http://doi.org/10.1111/j.1600-0528.1989.
tb00012.x. PMid:2736897.
6. Mei RMS, de Lima AAS, Leão JCB Fo, Tanaka OM, Guariza O Fo,
Camargo ES. A cytological analysis of the oral mucosa adjacent
to orthodontic devices. Eur J Gen Dent. 2013;2(02):119-23.
http://doi.org/10.4103/2278-9626.112308.
7. Shulman JD, Beach MM, Rivera-Hidalgo F. The prevalence of
oral mucosal lesions in US adults: data from the Third National
Health and Nutrition Examination Survey, 1988-1994. J Am Dent
Assoc. 2004;135(9):1279-86. http://doi.org/10.14219/jada.
archive.2004.0403. PMid:15493392.
8. Pereira BR, Tanaka OM, Lima AA, Guariza-Filho O, Maruo H,
Camargo ES. Metal and ceramic bracket effects on human buccal
mucosa epithelial cells. Angle Orthod. 2009;79(2):373-9. http://
doi.org/10.2319/021508-92.1. PMid:19216594.
9. Rafighi A, Moghaddam F, Moslemzadeh SH, Nemati R, Roshangar
L. Effect of orthodontic fixed appliances on epithelial cells of
lower lip oral mucosa during orthodontic treatment. Iran J
Orthod. 2012;7(3):44-8.
10. Umalkar YN, Jadhav VV, Paul P, Saoji KP. Comparative evaluation
of cleaning efficacy of interdental brush and interdental floss in
orthodontics patients from vidarbha region: an interventional
study. Cureus. 2023;15(9):e46191. http://doi.org/10.7759/
cureus.46191. PMid:37905279.
11. Nanci A. Ten Cate’s oral histology: development, structure, and
function. St Louis: Mosby-Year Book. Inc; 1998.
12. Shabana AH, el-Labban NG, Lee KW, Kramer IR. Morphometric
analysis of suprabasal cells in oral white lesions. J Clin Pathol.
1989;42(3):264-70. http://doi.org/10.1136/jcp.42.3.264.
PMid:2703543.
13. Kwon OS, Chung JH, Cho KH, Suh DH, Park KC, Kim KH,etal.
Nicotine-enhanced epithelial differentiation in reconstructed
human oral mucosa in vitro. Skin Pharmacol Appl Skin Physiol.
1999;12(4):227-34. http://doi.org/10.1159/000066247.
PMid:10420143.
14. Matias AV, Cerentini A, Macarini LAB, Amorim JGA, Daltoé FP, von
Wangenheim A. Segmentation, detection, and classification of
cell nuclei on oral cytology samples stained with papanicolaou.
SN Computer Science. 2021;2(4):285. http://doi.org/10.1007/
s42979-021-00676-8.
15. Ramaesh T, Mendis B, Ratnatunga N, Thattil R. Cytomorphometric
analysis of squames obtained from normal oral mucosa and lesions
of oral leukoplakia and squamous cell carcinoma. J Oral Pathol
Med. 1998;27(2):83-6. http://doi.org/10.1111/j.1600-0714.1998.
tb02099.x. PMid:9526735.
16. Mustafa MN. The histopathological change of oral mucosa in
patient with orthodontic appliance. World Bulletin of Public
Health. 2022;13:176-81.
17. Wever DJ, Veldhuizen AG, Sanders MM, Schakenraad JM, van
Horn JR. Cytotoxic, allergic and genotoxic activity of a nickel-
titanium alloy. Biomaterials. 1997;18(16):1115-20. http://doi.
org/10.1016/S0142-9612(97)00041-0. PMid:9247349.
18. Montanaro L, Cervellati M, Campoccia D, Prati C, Breschi
L, Arciola C. No genotoxicity of a new nickel-free stainless
steel. Int J Artif Organs. 2005;28(1):58-65. http://doi.
org/10.1177/039139880502800110. PMid:15742311.
19. Angelieri F, Carlin V, Martins RA, Ribeiro DA. Biomonitoring of
mutagenicity and cytotoxicity in patients undergoing fixed
orthodontic therapy. Am J Orthod Dentofacial Orthop. 2011;139(4
Suppl):e399-404. http://doi.org/10.1016/j.ajodo.2009.06.029.
PMid:21435548.
20. Bernstein ML, Miller RL. Oral exfoliative cytology. J Am Dent
Assoc. 1978;96(4):625-9. http://doi.org/10.14219/jada.
archive.1978.0138. PMid:273634.
21. Hafez HS, Selim EMN, Eid FHK, Tawfik WA, Al-Ashkar EA, Mostafa
YA. Cytotoxicity, genotoxicity, and metal release in patients with
fixed orthodontic appliances: a longitudinal in-vivo study. Am
J Orthod Dentofacial Orthop. 2011;140(3):298-308. http://doi.
org/10.1016/j.ajodo.2010.05.025. PMid:21889074.
22. Natarajan M, Padmanabhan S, Chitharanjan A, Narasimhan
M. Evaluation of the genotoxic effects of fixed appliances
on oral mucosal cells and the relationship to nickel and
chromium concentrations: an in-vivo study. Am J Orthod
Dentofacial Orthop. 2011;140(3):383-8. http://doi.org/10.1016/j.
ajodo.2010.07.027. PMid:21889083.
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Braz Dent Sci 2024 Apr/June;27 (2): e4142
Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
Altaee ZH et al.
Changes in epithelial cells adjacent to orthodontic devices
Date submitted: 2023 Nov 09
Accept submission: 2024 Jun 01
Zena Hekmat Altaee
(Corresponding address)
University Of Anbar, College of Dentistry, Ramadi, Anbar, Iraq.
Email: zena.hikmt@uoanbar.edu.iq
