Metal and Ceramic Bracket Effects on Human Buccal Mucosa Epithelial Cells

Objective: To test the null hypothesis that metal and ceramic brackets have no effect on the epithelial cells of the buccal mucosa. Materials and Methods: Two metal and two ceramic brackets were bonded in 21 individuals of both sexes. With the use of liquid-based exfoliative cytology, morphometric and morphologic changes in buccal mucosa cells adjacent to these brackets were determined and were compared at three time points: baseline (T0), 60 days after placement (T1), and 30 days after removal of the brackets (T2). Results: A decrease in nuclear area and an increase in cytoplasmic area occurred in the buccal mucosa cells adjacent to the brackets at T1 (P < .01). At T2, this altered morphometry persisted only in cells adjacent to the metal brackets, although to a lesser degree than at T1 (P < .01). A greater decrease in nuclear area was noted in cells adjacent to the metal brackets than in those next to the ceramic brackets (P < .01). At T0, the proportions of surface and subsurface cells were similar, but at T1, a predominance of surface cells was observed (P < .05). At all time points, smears of cells appeared normal or normal with some inflammatory changes. Conclusion: The hypothesis is rejected. Placement of metal and ceramic brackets in the buccal cavity induces cellular alterations. These alterations do not suggest malignancy.