original article

Force decay evaluation of latex and non-latex orthodontic

intraoral elastics: in vivo study
Daniela Ferreira de Carvalho Notaroberto1, Mariana Martins e Martins2,
Maria Teresa de Andrade Goldner3, Alvaro de Moraes Mendes3, Cátia Cardoso Abdo Quintão3

DOI: https://doi.org/10.1590/2177-6709.23.6.042-047.oar

Objective: This clinical study was conducted in order to evaluate force decay over time of latex and non-latex orth-
odontic intraoral elastics. Methods: Patients (n = 15) were evaluated using latex and non-latex elastics in the periods of
: 0, 1, 3, 12 and 24 hours. The rubber bands were transferred to the testing machine (EMIC DL-500 MF), and force
values were recorded after stretching the elastic to a length of 25mm. Paired t test was applied and analysis of variance
(ANOVA) was used to evaluate the variation of force generated. LSD (Fisher’s least significant difference) post-hoc test was
thus employed. Results: As regards the initial forces (zero time), the values of force for non-latex elastic were slightly
higher than for the latex elastic. In the subsequent times, the forces generated by the latex elastic showed higher values.
Regarding the material degradation, at the end of 24 hours the highest percentage was observed for non-latex elastic.
Conclusions: The latex elastics had a more stable behavior during the studied period, compared with non-latex.

Keywords: Elastomers. Tensile strength. Latex. Silicone elastomers.

Objetivo: o objetivo deste estudo clínico foi avaliar e comparar o comportamento dos elásticos de látex e não látex quanto à perda
de força ao longo do tempo. Método: os pacientes (n = 15) foram avaliados usando ambos os tipos de material (látex e não látex)
em cada tempo: 0, 1, 3, 12 e 24 horas. Os elásticos foram transferidos para a máquina de ensaios mecânicos (EMIC DL-500 MF)
e os valores de força foram registrados após a distensão dos elásticos a uma distância de 25 mm. Foi aplicado o teste t pareado, e a
análise de variância (ANOVA) foi realizada para verificar a variação das forças geradas em todos os tempos estudados. Em seguida,
o teste post-hoc LSD (Fisher’s least significant difference) foi aplicado. Resultados: quanto às forças iniciais (tempo zero), os valores de
força dos elásticos não látex foram ligeiramente maiores do que dos elásticos de látex. Nos tempos subsequentes, as forças geradas
pelos elásticos de látex apresentaram valores superiores às geradas pelos elásticos não látex. Em relação à degradação do material, ao
fim do período de 24 horas, o maior percentual foi observado pelos elásticos não látex. Conclusões: os elásticos de látex apresen-
taram comportamento mais estável durante o período de estudo, em comparação aos não látex.

Palavras-chave: Látex. Elastômeros de silicone. Hipersensibilidade ao látex.

1
Universidade do Estado do Rio de Janeiro, Programa de Pós-graduação em How to cite: Notaroberto DFC, Martins e Martins M, Goldner MTA,
Odontologia, Departamento de Odontologia Preventiva e Comunitária (Rio de Mendes  AM, Quintão CCA. Force decay evaluation of latex and non-latex
Janeiro/RJ, Brazil). orthodontic intraoral elastics: in vivo study. Dental Press J Orthod. 2018 Nov-
2
Universidade Federal Fluminense, Faculdade de Odontologia, Disciplina de Dec;23(6):42-7. DOI: https://doi.org/10.1590/2177-6709.23.6.042-047.oar
Ortodontia (Niterói/RJ, Brazil).
3
Universidade do Estado do Rio de Janeiro, Departamento de Odontologia Submitted: October 06, 2017 - Revised and accepted: February 17, 2018
Preventiva e Comunitária, Disciplina de Ortodontia (Rio de Janeiro/RJ, Brazil).
» The authors report no commercial, proprietary or financial interest in the products
Contact address: Daniela Ferreira de Carvalho Notaroberto or companies described in this article.
Rua Eduardo Guinle, 55/1001, bloco 02, Botafogo, Rio de Janeiro/RJ » Patients displayed in this article previously approved the use of their facial and in-
CEP: 22.260-090 – Email: danielafcn@yahoo.com.br traoral photographs.

© 2018 Dental Press Journal of Orthodontics 42 Dental Press J Orthod. 2018 Nov-Dec;23(6):42-7
Notaroberto DFC, Martins e Martins M, Goldner MTA, Mendes AM, Quintão CCA original article

INTRODUCTION This study was approved by the Research Ethics

Orthodontic elastics are still valuable devices, wide- Committee of Hospital Universitário Pedro Ernes-
ly used in clinical practice, because they present many to/UERJ (Ethics Committee document #285.772).
varieties of application regarding the direction of force All participants received prior information about the
applied to the teeth to be moved, thus helping in the research and signed an informed consent form.
correction of several malocclusions.1 Intraoral latex (n  = 75) and non-latex elastics
Initially, these elastics were composed of natural (n = 75) (American Orthodontics, Sheboygan, USA),
rubber (latex), a raw material discovered and used for at a 3/16-inch size were tested. They were within the
centuries by the ancient Inca and Mayan civilizations.2 expiration dates and stored in sealed plastic packages
They are still widely used today,3,4 mainly because of in a cool and dark environment.
the high flexibility and low cost.5 However, by the Using a specific formula for split-mouth or cross-
1980s, allergic reactions to latex became more prevalent over studies,17 sample size calculation was performed
and better recognized.6,7 With the aim of maintaining based in a pilot study (n = 5), in which the values in
the mechanical properties of the elastics, without caus- gram-force (gf) generated by the elastics of the five
ing allergy in patients with hypersensitivity to latex, patients were used. The sample size of the present
orthodontic rubber elastics based on synthetic rubber study was then determined to be 13 patients, with
(non-latex) have been used more frequently.8-10 So, it 80% of test power, 5% of alpha level, 24.75 of stan-
is imperative to evaluate and compare the mechanical dard deviation of difference, and 20 of average dif-
properties of these two different materials. ference; however, to avoid missing data, 15 patients
Some laboratory studies were performed to analyze were selected for the study.
the behavior of non-latex elastics compared to latex Systematic convenience sampling was used, in
elastics.4,6,9,11-13 Most of these studies showed a marked which participants were selected in a post-graduate
reduction in the strength levels of these elastics within orthodontic program of a public university, follow-
the first 24 hours, showing the non-latex elastics limi- ing dental appointment schedules between February
tation in maintaining a constant force for an extended 2016 and August 2016.
period.4,6,11,12 Manufacturers have added chemical sub- Patients (n = 15) with mean age of 20.16 years,
stances to retard these effects and extend the lifetime of who were undergoing orthodontic treatment were
these elastomers.2 selected. As inclusion criteria they should be in final
However, in the oral cavity, the characteristics of elas- phase of the treatment, using rectangular or round
tics materials are affected by physical, chemical and bio- arches of 0.020-inch of diameter, with no extractions
logical factors, some of them related to functional activi- and with a prescription for using Class II or Class III
ties, salivary changes and nutrition habits.3,14 Non-latex intermaxillary elastics, on both side of the mouth.
elastics also must be tested in the oral environment and, The side selection for the use of each elastic mate-
at our knowledge, just one clinical study15 was reported in rial (latex or non-latex) was randomized and sequen-
the literature. The related article did not evaluate the first tial, using sealed brown envelopes, so that the patient #1
hours of use, which are described as being critical in rela- would use latex on the right side and non-latex on the
tion to the greatest force loss of the intermaxillary elas- left side (Fig 1), patient #2 would use non-latex on the
tics. Other few clinical studies evaluating intraoral elastics right side and latex on the left side, and so on.
were performed evaluating only latex elastics.3,16 The elastics were attached to canine and first mo-
Thus, the purpose of the present study was to evaluate lars hooks (Fig 1). The mean value of the distance be-
in vivo the force degradation of latex and non-latex elastics tween the hooks for the placement of the elastic was
exchanged at different times, over a period of 24 hours. 25 mm. The patients were instructed to use an inter-
maxillary elastic for 1, 3, 12 and 24 hours. They could
MATERIAL AND METHODS only remove the elastic to eat or brush the teeth, re-
A prospective controlled clinical trial with split-mouth placing the same elastic then.
design was conducted to evaluate the behavior of latex By the time of elastic removal, the patient was re-
and non-latex elastics over 24 hours. ferred to the clinic next to the laboratory, allowing

© 2018 Dental Press Journal of Orthodontics 43 Dental Press J Orthod. 2018 Nov-Dec;23(6):42-7
original article Force decay evaluation of latex and non-latex orthodontic intraoral elastics: in vivo study

Figure 1 - A) Latex elastic on the right side;

A B B) non-latex elastic on the left side.

the elastics to be removed from the patient mouth and RESULTS

immediately adapted to the mechanical testing ma- Although in baseline (control group) non-latex
chine (EMIC DL-500 MF), for force measurement. elastics have generated higher values than latex elastics
Each elastic was carefully transferred with a pair of when stretched to 25mm, in all the other periods the
tweezers by the same operator from the patient’s latex strength force values were superior to non-latex
mouths to the test machine, and was then discarded elastics. Paired t test showed significant difference be-
after measurement. tween latex and non-latex elastics in almost all observed
The cross-head speed of the testing machine was times, except in baseline (control group) (Table 1).
30 mm/min, as recommended by Fernandes et al18 Analysis of variance for paired data (ANOVA)
and Lopez et al,12 and the calibrated load cell capac- detected significant differences when comparing the
ity was 2.0 Kgf. Extension force magnitudes of the strength force values of latex and non-latex elastics
elastics were immediately recorded after they were between all times studied (p < 0.001). Then, LSD
removed from the patient’s mouth and stretched at post-hoc test was performed and statistical differences
a distance of 25 mm. All procedures were performed were found (Table 1).
by the same operator. Force degradation percentages for latex and non-
Descriptive statistics were used as mean, median, latex elastics, between all the times are shown in Fig-
standard deviation, maximum and minimum, relative ure  2. The highest percentage difference generated
to the elastic force values measured in grams/force and of force decay occurred between baseline and 1 hour
organized for the amounts of liberated force observed (14.60% for latex elastics and 27.32% for non-latex
at different time intervals. elastics). Over the next intervals (1-3 hours; 3-12 hours
The collected data were analyzed by paired t test, and 12-24 hours), the percentage difference generated
in order to compare the different types of elastic at of force decay occurred more subtly. After 24 hours of
each time; and by analysis of variance (ANOVA), to the study, the biggest difference between the degrada-
evaluate the variation of the forces generated at all se- tion percentage of the force was observed for non-latex
lected times. A post-hoc test (Fisher’s least significant elastics (39.23%) compared to latex elastics (19.92%).
difference, LSD) was applied to identify which pairs All the participants had an excellent cooperation
of the force remained significantly different during with the use of elastic, but of the 15 evaluated pa-
the study (SPSS software version 20.0; IBM, Ar- tients, 7 needed to repeat the use of the elastics dur-
monk, NY). A p value less than 0.05 was considered ing the 24-hour period, due to the rupture of the
statistically significant. non-latex elastics.

© 2018 Dental Press Journal of Orthodontics 44 Dental Press J Orthod. 2018 Nov-Dec;23(6):42-7
Notaroberto DFC, Martins e Martins M, Goldner MTA, Mendes AM, Quintão CCA original article

Table 1 - Mean and standard deviation of the forces (gf) generated by intermaxillary orthodontic latex and non-latex elastics, according to time of experiment.

Time
Type of elastic 0h 1h 3h 12h 24h
Latex 224.49 ± 11.09a 191.70 ± 11.92b 186.18 ± 10.25bc 179.13 ± 10.41c 179.75 ± 16.45c
Non-latex 228.03 ± 13.33a 165.72 ± 10.19b 162.43 ± 13.68b 146.43 ± 13.27c 138.56 ± 14.14d
Paired t test p = 0.470 p < 0.001 p < 0.001 p < 0.001 p < 0.001

Values with different superscript letters (a, b, c, d) indicate significant differences, over time (LSD post-hoc test).

the forces released by the latex and non-latex elastics

250 was conducted by Pithon et al15 and evaluated only 0,
12 and 24 hours. The total time of 24 hours was chosen
200
because this is the period in which routinely it is asked
Gram-force (gf)

150 the patient to replace the elastics by new ones.

Latex
Non-latex
The results showed that both elastics (latex and
100
non-latex) have progressive force reductions over time
50
(24 hours period).
The biggest drop of the force unleashed by the latex
0
0h 1h 3h 12h 24h
elastics occurred in the first hour, with significant dif-
ference. On subsequent times, the decrease in strength
Intervals of times
0-1h 1-3h 3-12h 12-24h 0-24h was softer, without statistical significance (Table 1).
Latex 14.60% 2.87% 3.78% -0.34% 19.92% These results are in agreement with the findings of labo-
Non-latex 27.32% 1.98% 9.85% 5.37% 39.23% ratory studies affirming that the greatest fall in the values
of the forces generated by the latex intermaxillary elas-
Figure 2 - Latex and non-latex elastics behavior in the 24-hour period.
tics occur in the first hours after their distension and as
time progressed, the degradation became slower.5,18,19,24
The few clinical studies conducted also reported this
behavior. Wang et al3 and Qodcieh et al16 found that the
large force loss occurred within the first hour.
DISCUSSION The non-latex elastics also demonstrated a significant
The literature has provided several studies evaluating large decrease in the amount of force generated between
the force released by the intermaxillary elastics conducted 0 and 1 hour, but continued to show significant loss of
in laboratorial environment.5,6,8-13,18-21 Some have evalu- force within 3 to 12 hours and within 12 to 24 hours
ated the differences between the forces released by latex (Table 1). Similarly, Kersey et al,4 in a study involving
and non-latex elastics.4,6,9,11-13 However, it is known that the non-latex intermaxillary elastics of 1/4-in diameter,
the oral medium is much more complex, with a great va- noticed a decrease in the values of forces generated be-
riety of interacting factors such as salivary pH, diet, oral tween 20% and 30% in the first hour, and 40% to 60%
hygiene conditions and oral habits.3,14 In  situ study, as after 24 hours. However, higher percentage values than
conducted in this research, is the more precise method those obtained in this study were reported by Araujo
to test materials that will be held in the oral environment. and Ursi,23 who observed a reduction in the amount of
A split-mouth study model was adopted, reducing vari- force generated by the non-latex elastics from 20.31%
ability and allowing a smaller sample.17 to 38.47% in the first hour, and from 47.7% to 75.95%
The elastic force was measured at 0 (baseline), 1, 3, on 28 days of stretching. The only clinical study with
12 and 24 hours, considering the fact that laboratory non-latex elastics did not evaluate the first hours, but
studies indicate the greatest force drop occurring in the showed a progressive and significant reduction of the
first hours.5,18,19,22,23 The only clinical study found in our force generated by these elastics from 0 to 12 hours and
literature review that analyzed the differences between also from 12 to 24 hours.15

© 2018 Dental Press Journal of Orthodontics 45 Dental Press J Orthod. 2018 Nov-Dec;23(6):42-7
original article Force decay evaluation of latex and non-latex orthodontic intraoral elastics: in vivo study

When the forces generated by the intermaxil- It is important to emphasize that this study evaluated
lary elastics of the two types (latex and non-latex) the difference in composition between elastics. Thus,
were compared, significant differences were found only one trademark and one size were evaluated, for a
in all the times studied, except for the baseline (Ta- better interpretation of the results. Other brands and di-
ble  1). These data are in agreement with the study ameters may perform differently and must be tested.
by Pithon et al,15 who found that latex intermaxil-
lary elastics with 1/8-in diameter lose less force over CONCLUSIONS
time compared to non-latex elastics. However, in Latex elastics showed a more stable behavior within
the study of Pithon et al,15 latex and non-latex elas- 24 hours, when compared to non-latex elastics.
tics 1/4-in and 5/16-in in diameter demonstrated no During the oral experimental time (3, 12 and 24
significant differences after 24 hours. hours), the latex elastics had higher force released val-
The most significant decrease in force values ​​oc- ues, when compared to non-latex elastics.
curred in the first hour, for both latex and non-latex
elastics, with the difference percentage higher for
non-latex elastic, of 27.32%, compared to the differ-
ence for latex, 14.60%. After 24 hours, the percent-
age difference for non-latex elastics was 39.23% and
for latex was 19.92% (Fig 2). The laboratory stud-
ies9,12 found similar results, detecting greater loss of
strength for the non-latex elastics, when compared
to the latex ones. Kersey et al4, when comparing la-
tex and non-latex elastics from a single manufacturer
(American Orthodontics, the same manufacturer
used in this study), found that latex elastics maintain
higher strength levels over 24 hours, retaining 83% of
initial strength, compared to 69% retained by non-
latex elastics. The clinical study showed the same re-
sults, a greater loss of the initial force in 24 hours for
the non-latex elastics.15
Of the 15 patients evaluated, 7 needed to re-
peat the use of the elastics during the 24-hour pe-
riod, due to the rupture of the non-latex elastics.
This  limitation of non-latex elastics was also ob- Author’s contribution (ORCID )
served in the studies of Russell et al6 and Hwang
and Cha.13 No fracture was observed in latex elastic Daniela F. C. N. (DFCN): 0000-0002-3834-1797
throughout the clinical study. Mariana M. Martins (MMM): 0000-0002-1237-1947
These findings are important because non-latex Maria T. A. Goldner (MTAG): 0000-0003-4690-9562
elastics are an alternative for patients with latex sensitiv- Cátia C. A. Quintão (CCAQ): 0000-0003-4627-8190
ity. It is necessary to understand the clinical behavior Álvaro de M. Mendes (AMM): 0000-0002-3428-0296
of these elastics in order to establish the best way to use
them. As the clinical behavior was different at all times Conception or design of the study: DFCN, AMM. Data
tested in the oral cavity (1, 3, 12, 24 hours) and having acquisition, analysis or interpretation: DFCN, MMM,
these non-latex elastics released smaller forces and los- MTAG, CCAQ, AMM. Writing the article: DFCN,
ing greater amount of force over time, it is suggested MTAG. Critical revision of the article: DFCN, MMM,
that the non-latex elastics must be changed more fre- MTAG, CCAQ, AMM. Final approval of the article:
quently in order to obtain a better action during their DFCN, MMM, MTAG, CCAQ, AMM. Obtained
use in orthodontic treatment. funding: DFCN. Overall responsibility: DFCN.

© 2018 Dental Press Journal of Orthodontics 46 Dental Press J Orthod. 2018 Nov-Dec;23(6):42-7
Notaroberto DFC, Martins e Martins M, Goldner MTA, Mendes AM, Quintão CCA original article

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© 2018 Dental Press Journal of Orthodontics 47 Dental Press J Orthod. 2018 Nov-Dec;23(6):42-7