Abstract
BACKGROUND: Therapeutic mouthwashes are commonly used in dentistry to support mechanical plaque removal. Their interaction with orthodontic materials is increasingly studied due to potential effects on biocompatibility and biomechanics. OBJECTIVE: To investigate in a systematic manner and evaluate the quality of the available evidence from randomized clinical trials regarding the effects of various mouthwashes on the morphology, structure, and mechanical properties of polymeric and metallic orthodontic materials. SEARCH METHODS: Comprehensive electronic and manual searches were conducted in seven databases from inception until August 2024. SELECTION CRITERIA: We analysed randomized controlled clinical studies that examined the impact of mouthwashes on the morphology, structure, and mechanical properties of both polymeric and metallic orthodontic materials. DATA COLLECTION AND ANALYSIS: Data eligibility, data extraction, and risk of bias (RoB-2 tool) were performed independently. RESULTS: Ten studies were included, with most of them presenting some concerns in terms of bias. Chlorhexidine mouthrinse use did not affect the shear bond strength of polycarbonate brackets, the soldering alloys, as well as the stainless-steel bracket surfaces, but increased the roughness and friction of stainless-steel wires. The corrosion and mechanical properties of NiTi wires were not significantly affected by chlorhexidine. Rinsing with fluoride solutions increased surface roughness of NiTi wires, with more pronounced effects seen in acidulated fluoride solutions. While yield strength increased, no significant impacts on unloading force or modulus of elasticity was observed. Mouthwashes containing Salvadora persica did not significantly alter the surface topography of stainless-steel brackets and the roughness of stainless-steel archwires. CONCLUSIONS: The evidence from randomized clinical trials suggests that chlorhexidine- and fluoride-containing mouthwashes may impact the structure and certain mechanical properties of stainless-steel and NiTi archwires. While study limitations exist, clinicians should be mindful of possible effects on orthodontic treatment. REGISTRATION: Open Science Framework: osf.io/hz6wk.