Evaluation of salivary alpha-amylase and cortisol levels in patients undergoing orthodontic mini-implant treatment: a short-term prospective comparative study.

Abstract

Background: This study aimed to evaluate salivary alpha-amylase (sAA) and salivary cortisol (sC) levels, alongside self-reported dental anxiety, in patients undergoing orthodontic mini-implant (OMI) placement compared with those receiving routine orthodontic treatment (noninvasive follow-up procedures such as archwire or elastic ligature replacement). The primary outcomes were the changes in sC and sAA levels, while the secondary outcome was the dental fear survey (DFS) score. It was hypothesized that OMI placement would elicit stronger physiological and psychological stress responses.

Methods: A short-term prospective comparative study was conducted on 54 participants (27 OMI and 27 control), aged 12-30 years. Dental anxiety was assessed using the DFS. Salivary samples were collected at baseline (T1) and immediately after the procedure (T2) for sAA and sC analysis. Mann-Whitney U, Wilcoxon, t-tests, and mixed ANOVA were performed (α = 0.05).

Results: sC increased significantly in the OMI group (0.30 ± 0.09 to 0.39 ± 0.13 µg/dl; Δ = +0.09 µg/dl, P < .001) but remained stable in controls. The OMI group demonstrated higher DFS scores than controls (63.81 ± 22.59 vs. 40.07 ± 21.28). Female participants reported higher dental fear than males (P = .004), and DFS correlated negatively with age (P = .014). sAA levels were higher in the OMI group, although neither group nor time effects were significant.

Conclusions: Orthodontic mini-implant placement induces stronger acute stress responses than routine orthodontic treatment, as evidenced by higher dental fear and increased salivary cortisol. These findings highlight the need for enhanced patient management during invasive orthodontic interventions.