Exploring the potential of bromelain in orthodontic treatment
Maria Felicitas Ajeng Estuningtyas(1), Dyah Karunia(2), Yanuarti Retnaningrum(3*)
(1) Orthodontics Specialty Program, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
(2) Department of Orthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
(3) Department of Orthodontics, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
(*) Corresponding Author
Abstract
Bromelain, a proteolytic enzyme derived from pineapple, has attracted significant attention in both medicine and dentistry due to its diverse therapeutic properties. It has been widely studied for its anti-inflammatory, digestive, and wound-healing effects. In dentistry, bromelain has been investigated for applications such as reducing postoperative pain, facilitating enamel deproteinization, aiding in caries removal, and serving as an endodontic irrigant. In orthodontics, its potential lies in deproteinizing enamel to improve the bond strength of orthodontic brackets during placement. Studies suggest that applying bromelain prior to acid etching can enhance bracket bond strength, providing a safer and more efficient alternative to sodium hypochlorite. It has also shown promise in reducing plaque accumulation and gingivitis, particularly in patients with fixed orthodontic appliances. Bromelain’s antibacterial and anti-inflammatory properties support its role in maintaining oral hygiene and promoting healing. However, most existing evidence comes from in vitro or short-term clinical studies. Long-term clinical trials are needed to confirm its safety and efficacy in routine orthodontic practice.
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1. Li D, Jing M, Dai X, Chen Z, Ma C, Chen J. Current status of pineapple breeding, industrial development, and genetics in China. Euphytica. 2022; 218: 85.
doi:10.1007/s10681-022-03030-y
2. Leelakanok N, Petchsomrit A, Janurai T, Saechan C, Sunsandee N. Efficacy and safety
of bromelain: A systematic review and metaanalysis. Nutr Health. 2023; 29(3): 479-503.
doi: 10.1177/02601060231173732
3. Sharafeddin F, Yazdanpanah MH, Jowkar Z. Evaluation of the effects of bromelain and
papain enzymes on shear bond strength of composite resin to enamel. Int J Dent. 2021;
2021: 3233639. doi:10.1155/2021/3233639
4. Saptarini NM, Mustarichie R, Rahayu D. Isolation, characterization, and evaluation
of protease activity of crude bromelain of pineapple peel, core, and crown from Subang
District, Indonesia. J Pharm Bioallied Sci. 2023; 15(1): 42–48. doi:10.4103/jpbs.jpbs_26_22
5. Kansakar U, Trimarco V, Manzi MV, Cervi E, Mone P, Santulli G. Exploring the therapeutic
potential of bromelain: Applications, benefits, and mechanisms. Nutrients. 2024; 16(3):
2060. doi: 10.3390/nu16132060
6. Chakraborty AK, Mitra S, Tallei TE, Tareq AM, Nainu F, Cicia D, et al. Bromelain a potential
bioactive compound: A comprehensive overview from a pharmacological perspective.
Life. 2021; 11(4): 317. doi: 10.3390/life1104031711
7. Darmawati S, Kartika AI, Aulia DI, Handayani W, Aziz IR. Microstructural and protein subunit
analysis: The effect of protease from chayote, pineapple peel and biduri leaves as natural
tenderizer on mutton, beef and buff. Trends Sci. 2023; 20(3): 1-11. doi:10.48048/tis.2023.6519
8. Ali HI, Mutlak BH, Alshareef SA, Alhuwaymil Z. Effect of CCl4 on renal tissues of male
mice and prevented by pretreatment with bromelain loaded with gold nanoparticles:
Histopathological and caspase-9 expression alterations. Trends Sci. 2024; 21(12): 1-15.
doi: 10.48048/tis.2024.8358
9. AlQahtani FA, Kuriadom S, AlSaleh MS, AlAnzy H, George JM, AlShahri N. Effectiveness of
oral bromelain on third molar surgery patients: A systematic review of systematic reviews.
Adv Oral Maxillofac Surg. 2023; 12: 100449. doi:10.1016/j.adoms.2023.100449
10. Khatib MS, Devarasanahalli SV, Aswathanarayana RM, Venkateswara AH, Nadig RR. Microtensile bond strength of composite resin following the use of bromelain and papain as deproteinizing agents on etched dentin: An in vitro study. Int J Clin Pediatr Dent.
2020; 13(1): 43–47. doi: 10.5005/jp-journals-10005-1743
11. Mamani-Cori V, Coasaca-Ramos MM, Mamani- Cori S. Chemical-mechanical removal of caries
lesions in primary teeth with a bromelain-based gel. Brazil: Proceedings of the 9th Brazilian
Technology Symposium; 2023. 475–481. doi: 10.1007/978-3-031-66961-3_44
12. Mavani HAK, Tew IM, Wong L, Yew HZ, Mahyuddin A, Ghazali RA, Pow EHN. Antimicrobial efficacy of fruit peels eco-enzyme against Enterococcus faecalis: An in vitro study. Int J Environ Res Public Health. 2020; 17(14): 1–12. doi: 10.3390/ijerph17145107
13. Abinaya R, Nagar P, Urs P, Janani J, Smitha S. Comparing the efficacy of three minimally
invasive techniques on demineralized dentin in primary teeth and evaluating its residual dentin
and microhardness levels: An in vitro study. Int J Clin Pediatr Dent. 2020; 13(6): 585–589.
doi: 10.5005/jp-journals-10005-1815
14. Khatib MS, Devarasanahalli SV, Aswathanarayana RM, Venkateswara AH, Nadig RR. Microtensile bond strength of composite resin following the use of bromelain and papain as deproteinizing agents on etched dentin: An in vitro study. Int J Clin Pediatr Dent. 2020; 13(1): 43–47. doi: 10.5005/jp-journals-10005-1743
15. Hong JH, Kim MR, Lee BN, Oh WM, Min KS, Im YG, Hwang YC. Anti-inflammatory and mineralization effects of bromelain on lipopolysaccharide-induced inflammation of human dental pulp cells. Medicina (Kaunas). 2021; 57(6): 591. doi: 10.3390/medicina57060591
16. Mameli A, Natoli V, Casu C. Bromelain: An overview of applications in medicine and dentistry. Biointerface Res Appl Chem. 2021; 11(1): 8165–8170. doi: 10.33263/BRIAC111.81658170
17. Alves EHP, Carvalho ADS, Silva FRP, França LFC, Lenardo DD, Vasconcelos ACCG, et al. Bromelain reduces non-alcoholic fatty liver disease and periodontal damages caused by
ligature-induced periodontitis. Oral Dis. 2020;26(8): 1793–802. doi: 10.1111/odi.13476
18. Sharafeddin F, Safari M. Effect of papain and bromelain enzymes on shear bond strength
of composite to superficial dentin in different adhesive systems. J Contemp Dent Pract.
2019; 20(9): 1077–1081. doi: 10.5005/jp-journals-10024-2646
19. Rose J, Ghoneima A, Lippert F, Maxwell L, Eckert G, Stewart KT. A visual evaluation
of oral plaque removal utilizing an adjunct enzyme pre-rinse in orthodontic subjects.
Angle Orthod. 2020; 90(6): 844–850. doi:10.2319/120819-776.1
20. Patel C, Kumaresan S. Effectiveness of bromelain mouthrinse in gingival inflammation
and bacterial plaque among adolescents: A randomized clinical trial. Int J Community
Dent. 2022; 10: 64–69. doi:10.56501/intjcommunitydent.v1
21. Hernández-Zabaleta D, Coronel-Zubiate FT,Tafur Chávez NA, Salazar OP, Alexander E, Torres J. Shear resistance of bonded brackets in enamel treated with different deproteinizing agents. J Int Dent Med Res. 2025; 18(1): 88–94.
22. Pavithra S, Sharma G, Krishnan R. Influence of different acid etching times on the shear bond strength of orthodontic adhesives. Int J Adhes Adhes. 2020; 102: 102672.
doi: 10.1016/j.ijadhadh.2020.102672
23. Gupta N, Mittal N, Giri S, Arora C, Malhotra P, Ahluwalia R. A review of the research on
deproteinizing agents as a first step toward improved bonding. J Survey Fish Sci. 2023;
10(1): 1234–1242.
24. Barnhart EC, Campbell PM, Noureldin A, Julien K, Buschang PH. The quality of etched enamel in different regions and tooth types and its significance in bonding and the development of white spot lesions. Angle Orthod. 2021; 91(5): 576-582. doi: 10.2319/090120-761.1
25. Thankachan SP, Emmatty TB, Jose B, Krishna KK, Peter J, Methippara JJ, Sebastian R.
Comparative efficacy of three deproteinizing agents on the shear bond strength of pit and
fissure sealant: An in vitro study. Int J Prev Clin Dent Res. 2022; 9(3): 72.
doi: 10.4103/ijpcdr.ijpcdr_18_22
26. García-Mota LF, Fernández-Barrera M.-Á, Garcia-Contreras R, Grazioli G, Zamarripa-
Calderón JE. Rivera-Gonzaga JA, Cuevas-Suárez CE. Adhesive performance of pit and
fissure sealants on deproteinized enamel with different proteolytic agents: in vitro study. Dentistry Journal. 2024; 12(7): 206. doi: 10.3390/dj12070206
27. Alshahni RZ, Sato K, Hosaka K, Hatayama T, Chiba A, Foxton RM, et al. Effect of smear
layer deproteinization with enzyme solutions on bonding efficacy of one-step self-etch
adhesives. Int J Adhes Adhes. 2020; 102: 102672. doi:10.1016/j.ijadhadh.2020.102672.
28. Jakubovics NS, Goodman SD, Mashburn-Warren L, Stafford GP, Cieplik F. The dental
plaque biofilm matrix. Periodontol 2000. 2021; 86(1): 32-56. doi: 10.1111/prd.12361
29. Gerardi D, Bernardi S, Bruni A, Falisi G, Botticelli G. Characterization and morphological methods for oral biofilm visualization: where are we nowadays? AIMS Microbiol. 2024; 10(2): 391–414. doi: 10.3934/microbiol.2024020
30. Ren X, Zhang Y, Xiang Y, Hu T, Cheng R, Cai H. The efficacy of mouthwashes on oral microorganisms and gingivitis in patients undergoing orthodontic treatment: a systematic review and meta‑analysis. BMC Oral Health. 2023; 23(1): 204. doi: 10.1186/s12903-023-02920-4
31. Beumaputra AP, Handayani P, Syehrun SHR, Wulansari BA. Effectiveness of mouthwashes
banana and peel extract against plaque index of fixed orthodontic patient. J Kedokteran
Kesehatan. 2023; 10(1): 1–8. doi: 10.32539/jkk.v10i1.19033
32. Nanasombat S. Antioxidant, anti-oral cancer, and antimicrobial activity of medicinal
plant extracts: Development of mouthrinse formulations. Trends Sci. 2023; 20(5): 1-13.
doi: 10.48048/tis.2023.4785
33. Bhatt R, Miral M, Patel M, Patel F, Makwani D, Rohan-B, Megha-P, Mehta M. Assessment
of pit and fissure sealants following enamel deproteinization using three different methods
for shear bond strength and microleakage - a comparative in vitro study. J Pharm Negat.
2022; 13(05): 30320-3028. doi: 10.47750/pnr.2022.13.S05.451
34. Hikisz P, Bernasinska-Slomczewska J. Beneficial properties of bromelain. Nutrients.
2021; 13(12): 4313. doi: 10.3390/nu13124313
35. Bhoobalakrishnan MS, Rattan V, Rai S, Jolly SS, Malhotra S. Comparison of efficacy and
safety of bromelain with diclofenac sodium in the management of postoperative painand swelling following mandibular third molar surgery. Adv Oral Maxillofacial Surg. 2021; 3:
100112. doi: 10.1016/j.adoms.2021.100112
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