Prevention of demineralization around orthodontic brackets in vitro

doi:10.1016/j.ajodo.2006.09.043

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 131, Issue 6, June 2007, Pages 705.e1-705.e9

https://doi.org/10.1016/j.ajodo.2006.09.043 Get rights and content

Introduction

The demineralization of enamel adjacent to orthodontic brackets is a significant clinical problem. The purpose of this in-vitro study was to investigate the effect of sodium fluoride (Colgate Neutrafluor 9000 ppm) (NaF) and 10% casein phosphopeptide-amorphous calcium phosphate (GC Tooth Mousse) (TM) on enamel demineralization adjacent to orthodontic brackets.

Methods

Forty specimens were sectioned from the buccal or lingual surfaces of extracted sound third molars. Twenty specimens had molar tubes bonded with composite resin (Transbond XT, 3M, St Paul, Minn) (CR), and 20 were bonded with resin-modified glass ionomer cement (Fuji Ortho LC, GC America, Alsip, Ill) (RMGIC). A 2-mm window for enamel demineralization was prepared. The specimens were randomly divided into 4 treatment groups: control, TM, TM/NaF (50/50 w/w), and NaF. The treatment solutions were placed around the bracket margins, and the specimens were immersed inverted into a carbopol demineralization solution at 37°C. The enamel specimens were exposed for 96 hours, with the demineralization and topical solutions changed every 4 hours. Quantitative light-induced fluorescence (QLF) images were taken every 8 hours under controlled conditions. The difference in fluorescence (ΔF) and the proportional ΔF (%F) change between baseline and 96 hours was calculated.

Results

RMGIC significantly reduced ΔF and %F when compared with CR (ANOVA, P = .029 and P = .034, respectively). Application of TM with CR, NaF with CR, and TM/NaF with CR significantly reduced ΔF and %F compared with the control CR (Tukey post-hoc test, P <.001). Application of TM/NaF with RMGIC significantly reduced ΔF and %F compared with the control RMGIC (Tukey post-hoc test, P = .008, P = .019, respectively).

Conclusions

With the limitations of any in-vitro study, the following clinical conclusions can be drawn. The use of RMGIC alone can significantly decrease enamel demineralization compared with CR. The application of TM/NaF can provide significant additional prevention of enamel demineralization when RMGIC is used for bonding. The application of TM, NaF, or TM/NaF can significantly prevent enamel demineralization when CR is used for bonding. The use of both agents should be recommended for any at-risk orthodontic patient to provide preventive actions and potentially remineralize early (subclinical) enamel demineralization.

Section snippets

Material and methods

Ethics approval (HREC Project No 050376) was obtained from the Human Research Ethics Committee of the University of Melbourne before this research project.

Twenty-five previously collected third molars from a fluoridated community were stored in 10% neutral buffered formalin solution for at least 2 weeks. All teeth were rinsed and stored moist in double deionized water (MilliQ water, Millipore Corp, Billerica, Mass) before experimental use. The outer enamel surface was polished wet to a mirror

Results

The control CR test group showed the greatest amount of enamel demineralization, whereas the TM and NaF RMGIC groups had the least amount of demineralization (Table II). One-way ANOVA showed statistically significant (P <.05) differences between all test groups, but not within each test group (Table III).

The CR specimens showed significantly greater demineralization than the RMGIC specimens at 96 hours (CR %F = 33.71 ± 23.85; RMGIC %F = 20.56 ± 12.23; t test, P = .034). The use of RMGIC alone

Discussion

The use of topical medicaments that can successfully prevent white spot lesion formation during orthodontic treatment would be beneficial for patients at risk of developing such lesions. The use of topical fluoride in its various forms (toothpaste, mouthrinse, gels, varnishes, fluoride-releasing cements, and elastomeric auxilliaries) has, to date, been the most commonly used caries preventive protocol during orthodontic treatment for at-risk patients, in addition to patient education and

Conclusions

With the limitations of any in-vitro study, the following clinical conclusions can be drawn.

1
The use of RMGIC for orthodontic bonding would appear to significantly prevent the development of enamel demineralization, even without the additional application of a topical agent.
2
If composite resin has been used for bonding, it is likely that the separate topical application of either TM or NaF gel (9000 ppmF) will prevent enamel demineralization.
3
If RMGIC has been used for bonding, the application of

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To investigate and compare the effect of self-assembling peptide SAP (P_11-4), casein phosphopeptide-amorphous calcium phosphate fluoride paste (CPP-ACPF), and fluoride varnish (FV) on preventing enamel demineralization around orthodontic brackets.
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Two-way ANOVA demonstrated significant differences between remineralizing agents and time points. After 4 weeks, the SAP (P_11-4) group had had significantly higher Ca/P ratio and SMH (1.68 ± 0.11 and 346.47 ± 55.38) compared to other groups, followed by CPP-ACPF (1.52 ± 0.19 and 283.53 ± 64.75), FV (1.37 ± 0.14 and 262.80 ± 82.98), and the control group (1.31 ± 0.10 and 213.00 ± 41.95). Significantly higher Ca/P ratio and SMH were observed at 2 weeks in the control group (1.44 ± 0.10 and 269.63 ± 57.37) and FV group (1.52 ± 0.09 and 321.17 ± 55.24) compared to 4 weeks. No significant differences were found regarding Ca/P ratio and SMH at 2 weeks in the CPP-ACPF (1.55 ± 0.15 and 295.14 ± 53.88) and SAP P_11-4 groups (1.64 ± 0.10 and 320.18 ± 58.04) compared to 4 weeks.
SAP (P_11-4) had the greatest remineralizing efficacy compared to FV and CPP-ACPF. Moreover, extended period of time improved the preventive efficacy of SAP (P_11-4) compared to the other regimens.
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The study aimed to evaluate and compare the surface micro-hardness, roughness, color, and morphology of enamel after Er,Cr:YSGG laser irradiation, followed by application of three types of bioactive glasses-based resin infiltrants, and the samples groups were challenged with the pH cycle.
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After laser irradiation, the micro-hardness was significantly high with 45S5 group compared to resin-only (p = 0.021), F-BG (p = 0.042), and B-BG (p = 0.001) groups. After the pH challenge, the micro-hardness values for all groups were reduced significantly (p ≤ 0.05). The surface roughness was least with the resin-only group and showed a non-significant difference with F-BG (p = 0.34) and significant differences with both B-BG (p = 0.005), and 45S5 (p = 0.010) groups. After the pH cycle, the roughness of all groups was increased significantly (p ≤ 0.05), except B-BG group showed a non-significant difference (p = 0.528). The B-BG group showed significantly high ΔE between day 0 and baseline compared to resin-only (p = 0.0008), F-BG (p = 0.017), and 45S5 (p = 0.029), whereas between day 14 and baseline, the lowest ΔE value was observed for B-BG (14.2 ± 2.10) and maximum for the resin-only (20.57 ± 2.47) group. The SEM images showed pitting on the surface of all resin infiltrant groups after 14 days of pH challenge.
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Experimental orthodontic composite were formulated using varying percentages of nano-hydroxyapatite particles. Assessments were based on four groups: a control group (3M™ Transbond™ XT) and experimental composites containing 2% (HA2), 5% (HA5) and 10% (HA10) hydroxyapatite. Vickers Microhardness test was performed to investigate the remineralizing effect in 3 stages: initial stage, after demineralization and after 4 weeks of exposure to artificial saliva. Scanning electron microscopy with energy dispersive X-ray spectroscopy analyser (SEM/EDAX) was used to evaluate hydroxyapatite precipitation and elemental composition of enamel surface. Shear Bond Strength tests were carried out using a universal testing machine and the debonding pattern was assessed using Adhesive Remnant Index (ARI).
All groups showed clinically acceptable SBS values. The highest SBS was achieved in the HA2 group, followed by Transbond™ XT, HA5 and HA10. There was no significant difference in the ARI scores. In terms of microhardness properties, HA5 and HA10 demonstrated a significant increase after 4 weeks. The results of SEM analysis showed the precipitation of hydroxyapatite crystals and EDAX analysis indicated the increase of calcium and phosphate ion peaks compared to the demineralized sample. The data were analysed using one-way ANOVA and Tukey's Post-hoc test.
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Citation Excerpt :
Therefore, the use of dental materials that provide bacterial clearance and fluoride release is recommended [14]. Glass ionomer cement may be selected due to its remineralizing and antibacterial properties, which are utilized in orthodontic treatment for bonding brackets and band cementation [15,16]. Due to the poor mechanical properties of glass ionomer when used for bracket bonding, the shear bond strength is significantly reduced compared to composite resin adhesives, but it is used as adhesive for bonding brackets and buccal tubes in at-risk orthodontic patients to provide preventive actions and potentially remineralize subclinical enamel demineralization [17,18].
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Original articlePrevention of demineralization around orthodontic brackets in vitro

Introduction

Methods

Results

Conclusions

Section snippets

Material and methods

Results

Discussion

Conclusions

Am J Orthod

Am J Orthod

Am J Orthod Dentofacial Orthop

J Am Dent Assoc

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Arch Oral Biol

Arch Oral Biol

Dent Clin North Am

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Orthodontic appliances and enamel demineralizationPart 2. Prevention and treatment of lesions

Am J Orthod Dentofacial Orthop

Decalcification during orthodontic treatment with fixed appliances—an overview

Br J Orthod

Enamel demineralization during orthodontic treatmentAetiology and prevention

Aust Dent J

Solubility properties of human tooth mineral and pathogenesis of dental caries

Oral Dis

Fluorides, orthodontics and demineralization: a systematic review

J Orthod

Caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliancesA systematic review

Caries Res

Effects of self-applied topical fluoride preparations in orthodontic patients

Angle Orthod

Current concepts on the theories of the mechanism of action of fluoride

Acta Odontol Scand

Resisting the onset of hydroxyapatite dissolution through the incorporation of fluoride

J Phys Chem

Remineralization of enamel subsurface lesions by casein phosphopeptide-stabilized calcium phosphate solutions

J Dent Res

Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate

J Dent Res

Retention in plaque and remineralization of enamel lesions by various forms of calcium in a mouthrinse or sugar-free chewing gum

J Dent Res

Binding characteristics of streptococcus mutans for calcium and casein phosphopeptide

Caries Res

Original article
Prevention of demineralization around orthodontic brackets in vitro