Elsevier

Seminars in Orthodontics

Volume 13, Issue 4, December 2007, Pages 281-291
Seminars in Orthodontics

Effects of Orthodontic Mechanics on Tooth Enamel: A Review

https://doi.org/10.1053/j.sodo.2007.08.009Get rights and content

Orthodontic treatment has the potential to cause some damage to dental enamel during cleaning with abrasives before etching, the acid etching process itself, enamel fractures caused by forcibly removing brackets, mechanical removal of composite remnants with rotary instruments or in the rebonding of failed brackets. In addition the enamel surface may be demineralized as the result of bacterial biofilm (dental plaque) around orthodontic attachments and also may get worn or eroded due to contact with ceramic brackets. Structural damage may also be caused intentionally by clinicians when reducing enamel by interproximal enamel stripping to gain space. Clinicians should make every effort to minimize damage to dental tooth enamel. In addition patients should be well informed about the importance of optimal oral hygiene.

Section snippets

Potential Damages During Bonding

Advances in adhesive technology and the introduction of new materials and bonding techniques have greatly influenced and revolutionized orthodontic practice. Contemporary adhesives can be divided into two systems: etch and rinse (E&R) and self-etch adhesives/primers (SEP).2 The first system (E&R) uses phosphoric acid etching and primer/adhesive resin application as two separate phases, while the latter (SEP) combines etching and priming together in a single phase and the adhesive resin in

Enamel Damage During Debonding Procedures

The objectives of debonding are to remove the attachment and all the adhesive resin from the tooth and to restore the surface as closely as possible to its pretreatment condition. To achieve these objectives, correct bonding and debonding are of fundamental importance. There are several factors involved in debonding, the most important of which are the type of bracket and adhesive used, instruments used for bracket removal, and the armamentarium for resin removal.25 The ideal orthodontic

Interdental Stripping: Intentional Damage

Interdental stripping, also called as interproximal enamel reduction, enamel reproximation, or slenderization, is a common clinical procedure in orthodontic therapy. Among various techniques available today, the most commonly used ones are handheld or motor-driven abrasive strips, and tungsten carbide or diamond burs.48 The main indications for this technique include reshaping the approximal contacts, managing Bolton discrepancy problems, treating mild or moderate crowding, and stabilizing the

Enamel Wear

Abrasion of enamel surfaces can occur when teeth make contact with either metal or ceramic brackets. The latter is common on upper canine tips, as the cusp tip hits the lower canine brackets during retraction. It may also be seen on the incisal edges of upper anterior teeth where ceramic brackets are placed on lower incisors of a patient who has an increased overbite. The clinician should always ensure that no enamel damage is occurring due to bracket placement. One method to achieve the latter

Susceptibility to Caries and White Spot Formation

Demineralization is a common side effect associated with fixed appliance orthodontic treatment. The development of white spot lesions (WSL) is almost inevitable when oral hygiene is poor (Fig 1A and B). The components of the appliance and the bonding materials promote plaque accumulation and bacterial colonization, especially Streptococcus mutans and Lactobacillus,55 with subsequent acid production leading to decalcification. This might produce an alteration in the appearance of the enamel

Enamel Damage During Adhesive Removal and Rebonding Failed Brackets

Although the primary orthodontic goal lies in returning the enamel surface to its original state following removal of orthodontic attachments, the adhesive removal procedures after debonding may remove up to 55.6 μm of surface enamel.81 The failure at the bracket-adhesive interface decreases the probability of enamel damage, but has the disadvantage of requiring the mechanical removal of the residual adhesive after debonding.

The search for an efficient and safe method of adhesive resin removal

Conclusion

Enamel damage can be considered as an inevitable sequela to orthodontic treatment, with various procedures producing varied effects. The aim of every orthodontic practitioner should be to minimize damages to enamel, helping improve the longevity of teeth as well as dentition as a whole. This can be done by keeping abreast with the recent technologies and using them in a proper manner. This brings in the necessity to have a fundamental knowledge of preventive dentistry principles and the

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