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Demineralization adjacent to orthodontic brackets after application of conventional and self-etching primer systems

Demineralisation des Bracketumfeldes nach Anwendung konventioneller und selbst konditionierender Schmelzadhäsivsysteme

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

An Erratum to this article was published on 19 November 2014

Abstract

Objectives

The goal of this work was to compare the demineralization of enamel associated with two different self-etching primers and traditional acid etching.

Materials and methods

A total of 15 volunteers (23–32 years, 8 male and 7 female) were provided with a removable archwire/resin appliance to be worn 20 h/day for 28 days. The device was attached to the mandibular posterior teeth and included samples of human enamel (from extracted third molars) located in both posterior vestibules. Both sides featured the same distribution of samples, including one untreated control sample (group A) and three samples with brackets (Victory™ APC II) bonded to their surface after conditioning with a self-etching non-fluoride primer (iBond™ Gluma® Inside; group B), a self-etching fluoride-releasing primer (Transbond™ Plus; group C), or traditional acid-etching with 35 % phosphoric acid and Transbond™ XT (group D).

Mineral loss was assessed extraorally under standardized conditions using quantitative light-induced fluorescence (QLF) with a specialized camera system (Inspektor Pro). Results were expressed as relative fluorescence loss (ΔF in %). A baseline measurement (T0) was taken before the appliance was first inserted but with the brackets already bonded. Fluorescence loss was analyzed after 3 (T1), 7 (T2), 14 (T3), and 28 days (T4) and compared to the baseline loss (T0) for each of the four study groups (A to D). Kruskal–Wallis and Mann–Whitney U tests were used to compare the results for statistical significance.

Results

The lowest percentages of fluorescence loss both at baseline and during the follow-up assessments was found in group C. While all three experimental groups (B, C, D) presented total decreases in fluorescence loss after 28 days, indicating remineralization, the decrease in group C was the largest. The Kruskal–Wallis test yielded no significant differences between the three groups other than a significantly lower percentage of fluorescence loss in group C than in group D during the last assessment (T4). The untreated samples of control enamel (group A) revealed increasing percentages of fluorescence loss over the entire study period.

Conclusion

Use of the self-etching primers (groups B and C) was not associated with patterns of enamel demineralization different from those noted after traditional etching with phosphoric acid (group D). The only significant difference we observed was between the self-etching fluoride-releasing primer (group C) and traditional etching (group D) at the final assessment (T4). Thus, the fluoride-releasing system Transbond™ Plus was advantageous.

Zusammenfassung

Ziel

Ziel dieser Untersuchung war es, in situ den Mineralverlust zweier selbst konditionierender Systeme im Vergleich zu konventioneller Schmelzätzung zu untersuchen.

Material und Methodik

Von 15 Probanden (23–32 Jahre, 8 männlich, 7 weiblich) wurde für 28 Tage (≥ 20 h/Tag) eine herausnehmbare Drahtbogen-Kunststoff-Schiene getragen, die an den Unterkieferseitenzähnen befestigt war und in die beidseits bukkal humane Schmelzproben von extrahierten Weisheitszähnen eingearbeitet waren. Auf jeder Seite wurde eine unbehandelte Schmelzprobe mitgeführt (Gruppe A). Zwei selbst konditionierende Adhäsivsysteme [iBond™ Gluma® inside (Gruppe B) und Fluorid freisetzendes Transbond™ Plus Self Etching Primer (Gruppe C)] und ein konventionelles Schmelzätzverfahren [35 %ige Phosphorsäure mit Transbond™ XT (Gruppe D)] wurden verwendet, um Brackets (Victory APC™ II) zu befestigen.

Der Mineralverlust wurde mittels quantitativer Lichtfluoreszenz (Inspektor Pro Intraoral Fluorescence Camera, Inspektor Research Systems BV) unter standardisierten Bedingungen extraoral als Fluoreszenzverlust (∆F) in % bestimmt. Die Baseline-Messung (T0) erfolgte nach Bracketbefestigung und vor Eingliederung der Schiene. Jeweils nach 3 (T1), 7 (T2), 14 (T3) und 28 (T4) Tagen wurde der prozentuale Fluoreszenzabfall der verwendeten Systeme mit den Baseline-Werten quantitativ verglichen. Die Ergebnisse wurden mit dem Kruskal-Wallis-Test und dem Mann-Whitney-U-Test auf Signifikanz untersucht.

Ergebnisse

Transbond™ Plus zeigte sowohl in der Ausgangsmessung als auch in den weiteren Verlaufskontrollen die geringsten Fluoreszenzverluste. Über den Beobachtungszeitraum von 28 Tagen war für alle Adhäsivsysteme insgesamt eine Abnahme des Fluoreszenzverlustes, also eine Remineralisation, zu verzeichnen. Diese war bei Transbond™ Plus am größten. Der Kruskal-Wallis-Test ergab keine signifikanten Unterschiede zwischen den 3 Gruppen. Lediglich bei der Abschlussmessung nach 4 Wochen war der Fluoreszenzverlust bei den mit Transbond™ Plus befestigten Proben signifikant geringer als bei den Proben, die mit konventioneller Schmelzätztechnik vorbehandelt worden waren. Die unbehandelten Schmelzproben wiesen während des gesamten Beobachtungszeitraumes einen zunehmenden Fluoreszenzverlust auf.

Schlussfolgerung

Die Demineralisation des Zahnschmelzes bei den untersuchten selbst konditionierenden Adhäsiven (Gruppe B und C) unterscheidet sich nicht von der der konventionellen Konditionierung mittels Phosphorsäure (Gruppe D). Ein signifikanter Unterschied war lediglich bei der Abschlussmessung nach 4 Wochen zwischen Transbond™ Plus (Gruppe C) und der konventionellen Ätztechnik (Gruppe D) zu verzeichnen. Das Fluorid freisetzende System Transbond™ Plus ist daher vorteilhaft.

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Compliance with ethical guidelines

Conflict of interest. D. Visel, T. Jäcker, P.G. Jost-Brinkmann, and T.M. Präger state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Visel, T. Jäcker, P.G. Jost-Brinkmann und T.M. geben an, dass kein Interessenkonflikt besteht. Alle angewandten Verfahren stehen im Einklang mit den ethischen Normen der verantwortlichen Kommission für Forschung am Menschen (institutionell und national) und mit der Deklaration von Helsinki von 1975 in der revidierten Fassung von 2008. Alle Patienten wurden erst nach erfolgter Aufklärung und Einwilligung in die Studie eingeschlossen.

Acknowledgment

The authors wish to thank the manufacturers 3M Unitek, Heraeus Kulzer, and GABA for providing the materials used in this study. They are also indebted to Michael Radeck and Dr. Edgar Dietrich for statistical support.

Danksagung

Wir danken 3M Unitek™, Heraeus Kulzer und GABA für die Bereitstellung der Materialien. Weiterhin gilt unser Dank Michael Radeck und Dr. Edgar Dietrich für die Unterstützung bei der statistischen Auswertung.

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  1. Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Charité - Center for Dentistry, Oral Medicine and Maxillofacial Surgery, Assmannshauser Str. 4–6, 14197, Berlin, Germany

    D. Visel, T. Jäcker, P.-G. Jost-Brinkmann & T.-M. Präger

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  1. D. Visel
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Visel, D., Jäcker, T., Jost-Brinkmann, PG. et al. Demineralization adjacent to orthodontic brackets after application of conventional and self-etching primer systems. J Orofac Orthop 75, 358–373 (2014). https://doi.org/10.1007/s00056-014-0233-9

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