In-vivo effects of fluoridated antiplaque dentifrice and bonding material on enamel demineralization adjacent to orthodontic appliances

doi:10.1016/j.ajodo.2004.12.026

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 130, Issue 3, September 2006, Pages 357-363

https://doi.org/10.1016/j.ajodo.2004.12.026 Get rights and content

Introduction: The effect of a fluoridated antiplaque dentifrice on the development of caries lesions adjacent to dental appliances bonded with ionomeric material is unknown. Methods: Fourteen orthodontic patients were randomly divided into 2 groups of 7. One group brushed 3 times a day with a fluoridated dentifrice, and the other used an experimental antiplaque fluoridated formulation. Bracket bases were randomly bonded with either resin-modified glass ionomer cement or composite resin to the buccal surfaces of either the maxillary left or right premolars in each subject. The teeth were banded, leaving a space on the buccal surface to allow dental plaque accumulation. After 28 days of dentifrice use, the teeth were extracted, and mineral loss in the enamel adjacent to the bonded material was assessed by cross-sectional microhardness. Results: Mineral loss in the enamel surrounding the bond with the resin-modified glass ionomer cement was lower (P <.05) than around the composite bond. Enamel demineralization was lower (P <.05) in subjects who used the experimental antiplaque fluoridated formulation than in those who used the fluoridated one. Conclusions: The data suggest that an antiplaque fluoridated dentifrice is superior to one that is only fluoridated for reducing enamel demineralization adjacent to dental material bonded with composite, but the effect seems irrelevant when bonding is done with the ionomeric material.

Section snippets

Material and methods

This study was approved by the Ethical Committee on Research of the Faculty of Dentistry Araraquara, Araraquara, SP, Brazil Fourteen orthodontic patients, aged 11 to 17 years, whose maxillary premolars were to be extracted, were selected for this research. Only patients with low caries experience (maximum of 4 restored occlusal surfaces) and without active caries lesions were included. The premolars used were also free of intrinsic stains and cracks in the enamel.

The split-mouth design was used

Results

ANOVA of the data for the occlusal region showed statistically significant effects for the factors material, position, and depth, and for the interactions material*position, dentifrice*depth, and material*depth (Table I). The effects of the dentifrice and the material*dentifrice interaction were not statistically significant (P = .3674 and .7381, respectively). For the interaction material*position, the enamel microhardness values in the positions 0, 100, and 200 of the bases bonded with resin

Discussion

In this study, an in-vivo model was used, in which dental bands were specially made to create a niche for plaque accumulation at the buccal surfaces of premolars to be extraction for orthodontic reasons.¹⁷ This model had several advantages: the development of the caries lesions was studied in vital teeth; minimal patient cooperation was required; no special diet was required; and, because the protected enamel surface allowed the accumulation of thick plaque, no other site was at risk of caries

Conclusions

The data suggest that, if the bonding material is a composite, caries reduction adjacent to orthodontic material with a fluoridated antiplaque dentifrice would be better than with the fluoridated-only dentifrice. However, this effect seems irrelevant when an ionomeric material is used.

We thank Dr Raimundo Rosendo Prado, Jr, Federal University of Piauí, for reviewing the English version of this article.

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Therefore, other less patient-dependent methods should be considered to prevent dental caries [4,5]. To prevent the occurrence of WSLs during fixed orthodontic treatment, many researchers have evaluated different techniques and materials such as the use of probiotics and antibiotics [6], fluoride-releasing adhesives [7,8], Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) [9], chlorhexidine [5] and Ozone [10]. Recently, the antibacterial properties of semiconductor nanoparticles such as titanium dioxide (TiO2) [11], zinc oxide, silver oxide [12], copper oxide (CuO) [13], and propolis [14] have attracted great attention.
White spot lesion (WSL) is one of the most important complications of fixed orthodontic treatment. Many methods have been studied to prevent this problem. This study is aimed to investigate the effect of high concentration nano-hydroxyapatite (nHAP) on shear bond strength (SBS) of metal brackets and Adhesive Remnant Index (ARI) score in different preparation methods.
Sixty human premolars, which were extracted for orthodontic reasons were included in this in vitro study. The teeth were randomly divided into 4 groups of 15 each: one control group and three nHAP groups. After applying nHAP for 2 to 3 minutes daily for 10 days, the groups 2 to 4 underwent sandblasting using 50 μm aluminium oxide and 30 seconds etching, 60 and 30 seconds etching, respectively, and the brackets were then bonded to the teeth. After debonding, SBS and ARI scores were recorded. Data were analysed using the ANOVA test and posthoc test for pairwise comparisons.
No significant difference was observed in SBS between the control group and the nHAP groups. The sandblasted teeth showed significantly higher SBS than the 30 seconds etching after nHAP application (P = 0.02). The teeth etched for 60 seconds showed a significantly higher ARI score than the 30 seconds etched teeth with (P = 0.003) or without (P < 0.001) nHAP application.
The use of nHAP before bracket bonding can be considered as a caries preventive method since it did not compromise the SBS. Sixty seconds etching is recommended for less likely damage to the enamel after debonding.
In-vitro study of the effect of casein phosphopeptide amorphous calcium fluoride phosphate on iatrogenic damage to enamel during orthodontic adhesive removal
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White-spot lesions (WSL) might be susceptible to mechanical damage during orthodontic bracket and adhesive removal. The aims of this in-vitro study were to investigate enamel loss on bracket and adhesive removal when the brackets were surrounded by WSL and to determine the effect of remineralizing these lesions with a 1% (w/v) casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) solution before bracket and adhesive removal.
Precoated metal mandibular incisor brackets were centrally bonded onto polished third molars and WSL produced by exposure to a demineralization buffer for 4, 12, and 30 days (n = 20 per group). Half of the demineralized window was covered with acid-resistant nail varnish, and the specimens were then subjected to remineralization with 1% CPP-ACFP. Brackets and residual adhesive were removed, and enamel damage was assessed by digital photography, profilometry, and scanning electron microscopy. Lesion depth, mineral loss, and remineralization were measured by transverse microradiography.
WSL enamel around the bracket was more susceptible to iatrogenic damage at adhesive removal compared with sound enamel. Remineralization of lesions with 1% CPP-ACFP before adhesive removal significantly (P <0.002) reduced the area and depth of damage.
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Effect of antibacterial monomer-containing adhesive on enamel demineralization around orthodontic brackets: An in-vivo study
2011, American Journal of Orthodontics and Dentofacial Orthopedics
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Shallower lesion depths were found in the enamel around the brackets bonded with the antibacterial monomer-containing adhesive compared with the conventional adhesive system. Our lesion-depth results were higher than those of Pascotto et al19 but lower than the report of de Moura et al.20 In previous studies, Pascotto et al and de Moura et al showed lesions up to depths of 30 and 70 μm from the enamel surfaces, respectively. These could be attributed to the experimental models used.
The aims of this study were to evaluate the effect of an antibacterial monomer-containing self-etching adhesive in reducing enamel demineralization around orthodontic brackets in vivo and to compare it with the conventional adhesive system quantitatively.
Fourteen orthodontic patients were randomly divided into 2 equal groups; they received brackets fitted to all their teeth, bonded with either Clearfil Protect Bond (Kuraray Medical, Okayama, Japan) (experimental group) or Transbond XT (3M Unitek, Monrovia, Calif) (control group). Block randomization to obtain equal numbers in each group was used. After 30 days, all first premolars were extracted with orthodontic indications and longitudinally sectioned. Demineralization was assessed by cross-sectional microhardness. Determinations were made at the bracket edge cementing limits and at occlusal and cervical points 100 and 200 μm away from the edge. In all of these positions, 6 indentations were made at depths of 10 to 90 μm from the enamel surface. Analysis of variance (ANOVA) and the Tukey post-hoc test were used. The statistical significance level was set at P <0.05.
ANOVA showed statistically significant differences for adhesive type, position, depth, and their interactions (P <0.05). The multiple comparison test showed that the antibacterial monomer-containing adhesive was significantly more efficient than the conventional adhesive system, reducing enamel demineralization in almost all evaluations (P <0.05).
The results indicated that using antibacterial monomer-containing adhesive for bonding orthodontic brackets successfully inhibited caries in vivo. This cariostatic effect was localized at the area around the brackets and was significant after 30 days.
Demineralization properties of newly erupted and mature premolars around orthodontic brackets: An in-vivo study
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It was determined that all patients in both groups were equivalent with regard to caries risk or demineralization activity. Instead of in-vitro studies with extracted bovine and human teeth, our model had several advantages: the development of the caries lesions was studied in vital teeth; it required minimal patient cooperation and no special diet; and, because the protected enamel surface allowed the accumulation of thick plaque, no other site was at risk of caries with this procedure.20 The only disadvantage of this procedure was the limited study period of 30 days, because of ethical considerations, as with most other caries models.
The aims of this study were to evaluate the in-vivo reaction of newly erupted enamel to demineralization around orthodontic brackets and to compare it with that of mature enamel.
Thirteen orthodontic patients scheduled to have 4 first premolars extracted for orthodontic reasons were divided into 2 groups. Group 1 included 7 younger patients with newly erupted teeth (4 boys, 3 girls; mean age, 11.21 ± 1.12 years; range, 11-13 years). Group 2 contained 6 adults with mature teeth (5 men, 1 woman; mean age, 34.64 ± 4.01 years; range, 25-41 years). Brackets were placed, and, 30 days later, the teeth were extracted. These teeth were longitudinally sectioned, and demineralization was assessed by cross-sectional microhardness. Determinations were made at the bracket-edge composite limits and at occlusal and cervical points 100 μm away. Evaluations under the brackets and at the lingual surfaces were made as controls. In all these positions, 6 indentations were made at depths from 10 to 90 μm from the enamel surface. Analysis of variance (ANOVA) and Tukey tests were used for statistical evaluation at the P <0.05 level.
ANOVA showed statistically significant differences for tooth type, position, depth, and their interactions (P <0.05), except the tooth type and position interaction. The multiple comparison test showed less demineralization in the enamel around orthodontic brackets bonded to mature teeth campared with newly erupted teeth (P <0.05).
During the 30-day study period, the tooth enamel in the adult orthodontic patients was more resistant to demineralization than that of the younger patients.
White Spot Lesions: Formation, Prevention, and Treatment
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Tin atoms in stannous products also block the passage of sucrose into bacterial cells, thus inhibiting acid production. It was observed that the use of a fluoridated antiplaque dentifrice may reduce enamel demineralization around brackets more than the use of a fluoridated dentifrice alone.12 However, while this effect appears significant when used in patients with orthodontic brackets bonded with composite resins, the extra benefit is not discernible if the brackets are bonded with a resin-modified glass ionomer (RMGI).
As oral hygiene becomes more difficult in patients with fixed orthodontic appliances, the decalcification of the enamel surface adjacent to these appliances is prevalent. Decalcification is manifested as a white spot lesion (WSL), and orthodontic patients develop significantly more WSLs than nonorthodontic patients. If WSLs are left untreated, they may progress to produce carious cavitations, and may also present esthetic problems. Thus, the prevention, diagnosis, and treatment of WSLs is crucial to minimize tooth decay as well as tooth discoloration that could compromise the esthetics of the smile.
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: Based on a thesis submitted by the first author to the Faculty of Dentistry of Araraquara, State University of São Paulo, Brazil, in partial fulfillment of the requirements for the doctorate degree in Pediatric Dentistry. The third author, authorized by the University of Campinas, was a scientific consultant of Kolynos do Brasil during this study.

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Original articleIn-vivo effects of fluoridated antiplaque dentifrice and bonding material on enamel demineralization adjacent to orthodontic appliances

Section snippets

Material and methods

Results

Discussion

Conclusions

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Direct bonding with glass ionomer cement

J Clin Orthod

Salivary fluoride concentrations in children with glass ionomer cemented orthodontic appliances

Caries Res

Effect of a combined chlorhexidine and NaF mouthrinse: an in vivo human caries model study

Scand J Dent Res

Original article
In-vivo effects of fluoridated antiplaque dentifrice and bonding material on enamel demineralization adjacent to orthodontic appliances