Effect of topical fluoride gel and fluoride varnish in the prevention of white spot lesions in patients undergoing fixed orthodontic treatment: An in vivo study

Objectives: Our primary objective was to establish the efficacy of fluoride gel and fluoride varnish in the prevention of white spot lesions (WSLs) development during fixed orthodontic treatment. Materials and Methods: The study sample consisted of 60 adult patients in a prospective split-mouth study design. Interventions, that is, topical fluoride gel and topical fluoride varnish were assigned at the time of bonding to either the right or left halves of the dentition. In all subjects, repeated evaluation of demineralization was done on the facial surfaces of sample teeth in each quadrant. Evaluation using laser fluorescence and by direct visual observation under magnification was carried out at bonding (T0), 3 months (T1), and 6 months (T2). Results: The distribution of mean DIAGNOdent score at T1 (3.14 ± 1.00 vs. 2.81 ± 0.852) and T2 (4.17 ± 1.41 vs. 3.51 ± 1.13) was observed which is significantly higher in the Gel group compared to the Varnish group. In the Gel group, the distribution of mean DIAGNOdent score at T1 (3.14 ± 1.00) and T2 (4.17 ± 1.41) is significantly higher compared to mean DIAGNOdent score at baseline T0 (2.07 ± 0.66). In the Varnish group, the distribution of mean DIAGNOdent score at T1 (2.81 ± 0.852) and T2 (3.51 ± 1.13) is significantly higher compared to the mean DIAGNOdent score at T0 (2.07 ± 0.66). Visual scores also correlated with DIAGNOdent scores. Conclusion: Fluoride varnish is more efficacious than fluoride gel in reducing enamel demineralization. Initial application of fluoride varnish around the orthodontic bracket at bonding appointment can offer significant protection against WSLs.

Evaluation of white spot lesions around orthodontic brackets using different bonding agents – An in vivo study

Objectives: The objectives of the study were to assess the white spot lesions around orthodontic bracket macroscopically using two different bonding agents – one with amorphous calcium phosphate (ACP) (Aegis Ortho) and one without ACP (Transbond XT). Materials and Methods: The study comprises 10 patients from 14 to 23 years of age. Patients were divided into control and study groups. Forty premolar teeth were then observed (20 teeth in each group). Bonding procedure was done and brackets were positioned on all four 1st pre-molars teeth and pre-treatment photographs were taken. The experimental material used was Aegis Ortho composite (study group) and Transbond XT (control group). Debonding procedure (by Wing deformation technique) was performed after 16 weeks which led to adhesive fracture at composite resin adhesive bracket interface leaving essentially all adhesive on the enamel. Then, follow-up photographs were taken to evaluate each. Results: Aegis Ortho containing ACP used for bonding purpose, provided lesser enamel demineralization than Transbond XT. Conclusion: Aegis Ortho for orthodontic bonding is significantly more beneficial and reliable, however, further investigations are also required to understand its clinical performance better.

A novel method quantifying caries following orthodontic treatment

This retrospective pilot study used a newly developed evaluation tool to assess the prevalence and incidence of White Spot Lesions (WSL) before and after multibracket appliance (MB) therapy. Digital photographs of 121 adolescent patients (63 ♂, 58 ♀) with metal brackets were analyzed retrospectively before and after MB therapy. The labial surfaces of anterior teeth, canine teeth, and premolars in the upper (UJ) and lower jaws (LJ) were evaluated using the Enamel Decalcification Index (EDI) by Banks and Richmond (Eur J Orthod, 16(1):19–25, 1994, levels 0–3) and a specially developed digitally scaled graticule with concentric circles to quantify the extent of WSL (in %). The statistical data analysis was based on crosstabulations and logistic regression. Before MB, 69.4% of the patients presented at least one WSL and 97.5% after, an increase of 28.1%. Before MB, 18.4% of the tooth surfaces (TS) showed an EDI level of 1–3. After MB, 51.8% of the TS featured WSL. 18.2% of the TS showed a WSL to the extent of ≥ 20–100% before and 52.3% after MB. The incidence in the UJ (71–79%) as well as the LJ (64–76%) was highest for the first and second premolars and lowest for LJ incisors (22–35%). The probability for developing a new distal WSL is higher than developing gingival, mesial or occlusal WSL. Labial MB therapy drastically increases the risk of developing WSL. We verified a concise quantification of the extent of labial WSL with the evaluation index.

Effect of Eugenol on Streptococcus mutans Adhesion on NiTi Orthodontic Wires: In Vitro and In Vivo Conditions

Objective The purpose of this study was to compare the antibacterial effect of two types of Eugenol against Streptococcus mutans and then assess the effect of different concentrations of two types of Eugenol on S. mutans adhesion on Nickel-Titanium (NiTi) orthodontic wires in comparison to in vivo wires with fluoride-based hygiene regimen. Material and methods Culture of Streptococcus mutans with NiTi orthodontic wires was done. Different media were prepared by adding 100%, 50%, 25%, and 12.5% of two origins of Eugenol (one biological obtained by hydrodistillation of Syzygium aromaticum and one chemical already prepared available in drugstores for dental use (Idental, MOROCCO, lot number: UAN/17–211/1). Three sizes of NiTi wires (0.016 inch, 0.016 × 0.022 inch, 0.017 × 0.025 inch) were retrieved from adult patients undergoing orthodontic treatment after 1 month of setting them up in the mouth. After incubation, colony forming unites were calculated and a SEM analysis was done to the surface of each wire. ANOVA test was done between all groups to find statistical differences and post-hoc t-test with Bonferroni analysis was performed to elucidate differences between all groups with α = 0.05. Results Eugenol has an anti-bacterial effect against S. mutans. The biological Eugenol has greater effect than the chemical one. The same observations were done for anti-adherent effect, the biological Eugenol demonstrated the highest anti-adherent effect at all concentrations while the effect of the chemical Eugenol was the lowest. Conclusions The origin and the extraction mode of Eugenol have a crucial role in its antimicrobial and anti-adherent effect. Eugenol might constitute an alternative to Fluoride because it has an anti-adherent effect, limiting the incidence of white spot lesions.

Enamel Deproteinization: Will It Save The Shear Bond Strength For The Sake Of Preventing White Spot Lesions?

Objective: This study attempted to investigate the effect of enamel deproteinization using citric acid, PEG 400 and NaOCL on the shear bond strength of orthodontic brackets to enamel using nano-silver modified resin for the prevention of white spot lesions. Material and Methods: 68 premolars were used in the study; nano-silver modified adhesive resin was used to bond orthodontic brackets to the enamel. Specimens were divided into 4 groups according to the applied surface treatment before bonding. Group I (control): acid etching with 37% phosphoric acid. Group II: deproteinization using 5.25% sodium hypochlorite (NaOCl) before acid etching. Group III:deproteinization using 10% citric acid before acid etching. Group IV:deproteinization using 5% polyethylene glycol (PEG 400) before acid etching. The specimens were then thermo- cycled for 6000 cycles. They were examined for surface roughness, shear bond strength and using electron microscope. electron microscope Results: In both surface roughness and shear bond strength tests, Group III (citric acid) showed the highest values, followed by Group II (sodium hypochlorite); (p < 0.001). The least values were shown for Groups I (control) and IV (PEG 400), with no statistically significant difference between them (p = 0.948). SEM revealed etching pattern type 1 and 2 in the citric acid group while PEG 400 showed shallower micro- porosities. Conclusions: Deproteinization of enamel using either NaOCl or citric acid increased the bond strength of nano-sliver modified resin to enamel, with citric acid showing greater increase in bond strength. Deproteinization using PEG 400 did not increase the bond strength. Keywords Deproteinization; Sodium hypochlorite; Citric acid; PEG 400; Nano- silver modified adhesives.