Effects of combined application of antimicrobial and fluoride varnishes in orthodontic patients

Orthodontists' instructions for oral hygiene in patients with removable and fixed orthodontic appliances

INTRODUCTION

The aim of this questionnaire-based survey was to evaluate information on frequencies, instructions and products relating to oral hygiene (OH) in orthodontic practices.

METHODS

Using a computer-generated randomization list, 1000 orthodontists were selected and sent a questionnaire. The size and number of inhabitants of the federal states of Germany were considered. The federal states with the highest return rate (Baden-Wuerttemberg [BW], Bavaria [B], Hesse [H], Lower Saxony [LS], Nordrhein-Westphalia [NRW]) were considered and differences between the 16 federal states were divided into North, South, East and Central Germany.

RESULTS

The response rate of the questionnaires was 52.4%. The majority (53.8%) worked in one practice alone. Most (59.1%) have been orthodontists for 5-25 years. For vestibular multibracket appliances (MBA) in BW, B, H and LS over 90% recommended interdental brushes (IDB). In NRW 91.4% recommend fluoride gel. In B and H more than 80% chose electric toothbrush (ETB), in BW, LS and NRW more than 80% manual toothbrush (MTB). For lingual MBA (LMBA) in BW, H, LS and NRW with approximately 50% each fluoride gel, IDB and MTB were chosen. In B fluoride gel, IDB and ETB. For removable apparatus (RA), five federal states recommended MTB (>80%) and ETB (BW, B, H > 80%; NRW > 70%; LS > 60%).

CONCLUSION

Electric toothbrushes are recommended for the use with all appliances, only with removable appliances manual toothbrushes are favoured. For vestibular MBA it is strongly advised to use IDB additionally.

Orthodontic Patients with Poor Oral Health-Related Quality of Life are More Likely to Have Emotional Distress: A Cross-Sectional Study

Objective

This study aims to investigate the relationship between oral health-related quality of life (OHRQoL) and emotional distress (ED), including anxiety and depression, in orthodontic patients.

Methods

A cross-sectional study was conducted involving 603 orthodontic patients, consisting of 401 females (66.5%) with a mean age of 24.15 ± 7.72 and 202 males (33.5%) with a mean age of 24.16 ± 7.72. A questionnaire containing questions of demographic information, the Oral Health Impact Profile (OHIP-14) and the Huaxi emotional-distress index (HEI) was employed to assess OHRQoL and ED. According to the HEI score, the respondents were divided into ED group (HEI > 8) and non-ED group (HEI ≤ 8). Data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney test and logistic regression analysis with the significance level set at p < 0.05.

Results

The prevalence of poor OHRQoL and ED of the study sample was 28.4% and 19.57%, respectively. There was a significantly higher prevalence of ED among poor OHRQoL patients (35.67%) compared to those with good OHRQoL (13.19%) (p < 0.001). Poor OHRQoL and risky drinking behavior addressed higher significant correlation with ED patients than non-ED patients (p < 0.05). There were no statistical differences in other factors such as gender, age, and appliance type (p > 0.05). Poor OHRQoL orthodontic patients were at a higher risk of suffering from anxiety and depression compared to those with good OHRQoL (age-risky drinking behavior-sex-adjusted: OR = 4.00; all p < 0.001).

Conclusion

Oral health-related quality of life (OHRQoL) is related to emotional stress. Namely, patients with poor OHRQoL are more likely to experience anxiety and depression. As a result, orthodontists should consistently assess the emotional well-being and OHROoL of patients over the treatment course for better treatment outcomes.

Randomized multicenter study on the plaque removal efficacy of 2 interdental brushes around the base of orthodontic brackets

INTRODUCTION

The objective of this multicenter study was to analyze the efficacy of cleaning 2 interdental brushes (IDBs) around brackets in patients with fixed orthodontic appliances.

METHODS

The study design was a multicenter, randomized, examiner-blinded crossover study with 3 interventions, the first of which was a baseline intervention. This study included 20 patients (12 females, 8 males) aged 12-18 years with fixed orthodontic devices examined at the Department of Orthodontics, University Medical Center of the Johannes Gutenberg University Mainz, and the Children's Dental Clinic St. Gallen. The outcome was a conventional, cylindrically shaped IDB (IDBG-S [IB]; Top Caredent GmbH, Schönau, Germany) was examined in comparison with an innovative waist-shaped IDB (Circum, CDB-8 [CB]; Top Caredent GmbH). The participants did not use the IDB themselves. The brushing procedure was performed professionally by 1 operator (C.E.). Each buccal tooth surface with a bracket was split into 8 areas, the main areas being 1 and 8. These main areas, which were difficult for toothbrushes to reach, were mesial (area 1) and distal (area 8) of the bracket edges in the gingival direction. Plaque index (PI) scores were assessed at 2 examinations before and after the cleaning procedure on 8 tooth surfaces in the area with orthodontic brackets. A computer-generated program randomly allocated the IDB sequence to the participants. Examiners (L.Z.-G. and Y.W.) assessing the outcomes were blinded to the intervention and the randomized allocation of participants to the different IDBs.

RESULTS

Both IDBs showed a plaque removal effect (CB, 0.68 [interquartile range, 0.63-0.77]; IB, 0.43 [interquartile range, 0.33-0.55]). The difference between the 2 IDB was statistically significant (P = 0.002). In particular, the CB yielded a higher plaque removal efficacy (CB effect, 0.68; IB effect, 0.21) at the main areas 1 and 8, which were difficult to reach. Ten participants were randomized to each sequence, and all 20 completed the study. No side effects or adverse events were reported or observed.

CONCLUSION

The waist-shaped brush head of the CB significantly enhanced plaque reduction in total and particularly in problem areas.

REGISTRATION

This trial was registered at the German Clinical Trials Registry (no. DRKS00014088; https://www.drks.de/drks_web/navigate.xxdo?navigationId=trial.HTML&TRIAL_ID=DRKS00014088) PROTOCOL: The protocol was not published before trial commencement.

FUNDING

This study was supported by the manufacturer Top Caredent GmbH, Schönau, Germany, which provided all interdental brushes used in this study.

White spot lesions, plaque accumulation and salivary caries-associated bacteria in clear aligners compared to fixed orthodontic treatment. A systematic review and meta- analysis

OBJECTIVE

To analyse the available evidence regarding the incidence and severity of white spot lesions (WSLs), plaque accumulation and salivary caries-associated bacteria(SCB) in clear aligners (CA) verses conventional fixed (CF) orthodontic appliances.

METHODS

Electronic searches of MEDLINE, Scopus, Embase, Google Scholar, Clinical trial registry, OpenGrey and ProQuest were done for all relevant studies. Eligibility criteria were; Randomized Controlled Trials and Non-Randomized Studies that compared the incidence and severity of WSLs, plaque accumulation and SCB between CA and CF appliances in patients undergoing orthodontic treatment. The risk of bias(ROB) and certainty of evidence was assessed independently by two reviewers using Cochrane's ROB and GRADEpro, respectively. Standardized mean difference (SMD) was used to estimate the effect size using STATA 17 software.

RESULTS

A total of 14 studies met the eligibility criteria, and eight were suitable for meta-analysis. The qualitative results showed lower incidence and severity of WSLs, plaque accumulation, and SCB in CA group compared to CF appliances. The pooled results showed significantly lower plaque accumulation(SMD - 1.58;95%CI:-2.57,0.58;p = 0.002) in CA compared to CF appliances.

CONCLUSIONS

A moderate-quality evidence reveals less plaque accumulation and less SCB in CA, which might be related to the reduced incidence and severity of WSLs associated with CA when compared with CF appliances. However, the results of the present study should be interpreted with caution given the high ROB among some of the included studies as well as the marked heterogeneity across the studies.

CLINICAL RELEVANCE

For patients who can be treated with either CA or CF appliances, CA may be a better choice concerning oral health.

REGISTRATION

Open Science Framework (DOI: https://doi.org/10.17605/osf.io/kcpvb ).

Effectiveness of amine fluoride mouthwash in preventing white spot lesions during fixed orthodontic therapy - A randomized control trial

Background and Aim

One of the main reasons that patients seek orthodontic treatment is aesthetics. Unfortunately, treatment with fixed orthodontic appliances can at times increase the chances of developing white spot lesions on the surfaces of teeth, thus creating a new aesthetic issue for the patient. The prevalence of white spot lesions (WSL) reported after treatment varies from 2% to 97%, and these lesions can occur despite increased attention to hygiene. Hence the aim of this study was to assess the effect of Amine fluoride mouthwash in preventing white spot lesions during fixed orthodontic therapy.

Materials and Methods

Study participants were randomly divided into two groups (Group A - experimental 25 patients and Group B - control 25 patients). The pre-intervention and post-intervention intra-oral digital photographs were analysed by using ImageJ software to assess the percentage of the facial surface affected on the teeth (10 maxillary teeth), which had white spot lesions.

Results

The mean value of WSLs showed significant difference between the experimental and control groups. Mean values of WSL in the experimental group decreased from 2 to 1.54 with a mean difference of 0.46 after 6 months of follow-up which indicated that amine fluoride mouthwash was effective in preventing WSLs during fixed orthodontic treatment.

Conclusion

WSLs scores were significantly reduced in patients who received the mouthwash when compared to patients who followed standard oral hygiene regimen with fluoridated toothpaste only. In clinical practice, amine fluoride mouthwash is an effective method for the prevention of WSLs during fixed orthodontic treatment.

Evaluation of the Impact of Chlorhexidine Mouth Rinse on the Bond Strength of Polycarbonate Orthodontic Brackets: A Case-Control Study

BACKGROUND

Shear bond analysis is the procedure used most frequently to gauge the tensile strength of adhesives incorporated in orthodontic treatments. In shear tensile strength analysis, pressure is placed as close as feasible to the interface between the orthodontic bracket and the surface of the tooth, parallel to the long axis of the tooth. Although numerous research on extracted teeth of human and bovine teeth have been conducted, there may still be variables such as pH, humidity, temperature, and others that could affect how these materials behave in the mouth cavity. The impact of chlorhexidine (CHX) on the binding capacity for non-metallic orthodontic brackets in vivo is not well understood.

OBJECTIVE

The goal of the current study is to determine how mouth rinses containing 0.12% CHX affect the adhesive strength of polycarbonate orthodontic brackets.

METHODS AND MATERIALS

Thirty-four patients were part of the test category, and they were instructed to wash their oral cavity for approximately 30 seconds using 20 ml of 0.12% CHX gluconate (Septodent). Thirty-four patients made up the control category and were instructed to wash their oral cavity for 30 seconds with a placebo mouthwash of a similar hue (20 ml). Both types of mouthwash were administered to the participants by an administrator who was not specifically involved in the trial and were kept in 120 ml labeled plastic bottles. The study participants were also kept unaware of the type of mouthwash. For the mouthwash utilized by study participants, a double-blinding technique was applied.

RESULTS

Thirty-four patients were evaluated in the test category. Since the orthodontic bracket broke in two patients, therefore, 32 patients were evaluated in the control category. The mean value of the strength of the shear bond in the experimental category was 15.32 megapascal (Mpa). The SD value was 2.51. The mean value of the strength of the shear bond in the control subgroup was 15.63. On statistical analysis, the t-value was 0.47. The p-value was 0.671. The difference in findings of the strength of the shear bond was statistically non-significant.

CONCLUSION

The results of this investigation allow us to draw the conclusion that the shear bond properties of polycarbonate orthodontic brackets are unaffected when treated with 0.12% CHX preceding the binding. The clinically meaningful adhesion strength was likewise attained by the polycarbonate orthodontic brackets.

Influence of resin modified glass ionomer cement incorporating protein-repellent and antimicrobial agents on supragingival microbiome around brackets: an in-vivo split-mouth 3-month study

Objective

To explore the influence of resin modified glass ionomer cement (RMGIC) adhesives containing protein-repellent and quaternary ammonium salt agents on supragingival microbiome, enamel and gingival health around brackets.

Materials and Methods

Ten patients (21.4 ± 3.5 years) about to receive fixed orthodontics were enrolled in this study. Unilateral upper teeth bonded with RMGIC incorporating 2-Methacryloyloxyethyl phosphorylcholine (MPC) and Dimethylaminohexadecyl methacrylate (DMAHDM) were regarded as experimental group (RMD), while contralateral upper teeth bonded with RMGIC were control group (RMGIC), using a split-mouth design. Supragingival plaque was collected from both groups before treatment (T0), and at 1 month (T1) and 3 months (T2) of treatment. High-throughput sequencing was performed targeting v3-v4 of 16S rRNA gene. Streptococcus mutans and Fusobacterium nucleatum quantification was done by qPCR analysis. Bracket failures, enamel decalcification index (EDI), DIAGNODent scores (Dd), plaque index (PI) and gingival index (GI) were monitored at indicated time points.

Results

Within 3 months, alpha and beta diversity of supragingival plaque had no difference between RMGIC and RMD groups. From T0 to T2, the relative abundance of Streptococcus depleted in RMD but remained steady in RMGIC group. Streptococcus, Prevotella, and Fusobacterium became depleted in RMD, Haemophilus and Capnocytophaga became depleted in RMGIC group but Prevotella enriched. Quantification of Fusbacterium nucleatum and Streptococcus mutans showed significant difference between RMGIC and RMD groups at T2. Teeth bonded with RMD had significant lower plaque index (PI) and DIAGNODent (Dd) score at T2, compared with teeth bonded with RMGIC (p < 0.05). No difference in bracket failure rate was examined between both groups (p > 0.05).

Conclusion

By incorporating MPC and DMAHDM into RMGIC, the material could affect the supragingival microbial composition, inhibit the progress of plaque accumulation as well as the key pathogens S. mutans and F. nucleatum in the early stage of orthodontic treatment.

Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting

INTRODUCTION

The objective of this study was to determine the prevalence of white spot lesions (WSL) in orthodontic patients in an academic setting. Specific aims include using a novel combination to measure plaque accumulation (PA) and detect the association between WSL and PA and the associations between multiple independent variables.

METHODS

Cross-sectional data were collected on 111 patients. To enhance standardization, a combination of plaque-disclosing agents and standardized intraoral photographs was used to analyze plaque index (PI) and WSL for all teeth except molars. Factors including time in fixed appliances (FA), number of teeth, location of the lesions, and demographic information were reported. A multiple linear regression model was used to detect associations between the PI and WSL and the independent variables (P <0.05).

RESULTS

Approximately 79.3% of participants had at least one WSL, with a mean of 4 affected teeth per patient. A significant association was found between time in FA and the more severe PI reporting (P <0.001). There was no significant association between WSL and PI or the other variables. WSL was greater in the maxilla than in the mandible. PI was greater on the left than on the right side. Interexaminer reliability was assessed for PI and WSL (κ = 0.93 and 0.92).

CONCLUSIONS

The prevalence of WSL for orthodontic patients treated at this institution was greater than previously reported in the literature. In addition, the severity of PI was associated with increased time in FAs. Combining the proposed method of reporting PA facilitates standardization, calibration, and documentation in an academic environment.

Formulation and characterization of experimental orthodontic adhesive containing antibacterial dimethacrylate DABCO monomers: An in vitro study

OBJECTIVE

The purpose of the study was to investigate the antibacterial efficacy and mechanical properties of experimental orthodontic adhesives containing newly synthesized antibacterial dimethacrylate monomers with doubly charged 1,4-diazabicyclo[2.2.2]octane (DABCO) group (dication).

METHODS

Experimental orthodontic adhesives were formulated using varying compositions of synthesized antibacterial dimethacrylate monomers containing DABCO dication, C16DC2DMA and BisC11DCDMA, replacing part of the control group, Transbond™XT. The concentrations of monomers tested were 5% C16DC2DMA, 10% C16DC2DMA, 5% BisC11DCDMA, and 10% BisC11DCDMA. The biofilm-inhibition effects of the experimental adhesives against Streptococcus mutans were tested. Brackets were then bonded to extracted human teeth utilizing the experimental adhesives in the bonding protocol. The shear bond strength and modulus of elasticity of the control and experimental groups were tested. The adhesive remnant index scores were recorded.

RESULTS

The experimental adhesives containing 5% or 10% BisC11DCDMA and 10% C16DC2DMA showed significantly lower S. mutans colony forming units (CFU) than the control. Both BisC11DCDMA experimental groups displayed similar mechanical properties as compared to the control, although 10% C16DC2DMA showed a reduction in shear bond strength as compared to the control. For all experimental adhesives, the adhesive remnant index scores were not significantly different compared to the control.

CONCLUSION

BisC11DCDMA is a novel antibacterial dimethacrylate monomer that exhibits the significant ability to inhibit bacterial growth while maintaining acceptable mechanical properties. When incorporated into orthodontic adhesives, this monomer may reduce the occurrence of white spot lesions around brackets in orthodontic patients.

Fluoride varnish, ozone and octenidine reduce the incidence of white spot lesions and caries during orthodontic treatment: randomized controlled trial

This randomized, parallel, controlled trial assessed the effect of fluoride varnish, ozone and octenidine on white spot lesions (WSLs) and caries during orthodontic treatment. Patients were enrolled between 1st September 2017 and 31st August 2020 at initiation of orthodontic treatment in Department of Interdisciplinary Dentistry Pomeranian Medical University in Szczecin, Poland. All participants were randomly assigned to four study and one control groups using number random generator. However, investigators were not blinded due to the nature of the study. Groups I, II, III, IV had professional cleaning and varnishing (5% NaF) every 4 weeks. Groups II and IV had in-office ozone therapy before varnishing, groups III and IV received domestic octenidine mouthrinse. Group K had no professional hygienic or prophylactic procedures. WSLs were assessed at T0 and then every 4 weeks (T1-T4) and caries-at T0 and T4. The specific objective was to assess the influence of fluoride varnish, ozone and octenidine on the incidence of white spot lesions and caries during orthodontic treatment. The primary outcome of this report was the highest number of WSLs in group K and the lowest percentage of patients with WSLs in group IV. Each group comprised 30 randomized participants; they were all analyzed. No WSLs were found at T0, but they were stated in all groups at T4. The numbers of patients with WSLs significantly increased between T0-T4 in groups I and K. Group IV had the lowest percentage of patients with WSLs in T1-T4. WSLs in group IV were found no earlier than at T2. Group K had the highest percentage of WSLs at T4: 26%. At T0 all the groups had DMFs above 0 with a significant increase at T4. No side effects of the introduced prophylaxis were observed in any group. Caries is an important problem of fixed orthodontic treatment. Even an extremely intensive prophylaxis could not completely prevent WSLs and caries. Simultaneous application of fluoride varnish, ozone gas exposure and octenidine appears to have a beneficial effect in limiting the development of WSLs.Trial registration: NCT04992481.

Comparative Evaluation of the Efficacy of Chlorhexidine, Fluoride and the Combined Use of Chlorhexidine and Fluoride Varnishes on Salivary Streptococcus mutans Count in Children with Mixed Dentition: An In Vivo Study

Aim

Materials and methods

Results

Conclusion

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The antibacterial effect of silver, zinc-oxide and combination of silver/ zinc oxide nanoparticles coating of orthodontic brackets (an in vitro study)

Background

Preventive measures are essential during the length of orthodontic treatment to reduce the risk of decalcification and white spot lesions formation. With the evolution of procedures that enable coating of the orthodontic brackets using nanoparticles known for their good antibacterial activity, coating the brackets with nanoparticles of silver, zinc oxide and combination of silver and zinc oxide to evaluate their antibacterial effect in comparison to a control group without coating was carried out in this study.

Methods

Four groups of 12 brackets each were included in the study. The coating procedure was carried out using physical vapor deposition. The antibacterial activity was tested on Streptococcus mutans and Lactobacillus Acidophilus using colony forming count. The antibacterial activity was evaluated immediately after coating and later after 3 months.

Results

Brackets coated with combination of silver and zinc oxide nanoparticles had the highest ability on reduction of both Streptococcus mutans and Lactobacillus Acidophilus count followed by silver nanoparticles and then zinc oxide nanoparticles. No significant difference was found between the first and second antibacterial tests.

Conclusion

The silver/zinc oxide nanoparticles coated brackets had the highest antibacterial effect in comparison to silver nanoparticles and zinc oxide nanoparticles individually coated brackets on Streptococcus mutans and Lactobacillus acidophilus, and all types of coatings showed enhanced antibacterial effect in comparison to the uncoated bracket. Coating of orthodontic brackets could be further assessed in clinical application to prevent decalcification.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02263-6.

Long-term evaluation of orthodontic brackets shear bond strength with or without fluoride-releasing adhesive

BACKGROUND

The aim of this study was the evaluation of the long-term effect on shear bond strength (SBS) of orthodontic brackets treated with or without a fluoride-releasing system.

METHODS

A total of 80 bovine teeth were randomly divided into 2 groups (G1, G2): in G1 teeth were treated with a fluoride-releasing system (Fluor Protector, Ivoclar Vivadent, Schaan, Liechtenstein) and with spectrum (Micerium, Genoa, Italy); in G2 only spectrum was used. Shear bond strength (SBS) was measured in MPa 24 hours after bonding (T0) and after 30 (T1), 60 (T2), 90 (T3) and 180 days (T4).

RESULTS

A repeated measures ANOVA on rank-transformed data was used and differences in time between G1 and G2 were revealed (P<0.001). From 3 months mean measurement of G1 was higher than G2 (P=0.015). No difference was revealed between T3 and T4 in either group (P=0.48 for G1 and P=0.46 for G2).

CONCLUSIONS

After 3 months, G1 showed a significantly higher value than G2. Both groups did not show changes in shear bond strength between month 3 and month 6.

Effects of probiotic and fluoride mouthrinses on Streptococcus mutans in dental plaque around orthodontic brackets: A preliminary explorative randomized placebo-controlled clinical trial

Background:

Although it is shown that probiotic agents might reduce Streptococcus mutans, no study has evaluated this effect in the form of probiotic mouthrinse. The purpose of this study was to compare the effect of probiotic experimental mouthwash Lactobacillus plantarum versus sodium fluoride and placebo mouthwashes on the number of S. mutans present in dental plaque around orthodontic brackets in fixed orthodontic patients.

Materials and Methods:

This study was a randomized clinical trial. The total of 38 patients participate consisting of 12 patients in the fluoride group, 13 in the probiotic, and 12 in the placebo group. They were given mouthwashes to use twice a day for 2 weeks. Plaque sampling was performed using the 4-pass technique in all three groups in two stages: before the intervention and after 2 weeks of using the mouthwash. The number of bacteria present in the dental plaque was then reported based on the number of colonies grown on agar medium. Data were analyzed using Kruskal–Wallis and Wilcoxon tests (α = 0.05).

Results:

Gender distribution, mean age, and protocol adherence were not significantly different among all three groups. After the intervention, the number of S. mutans present in the dental plaque followed an increasing manner in the placebo (P = 0.005) and probiotic (P = 0.158) groups and decreased in fluoride group (P = 0.025).

Conclusion:

The L. plantarum probiotic mouthwash was ineffective in reduction of S. mutans in dental plaque. However, fluoride mouthwash is considerably effective against S. mutans and thus recommended.

Comparative evaluation of the efficacy of the desensitizing and remineralizing agent in the reduction of dentin hypersensitivity after orthodontic debonding - a randomized clinical trial

Introduction

Enamel loss is a common problem during various orthodontic procedures. The study aims to compare the efficacy of a desensitizer and remineralizer in the reduction of the dentin hypersensitivity (DH) associated with enamel microcracks after orthodontic debonding.

Methods

A unicentric two arm parallel study with 30 subjects randomly assigned to each groups following debonding. Group-1 subjects were treated with Gluma® desensitizer (5% glutaraldehyde and 35% hydroxyethyl methacrylate (HEMA)) and the Group-2 intervention included a remineralizing agent GC Tooth Mousse Plus® (casein phospho peptide and amorphous calcium Fluro phosphate (CPP:ACFP)). The Visual Analogue Scale (VAS) was utilized to evaluate DH as subjective perception of pain following the Air blast test and Cold test. The VAS scale was indexed from 0–10 markings based on the intensity of perception. Five different time points T0 and T1 - immediately after debonding and intervention on day 1, T2 – 48 hours, and T3 after 72 hours were taken for the assessment of VAS scores.

Results

The VAS scores for the airblast test for group 1 were (2.73, 0, 0.06, 0.03) and group 2 (2.46, 0, 0.16, 0.13) at different periods. The sensitivity scores for the cold blast test for group 1 were (2.73, 0, 0.13, 0.03) and for group 2 (2.46, 0, 0.16, 0.13). There was 98 percent reduction in DH between T0 and T3 and was statistically significant (p<0.05) for both the groups.

Conclusion

Gluma® desensitizer and GC Tooth Mousse Plus® are equally effective in the reduction of DH in the orthodontic patient following debonding.

Effect of Chlorhexidine Varnish and Fluoride Varnish on White Spot Lesions in Orthodontic Patients- a Systematic Review

Aim:

The aim of this study is to critically review the studies that studied the effect of Chlorhexidine varnish and fluoride varnish on White Spot Lesion (WSL) in patients undergoing orthodontic treatment.

Materials and Methods:

The electronic database PubMed, The Cochrane Library, Medline, Embase, Google Scholar, Web of Knowledge along with a complimentary manual search of all orthodontic journals till the first week of December 2019 was searched. English language study performed on humans, randomized or nonrandomized clinical trials, comparing the effect of fluoride and chlorhexidine varnish on WSL was included in the review. Quality assessment of included studies was performed.

Clinical Significance:

The need for an adjunct oral hygiene aid to reduce the incidence and prevalence of white spot lesions in orthodontic patients is necessary. The use of these varnishes will aid in the same and thus make the adverse effects of fixed orthodontic treatment negligible.

Review of Literature:

Enamel demineralization is a significant risk associated with orthodontic treatment when oral hygiene is poor. Prevention of demineralization during orthodontic treatment is one of the greatest challenges faced by clinicians despite modern advances in caries prevention. The development of White Spot Lesions (WSLs) is attributed to prolonged plaque accumulation around the brackets.

Results:

The search identified a total of 3 studies that were included in this review. One study had Low risk of bias and the remaining 2 studies had moderate overall risk. Results showed that there was a reduction in the incidence of white spot lesions in orthodontic patients after application of chlorhexidine and Fluoride varnish.

Conclusion:

Low level evidence is available to conclude that the use of chlorhexidine varnishes and fluoride varnishes reduces the prevalence of white spot lesions in patients undergoing fixed orthodontic treatment. Due to its limitations, the results of this systematic review should be handled with caution and further well-planned Randomized Clinical Trial (RCT) are needed to provide a discrete conclusion.

Comparative evaluation of fluoride varnishes, self-assembling peptide-based remineralization agent, and enamel matrix protein derivative on artificial enamel remineralization in vitro

Background

One of the most unfavorable side effects of fixed orthodontic treatment is white spot lesions (WSLs). Although the most important approach is prevention of WSLs, it is also essential to evaluate the efficacy of the remineralization agents. However, there is no concurrence in the literature with respect to the remineralization process of these agents. The objective of the present study was to evaluate the effects of different fluoride varnishes, enamel matrix protein, and self-assembling peptide derivatives with varying chemical compositions on remineralization of artificially created WSLs in vitro using quantitative light-induced fluorescence (QLF).

Methods

Artificial WSLs were created on bovine enamel samples using acidic buffer solution (pH 5, 10 days). Specimens were randomly allocated to six groups (n = 10/group): (1) Emdogain (Straumann, Basel, Switzerland), (2) Curodont Repair (Credentis AG, Switzerland), (3) Duraphat (Colgate-Palmolive, New York, NY), (4) Clinpro XT (3 M ESPE, Pymble, New South Wales, Australia), (5) Enamel Pro Varnish (Premier Dental Products, PA, USA), and (6) control (untreated). The agents were applied to the WSLs according to the manufacturers’ instructions. Fluorescence loss (ΔF), lesion area (area), and impact (ΔQ) values of enamel surfaces were quantified by QLF-D Biluminator^TM (Inspektor-Pro, Amsterdam, The Netherlands) at baseline and after 7, 14, and 21 days of application of the respective materials.

Results

ΔF value presented a significantly decreasing trend throughout the 21 days for all groups except the Duraphat and Enamel Pro varnishes. The changes between 14th and 21st days of the Clinpro XT varnish application were significantly higher than Emdogain, Curodont, and Enamel Pro. The Curodont group showed higher lesion area changes between the first and second week in comparison to the Emdogain, Clinpro XT, and Enamel Pro groups, whereas Clinpro XT assured the highest reduction from the second to the third week of the observation period.

Conclusions

The fluorescence loss was significantly reduced with enamel matrix protein, self-assembling peptide, and light-curable fluoride varnishes in the analysis for 21 days. Curodont and Clinpro XT were effective in diminishing the fluorescence loss and lesion area compared to the Duraphat, Enamel Pro fluoride varnishes, and Emdogain in different time points.

Evaluation of caries risk reduction following preventive programs in orthodontic patients, using Cariogram computer model: A quasi-experimental trial

Objective:

This study evaluated the effectiveness of preventive strategies on caries risk reduction in patients undergoing orthodontic treatment, using the Cariogram program.

Methods:

In this quasi-experimental study, samples were selected using a convenience quota sampling technique, in a public dental school. At first, caries risk profile was determined for each subject using the Cariogram before brackets bonding. The sample size consisted of 36 patients. The intervention group (n = 18) received preventive programs, and the control group (n = 18) was trained based on the routine oral health education by means of pamphlets. Then, Cariogram parameters were calculated for patients in both groups after six months.

Results:

The age range of participants was from 12 to 29 years. The mean percentage of the “Actual chance of avoiding new cavities” section in the intervention group increased from 45.72 ± 21.64 to 62.50 ± 17.64. However, the mean percentage of other parameters - such as “Diet”, “Bacteria” and “Susceptibility” - decreased after six months (p< 0.001). Besides, the differences in the mean percentage between intervention and control group at the end of the study period (T₁) related to the Cariogram parameters were statistically significant (p< 0.001). Accordingly, the mean percentage of ‘Actual chance of avoiding new cavities’’ parameter in the intervention group (62.50) was statistically higher than in the control group (42.44) (p< 0.001).

Conclusion:

Implementing different preventive approaches is able to reduce the caries risk in patients undergoing fixed orthodontic treatment, which can be clearly demonstrated using Cariogram program.

A Novel Method Using Confocal Laser Scanning Microscopy for Three-Dimensional Analysis of Human Dental Enamel Subjected to Ceramic Bracket Debonding

The aim of this in vitro study was to present a method using confocal laser scanning microscopy for three-dimensional analysis of human dental enamel subjected to ceramic bracket debonding. The labial enamel surfaces of three upper central incisors were prepared and mounted in the form of standardized specimens. A sample repositioning protocol was established to enable surface measurement and analysis before and after bracket debonding. Observations were made of representative areas measuring 1,280 × 1,280 μm2, in the center of the enamel samples, as well as of the total topography (2,500 × 3,500 μm) of the bonding areas provided by the equipment software. Noncontact three-dimensional high-resolution image analyses revealed the capabilities of the employed technique and methodology to permit the examination of specific characteristics and alterations on the surfaces, before and after the debonding and finishing procedures. The new protocol was effective to provide qualitative and quantitative assessments of changes on the same dental surfaces at different trial times. The methodology constitutes a feasible tool for revealing the effects of debonding of ceramic brackets on sound and previously injured dental enamel surfaces.

Estimation and correlation of salivary calcium, phosphorous, alkaline phosphatase, pH, white spot lesions, and oral hygiene status among orthodontic patients

Introduction:

The initial carious lesions are the so-called “white spot” lesions (WSLs), which implies that there is a subsurface area with most of the mineral loss beneath a relatively intact enamel surface. It is common in patients who are taking orthodontic treatment. Salivary reservoir of calcium and phosphorous counteracts the demineralization and encourages re-mineralization providing protection against caries challenge. This study was aimed to estimate and correlate the oral hygiene status, WSLs and salivary calcium, phosphorus, alkaline phosphatase (ALP), and pH in patients undergoing fixed orthodontic therapy.

Materials and Methods:

All clinical and biochemical parameters were recorded in 27 patients before starting orthodontic treatment and at 6 months of orthodontic treatment. The salivary calcium, phosphorous, ALP, and pH were determined by Arsenazo III method, Molybdate – UV and the International Federation of Clinical Chemistry method, respectively. International caries detection and assessment system index for WSL, orthodontic plaque index, bleeding on probing, and gingival index were recorded. Shapiro–Wilk's test and Wilcoxon test were applied to the data collected for statistical analysis.

Results:

There was a statistically significant increase with ALP levels, orthodontic plaque index score, gingival index score, and bleeding on probing index score. A statistically significant reduction was seen with respect to levels of calcium and pH.

Conclusion:

Maxillary canines and lateral incisors were the most affected teeth with WSLs (78.84%). There is a need for more stringent prevention programs and oral hygiene practices prior to initiation of orthodontic treatment and also during orthodontic treatment.

Effect of Light-Curable Fluoride Varnish and Conventional Topical Fluoride Varnish on Prevention of Enamel Demineralization Adjacent to Orthodontic Brackets: A Comparative Study

Objectives: Various fluoride varnishes have shown promising result in preventing enamel demineralization around orthodontic brackets as they do not depend on patient compliance. The objective of the study was to compare the effect of light-curable fluoride varnish (Clinpro XT) and conventional topical fluoride varnish (Fluoritop SR) in preventing enamel demineralization adjacent to orthodontic brackets.

Methods: 20 patients who required extraction of four first premolars for orthodontic treatment were bonded with orthodontic brackets and each premolar received single application of Clinpro XT and Fluoritop SR fluoride varnish in 2 diagonally opposite quadrants and rest 2 premolars acted as control. The sample teeth were debonded and extracted after 1 month and 2 months of varnish application. The samples were sectioned using hard tissue microtome and evaluated under polarized light microscopy to measure the depth of demineralization.

Results: Kolmogorov Smirnov test showed normal distribution of data. Comparison between the study groups with depth of demineralization scores showed statistically significant variation in one-way analysis of variance test. Turkey’s multiple post hoc procedures showed statistically significant difference in the depth of demineralization between all the 3 groups after 1 month and 2 months. Dependent t test showed statistically significant increment in the depth of demineralization in all the 3 groups between 1 month and 2 months.

Conclusion: This study concluded that single application of both Fluoritop SR and Clinpro XT was effective in reducing significant depth of demineralization compared to control. Clinpro XT showed significantly less demineralization compared to Fluoritop SR after 1 month and 2 months of varnish application.

Antimicrobial Effect of Orthodontic Materials on Cariogenic Bacteria Streptococcus mutans and Lactobacillus acidophilus

BACKGROUND White spot lesions (WSLs) are a common complication after orthodontic treatment. The aim of this study was to characterize and compare the antimicrobial properties of selenium-containing vs. fluoride-containing orthodontic materials. MATERIAL AND METHODS Antibacterial efficacy of orthodontic materials (SeLECT Defense bonding agent, Adhesive agent, Band Cement, Transbond Plus SEP bonding agent, Transbond Plus Adhesive agent, Fuji I Band cement, Fuji Ortho LC Adhesive agent, Ortho Solo Bonding agent, Transbond XT bonding agent, and Transbond XT primer) was tested with the inhibition of 2 bacterial strains: S. mutans (ATCC 10449) and L. acidophilus (ATCC 4356). The antimicrobial efficacy of the materials was measured by agar diffusion test. The diameters of inhibition zones around each disk were measured in millimeters (mm). RESULTS Materials containing selenium and fluoride showed significant differences from the negative control (both p<0.001). Orthodontic materials containing fluoride as a potential antimicrobial agent showed larger zones of inhibition in total (9.1±2.6 mm), the selenium group was the second-most effective (4.7±4.9 mm), and the group without any potential antimicrobial agent showed the least antimicrobial effect (0.9±1.0 mm). Materials from the group with no antibacterial agent were not significantly different from the negative control group (p>0.05). CONCLUSIONS Materials containing selenium carried the most significance when comparing microorganisms with the agent, since they were the only ones showing difference between the 2 microorganisms. They showed statistically significant difference in efficacy against S. mutans, and poor antimicrobial effect against L. acidophilus. These data suggest that orthodontic materials containing selenium might have the potential to prevent WSLs due to their antimicrobial properties.

Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment

BACKGROUND

Early dental decay or demineralised lesions (DLs, also known as white spot lesions) can appear on teeth during fixed orthodontic (brace) treatment. Fluoride reduces decay in susceptible individuals, including orthodontic patients. This review compared various forms of topical fluoride to prevent the development of DLs during orthodontic treatment. This is the second update of the Cochrane Review first published in 2004 and previously updated in 2013.

OBJECTIVES

The primary objective was to evaluate whether topical fluoride reduces the proportion of orthodontic patients with new DLs after fixed appliances. The secondary objectives were to examine the effectiveness of different modes of topical fluoride delivery in reducing the proportions of orthodontic patients with new DLs, as well as the severity of lesions, in terms of number, size and colour. Participant-assessed outcomes, such as perception of DLs, and oral health-related quality of life data were to be included, as would reports of adverse effects.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 1 February 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library (searched 1 February 2019), MEDLINE Ovid (1946 to 1 February 2019), and Embase Ovid (1980 to 1 February 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

Parallel-group, randomised controlled trials comparing the use of a fluoride-containing product versus a placebo, no treatment or a different type of fluoride treatment, in which the outcome of enamel demineralisation was assessed at the start and at the end of orthodontic treatment.

DATA COLLECTION AND ANALYSIS

At least two review authors independently, in duplicate, conducted risk of bias assessments and extracted data. Authors of trials were contacted to obtain missing data or to ask for clarification of aspects of trial methodology. Cochrane's statistical guidelines were followed.

MAIN RESULTS

This update includes 10 studies and contains data from nine studies, comparing eight interventions, involving 1798 randomised participants (1580 analysed). One report contained insufficient information and the authors have been contacted. We assessed two studies as at low risk of bias, six at unclear risk of bias, and two at high risk of bias. Two placebo (non-fluoride) controlled studies, at low risk of bias, investigated the professional application of varnish (7700 or 10,000 parts per million (ppm) fluoride (F)), every six weeks and found insufficient evidence of a difference regarding its effectiveness in preventing new DLs (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.14 to 1.93; 405 participants; low-certainty evidence). One placebo (non-fluoride) controlled study, at unclear risk of bias, provides a low level of certainty that fluoride foam (12,300 ppm F), professionally applied every two months, may reduce the incidence of new DLs (12% versus 49%) after fixed orthodontic treatment (RR 0.26, 95% CI 0.11 to 0.57; 95 participants). One study, at unclear risk of bias, also provides a low level of certainty that use of a high-concentration fluoride toothpaste (5000 ppm F) by patients may reduce the incidence of new DLs (18% versus 27%) compared with a conventional fluoride toothpaste (1450 ppm F) (RR 0.68, 95% CI 0.46 to 1.00; 380 participants). There was no evidence for a difference in the proportions of orthodontic patients with new DLs on the teeth after treatment with fixed orthodontic appliances for the following comparisons: - an amine fluoride and stannous fluoride toothpaste/mouthrinse combination versus a sodium fluoride toothpaste/mouthrinse, - an amine fluoride gel versus a non-fluoride placebo applied by participants at home once a week and by professional application every three months, - resin-modified glass ionomer cement versus light-cured composite resin for bonding orthodontic brackets, - a 250 ppm F mouthrinse versus 0 ppm F placebo mouthrinse, - the use of an intraoral fluoride-releasing glass bead device attached to the brace versus a daily fluoride mouthrinse. The last two comparisons involved studies that were assessed at high risk of bias, because a substantial number of participants were lost to follow-up. Unfortunately, although the internal validity and hence the quality of the studies has improved since the first version of the review, they have compared different interventions; therefore, the findings are only considered to provide low level of certainty, because none has been replicated by follow-up studies, in different settings, to confirm external validity. A patient-reported outcome, such as concern about the aesthetics of any DLs, was still not included as an outcome in any study. Reports of adverse effects from topical fluoride applications were rare and unlikely to be significant. One study involving fluoride-containing glass beads reported numerous breakages.

AUTHORS' CONCLUSIONS

This review found a low level of certainty that 12,300 ppm F foam applied by a professional every 6 to 8 weeks throughout fixed orthodontic treatment, might be effective in reducing the proportion of orthodontic patients with new DLs. In addition, there is a low level of certainty that the patient use of a high fluoride toothpaste (5000 ppm F) throughout orthodontic treatment, might be more effective than a conventional fluoride toothpaste. These two comparisons were based on single studies. There was insufficient evidence of a difference regarding the professional application of fluoride varnish (7700 or 10,000 ppm F). Further adequately powered, randomised controlled trials are required to increase the certainty of these findings and to determine the best means of preventing DLs in patients undergoing fixed orthodontic treatment. The most accurate means of assessing adherence with the use of fluoride products by patients and any possible adverse effects also need to be considered. Future studies should follow up participants beyond the end of orthodontic treatment to determine the effect of DLs on patient satisfaction with treatment.

Effect of CO2 Laser on the Prevention of White Spot Lesions During Fixed Orthodontic Treatment: A Randomized Clinical Trial

Objective

This study aimed to assess the effect of carbon dioxide (CO2) laser on prevention of white spot lesions (WSLs) associated with fixed orthodontic treatment.

Methods

In this parallel controlled trial, 554 maxillary anterior teeth in 95 patients with age range of 12-30 years were included. The samples were randomly divided in two groups: 1) CO2 laser (n=278) and 2) control (n=276) groups. Following bracket attachment, the teeth in the laser group were exposed to CO2 laser (0.4 mw, 10.6 μm, 5 Hz) for 20 s, and the control group received placebo light. Incidence, severity, and extent of the lesions were assessed in four surface regions (gingival, incisal, mesial, and distal) at baseline and 6 months post-irradiation. The inter-group comparison was performed by the Mann-Whitney U test and McNemar analysis.

Results

A significant difference regarding WSLs incidence in all teeth was observed between the two study groups (p<0.001). The two study groups illustrated a significant difference in lesion extent and incidence in incisal, mesial, and distal regions (p<0.05). The WSLs were significantly different in terms of severity in the incisal and mesial sites (p<0.05).

Conclusion

The CO2 laser irradiation seemed to effectively prevent incidence of WSLs. In addition, its effectiveness varied depending on the surface region.

Effectiveness of caries-preventing agents on initial carious lesions within the scope of orthodontic therapy

Objective

To evaluate the effectiveness of three different caries-preventing agents on artificial caries in a Streptococcus mutans-based caries model.

Methods

Sixty-five caries-free human molar enamel blocks were treated with a demineralization solution and a remineralization solution. The specimens were assigned to the following groups according to the caries-protective product applied: group A, chlorhexidine varnish; group B, fluoride-releasing chemically cured sealant; group C, fluoride-releasing lightcured sealant; group D, positive control (specimens that were subjected to de- and remineralization cycles without treatment with any caries-protective agents); and group E, negative control (specimens that were not subjected to de- and remineralization cycles). Samples in groups A–D were stored in demineralization solution with S. mutans and thereafter in artificial saliva. This procedure was performed for 30 days. Average fluorescence loss (ΔF) and surface size of the lesions were measured using quantitative light-induced fluorescence at baseline and on the 7th, 14th, and 30th days.

Results

After 30 days, group A demonstrated a significant increase in ΔF and the surface size of the lesions, no significant difference in comparison with the positive control group, and a significant difference in comparison with the negative control group. Group B showed no significant changes in both parameters at any of the measurement points. While group C showed increased ΔF after 14 days, no significant fluorescence change was observed after 30 days.

Conclusions

Both fluoride-releasing sealants (chemically or light-cured) show anti-cariogenic effects, but the use of chlorhexidine varnish for the purpose of caries protection needs to be reconsidered.

Effects of orthodontic treatment and different fluoride regimens on numbers of cariogenic bacteria and caries risk: a randomized controlled trial

Background

Caries is an undesirable side-effect of treatment with fixed orthodontic appliances. Therefore, it is crucial to understand how orthodontic treatment and different fluoride regimens affect caries risk and individual risk factors.

Objective

To evaluate the effects of orthodontic treatment and different fluoride regimens on caries risk and caries risk factors, including cariogenic bacteria.

Trial design

Three-armed, parallel group, randomized, controlled trial.

Methods

Patients referred to the Specialist Clinic of Orthodontics, Mölndal Hospital, Sweden, were distributed randomly into the following groups: group I (Control group), 1450 ppm fluoride (F) toothpaste; group II, 1450 ppm F toothpaste plus 0.2 per cent sodium fluoride (NaF) mouth rinse; and group III, 5000 ppm F toothpaste. The inclusion criteria were: age 12-20 years; and bimaxillary treatment with fixed appliances. The primary outcome variables were: caries risk; and the numbers of cariogenic bacteria. Radiographs were taken before treatment to determine the caries status. Data were collected before treatment and after 1 year with a fixed appliance. The variables were compiled into a Cariogram to assess the caries risk. Comparisons were made over time within and between the groups. The generation of randomization sequence was performed in blocks of 30. Blinding was employed during the data analysis and the caries registration.

Recruitment

The clinical study duration was from October 2010 to December 2012.

Results

Overall, 270 patients were randomized, of which 15 were excluded from the study. Therefore, 255 patients were included in the analyses. The caries risk increased significantly during orthodontic treatment in group I (P < 0.0001), whereas groups II and III had unchanged caries risks. All the groups showed statistically significant increases in the numbers of cariogenic bacteria.

Harms

No harms were reported during the trial.

Conclusions

To avoid an increased risk of caries during orthodontic treatment, everyday use of high-fluoride toothpaste (5000 ppm F) or mouth rinse (0.2% NaF) in combination with ordinary toothpaste is recommended.

Registration

The trial was not registered.

Effect of fluoride dentifrices on white spot lesions during orthodontic treatment: A randomized trial

OBJECTIVES

To determine the effect of Clinpro 5000, Clinpro Tooth Crème, and MI-Paste Plus on the formation of white spot lesions in patients undergoing orthodontic treatment.

MATERIALS AND METHODS

Three prospective groups with 40 patients undergoing orthodontic treatment in each group were evaluated (total recruitment = 120 subjects). The selected product was brushed on for 2 minutes twice daily for 4 months. Subjects were reviewed for 4 months on a monthly basis. The Enamel Decalcification Index (EDI) was used to determine the number of white spot lesions per surface at each visit.

RESULTS

100 subjects (35 using Clinpro 5000, 32 using Clinpro Tooth Crème, and 33 using MI Paste Plus) completed the study. The data lend strong support for Clinpro 5000 providing superior protection against enamel decalcification when compared to Clinpro Crème, and mixed support when compared to MI Paste Plus.

CONCLUSIONS

The use of Clinpro 5000, Clinpro Crème, and MI paste Plus all have a reduction effect on white spot lesions when compared to studies reported previously. Clinpro 5000 has a marginally better effect than the two other test pastes. The results of this study can be used by clinicians when deciding the effectiveness of using fluoride dentifrice products to prevent white spot lesions in their orthodontic practice (ClinicalTrials.gov ID: NCT03440996).

Benzalkonium chloride in an orthodontic adhesive: Its effect on rat enamel demineralization using color-based image analysis

INTRODUCTION

The aim of this study was to determine the effect of an orthodontic bonding adhesive containing benzalkonium chloride (BAC) on enamel demineralization.

METHODS

Eighteen female Sprague-Dawley rats, aged 8 to 10 weeks, were inoculated with Streptococcus sobrinus for 5 days. The animals were randomly divided into the control, non-BAC, and BAC groups. The 6 animals in each group did not receive any brackets, received brackets on the maxillary left first molars bonded with conventional adhesive, or received brackets on the maxillary left and right first molars bonded with adhesive incorporated with 0.25% and 0.75% BAC (wt/wt), respectively. After 7 weeks, the maxillae were soaked in murexide stain to observe the surface area (mm²) and percentages of enamel demineralization on the palatal, mesial, buccal, and occlusal surfaces of the maxillary molars using color-based image analysis.

RESULTS

The non-BAC and BAC groups exhibited greater enamel demineralization compared with the control group. The surface areas and percentages of enamel demineralization in the BAC group were less compared with the non-BAC group. Less enamel demineralization was noted in the animals treated with 0.75% BAC compared with those given 0.25% BAC in all areas; however, these differences were not great enough to attain statistical significance at the 0.05 level.

CONCLUSIONS

The addition of BAC to an orthodontic composite has the potential to reduce the amount and percentage of enamel demineralization. In addition to being an antibacterial agent, BAC may also have an anticariogenic effect. Increased sample sizes and testing of more concentrations of BAC are recommended.

Do total or partial etching procedures effect the rate of white spot lesion formation? A single-center, randomized, controlled clinical trial

OBJECTIVE

To determine whether total or partial etching procedures influence the appearance of white spot lesions (WSLs).

MATERIALS AND METHODS

This split-mouth, double-blind, controlled, randomized study included 20 patients (mean age 16.75 years), who had class I malocclusion, mild crowding, and satisfactory oral hygiene. A total of 40 maxillary quadrants were randomly allocated to be treated using a total etching (TE) or partial etching (PE) protocol. Quantitative light fluorescence images were captured at the beginning and at 3 (T1) and 6 (T2) months after beginning orthodontic treatmen, as well as when the debonding phase of orthodontic treatment was complete (T3). The presence of pre- and posttreatment WSLs was assessed with quantitative light fluorescence software and analyzed with Student's t-test.

RESULTS

The analyses showed that, at T2, the total etching group had significantly higher ΔQ and A scores than the partial etching group ( P < .05). The ΔF scores increased significantly at all timepoints in the TE group, but only at T1 and T3 in the PE group. However, no differences were noted at T3 between the TE and PE groups ( P > .05). The inclusion of only right-handed people may have limited the generalizability of the findings. The absence of analyses of the plaque and gingivitis scores of patients was another limitation of this study.

CONCLUSIONS

WSL formation was observed mostly in maxillary lateral incisor teeth irrespective of the etching technique. Although PE seems to be more successful in the first 6 months, no difference was observed between PE and TE in the long term for WSL formation.

A comparison of different sealants preventing demineralization around brackets

AIM

Aim of the study was to compare how six different sealants resisted thermal, mechanical, and chemical loading in vitro.

MATERIALS AND METHODS

In all, 120 extracted human, nondecayed molars were divided into six groups (20 samples each) and embedded in resin blocks. The buccal surfaces of the tooth samples were polished and divided into three areas. Area A contained the product to be analyzed, area B was covered with colorless nail varnish (negative control), and area C remained untreated (positive control). The samples were stored in 0.1% thymol solution. To simulate a 3-month thermomechanical load, the samples were subjected to thermal cycling and a cleaning device. After 7 days incubation in a ten Cate demineralization solution (pH value: 4.6), the samples were dissected using a band saw and the lesion depths and demineralization areas were evaluated and compared microscopically.

RESULTS

The tooth surfaces treated with PRO SEAL® showed no demineralization. Mean lesion depths of 108.1, 119.9, 154.9, 149.2, and 184.5 μm were found with Alpha-Glaze®, Seal&Protect®, Tiefenfluorid®, Protecto®, and Fluor Protector, respectively. There was a significant difference between PRO SEAL® and the other products (p > 0.0001). There was no significant difference between the other products.

CONCLUSION

PRO SEAL® resisted thermal, mechanical, and chemical loading in vitro, providing protection against white spot lesions.

Comparative assessment of fluoride varnish and fluoride film for remineralization of postorthodontic white spot lesions in adolescents and adults over a 6-month period: A single-center, randomized controlled clinical trial

INTRODUCTION

The objective of this 3-arm parallel randomized trial was to evaluate the effects of a fluoride varnish and a fluoride film on the remineralization of white spot lesions around orthodontic brackets after orthodontic treatment.

METHODS

Patients who had recently completed orthodontic treatment were randomly assigned to the varnish, film, and control groups. Eligibility criteria included age of 12 to 25 years, good general health, and at least 1 maxillary anterior tooth with a white spot lesion. The primary outcome was the decrease in the lesion volume of each patient after 6 months of treatment; fluorescence loss and area were the secondary outcome measures. Randomization was accomplished according to a computer-generated randomization schedule, and allocation concealment was achieved with nontransparent concealed envelopes. Blinding was applicable for the treatments only. The test groups received fluoride varnish or film treatment once a month for 6 months, and the control group received a placebo treatment. All patients received oral hygiene education and were required to use fluoride toothpaste daily. Quantitative light-induced fluorescence images were taken at baseline and at the 3-month and 6-month follow-ups. A mixed-effects linear model was used to analyze quantitative light-induced fluorescence parameters with confounders integrated into the model.

RESULT

Two hundred forty patients (mean age, 16.9 years; range, 12-25 years) with 597 teeth with a white spot lesion were randomized 1:1:1 to the varnish, film, and control groups. Baseline demographics were similar between groups, and 29 patients were lost to follow-up. The primary analysis was carried out on a per-protocol basis involving 72 patients in the control group, 69 patients in the varnish group, and 70 patients in the film group who completed the study. The product of fluorescence loss and lesion area values were statistically associated with time (estimate, -4.58; 95% confidence interval [CI], -5.84 to -3.31; P <0.0001), and a significant decrease in the product of fluorescence loss and lesion area was observed in all groups after 6 months with each treatment. The interaction between group and time in the statistical analysis indicated that the product of fluorescence loss and lesion area values of the 3 groups followed different trends over time. Further pair-wise comparisons showed that the decreases in the 2 test groups were significantly greater than those in the control group (varnish vs control: estimate, -11.83; 95% CI, -15.39 to -8.26; P <0.0001; film vs control, estimate: -7.72; 95% CI, -11.34 to 4.10; P <0.0001) in the analysis for 6 months. In addition, the decrease in the varnish group was significantly greater than that in the film group (estimate, 4.11; 95% CI, 0.48 to 7.73; P = 0.0266) in the analysis for 6 months. No serious adverse effects associated with the use of the tested varnish, film, or placebo occurred.

CONCLUSIONS

After removal of the orthodontic brackets, some natural remineralization of white spot lesions occurred, and daily use of fluoride toothpaste may be helpful for this process. However, not all patients experienced this remineralization, and treatment with fluoride varnish or fluoride film induced greater remineralization of white spot lesions. In addition, our results suggest that fluoride varnish may be slightly more effective than fluoride film. However, further similar clinical trials with more patients are needed to definitively determine which fluoride treatment is most effective.

REGISTRATION

This trial was registered on the Chinese Clinical Trial Register, number ChiCTR-TRC-13003764.

PROTOCOL

The details of the trial protocol are posted online at: http://apps.who.int/trialsearch/Trial.aspx?TrialID=ChiCTR-TRC-13003764.

Prevention and Treatment of White Spot Lesions in Orthodontic Patients

Decalcification of enamel, appearing as white spot lesions (WSLs), around fixed orthodontic appliances is a major challenge during and after fixed orthodontic treatment by considering the fact that the goal of orthodontic treatment is to enhance facial and dental esthetic appearance. Banded or bonded teeth exhibit a significantly higher rate of WSLs compared to the controls with no braces as fixed appliances and the bonding materials promote retention of biofilms. These lesions are managed in the first step by establishing good oral hygiene habits and prophylaxis with topical fluorides, including high-fluoride toothpastes, fluoride mouthwashes, gels, varnishes, fluoride-containing bonding materials, and elastic ligatures. Recently, other materials and methods have been recommended, including the application of casein phosphopeptides-amorphous calcium phosphate, antiseptics, probiotics, polyols, sealants, laser, tooth bleaching agents, resin infiltration, and microabrasion. This article reviews the currently used methods to manage enamel demineralization during and after orthodontic treatment and the risk factors and preventive measures based on the latest evidence.

Control of White Spot Lesions with Use of Fluoride Varnish or Chlorhexidine Gel During Orthodontic Treatment A Randomized Clinical Trial

OBJECTIVE

To compare the effectiveness of fluoride varnish and 2% chlorhexidine gel for controlling active white spot lesions (WSLs) adjacent to orthodontic brackets.

STUDY DESIGN

Thirty-five orthodontic patients (17.2 ± 2.3 years old) presenting 60 WSLs adjacent to orthodontic brackets were enrolled in this randomized, blind, 3-armed and controlled clinical trial. The patients were randomly allocated to 1 of 3 arms: (1) two applications of 5% NaF varnish- F, with one-week interval, (2) two applications of 2% chlorhexidine gel-CHX, with one-week interval and (3) usual home care-control (CO). The WSLs were scored by using a DIAGNOdent pen. An independent examiner scored the surfaces using Nyvad criteria for caries assessment.

RESULTS

A total of thirty patients presenting 51 lesions completed the study. All treatments reduced the fluorescence values during the experimental period; however, F induced faster remineralization than CHX. After 3 months, 70.58 % were inactive considering all groups. DIAGNOdent pen and Nyvad presented a significant correlation.

CONCLUSION

After 3 months of treatment, F, CHX and CO were capable of controlling the WSLs adjacent to the orthodontic brackets. However, the treatment with F was capable of controlling the progression of the WSLs in a shorter period of time.

Effects of chlorhexidine varnish on caries during orthodontic treatment: a systematic review and meta-analysis

This study aimed to perform a systematic review and meta-analysis to evaluate the effectiveness of chlorhexidine varnish on the reduction of caries incidence during fixed orthodontic treatment. The literature searches involved The Cochrane Library, Medline, Scopus, OpenSigle databases and manual searches. The search on OpenSigle did not produce any additional articles. Clinical studies conducted in patients with orthodontic fixed appliances that used professional application of chlorhexidine varnish were included. The effect-size was calculated and a meta-analysis was performed. From 182 abstracts, a total of six articles fulfilled the inclusion criteria. After reading the full articles, one was excluded because of lack of a control group. Three articles were used for continuous data analysis, and two articles were used for the dichotomous data analysis. The pooled meta-analysis with continuous data demonstrated chlorhexidine varnish effectiveness on caries reduction (p = 0.003), with a mean difference and confidence interval of -1.49 [-2.47, -0.51]. On the basis of the pooled meta-analysis of continuous data, we were able to conclude that professional application of chlorhexidine varnish is effective in caries incidence reduction during fixed orthodontic treatment.

Preparation of fluoride-loaded microcapsules for anticariogenic bacterial growth using a coaxial ultrasonic atomizer

A new method to deliver fluoride using biodegradable poly(lactic-co-glycolic acid) microcapsules to suppress cariogenic bacterial growth during orthodontic treatment was investigated. A coaxial ultrasonic atomizer was used to encapsulate KF solution into microcapsules. The orthodontic adhesive resin disk containing fluoride loaded microcapsules (DFLM) was prepared by LED light curing. The microstructure of microcapsules, successful loading of KF, fracture strength, and shear bonding strength were assessed by FE-SEM, confocal laser scanning microscope, and general purpose testing machine, respectively. Fluoride release from the DFLM in phosphate buffered saline and pH changes were measured after different periods of soaking time. Antibacterial activity of the DFLM was assessed in tryptic soy broth containing mutant streptococci. The starting inoculum and the orthodontic resin disk containing microcapsules not loaded with KF were used as negative and positive controls, respectively. As results, the cumulative amount of KF after 49 days was about 85% of the initial amount of fluoride contained in the microcapsules. The fracture and shear bonding strengths of the orthodontic resin disks with and without the microcapsules were similar to each other. The DFLM showed lower bacterial growth than the control groups, whereas no statistically significant differences were found between the negative and positive controls. It can be concluded that the microcapsules loaded with fluoride prepared by a coaxial ultrasonic atomizer have good potential for application as an antibacterial agent due to their excellent cariogenic antibacterial activity when incorporated into orthodontic adhesive resin. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 31-39, 2018.

Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial

Background

One of the most undesirable side effects of comprehensive orthodontic treatment is white spot lesions (WSLs). Despite many attempts at prevention of WSLs, its prevalence remains very high on debonding. There are many agents like fluoride toothpastes, fluoride varnishes, and fluoride mouth rinses, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is frequently used for the remineralization of WSLs. However, there is no consensus in the literature with respect to the success rates of these agents. Thus, the present study was designed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs.

Methods

Forty-five subjects in the age range of 16–25 years having at least one post-orthodontic WSL were included in the study. All the subjects were randomly divided into three groups (toothpaste group, varnish group, and CPP-ACP group). The efficacy of various remineralizing agents on the remineralization of WSLs was evaluated clinically and by DIAGNOdent immediately after debonding and subsequently after 1, 3, and 6 months of their use.

Results

Twice daily use of fluoride toothpaste alone had no significant effect on remineralization of WSLs at various intervals of observations (P = 0.078). Application of fluoride varnish along with twice daily use of fluoride toothpaste for 6 months significantly decreased the severity of WSLs (P < 0.01). Twice daily use of CPP-ACP plus crème along with fluoride toothpaste had significant effect on remineralization of WSLs at the end of 6 months of observation (P < 0.05). Between the group comparison showed that the mean visual and DIAGNOdent scores at various time intervals of observations were decreased more when fluoride varnish and CPP-ACP crème were used in addition to daily use of fluoride toothpaste, but the differences were not statistically significant (P > 0.05).

Conclusions

The use of fluoride varnish and CPP-ACP plus crème in addition to twice daily use of fluoride toothpaste had no additional benefit in the remineralization of post-orthodontic WSLs.

[Increased susceptibility for white spot lesions by surplus orthodontic etching exceeding bracket base area]

INTRODUCTION

There is a paucity of information with regard to the susceptibility of iatrogenic white spot lesion formation after inattentive, surplus orthodontic etching with 30% phosphoric acid and the subsequent provision or absence of adequate oral hygiene.

METHODS

Ninety sound enamel specimens were randomly allocated to 6 trial groups (N = 15 each) for etching with 30% phosphoric acid for either 15 seconds and standardized daily enamel brushing or no brushing, etching for 30 seconds with daily brushing or no brushing, or nonetched controls with brushing or no brushing. Nutritive acidic assaults were simulated by demineralization cycles 3 times per day for 1 hour with interim storage in artificial saliva. Lesion depths in terms of percentage of fluorescence loss (delta F, delta Q) and lesion extension compared with the baseline were assessed by using quantitative light-induced fluorescence after 2, 7, 14, 21, and 42 days. Etching duration, trial time elapse, and oral hygiene, as well as the significance of factor interactions, were analyzed with 3-way analysis of variance (α=5%).

RESULTS

The impact of the factors of enamel brushing, trial time elapse, and etching each had a comparably significant effect on lesion progression. The effect of surplus etching on white spot lesion formation was significantly enhanced by the simultaneous absence of enamel brushing and also the progression of trial time. The combination of 30 seconds of surplus etching with inadequate oral hygiene was especially detrimental.

CONCLUSIONS

Excessive surplus orthodontic etching of the complete labial enamel surface, instead of the bracket bases only, must be avoided to prevent iatrogenic white spot lesions. Etching times not exceeding 15 seconds are favorable.

Effects of different orthodontic primers on enamel demineralization around orthodontic brackets

AIM

The purpose of this work is to evaluate the effectiveness of one self-etching and two filled orthodontic primers on enamel demineralization around orthodontic brackets.

METHODS

Brackets were bonded to 84 bovine teeth and the vestibular enamel surfaces covered with acid-resistant nail varnish exposing 1 mm of space on each side of the bracket base. The teeth were allocated to four groups, using either Transbond XT conventional primer on etched enamel (group 1), Transbond Plus Self-Etching Primer on untreated enamel (group 2), Pro Seal filled resin primer on etched enamel (group 3), or Opal Seal filled resin primer on etched enamel (group 4). Each tooth was subjected to 15,000 strokes of brushing followed by exposure to an acid challenge. Calcium-ion release from each sample was calculated using atomic absorption spectrophotometry. Data were analyzed using one-way ANOVA and a post hoc Tukey test. Differences were considered statistically significant at p ≤ 0.05.

RESULTS

Statistically significant differences were observed between the four groups (p < 0.001). No significant difference was found between the controls (group 1) and the Opal Seal group. Higher calcium release was observed in the Pro Seal group and the self-etching primer group compared to the controls. The highest calcium release was recorded in the self-etching primer group.

CONCLUSION

Filled sealants may not have a protective effect against enamel demineralization. Transbond Plus Self-Etching Primer should be used cautiously, considering the risk of demineralization involved in its application.

Control of white spot lesion adjacent to orthodontic bracket with use of fluoride varnish or chlorhexidine gel

The aims of this study were to compare the effectiveness of fluoride varnish and chlorhexidine gel in controlling white spot lesions (WSLs) adjacent to orthodontic brackets and to compare the ability of Quantitative Light-Induced Fluorescence (QLF) to measure mineral uptake with that of transverse microradiography (TMR). Thirty premolars with artificially induced WSLs were randomly assigned to three groups: (1) two applications of 5% NaF-varnish (F), with one-week interval, (2) two applications of 2% chlorhexidine gel (CHX), with one-week interval, and (3) control (CO), no treatment. QLF was used to measure changes in fluorescence before and after caries induction, 1 week after each application and 1, 2, and 3 months after the last application of F or CHX. TMR was performed to quantify lesion depth and mineral content after caries induction to evaluate the effects of F, CHX, and CO 3 months after the last application of agents. The data were analyzed by repeated measures ANOVA and Tukey's test. All treatments increased the mineral content during the experimental period; however, F induced faster remineralization than CHX. The correlation between QLF and TMR was significantly moderate. Two applications of fluoride varnish or 2% chlorhexidine gel at one-week intervals were effective in controlling WSLs.

The effect of various oral hygiene products on the microbial flora in patients undergoing orthodontic treatment

Context

Orthodontic devices lead to significantly greater plaque accumulation and gingival inflammation resulting in a change of gingival flora from cocci and rods to motile organisms like spirochetes.

Aims

The aim was to study the effect of various oral hygiene products on the microbial flora in patients undergoing orthodontic treatment.

Materials and Methods

The microbial composition of 40 patients, divided into four groups of 10 patients each, was evaluated. Group I patients were prescribed nonfluoridated dentifrice which act as the control group, Group II patients were given fluoridated dentifrice while in Group III and Group IV fluoridated mouth rinse and cetylpyridinium chloride mouth rinse, respectively, along with nonfluoridated toothpaste was prescribed. The plaque sample was collected at the start of orthodontic treatment, after 30 days, 60 days and 90 days for all the patients. The microscopic slides were prepared and observed under dark field microscopy at the magnification of ×1000 and microbes were classified as cocci, spirochetes, fusiforms, filaments, and rods.

Results

After applying analysis of variance and Tukey honest significant difference test, it was observed that after 30 days, only the proportion of filaments was found to be significantly higher in Group I. After 60 days, Group I had significantly lower proportion of cocci and a higher proportion of rods as compared to other groups. After 90 days, Group I had significantly higher count of rods, filaments, fusiforms, and spirochetes as compared to Groups III and IV.

Conclusion

Less amount of the microbial shift to the pathogenic organisms was seen in the patients in whom mouthwashes along with tooth brushing were prescribed.

Short-term effect of removal of fixed orthodontic appliances on gingival health and subgingival microbiota: a prospective cohort study

OBJECTIVE

The aim of this prospective longitudinal study was to assess and compare the microbiological and clinical parameters of patients wearing a fixed orthodontic appliance, as opposed to 10 days after the bracket had been removed following treatment.

MATERIALS AND METHODS

In total, 122 patients participated in this study; 61 of the subjects were assessed at baseline (wearing a fixed orthodontic appliance: T1) and 10 days after bracket removal (T2). The other 61 individuals had never worn an orthodontic appliance before and these subjects served as controls (CT). Subgingival plaque samples were assessed for bleeding on probing (GBI) and plaque index (VPI). PCR of 16s rDNA, followed by reverse species-specific hybridization for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola were performed. A descriptive analysis was conducted; chi-squared, Student's matched and unmatched t-tests, the point biserial correlation coefficient and the McNemar test were used to test for differences between groups (p < 0.05).

RESULTS

The GBI and VPI clinical parameters showed statistical differences (p < 0.05) between T1-T2, T1-CT and T2-CT. The prevalence of T. denticola had significantly decreased (p = 0.039) 10 days after appliance removal. At T2, a significant positive correlation was found between GBI and A. actinomycetemcomitans (p < 0.01) and between clinical parameters and P. intermedia. In patients without a fixed orthodontic appliance (T2 and CT), there was a significant positive correlation between T. forsythia and VPI.

CONCLUSION

Local factors associated with the wearing of a fixed orthodontic appliance influence changes in subgingival plaque that leads to more inflammation and bleeding.

Fluorides, orthodontics and demineralization: a systematic review

OBJECTIVES

To evaluate the effectiveness of fluoride in preventing white spot lesion (WSL) demineralization during orthodontic treatment and compare all modes of fluoride delivery.

DATA SOURCES

The search strategy for the review was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for RCTs or CCTs: Cochrane Clinical Trials Register, Cochrane Oral Health Group Specialized Trials Register, MEDLINE and EMBASE. Inclusion and exclusion criteria were applied when considering studies to be included. Authors of trials were contacted for further data.

DATA SELECTION

The primary outcome of the review was the presence or absence of WSL by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth.

DATA EXTRACTION

Six reviewers independently, in duplicate, extracted data, including an assessment of the methodological quality of each trial.

DATA SYNTHESIS

Fifteen trials provided data for this review, although none fulfilled all the methodological quality assessment criteria. One study found that a daily NaF mouthrinse reduced the severity of demineralization surrounding an orthodontic appliance (lesion depth difference -70.0 microm; 95% CI -118.2 to -21.8 microm). One study found that use of a glass ionomer cement (GIC) for bracket bonding reduced the prevalence of WSL (Peto OR 0.35; 95% CI 0.15-0.84) compared with a composite resin. None of the studies fulfilled all of the methodological quality assessment criteria.

CONCLUSIONS

There is some evidence that the use of a daily NaF mouthrinse or a GIC for bonding brackets might reduce the occurrence and severity of WSL during orthodontic treatment. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient.

The impact of chlorhexidine mouth rinse on the bond strength of polycarbonate orthodontic brackets

OBJECTIVE

The purpose of the current in-vivo study was to assess the effect of using 0.12% chlorhexidine (CHX) mouth rinse, before bonding, on shear bond strength of polycarbonate brackets bonded with composite adhesive.

SUBJECTS AND METHODS

Eighteen orthodontic patients with a mean age 21.41 ± 1.2 years, who were scheduled to have 2 or more first premolars extracted, were included in this study. Patients were referred for an oral prophylaxis program which included, in part, the use of a mouth rinse. Patients were divided into 2 groups, a test group of 9 patients who used 0.12% CHX gluconate mouth rinse twice daily and a control group of 9 patients who used a mouth rinse without CHX, but with same color. After 1 week, polycarbonate brackets were bonded to first premolars with Transbond XT composite adhesive. Premolars were extracted after 28 days and tested for shear bond strength on a universal testing machine. Student's t-test was used to compare shear bond strengths of both groups.

RESULTS

No statistically significant difference was found in bond strengths' values between both groups. The test group (with CHX) has mean shear bond strength of 14.21 ± 2.42 MPa whereas the control group (without CHX) revealed a mean strength of 14.52 ± 2.31 MPa.

CONCLUSION

The use of 0.12% CHX mouth rinse, for one week before bonding, did not affect the shear bond strength of polycarbonate brackets bonded with Transbond composite. Furthermore, these brackets showed clinically acceptable bond strength.