Abstract
Orthodontic treatment is widely used to correct irregular teeth and/or jaw discrepancies to improve oral function and facial aesthetics. However, it is frequently associated with enamel damage that include chipping, demineralisation, and white spot formation. So far, current bonding systems that can maintain shear bond strengths (SBS) suitable for clinical performance are unable to limit enamel demineralisation, adhesive remnants and damage caused on removal of brackets after treatment. This study reports a novel “safe enamel etch” clinically viable procedure that was accomplished via application of novel etchant pastes developed with β-tricalcium phosphate and monocalcium phosphate monohydrate powders mixed with citric acid (5 M) or phosphoric acid (37% PA) to yield BCA and BPA etchants respectively. Although enamel etched with clinically used PA gel yielded higher SBS than the BCA/BPA etchants, it exhibited greater adhesive remnants with evidence of enamel damage. In contrast, the experimental etchants resulted in unblemished enamel surfaces with zero or minimal adhesive residue and clinically acceptable SBS. Furthermore, the BPA etchant caused lower enamel decalcification with extensive calcium-phosphate precipitation. The study conclusively showed that BPA facilitated in vitro enamel adhesion without detrimental effects of the aggressive PA gel with potential for remineralisation and saving time at the post-debonding step.
Highlights
Malocclusion of teeth is common in different age groups and can have negative influence on dentofacial development, contributing to impaired orofacial function, patient’s psychological well-being and quality of life
Bracket bases are currently provided with mesh designs that ensure robust mechanical interlocking between the bracket and adhesive (Fig. 1), whilst research is ongoing to improve enamel conditioning strategies that can attain clinically successful bond strengths yet maintain an unblemished enamel surface[5]
A commercial phosphoric acid (PA) gel was used as the control group whilst the experimental etchants comprised of equimolar amounts of β-TCP and monocalcium phosphate monohydrate (MCPM) in presence of either phosphoric (BPA) or citric acid (BCA)
Summary
Malocclusion of teeth is common in different age groups (especially children and adolescents) and can have negative influence on dentofacial development, contributing to impaired orofacial function, patient’s psychological well-being and quality of life. The treatment outcomes are frequently associated with a wide range of enamel damage including demineralisation or white spot formation that occur during the prolonged treatment, whilst enamel chipping or cracking very often ensues at the time of appliance removal due to the high debonding force required to remove the brackets[2], which results in some of the adhesive being left on the enamel surface The removal of these adhesive remnants is required at the completion of treatment, which causes further trauma to the enamel[3]. The hypothesis is that the use of CaP precursors, which on mixing with an acid produces a CaP etchant capable of overcoming the detrimental effects of a strong acid alone on enamel damage, without compromising the bracket bond strength
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