Effectiveness of a Selective Etching Technique in Reducing White Spots Formation around Lingual Brackets: A Prospective Cohort Clinical Study

Domenico Dalessandri,Luca Visconti,Gaetano Isola,Marino Bindi,Francesca Massetti,Stefano Bonetti,Corrado Paganelli,Marco Migliorati

doi:10.3390/coatings11050572

Domenico Dalessandri, Luca Visconti + Show 6 more

Open Access

https://doi.org/10.3390/coatings11050572

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Abstract

The risk of developing white spot lesions (WSLs) after orthodontic treatment with lingual brackets is generally considered lower than with labial ones, even if plaque accumulation is frequently higher due to the increased difficulty level in oral hygiene maintenance. In this prospective clinical study, selective enamel etching technique effectiveness in reducing plaque accumulation and WSLs was tested. Thirty patients were bonded with a split-mouth approach: two randomly selected opposite quadrants were used as the test sides, using customized plastic etching guides, and the other two as control sides, applying traditional direct etching methods. The plaque presence around the braces was recorded after 1, 3, 6, and 12 months according to a lingual plaque accumulation index (LPAI), as was the presence of WSLs. PAI measured values were significantly higher in the control sides during the observation period. Test and control sides differed significantly for new WSL onset only after 12 months of treatment. Therefore, the present research demonstrated that this guided enamel etching technique allowed for significant reduction in plaque accumulation around the lingual brackets and reduced onset of white spots after one year of treatment.

Highlights

Lingual orthodontics is the most esthetic and an almost invisible orthodontic technique available to correct several types of malocclusions [1]
Even if compared with clear aligner therapy (CAT), which employs a sequence of transparent plastic trays to progressively straighten teeth, lingual braces are hard to see at talking distance because they are bonded to the internal teeth surface [2]
The same occurs with CAT when using similar inter-arch elastics attached to buttons bonded to teeth, or to special notches cut on the plastic tray margins [4]

Summary

Introduction

Lingual orthodontics is the most esthetic and an almost invisible orthodontic technique available to correct several types of malocclusions [1]. Even if compared with clear aligner therapy (CAT), which employs a sequence of transparent plastic trays to progressively straighten teeth, lingual braces are hard to see at talking distance because they are bonded to the internal teeth surface [2]. It can be argued that the use of inter-arch elastics attached to lingual braces, or to composite buttons placed on the external teeth surface, has a negative impact on smile esthetics. The same occurs with CAT when using similar inter-arch elastics attached to buttons bonded to teeth, or to special notches cut on the plastic tray margins [4]. This occurs when applying several attachments to the vestibular teeth surface, such as tooth-colored

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