Efficacy of different strategies in protecting enamel against demineralization during fixed orthodontic treatment

Abstract

Sealant application is a common strategy for preventing enamel demineralization during multibracket treatment. The aim of this study was to assess the efficacy in enamel demineralization prevention of two fluoride-containing enamel varnishes compared to a non-fluoride varnish, weekly fluoride gel application, and a non-treated control group. Enamel specimens obtained from 75 human upper permanent incisors were randomly allocated to five trial groups (each n = 15): A), ProSeal (Reliance), B), Maximum Cure® (Reliance), C), CervitecPlus (Ivoclar Vivadent, Schaan, Liechtenstein), D) elmex® gelée (GABA, Lörrach, Germany), and E), a non-treated control group. Groups A-C received a baseline varnish application, whereas group D specimens received a once weekly gel application for 2min. Six demineralization cycles per day were carried out for 5min each using 0.05M citric acid, with the specimens stored in remineralization solution between cycles. Lesion depth expressed in percentage fluorescence loss (Δ-F in %) compared to baseline (T0) was assessed quantitatively with light-induced fluorescence (QLF) after 3 (T1), 7 (T2), 14 (T3), and 30 (T4) days globally and for each time point, and analyzed for compounds using the Kruskal-Wallis test (α = 5%), and additional one-sample Wilcoxon tests for each time/compound combination (Bonferroni-corrected α-levels α* = 0.05/4 = 0.0125). Significant fluorescence loss revealing greater lesion depth was detected in the untreated controls (E) at T3, and in groups A (ProSeal) and C (CervitecPlus) at T4. No significant Δ-F changes were seen in the specimens from groups B (Maximum Cure®) and D (elmex® gelée). Maximum Cure® sealant seems to offer efficient protection against demineralization during fixed orthodontic treatment, as does weekly application of elmex® fluoride gel.