Abstract
Background/Aim: Orthodontic treatment has an inherent potential for causing defects to enamel in the course of bonding and debonding procedures, interproximal enamel stripping and induce the presence of white spot lesions, enamel discoloration or wear. The aim of this study is to present the stages of orthodontic therapy associated with potential damage to enamel and list the enamel alterations observed in each stage. Material and Methods: A literature search was carried out in MEDLINEPubMed database for papers published up to and including February 2015. Results: Enamel loss is induced by cleaning with abrasives before etching, the acid etching process itself, forcibly removing brackets, and mechanical removal of composite remnants with rotary instruments. Loss of enamel or topographic changes in the form of cracks, scarring and scratches may occur. Clinicians may cause structural damage of enamel by interproximal enamel stripping. Additionally, the enamel surface may become demineralized due to plaque accumulation around the orthodontic attachments. Additional complications are enamel color alterations due to its microstructural modifications or discoloration of adhesive remnants and enamel wear due to contact with the brackets of the opposing teeth. Conclusions: Therapeutic procedures performed in the course of orthodontic treatment may cause irreversible physical damage to the outermost enamel. To avoid this, the orthodontic practitioner should take great care in every stage of the treatment and manage the enamel surface conservatively. Moreover, patients should follow an effective oral hygiene regimen. Given these conditions enamel damage during orthodontic therapy is eliminated and longevity of the dentition is promoted.
Highlights
Tooth enamel is the most mineralized, and the hardest, of all substances in the human body
It has been shown that the use of the polishing brush causes greater enamel loss than that of the rubber cup, while no difference was found among the various slurries
Therapeutic procedures performed as a part of orthodontic treatment may cause irreversible physical damage to enamel surface
Summary
Tooth enamel is the most mineralized, and the hardest, of all substances in the human body. It is composed of 96 wt% of mineral content combined with 4 wt% of organic material and water[1,2]. Orientation of prisms in the enamel is not homogeneous; in permanent teeth they are vertical at the cusp tip or incisal edge, become oblique toward the middle part of the occlusal surface and are aligned towards the root in the cervical region[3]. The enamel exhibits a variable thickness over the tooth surface, often being the thickest at the incisal edge and cusp tips of molars and premolars, up to 2.5 mm; and is thinnest where it meets the cementum at the cementoenamel junction. At the cervical area of teeth, as well as at the pits and fissures of the tooth, there is a surface of aprismatic layer of enamel
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