Abstract
Abstract All patients receiving orthodontic treatment with fixed appliances have a significantly higher risk of developing white spot lesions (WSLs), which are considered the most common iatrogenic complication of treatment. Cleft lip and/or palate (CLP) is a common craniofacial anomaly occurring in approximately one in 800 births. Patients affected by cleft lip and/or palate tend to have poorer oral hygiene and a greater risk of WSLs and caries than non-cleft sibling controls. Patients presenting with a cleft lip and/or palate also have a higher prevalence of molar-incisor hypomineralisation (MIH), which suggests that clinicians involved in the oral health management of cleft patients need to consider all available caries prevention protocols. Cases presenting with hypomineralised teeth create more difficulty in bonding attachments to affected enamel using an acid etch technique and a composite resin material due to the abnormal prism structure. The bond strength to hypomineralised enamel can be as low as two-thirds that of the bond strength to unaffected enamel, which may not be adequate for routine fixed appliance treatment. Furthermore, the removal of orthodontic brackets from hypomineralised enamel may lead to more severe damage to the affected teeth. Resin modified glass-ionomer cement (RMGIC), bonded after conditioning the enamel with polyacrylic acid, creates no resin tags as a result of a chemical rather than a mechanical bond. Therefore, there is less enamel loss during bracket debonding when compared with acid-etch preparation and composite resin bonding. Furthermore, in cases in which the quality of the enamel is deficient causing limits to the shear bond strength of the acid-etched composite resin, the chemical bonding action of RMGIC overcomes the lack of adherence and protects the enamel. RMGIC has cariostatic properties and clinical evidence supports the routine use of these adhesives for bonding in all fixed appliance cases as a strategy for reducing the incidence of white spot lesions and damage to the enamel during bracket debonding.
Highlights
Cleft lip and/or palate (CLP) is a common craniofacial anomaly that occurs in approximately one in 800 births.[1]
The depth of cure with irradiated Resin modified glass-ionomer cement (RMGIC) is significantly higher than auto-curing RMGIC such that light cured RMGICs are stronger materials with greater adhesion than auto-cured RMGICs
The cariostatic effect of RMGICs has been shown in vivo, adjacent to orthodontic attachments bonded with RMGIC.[46]
Summary
Cleft lip and/or palate (CLP) is a common craniofacial anomaly that occurs in approximately one in 800 births.[1]. Any remaining HEMA not irradiated by light will continue to set by chemical polymerisation.[43] The depth of cure with irradiated RMGIC is significantly higher than auto-curing RMGIC such that light cured RMGICs are stronger materials with greater adhesion than auto-cured RMGICs. A major advantage of RMGIC is the ability to act as a reservoir of fluoride in the oral cavity and to provide a mechanical barrier that protects the tooth surface against bacteria.[41] RMGICs are able to take up fluoride from external sources such as toothpaste or fluoride gels slowly release ions to reduce the acidic nature of any surrounding biofilm.[44] RMGICs have a therapeutic effect against caries[45] through the leaching of fluoride into adjacent enamel in a manner similar to conventional glass-ionomer cements in the prevention of white spot lesions.[15,36] The cariostatic effect of RMGICs has been shown in vivo, adjacent to orthodontic attachments bonded with RMGIC.[46] This is a particular advantage in communities without fluoridated water supplies and where only bottled (non-fluoridated) drinking water is available. Clean the enamel surface to be bonded with a rubber cup or brush with a slurry of pumice and water
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