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Abstract
Enamel demineralization can occur as aside effect during orthodontic treatment with fixed appliances and should be detected as early as possible. Anew approach to assess demineralization is asystem consisting of aphotosensitive protein that binds to free calcium ions at the enamel surface. Acamera is then used to visualize the bioluminescence spots. This invitro study aimed to evaluate the ability of the bioluminescence technology to assess artificially demineralized enamel adjacent to various orthodontic brackets. In all, 108 human enamel samples were allocated randomly to groups with different orthodontic bracket material: stainless steel, titanium, ceramic. Initial lesions were created adjacent to the brackets. The samples were assessed by bioluminescence before and after demineralization. Images were assessed for presence of bioluminescence spots (yes/no). To quantify the bioluminescence measurements, the images' pixel values(P) were calculated within adefined area(F) adjacent to each bracket before and after demineralization. Quantitative light-induced fluorescence measurements (ΔF, ΔQ) were performed as the reference standard for demineralization. After demineralization, bioluminescence spots were visible (yes/no decision) in 87% of the samples. The pixel analysis of the bioluminescence spots showed significantly higher pixel values after demineralization compared to baseline (p < 0.0001). The bracket material had no influence on the bioluminescence measurements. All samples showed fluorescence loss with amedian ΔF of -9.52% (±3.15) and amedian ΔQ of -1.01% × mm2 (±3.34), respectively. The bioluminescence technology is apromising tool to demonstrate demineralization adjacent to different orthodontic brackets invitro.
Highlights
Orthodontic treatment with fixed multibracket appliances is a common method to treat malpositioned teeth
A new approach for detecting enamel demineralization is the assessment of free calcium ions indicating enamel demineralization
The results show that luminescence spots were detectable after demineralization and that significantly higher pixel values were measured after demineralization of the enamel compared to the values from baseline measurements (Table 2)
Summary
Orthodontic treatment with fixed multibracket appliances is a common method to treat malpositioned teeth. A standard procedure is to attach brackets on the labial or lingual surfaces of the teeth. Treatment with multibracket appliances makes oral hygiene more difficult and leads to undesired adverse effects to the teeth and the surrounding structures [28]. Without proper preventive intervention, such lesions can progress to dentine caries [11]. Detection of demineralization adjacent to brackets is challenging. Visual assessment is an important method for detecting initial lesions, it is often subjective; subsidiary methods may provide additional benefit in objectifying and documenting demineralization, including digital documentation. Remineralizing measures can only be used effectively if demineralization is detected early and the evident success of remineralizing procedures, in terms of follow-up, can significantly improve patient cooperation
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