Enamel Decalcification Research Articles

Effect of Orthodontic Treatment on Endodontically Treated Teeth

ABSTRACT Background: This research has been conducted to assess the effect of orthodontic treatment on endodontically treated tooth. Materials and Methods: Overall, fifty subjects had been recruited. The participants received root canal therapy within 3 months as well as had an appointment for fixed orthodontic therapy. All candidates underwent an intraoral investigation. Radiographic evaluation as well as therapy planning were completed. Fixed orthodontic therapy had been initiated. All of the participants had been recalled. Endodontically restored teeth had been evaluated. All outcomes were assessed via Statistical Package for the Social Sciences (SPSS) software. Results: In this study, there were 25 males and 25 females. Pulp stones were seen in 15 subjects. Apical periodontitis was seen in nine subjects. Apical root resorption was seen in seven subjects, and enamel decalcification was seen in four subjects. Overall, 35 out of 50 subjects showed negative effects of orthodontic treatment on endodontically treated teeth. Conclusion: Excessive orthodontic force may result in increased pulp and peri-apical inflammation.

White Spot Lesions in Fixed Orthodontics: A Literature Review on Etiology, Prevention, and Treatment.

White spot lesions (WSLs) are a common complication after treatment using fixed orthodontic appliances. Decalcification of enamel surrounding fixed orthodontic appliances, known as WSLs, poses a significant aesthetic difficulty during and after treatment, as the purpose of fixed orthodontic therapy is to improve facial and dental appearance. Modern dentistry utilizes remineralization therapiesto non-invasively treat WSLsto prevent the progression of disease and enhance the strength, appearance, and functionality of the affected tooth. This review aims to identify and assess the etiology, formation, and risk factors, as well as current treatment approaches used in achieving WSLs remineralization, induced by fixed orthodontic appliances.An electronic search on the PubMed and ScienceDirect databases was performed using a selected keyword.A total of 172 studies (from 2013 to 2023) were retrieved. Their references were also checked to find other relevant studies. Duplicate copies were excluded. After the abstract and full-text screening, only 39 studies were included. Even though numerous studies address the different treatment modalities for managing post-orthodontic WSLs, such as antiseptics; fluoridessuch as dentifrices, mouthwash, and varnish, and remineralizing agents such as casein phosphopeptides amorphous calcium phosphate, biomimetic self-assembling peptides, lasers, bleaching, microabrasion, and resin infiltration. There is a lack of evidence-based studies that examine the long-term effects of WSLtreatment. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

Assessment of the Additive Effect of Remineralizing Agents in Combination With Fluoride Releasing Adhesives in the Prevention of Enamel Decalcification in Orthodontic Patients: An In Vitro Study.

Introduction Incorporation of remineralizing agents with fluoride-releasing bracket adhesives may prevent the development of white spot lesions (WSL) or reverse the established WSL in patients undergoing fixed orthodontic treatment. We aimed to find out how effectively casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride varnish (FV) can remineralize teeth when mixed with fluoride-releasing orthodontic adhesive. Materials and methods We randomly assigned a total of 60 premolar teeth, therapeutically extracted for orthodontic purposes, into two equal groups. Group I (n = 30) utilized fluoride-releasing adhesive (FR), and Group II (n = 30) bonded with non-fluoride adhesive (NFR). Based on the applied remineralizing agent, we further divided each of the two groups into three equal subgroups of 10: Group IA (FR+FV), Group IB (FR+CPP-ACP), Group IC (control-only FR), Group IIA (NFR+FV), Group IIB (NFR+CPP-ACP), and Group IIC (control-only NFR). Following bonding procedures, all the samples underwent pH cycling for 28 days, where the enamel samples were immersed in 20 ml of demineralizing solution for three hours, followed by immersion in 30 ml of remineralizing solution for 17 hours. The samples were analyzed for shear bond strength (SBS) on a universal testing machine and hardness values (HV) by the Vickers microhardness test (VMT) using the indentation method. We also evaluated the adhesive remnant index (ARI) scores to determine the site of bracket failure. Statistical analysis The shear bond strength (SBS) and hardness value (HV) were expressed as the mean, standard deviation (SD), and median for each subgroup. We used the non-parametric Kruskal-Wallis test to analyze the SBS and HV, followed by the Dunn-Bonferroni test for intra-pair differences. The ARI score was expressed as the frequency of the percentage distribution, and the difference in the distribution of ARI scores between the groups was assessed by the Cochran chi-square test. The probability (p) value equal to or less than 0.05 was considered statistically significant. Results The results show that Group IB, bonded with a fluoride-releasing adhesive and a CPP-ACP remineralizing agent surface treatment, has the highest HV of300.23 units. Group IIC (only NFR) has the lowest hardness of153.3 units, which is statistically significant (p < 0.001). However, the ARI scores are not statistically significant between the groups tested. Conclusion The bond strength of the adhesive and the surface hardness of the enamel increased with the addition of fluoride varnish and CPP-ACP to both the fluoride-releasing and non-fluoride-releasing adhesives.

Evaluation of Antibacterial Effect of Hybrid Nano-coating of Stainless Steel Orthodontic Brackets on Streptococcus Mutans – An In vitro Study

ABSTRACT Nano-coating of orthodontic brackets with a combination or hybrid of metals and metal oxides may reduce the streptococcus mutans count and incidence of enamel decalcification seen around brackets in patients undergoing fixed orthodontic treatment. In total, 255 orthodontic brackets (3M Unitek, Monrovia, California, USA) were divided into one control group (group I) of 60 and three experimental groups of 65 each (groups II, III, and IV). The experimental group brackets were coated with a combination of silver-zinc oxide, copper oxide -zinc oxide, and silver-copper oxide nanoparticles using physical vapour deposition method. The two nanoparticles used for each group were mixed in the ratio of 1:1 by weight for providing a uniform hybrid coating. Sixty brackets from each group were used for microbiological evaluation of antibacterial activity against Streptococcus mutans in blood agar medium, and the remaining five brackets from each experimental group were used for SEM analysis to check the uniformity of the coating. Nano-coated brackets demonstrated better antibacterial properties than uncoated brackets. Copper oxide–zinc oxide nanoparticles coated brackets demonstrated better antibacterial properties than the silver–zinc oxide and silver– copper oxide coated brackets.

Sustained antibacterial activity of orthodontic elastomeric ligature ties coated with a novel kombucha-derived bacterial nanocellulose: An in-vitro study.

Incipient carious lesions, the most common complication in orthodontic patients with fixed appliances, call for the development of novel preventive dental materials that do not rely on patient adherence. The present study aimed to assess the ability of elastomeric ligatures coated with bacterial nanocellulose (BNC) to deliver sustained antibacterial activity, during the standard 28-day interval between orthodontic appointments, without compromising their mechanical properties. Kombucha membrane was used to produce cellulose as a secondary product from the fermentation of tea broth with symbiotic bacteria and yeast culture. Characterization of BNC-coated elastomeric ligatures was performed using Fourier Transform Infrared Spectroscopy and Energy Dispersive Spectroscopy analysis. The samples were pre-treated by immersion first in isopropyl alcohol, then in 8 mL nanocellulose solution for 7 days. Tensile strain and strength of the BNC-coated and conventional ligatures were evaluated using a tensile testing machine. Direct contact and agar diffusion tests were performed to assess the antibacterial activity of nanocellulose. In addition, the release profile of BNC was evaluated. Data analysis was performed by one-way analysis of variance (ANOVA) followed by post-hoc Tukey's test and Wilcoxon signed-rank test. P values less than 0.05 was regarded as significant. There was no statistically significant difference in tensile strain and strength between the BNC-coated and conventional ligatures. The coated ligatures provided sustained antibacterial activity during the required 28 days. The use of BNC-coated elastomeric ligatures in patients with fixed orthodontic appliances might be a promising solution to plaque formation and subsequent enamel decalcification.

Evaluation of oral health status for a group of orthodontic patients

Background: Malocclusion and fixed orthodontic appliance convoluted the ordinary oral hygiene measures, which may lead to accumulation and prolonged retention of dental plaque on tooth surfaces particularly around the orthodontic brackets and auxiliaries of the fixed orthodontic appliance. Objective: To evaluate the oral health status among a group of orthodontic patients by evaluating the plaque, gingival, calculus, and Enamel Decalcification indices. Patients and Methods: This study was conducted among 128 persons (64 with fixed orthodontic appliance as a study group and 64 without fixed orthodontic appliance as a control group. An assessment of related clinical parameters as plaque, gingival, as well as enamel decalcification indices were done. Results: The present study revealed that the mean plaque, gingival, as well as enamel decalcification indices for the total sample were (1.182±0.356), (1.230±0.269), and (1.329±0.413) respectively. Additionally, all of these indices were higher among study group (fixed orthodontic patient) than among control group (persons without orthodontic appliance) with statistically significant difference among groups for each. Conclusion: Fixed orthodontic appliance is an effective plaque retentive factor that accumulate dental plaque which is the main causative factor for development of enamel white spot lesion and periodontal disease.

Evaluation of oral health status for a group of orthodontic patients

Background: Malocclusion and fixed orthodontic appliance convoluted the ordinary oral hygiene measures, which may lead to accumulation and prolonged retention of dental plaque on tooth surfaces particularly around the orthodontic brackets and auxiliaries of the fixed orthodontic appliance. Objective: To evaluate the oral health status among a group of orthodontic patients by evaluating the plaque, gingival, calculus, and Enamel Decalcification indices. Patients and Methods: This study was conducted among 128 persons (64 with fixed orthodontic appliance as a study group and 64 without fixed orthodontic appliance as a control group. An assessment of related clinical parameters as plaque, gingival, as well as enamel decalcification indices were done. Results: The present study revealed that the mean plaque, gingival, as well as enamel decalcification indices for the total sample were (1.182±0.356), (1.230±0.269), and (1.329±0.413) respectively. Additionally, all of these indices were higher among study group (fixed orthodontic patient) than among control group (persons without orthodontic appliance) with statistically significant difference among groups for each. Conclusion: Fixed orthodontic appliance is an effective plaque retentive factor that accumulate dental plaque which is the main causative factor for development of enamel white spot lesion and periodontal disease. Keywords: Oral health status, Fixed orthodontic appliance, white spot lesion, periodontal disease.

What’s new for the clinician – summaries of recently published papers

Interdental cleaning devices in the form of dental floss and interdental brushes have traditionally being used as adjuncts to plaque removal in the interproximal areas of teeth. However, their routine use among younger adolescents has been reported in many studies to be less than optimal. In orthodontic patients, fixed braces promote supra- and subgingival accumulation of biofilm by impeding oral hygiene resulting in an altered oral microbiome, enamel decalcification and gingivitis1. It was recently shown that patients with upper and lower multibracket appliances are affected significantly more frequently by gingivitis (65%) and white spot lesions (30%).1 Additionally, in the predominantly young orthodontic patients, interdental spaces are often too narrow to use interdental brushes and flossing is challenging and time-consuming. Oral irrigators are easy to use even in the presence of orthodontic braces and are therefore favoured by many patients. Most oral irrigators use a stream of water only to mechanically remove plaque from interproximal areas but there are also oral irrigators which use a mixture of air and water, called microburst technology.

The effect of surface roughening of orthodontic elastomers on hydrophobicity and in vitro adherence of Streptococcus gordonii

ObjectivesBiofilm formation around orthodontic appliances causes gingivitis, enamel decalcification and caries. Bacteria adhere less readily to superhydrophobic surfaces. The aim of this study was to determine whether a superhydrophobic surface could be generated on orthodontic elastomers by surface modification in order to reduce bacterial adhesion. Materials and methodsOrthodontic elastomers were modified with sandpapers of various grit sizes (80–600 grit). Surface roughness of the modified and unmodified surfaces was assessed qualitatively with scanning electron microscopy and quantitatively with confocal microscopy. Water contact angles were measured with a goniometer to quantify hydrophobicity. Measurements were performed on unextended elastomers (100% original length) and elastomers extended to 150%, and 200% of the original length. Adhesion of Streptococcus gordonii to saliva coated elastomers was measured by counting colony forming units on agar plates. ResultsAbrasion with different sandpapers produced elastomers with surface roughness (Ra) ranging from 2 to 12 μm. Contact angles followed a quadratic trend with a maximum contact angle of 104° at an Ra of 7–9 μm. Average water contact angles, when viewed perpendicular to the direction of extension, decreased from 99° to 90° when the extension was increased from 100% to 200% and increased from 100° to 103° when viewed parallel to the direction of extension. Bacterial adhesion increased as roughness increased and this effect was more pronounced with elastomer extension. ConclusionThe surface roughness of orthodontic elastomers influences both their hydrophobicity and bacterial adhesion. Superhydrophobicity of elastomers could not be achieved with sandpaper abrasion.

Influence of resin modified glass ionomer cement incorporating protein-repellent and antimicrobial agents on supragingival microbiome around brackets: an in-vivo split-mouth 3-month study.

To explore the influence of resin modified glass ionomer cement (RMGIC) adhesives containing protein-repellent and quaternary ammonium salt agents on supragingival microbiome, enamel and gingival health around brackets. Ten patients (21.4 ±3.5 years) about to receive fixed orthodontics were enrolled in this study. Unilateral upper teeth bonded with RMGIC incorporating 2-Methacryloyloxyethyl phosphorylcholine (MPC) and Dimethylaminohexadecyl methacrylate (DMAHDM) were regarded as experimental group (RMD), while contralateral upper teeth bonded with RMGIC were control group (RMGIC), using a split-mouth design. Supragingival plaque was collected from both groups before treatment (T0), and at 1 month (T1) and 3 months (T2) of treatment. High-throughput sequencing was performed targeting v3-v4 of 16S rRNA gene. Streptococcus mutans and Fusobacterium nucleatum quantification was done by qPCR analysis. Bracket failures, enamel decalcification index (EDI), DIAGNODent scores (Dd), plaque index (PI) and gingival index (GI) were monitored at indicated time points. Within 3 months, alpha and beta diversity of supragingival plaque had no difference between RMGIC and RMD groups. From T0 to T2, the relative abundance of Streptococcus depleted in RMD but remained steady in RMGIC group. Streptococcus, Prevotella, and Fusobacterium became depleted in RMD, Haemophilus and Capnocytophaga became depleted in RMGIC group but Prevotella enriched. Quantification of Fusbacterium nucleatum and Streptococcus mutans showed significant difference between RMGIC and RMD groups at T2. Teeth bonded with RMD had significant lower plaque index (PI) and DIAGNODent (Dd) score at T2, compared with teeth bonded with RMGIC (p < 0.05). No difference in bracket failure rate was examined between both groups (p > 0.05). By incorporating MPC and DMAHDM into RMGIC, the material could affect the supragingival microbial composition, inhibit the progress of plaque accumulation as well as the key pathogens S. mutans and F. nucleatum in the early stage of orthodontic treatment.

Bonding Surface Designs in Fixed Orthodontic Attachments.

Fixed orthodontic attachments/appliances work as a medium to transfer the force applied to the teeth. In bonded types, several factors affect the attachment bond strength and their clinical success. The primary approach for increasing the bond strength focused on altering the time and concentration of acid etching; however, the results showed that these changes might increase susceptibility to enamel decalcification. The bonding mechanism of orthodontic attachments may be chemical, mechanical, or a combination of both. Most attachment bonding surfaces (ABSs) have no chemical bond to resin composites. Hence, mechanical retention plays a major role. Developing more bonding surfaces by increasing the macroscopic size of the attachments has esthetic and hygienic limitations, so the ABS design plays a more important role in maintaining and improving the bond strength. In this research, different ABS designs are reviewed and categorized according to manufacturing methods and their features.

INTERVENTIONS PRIOR AND DURING THE ORTHODONTIC TREATMENT FOR ORTHODONTICALLY INDUCED WHITE SPOT LESIONS

Objective. To evaluate the efficiency of various interven­tions performed before and during orthodontic treatment which aim to reduce the incidence of WSL. Materials and methods. Using PRISMA guidelines in search of clinical trials published between 2017 and 2022, a literature analysis was performed. This search was conducted using following Medical Subject Heading (MeSH) terms in 2 databases: “prevention and control” AND “Orthodontics” AND “Tooth Demineralization”. Supplementary, a manual search was conducted in Go­ogle Scholar. Results. The literature search resulted in a total of 3626 study articles, of which 8 publications were used in the present review, according to a selection based on the pre-established eligibility criteria. The review showed that F varnish, 10% Xylitol varnish had positive outcomes in comparison with placebo. 0.44% APF formulated daily oral rinse and nanosilver mouthwash were better than 0.2% NaF weekly rinse and CHX, F mouthwashes res­pectively. NovaMin toothpaste, MIPP and MIV, exami­ned in different studies, proved no significant difference over regular F toothpaste. MIV compared to ProSeal provided no statistically significant between-group diffe­rences as well. Clinpro 5000 provided superior protection against enamel decalcification when compared to Clinpro Tooth Creme and MI Paste. Conclusion. The white spot lesions have improved, re­gressed, or eliminated with topical agents including F, Xylitol, or CPP-ACP during the fixed orthodontic treat­ment. In order to determine the most effective therapeu­tic approach for the treatment of surface and subsurface demineralization of the enamel, more research is needed to provide scientific proof.

Effectiveness of Clinpro Tooth Crème in comparison with MI Varnish with RECALDENT™ for treatment of white spot lesions: a randomized controlled trial.

Unsightly opaque white impaired enamel may ruin a great aesthetic orthodontic outcome. This study aims to evaluate effectiveness of Clinpro Tooth Crème (0.21% w/w NaF anti-caries dentifrice with 950ppm fluoride and f-TCP) and MI Varnish with RECALDENT™ (CPP-ACP) for treatment of white spot lesions (WSLs). This was a randomized (1:1:1), single-blind, 3-armed, active-controlled, parallel-group trial. The study comprised three groups of 35 patients randomly assigned in blocks of 3 or 6 to one of the three following arms of the study- Group I: Clinpro™ Tooth Crème 0.21% Sodium Fluoride Anti-Cavity Paste with functional-Tri Calcium Phosphate(f-TCP) group. Group II: Fluoride varnish group (MI Varnish with RECALDENT™). Group III: Home-care group (control). For the subjective assessment, a blinded panel of 4 dental experts rated the improvement in WSLs over the eight weeks using a visual analog scale (VAS). In total, 240 WSLs were identified, with maxillary lateral incisors and canines showing the highest incidence. Group I achieved the highest success rate of 67.61 (%) followed by group II (60.59%). There were no significant differences between the success rates of treatment in groups I and II. A minimum decline in WSLs was found in the control group, with a success rate of only 32.43%, significantly less than the first two groups (P < .001). Both the test agents in consideration were comparable in their remineralization potential. Clinpro Tooth Crème provides additional protection against decalcification of enamel compared to MI Varnish with RECALDENT™ (CPP-ACP). TRIAL/PROJECT REGISTRATION NO. 4857/2017 on 21 June 2017.

Variation in adhesion of Streptococcus mutans and Porphyromonas gingivalis in saliva-derived biofilms on raw materials of orthodontic brackets.

ObjectiveTo evaluate differences in the adhesion levels of the most common oral pathogens, Streptococcus mutans and Porphyromonas gingivalis, in human saliva-derived microcosm biofilms with respect to time and raw materials of orthodontic brackets.MethodsThe samples were classified into three groups of bracket materials 1) monocrystalline alumina ceramic (CR), 2) stainless steel metal (SS), and 3) polycarbonate plastic (PL), and a hydroxyapatite (HA) group was used to mimic the enamel surface. Saliva was collected from a healthy donor, and saliva-derived biofilms were grown on each sample. A real-time polymerase chain reaction was performed to quantitatively evaluate differences in the attachment levels of total bacteria, S. mutans and P. gingivalis at days 1 and 4.ResultsAdhesion of S. mutans and P. gingivalis to CR and HA was higher than the other bracket materials (SS = PL < CR = HA). Total bacteria demonstrated higher adhesion to HA than to bracket materials, but no significant differences in adhesion were observed among the bracket materials (CR = SS = PL < HA). From days 1 to 4, the adhesion of P. gingivalis decreased, while that of S. mutans and total bacteria increased, regardless of material type.ConclusionsThe higher adhesion of oral pathogens, such as S. mutans and P. gingivalis to CR suggests that the use of CR brackets possibly facilitates gingival inflammation and enamel decalcification during orthodontic treatment.

Effect of Er, Cr:YSGG laser enamel etching with varying power output and irradiation time on the shear bond strength.

BACKGROUND:Laser etching addresses the disadvantages of conventional acid etching technique, such as enamel decalcification and formation of white spot lesions. The aim of the present study was to evaluate and compare the shear bond strength (SBS), adhesive remnant index (ARI), and the surface characteristics of the samples treated with conventional acid etching and Er, Cr: YSGG laser etching with variable output power and time durations.METHODOLOGY:The study sample included 78 extracted teeth divided into six groups of 13 teeth each, and 3 samples from each group were utilized for analyzing etch patterns, and the remaining 10 teeth from each group were used for evaluating the shear bond strength. In Group I phosphoric acid etching was done, whereas in Group II– VI Laser etching 1.5 W/10 s, 1.5 W/15 s, 3 W/5 s, 3 W/10 s, 3 W/15 s. Statistical analysis for shear bond strength testing was performed using one-way ANOVA followed by Post HOC tests.RESULTS:The mean shear bond strength of Group I was 7.16 Mpa and Group III of 5.43 Mpa. Group II, IV, V, and VI had mean shear bond strength of 4.93 Mpa, 3.88 Mpa, 4.05 Mpa, and 4.88 Mpa, respectively. The ARI scores Group I had a significant number of samples with scores 2 other groups showed increased Score 0. The etch pattern of groups I, II, III showed the combined dissolution of both prism cores, and peripheries were seen. In group IV, the etching pattern was irregular with the pitted type of surface. In groups V and VI, relatively flat and smooth enamel surface was seen.CONCLUSION:The bond strength attained by laser etching (1.5 W/10 s and 1.5 W/15 s) was comparable to that obtained by the acid etching technique.

Antibacterial Effect of Experimental Orthodontic Adhesives Containing Gold Nanoparticles against &lt;i&gt;Streptococcus mutans&lt;/i&gt; and &lt;i&gt;Streptococcus sobrinus&lt;/i&gt;

Enamel decalcification usually can be found around orthodontic bracket after debonding. Orthodontic adhesives resistant to bacterial colonization were used to prevent white spot lesion and dental caries in orthodontic treatment with fixed appliance. The objectives of this study were to evaluate the antibacterial properties of expeimental orthodontic adhesive containing gold nanoparticles (AuNPs). 108 orthodontic adhesive discs containing 1.0 wt%, 0.5 wt%, 0.25 wt% AuNPs and without AuNPs were prepared from in-house orthodontic adhesive (27 discs per group). The antibcterial properties of adhesive discs were evaluated by direct contact test. Streptococcus mutans and Streptococcus sobrinus suspensions were placed on the discs and incubated at 37 °C for 1 hour. The adhesive discs were transferred to BHI broth and were incubated at 37°C for 16, 20 and 24 h. Bacterial growth was evaluated by optical density (OD) measurement at 590nm. The results showed that experimental orthodontic adhesives with 1.0 wt% and 0.5 wt% AuNPs exhibited higher antibacterial activity compared to the control group (p &lt; 0.05). At 24 h of incubation, the median OD of 1.0 wt%, 0.5 wt%, 0.25 wt% and control in S. mutans were 0.109, 0.006, 0.007 and 0.372, rescpectively. In S. sobrinus, the median OD were 0.173, 0.012 , 0.007 and 0.328. The incorporation of gold nanoparticles into orthodontic adhesives exhibited antibacterial activity against cariogenic microorganism. At a concentration of 0.5 wt% and 1.0 wt% AuNPs, experimental orthodontic adhesive could reduce bacterial growth of both S. mutans and S. sobrinus.

A novel method quantifying caries following orthodontic treatment

This retrospective pilot study used a newly developed evaluation tool to assess the prevalence and incidence of White Spot Lesions (WSL) before and after multibracket appliance (MB) therapy. Digital photographs of 121 adolescent patients (63 ♂, 58 ♀) with metal brackets were analyzed retrospectively before and after MB therapy. The labial surfaces of anterior teeth, canine teeth, and premolars in the upper (UJ) and lower jaws (LJ) were evaluated using the Enamel Decalcification Index (EDI) by Banks and Richmond (Eur J Orthod, 16(1):19–25, 1994, levels 0–3) and a specially developed digitally scaled graticule with concentric circles to quantify the extent of WSL (in %). The statistical data analysis was based on crosstabulations and logistic regression. Before MB, 69.4% of the patients presented at least one WSL and 97.5% after, an increase of 28.1%. Before MB, 18.4% of the tooth surfaces (TS) showed an EDI level of 1–3. After MB, 51.8% of the TS featured WSL. 18.2% of the TS showed a WSL to the extent of ≥ 20–100% before and 52.3% after MB. The incidence in the UJ (71–79%) as well as the LJ (64–76%) was highest for the first and second premolars and lowest for LJ incisors (22–35%). The probability for developing a new distal WSL is higher than developing gingival, mesial or occlusal WSL. Labial MB therapy drastically increases the risk of developing WSL. We verified a concise quantification of the extent of labial WSL with the evaluation index.

The efficacy of fluoride varnish vs a filled resin sealant for preventing white spot lesions during orthodontic treatment.

To compare the efficacy of casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) MI Varnish (GC America, Inc, Alsip, IL) and ProSeal (Reliance Orthodontic Products, Itasca, IL) sealant in preventing the development of white spot lesions (WSLs) in orthodontic patients. This prospective randomized clinical trial included 40 orthodontic patients 12-17 years of age. One group had sealants placed on their anterior maxillary teeth, with reapplications every 3 months. The other group had MI Varnish applied every 4-6 weeks. WSL formation and oral hygiene were evaluated at the initial appointment before bonding (T1) and 12 months later (T2). Standardized digital photographs were analyzed using the enamel decalcification index (EDI). Statistical comparisons were made using independent and paired-sample t-tests as well as chi-square tests. In this trial, 43% of patients and 15% of teeth developed new WSLs. Lateral incisors showed the highest incidence of decalcification and WSL formation. WSL formation and EDI score increases during treatment were significantly greater in the gingival region than in the mesial, distal, or incisal regions. Of the EDI scores at T2, 93.8% were 0 and 5.5% were 1. Poor oral hygiene at T2 showed a high positive predictive value (76%) for the development of WSLs. There were no statistically significant between-group differences for the development of WSLs. MI Varnish and ProSeal sealant provided similar levels of protection during the first 12 months of fixed orthodontic treatment. The severity of the WSLs that developed was minimal. WSLs were most likely to develop on lateral incisors and in the gingival regions of teeth, especially among patients with poorer oral hygiene.

An orthodontic acrylic resin containing seaweed Ulva lactuca as a photoactive phytocompound in antimicrobial photodynamic therapy: Assessment of anti-biofilm activities and mechanical properties

BackgroundUncontrolled accumulation of microbial plaque and formation of biofilm on the surface orthodontic acrylic removable appliances increases the risk of enamel decalcification and periodontal diseases. The purpose of the present study was to evaluate antimicrobial activities, anti-virulence potencies, and mechanical properties of orthodontic acrylic resin containing different concentrations of Ulva lactuca (a green marine macroalga) following photo-activation against Streptococcus mutans. Materials and methodsMinimum inhibitory concentration (MIC) of U. lactuca was determined against S. mutans. Acrylic resin specimens with different concentrations of U. lactuca (0.2 %, 0.5 %, 1%, 2.5 %, 5%, and 10 % weight/weight) were fabricated. Flexural strength values, antimicrobial effects, and anti-biofilm activities of samples were assessed in comparison with original acrylic resin as the control group. Also, the expression of the virulence-associated genes was assessed by quantitative real-time polymerase chain reaction. ResultsU. lactuca at concentrations of 1–10% significantly reduced the S. mutans growth rate by 20.3%–63.3% in comparison to the control group (P < 0.05). Therefore, the concentration of 1% of U. lactuca was considered as a MIC. The highest and lowest flexural strength values were observed in the control group (43.5 ± 2.4 MPa) and the group with a 10 % concentration of U. lactuca (19.2 ± 1.8 MPa), respectively. Flexural strength values decreased in samples containing 2.5 %, 5%, and 10 % concentrations of U. lactuca in comparison to the control group significantly (P > 0.05). In the disc agar diffusion test, the growth inhabitation zones around samples containing different concentrations of photo-activated U. lactuca ranged from 13 mm to 25 mm in diameter. Interestingly, the anti-biofilm activity of U. lactuca-mediated aPDT against S. mutans was dose-dependent. Additionally, the sub-MIC dose of U. lactuca (0.5 %) following photo-activation could significantly decrease the expression levels of gtfB, gtfC, and gtfD to 4.1-, 5.3-, and 7.4-fold, respectively. ConclusionsAdding photo-activated U. lactuca to the orthodontic acrylic resin at a concentration of 1% increases its antibacterial and anti-biofilm activities besides not detrimentally affects its flexural strength.

Evaluation of the Effect of Fixed and Removable Appliances on Salivary Parameters (Salivary Flow Rate pH and Buffering Capacity) in Children Aged 5-12 Years: An In Vivo Study.

AimTo evaluate and compare the effect of fixed and removable space maintainers or appliances on salivary factors (“salivary flow rate,” pH, and buffering capacity of saliva) in children aged 5–12 years over a period of 3 months.Materials and methodsSixty children were selected for the study and equally alienated into two groups as group I for fixed appliances and group II for removable appliances). Unstimulated saliva was collected from children wearing fixed and removable space maintainers or appliances at baseline, 1, 2, and 3 months.ResultsAt the end of 3 months, there was a slight decrease in the buffering capacity and pH of saliva, which was not statistically significant in both the groups. An increase in unstimulated salivary flow rate was also seen in both the groups at the end of 3 months.ConclusionFixed and removable space maintainers or appliances act as opportunistic plaque retentive sites in children, necessitating appropriate oral hygiene maintenance and its reinforcement. Failure to adhere to a strict oral hygiene regimen can cause considerable enamel decalcification and plaque retention leading to alteration in oral microflora which has detrimental effects.Clinical significanceThis study paves way for provision of incorporating practice guideline information for both dentists and children undergoing long-term space maintainer or appliance therapy in children.How to cite this articleKukreja P, Hugar SM, Hallikerimath S, et al. Evaluation of the Effect of Fixed and Removable Appliances on Salivary Parameters (Salivary Flow Rate pH and Buffering Capacity) in Children Aged 5–12: An In Vivo Study. Int J Clin Pediatr Dent 2021;14(6):774–778.