White Spot Lesion Formation Research Articles

Antibacterial activity and bond strength of silver nanoparticles modified orthodontic bracket adhesive: A systematic review and meta-analysis of in-vitro and in-vivo studies

The formation of white spot lesions (WSLs) around orthodontic brackets as a result of biofilm accumulation is a common complication of fixed orthodontic therapy. A systematic review and meta-analysis were conducted to assess the antibacterial efficacy and bond strength of silver nanoparticles (AgNPs) incorporated orthodontic bracket adhesive to prevent WSLs. An electronic search of English literature was performed using Dissertations and Theses Global, Web of Science, LILACS, Cochrane, Scopus, and MEDLINE/PubMed using predetermined inclusion criteria. Specific terms were utilized in searching from the inception of the respective database up to April 2021. After the search strategy was applied by a reviewer, the data was extracted and results were analyzed. The focused question was: “whether AgNPs containing orthodontic bracket adhesives are superior to non-modified orthodontic bracket adhesives in terms of antibacterial activity and shear bond strength for the prevention of WSLs around brackets.” Ten articles were included and a meta-analysis was performed. The bacterial growth inhibition was assessed in 7/10 included studies. Out of them, 2 studies showed no bacterial growth inhibition zone adjacent to orthodontic bracket adhesives supplementing AgNPs, while 5 articles exhibited a significant microbial growth inhibition zone diameter against varying bacteria. Streptococcus mutans was the main bacteria considered by the included studies (n = 10). In the included studies, the mean SBS scores of control group adhesives ranged between 5.48 ± 1.98 MPa and 24.53 ± 4.1 MPa, while the mean SBS scores of experimental group adhesives ranged between 5.22 ± 1.16 MPa and 17.63 ± 3.2 MPa. Low risk of bias of the included articles was observed in the meta-analysis. Although, studies have confirmed that the incorporation of AgNPs into orthodontic adhesive enhances its antibacterial activity, however, a degree of heterogeneity was observed throughout the studies due to the deficit in the in vitro models standardized protocols.

Assessment of the Effectiveness of Different Fluoride-releasing Bonding Agents on Prevention of Enamel Demineralization around Orthodontic Bracket: An In Vitro Study

The aim of the current research was to evaluate the efficacy of different fluoride-releasing bonding products in preventing enamel demineralization around orthodontic brackets by using a scanning electron microscope (SEM). This research was performed using 80 healthy human premolar teeth that were extracted in course of orthodontic therapy. Until use, the sample premolars were subjected to storage in 0.1% thymol. Each premolar was thereafter cleansed with pumice for 10 seconds. Stainless steel brackets for premolars were employed. The 80 samples were allocated at random to one of the four groups (20 in each) as follows: Group I, control; group II, Transbond Plus color change adhesive; group III, GC Fuji Ortho LC; and group IV, Vitremer. An hour following bonding, all samples were subjected to pH cycling at a temperature of 37°C for a 14-day period. The premolar teeth were assessed below SEM. Analysis was performed with the one-way analysis of variance. Statistical significance was set at a p-value less than 0.05. The extreme area of demineralization was abridged by the use of Transbond™ Plus color change adhesive (108.19 ± 0.68), trailed by GC Fuji Ortho LC (119.24 ± 0.37) use, Vitremer (121.56 ± 0.92) as well as the control group (141.88 ± 1.09) in that order. And there was a statistically significant difference found between the groups (p <0.001). Tukey's honestly significant difference (HSD) was employed in an overall comparison of mean areas of enamel demineralization, which depicted that differences were significant statistically with the exception of group III and group IV. The current research came to a conclusion that the Transbond Plus color change adhesive group was more potent in significant inhibition of demineralization areas in comparison to GC Fuji Ortho LC group and Vitremer group. In course of fixed orthodontic therapy, demineralization of enamel is an inherent occurrence. Multiple approaches are being continually developed to avoid the formation of white spot lesions (WSLs) that compromise esthetics and cause deprived remineralization that enhances the menace of dental caries. Bonding agents that can release fluorides are thus considered highly efficacious.

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.

A Comparative Analysis of Surface Characteristics of Enamel after Conventional Acid Etching and Er,Cr:YSSG Laser Irradiation.

BackgroundTo evaluate the influence of Erbium, Chromium:Yttrium-Scandium-Gallium-Garnet (Er,Cr:YSGG) laser irradiation (2W 15Hz, 2W 25Hz) on Penetration Depth, Surface Roughness, Surface Morphology and Etching Pattern of enamel and to compare it with conventional acid etching. Material and MethodsSixty sound human premolars extracted for orthodontic reasons were used for this study. Penetration Depth and Surface Roughness between Acid Etched and Laser Etched Enamel were evaluated using Non-contact 3D- Profilometer .Surface Morphology and the Etching Pattern were evaluated using Field Emission - Scanning Electron Microscope. ResultsOn comparing the maximum depth and surface roughness values among all the three groups, highest was found in the acid-etched group, followed by the 2W 15Hz laser–etched group and the least was with the 2W 25Hz laser–etched group. The laser etching of enamel surface with an Er,Cr:YSGG laser system showed Type 3 etching pattern, whereas acid etched surface showed Type 1 etching pattern as described by Silverstone (1974). ConclusionsEr,Cr:YSGG laser irradiation produces favourable etching pattern and micro-irregularities that are suitable for resin penetration. Moreover, due to its decreased surface roughness and penetration depth, laser etching can significantly decrease the probability of formation of white spot lesions which is proved to be the potential disadvantage of conventional acid etching. Hence, laser etching can be preferred over the conventional phosphoric acid etching for orthodontic bonding. Key words:Laser, Er,Cr:YSGG, Surface Roughness, Etching Pattern,Penetration Depth,SEM, Laboratory Research, Acid etching.

Evaluation of a newly developed calcium fluoride nanoparticles-containing orthodontic primer: An in-vitro study

ObjectivesFluoride and calcium ions have the ability to reduce the formation of white spot lesions (WSL) in enamel. This study aimed to develop a novel orthodontic primer that incorporates calcium fluoride nanoparticles (nCaF2) and investigate its cytotoxic and physical properties as this primer could enhance the remineralization process when used with the conventional acid etching technique. Materials and methodsThree groups of the newly introduced primers were prepared by adding and mixing nCaF2 (Nanoshell Company, USA at 5%, 10%, 20% in weight) to Transbond™ XT orthodontic primers (3M-Unitek, Monrovia, USA). X-Ray Diffraction (XRD) was performed to verify and evaluate the phase of the nanopowders. Field Emission Scanning Electron Microscope (FESEM) observation was used to assess the homogeneity of tested primers, and Energy Dispersive X-Ray Spectroscopy (EDS) was performed to analyze elements of the prepared samples. The three primer groups were compared to the control primer (without the addition of nCaF2) in terms of cytotoxic behavior, homogeneity, agglomeration, shear bond strength (SBS), and adhesive remnant index (ARI). ResultsnCaF2 primers with all the prepared concentrations revealed good homogeneity with no apparent agglomeration after four months of mixing. Cytotoxicity of the new primers was higher than that of the control primer, but it was within the accepted limits of the ISO standards (70% cell viability). While the SBS and ARI values were comparable with the control primer (p > 0.05). ConclusionsThe newly developed orthodontic primers with different concentrations of nCaF2 (5%, 10%, and 20%) showed a homogenous distribution of nCaF2 within the primers with no apparent agglomeration, acceptable cytotoxic level, adequate SBS, and ARI. Future clinical testing of nCaF2-containing orthodontic primer as a preventive measure for WSLs during fixed orthodontic treatment is suggested.

Effectiveness of Various Remineralizing Agents on White Spot Lesions after Orthodontic Treatment: A Comparative Study

To evaluate and compare the ability of three commercially available remineralizing agents on the surface microhardness (SMH) of enamel after induction of white spot lesions (WSLs) by demineralization. About 80 sound mandibular human premolars that were later removed as a part of orthodontic treatment were employed in this research under the inclusion criteria. After cleaning and disinfecting the teeth, their crowns were mounted in acrylic resin and painted with nail varnish, not including a 3 mm × 3 mm window in the middle of the buccal surface. Each tooth was soaked in 15 mL of a demineralizing solution at a pH of 4.5 that was prepared for this study and left in a place for 10 subsequent days to permit the formation of WSLs after which the SMH was again assessed. The premolar teeth were then randomly allocated and equally divided into one of the four groups of 20 each depending on the treatment they received as Group 1: control group, Group 2: Colgate sensitive Pro-Relief toothpaste group, Group 3: Amflor group, and Group 4: Enafix group. After 15 days, the microhardness of all samples was estimated and alterations in the same were noted. Scanning electron microscopy (SEM) was used to evaluate the surface morphology. Enhanced and highest mean SMH was present in the Colgate sensitive Pro-Relief group (53.26 ± 0.10) followed by Enafix group (47.72 ± 0.21), Amflor group (44.84 ± 0.66), and control group (39.52 ± 0.32), respectively after application of remineralizing agents. Except for Group 3 vs Group 4, statistically significant differences (p < 0.05) were noted in all the groups. All the three agents employed in this study, that is, Colgate sensitive Pro-Relief toothpaste, Amflor, and Enafix improved the SMH of teeth after the therapy given over 15 days compared to the microhardness following demineralization. White spot lesions often occur on labial surfaces of teeth after orthodontic treatment. Hence, these lesions pose esthetic challenges thereby affecting treatment satisfaction perceived by the patient. As esthetics and appearance are of foremost significance after orthodontic treatment, elimination protocols for remineralization of WSLs are of utmost importance employing economic means. How to cite this article: Nalawade VA, Jeri SY, Dash BP, et al. Effectiveness of Various Remineralizing Agents on White Spot Lesions after Orthodontic Treatment: A Comparative Study. J Contemp Dent Pract 2021;22(5):545-548.

Orthodontic adhesive doped with nano-graphene oxide: physico-mechanical and antimicrobial properties.

In fixed orthodontics, formation of white spot lesions, enamel demineralization, and tooth decay around appliances are common complications which mar the outcome. The aims of this study were the determination of the shear bond strength (SBS) and adhesive remnant index (ARI) of orthodontic adhesive doped with N-GO, as well as the assessment of antimicrobial activities of the modified orthodontic adhesive against Streptococcus mutans. N-GO was characterized by a scanning electron microscope (SEM), Fourier transformation infrared (FTIR), X-ray diffraction (XRD), and Zeta potential. The SBS and ARI of modified orthodontics adhesive containing different concentrations of N-GO (0, 1, 2, 5, and 10 wt%) were then measured. The influences of adding N-GO on antimicrobial properties of orthodontic adhesive were determined against S. mutans by disc agar diffusion (DAD) testing and biofilm formation inhibition assay. The SEM, FTIR, XRD, and Zeta potential analysis indicated the successful synthesis of N-GO. Orthodontics adhesive doped with 5 wt% N-GO showed the highest concentration of N-GO and SBS value (21.71±7.45 MPa, p<0.05) simultaneously with no significant differences in adhesive remnant index compared with the control group. SBS in the 1, 2, and 5% N-GO were significantly higher than that in 10% N-GO (p=0.025, p=0.036, p=0.041, respectively). The disinfection ability of the modified orthodontic adhesive doped with N-GO against S. mutans in the DAD and biofilm formation inhibition assays were positively associated with increased in N-GO concentrations (p<0.05). However, the 5 and 10 wt% N-GO showed a statistically significant decrease the CFU/mL of the test microorganisms in biofilm structures (p<0.05). It could be concluded that 5 wt% of N-GO can be considered as an orthodontic adhesive additive to reduce the microbial count and biofilm with no adverse effect on SBS and ARI.

Effect of nanosilver mouthwash on prevention of white spot lesions in patients undergoing fixed orthodontic treatment - a randomized double-blind clinical trial

Background/purposeThe formation of white spot lesions (WSLs) around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, marking the result of a successfully completed treatment. This double-blind, randomized clinical trial study aims to investigate the varying effects of nano-silver, chlorhexidine (CHX) or fluoride mouthwashes on WSLs. Materials and methodsDouble-blind prospective randomized clinical trial, comprised of forty-two patients with mild to moderate crowding, were recruited for this study. Randomization and allocation to trial group were carried out by computer system in college of dentistry, university of Sulaimani from January 2020 to September 2020. The patients were divided into three groups (14 per group) according to the type of mouthwash used during the treatment (nano-silver, CHX or fluoride), using block randomization. The clinical examination for the presence of WSLs was recorded through visual examination of the upper and lower anterior teeth using the International Caries Detection and Assessment System (ICDAS II) score before bonding and at 30, 90 and 180 days after bonding of the upper and lower arches. ResultsThe total number of patients was 42 (16 males and 26 females) with a mean age of 23.02 ± 3.841 (18–37) years old, distributed into three groups of 14 patients. There is significant difference in white spot lesions formation between the three groups; the mean of WSLs in nanosilver group is lower than CHX and fluoride group in 90 and 180 days of follow-up (P < 0.05). ConclusionNano-silver mouthwash is more effective than CHX and fluoride mouthwash in reducing WSLs during orthodontic treatment.

Antibacterial and white spot lesions preventive effect of an orthodontic resin modified with silver-nanoparticles.

BackgroundTo evaluate the antibacterial property of a modified orthodontic resin with different concentrations of silver-nanoparticles (AgNPs), and quantify its preventive effect on the formation of white spot lesions (WSLs). Material and MethodsAn orthodontic resin (Transbond XT) was modified with four concentrations of AgNPs (1%, 0.5%, 0.1%, and 0.05%), the orthodontic resin without AgNPs was used as control. Polymerized resin discs (n=80) were submitted to Agar diffusion test on Petri dishes inoculated with Streptococcus mutans and Lactobacillus acidophilus. In addition, resin discs of each group (n=40) were placed in 96-well plates with bacterial suspensions to evaluate the colony-forming-units (CFU). For the WSLs prevention test, brackets were bonded with the experimental orthodontic resins on 45 premolars (n=5), and were subjected to a microbiological caries induction method for 9 days. Photographs were taken before and after the test, and the images were evaluated with the Image J software to calculate the area of WSLs. The data were analyzed using ANOVA and Tukey-HSD test, Student´s t-test and Kruskal-Wallis test (α=0.05). ResultsThe 0.5% and 1% AgNPs modified resin inhibit the growth of S. mutans and L. acidophilus. All the modified resins showed significantly less CFU, when compared to the control (p<0.05). 1% AgNPs resin promote the higher prevention of WSLs formation. There was no significant difference between the control group and the 0.1% and 0.05% groups. Conclusions0.5% and 1% of AgNPs modified orthodontic resin exhibit an important antibacterial activity against S. mutans and L. acidophilus, and prevent the formation of WSLs. Key words:White spot lesions, antibacterial, orthodontics, adhesive, Silver-nanoparticles.

Evaluation of surface roughness and microhardness of enamel white spot lesions treated by resin infiltration technique (icons): An in-vitro study

Objectives This research was designed to evaluate the effect of resin infiltration material (Icon) and remineralizing agents (n-HA, CPP-ACP) on micro hardness and surface roughness of enamel white spot lesion. Materials & Methods 120 sound non carious human anterior teeth were used in this study. The teeth were divided according to the test of evaluation into two main groups. Group H: for assessment of micro hardness and group R: for assessment of surface roughness (60 teeth each).Then each group was divided into four equal subgroups (15 teeth each) according to the treatments applied as follows: subgroup(C): control, subgroup (P): CPPACP, subgroup (I): Icon and subgroup (N): n-HA. Each subgroup was further subdivided into three equal divisions (5 teeth each) according to the storage times in artificial saliva; one week (S1), four weeks (S2) and eight weeks (S3). The crowns of all teeth were separated from the roots and embedded horizontally in middle of the mould leaving the labial surface projecting using self-curing acrylic resin. Al specimens were immersed in demenaralizing solution for artificial enamel white spot lesion formation. Then treated with each respective material as follow: In subgroup (I) Icons was applied on labial surface of specimens and then immersed in artificial saliva. In subgroup (P) the labial surfaces of specimens were brushed manually by a soft toothbrush and with gentle pressure; brushing procedures were carried out three times daily with CPP–ACP- containing paste for 3 minutes then immersed in artificial saliva. In subgroup (N) specimens were immersed in 10% n-HA solution for 3min then immersed in artificial saliva and these applications were repeated daily. While subgroup (C) did not receive any surface treatment, but it immersed in artificial saliva as a positive control subgroup, artificial saliva was changed daily. For assessment of microhardness and surface roughness the enamel white spot lesion specimens in the four different subgroups were examined three times (after one week, four weeks and eight weeks from the first time of treatment application) by Vickers micro hardness testing machine and none contact profilometer. Results The results of microhardness revealed that the subgroup (N) was provided the highest micro hardness mean value, followed by subgroup (I) group, then subgroup (P) group while subgroup (C) showed the lowest micro hardness mean value.The results of surface roughness revealed that the subgroup (P) group was provided the highest surface roughness mean value, followed by subgroup (C), then subgroup (N) while subgroup (I) showed the lowest surface roughness. Conclusions Resin infiltration material (Icon) had a positive effect on microhardness and surface roughness of enamel white spot lesion.

Prevention of white spot lesion formation during treatment with fixed orthodontic appliances

One of the main disadvantages of orthodontic treatment with fixed appliances is the formation of demineralisations around the brackets. These demineralisations develop because the brackets produce an increased number of plaque retention sites and a change in the oral environment, resulting in a different plaque composition. To prevent the formation of these demineralisations several methods are used during orthodontic treatment. Using additional fluoride is the best solution, for example, rinsing daily with a fluoride mouthwash, applying a fluoride varnish during every scheduled check-up, or using toothpaste with a high concentration of fluoride. The last 2 methods are less effectively incorporated in daily practice in the Netherlands due to financial or time factors. Additional measures, like using fluoride-releasing adhesives, CPP-ACP(F) or a chlorhexidine rinse appear to be less effective in reducing demineralisations. It is also important to provide specific oral hygiene and dietary instructions, based on an individual risk assessment.

Role of Probiotics in Oral Health Maintenance Among Patients Undergoing Fixed Orthodontic Therapy: a Systematic Review of Randomized Controlled Clinical Trials.

The aim was to assess the role of probiotics in oral health maintenance among patients undergoing fixed orthodontic therapy (OT). An unrestricted search of indexed databases was performed until April 2020 using the following Mesh-terms: (1) probiotic and (2) orthodontic. Randomized controlled clinical trials (RCTs) evaluating the influence of probiotic therapy (PT) towards oral health maintenance/improvement in patients undergoing fixed OT were included. Data screening, selection, and extraction were performed; and the risk of bias was assessed using the Cochrane Collaboration's tool. All evaluations were performed by 2 independent researchers; and disagreements were resolved via discussion. Nine RCTs were included. Eight studies reported that PT improves oral health in patients undergoing fixed OT. Seven studies showed that PT reduces the counts of oral pathogenic bacteria in the oral biofilm and/or saliva. One study reported that PT reduces halitosis in patients undergoing fixed OT. One study found that PT reduces the scores of plaque index (PI) and gingival index (GI); and one study reported that PT has no significant influence on PI and GI in patients undergoing fixed OT. One study reported that PT does not prevent the formation of white spot lesions during fixed OT. Three and 6 studies had a moderate and low risk of bias, respectively. A power analysis was performed in 4 studies. In conclusion, probiotics exhibit antimicrobial activity against oral pathogenic bacteria; however, due to the limitations of the studies assessed, further well-designed RCTs are needed.

A comparative assessment of orthodontic treatment outcomes using the quantitative light-induced fluorescence (QLF) method between direct bonding and indirect bonding techniques in adolescents: a single-centre, single-blind randomized controlled trial.

The aim of this two-arm parallel trial was to evaluate enamel demineralization in fixed orthodontic treatment using an indirect bonding technique in comparison to a direct bonding technique by the quantitative light-induced fluorescence (QLF) method. Fifty-six patients who needed fixed orthodontic treatment were randomly separated into either the direct bonding group or the indirect bonding group. The presence and extent of lesions on the buccal surfaces of all teeth, except the molar teeth, were assessed. The percentage of fluorescence loss (ΔF and ΔFmax), the degree of demineralization (ΔQ) and lesion area (WS area) were determined using the system's software. The data were analysed with the Wilcoxon signed-rank and Mann-Whitney U-tests (P < 0.05). Treatment with a direct bonding or an indirect bonding technique. This study was completed with 25 patients in the indirect bonding group (12 females, 13 males; mean age: 15.42 ± 1.71 years) and 26 patients in the direct bonding group (12 females, 14 males; mean age: 14.73 ± 1.65 years). In the indirect bonding technique, a few teeth (especially mandibular left canine: 50.45 ± 93.48; 95% confidence interval: -12.35 and 113.26) were found to develop significant white spot lesion (WSL) formation (P < 0.05). However, the number of teeth with demineralization was higher in the direct bonding group (P < 0.05). The bonding procedures used in the indirect bonding technique contribute to reducing the degree of WSL formation. Further, the use of flowable composite adhesives in this bonding process is more effective at reducing the appearance of WSLs than in cases where conventional composite adhesives are used. The limitation of our trial may be the small sample size and the short follow-up time for the patients. No harms were detected during the study. The protocol was not published before trial commencement. This trial was registered post hoc at 'Clinical Trials' (http://www.clinicaltrials.gov), registration number (ID): NCT03738839.

Evaluating the change in Streptococcus mutans in plaque around orthodontic brackets using fluoride toothpaste, probiotic curd, and recaldent - A comparative in-vivo study

Introduction: Enamel demineralization is still a problem associated with orthodontic treatment, leading to the formation of white spot lesions;this is a grave concern to orthodontists and patients. Various methods are now employed to reduce the incidences of demineralization.Aim: To evaluate and compare the effects of Fluoride toothpaste, Probiotic curd, and Recaldent on Streptococcus mutans colonies inplaque around orthodontic brackets in different groups of patients. Further, the three agents were compared and assessed for regular useby orthodontic patients for reduction of decalcification.Materials and methods: This study consisted of 60 randomly selected patients having orthodontic treatment in the Department oforthodontics and dentofacial orthopaedics. The study protocol was approved by the institutional Ethics committee of MCE Society,Azam Campus, Pune. Group A: The patients were given fluoride containing toothpaste (ParodontaxTM Daily Fluoride toothpasteGlaxoSmithKline). Group B: The patients were asked to brush twice daily with recaldent containing tooth mousse (Dentsply ToothMousse- GC). Group C: Patients were given probiotic curd(Nestle Acti Plus). Samples were collected twice, once initially, seven days afterbonding at the start of the study and secondly, after 30 days. After DNA extraction PCR analysis was done to evaluate the colonies ofS. mutans as colony forming units per milliliter (CFU/ml) in the plaque specimens. RealPlex software programme was used to plot theresults of the colonies detected in the sample.Results: Streptococcus mutans colonies around the brackets after 30 days post use of Fluoride toothpaste, probiotic curd and Recaldentwas reduced by 44.5 %, 0.86 % and 41.8% respectively.Conclusion: The regular use of fluoride toothpaste and Recaldent will help in reducing decalcification during orthodontic treatment.Further research is needed to establish the advantages of probiotic curd in reducing white spot lesions.

Quantitative light-induced fluorescence assessment of white spots following semi-rapid maxillary expansion.

This study aimed to investigate if the semi-rapid maxillary expansion (SRME) can cause white spot lesion (WSL) formation using quantitative light-induced fluorescence digital (QLF-D). The SRME group comprised 15 patients (9 girls, 6 boys; 13.5 ± 1 years) who had transverse maxillary deficiency and underwent expansion with full-coverage expanders. The screw of the expanders in the SRME group was activated twice a day for the first week. After decementation at the end of the first week, the screw activation protocol was changed to 3 turns/ week. In the SRME group, the QLF-D images were captured before starting treatment and 3.18 ± 0.32 months later when the expansion treatment was completed. The control group consisted of 15 subjects (8 girls, 7 boys; mean age 14.2 ± 1.9 years) who never had orthodontic treatment. The images of the control group were obtained with 3 months interval. The images were analyzed in terms of demineralization using analysis software. The left central incisor was the only tooth that was affected by WSL formation in the SRME group after expansion. The left central incisor tooth's fluorescence levels were decreased and the lesion area increased significantly (p < 0.05). No significant mineralization changes occurred in the control group (p > 0.05). SRME resulted in WSL formation in the left central incisor, while other teeth were not affected by demineralization. Although providing adequate oral hygiene is easier during SRME due to the removable appliance, the orthodontist should still be aware that it may cause demineralization.

Role of taste perception in white spot lesion formation during orthodontic treatment.

To investigate the role of individual's taste sensitivity using 6-n-propylthiouracil (PROP) in the development of white spot lesions (WSLs) in adolescent orthodontic patients. 44 healthy adolescents, aged 12 to 16 years old, who were in fixed-appliance orthodontic treatment for at least 6 months, consented to participate in this cross-sectional study. Data regarding participants' demographic information, oral hygiene practices, and dietary habits were obtained by a questionnaire. An oral clinical examination was performed to determine the oral hygiene status, the presence of WSLs and dental caries experience. The taste phenotype of the participants was evaluated through PROP test and they were accordingly divided into PROP nontasters and PROP tasters. The sample consisted of 24 subjects in the WSL group and 20 subjects in the WSL-free group. The WSL group demonstrated higher mean plaque score (48.2), mean decayed, missing, and filled surfaces (2.38), and mean decayed, missing, and filled teeth (1.96) scores compared to the WSL-free group (38.7, 0.85, and 0.55, respectively), but no significant differences were found. Most subjects in the WSL group were PROP nontasters (66.6%) whereas most subjects in the WSL-free group were PROP tasters (75%); a significant difference was observed between the groups (P = .006). The prevalence of white spot lesions was significantly higher in adolescent orthodontic patients who were PROP nontasters compared to PROP tasters. A PROP taste perception could be a potential risk factor for the formation of WSLs during fixed orthodontic treatment that warrants further attention.

Effect of fluoride dentifrices on white spot lesions during orthodontic treatment: A randomized trial.

To determine the effect of Clinpro 5000, Clinpro Tooth Crème, and MI-Paste Plus on the formation of white spot lesions in patients undergoing orthodontic treatment. Three prospective groups with 40 patients undergoing orthodontic treatment in each group were evaluated (total recruitment = 120 subjects). The selected product was brushed on for 2 minutes twice daily for 4 months. Subjects were reviewed for 4 months on a monthly basis. The Enamel Decalcification Index (EDI) was used to determine the number of white spot lesions per surface at each visit. 100 subjects (35 using Clinpro 5000, 32 using Clinpro Tooth Crème, and 33 using MI Paste Plus) completed the study. The data lend strong support for Clinpro 5000 providing superior protection against enamel decalcification when compared to Clinpro Crème, and mixed support when compared to MI Paste Plus. The use of Clinpro 5000, Clinpro Crème, and MI paste Plus all have a reduction effect on white spot lesions when compared to studies reported previously. Clinpro 5000 has a marginally better effect than the two other test pastes. The results of this study can be used by clinicians when deciding the effectiveness of using fluoride dentifrice products to prevent white spot lesions in their orthodontic practice (ClinicalTrials.gov ID: NCT03440996).

White spot lesions in orthodontic patients: An expert opinion

Formation of white spot lesions (WSLs) has remained a common occurrence during fixed orthodontic treatments, particularly in patients with poor oral hygiene. Such lesions, if not addressed, may progress to caries, thereby leading to poor aesthetics and patient dissatisfaction. Given the complexities and the alarming rise in the prevalence of WSLs in orthodontic patients, there is a need to develop a set of recommendations based on the Indian scenario to address unmet patient needs in managing WSLs. This paper is an outcome of expert group discussion convened with the primary objective to discuss the knowledge–practice gaps in the field of orthodontics, to understand the prevailing clinical practice patterns in managing WSLs in Indian settings, and to facilitate information exchange among subject matter experts. In brief, patient education and motivation regarding the importance of maintaining good dietary compliance and excellent oral hygiene are the cornerstones for the prevention and management of WSLs. Moreover, identification and management of various risk factors could prove beneficial. Noninvasive treatment of early or active WSLs by means of remineralizing agents could ensure better prognosis and could help prevent WSL progression.

Evaluation of an antibacterial orthodontic adhesive incorporated with niobium-based bioglass: an in situ study

This in situ study aimed to evaluate the antibacterial and anti-demineralization effects of an experimental orthodontic adhesive containing triazine and niobium phosphate bioglass (TAT) around brackets bonded to enamel surfaces. Sixteen volunteers were selected to use intra-oral devices with six metallic brackets bonded to enamel blocks. The experimental orthodontic adhesives were composed by 75% BisGMA and 25% TEGDMA containing 0% TAT and 20% TAT. Transbond XT adhesive (TXT) was used as a control group. Ten volunteers, mean age of 29 years, were included in the study. The six blocks of each volunteer were detached from the appliance after 7 and 14 days to evaluate mineral loss and bacterial growth including total bacteria, total Streptococci, Streptococci mutans, and Lactobacilli. Statistical analysis was performed using GLM model - univariate analysis of variance for microhardness and 2-way ANOVA for bacterial growth (p<0.05). The 20% TAT adhesive caused no difference between distances from bracket and the sound zone at 10-µm deep after 7 and 14 days. After 14 days, higher mineral loss was shown around brackets at 10- to 30-µm deep for TXT and 0% TAT adhesives compared to 20% TAT. S. mutans growth was inhibited by 20% TAT adhesive at 14 days. Adhesive with 20% TAT showed lower S. mutans and total Streptococci growth than 0% TAT and TXT adhesives. The findings of this study show that the adhesive incorporated by triazine and niobium phosphate bioglass had an anti-demineralization effect while inhibiting S. mutans and total Streptococci growth. The use of this product may inhibit mineral loss of enamel, preventing the formation of white spot lesions.

Adhesive precoated bracket systems and operator coated bracket systems: Is there any difference? A systematic review and meta-analysis.

To investigate whether adhesive precoated brackets (APC) are more efficient than operator-coated brackets (OPC) regarding failure rate, bonding time, patient experience, gingival health, plaque accumulation, and white spot lesion formation. Five online databases: Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, PubMed, MEDLINE, and Web of Science were searched for potential eligible randomized controlled trials (RCTs). A Google Scholar and gray literature search was undertaken. References of included studies were screened for potential eligible studies. Results were collated from each database and modified Cochrane data extraction forms were completed. Quality assessment was performed using Cochrane RoB 2.0 tool for RCTs. Five studies met the inclusion criteria. All reported failure rates using metal brackets for both APC and OPC systems except one that compared clear APC to clear OPC. Three studies reported bonding time differences between the bracket systems. A quantitative synthesis of four studies reporting failure and three reporting bonding time was undertaken. Random effect meta-analysis determined there were no statistically significant differences in bond failures between bracket systems with an odds ratio of 0.890 (P = .808). Bonding time showed a statistically significant (P = .01) but not clinically significant shorter bonding time with OPC. There was insufficient evidence to assess plaque accumulation, gingival health, and either patient or operator experience. There is no superiority of either bracket system regarding failure rate. OPC are statistically significantly superior over APC in bonding time although this is most likely not clinically significant.