Antibacterial properties of 4 orthodontic cements. Am J Orthod Dentofacial Orthop. 2005;127:56-63. [PMID: 15643415 DOI: 10.1016/j.ajodo.2003.11.023]

Mechanical and microbiological properties of orthodontic resin modified with nanostructured silver vanadate decorated with silver nanoparticles (βAgVO3)

OBJECTIVE

To investigate the impact of incorporating the antimicrobial nanomaterial β-AgVO3 into orthodontic resin, focusing on degree of conversion, surface characteristics, microhardness, adhesion properties, and antimicrobial activity.

METHODS

The 3 M Transbond XT resin underwent modification, resulting in three groups (Control, 2.5% addition, 5% addition) with 20 specimens each. Fourier transform infrared spectroscopy assessed monomer conversion. Laser confocal microscopy examined surface roughness, and microhardness was evaluated using Knoop protocols. Shear strength was measured before and after artificial aging on 36 premolar teeth. Microbiological analysis against S. mutans and S. sanguinis was conducted using the agar diffusion method.

RESULTS

Degree of conversion remained unaffected by time (P = 0.797), concentration (P = 0.438), or their interaction (P = 0.187). The 5% group exhibited the lowest surface roughness, differing significantly from the control group (P = 0.045). Microhardness showed no significant differences between concentrations (P = 0.740). Shear strength was highest in the control group (P < 0.001). No significant differences were observed in the samples with or without thermocycling (P = 0.759). Microbial analysis revealed concentration-dependent variations, with the 5% group exhibiting the largest inhibition halo (P < 0.001).

CONCLUSIONS

Incorporating β-AgVO3 at 2.5% and 5% concentrations led to significant differences in surface roughness, adhesion, and antimicrobial activity. Overall, resin modification positively impacted degree of conversion, surface characteristics, microhardness, and antimicrobial activity. Further research is warranted to determine clinically optimal concentrations that maximize antimicrobial benefits while minimizing adverse effects on adhesion properties.

CLINICAL SIGNIFICANCE

Incorporating β-AgVO3 into orthodontic resin could improve patient quality of life by prolonging intervention durability and reducing the impact of cariogenic microorganisms. The study's findings also hold promise for the industry, paving the way for the development of new materials with antimicrobial properties for potential applications in the health sector.

Effect of calcium fluoride nanoparticles in prevention of demineralization during orthodontic fixed appliance treatment: a randomized clinical trial

BACKGROUND

White spot lesions (WSLs) are the most common complications of fixed appliance orthodontic treatment.

OBJECTIVES

To evaluate the effectiveness of calcium fluoride nanoparticles-containing orthodontic primer (nCaF2-primer) in preventing the incidence of WSLs during orthodontic treatment.

TRIAL DESIGN

Single-centre, double-blinded, split-mouth, randomized clinical trial.

METHODS

The sample involved 31 orthodontic patients (≥12 years). Participants were recruited using a simple nonstratified randomization. Data collection, measurements, and analysis were performed blindly. Outcome measures included comparing the effect of nCaF2-primer with control primer (Transbond) regarding the degree of demineralization (DIAGNOdent pen), Streptococcus mutans (S. mutans) bacterial counting [real-time polymerase chain reaction device (PCR)], and WSLs incidence (pre- and post-operative photographs). The measurements were performed before bonding, 1, 3, and 6 months after bonding and after appliance removal. A two-way repeated measure analysis of variance test (for DIAGNOdent pen scores), and Wilcoxon signed-rank test (for the difference between bacterial counting and WSLs incidence) were used (P < 0.05).

RESULTS

Thirty-one patients were recruited and randomized (mean age 17.9 ± 2.45 years). For the primary outcome (DIAGNOdent pen scores) and secondary outcome of S. mutans counting: 31 patients (310 teeth for each group) were included in scoring at T1 and T3, and 30 patients (300 teeth) were included at T6. While for the photographic scores, 26 patients were included after bracket bonding. The demineralization scores showed significant differences at all-time intervals within the 6 months after bracket bonding which was more noticeable after the first month. There was a significant difference in bacterial count between the two primer groups at the T1 only. Regarding photographic scores, there were no significant differences in the WSLs incidence between the two primers groups after brackets removal. No harm was detected during treatment, except the usual pain/gingival irritation.

CONCLUSIONS

nCaF2-primer effectively decreased demineralization scores within the 6 months after bracket bonding. Moreover, it significantly reduced S. mutans colonization after the first month. However, the tested primer did not have an extra advantage in preventing WSLs development at the clinical level after appliance removal.

TRIAL REGISTRATION

The trial was registered with ClinicalTrials.gov on 8 May 2021 (registration number: NCT04994314).

Incorporation of chlorhexidine in self-adhesive resin cements

The aim of this study was to evaluate the maximum amount of chlorhexidine (CHX) that could be incorporated to self-adhesive resin cements to add antibacterial effect without affecting the physical properties. The CHX was incorporated into a commercial self-adhesive resin cement at mass fractions of 0.5-15 wt%, and the CHX-release profile, antibacterial effect, flexural and bond strengths of experimental cements were evaluated. Increasing the CHX content from 5 to 15 wt% resulted in a higher released concentration of CHX. In agar diffusion tests, experimental cements containing 5, 10, and 15 wt% CHX produced inhibition zones against oral bacteria. In flexural strength and shear bond strength to dentin, no significant reduction was observed with the incorporation of 5 wt% CHX. This in vitro study suggests that the addition of 5 wt% CHX yielded an antibacterial self-adhesive cement and had no adverse effect on the flexural and shear bond strengths.

The effect of the addition of propolis to resin-modified glass ionomer cement bracket adhesive materials on the growth inhibition zone of Streptococcus mutans

Background: Orthodontic treatments progress alongside the development of adhesive materials. The present study aimed to determine the antibacterial properties of propolis, a natural product, in a mixture of resin-modified glass ionomer cement by observing the growth inhibition zone of  Streptococcus mutans.Methods: This was an in vitro study conducted on 45 samples of adhesive material, which were divided into control group (resin-modified glass ionomer cement bracket adhesive material), two groups of propolis concentrations (15%, and 25%) and duration (0, 15, and 30 days). The antibacterial effect of each sample was evaluated against S. mutans using an agar plate diffusion test. Measurement of the diameter of the growth inhibition zone of S. mutans was carried out. The data obtained were analyzed statisticallyThe significance value of the Kruskal Wallis and Mann-Whitney test was set at p <0.05, while the significance value of the normality and homogeneity test was set at p> 0.05). Datas in this study that were not normally distributed (p = 0.012) but homogeneous (p = 0.110) were analyzed by the Kruskal-Wallis test (p = 0.003) and then the Mann-Whitney test was performed to determine differences in significance between groups. Results: There was a relationship between concentration and duration of propolis to the growth inhibition zone of S. mutans (p=0.003). The addition of 25% propolis concentration inhibited the growth of S. mutans more than the addition of 15% and without propolis (control group). The addition of propolis to resin-modified glass ionomer cement for 15 days was more effective in inhibiting the growth of S. mutans.Conclusion: The addition of propolis to adhesive materials provides an inhibitory effect on the growth of S. mutans, which may be effective in the world of preventive dentistry.

The effect of the addition of propolis to resin modified glass ionomer cement bracket adhesive materials on the growth inhibition zone of Streptococcus mutans

Background: Orthodontic treatments progress alongside the development of adhesive materials. The aim of the present study was to determine the antibacterial properties of propolis, a natural product, in a mixture of resin modified glass ionomer cement by observing the growth inhibition zone of Streptococcus mutans. Methods: This was an in vitro study conducted on 45 samples of adhesive material, which were divided into three groups of propolis concentrations (0%, 15%, and 25%) and duration (0, 15, and 30 days). The antibacterial effect of each sample was evaluated against S. mutans using an agar plate diffusion test. Measurement of the diameter of the growth inhibition zone of S. mutans were carried out. The data obtained were analyzed statistically by Kruskal Wallis test. Results: There was a relationship between concentration and duration of propolis to the growth inhibition zone of S. mutans (p<0.05). The addition of 25% propolis concentration inhibited the growth of S. mutans more than the addition of 15% and 0% propolis concentration. The addition of 0%, 15%, and 25% propolis concentration to resin modified glass ionomer cement for 15 days was more effective in inhibiting the growth of S. mutans.Conclusion: The addition of propolis to adhesive materials provides an inhibitory effect on the growth of S. mutans, which may be effective in the world of preventive dentistry.

Antibacterial Activity of Commercial Dentine Bonding Systems against E. faecalis-Flow Cytometry Study

Literature presents inconsistent results on the antibacterial activity of dentine bonding systems (DBS). Antibacterial activity of adhesive systems depends on several factors, including composition and acidity. Flow cytometry is a novel detection method to measure multiple characteristics of a single cell: total cell number, structural (size, shape), and functional parameters (viability, cell cycle). The LIVE/DEAD^® BacLight™ bacterial viability assay was used to evaluate an antibacterial activity of DBS by assessing physical membrane disruption of bacteria mediated by DBS. Ten commercial DBSs: four total-etching (TE), four self-etching (SE) and two selective enamel etching (SEE) were tested. Both total-etching DBS ExciTE F and OptiBond Solo Plus showed comparatively low antibacterial activity against E. faecalis. The lowest activity of all tested TE systems showed Te-Econom Bond. Among SE DBS, G-ænial Bond (92.24% dead cells) followed by Clearfil S3 Bond Plus (88.02%) and Panavia F 2.0 ED Primer II (86.67%) showed the highest antibacterial activity against E. faecalis, which was comparable to isopropranol (positive control). In the present study, self-etching DBS exhibited higher antimicrobial activity than tested total-etching adhesives against E. faecalis.

Influence of resin-modified glass ionomer and topical fluoride on levels of Streptococcus mutans in saliva and biofilm adjacent to metallic brackets

Decalcification of enamel during fixed orthodontic appliance treatment remains a problem. White spot lesions are observed in nearly 50% of patients undergoing orthodontic treatment. The use of fluoride-containing orthodontic materials has shown inconclusive results on their ability to reduce decalcification. The aims of this investigation were to compare the levels of Streptococcus mutans (SM) in saliva and biofilm adjacent to orthodontic brackets retained with a resin-modified glass ionomer cement (RMGIC) (Fuji ORTHO LC) and a light cured composite resin (Transbond XT), and to analyze the influence of topical application of the 1.23% acidulated phosphate fluoride (APF) on SM counts. In a parallel study design, two groups (n=14/15) were used with random allocation and high salivary SM counts before treatment. Biofilm was collected from areas adjacent to the brackets on teeth 13, 22, 33, and 41. Both saliva and biofilm were collected on the 7th, 21st, 35th, and 49th days after appliance placement. Topical fluoride application was carried out on the 35th day. Bonding with RMGIC did not alter SM counts in saliva or biofilm adjacent to the brackets. On the other hand, the biofilm adjacent to brackets retained with composite resin showed a significant increase in SM counts along the trial period. Topical application of 1.23% APF did not reduce salivary or biofilm SM counts regardless of the bonding material. In conclusion, fluoride topical application did not show efficacy in reducing SM. The use of RMGIC as bonding materials allowed a better control of SM cfu counts in dental biofilm hindering the significant increase of these microorganisms along the trial period, which was observed in the biofilm adjacent to the composite material.

Effect of methacrylated-based antibacterial monomer on orthodontic adhesive system properties

INTRODUCTION

Antibacterial adhesives were developed to reduce the incidence of white spot lesions in orthodontic patients. Compounds that contain triazine are known as effective antibacterial agents. The aims of this study were to develop an experimental orthodontic adhesive containing 1,3,5-triacryloylhexahydro-1,3,5-triazine (TAT) and to characterize it.

METHODS

TAT was added in 3 concentrations (10%, 15%, and 20%) to the experimental orthodontic adhesive. Antibacterial activity was assayed by brain-heart infusion broth dilution against Streptococcus mutans. The degree of conversion was measured using Fourier transform infrared spectroscopy, and solvent degradation was evaluated by Knoop microhardness before and after immersion in ethanol for 2 hours. The shear bond strength of metal brackets bonded to bovine enamel surface was assessed.

RESULTS

All experimental adhesives reduced bacterial growth. The addition of 15% and 20% TAT increased the degree of conversion compared with the control group (0%) and the 10% group. All groups showed a decrease in hardness after ethanol immersion, and there was also a decrease in the percentage of variation of Knoop hardness in the experimental adhesives containing TAT, whereas the shear bond strength increased.

CONCLUSIONS

Orthodontic adhesives containing TAT are promising antibacterial materials, especially those with 15% and 20% TAT.

Evaluation of antibacterial effects of pulp capping agents with direct contact test method

Objectives:

Calcium hydroxide has been used in dentistry as a major capping material having the capacity to introduce the formation of a mineralized dentin bridge, but it has no direct inducing effect to the pulp cells. The purpose of this study was to evaluate the antibacterial properties of three different pulp capping agents using a direct contact test (DCT).

Materials and Methods:

The antibacterial properties of three pulp capping agents were evaluated a DCT. For the DCT, wells (n = 12) of 96-microtiter plates were coated with the tested cements (Dycal, Dentsply, USA; DiaRoot BioAggregate, Diadent, Holland; Calcimol LC, Voco, Germany) and Kalzinol (zinc oxide/eugenol cement, Dentsply, USA) was used as control material. A Lactobacillus casei suspension was placed on the surface of each specimen for 1 h at 37°C. Bacterial growth was monitored for 16 h with a temperature-controlled microplate spectrophotometer. The kinetics of the outgrowth in each well were recorded continuously at 650 nm every 30 min. The data were analyzed by one-way ANOVA, and Tamhane's T2 multiple comparison test. The level of significance was determined as P < 0.05.

Results:

All pulp capping agents showed an increase in the logarithmic growth rate of L. casei when compared with the control group (P < 0.05). Therefore, all pulp capping agents did not show antibacterial activity.

Conclusions:

The tested pulp capping agents haven't got antibacterial properties. Therefore, they should be used carefully when pulp is exposed or only very thin dentin remained over the pulp to avoid bacterial contamination.

The effects of in vitro fluoride mouth rinse on the antibacterial properties of orthodontic cements

OBJECTIVES

To investigate the ability of orthodontic cements to regain their antibacterial effect after aging for 1 month, followed by 2 weeks of fluoride 'recharging' through daily fluoride rinse.

MATERIALS AND METHODS

Four orthodontic cements were tested: composite resin-based materials (Transbond XT and Transbond Plus), a conventional glass ionomer cement (CX Plus) and dual-cured resin-reinforced glass ionomer cement (Fuji ORTHO LC) by direct contact test. After polymerization and a 30-day aging process, the samples were rinsed daily with 0.05% NaF solution for 14 days. Twenty-four hours after the last fluoride rinse, Streptococcus mutans cells (approximately 1 x 10(6) ) were placed on the surface of each sample for 1 h at 37°C to establish direct contact. Bacterial growth was monitored for 24 h by temperature-controlled spectrophotometry. Similar experiments were conducted after aging for 48 h and 72 h after the last fluoride rinse. One-way anova, two-way anova, and Tukey's multiple comparison test were applied to the data.

RESULTS

Twenty-four hours after the last fluoride rinse, the resin-modified glass ionomer and the glass ionomer showed potent antibacterial properties, whereas the composite-based material Transbond XT encouraged bacterial growth. After 72 h, only Fuji Ortho LC maintained its bacteriostatic properties while all the other tested materials showed no antibacterial activity.

CONCLUSIONS

Fourteen days daily fluoride rinse temporarily revives the antibacterial properties of the resin-modified glass ionomer cement and glass-ionomer-based cement.

Antibacterial and mechanical properties of propolis added to glass ionomer cement

OBJECTIVE

To investigate whether adding ethanolic extracts of propolis (EEP) might influence the antibacterial and mechanical (shear-peel band strength [SPBS]) properties of conventional glass ionomer cement (GIC) used in orthodontic band cementation.

MATERIALS AND METHODS

The cement was divided into four groups: one using the original composition and three with 10%, 25%, and 50% EEP added to the liquid and then manipulated. An antimicrobial assay, broth-dilution method was used to determine the antibacterial capacity of the GIC containing EEP. Eighty teeth were used for the mechanical assay, and an Instron testing machine was used to evaluate the SPBS. Kolmogorov-Smirnov and Kruskal-Wallis tests were used for statistical analyses.

RESULTS

GIC with the addition of 25% and 50% EEP activated inhibition of Streptococcus mutans (ATCC 25175) growth, but this effect did not occur in the group to which 10% EEP was added or in the control GIC group. There was no significant difference between the groups in terms of SPBS (P > .05).

CONCLUSIONS

The addition of EEP may increase antibacterial properties without negatively modifying the mechanical properties of conventional GIC.

Priming the tooth surface with chlorhexidine and antibacterial activity of resin cement

AIM: To evaluate the effect of priming the tooth surface with 2% chlorhexidine gluconate on antibacterial activity of resin cement.

METHODS: Ten patients in whom a single missing tooth was present on both the right and left side in the upper or lower arch were selected. Two fixed partial dentures (FPDs) in each patient on the right and left side were planned. Each FPD was assigned either to the control or test group. In the control group, FPD was luted with resin cement and in the test group, the tooth surface was primed with 2% chlorhexidine gluconate before luting with resin cement. Bacteriological samples were collected at base line level, as the patient came to the outpatient department before the start of any treatment, 5 wk prior to cementation of FPD and at 13 wk (8 wk after final cementation). Microbiological processing of all samples was done and the results were statistically analyzed.

RESULTS: In the test group, a predominance of aerobic/facultative gram positive cocci rod was seen which indicates a healthy periodontal site, whereas in the control group, a predominance of anaerobic gram negative rods was present which indicates an unhealthy periodontal condition. This is evident by the fact that the anaerobic bacteria percentage in the control sample is 57% and 15% in the test sample after 13 wk, whereas the aerobic/facultative bacteria percentage is 43% in the control sample and 85% in the test sample after 13 wk. The percentage of gram negative bacteria in the control sample is 61% and in the test sample is 20% after 13 wk, whereas the percentage of gram positive bacteria in the control sample is 39% and in the test sample is 80% after 13 wk. The shift from anaerobic gram negative bacteria to aerobic gram positive bacteria is clearly seen from the control to test sample after 13 wk.

CONCLUSION: The present study demonstrated that priming the tooth surface with 2% chlorhexidine gluconate may enhance antibacterial activity of the resin cement.

Antibacterial properties of dental luting agents: potential to hinder the development of secondary caries

A modified direct contact test was used to evaluate the antibacterial properties of four commercially available dental luting agents (RelyX Unicem, Ketac Cem, Ceramir Crown & Bridge and Harvard Cement) and two reference materials (glass-ionomer cement and calcium aluminate cement) compared to a negative-control material (PMMA). Streptococcus mutans bacteria were placed in direct contact with specimens that had been aged for 10 min, 1 day, and 7 days, in order to test the antibacterial properties of the materials. A metabolic assay containing resazurin was used to quantify the amount of viable bacteria remaining after the direct contact tests. The effects of pH and fluoride on bacteria proliferation were also evaluated. Strongest antibacterial properties were found for calcium aluminate cement, followed by Ceramir Crown & Bridge and RelyX Unicem. Ketac Cem, Harvard Cement, and the reference glass-ionomer cement showed bacteria content either higher than or not significantly different from the PMMA control in all instances. pH levels below 6.3 and above 9.0 were found to have negative effects on bacterial proliferation. No correlation between either acidic materials or fluoride release and antibacterial properties could be seen; rather, basic materials showed stronger antibacterial properties.

Analysis of the properties of dental cements after exposure to incubation media containing Streptococcus mutans

AIM

Indirect restorations are increasingly used in dentistry, and the cementation interface is possibly the most critical region of the work. The objective of the present work was to evaluate the influence of exposure to a culture medium containing S. mutans on the hardness and solubility of four different cementing agents (zinc phosphate, glass ionomer, glass ionomer modified with resin and resin cement).

MATERIALS AND METHODS

Test specimens composed of these cements were exposed for 30 days in a culture medium containing S. mutans. After leaching, the test materials were assessed in terms of their solubility (loss of mass) and Knoop (KHN) microhardness. Changes in surface morphology were identified using scanning electron microscopy (SEM).

RESULTS

The resin cement showed no significant solubility and its hardness increased following exposure and leaching, while the zinc phosphate cement was the most soluble and its hardness decreased after exposure to the culture medium. SEM analyses identified morphological alterations on the surfaces of the test materials that were compatible with the solubility results.

CONCLUSION

It is concluded that resinous cements perform better than water-based cements when exposed to acidic conditions.

CLINICAL SIGNIFICANCE

The effects of acids from Streptococcus mutans can interfere with the efficiency and properties of some cements used for fixation of indirect restorations, exposed to the buccal environment.

Can we add chlorhexidine into glass ionomer cements for band cementation?

OBJECTIVE

To test if the addition of chlorhexidine digluconate (CHD) might influence the mechanical properties and antibacterial properties of two different conventional glass ionomer cements (GICs) used for band cementation.

MATERIALS AND METHODS

Two commercial brands of conventional GICs were used: Ketac Cem Easymix (3M/ESPE, St Paul, Minn) and Meron (Voco, Cuxhaven, Germany). The cements were manipulated in their original composition and also with 10% and 18% CHD in the liquid to create a total of six groups. Diametral tensile strength, compressive strength, microhardness, shear bond strength, and antibacterial effects in 5, 45, and 65 days against Streptococcus mutans were tested in all groups, and the data were submitted to statistical analyses.

RESULTS

There were no significant differences between the groups of the same material in diametral tensile, compressive strength, and shear bond strength (P > .05). There was significant improvement in the microhardness to the Ketac Cem Easymix (P < .001). GICs with the addition of CHD showed significant inhibition of S. mutans growth in comparison with the control groups at the three time points evaluated (P < .001). The addition of 18% CHD resulted in higher bacterial inhibition (P < .001).

CONCLUSIONS

The addition of chlorhexidine digluconate to conventional GICs does not negatively modify the mechanical properties and may increase the antibacterial effects around the GICs even for relatively long periods of time.

Streptococcus mutans counts in plaque adjacent to orthodontic brackets bonded with resin-modified glass ionomer cement or resin-based composite

This study investigated the number of Streptococcus mutans CFU (colony forming units) in the saliva and plaque adjacent to orthodontic brackets bonded with a glass ionomer cement--GIC (Fuji Ortho) or a resin-based composite--RC (Concise). Twenty male and female patients, aged 12 to 20 years, participated in the study. Saliva was collected before and after placement of appliances. Plaque was collected from areas adjacent to brackets and saliva was again collected on the 15th, 30th, and 45th day after placement. On the 30th day, 0.4% stannous fluoride gel was applied for 4 minutes. No significant modification in the number of Streptococcus mutans CFU in saliva was observed after placement of the fixed orthodontic appliances. On the 15th day, the percentage of Streptococcus mutans CFU in plaque was statistically lower in sites adjacent to GIC-bonded brackets (mean = 0.365) than in those adjacent to RC-bonded brackets (mean = 0.935). No evidence was found of a contribution of GIC to the reduction of CFU in plaque after the 15th day. Topical application of stannous fluoride gel on the 30th day reduced the number of CFU in saliva, but not in plaque. This study suggests that the antimicrobial activity of GIC occurs only in the initial phase and is not responsible for a long-term anticariogenic property.

Prevention of demineralization around orthodontic brackets in vitro

INTRODUCTION

The demineralization of enamel adjacent to orthodontic brackets is a significant clinical problem. The purpose of this in-vitro study was to investigate the effect of sodium fluoride (Colgate Neutrafluor 9000 ppm) (NaF) and 10% casein phosphopeptide-amorphous calcium phosphate (GC Tooth Mousse) (TM) on enamel demineralization adjacent to orthodontic brackets.

METHODS

Forty specimens were sectioned from the buccal or lingual surfaces of extracted sound third molars. Twenty specimens had molar tubes bonded with composite resin (Transbond XT, 3M, St Paul, Minn) (CR), and 20 were bonded with resin-modified glass ionomer cement (Fuji Ortho LC, GC America, Alsip, Ill) (RMGIC). A 2-mm window for enamel demineralization was prepared. The specimens were randomly divided into 4 treatment groups: control, TM, TM/NaF (50/50 w/w), and NaF. The treatment solutions were placed around the bracket margins, and the specimens were immersed inverted into a carbopol demineralization solution at 37 degrees C. The enamel specimens were exposed for 96 hours, with the demineralization and topical solutions changed every 4 hours. Quantitative light-induced fluorescence (QLF) images were taken every 8 hours under controlled conditions. The difference in fluorescence (DeltaF) and the proportional DeltaF (%F) change between baseline and 96 hours was calculated.

RESULTS

RMGIC significantly reduced DeltaF and %F when compared with CR (ANOVA, P = .029 and P = .034, respectively). Application of TM with CR, NaF with CR, and TM/NaF with CR significantly reduced DeltaF and %F compared with the control CR (Tukey post-hoc test, P <.001). Application of TM/NaF with RMGIC significantly reduced DeltaF and %F compared with the control RMGIC (Tukey post-hoc test, P = .008, P = .019, respectively).

CONCLUSIONS

With the limitations of any in-vitro study, the following clinical conclusions can be drawn. The use of RMGIC alone can significantly decrease enamel demineralization compared with CR. The application of TM/NaF can provide significant additional prevention of enamel demineralization when RMGIC is used for bonding. The application of TM, NaF, or TM/NaF can significantly prevent enamel demineralization when CR is used for bonding. The use of both agents should be recommended for any at-risk orthodontic patient to provide preventive actions and potentially remineralize early (subclinical) enamel demineralization.

Prevention of white spot lesions in orthodontic practice: a contemporary review

The development of white spot demineralization associated with fixed appliance orthodontic treatment is a significant clinical problem. Both established and experimental methods for prevention of such lesions in day-to-day clinical practice are presented and discussed.