Enamel demineralization during orthodontic treatment. Aetiology and prevention

Comparison of enamel demineralization and periodontal status between direct and digital indirect bonding techniques : A split-mouth clinical trial of direct vs. digital indirect bonding

OBJECTIVES

This randomized clinical trial aimed to evaluate the effects of digital indirect bonding (DIB) compared to the direct bonding (DB) technique in terms of enamel demineralization and periodontal status.

MATERIALS AND METHODS

A total of 24 patients (17 females, 7 males) with a mean age of 13.83 ± 1.55 years were bonded using DB and DIB techniques using a split-mouth study design. Bonding techniques were randomly allocated to quadrants. Demineralization measurements were performed with the DIAGNOdent pen (Kavo, Biberach, Germany) from four sides (distal, gingival, mesial, and incisal/occlusal) of all brackets immediately after bonding, 1 month (T1), and 6 months (T2) after bonding. Periodontal measurements were taken before bonding and at the same time points (T1 and T2). Data were statistically analyzed with the Mann-Whitney U test to determine possible differences between groups.

RESULTS

Incisal/occlusal sides exhibited the lowest demineralization values at T2. The gingival side of upper centrals, mesial side of upper laterals, and distal sides of upper first premolar and lower laterals brackets bonded with the DIB technique exhibited significantly increased demineralization compared with the DB technique from T0 to T2 (p < 0.05). Periodontal parameters increased 1 month after bonding and decreased during the follow-up. Bonding technique showed no statistically significant difference in plaque index, gingival index, and bleeding on probing values at any time interval.

CONCLUSION

There were many locations around the brackets with significantly higher demineralization after 6 months in patients who received digital indirect bonding compared to the DB group. Although periodontal health was generally adequate, complete removal of adhesive flash should be carefully carried out to decrease the risk of demineralization during indirect bonding technique with digital workflows.

Prevalence of different types of interproximal contacts in the permanent dentition - a study cast evaluation

Background

A new classification called OXIS was proposed for categorizing the interproximal contacts of primary molars, modified for the primary canines and its prevalence was established. No such information is available for the permanent dentition. Hence, the aim was to establish the variations in interproximal contacts of the permanent dentition and thereby modify the OXIS classification of primary molars and primary canines to the permanent dentition.

Methods

We propose a study-cast-based classification of interproximal contacts of the permanent dentition. Three hundred and forty-three pretreatment casts of patients based on an inclusion and exclusion criteria were selected. Contacts of posterior teeth were classified based on OXIS classification of interproximal contacts, and its modification was used for anterior teeth.

Results

Among the posterior contacts, the 'O' type of contact was least prevalent, while most prevalent was the 'S' type for second molar-first molar contact, 'I' type for the first molar-second premolar contact, and 'X' type for the second premolar-first premolar contact. Among the anterior contacts, least prevalent was 'S1' type for the first premolar-canine contact, and I type for the canine-lateral incisor and the lateral incisor-central incisor contacts. There was no statistical significance between right- and left-side contacts ( P > 0.05) while significance was seen between maxillary and mandibular contacts ( P < 0.05). Similarity of contacts ranged from 5.17% to 10.05%.

Conclusion

The OXIS classification is applicable to posterior permanent teeth, and its modification is representative of anterior permanent teeth.

Carboxymethyl chitosan stabilized AuNPs/ACP nanohybrids in enamel white spot lesions

Acidic bacterial biofilms-associated enamel white spot lesions (WSLs) are one of the hallmarks of early caries, causing demineralization and decomposition of dental hard tissues. Therefore, to effectively prevent and treat WSLs, it is important to inhibit the activity of cariogenic bacteria while promoting the remineralization of demineralized enamel. Amorphous calcium phosphate (ACP) favors hard tissue remineralization due to its biological activity and ability to release large amounts of Ca2+ and PO4 3-. However, ACP-based biomineralization technology is not effective due to its lack of antimicrobial properties. Here, carboxymethyl chitosan (CMCS) was employed as a reducing agent and stabilizer, and dual-functional nanohybrids CMCS/AuNPs/ACP with biofilm resistance and mineralization properties were successfully synthesized. The addition of AuNPs enhances the antimicrobial activity and participates in regulating the formation of hydroxyapatite (HAp). The nanohybrids exhibited significant destructive effects against cariogenic bacteria and their biofilms and showed bactericidal activity under bacteria-induced acidic conditions. More importantly, this nanohybrids showed superior results in promoting the remineralization of demineralized enamel, compared to fluoride and CMCS/ACP in vitro. The CMCS/AuNPs/ACP nanohybrids not only reverse the cariogenic microenvironment at the microbial level, but also promote self-repairing of enamel WSLs regarding the microstructure. The present work offers a theoretical and experimental basis for using the CMCS/AuNPs/ACP nanohybrids as a potential dual-functional agent for the clinical treatment of enamel WSLs.

Three-dimensional evaluation of interproximal contacts of permanent dentition: a cone beam computed tomography study

PURPOSE

To assess the various patterns of the inter-proximal contact areas of the permanent dentition using the available cone beam computed tomography (CBCT) images.

METHODS

A retrospective cross-sectional study was performed on existing CBCT images from a University hospital and teaching department. Three thousand two hundred and fifty inter-proximal contacts were assessed from 125 existing CBCT scans of patients (age range: 14 years 3 months-29 years 9 months) who had matched the eligibility criteria. The types of inter-proximal contacts of the permanent dentition were scored at occlusal, middle, and cervical thirds, according to the OXIS inter-proximal contacts classification. Chi-square test was used to assess the contacts and gender/arches.

RESULTS

The most prevalent contact was type I for the posterior teeth contacts, and types S1 and S2 for the anterior teeth contacts. Statistical significance was not observed between the contacts on the left and right sides (P > 0.05), while statistical significance was observed between the inter-proximal contacts of the maxilla and mandible (P < 0.05).

CONCLUSION

The CBCT-based three-dimensional assessment of the inter-proximal contact areas of the permanent dentition is representative of the OXIS classification. The occlusal level contact was predominantly representative of the overall type of the contact.

Evaluation of the effects of 2 different adhesive-coated bracket systems on white spot lesion formation

INTRODUCTION

This study evaluated the effects of 2 different adhesive-precoated (APC) bracket systems on white spot lesions (WSLs).

METHODS

The study had a split-mouth design, and 34 patients were included. The APC Flash-Free (FF) and APC II system brackets were used. At the end of the treatment, digital photographs of each tooth were taken, the WSLs were scored, and lesion areas were calculated. In the same session, the mineralization level of the teeth was measured by DIAGNOdent. The 2 bracket systems were compared in terms of bonding time.

RESULTS

There was no difference between the 2 groups regarding the number of WSLs or the size of the lesion areas. In the maxillary arch, 55.3% of the teeth in the FF group and 61.2% in the control group were healthy. In the mandibular arch, no lesions occurred in 61.2% of the teeth in the FF group and 64.7% of the control group. In the evaluation of DIAGNOdent measurements, WSL formation was detected in 3 teeth in the FF group and 4 in the control group. No statistically significant difference was found between the 2 groups. There was a significant difference between the 2 groups in the evaluation of bonding times.

CONCLUSIONS

The effects did not differ between FF and conventional brackets in patients undergoing fixed orthodontic treatment. The use of FF brackets significantly shortened the bonding time.

Evaluation of Antimicrobial Properties and Shear Bond Strength of Conventional Orthodontic Adhesive Modified With Calotropis gigantea Nanoparticles: An In Vitro Study

INTRODUCTION

Bonding of brackets with adhesives during orthodontic fixed appliance therapy is associated with white spot lesions (WSLs). An adhesive developed with an antimicrobial property is advantageous to prevent decalcification of the enamel surface. The current study assesses the antimicrobial and shear bond strength (SBS) characteristics of an experimental conventional orthodontic adhesive incorporated with different concentrations of nanoparticles (NPs) prepared from the leaves of Calotropis gigantea and compares them with non-admixed conventional adhesive.

MATERIALS AND METHODS

A total of 40 premolar teeth therapeutically extracted for orthodontic purposes were randomly assigned to four equal groups of n = 10 each. In control Group I, unmodified conventional adhesive was used to bond the brackets. In the three experimental groups, Group II, Group III, and Group IV, the brackets were bonded with modified conventional adhesive admixed with the C. gigantea NPs in concentrations of 1%, 5%, and 10%, respectively. The agar well diffusion test and the disc agar diffusion (DAD) test were utilized for assessing the anti-microbial activity of the composite discs. The SBS of the groups was determined by a universal testing machine.

STATISTICAL ANALYSIS

A one-way ANOVA and Tukey's honestly significant difference (HSD) post-hoc test was used to analyze the difference in shear bond strength and microbial inhibition zone diameter between the groups with a probability (p) value of equal to or less than 0.05 as statistical significance.

RESULTS

The mean SBS for Group I without nanoparticles is 6.99±0.75 MPa. The SBS value decreased inversely in proportion to the concentration of NPs: Group II (1% NP) 6.29±0.67 MPa; Group III (5% NP) 4.40±0.47 MPa; and Group IV (10% NP) 1.98±0.21 MPa, which is statistically significant (p < 0.001). The incorporation of C. gigantea NPs resulted in a decrease in the actual microbial potency of the conventional adhesive.

CONCLUSION

Isolated C. gigantea NPs, when used alone, proved to have antimicrobial efficacy, but orthodontic adhesives admixed with C. gigantea NPs showed no additive effect, and SBS values decreased with increased concentrations of NPs.

Microhardness and surface roughness of resin infiltrated bleached enamel surface using atomic force microscopy: An in vitro study

to evaluate the microhardness (VHN) and surface roughness (Ra) of human enamel surface treated with resin infiltration followed by in office bleaching and to study the effect of artificial saliva (AS) storage time on the VHN and Ra of resin infiltrated enamel. Materials and methods: Eighty enamel specimens were prepared from extracted human premolar teeth. Specimens were divided into two main groups (I and II) then, they were demineralized to create white spot lesions (WSLs). Group I was divided into A and B sub groups. Group A was treated with in office bleaching material while for group B, resin infiltration (Icon) was applied after 24 h storage in AS followed by bleaching. Group II was divided into (C and D). Group C was treated like group B. Specimens in group D were stored in AS for 14 d after treatment with Icon and before application of bleaching. Atomic force microscopy (AFM) Ra analysis and VHN calculation were done. Independent T Test was used to compare between groups at P < 0.05. Results: Group B demonstrated a significant increase in VHN compared with group A. Storage time in AS showed no significant difference on VHN or Ra between groups. Conclusion: Application of resin infiltration before bleaching significantly increased VHN and slightly improved Ra of WSLs compared with bleaching alone. Application of bleaching material after 24 h or 14 days of the application of resin infiltration did not have a significant effect or surface hardness or roughness of WSLs.

Preparation of Nanocomposites for Antibacterial Orthodontic Invisible Appliance Based on Piezoelectric Catalysis

Compared to fixed orthodontic appliances with brackets, thermoplastic invisible orthodontic aligners offer several advantages, such as high aesthetic performance, good comfort, and convenient oral health maintenance, and are widely used in orthodontic fields. However, prolonged use of thermoplastic invisible aligners may lead to demineralization and even caries in most patients' teeth, as they enclose the tooth surface for an extended period. To address this issue, we have created PETG composites that contain piezoelectric barium titanate nanoparticles (BaTiO₃NPs) to obtain antibacterial properties. First, we prepared piezoelectric composites by incorporating varying amounts of BaTiO₃NPs into PETG matrix material. The composites were then characterized using techniques such as SEM, XRD, and Raman spectroscopy, which confirmed the successful synthesis of the composites. We cultivated biofilms of Streptococcus mutans (S. mutans) on the surface of the nanocomposites under both polarized and unpolarized conditions. We then activated piezoelectric charges by subjecting the nanocomposites to 10 Hz cyclic mechanical vibration. The interactions between the biofilms and materials were evaluated by measuring the biofilm biomass. The addition of piezoelectric nanoparticles had a noticeable antibacterial effect on both the unpolarized and polarized conditions. Under polarized conditions, nanocomposites demonstrated a greater antibacterial effect than under unpolarized conditions. Additionally, as the concentration of BaTiO₃NPs increased, the antibacterial rate also increased, with the surface antibacterial rate reaching 67.39% (30 wt% BaTiO₃NPs). These findings have the potential for application in wearable, invisible appliances to improve clinical services and reduce the need for cleaning methods.

White Spots: Prevention in Orthodontics-Systematic Review of the Literature

Early-stage dental demineralization, called white spots (WS), get their name from the characteristic colour that enamel takes on due to the acid attack of salivary cariogenic bacteria. They are often associated with fixed orthodontic therapy (FOT) and, if left untreated, evolve into caries with repercussions on oral health and dental aesthetics. This review aims to identify the most effective prophylaxis strategies to prevent WS during FOT. The search for the reviewed studies was conducted on the Pubmed, Scopus, and Web of Science databases, selecting English-only articles published in the 5 years from January 2018 to January 2023. The keywords used were "WS" and "fixed orthodontic*", using "AND" as the Boolean operator. A total of 16 studies were included for qualitative analysis. Prevention begins with maintaining proper oral hygiene; fluoride in toothpaste, mouthwashes, gels, varnishes, and sealants can be added to prophylaxis and used regularly. Using a laser in combination with fluoride helps prevent the occurrence of WS and assists in the repair processes of initial lesions. Further studies are needed to establish international guidelines for preventing WS in orthodontically treated patients.

Intra-Oral Photograph Analysis for Gingivitis Screening in Orthodontic Patients

This study aimed to confirm the presence of gingival inflammation through image analysis of the papillary gingiva using intra-oral photographs (IOPs) before and after orthodontic treatment and to confirm the possibility of using gingival image analysis for gingivitis screening. Five hundred and eighty-eight (n  =  588) gingival sites from the IOPs of 98 patients were included. Twenty-five participants who had completed their orthodontic treatments and were aged between 20 and 37 were included. Six points on the papillary gingiva were selected in the maxillary and mandibular anterior incisors. The red/green (R/G) ratio values were obtained for the selected gingival images and the modified gingival index (GI) was compared. The change in the R/G values during the orthodontic treatment period appeared in the order of before orthodontic treatment (BO), mid-point of orthodontic treatment (MO), three-quarters of the way through orthodontic treatment (TO), and immediately after debonding (IDO), confirming that it was similar to the change in the GI. The R/G value of the gingiva in the image correlated with the GI. Therefore, it could be used as a major index for gingivitis diagnosis using images.

Comparison between a glass ionomer cement and a compomer concerning bonded acrylic expander retention and white spot formation : A randomized clinical trial

BACKGROUND

The goal of the present study was to compare a compomer and a glass ionomer cement (GIC) used for full the cementation of acrylic splint-type maxillary expanders with respect to failure rate and white spot lesions (WSLs) in vivo.

METHODS

A total of 120 patients with posterior crossbite and transverse maxillary deficiency were included to the study. The patients were randomly allocated to two groups: GIC group (n = 60) and compomer group (n = 60). The hyrax screw in both groups was activated two times a day for the first week then once a day until the desired amount of expansion was achieved. The rapid maxillary expansion (RME) appliance was left in the mouth for an extra month after the active expansion phase as a retention appliance. Then cementation failures were recorded. In addition, the patients were evaluated for white spot lesions (WSLs) before cementation and after removal of the appliance.

RESULTS

A total of 12 (20%) and 2 (3.3%) RME devices failed in the GIC and the compomer group, respectively. This difference between groups was statistically significant (p = 0.044). There were also statistically significant differences between the GIC and compomer groups in terms of WSLs on the central (p = 0.06) and lateral (p = 0.011) incisors, and on the first molar (0.028). However, no differences were observed for the canines (p = 0.185), first (p = 0.457) and second premolars (p = 0.116). In total, there was a statistically significant difference between the GIC and compomer groups (p = 0.048), with more WSLs in the GIC group.

CONCLUSIONS

Among the products used in the study, the compomer should be preferred over the GIC for cementation of acrylic splint-type rapid maxillary expanders in terms of failure rate and WSLs.

Associations between Oral Health and Cannabis Use among Adolescents and Young Adults: Implications for Orthodontists

Cannabis use is prevalent among adolescents and young adults in the US. Virtually all modes of cannabis consumption involve the oral cavity, and previous studies have linked cannabis use with poorer oral health. We sought to identify associations between cannabis use and various oral health outcomes and behaviors among individuals 12-25 years of age, and to discuss implications for orthodontists who largely interact with this age group over an extended period of treatment time. We examined data from patient electronic health records (N = 14,657) obtained between 2015 and 2021. Associations between lifetime and current self-reported cannabis use and several oral health outcomes or related behaviors that reflect periodontal health, caries status, oral lesions, and physical integrity of tooth structure and restorations were examined in a bivariable and multivariable manner, controlling for patient age, sex, and self-reported tobacco and alcohol use. Reporting lifetime cannabis use was associated with higher risk for having oral lesions (aPR = 1.41, 95% CI: 1.07-1.85), bruxism (aPR = 1.31, 95% CI: 1.09-1.58), and frequent consumption of sugary beverages and snacks (aPR = 1.27, 95% CI: 1.12-1.41). Reporting current cannabis use was associated with higher risk for oral lesions (aPR = 1.45, 95% CI: 1.03-2.06) and frequent consumption of sugary beverages and snacks (aPR = 1.26, 95% CI: 1.07-1.48). Cannabis users aged 12-25 are at increased risk for bruxism, oral lesions, and frequent consumption of sugary beverages and snacks. Orthodontists and other dental professionals should probe for drug use and be cognizant of increased risk for oral health problems in patients that report actively using cannabis.

Evaluation of Bioactive Glass and Low Viscosity Resin as Orthodontic Enamel Sealer: An In Vitro Study

The study aimed to evaluate the effect of applying fluoride bioactive glass (FBAG) and Alpha-Glaze® (resin sealer) on the shear bond strength of orthodontic brackets to enamel bonded by Transbond XT, brushing−abrasion durability, and their protective effect against simulated cariogenic acidic attack. Materials include 135 extracted premolars that were divided into three groups—FBAG, Alpha-Glaze, and control. The shear bond strength test was measured using an Instron Universal Testing Machine. The brushing abrasion challenge took place with a tooth-brushing simulator. Transmitted light microscopy examinations were performed after the specimens were demineralized for 4 days. The results show that the shear bond strength values of the three groups did not report any statistically significant differences: FBAG (28.1 ± 5.5 Mpa), Alpha-Glaze (32.5 ± 7.4 Mpa), and control (30.7 ± 6.5 Mpa) p < 0.05. The Adhesive Remenant Index (ARI) study showed chipping of enamel in 6.6% of Alpha-Glaze and control specimens and 40% of specimens had their enamel surface covered with resin. Furthermore, 30% of the FBAG and 100% of the Alpha-Glaze sealer specimens resisted the abrasion test. In conclusion, FBAG can serve as an orthodontic-sealer capable of protecting the enamel surface surrounding orthodontic brackets. However, the Alpha-Glaze sealer did not offer the capability of protecting the enamel.

Bitter Taste Perception and Dental Biofilm Cariogenicity in Orthodontics

BACKGROUND

Bitter taste perception and sweetness preference have been associated with dental caries. Propylthiouracil (PROP) has been used to determine the genetic sensitivity to bitter taste in early childhood caries. However, the role of the bitter threshold in dental biofilm cariogenicity has not been reported. The purpose of this study was to investigate the role of individual taste sensitivity using PROP in dental biofilm cariogenicity in orthodontic patients.

METHODS

Forty orthodontic patients (12-42 years old) undergoing fixed appliance orthodontic treatment participated in this cross-sectional study. Their demographic, oral hygiene practice, and dietary habits data were obtained using a questionnaire. The patients' bitter taste threshold was measured using a PROP assay. The patients were subsequently classified as super-tasters (STs), medium-tasters (MTs), and non-tasters (NTs). Dental biofilm cariogenicity was determined using a 3-tone disclosing gel that becomes pink (new dental biofilm), purple (mature dental biofilm), and light blue (cariogenic dental biofilm) based on dental biofilm maturity.

RESULTS

The NT, MT, and ST groups comprised 10%, 27.5%, and 62.5% of the patients, respectively. Most of the STs (56%) and MTs (63.6%) were female, whereas no females were NTs. The dental biofilm cariogenicity was significantly different between the PROP bitterness groups (P < .05). The highest percentage of mature biofilm, followed by cariogenic and new biofilm, was found in the MT and ST groups. However, the cariogenic biofilm percentage was significantly higher compared with mature biofilm (P < .05) in the NT group. A low frequency (<1 time/d) of sugary and acidic food intake between meals was observed in the ST, MT, and NT groups with no significant difference amongst the groups (P > .05).

CONCLUSIONS

Cariogenic dental biofilm was highly present in orthodontic patients with the NT phenotype.

An Extensive Comparison of the Clinical Efficiency of Acidulated Phosphate Fluoride (APF) and Neutral Sodium Fluoride (NaF) Oral Rinses in the Prevention of White Spot Lesions during Fixed Orthodontic Treatment: A Randomized Controlled Trial

Background

The purpose of this randomized trial is to compare the efficacy of weekly once regime of neutral sodium fluoride (NaF) oral rinse with that of acidulated phosphate (APF) formulated daily mouth rinse in the reduction of white spot lesions (WSLs) associated with fixed orthodontic appliance treatment.

Methods

The participants (n = 90) of this single-center, two-arm parallel study without a control group were randomly assigned with 1 : 1 distribution to each of the two groups after the bonding of brackets. Group A/test group 1 (n = 45) was given weekly rinse of neutral sodium fluoride (Colgate® PreviDent® Dental Rinse-0.2% NaF), and for group B/test group 2 (n = 45), an APF formulated daily oral rinse (Colgate® Ortho Defense^@ PhosFlur® Rinse-0.044% w/v of NaF) was given for six months. The outcome was assessed by the International Caries Detection and Assessment System (ICDAS) index for scoring the demineralization, and for scoring gingivitis, Loe and Silness gingival index (GI) was utilized. Four different time points “T0”immediately before bonding procedures, “T1” after 4weeks, “T2” after 12 weeks, and “T3” after 24 weeks were taken to assess the ICDAS and GI scores.

Results

The mean ICDAS scores for group A (NaF) were 0.025, 0.051, 0.093, and 0.113 and for group B (APF) were 0.014, 0.022, 0.038, and 0.015 at different points of time. The GI scores for group A were 0.008, 0.22, 0.33, and 0.38 and for group B were 0.003, 0.136, 0.181, and 0.097 at different time points. There was a statistically significant difference (p < 0.05) for both groups in terms of reducing WSL and GI.

Conclusion

APF formulated daily oral rinse—0.044% w/v of NaF—is more effective than the weekly once regimen of 0.2% NaF oral rinse to prevent white spot lesions.

Role of the general dental practitioner in managing the risks of orthodontic treatment

The aim of this article is to outline the potential risks in orthodontic treatment and the general dental practitioner's role in reducing and managing such risks. The success of orthodontic treatment largely depends on patient understanding of the risk/benefit implications of the orthodontic treatment and all of the potential consequences involved in such treatment. A perfect blend of good case selection, sound clinical judgement and, more importantly, a patient's clear understanding of the potential risks involved and the treatment implications help minimise and manage potential hazards that occur during the course of the treatment.

Screening of biochemical parameters in the orthodontic treatment with the fixed appliances: A follow-up study

The aim of this study was to assess the changes in vital salivary parameters such as calcium, phosphorous, alkaline phosphatase, buffering capacity, pH, flow-rate and Oral Hygiene Index (OHI) in fixed orthodontic treatment patients during the retention period. In this study, saliva samples were collected from 35 patients before de-bonding (T₀) and after 4 to 5 weeks of de-bonding or on retention period (T₁). The biochemical parameters such as calcium, phosphorous and alkaline phosphatase levels were measured with saliva samples. Additionally, flow-rate, buffering capacity, pH and OHI levels was also measured. The current study results showed reduction in calcium, alkaline phosphatase, pH, flow-rate and OHI levels during T₁ (p < 0.05). However, phosphorous and buffering capacity levels were increased at T₁. The phosphorous levels showed non statistically significant difference when compared between T₀ and T₁ (p = 0.42). The remaining salivary parameters showed statistically significant difference when compared between T₀ and T₁ (p < 0.05). The present study concludes that there was a statistically significant decrease in the calcium, alkaline phosphatase, pH, flow rate and OHI values a month after de-bonding and increased in the buffering capacity values.

Therapeutic properties of glass-ionomer cements: Their application to orthodontic treatment

Fluoride has been shown to be an effective agent in the prevention of caries during orthodontic treatment. Resin-modified glass-ionomer cements possess therapeutic anticariogenic properties acting as a fluoride reservoir and releasing fluoride into the environment, particularly at low pH where there is a threat of enamel demineralisation and white spot lesions (WSL's). Patient compliance to instructions in standard oral hygiene measures limits the success of caries prevention and the routine use of glass-ionomer cements can mitigate the lack of compliance, although RMGIC's are not a panacea against WSL's. The adhesion of GIC's to the enamel surface is a physicochemical bond rather than a mechanical bond which reduces the risk of iatrogenic damage to the enamel when bonding and debonding attachments. RMGIC's can be recommended as a bonding adhesive for all attachments but one needs to be selective when bonding molar attachments to avoid occlusal interferences as masticatory forces can be high in these areas.

Comparison of bleaching effects when applied to white-spot lesions before or after resin infiltration: An in vitro study

BACKGROUND

The purpose of this study was to compare color alterations (ΔE) of white-spot lesions (WSLs) bleached before versus after resin infiltration (RI).

METHODS

Using the facial surfaces of bovine maxillary incisors, WSLs were created and the teeth were allocated into 2 groups (n = 45/group): bleach then RI (B-RI group) and RI then bleach (RI-B group). To determine ΔE, Commission Internationale de l'Eclairage L∗ a∗ b∗ (L∗ represents lightness, ranging from black to white [0-100]; a∗ represents green to red chromaticity [-150-+100]; and b∗ represents blue to yellow chromaticity [-100-+150]) measurements were obtained at baseline, after WSL formation, and after RI and bleaching. Representative specimens were evaluated by means of scanning electron microscopy. Statistical analyses included the Mann-Whitney U and Wilcoxon signed rank tests (P ≤ .0016) and repeated measures analysis of variance (P ≤ .05).

RESULTS

No differences in ΔE were found comparing B-RI with RI-B groups or when the B-RI group was compared with bleached enamel. A statistically significant difference was found when the RI-B group was compared with bleached enamel (ΔE, 0.81; P < .001), but the difference was deemed not clinically significant. Scanning electron microscopy revealed that bleaching after RI increased surface roughness of the resin.

CONCLUSIONS

There were no clinically significant differences in ΔE of WSLs when bleach was applied before or after RI; however, applying bleaching agent after RI roughened the surface of the resin material.

PRACTICAL IMPLICATIONS

Results indicate that ΔE were not clinically significantly different between WSLs bleached before versus after RI, although it is best to sequence bleaching before RI therapy, as bleaching after RI roughened the restoration's surface.

Outcomes used in trials regarding the prevention and treatment of orthodontically induced white spot lesions: A scoping review

INTRODUCTION

The objective was to identify and summarize the outcomes and evaluation methods used in clinical trials regarding the prevention and treatment of orthodontically induced white spot lesions (WSLs).

METHODS

Three electronic databases were searched to identify studies that were (1) clinical trials on prevention and/or treatment of orthodontically induced WSLs, (2) reported in English, and (3) published between January 2010 and October 2019. At least 2 authors assessed the eligibility and extracted the characteristics, outcomes, and evaluation methods from included studies. All disagreements were resolved through discussion.

RESULTS

Among 1328 studies identified, 51 were eligible and included. A total of 48 different outcomes and 11 different evaluation methods were used in these studies. The most frequently used outcomes were WSLs clinical visual examination scores (n = 22, 43.1%), DIAGNOdent values (n = 14; 27.5%), fluorescence loss measured with quantitative light-induced fluorescence (QLF) (n = 10; 19.6%), and lesion area measured with QLF (n = 10; 19.6%). The most frequently used evaluation methods were clinical examination (n = 25; 49.0%), visual inspection by photographs (n = 15; 29.4%), DIAGNOdent (n = 14; 27.5%), and QLF (n = 10; 19.6%). None of the included studies reported data on quality of life.

CONCLUSIONS

Substantial outcome heterogeneity exists among studies regarding the prevention and treatment of orthodontically induced WSLs. Most of the identified outcomes are aimed to assess morphologic changes of WSLs and may not reflect patient perspectives.

REGISTRATION

The Core Outcome Set for trials on the prevention and treatment of enamel White Spot Lesions (COS-WSL) project was registered in the COMET Initiative database (No. 1399).

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.

Salivary pH changes under the effect of stainless steel versus elastomeric ligatures in fixed orthodontic patients: a single-center, randomized controlled clinical trial

BACKGROUND

Fluctuations in pH of saliva during a prolonged treatment course influences the enamel demineralization progress, which is one of the complications of fixed orthodontic treatment. This randomized clinical trial aimed to evaluate and compare the short-term effects of stainless steel (SS) versus elastomeric (EM) ligatures on salivary pH in patients scheduled for fixed orthodontic treatment.

METHODS

Seventy participants were enrolled in the study (54 female, 16 male) aged 19-36 years who met specific inclusion criteria. They were randomly selected and allocated into two equal groups through computer-generated randomization. All patients received fixed orthodontic treatment using conventional orthodontic brackets. Two commonly used archwire ligature methods were used: SS and EMs. An unstimulated (resting) salivary sample was collected before tying of the ligatures at T0 (baseline), 2 weeks, 6 (weeks), and 12 (weeks). Salivary pH was measured using a digital pH meter. The level of significance was set at p value < 0.05.

RESULTS

The salivary pH level was stable between T0 and T1 (6.72 ± 0.14), then significantly and progressively increased from T1 to T2 (6.78 ± 0.13) and from T2 to T3 (6.81 ± 0.14) with (p < 0.05) in the SS group. In the EM group, the salivary pH level was significantly decreased in all follow-up periods; T0 (6.77 ± 0.16), T1 (6.72 ± 0.14), T2 (6.67 ± 0.13) and T3 (6.64 ± 0.13).

CONCLUSION

The EM ligatures showed a significant decrease in salivary pH to an unfavorable level, which increased the risk of enamel demineralization. Therefore, EMs as ligature material is preferably should not be recommended in patients with high caries index or inadequate oral hygiene. Trial registration ANZCTR.org. (ACTRN12618001647224) http://www.anzctr.org.au/ACTRN12618001647224.aspx . Registration Date: 5/10/2018, "Retrospectively registered".

Effects of Hawley, Essix, and Vivera® retainers on salivary properties, oral hygiene, and Streptococcus mutans levels: A prospective clinical pilot study

Objectives:

The objectives of the study were to investigate the in vitro and in vivo effects of various removable orthodontic retainer materials on clinical and microbiological parameters, specifically on saliva characteristics, oral hygiene, and salivary levels of Streptococcus mutans (S. mutans).

Materials and Methods:

This study consists of two parts: An in vitro study and in vivo prospective clinical pilot study. The in vitro study measures surface roughness and S. mutans adhesion of three orthodontic retainer materials: Polymethylmethacrylate (PMMA) used in traditional Hawley removable retainers, polypropylene (PP), and polyurethane (PU) used in vacuum-formed retainers. In the clinical pilot study, 20 subjects, on completion of orthodontic treatment were randomized into three groups to receive PMMA, PP, or PU removable orthodontic retainers. They were compared with control subjects with no orthodontic treatment and retainers. Quantitative analysis of salivary S. mutans using real-time polymerase chain reaction was performed to screen for differences during retainer issue (T0) and 8–15 weeks later (T1). Salivary flow rate, pH, buffering capacity, and plaque scores were also recorded at these two periods for comparison.

Results:

PMMA had significantly greater surface roughness and S. mutans adhesion than PP and PU (P = 0.027). The PMMA group displayed significantly greater amounts of salivary S. mutans count when compared to the PP (0.001) and PU (P = 0.011) groups.

Conclusion:

PMMA retainers showed increased S. mutans adhesion and intra-oral colonization of S. mutans compared to PP and PU retainers. The results validate further clinical testing for a relationship between caries risk and type of retainer prescribed.

Does a diluted chlorhexidine-based orthodontic mouthwash cause less discoloration compared to chlorhexidine mouthwash in fixed orthodontic patients? A randomized controlled trial

OBJECTIVE

Chlorhexidine gluconate is currently the most effective oral antimicrobial agent against microorganisms, but discoloration of the teeth prevents its long-term use and can reduce patient cooperation. In this study, the effect of chlorhexidine and a diluted chlorhexidine-based, fluoride, cetylpyridinium and vitamin added mouth rinse (Orthokin) on stain index in fixed orthodontic patients was compared.

MATERIALS AND METHODS

This study was performed as a double blind randomized controlled trial on 50 patients undergoing fixed orthodontic treatment in the age group of 14-30 years. The patients were categorized as two groups of chlorhexidine and Orthokin mouth rinses and were asked to use mouthwash for eight weeks. Groups were matched according to colouring food consumption. Extrinsic staining index was assessed by modified Loben technique. Data was analysed by SPSS software. P value was set to be 0.05.

RESULTS

In the chlorhexidine group, the stain extent index and overall stain index were increased significantly at 8 weeks (P<0.001 and P=0.002, respectively). However, the increase in stain intensity index was insignificant (P=0.07). In Orthokin group, the changes in stain extent, stain intensity and overall stain were insignificant (P=0.66, P=1.000, P=0.47, respectively).

CONCLUSION

According to the results of the present study, chlorhexidine mouthwash causes more staining of teeth compared to Orthokin mouthwash. It seems that lower concentrations of chlorhexidine can be prescribed to orthodontic patients. Although these compounds are effective in sense of oral hygiene, they do not cause significant discoloration.

Is wearing orthodontic appliances associated with eating difficulties and sugar intake among British adolescents? A cross-sectional study

AIM

To determine whether wearing orthodontic appliances was associated with eating difficulty and lower sugars intake among British adolescents.

METHODS

This study analysed data from 4116 12- and 15-year-olds who participated in the 2013 Children's Dental Health Survey in the UK. Information on eating difficulties in the past 3 months and usual intake of six sugary items was collected through self-administered questionnaires. The presence and type of orthodontic appliances (fixed or removable) were assessed during clinical examinations. Logistic regression was used to evaluate the association between wearing orthodontic appliances and eating difficulty whereas linear regression was used to evaluate the association between wearing orthodontic appliances and sugars intake. Regression models were adjusted for socio-demographic, behavioural, and clinical characteristics of adolescents.

RESULTS

12.9 per cent of the 4116 adolescents wore orthodontic appliances (10.1 per cent fixed and 2.8 per cent removable), 21.0 per cent reported eating difficulties and the mean daily intake of sugars was 5.3 times/day (SD: 3.7, range: 0-20). Adolescents with fixed appliances had 4.02 (95% CI: 3.03, 5.33) greater odds of reporting eating difficulty than those with no appliances, but no differences were found between adolescents wearing removable and no appliances. No association was found between wearing orthodontic appliances and daily sugars intake either [coefficients of 0.20 (95% CI: -0.27, 0.66) and -0.30 (95% CI: -0.96 to 0.36) for adolescents wearing fixed and removable appliances, respectively].

CONCLUSION

Wearing fixed orthodontic appliances were associated with greater odds of reporting eating difficulty, but not with lower sugars intake among British adolescents.

Comparative in vitro study of the cleaning efficacy of AirFloss ultra and I-Prox Sulcus brushes in an orthodontic phantom model

Preventing biofilm-related risks such as gingivitis and white spot lesions during orthodontic treatments is very challenging. The cleaning efficiencies of AirFloss Ultra and I-Prox P sulcus brushes were evaluated using an orthodontic phantom model. After attaching brackets onto black-coated maxillary KaVo teeth, a plaque substitute was applied. The evaluated tooth surfaces were divided into two areas. Cleaning was performed with an AirFloss Ultra with two (A-2) or four (A-4) sprays or an I-Prox P for two (I-2) or four (I-4) seconds. Images before and after cleaning were digitally subtracted, and the percentage of fully cleaned surfaces was determined (Adobe Photoshop CS5, ImageJ). Statistical analysis was performed by ANOVA and post hoc tests with Bonferroni correction (SPSS 25, p < 0.05). The mean values of total cleaning efficacy were 26.87% for I-2, 43.73% for I-4, 34.93%, for A-2 and 56.78% for A-4. The efficacy was significantly higher for A-4 than for A-2, I-4, and I-2. There were significant differences between the four groups. Repeated cleaning led to an improved result. Within the study limitations, the AirFloss Ultra with four sprays proved to be more efficient than the sulcus brush I-Prox P for cleaning.

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

Aim

To 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 methods

Sixty 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.

Results

At 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.

Conclusion

Fixed 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 significance

This 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 article

Kukreja 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.

The Effect of Regime Oral-Hygiene Intervention on the Incidence of New White Spot Lesions in Teenagers Treated with Fixed Orthodontic Appliances

The present study aimed to evaluate the effect of the oral-hygiene regime on the incidence of enamel demineralization in young patients treated with fixed appliances. Research was conducted in a group of 144 patients aged 12–18 years, divided into 2 groups: orthodontically treated and control. The study was divided into three stages: before treatment (I), at 1 month (II), and at 6 months (III) for their follow-up. The International Caries Detection and Assessment System (ICDAS) was used for the visual assessment of white spot lesions (WSL). After 1 month, no new white spot lesions were observed. After 6 months of the treatment, new lesions were observed in 5% of the orthodontically treated patients and in 6% of the patients in the control group. New decalcifications were located on the proximal surfaces of the central incisors, first premolars, and first molars in the orthodontically treated group; and on the lateral incisors, first premolars, and first molars in the control group. We also observed new enamel demineralization on the vestibular surfaces of the canine and first premolar in the study group. The placement of a fixed appliance did not significantly affect teeth with the presence of new white spot lesions compared to the control group during 6 months of observation.

Short-term effects of fixed orthodontic appliance on concentrations of mutans streptococci and persister cells in adolescents

INTRODUCTION

Orthodontic patients are at an increased risk for developing caries. Dental caries is a biofilm-mediated disease, with mutans streptococci (MS) as the primary etiologic bacterial group. It has been suggested that persister cells (PCs), a subset of cells within the biofilm, contribute to the chronic infectious nature of dental caries. PC formation can be induced by environmental stressors such as orthodontic treatment. The aim of this study was to quantify MS, aerobic and facultative anaerobe bacterial PC proportions from plaque samples during the initial stage of orthodontic treatment. This study is the first to analyze the role of PCs in a population of patients highly susceptible to caries, that is, patients undergoing orthodontic treatment.

METHODS

Plaque samples were collected from 17 participants (11 males and 6 females; age range: 11-18 years) before and 1 month after insertion of fixed orthodontic appliances. Percentages of MS and PCs were determined with selective media and a classical persister microbial assay, respectively.

RESULTS

There was a statistically significant decrease in %MS (P = 0.039) but no statistically significant difference in %PCs (P = 0.939) after 1 month of orthodontic appliance placement.

CONCLUSION

Our study illustrated the technical feasibility of analysis of PCs in plaque samples of patients during orthodontic treatment and revealed that PC formation during orthodontic treatment is highly variable across individuals.

Microbial profile in different orthodontic appliances by checkerboard DNA-DNA hybridization: An in-vivo study

INTRODUCTION

The design of the orthodontic bracket or appliance is 1 of the most important factors for creating retentive areas for biofilm formation. In orthodontics, this would be the first study to compare the microbial level changes in 3 different types of orthodontic appliances using checkerboard DNA-DNA hybridization technique. The purpose of this study was to evaluate and compare the extent of appearance of orange and red microbial complexes in patients undergoing orthodontic treatment using aligners, conventional metallic fixed labial appliances, and lingual fixed appliances.

METHODS

A total of 60 patients, of which 20 patients were undergoing treatment with aligners, 20 patients with labial fixed appliances, and 20 patients with lingual fixed appliances, were included in our study. After 30 days, debonded brackets and rinsed aligners were stored and processed for analysis with checkerboard DNA-DNA hybridization.

RESULTS

Most bacterial species showed moderate counts, with the exception of Treponema denticola, which showed a higher count in all 3 types of appliances. Fusobacterium nucleatum, Porphyromonas gingivalis, and T denticola were present in a higher percentage in the lingual appliance. Fusobacterium periodontium and Prevotella intermedia were present in a higher percentage in the labial fixed appliance. Campylobacter rectus, Tannerella forsythia, and Prevotella melaninogenica counts were moderate in all 3 appliances, with the first 2 microbes showing slightly higher counts in aligners. The association between all the microorganisms were statistically insignificant, with the exception of F nucleatum, which showed a strong statistically significant association in all 3 types of appliances.

CONCLUSIONS

The microbial contamination in metallic brackets was higher than that of aligners, when used for a month. Lingual fixed appliances showed more microbial contamination than labial fixed appliances followed by aligners.

Assessment of the resin infiltration and CPP-ACP applications before orthodontic brackets bonding

The aim of this study is to investigate the efficiency of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) gel and resin infiltrant on decalcified enamel, and to explain the correlation, if any, between ion release capacities and shear bond strength (SBS). A total of 80 premolar teeth were used (n=20). Group I was the control, while a demineralization protocol was performed for other groups. CPP-ACP gel and resin infiltrant, respectively, was applied to Groups III and IV. Pre and post-demineralization energy dispersive X-Ray analysis of all groups and post-application of Groups III and IV were undertaken. SBS tests were performed. Ca/P ratio significantly increased after the applications. Both agent groups showed a significant decrease in SBS values compared to others. There was no correlation between SBS and Ca/P ratio changes. It can be said that CPP-ACP and resin infiltrant therapies enhance the tooth mineral content, but show lesser SBS values than the control and demineralization only groups.

Current treatment modalities of orthodontically induced white spot lesions and their outcome - a literature review

Introduction

White spot lesion is a demineralization of the enamel that appears as a white spot on the surfaces of the tooth. The cause of this spot is determined by the activity of the bacterial plaque and it represents the initial stage of a carious lesion. This lesion is a common side effect for patients with fixed orthodontic appliances mainly because of the brackets' position that favors the accumulation of plaque that ultimately leads to the formation of the white spot.

Methods

We conducted a search on a single database, PubMed. "Orthodontic", "white spot lesions", "enamel demineralization treatment" and "remineralization" were the search terms used. We found 324 articles, but we took in consideration only the ones from the last 10 years, which resulted in 223 articles.

Results

The first step after research was article selection: first by scrutinizing the title and secondly by reviewing the abstracts or full texts. The exclusion criteria were: meta-analysis, reviews, original articles regarding prevention of white spot lesions and their prevalence or incidence. We included the articles that seemed relevant for the treatment of white spot lesions, made either on extracted teeth either on orthodontic patients. We found 75 articles to be eligible for this research and we eliminated 5 because of the lack of an abstract or full text and a further 22 were rejected because they did not fit the aforementioned criteria.

Conclusion

Although some traditional methods for the treatment of white spot lesions seem to have undesirable results, nowadays with new technologies and thorough investigations in nanotechnology, the eradication of the lesion appears to be short term.

Effectiveness of different preventive agents on initial occlusal and proximal caries lesions: A follow-up study

Background/purpose

Monitoring the effects of different caries-preventive agents on initial caries lesions in orthodontic patients is important. Therefore, the purpose of this study is to investigate the efficacy of different preventive methods in preventing occlusal and proximal incipient lesions (ILs) during fixed orthodontic treatment.

Materials and methods

Forty-eight subjects at the beginning of fixed orthodontic treatment were included. All subjects were well educated and motivated to use the fluoride toothpaste (Colgate Total, 1450 ppm F) three times a day during the study period. Four different groups were created with a split-mouth design: placebo, fluoride gel, fluoride varnish, and chlorhexidine varnish. The occlusal surfaces of the second molar teeth were assessed with DIAGNOdent pen (DD) during the first 12 months (6th and 12th), and the proximal surfaces of each quadrant were monitored using bitewing radiographs until the 24th month (baseline and 24th month).

Results

The mean DD values increased in each group during the first 6 months compared to the baseline, but a significant increment was only obtained in the control and fluoride gel groups (p < 0.05). Fluoride and chlorhexidine varnish had significantly more preventive effects than the control and the fluoride gel for occlusal surfaces at the 6th and 12th month and for intact proximal surfaces at the 24th month, but no significant differences were found between the two varnish groups (p > 0.05). No significant differences were found between the four methods in terms of caries progression for proximal ILs after 24 months.

Conclusion

Effective toothbrushing with 1450 ppm fluoridated toothpaste and topical fluoride gel application seems to be inadequate for prevention of new proximal ILs during fixed orthodontic treatment. Fluoride and chlorhexidine varnish showed more protection in relation to occlusal surfaces.

Near-Infrared Imaging of Artificial Enamel Caries Lesions with a Scanning Fiber Endoscope

Several studies have shown that near-infrared imaging has great potential for the detection of dental caries lesions. A miniature scanning fiber endoscope (SFE) operating at near-infrared (NIR) wavelengths was developed and used in this study to test whether the device could be used to discriminate demineralized enamel from sound enamel. Varying depths of artificial enamel caries lesions were prepared on 20 bovine blocks with smooth enamel surfaces. Samples were imaged with a SFE operating in the reflectance mode at 1310-nm and 1460-nm in both wet and dry conditions. The measurements acquired by the SFE operating at 1460-nm show significant difference between the sound and the demineralized enamel. There was a moderate positive correlation between the SFE measurements and micro-CT measurements, and the NIR SFE was able to detect the presence of demineralization with high sensitivity (0.96) and specificity (0.85). This study demonstrates that the NIR SFE can be used to detect early demineralization from sound enamel. In addition, the NIR SFE can differentiate varying severities of demineralization. With its very small form factor and maneuverability, the NIR SFE should allow clinicians to easily image teeth from multiple viewing angles in real-time.

Effects of probiotics on salivary Streptecoccus mutans and Lactobacillus levels in orthodontic patients

INTRODUCTION

In this study, we aimed to determine the effect of regular probiotic consumption on microbial colonization in saliva in orthodontic patients and to comparatively evaluate the difference between the systemic consumption of probiotic products and the local application.

METHODS

This study included 3 groups with 15 orthodontic patients in each. The control group included patients who had no probiotic treatment, the subjects in the kefir group consumed 2 × 100 ml of kefir (Atatürk Orman Ciftligi, Ankara, Turkey) per day, and the subjects in the toothpaste group brushed their teeth with toothpaste with probiotic content (GD toothpaste; Dental Asia Manufacturing, Shah Alam, Selangor, Malaysia) twice a day. Samples were collected at 3 times: beginning of the study, 3 weeks later, and 6 weeks later. The salivary flow rate, buffer capacity, and Streptococcus mutans and Lactobacillus levels in the saliva were evaluated. Chair-side kits were used to determine the S mutans and Lactobacillus levels.

RESULTS

A statistically significant decrease was observed in the salivary S mutans and Lactobacillus levels in the kefir and toothpaste groups compared with the control group (P <0.05). A statistically significant increase was observed in the toothpaste group compared with the control and kefir groups in buffer capacity. Changes in the salivary flow rate were not statistically significant.

CONCLUSIONS

The regular use of probiotics during fixed orthodontic treatment reduces the S mutans and Lactobacillus levels in the saliva.

Protein-repelling adhesive resin containing calcium phosphate nanoparticles with repeated ion-recharge and re-releases

OBJECTIVES

The objectives were to develop a calcium (Ca) and phosphate (P) ion-rechargeable and protein-repellent adhesive containing nanoparticles of amorphous calcium phosphate (NACP) and 2-methacryloyloxyethyl phosphorylcholine (MPC), and investigate the MPC effects on ion recharge and re-releases for the first time.

METHODS

Pyromellitic glycerol dimethacrylate and ethoxylated bisphenol-A dimethacrylate were used to fabricate adhesive PEHB. Six adhesives were tested: (1) Scotchbond (SBMP); (2) PEHB, (3) PEHB + 20%NACP; (4) PEHB + 30%NACP; (5) PEHB + 20%NACP+3%MPC; (6) PEHB + 30%NACP+3%MPC. Dentin shear bond strength, Ca/P ion release, recharge and re-release, and protein adsorption were measured. A microcosm biofilm model was tested for lactic-acid production and colony-forming units (CFU).

RESULTS

Adding NACP + MPC did not negatively affect dentin bond strength (p > 0.1). With increasing the number of recharge/re-release cycles, the Ca/P ion re-release reached similarly higher levels (p > 0.1), indicating long-term remineralization capability. One recharge enabled the adhesives to have continued re-releases for 21 days. Incorporation of 3% MPC yielded 10-fold decrease in protein adsorption, and 1-2 log decrease in biofilm CFU.

CONCLUSIONS

The new rechargeable adhesive with MPC + 30%NACP greatly reduced protein adsorption, biofilm growth and lactic acid. Incorporation of MPC did not compromise the excellent Ca/P ion release, rechargeability, and dentin bond strength.

CLINICAL SIGNIFICANCE

Novel bioactive adhesive containing MPC + NACP is promising to repel proteins and bacteria, and inhibit secondary caries at the restoration margins. The method of NACP + MPC to combine CaP-recharge and protein-repellency is applicable to the development of a new generation of materials including composites and cements to suppress oral biofilms and plaque formation and protect tooth structures.

A Mobile App (WhiteTeeth) to Promote Good Oral Health Behavior Among Dutch Adolescents with Fixed Orthodontic Appliances: Intervention Mapping Approach

Background

The insertion of fixed orthodontic appliances increases the risk of dental caries, particularly in adolescents. Caries can be prevented through good oral health behavior. To support adolescents with fixed orthodontic appliances and for promoting oral health behavior, we developed a theory- and evidence-based mHealth program, the WhiteTeeth app.

Objective

The objective of our paper was to describe the systematic development and content of the WhiteTeeth app.

Methods

For systematic development of the program, we used the intervention mapping (IM) approach. In this paper, we present the results of applying the first 5 steps of IM to the design of an mHealth program: (1) identifying target behaviors and determinants through problem analysis, including a literature search, a survey study, and semistructured interviews, to explore adolescent oral health behavior during orthodontic therapy; (2) defining program outcomes and objectives; (3) selecting theoretical methods and translating them into practical strategies for the program design; (4) producing the program, including a pilot test with 28 adolescents testing the acceptability and usability of the WhiteTeeth app; and (5) planning implementation and adoption.

Results

On the basis of our literature search, we identified fluoride use and control of dental plaque levels (eg, tooth brushing and proxy brush usage) as target behaviors for preventing caries. Next, we identified important and changeable determinants of oral health behavior that fitted the theoretical concepts of the Health Action Process Approach (HAPA) theory. The HAPA theory, the self-regulation theory, and the results of the semistructured interviews were used to define the program objectives, that is, the performance and change objectives. After defining the objectives, we identified multiple behavior change techniques that could be used to achieve these objectives, such as providing oral health information and feedback, prompting self-monitoring, coaching of set actions and coping plans, and sending reminders. We translated these methods into practical strategies, such as videos and a brushing timer. Next, we combined these strategies into a single program resulting in the WhiteTeeth app (which is available on both iTunes and Google Play stores as “Witgebit”). Adolescents with fixed orthodontic appliances and dental professionals were included in the development process to increase the success of implementation. The pilot test revealed that the app users appreciated and liked the app. The WhiteTeeth app can be integrated into current orthodontic care.

Conclusions

IM allowed us to identify multiple techniques that have been shown to be the most effective in initiating behavior change, but have not yet been incorporated into existing orthodontic apps. The WhiteTeeth app contains all these techniques, which makes it a unique and promising home-based app for promoting oral health in adolescents with fixed orthodontic appliances.

Evaluation of the effect of two types of laser on the growth of streptococcus mutans

Background and aims

This study was done to compare the antibacterial effect of Photodynamic therapy (PDT) on streptococcus mutans (S. mutans) using two different light sources and photosensitizers (PS).

Materials and methods

Five groups were studied in this research:no light and no toluidine blue ortho (TBO) as PS for control group, irradiation only (CO₂ laser or Nd:YAG laser), and irradiation with PS (CO₂ laser and TBO or Nd:YAG laser and TBO). Standard suspensions of S. mutans, based on the type of group, were used in different PDTs. Bacterial suspension from each treatment was subcultured onto the surface of Mueller-Hinton agar plates, and bacterial growth was assessed. The results were analyzed by analysis of variance (ANOVA).

Results

There was a statistically significant reduction in the viability of S. mutans in TBO with CO₂ laser and TBO with Nd:YAG laser groups (p value < 0.05). However, there was no significant difference between control and groups treated with lasers only. The highest number of the colonies of S. mutans in treated groups was observed in CO₂ laser irradiation only and the lowest number was seen in CO₂ laser with TBO. In the groups irradiated alone (without TBO), no significant reduction of colonies was observed. There was no significant difference between the experimental groups.

Conclusions

The colonies of S. mutans were susceptible to either CO₂ laser or Nd:YAG laser in the presence of TBO with no significant difference. So these lasers with this photosensitizer may be useful in prevention of dental caries and antimicrobial treatment protocols.

In vitro study of white spot lesion: Maxilla and mandibular teeth

Aim

The aim of the study was to evaluate the effect of resin infiltration on colour changes and surface roughness of artificial white spot lesions (WSLs) on maxillary and mandibular premolar.

Materials and methods

Sixty (60) extracted sound Maxilla (Mx) and Mandibular (Mn) premolars were randomly divided into 2 groups (test and control). Artificial WSLs were produced on buccal surface of teeth and were immersed in artificial saliva for 8 weeks. Colour components (L^∗, a^∗, b^∗) and surface roughness (Sa^∗) were assessed on 40 teeth using colour difference meter RD-100 and Alicona® Infinite Focus profilometer respectively. The measurements were done at baseline (T1), directly after artificial WSLs (T2), after 24 hours immersed in saliva and application of resin (T3) and immersion in artificial saliva for 1 (T4), 2 (T5), 4 (T6), 6 (T7) and 8 (T8) weeks. SEM images analysis were carried out on 20 teeth in four time points.

Results

The values of L^∗ (lightness), b^∗ (yellow/blue) and Sa^∗ (surface roughness) are gradually reduced to the baseline value. Whereas, the value of a^∗ gradually increased with distinct treatment time to achieve the baseline value. The higher value of L^∗ and Sa^∗, the whiter the lesion suggesting higher degree of enamel demineralization and surface roughness. Lower L^∗ values suggest a masking colour effect.

Conclusion

The material produced favorable esthetics on colour and the surface roughness of teeth at distinct treatment times. It is recommended to be used to improve WSL post orthodontic treatment.

Antibacterial Activity of Orthodontic Cement Containing Quaternary Ammonium Polyethylenimine Nanoparticles Adjacent to Orthodontic Brackets

Enamel demineralization is a common problem found in patients using orthodontic devices, such as orthodontic braces. It was found that Streptoccocus mutans growth increases adjacent to orthodontic devices, which may result in caries development. Incorporated antibacterial quaternary ammonium polyethylenimine (QPEI) nanoparticles were previously shown to be highly efficacious against various bacteria. Combining antibacterial materials in orthodontic cement may be advantageous to prevent bacterial outgrowth adjacent to orthodontic brackets. The aim was to evaluate the efficiency of orthodontic cement containing QPEI nanoparticles in reducing S. mutans and Lactobacillus casei outgrowth adjacent to orthodontic brackets. Orthodontic brackets were bonded to the buccal surfaces of extracted lower incisors. The antibacterial effect on S. mutans and L. casei outgrowth of Neobond bracket adhesive orthodontic cement with and without QPEI nanoparticles was compared. The antibacterial effect was evaluated using crystal violet staining and bacterial count (CFU/mL). The teeth in the experimental group, with the QPEI nanoparticles cement, showed significantly lower optical density (OD) values and CFU counts of S. mutans and L. casei than the teeth in the control group (p < 0.05). Based on the results, it can be concluded that orthodontic cement containing QPEI nanoparticles significantly inhibits S. mutans and L. casei growth around orthodontic brackets.

Correlation of CD4 count with cariogenic oral flora indicators and dental caries in HIV-seropositive children undergoing antiretroviral therapy in Mangaluru, South India

AIM

The aim of the present study was to compare the association of CD4 count with cariogenic oral flora indicators and dental caries in HIV-seropositive children receiving antiretroviral therapy (ART).

METHODS

A descriptive study was conducted among HIV-seropositive children receiving ART at Snehasadan Camillian Care and Support Center HIV/AIDS in Mangaluru, India. Demographic details and r recent CD4 counts were recorded. For dental caries, the Decayed, Missing, Filled Teeth (DMFT)/decayed, missing, filled/decayed, extracted, filled index was used. Data were analyzed using SPSS version 22. Spearman's correlation was used to correlate CD4 count with dental caries and cariogenic oral flora indicators (mutans streptococci and lactobacilli).

RESULTS

The study population comprised 35 patients. Dental caries prevalence was 54.1% in deciduous teeth and 41.2% in permanent teeth. Age and DMFT showed a significant, positive correlation; age and dmft showed a negative correlation (P < .05). A weak, negative correlation was found between age and Streptococcus mutans (S. mutans), and also CD4 count; S. mutans and CD4 count and dmft were not found to be statistically significant (P < .05).

CONCLUSION

No statistically-significant correlation was found between CD4 count and cariogenic oral flora indicators in HIV-positive patients. The presence of a minimum number of restored teeth compared to decayed teeth suggests a lack of dental care being given to HIV-positive patients.

Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part I: photographic data evaluation

Background

White spot lesions (WSLs) are a frequent side-effect of multibracket appliance treatment. The effect of local fluoridation on post-orthodontic WSL is however inconclusive.

Objective

Assessment of WSL changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment.

Trial design

Randomized, single-centre, double-blind, parallel-group, placebo-controlled study.

Participants

Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding.

Interventions

Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24).

Outcomes

Photographic WSL assessment (dimension and luminance) of the upper front teeth (T0-T5).

Randomization

Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each).

Recruitment

The clinical study duration lasted from March 2011 to September 2013.

Blinding

Unblinding was performed after complete data evaluation.

Numbers analysed

Intent-to-treat analysis set comprising 39 participants (test: n = 21, placebo: n = 18).

Outcome

Dimensional WSL quantification showed limited reliability. Luminance improvement (%) of WSL, however, was seen after 6 months (test/placebo: tooth 12, 24.8/18.0; tooth 11, 38.4/35.4; tooth 21, 39.6/38.3; and tooth 22, 15.2/25.0). No statistically significant group difference existed. Data suggest that WSLs are difficult to measure with respect to reliability and repeatability and methods for monitoring WSLs in clinical trials require improvement/validation.

Harms

Similar adverse events occurred in both groups; none was classified as possibly related to the study product.

Limitations

The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation.

Conclusion

Based on the results of this study, no difference could be detected with respect to the development of WSL under post-orthodontic high-dose fluoride treatment.

Registration

The study was registered with ClinicalTrials.gov (Identifier: NCT01329731).

Protocol

The protocol wasn't published before trial commencement.

Microcomputed tomography evaluation of white spot lesion remineralization with various procedures

INTRODUCTION

The aim of this study was to use microcomputed tomography to evaluate the effects on white spot lesions of 3 remineralizing agents compared with artificial saliva (Inonu University, Malatya, Turkey). The agents were GC Tooth Mousse (GC International, Itabashi-ku, Tokyo, Japan), 50-ppm sodium fluoride solution (Inonu University, Malatya, Turkey), and Clinpro 5000 (3M ESPE Dental Products (St Paul, Minn). The experimental and control teeth were stored in artificial saliva.

METHODS

Forty-four extracted premolars were divided into 4 groups of 11 teeth each (3 experimental groups and 1 control group). After white spot lesions were created on the teeth, a remineralizing agent was applied. Microcomputed tomography scanning was performed at the following times: T0 (sound enamel), T1 (day 0, when the white spot lesion was formed), T2 (day 15), and T3 (day 30). Volume, depth, surface area, and mineral density changes of the white spot lesions were evaluated at different time points using CTAn software (SkyScan; Bruker, Kontich, Belgium).

RESULTS

GC Tooth Mousse and Clinpro 5000 improved all measurements after 30 days. However, Clinpro 5000 was not as effective in reducing lesion depth as it was in the other parameters. The artificial saliva group and the 50-ppm sodium fluoride solution did not show significant effects in the regression of the white spot lesions at the end of the 30-day experiment.

CONCLUSIONS

GC Tooth Mousse and Clinpro 5000 were more effective in remineralization of white spot lesions than sodium fluoride solution and artificial saliva. They can be preferred for use clinically. Microcomputed tomography is a novel and effective method that shows promise in accurately evaluating white spot lesions and remineralization.

Development of anti-biofouling interface on hydroxyapatite surface by coating zwitterionic MPC polymer containing calcium-binding moieties to prevent oral bacterial adhesion

The purpose of the present study is to synthesize a 2-methacryloyloxyethyl phosphorylcholine (MPC) polymer capable of being immobilized on the tooth surface to prevent oral bacterial adhesion. The strategy is to develop an MPC-based polymer with Ca(2+)-binding moieties, i.e., phosphomonoester groups, for stronger binding with hydroxyapatite (HA) of the tooth surface. To this end, a 2-methacryloyloxyethyl phosphate (MOEP) monomer was synthesized and copolymerized with MPC by free radical polymerization. The coating efficiency of the synthesized polymer, MPC-ran-MOEP (abbreviated as PMP) with varied composition, onto a HA surface was estimated by means of contact angle measurement and X-ray photoelectron spectroscopy. The anti-biofouling nature of PMP-coated HA surfaces was estimated by analyzing protein adsorption, cell adhesion, and Streptococcus mutans adhesion. As a result, HA surface coated with a copolymer containing around 50% MPC (PMP50) showed the best performance in preventing protein adsorption and the downstream cell and bacterial adhesion.

STATEMENT OF SIGNIFICANCE

Preparation of anti-biofouling surface on the tooth enamel is the key technique to prevent dental and periodontal diseases, which are closely related with the biofilm formation that induced by the adsorption of salivary proteins and the adhesion of oral bacteria on the tooth surface. In this research, a PMP copolymer with an optimized ratio of zwitterionic and Ca(2+)-binding moieties could form a highly effective and robust anti-biofouling surface on HA surfaces by a simple coating method. The PMP-coated surface with high stability can provide a new strategy for an anti-adsorptive and anti-bacterial platform in dentistry and related fields.