In vitro measurement of enamel demineralization in the assessment of fluoride-leaching orthodontic bonding agents

Effect of fluoride exposure on cariostatic potential of orthodontic bonding agents: anin vitroevaluation

AIMS

The aims of this in vitro study were to compare the cariostatic potential of a resin modified glass ionomer cement (Fuji Ortho LC) to that of a resin control (Transbond) for bracket bonding and to compare the effect of extrinsic fluoride application on the cariostatic potential of each material.

SETTING

Ex vivo study.

MATERIALS AND METHODS

Orthodontic brackets were bonded to 40 extracted premolars, 20 with Fuji Ortho LC and 20 with Transbond. The teeth were subjected to pH cycling, pH 4.55, and pH 6.8, over a 30-day period. Ten teeth bonded with each material were immersed in a 1000 ppm fluoride solution for 2 minutes each day. Fluoride release was measured throughout the study from all teeth. After 30 days, the teeth were assessed visually for signs of enamel decalcification.

RESULTS

Significant differences in decalcification existed macroscopically between all four groups of teeth, with the exception of those bonded with Fuji Ortho LC alone compared with Transbond alone (P = 0.22), and Fuji Ortho LC alone compared with Transbond with added fluoride (P = 0.3). Fluoride release from Fuji Ortho LC alone fell to minimal values, but with the addition of extrinsic fluoride the levels fell initially and then followed an upward trend. There was minimal fluoride release, from Transbond alone, but with daily addition of extrinsic fluoride, subsequent fluoride release was increased. Significant differences existed in the amount of fluoride released between all groups, except comparing Fuji Ortho LC alone and Transbond with added fluoride.

CONCLUSIONS

The results of this study have indicated that with an in vitro tooth-bracket model, the creation of white spot inhibition could best be achieved by the use of a resin-modified glass ionomer cement, supplemented with fluoride exposure. The least protection was afforded by the composite control. The resin-modified glass ionomer cement alone and the composite with added fluoride demonstrated equivalent protection.

The efficacy of a fluoride varnish in reducing enamel demineralization adjacent to orthodontic brackets: an in vitro study

OBJECTIVES

To test the hypothesis that fluoride varnish is effective in reducing demineralization (white spot) lesions adjacent to bonded orthodontic brackets.

DESIGN

Two similar samples of extracted bovine incisors, with bonded orthodontic brackets, were separated into an experimental group (fluoride varnish was applied) and control group (no fluoride varnish) to examine the preventive effects of fluoride varnish.

SETTING AND SAMPLE POPULATION

The dental clinic of the State University of Maringá--UEM (Maringá, Paraná, Brazil). Thirty-eight extracted bovine incisors with bonded orthodontic brackets.

EXPERIMENTAL VARIABLE

Fluoride varnish was applied topically to half of the sample of extracted bovine teeth. No varnish was applied to the other half.

OUTCOME MEASURE

The depths of enamel demineralization (white spot) lesions were measured from polarized light microscopy images using image analysis software.

RESULTS

The teeth in both the experimental and control groups had been exposed to a cariogenic environment twice a day for 35 days. Those teeth that had been treated with two applications of fluoride varnish (one at the outset and another 15 days later) demonstrated about 38% less mean lesion depth than teeth where no varnish had been applied.

CONCLUSION

Orthodontists may wish to consider the application of fluoride varnish during fixed orthodontic therapy to help reduce the development of enamel white spot lesions.

Fluorides for the prevention of white spots on teeth during fixed brace treatment

BACKGROUND

White spots can appear on teeth during fixed brace treatment because of early decay around the brace attachments. Fluoride is effective at reducing decay in susceptible individuals and is routinely prescribed in various different forms to patients during orthodontic treatment.

OBJECTIVES

To evaluate the effectiveness of fluoride in preventing white spots during orthodontic treatment and to compare the different modes of delivery of fluoride.

SEARCH STRATEGY

We searched the Cochrane Oral Health Group's Trials Register (to 22 August 2002); CENTRAL (The Cochrane Library Issue 3, 2002); MEDLINE (January 1966 to July 2003); EMBASE (January 1980 to week July 2003). Authors of trials were contacted for further data.

SELECTION CRITERIA

Trials were selected if they met the following criteria: a randomised or quasi-randomised clinical trial, involving the use of a fluoride-containing product compared with no use or use of a non-fluoride control and enamel demineralisation was assessed during or after orthodontic treatment.

DATA COLLECTION AND ANALYSIS

Six reviewers independently, in duplicate, extracted data. The primary outcome was the difference in the presence or absence of white spots between experimental and control patients for parallel design studies, and between experimental and control quadrants, for split-mouth design studies. Potential sources of heterogeneity were examined. Sensitivity analyses were undertaken for the items assessed for quality and publication bias.

MAIN RESULTS

The primary outcome of the review was the presence or absence of white spots by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth. Other outcomes such as differences in size and severity of white spots, any patient based outcomes, such as perception of white spots could not be included because there were insufficient data. Fifteen trials, with 723 participants, provided data for this review. None of the studies fulfilled all of the methodological quality assessment criteria. There is some evidence that a daily sodium fluoride mouthrinse reduces the severity of enamel decay surrounding a fixed brace (weighted mean difference for lesion depth -70.0; 95% CI -118.2 to -21.8) and that use of a glass ionomer cement for bracket bonding reduces the prevalence (Peto OR 0.35; 95% CI 0.15 to 0.84) and severity of white spots (weighted mean difference for mineral loss -645 vol%.microm; 95% CI -915 to -375) compared with composite resins.

REVIEWERS' CONCLUSIONS

There is some evidence that the use of topical fluoride or fluoride-containing bonding materials during orthodontic treatment reduces the occurrence and severity of white spot lesions, however there is little evidence as to which method or combination of methods to deliver the fluoride is the most effective. Based on current best practice in other areas of dentistry, for which there is evidence, we recommend that patients with fixed braces rinse daily with a 0.05% sodium fluoride mouthrinse. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient.

Long-term in vitro fluoride release and rerelease from orthodontic bonding materials containing fluoride

The purpose of this study was to compare in vitro long-term (30 month) fluoride release and rerelease rates (after fluoride exposure) from 3 orthodontic bonding materials containing fluoride and 1 without fluoride. Ten samples of each material (Python, TP Orthodontics, LaPorte, Ind; Assure, Reliance Orthodontic Products, Itasca, Ill; Fuji Ortho LC, GC America, Alsip, Ill; and Transbond XT, 3M Unitek, Monrovia, Calif) were fabricated and stored in deionized distilled water at 37 degrees C. Five samples had fluoride-release rates measured at days 546, 637, 730, 821, and 913 after initial fabrication, and 5 samples were exposed to fluoride (Nupro 2% NaF gel, Dentsply Canada, Woodbridge, Ontario, Canada) for 4 minutes at day 535 and had measurements taken on days 546, 548, 552, 575, 637, 730, 821, and 913. To prevent cumulative measurements, the storage solutions were changed 24 hours before measurement. Statistically significant differences were found in fluoride-release rates (P <.0001), with Fuji Ortho LC releasing the most fluoride, followed by Python and Assure at all time points in the nonfluoride exposed group. In the fluoride-exposed group, there were significant differences in fluoride release (P <.0001), with Fuji Ortho LC releasing the most fluoride. A "burst-effect" pattern of fluoride release was seen after fluoride exposure for all materials. It was concluded that Fuji Ortho LC, Assure, and Python might have sufficient long-term fluoride-release rates to reduce white spot formation, and all are recommended as suitable fluoride-releasing orthodontic bonding materials.

Fluoride release from orthodontic cements-effect of specimen surface area and depth

OBJECTIVE

The aims of this in vitro study were firstly to compare fluoride release from a disc model of two orthodontic cements with various surfaces varnished, reducing the surface area by 25, 50 and 75%; secondly, to measure the fluoride release from previously exhausted discs of the same cements following removal of various depths of surface material.

METHODS

Forty discs of each cement, Fuji Ortho LC and Ultra Band-Lok, (6mm diameter by 3mm) were divided into two groups of 20 discs each. For each material, the first group was divided further into four groups of five discs, one group acting as control, while the other three groups were varnished reducing the surface area by 25, 50 and 75%, respectively. The second group was exhausted initially over a 60 day pre-experimental period and was subsequently divided into four groups of five discs, one group acting as control. The other three groups had material ground from one of the flat surfaces, to depths of 10, 100 or 1000 microm, to reveal a fresh surface. In both studies, the discs were immersed either daily (up to day 20) or twice weekly (up to day 60) in fresh 2ml aliquots of deionised water. The fluoride concentration in the deionised water was measured at the end of the experimental period.

RESULTS

For each cement, the relationship between the cumulative fluoride release and the percentage of the surface covered was clearly non linear at both 5 and 60 days. Fuji Ortho LC proved to release significantly greater amounts of fluoride at both 5 days and 60 days compared with Ultra Band-Lok. The results for Ultra Band-Lok were also significant when compared to the control group, but significantly less fluoride was released when compared with Fuji Ortho LC. When comparing the 25 and 50% covered discs, the amount of fluoride released was not significantly different for both cements. Furthermore, the relationship between fluoride release and depth was clearly non linear for both cements.

CONCLUSIONS

For the materials tested in this study, reducing the surface area of the discs did not reduce the cumulative fluoride release in a linear fashion. In addition, the previously exhausted discs began to release fluoride again, but this fell to concentrations similar to the control discs after the initial 5-day period for both cements. This suggests that further traces of previously unreleased fluoride had become available from the subsurface of these cements. The pattern of fluoride release was similar for all models tested.

Comparison of fluoride release protocols for in-vitro testing of 3 orthodontic adhesives

The objective of this study was to compare the fluoride release of 3 orthodontic adhesives using disks and bracketed teeth with different storage protocols. The adhesives used were a resin-modified glass ionomer (RMGI) (Fuji Ortho LC; GC America, Aslip, Ill), a polyacid-modified composite resin (PMCR)(Assure; Reliance Orthodontic Products, Itasca, Ill), and a composite control, Transbond XT (3M Unitek, Monrovia, Calif). Metal brackets were bonded to the buccal and lingual surfaces of 120 extracted human premolars. Five plastic containers holding 4 teeth (8 brackets) were used for each adhesive protocol. The samples were stored in containers holding 4 mL of deionized water at 37 degrees C for 28 and 84 days for the brackets and disks, respectively. The bracketed samples released larger initial amounts of fluoride compared with the disk samples during the first 5 to 6 days for both fluoride-releasing adhesives. The PMCR (Assure) released more fluoride (mg/cm(2)/day) than did the RMGI (Fuji Ortho LC) in all protocols with the exception of daily protocols when values diminished below the RMGI values near the 24th day and between the 56th and the 70th days for the bracketed and disk samples, respectively. Inconsistent values for fluoride release were noted in the bracket and disk samples when compared with daily versus cumulative water changes. Daily water changes revealed higher fluoride release levels (brackets), but this trend was not evident in the disk samples. Daily water changes may yield more clinically relevant data on fluoride release.

Varnish or polymeric coating for the prevention of demineralization? An ex vivo study

OBJECTIVE

The ability of an experimental coating, Odyssey, to prevent demineralisation ex vivo was compared with that of a fluoride varnish, Duraphat and a chlorhexidine-containing varnish, Cervitec.

DESIGN

an ex vivo single-blind study.

SETTING

Hard tissue research laboratory.

MATERIALS AND METHODS

thirty bovine enamel blocks 0.5 cm x 1.5 cm were divided into 6 groups of 5 specimens. The enamel blocks were then allocated to one of 6 surface treatments.

INTERVENTIONS

(1) surface left unprepared (control), (2) Duraphat application, (3) Cervitec application, (4) experimental polymer coating, (5) enamel conditioned with 10% citric acid and coated with the experimental polymer coating Odyssey (O + C), (6) enamel etched for 30 sec with 37% phosphoric acid and coated with the experimental coating (O + E). All specimens were cycled for 7 days through a daily procedure of demineralisation for 4 hours and remineralisation for 20 hours, and exposed to an equivalent of 2 months toothbrushing. A single operator blinded to the treatment allocation of each specimen carried artificial lesion depth assessment out using computer-assisted transverse microradiography.

RESULTS

The control group had the greatest mean lesion depth (97.16 + 29.8 microm) with the Duraphat group exhibiting the lowest mean lesion depth (24.53 + 15.44 microm). The Duraphat, Odyssey, O + C and O + E groups all had significantly less lesion depth when compared with no surface preparation (p < 0.05 for all comparisons). There were no significant differences between any of the Odyssey groups.

CONCLUSIONS

The efficacy of Duraphat application in preventing demineralisation ex vivo has been demonstrated in the present study, but clinical trials are required to assess its usefulness in orthodontic practice.

A comparison of fluoride release by resin-modified GIC and polyacid-modified composite resin

The objective of this study was to compare the fluoride release of 2 fluoride-containing orthodontic adhesives from bracketed teeth and adhesive disks, a resin-modified glass ionomer cement (Fuji Ortho LC, encapsulated; GC America Corp, Aslip, Ill) and a polyacid-modified composite resin (Assure; Reliance Orthodontic Products, Itasca, Ill). A composite resin without fluoride (Transbond XT; 3M Unitek, Monrovia, Calif) was used as a reference control. Metal brackets were bonded to the buccal surfaces of 120 human premolars (40 teeth per adhesive), and disks were made from each adhesive. The deionized storage water was changed, and fluoride release was measured at specified intervals up to 28 days for the bracketed teeth and up to 150 days for the disks. Fuji Ortho LC released 75% more accumulated fluoride than Assure (6.61 microg/bracket vs 3.77 microg/bracket) from bracketed teeth over the 28-day observation period. Assure released more fluoride per day than did Fuji Ortho LC from the disks during the first 3 months. For the rest of the 150-day period, Fuji Ortho LC released more fluoride per day than did Assure. The amount of fluoride released by these materials varied dramatically with different water-changing protocols. The large discrepancy between fluoride released from disks compared with that released from bracketed teeth suggests that caution must be used in extrapolating fluoride-release levels of adhesive disks to in vivo treatment conditions.

Daily exposure to fluoride mouthrinse produces sustained fluoride release from orthodontic adhesives in vitro

OBJECTIVES

To determine firstly, if sustained fluoride release can be achieved from five orthodontic adhesives: Ketac-Cem, Fuji ORTHO LC, Sequence, Transbond and Right-On, with daily exposure to fluoride mouthrinse in vitro, and secondly, if sustained fluoride release can be re-established from the same specimens, after an interruption in mouthrinse exposure.

METHODS

Ten brackets were bonded to bovine incisors using each adhesive. Each adhesive group was divided equally into a test and a control sub-group. In phase 1 (42 days), the test sub-groups were exposed for 1min daily to fluoride mouthrinse (225 ppm), followed by immersion in de-ionised water for 42 days to deplete their fluoride reserves. Mouthrinse exposure was then resumed in phase 2 (28 days). Mean cumulative fluoride release (MCFR) was calculated for days 0-21 of phase 1 and for the plateau portion of the fluoride release curves in phase 1 (days 21-42) and phase 2 (days 7-28).

RESULTS

During phase 1, the MCFR for each test sub-group was significantly greater than its control (p<0.05). There was no significant difference in MCFR between the curve plateau portion of phases 1 and 2 for all adhesives except Transbond, for which MCFR was less in phase 2 (p<0. 05).

CONCLUSIONS

Sustained fluoride release occurred for each adhesive exposed daily to fluoride mouthrinse, at a level significantly greater than its control. After fluoride exhaustion, re-exposure to daily fluoride mouthrinse produced sustained fluoride release levels comparable to those prior to exhaustion, for all adhesives except Transbond.

Fluoride release from orthodontic bonding agents: a comparison of three in vitro models

The aim of this in vitro study was to compare fluoride release from two cement disc models (partially varnished and unvarnished) of three orthodontic bonding materials with fluoride release from the same materials when used to bond an orthodontic bracket onto a tooth surface. A resin-modified glass ionomer cement (Vitremer) and a compomer material (Dyract Ortho) were compared with a conventional resin adhesive (Right-On). Ten discs (3.0 mm diameter and 1.5 mm thick) of each material were manufactured in a silicone mould and ten premolar teeth were bonded with orthodontic brackets using each material. All the premolar teeth were covered with nail varnish up to the bracket periphery and five of the discs for each material were coated with nail varnish on both upper and lower surfaces which halved the surface area. The fluoride released into 2 ml of deionised water, from each tooth or disc, was measured at regular intervals over 60 days. At 60 days, cumulative fluoride release was highest from the unvarnished discs, less for the varnished discs and least from the tooth-bracket model for both test materials. Despite having twice the surface area, the unvarnished disc model released only 1.2 to 1.5 times more fluoride than the varnished disc model. Compared with the tooth-bracket model, the unvarnished discs released 3.0 to 4.5 times more fluoride, whereas the varnished discs released only 2.2 to 3.7 times more fluoride. For the materials tested in this study, halving the surface of the discs did not reduce the cumulative fluoride release by half. The tooth/bracket model with minimal bonding material demonstrated substantial cumulative fluoride release. The pattern of fluoride release was similar for all models tested.