Prevalence of white spot lesions during orthodontic treatment with fixed appliances

Near-infrared imaging in orthodontic intraoral scanners for early interproximal caries detection

INTRODUCTION

Intraoral scanners commonly used in orthodontic offices now offer near-infrared imaging (NIRI) technology, advertised as a screening tool to identify interproximal caries. This study aimed to evaluate the reliability and validity of NIRI detection of interproximal carious lesions in a common intraoral scanner (iTero Element 5D; Align Technology, San Jose, Calif) with and without bitewing radiograph complement, compared with a microcomputed tomography (micro-CT) reference standard.

METHODS

Extracted human posterior teeth (premolars and molars) were selected for early (noncavitated) interproximal carious lesions (n = 39) and sound control surfaces (n = 47). The teeth were scanned via micro-CT for evaluation by 2 blinded evaluators using consensus scoring. The teeth were mounted to simulate anatomic interproximal contacts and underwent a NIRI scan using iTero Element 5D and bitewing radiographs. Two trained, calibrated examiners independently evaluated (1) near-infrared images alone with clinical photograph, (2) bitewing radiograph alone with clinical photograph, and (3) near-infrared images with bitewing radiograph and clinical photograph in combination, after at least a 10-day washout period between each evaluation.

RESULTS

Interrater reliability was highest for NIRI alone (k = 0.533) compared with bitewing radiograph alone (k = 0.176) or in combination (k = 0.256). NIRI alone showed high specificity (0.83-0.96) and moderate sensitivity (0.42-0.63) compared with a micro-CT reference standard. Dentin lesions were significantly more reliably detected than enamel lesions.

CONCLUSIONS

After rigorous training and calibration, NIRI can be used with moderate reliability, high specificity, and moderate sensitivity to detect noncavitated interproximal carious lesions.

Exploring publications in 3 major orthodontic journals: A comparative bibliometric analysis of two 10-year periods (2002-2011 and 2012-2021)

INTRODUCTION

This study aimed to perform a bibliometric analysis examining contributing countries and collaborative networks, authors and collaborative relationships, the performance of the institutions, and cocited journals and references in 3 major orthodontic journals (American Journal of Orthodontics and Dentofacial Orthopedics, European Journal of Orthodontics, and Angle Orthodontist) over two 10-year periods (2002-2011 and 2012-2021).

METHODS

In this study, 4432 publications in the first decade and 4012 publications in the second decade were quantitatively analyzed and visualized using visualization software such as VOSviewer (Leiden University, Leiden, Netherlands), CiteSpace (Drexel University, Philadelphia, Pa), and Scimago Graphica (SCImago Lab, Spain).

RESULTS

Institutions in the United States had the highest number of publications through the 2 decades, whereas Brazil, South Korea, and China achieved significant improvements in performance in the second decade compared with the first. Closer collaborative networks among scholars were revealed in the second decade. The cocitation analysis of the journals showed that highly cited journals included more professional orthodontic journals in the second decade than in the first decade.

CONCLUSIONS

Bibliometric analysis of publications in 3 major orthodontic journals over two 10-year periods revealed a trend of diversification in countries and institutions participating in publishing, international collaborations, and collaboration networks among authors in the field of orthodontics during the 2 decades.

Associations of Serum Vitamin D With Dental Caries and Periodontitis: The HUNT Study

OBJECTIVE

To study the relationships of serum 25-hydroxyvitamin D [25(OH)D] with dental caries and periodontitis in a general Norwegian adult population.

METHODS

We analysed a subsample of 1605 participants from the Trøndelag Health Study (HUNT) in Norway that had serum 25(OH)D levels measured in HUNT3 (2006-08) and oral health assessed in the HUNT4 Oral Health Study (2017-19). Negative binomial and Poisson regression models were used to estimate the ratios of means (RMs; for count oral outcomes) and prevalence ratios (PRs; for dichotomous oral outcomes).

RESULTS

Serum 25(OH)D was inversely associated with the number of decayed teeth in a dose-response gradient (<30.0 nmol/L: RM 1.41, 95% CI 1.07-1.85; 30.0-49.9 nmol/L: 1.14, 0.98-1.32 and ≥75.0 nmol/L: 0.84, 0.67-1.04, as compared to the 50.0-74.9 nmol/L group, P for trend <.001). Each 25 nmol/L decrease in 25(OH)D level was associated with a 15% (RM 1.15, 95% CI 1.05-1.26) increase in the mean number of decayed teeth. Serum 25(OH)D <30.0 nmol/L was associated with a 35% higher prevalence of severe periodontitis (PR 1.35, 95% CI 1.00-1.83). No association was observed between 25(OH)D and the number of natural teeth.

CONCLUSION

The present study suggested that serum 25(OH)D level had an inverse and dose-response association with the number of decayed teeth, and serum 25(OH)D <30 nmol/L was associated with a higher prevalence of severe periodontitis in this Norwegian adult population.

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

Introduction Incorporation of remineralizing agents with fluoride-releasing bracket adhesives may prevent the development of white spot lesions (WSL) or reverse the established WSL in patients undergoing fixed orthodontic treatment. We aimed to find out how effectively casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride varnish (FV) can remineralize teeth when mixed with fluoride-releasing orthodontic adhesive. Materials and methods We randomly assigned a total of 60 premolar teeth, therapeutically extracted for orthodontic purposes, into two equal groups. Group I (n = 30) utilized fluoride-releasing adhesive (FR), and Group II (n = 30) bonded with non-fluoride adhesive (NFR). Based on the applied remineralizing agent, we further divided each of the two groups into three equal subgroups of 10: Group IA (FR+FV), Group IB (FR+CPP-ACP), Group IC (control-only FR), Group IIA (NFR+FV), Group IIB (NFR+CPP-ACP), and Group IIC (control-only NFR). Following bonding procedures, all the samples underwent pH cycling for 28 days, where the enamel samples were immersed in 20 ml of demineralizing solution for three hours, followed by immersion in 30 ml of remineralizing solution for 17 hours. The samples were analyzed for shear bond strength (SBS) on a universal testing machine and hardness values (HV) by the Vickers microhardness test (VMT) using the indentation method. We also evaluated the adhesive remnant index (ARI) scores to determine the site of bracket failure. Statistical analysis The shear bond strength (SBS) and hardness value (HV) were expressed as the mean, standard deviation (SD), and median for each subgroup. We used the non-parametric Kruskal-Wallis test to analyze the SBS and HV, followed by the Dunn-Bonferroni test for intra-pair differences. The ARI score was expressed as the frequency of the percentage distribution, and the difference in the distribution of ARI scores between the groups was assessed by the Cochran chi-square test. The probability (p) value equal to or less than 0.05 was considered statistically significant. Results The results show that Group IB, bonded with a fluoride-releasing adhesive and a CPP-ACP remineralizing agent surface treatment, has the highest HV of 300.23 units. Group IIC (only NFR) has the lowest hardness of 153.3 units, which is statistically significant (p < 0.001). However, the ARI scores are not statistically significant between the groups tested. Conclusion The bond strength of the adhesive and the surface hardness of the enamel increased with the addition of fluoride varnish and CPP-ACP to both the fluoride-releasing and non-fluoride-releasing adhesives.

Manual vs. interactive power toothbrush on plaque removal and salivary Streptococcus mutans and Lactobacillus casei levels : Single-center, examiner-blinded, randomized clinical trial in orthodontic patients

INTRODUCTION

The purpose of this study was to compare efficacy of a manual and an interactive power toothbrush in orthodontic patients by assessing periodontal indexes and bacterial content of saliva samples.

METHODS

Forty patients (20 females, 20 males; age range 12-18 years) with fixed orthodontic appliances were included in the study. The patients were randomly divided into two groups in a 1:1 ratio using sealed envelopes: group 1: manual toothbrush (Oral‑B Ortho Brush, Procter&Gamble Company, Dublin, Ireland), group 2: interactive power toothbrush (Oral‑B Genius 8900, Procter&Gamble Company, Marktheidenfeld, Germany). All participants were given the same toothpaste (Colgate Triple Action, Colgate-Palmolive, New York, NY, USA). The brushing procedure for each patient was described in detail, both orally and visually, utilizing a video demonstration. Plaque and bleeding index scores were recorded for both the lower and upper arches at the beginning of the study (T0) and at weeks 6 (T1) and 12 (T2). In addition, the numbers of Streptococcus (S.) mutans, Lactobacillus (L.) casei, and Porphyromonas (P.) gingivalis bacteria were determined using a real-time polymerase chain reaction (PCR) analysis in saliva samples collected at T0, T1, and T2 times. Mann-Whitney U test and Student's t test were used to compare data between the groups, and one-way analysis of variance (ANOVA) and Friedman tests were used to compare data from different time intervals for each group.

RESULTS

Plaque index values were greater in group 1 at T1 and T2, although there was no difference between the groups at T0. The gingival index scores of both groups were similar at T0, T1, and T2. While group 2 had a larger number of salivary S. mutans at T0 and T2, there was no significant difference between the groups at T1. At all three time points, there was no significant difference in salivary L. casei levels between the groups.

CONCLUSIONS

Although the interactive power toothbrush was more effective at removing plaque than the manual toothbrush, the results of the gingival index did not reflect the plaque scores. The number of certain salivary bacteria and brush type did not appear to have a clear relationship.

Orthodontists' instructions for oral hygiene in patients with removable and fixed orthodontic appliances

INTRODUCTION

The aim of this questionnaire-based survey was to evaluate information on frequencies, instructions and products relating to oral hygiene (OH) in orthodontic practices.

METHODS

Using a computer-generated randomization list, 1000 orthodontists were selected and sent a questionnaire. The size and number of inhabitants of the federal states of Germany were considered. The federal states with the highest return rate (Baden-Wuerttemberg [BW], Bavaria [B], Hesse [H], Lower Saxony [LS], Nordrhein-Westphalia [NRW]) were considered and differences between the 16 federal states were divided into North, South, East and Central Germany.

RESULTS

The response rate of the questionnaires was 52.4%. The majority (53.8%) worked in one practice alone. Most (59.1%) have been orthodontists for 5-25 years. For vestibular multibracket appliances (MBA) in BW, B, H and LS over 90% recommended interdental brushes (IDB). In NRW 91.4% recommend fluoride gel. In B and H more than 80% chose electric toothbrush (ETB), in BW, LS and NRW more than 80% manual toothbrush (MTB). For lingual MBA (LMBA) in BW, H, LS and NRW with approximately 50% each fluoride gel, IDB and MTB were chosen. In B fluoride gel, IDB and ETB. For removable apparatus (RA), five federal states recommended MTB (>80%) and ETB (BW, B, H > 80%; NRW > 70%; LS > 60%).

CONCLUSION

Electric toothbrushes are recommended for the use with all appliances, only with removable appliances manual toothbrushes are favoured. For vestibular MBA it is strongly advised to use IDB additionally.

Antibacterial coating of orthodontic elastomeric ligatures with silver and bismuth nanofilms by magnetron sputtering: A feasibility study

OBJECTIVES

Magnetron sputtering was evaluated to equip surfaces of orthodontic elastomeric ligatures with silver and bismuth nanofilms.

MATERIAL AND METHODS

Antibacterial properties were evaluated by the adhesion of Streptococcus mutans. Polyurethane-based elastomeric ligatures were coated with silver and bismuth nanofilms via direct current magnetron sputtering. Surface roughness (Ra ) and surface-free energy (SFE) were assessed. Coated specimens were incubated with S. mutans for 2 h. Adhering bacteria were visualized by Hoechst staining and quantified by an ATP-based luminescence assay. One-way analysis of variance with Tukey post hoc testing and Pearson correlation analysis were performed (p < .05) to relate bacterial adhesion to surface roughness and surface-free energy.

RESULTS

Elastomeric ligatures were successfully coated with silver and bismuth nanofilms. Ra was significantly reduced by silver coating. Silver and bismuth coatings showed significantly higher SFE than controls. Adhesion of S. mutans was significantly decreased by silver coating. No correlation between bacterial adhesion and SFE was found. Correlation between bacterial adhesion and Ra was positive but not statistically significant.

CONCLUSIONS

Magnetron sputtering proved to be a feasible method to equip orthodontic elastomeric ligatures with silver and bismuth nanofilms. Silver coatings of elastomeric ligatures may reduce white spots and carious lesions in orthodontic patients. Future research is required to stabilize coatings.

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

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

Biofilm volume and acidification within initial biofilms formed in situ on buccally and palatally exposed bracket material

PURPOSE

Acidification by bacterial biofilms at the bracket/tooth interface is one of the most common problems in fixed orthodontic treatments, which can lead to white spot lesions (WSL) and caries. As lingual brackets were shown to exhibit reduced WSL formation clinically, the aim of this in situ study was to compare initial intraoral biofilm formation and acidification on bracket-like specimens placed buccally and palatally in the upper jaw as a possible cause for this observation.

METHODS

Intraoral biofilm was collected from splints equipped with buccally and palatally exposed test specimens, which were worn by 12 volunteers for a total of 48 h. The test specimens consisted of standard bracket material cylinders on top of a hydroxyapatite disc to represent the bracket/tooth interface. They were analyzed for three-dimensional biofilm volume and live/dead distribution by fluorescence staining and confocal laser scanning microscopy as well as for acidification by fluorescence-based pH ratiometry.

RESULTS

Similar general biofilm morphology with regard to volume and viability could be detected for buccally and palatally exposed specimens. For pH values, biofilms from both positions showed increased acidification at the bottom layer. Interestingly, the pH value at the top layers of the biofilms was slightly lower on palatally than on buccally exposed specimens, which may likely be due to anatomic conditions.

CONCLUSION

Based on the results of this study, initial intraoral biofilm formation and acidification is almost similar on the bracket material/biomimetic tooth interface when placed buccally or palatally in the upper jaw. As lingual brackets were shown to exhibit reduced WSL formation clinically, future studies should investigate further factors like bracket geometry.

Remineralization potential of strontium-doped nano-hydroxyapatite dentifrice and casein phosphopeptide-amorphous calcium phosphate cream on white spot lesions in enamel following orthodontic debonding - a randomized controlled trial

Aim and Objective

This study was intended to compare and determine the potency of strontium-doped nano-hydroxyapatite paste against a topical cream containing casein phosphopeptide-amorphous calcium phosphate and a regular dentifrice for remineralization of white spot lesions of enamel following orthodontic debonding.

Methods

Ninety individuals with white spot lesions on their enamel who visited the orthodontic department for de-bonding were selected for the research. Patients were randomly assigned to three distinct groups with each group consisting of 30 patients. Group 1 served as the control and received regular dentifrice, Group 2 received strontium-doped nano-hydroxyapatite paste, and Group 3 received casein phosphopeptide-amorphous calcium phosphate topical cream. Patients were instructed to locally apply a specified amount of the prescribed preparation twice daily for six weeks. The data were analysed using the statistical programme SPSS 22.0 (SPSS Inc., Chicago, IL, USA), and the level of significance had been set at p < 0.05.

Results

Group 1 did not show any change in the enamel following the application of toothpaste. Both Group 2 and 3 demonstrated higher post-treatment scores, indicating effective remineralization potential (p < 0.001). However, Group 2 (strontium-doped nano-hydroxyapatite paste) displayed significantly greater remineralization capacity when compared to group 3 (casein phosphopeptide-amorphous calcium phosphate topical cream).

Conclusion

Compared to conventional dentifrice and casein phosphopeptide-amorphous calcium phosphate paste, strontium-doped nano-hydroxyapatite preparation demonstrated greater enamel remineralization of the white spot lesions and favourable surface alterations in the enamel surface. strontium-doped nano-hydroxyapatite can be utilised safely and efficiently to treat early caries and remineralise white spot lesions on the enamel.

Effect of re-mineralizing surface treatment on the shear bond strength of orthodontic bracket: A systematic review and meta-analysis of in-vitro studies

INTRODUCTION

Re-mineralizing surface pretreatment is essential for both controlling and preventing white spot lesion (WSL) throughout the time of fixed orthodontic treatment. It is also important that the re-mineralizing have no negative impact on the bonding between the bracket, adhesive, and enamel. Therefore, this review is aimed to investigate the orthodontic brackets' shear bond strength after re-mineralizing surface treatment of enamel.

MATERIAL AND METHODOLOGY

The review was conducted following the PRISMA 2020 guidelines. In-vitro experimental studies measuring shear bond strength (SBS) of orthodontic brackets on both demineralized and intact enamel following re-mineralizing surface treatment were included. Database search was done in PubMed, Scopus, and Science Direct during July 2023. Methodological quality of the studies was assessed according to the guidelines for the reporting of pre-clinical in-vitro studies. Both qualitative and quantitative analyses of the included studies were done.

RESULTS

Matching the inclusion criteria, 46 and 37 studies were selected for qualitative and quantitative analysis respectively. On intact enamel re-mineralizing agents had no negative impact on the brackets' SBS. On the contrary, they seemed to enhance the bond strength remarkably on the demineralized enamel.

DISCUSSION

Re-mineralizing surface pretreatment is crucial prior to fixed orthodontic treatment as it did not reduce the bond strength. Although, it cannot be judged depending solely on the in-vitro results with high heterogeneity. Clinical evidence is required to support the statement.

Static friction, surface roughness, and antibacterial activity of orthodontic brackets coated with silver and silver chitosan nanoparticles

BACKGROUND

To determine the effect of silver and silver chitosan nanocoatings on monocrystalline ceramic, polycrystalline ceramic, and metallic brackets regarding friction, roughness, and antibacterial effect against Streptococcus mutans.

METHODS

A total of 99 upper right premolar brackets with a 0.022 × 0.025 -inch slot were divided into three groups, each 33 according to coating material; the non-coated group, silver nanoparticles (AgNPs), and silver chitosan nanoparticles (Ag-CsNPs) groups. Each group was equally subdivided into the following three subgroups regarding bracket materials: monocrystalline ceramic, polycrystalline ceramic, and metallic brackets. A universal testing machine determined static friction on a custom-made acrylic jig. Then a profilometer machine was used to collect roughness data, and finally, the anti-cariogenic effect was measured with the disc diffusion technique's "minimum zone of inhibition" against Streptococcus mutans. Two-way ANOVA was used to compare data between groups and subgroups, followed by the Bonferroni test for multiple pair-wise comparisons.

RESULTS

The nanocoating effect on ceramic brackets' static friction was non-significant. The AgNPs and Ag-CsNPs coated metallic group revealed a significant increase in static friction-a significant effect of the nanocoating in the surface roughness of monocrystalline and polycrystalline ceramic brackets. A significant favorable effect of AgNPs and Ag-CsNPs against Streptococcus mutans was observed.

CONCLUSIONS

AgNPs and Ag-CsNPs coats are unsuitable for decreasing friction in metallic brackets or improving roughness in polycrystalline ceramic brackets. Nano coating can improve roughness in monocrystalline ceramic brackets. Coating brackets with AgNPs and Ag-CsNPs has a tremendous antibacterial effect on Streptococcus mutans, a substantial factor in the incidence of dental caries.

White spot lesions in orthodontics: consensus statements for prevention and management

OBJECTIVE

To establish consensus recommendations for clinicians to manage white spot lesions (WSLs) during orthodontic treatment.

MATERIALS AND METHODS

Three task force members reviewed the literature to identify best practices for minimizing WSLs during orthodontic treatment. Each draft statement was read to the task force members by a facilitator, followed by voting, accepting, or editing if necessary. The statements were then sent electronically by an independent third party (Magellan Medical Technology Consultants Inc, Minneapolis, Minn) to a previously formed content validation panel consisting of 20 independent private practitioners and clinical academicians for validation.

RESULTS

Twenty-one statements were developed and sent for content validation. While 19 statements achieved a content validation index (CVI) of 0.78, two items did not. These items were edited by the task force members based on qualitative feedback from content validation participants. Each of these revised statements did achieve a CVI of 0.78 on second evaluation from the content validation panelists and therefore were included in this document.

CONCLUSION

To reduce the risk of WSLs, it is essential to implement individualized caries management measures based on a comprehensive assessment of the patient's oral and systemic health. Effective at-home and professional mechanical and chemical plaque control should be implemented for high-risk orthodontic patients. Fluoride to support prevention and materials such as orthodontic sealants should also be used to provide a physical barrier around the brackets in high-risk patients. By following these guidelines, orthodontic professionals can help promote oral health and minimize the need for restorative treatment.

Masking-efficacy and caries arrestment after resin infiltration or fluoridation of initial caries lesions in adolescents during orthodontic treatment-A randomised controlled trial

OBJECTIVES

The aim of this randomised, controlled, split-mouth trial was to assess the masking results in initial caries lesions (ICL) that were either resin infiltrated or fluoridated during treatment with fixed orthodontic appliances.

METHODS

Adolescent patients (age range:12-18years) with fixed orthodontic appliances who had developed ICL [ICDAS 1 or 2 (International Caries Detection and Assessment System)] during orthodontic treatment were consecutively recruited and randomly assigned to either resin infiltration with up to 3 etching procedures (Group:Inf) or to 3-monthly application of a fluoride varnish (Group:FV). Both interventions were performed according to the manufacturer's recommendations. Primary and secondary outcomes (ΔE, ICDAS, DIAGNOdent) included the evaluation of the appearance of the ICL before (T0), 1 week after (T1) treatment and at the last appointment before debonding (T2).

RESULTS

Fifteen patients (8females, 7males) with 57ICL were included. Mean (SD) observation time at the last appointment before debonding was 0.5 (0.3) years. At T0 FV and Inf did not differ significantly in ΔE (median ΔE0,FV(25th/75th percentiles):11.6 (8.7/20.3): ΔE0,Inf:15.1 (11.4/19.5); pT0 = 0.135), ICDAS (pT0 = 0.920) and DD (pT0 = 0.367). At T1 and T2 ΔE values (pT1<0.001, pT2<0.001), ICDAS scores (pT1<0.001, pT2<0.001) and DIAGNOdent values (pT1 = <0.001, pT2 = <0.001) for Inf were significantly reduced whereas ΔE values (pT1 = 0.382, pT2 = 0.072) and ICDAS scores (pT1 = 0.268, pT2<0.001) for FV remained unchanged.

CONCLUSIONS

Resin infiltration effectively masked ICL during treatment with fixed orthodontic appliances both immediately after application and at the last appointment before debonding. Furthermore, the visual appearance of fluoridated lesions was not as satisfactory as that of the infiltrated ones at both T1 and T2.

CLINICAL SIGNIFICANCE

Resin infiltration effectively masked ICL during treatment with fixed orthodontic appliances both immediately after application and at the last appointment before debonding. Furthermore, the visual appearance of fluoridated lesions was not as satisfactory as that of the infiltrated ones immediately after first application as well as half a year after application.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS-ID: DRKS00011797).

A survey of white spot lesion prevention and resolution in the US dental school curricula

PURPOSE/OBJECTIVES

White spot lesions (WSLs) are opaque white lesions on smooth tooth surfaces as a result of demineralization. Proven methods of prevention and resolution of these lesions are available yet the incidence rate, especially in orthodontic patients, is still high. Perhaps the way dental schools are educating students on the topic is insufficient. The purpose of this study was to determine if and how predoctoral dental students are taught about the prevention and resolution of WSLs.

METHODS

An electronic survey was developed and sent out to each of the 66 accredited dental schools in the United States and Puerto Rico. The survey consisted of 13 questions and inquired about whether the school includes instruction of WSLs in its predoctoral curriculum. If the school indicated instruction WSLs was in the predoctoral curriculum, further questions were asked pertaining to the content and method of the instruction. Demographic data was also gathered from each institution.

RESULTS

Twenty-eight of the 66 schools responded for a 42% response rate. Eighty-two percent of schools indicated they were teaching about prevention of WSLs, while 50% indicated they were teaching about resolution, or treatment, of WSLs. The most commonly taught methods were patient education, over-the-counter fluoride mouthrinse, toothpaste, or gel, and high fluoride content toothpaste.

CONCLUSION

The majority of responding dental schools are at least including some instruction of WSLs in the predoctoral curriculum. Many of the known prevention and treatment measures available, however, are not routinely taught.

Effect of Extent of White Spot Lesions on the Esthetic Outcome after Treatment by the Resin Infiltration Technique: A Clinical Trial

Objectives: This study aimed to assess the effect of extent of white spot lesions (WSLs) on the esthetic outcome (masking effect and durability) for 6 months after treatment by the resin infiltration technique. Materials and Methods: In this clinical trial, 79 teeth with WSLs in 18 patients were selected. The lesions were assigned to localized and generalized groups, and were all treated by resin infiltration. The color of WSLs was assessed at baseline, immediately after treatment, and 1, 3, and 6 months after treatment by using Easy Shade spectrophotometer and taking standard digital photographs. The surface area of WSLs was calculated on the photographs using MIP4Student software. Repeated Measures ANOVA was used to compare color change (∆E), and the Pearson's correlation test was applied to analyze the association between the extent of lesions and ∆E (alpha=0.05). Results: A significant difference was found between the two groups in ∆E at different time points (P<0.05). Also, in both localized and generalized lesions, the pretreatment ∆E was significantly different from the ∆E values at different time points after treatment (P<0.001). However, the post-treatment ∆E values were not significantly different (P>0.05). The Pearson test showed an inverse correlation between the extent of lesions and ∆E (P<0.05). Conclusion: The resin infiltration technique is successful in masking the WSLs, with a durability of at least 6 months. Color correction by this technique is more favorable in localized lesions.

Comparative Evaluation of Cleaning Efficacy of Interdental Brush and Interdental Floss in Orthodontics Patients From Vidarbha Region: An Interventional Study

Background Plaque and dental caries are the primary agents causing gingival and periodontal diseases, eventually progressing into tooth loss. If oral hygiene practice is poor, plaque easily accumulates on the tooth surface, especially in interproximal areas. To maintain a good oral environment, it is mandatory to remove or at least reduce the percentage of plaque formation from the oral cavity. To achieve this, interdental aids should be used along with toothbrushes, as cleansing the teeth only with a toothbrush is not effective. Various interdental aids, like interdental brushes, floss, toothpicks, etc., are now available on the market. The objective of the current survey was to rate knowledge as well as make a comparison between the cleaning effectiveness of interdental brushes and interdental floss to determine which was better at reducing plaque accumulation and, subsequently, dental caries. The survey was accessed by measuring individual plaque and gingival index before and after using interdental cleaning aids. Methodology The objective of the survey was to evaluate and analyze the efficiency of interdental brushes and interdental floss in maintaining oral hygiene among orthodontic patients residing in the Vidarbha region. After receiving approval from the Ethical Committee DMIHER(DU)/IEC/2023/721, a study was conducted over a 30-day period, focusing on a group of 100 individuals aged between 15 and 30 years, and their assessments were analyzed. The patient was briefed about the study and asked to make use of an interdental brush and interdental floss. The gingival index and plaque index were calculated on the same patients before and after the use of the interdental brush and interdental floss to determine which was better at reducing plaque accumulation on the surface of teeth. Descriptive analysis, unpaired for intergroup comparison, and paired T-tests for intragroup comparison were used. The software used was SPSS 24.0 (IBM Corp., Armonk, NY) and GraphPad Prism 7.0 (GraphPad Software, Inc., La Jolla, CA). Result Everyone's tooth surfaces naturally develop a thin layer of plaque biofilm, but the presence of heavy plaque deposits on teeth indicates poor dental hygiene, which can lead to various oral health issues. Failure to improve dental hygiene status can result in problems such as halitosis, gingival issues, periodontal disease, and eventually tooth loss. Dentists play a crucial role in raising awareness about these concerns among their patients and providing education on effective oral care practices, including the use of interdental aids in conjunction with toothbrushes. When comparing the effectiveness of interdental brushes and dental floss in removing plaque, interdental brushes have been found to be more efficient. They not only excel in plaque removal but also contribute to a reduction in gingival problems. The statistical analysis supports this, with a significant p-value of less than 0.01 for both the plaque index and gingival index when using interdental brushes, indicating their superior performance in maintaining oral health. Conclusion The study will help every individual improve their oral hygiene status with the help of an interdental aid and a toothbrush. This will reduce the chances of having gingival and periodontal diseases and eventually reduce the risk of tooth loss.

Comparison of three orthodontic bonding systems in white spot lesion development: a randomized clinical trial

OBJECTIVES

To compare the development of white spot lesions (WSLs) during fixed orthodontic therapy among a conventional three-step bonding system, a self-etching primer bonding system, and a one-step adhesive bonding system.

MATERIALS AND METHODS

Seventy-five patients were randomly allocated into three groups (group 1, conventional bonding system, n = 25; group 2, self-etch primer, n = 25; group 3, primer mixed with adhesive composite, n = 25). Quantitative light-induced fluorescence (QLF) was used to assess WSL parameters. Images were captured and then analyzed before treatment and at 2 months and 4 months after bond up. Lesion area (pixels), mean fluorescence loss (ΔF), and the number of newly developed WSLs were compared within and among the three groups. The significance level was P ≤ .05.

RESULTS

The mean increase in lesion area was 31.3 ± 2.8 pixels, 38.4 ± 4.3 pixels, and 119.5 ± 5.3 pixels for groups 1, 2, and 3, respectively (P ≤ .001). For ΔF, the loss was 3.3% ± 0.3%, 4.4% ± 0.2%, and 6.6% ± 0.2% for groups 1, 2, and 3, respectively. These changes were significantly different (P ≤ .01 to P ≤ .001). The incidence of newly developed lesions was 9.5 WSLs in group 1, 10 WSLs in group 2, and 15.9 WSLs in group 3.

CONCLUSIONS

The lack of primer contributed to the development of a larger number of and more severe WSLs.

Anterior En Masse Retraction in Orthodontics

This article reviews and critically analyzes the literature on mini-implants (temporary anchorage devices) for anterior en masse retraction in orthodontics. The search methods used were an E-database search, a secondary computerized search of orthodontics journals, and a reference list of selected studies. Eligibility criteria included individuals who underwent orthodontic treatment for correction of malocclusion with premolar extraction. Data were taken from PubMed and Scopus as well as the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Keywords used for searching the article were temporary anchorage devices, premolar extraction, orthodontics, and anterior en masse retraction, Anterior en masse retraction with sliding mechanics in pre-adjusted edgewise appliances was considered for the study. Data collection and analysis involved three different researchers performing three steps of selection. All titles were initially filtered for irrelevant review articles. In the first step, all summaries from the selected studies were reviewed, and in the second, the entire content of the papers was read. The study was then discarded based on qualifying standards. A chart was created using the data from the final chosen research as well as the findings. The following information was evaluated for the final table: author, publication year, research structure, study group, sample size, methods/measures, study findings, and conclusion about frictionless mechanics. Results showed that a meta-analysis was not feasible due to clinical and statistical variability, as well as variations in study design, sample selection, and sample size. Thus, it was concluded that sliding mechanisms are widely employed in orthodontic treatment, but temporary anchorage devices and sliding mechanisms deliver great results. There is a need to raise awareness about these devices and use them with care.

Influence of Reminder on Enhancing Compliance in Patients with Fixed Orthodontic Appliance Treatment (a Randomized Controlled Clinical Trial)

Purpose

Patient compliance during orthodontic treatment has a significant effect on the aims, outcome, and duration of the treatment. The aim of this study is to evaluate the influence of reminders on enhancing orthodontic patient compliance.

Patients and Methods

Twenty-six subjects undergoing orthodontic treatment with fixed appliances were randomly assigned into two groups: control (Ct) and intervention (In) groups. The oral hygiene parameters of plaque index (PI), bleeding index (BI), and white spot lesion (WSL) with appointment adherence and bracket fracture were recorded at base line (T0), 2 months (T1), 4 months (T2), and 6 months (T3). In group participants received weekly reminders and subjects' compliances were classified into poor, fair, and excellent compliance.

Results

Statistically significant differences were found in PI level at T2 between Ct and In groups (p-value = 0.006), whereas a non-significant difference was found for BI (p-value>0. 05). There was a statistically significant increase in WSL for the Ct group across the study time points (p-value = 0.03), while no significant change in WSL was detected for the In group (p-value>0.05). The compliance levels of In and Ct groups were excellent and fair, respectively.

Conclusion

The study suggests that weekly reminders can enhance the oral hygiene status in patients with orthodontic appliances (POA) and elevate the level of compliance to excellent.

Registration number

ClinicalTrials.gov NCT05331820.

An In Vitro Evaluation of the Effects of Air-Polishing Powders on Sound and Demineralised Enamel

AIM

To evaluate the effects of two air-polishing powders, during orthodontic treatment, on the surface roughness of sound and demineralised enamel.

MATERIALS AND METHODS

Forty-two caries-free human molars were collected, and the enamel surfaces were flattened and polished. Teeth were assigned to two groups (n = 21 each), a sound- and a demineralised-enamel group (subjected to pH-cycling over 2 weeks to create artificially induced white spot-like lesions). Within each group, teeth were further assigned to three groups (n = 7 each), air polished with either sodium bicarbonate, erythritol, or a negative control (water). Each sample was treated for 5 and 150 s. The average surface roughness (Ra) for each sample was measured using white-light-sensor profilometry.

RESULTS

On sound enamel, the Ra was roughly 0.17 ± 0.07 μm. After 150 s of air polishing, the Ra increased with erythritol (by 0.28 μm), and even more so with bicarbonate treatment (by 0.68 μm) (p < 0.01). On demineralised enamel, the Ra was roughly 0.79 ± 0.56 μm. The Ra increased after 5 s of air-polishing treatment similarly with erythritol and bicarbonate powders (by 1.03 μm and 1.04 μm, respectively) (p = 0.025), and even more after 150 s (by 2.48 μm and 2.49 μm, respectively) (p < 0.001).

CONCLUSIONS

On white spot lesions, one should be aware that enamel surface roughness will increase with both erythritol and bicarbonate air-polishing powders, especially with longer exposure times.

[Characteristics of white spot lesions associated with orthodontic treatment: a review]

Introduction

The purpose of this literature review is to provide scientific evidence on the characteristics of white spot lesions (WSL) during orthodontic treatment, their incidence, prevalence, risk factors related to their development, progression, and regression, as well as explain the most used diagnostic methods.

Materials and methods

An exhaustive search was carried out in the databases of Pubmed, Scopus, Science Direct and Embase up to the date of November 30, 2022. Cross-sectional studies that evaluated white spot lesions before and after orthodontic treatments were included. Two researchers carefully selected the articles evaluated and analyzed different key topics on the subject.

Results

It was found that the prevalence and incidence of white spots during orthodontic treatment varies widely depending on the diagnostic method used, the type of orthodontic technique used and the time of orthodontic treatment. The incidence of white spot lesions is highest in patients treated with conventional braces, followed by those who used self-ligating braces, and was lowest in patients who used aligners. The most affected teeth are the upper lateral incisors and upper maxillary canines at the level of the gingival third.

Conclusions

The incidence of white spots is associated with orthodontic treatment, being closely related to the treatment technique used and the treatment time. There is a regression of the LMB during the first year after removal of the appliance.

Shear bond strength of metallic brackets bonded to enamel pretreated with CPP-ACP: a systematic review and meta-analysis of in vitro studies

BACKGROUND

Development of white spot lesions (WSLs) is common among orthodontic patients. Several measures have been introduced to prevent and remineralize the lesions. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is used for both prevention and remineralization. The effect of its application before bonding is controversial. This systematic review was conducted to investigate the most up to date available literature regarding the effect of CPP-ACP enamel pre-treatment on shear bond strength (SBS) of metallic orthodontic brackets.

METHODS

A search was conducted in electronic databases (MEDLINE (via PubMed), Scopus, Cochrane Library, Web of Science and Google scholar (grey literature)) up to March 29th, 2023. The inclusion criteria included in vitro studies comparing the SBS of metal orthodontic brackets following pre-treatment of enamel using CPP-ACP versus control. The exclusion criteria included study types other than in vitro studies, studies conducted on non-human enamel, or studies using CPP-ACP in combination with another intervention. The included studies were analysed by two reviewers, independently. The risk of bias assessment was done using a modified risk of bias tool. A Meta-analysis was performed. I2 values and Q-test were used for assessment of heterogeneity. Results were displayed in forest plots with a random-effects model. Standardized mean difference, standard error (SE) and 95% confidence intervals were calculated for all studies.

RESULTS

The search resulted in 76 articles. After duplicate removal and assessment for eligibility, 15 studies were included in the review. High statistical heterogeneity was found among the included studies using I2 values and Q-Test (I2 = 95.147%; Q = 288.456; df = 14; P < 0.001). The overall effect of CPP-ACP pre-treatment on the SBS of metal orthodontic brackets was not significant (Mean difference = 1.163 MPa, SE = 0.757, 95% CI = -0.321, 2.648, p value = 0.125). The use of CPP-ACP for prevention of WSLs did not significantly affect the SBS of brackets (Standardized mean difference = 1.009, SE = 0.884, 95% CI = -0.723, 2.740, p value = 0.254). No significant change was found when CPP-ACP was used for remineralization of WSLs (Standardized mean difference = 1.501, SE = 1.087, 95% CI = -0.630, 3.632, p value = 0.167).

CONCLUSIONS

Within the limitations of the study, the evidence suggests that the use of CPP-ACP for either prevention or remineralization of WSLs before bonding does not affect the SBS of metal orthodontic brackets.

Evaluation of the Prevalence of White Spot Lesions During Fixed Orthodontic Treatment Among Patients Reporting for Correction of Malocclusion: A Prevalence Study

BACKGROUND

Despite recent breakthroughs in caries preventive measures, one of the biggest issues clinicians confront is preventing demineralization while undergoing orthodontic therapy. The buildup of plaques around orthodontic brackets over time causes white spot lesions (WSLs). The goal of the present research was to assess the prevalence of WSLs in patients undergoing orthodontic treatment before starting therapy and at six and 12 months into therapy, adopting the visual examination approach.

MATERIALS AND METHODS

We looked for WSLs on tooth surfaces gingival to an archwire because this is the area most likely to experience enamel demineralization during orthodontic treatment. The visual assessment was conducted using the following scale at baseline, six months, and 12 months for orthodontic patients: score 0: no demineralization or noticeable white patches on the surface; score 1: mild demineralization with a visible white spot but no surface disruption; score 2: moderate demineralization with a noticeable WSL that has a roughened surface but does not need repair; and score 3: severe demineralization with a noticeable WSL that needs repair. Fisher's exact test was used after a chi-square analysis to determine whether there were any differences between all three categories (six months, 12 months, and control).

RESULTS

The frequency of WSL in patients at 12 months of orthodontic treatment was 46.57%, while it was 11.86% in patients who just started orthodontic treatment. The difference was statistically significant (p = 0.01), showing that the frequency was greater in patients at 12 months of orthodontic treatment as compared to patients who had just started undergoing orthodontic treatment. The frequency of WSL in patients at six months of orthodontic treatment was 37.34%, while it was 11.86% in patients who just started orthodontic treatment. The difference was statistically significant (p = 0.03), showing that the frequency was greater in patients at six months of orthodontic treatment as compared to patients who had just started undergoing orthodontic treatment. The frequency of WSL in patients at six months of orthodontic treatment was 37.34%, while it was 46.57% in patients at 12 months of orthodontic treatment. The frequency was greater in patients at 12 months of orthodontic treatment as compared to patients at six months of orthodontic treatment; however, the difference was non-significant statistically (p = 0.76).

CONCLUSION

This clinical investigation revealed that the number of WSLs increased significantly during the first six months of treatment and then increased gradually until the final 12 months. During the first few months of treatment, doctors should assess the patients' dental hygiene habits and, if necessary, take further precautions to prevent demineralization.

Efficacy of Nano Silver Fluoride and/or Diode Laser In Enhancing Enamel Anticariogenicity around orthodontic brackets

PURPOSE

This in vitro study aimed to compare the anticariogenic effect of using diode laser irradiation and/or nano silver fluoride varnish around orthodontic brackets.

MATERIALS AND METHODS

60 caries-free and intact premolars were randomly divided into 3 experimental groups as follow: (1) Group I (nano silver fluoride treated group, n = 20), (2) Group II (diode laser treated group, n = 20) and (3) Group III (combined nano silver fluoride and diode laser treated group, n = 20). Anticariogenicity was assessed using polarized light, scanning electron microscope, elemental and shear bond strength analyses.

RESULTS

PLM and SEM showed presence of few demineralized areas in group I. Group II revealed a dramatic increased demineralization. Group III disclosed almost typical homogenous surface enamel. elemental analysis showed a highly significant difference between Group III and II and a significant difference between Group III and I. Shear bond strength analysis revealed a significant difference between group I and II and between group III and II. The difference between group III and I was non-significant.

CONCLUSION

Both diode laser and nano silver fluoride positively affected dental enamel with the most superior enhancement in enamel criteria was achieved by surface pretreatment by combined nano silver fluoride varnish and diode laser irradiation.

Effectiveness of a New App in Improving Oral Hygiene in Orthodontic Patients: A Pilot Study

OBJECTIVES

The aim of this randomised clinical trial was to evaluate the effects of a mobile application (app) on the oral hygiene (OH) of adolescents undergoing fixed orthodontic treatment.

METHODS

Eight volunteers (14-19 years old) were randomly allocated to the experimental or control groups. Volunteers in the control group received standard OH (SOH) instructions, whilst volunteers in the experimental group received SHO + OH guidance and motivation through an app tailor-made for this study. Clinical assessments were made using the visible plaque index (VPI) and gingival bleeding index (GBI) at 5 different time points: before orthodontic device installation (T0); at baseline (T1); and 30 (T2), 60 (T3), and 90 (T4) days after randomisation. Significant differences were evaluated using Student t test and multilevel logistic regression analysis.

RESULTS

Although no significant difference could be observed, VPI at T1 and T2 were lower for volunteers in the experimental group (33.20 ± 19.29; 32.10 ± 7.72) than for the volunteers in the control group (42.11 ± 8.56; 43.59 ± 34.71). The same was observed for GBI, in which volunteers in the experimental group presented lower GBI at T1 and T2 (12.70 ± 8.10; 13.72 ± 7.39) than volunteers in the control group (27.53 ± 17.89; 20.38 ± 9.95). Good acceptance for using the app was shown by volunteers.

CONCLUSIONS

This study shows the potential utility of the mobile app for improving the OH of adolescents.

Comparative Evaluation of 0.25% Lemongrass Oil Mouthwash and 0.2% Chlorhexidine Mouthwash in Fixed Orthodontic Patients Suffering from Gingivitis

AIM

The aim of this study is to compare the antiplaque and antigingivitis efficacy of 0.25% lemongrass oil mouthwash and 0.2% chlorhexidine mouthwash in patients undergoing fixed orthodontic treatment, who are suffering from gingivitis.

MATERIALS AND METHODS

A total of 60 patients undergoing fixed orthodontic treatment with mild-to-moderate gingivitis were selected for the study. The patients were randomly divided into three groups of twenty each, that is, group I: 0.25% lemongrass oil mouthwash (n = 20); group II: 0.2% chlorhexidine mouthwash (n = 20); and group III: oral prophylaxis (n = 20). Baseline gingival index (GI) and plaque index (PI) were accessed followed by oral prophylaxis was done and the PI score was set to zero for all the patients. Patients were asked to swish their mouth with their respective mouthwashes and brushing (twice daily), that is, morning and before bedtime for 21 days. The PI and GI scores were recorded for all three groups on the 14th and the 21st days. The post hoc Bonferroni test was used for multiple comparisons of mean differences among variables after the application of the analysis of variance (ANOVA) test for comparison within the groups.

RESULTS

A lower PI and the GI were found in the lemongrass oil mouthwash group by the 14th and the 21st days, respectively, a statistically significant difference (p < 0.001) compared to the chlorhexidine mouthwash group.

CONCLUSION

The findings of the current study suggested that 0.25% lemongrass oil mouthwash has the potential to be used as a natural or herbal alternative to chlorhexidine mouthwash.

CLINICAL SIGNIFICANCE

It can be suggested that 0.25% lemongrass oil mouthwash may be a good herbal alternative to mouthwash containing 0.2% chlorhexidine gluconate.

Antibacterial and Physicochemical Properties of Orthodontic Resin Cement Containing ZnO-Loaded Halloysite Nanotubes

Demineralized white lesions are a common problem when using orthodontic resin cement, which can be prevented with the addition of antibacterial substances. However, the addition of antibacterial substances such as zinc oxide alone may result in the deterioration of the resin cement's functions. Halloysite nanotubes (HNTs) are known to be biocompatible without adversely affecting the mechanical properties of the material while having the ability to load different substances. The purpose of this study was to prepare orthodontic resin cement containing HNT fillers loaded with ZnO (ZnO/HNTs) and to investigate its mechanical, physical, chemical, and antibacterial properties. A group without filler was used as a control. Three groups containing 5 wt.% of HNTs, ZnO, and ZnO/HNTs were prepared. TEM and EDS measurements were carried out to confirm the morphological structure of the HNTs and the successful loading of ZnO onto the HNTs. The mechanical, physical, chemical, and antibacterial properties of the prepared orthodontic resin cement were considered. The ZnO group had high flexural strength and water absorption but a low depth of cure (p < 0.05). The ZnO/HNTs group showed the highest shear bond strength and film thickness (p < 0.05). In the antibacterial test, the ZnO/HNTs group resulted in a significant decrease in the biofilm's metabolic activity compared to the other groups (p < 0.05). ZnO/HNTs did not affect cell viability. In addition, ZnO was cytotoxic at a concentration of 100% in the extract. The nanocomposite developed in this study exhibited antimicrobial activity against S. mutans while maintaining the mechanical, physical, and chemical properties of orthodontic resin cement. Therefore, it has the potential to be used as an orthodontic resin cement that can prevent DWLs.

Pre-treatment oral microbiome analysis and salivary Stephan curve kinetics in white spot lesion development in orthodontic patients wearing fixed appliances. A pilot study

BACKGROUND

White spot lesions (WSLs) are a formidable challenge during orthodontic treatment, affecting patients regardless of oral hygiene. Multifactorial in nature, amongst potential contributors to their development are the microbiome and salivary pH. The aim of our pilot study is to determine if pre-treatment differences in salivary Stephan curve kinetics and salivary microbiome features correlate with WSL development in orthodontic patients with fixed appliances. We hypothesize that non-oral hygiene determined differences in saliva could be predictive of WSL formation in this patient population through analysis of salivary Stephan curve kinetics, and that these differences would further manifest as changes in the oral microbiome.

METHODS

In this prospective cohort study, twenty patients with initial simplified oral hygiene index scores of "good" that were planning to undergo orthodontic treatment with self-ligating fixed appliances for at least 12 months were enrolled. At pre-treatment stage, saliva was collected for microbiome analysis, and at 15-minute intervals after a sucrose rinse over 45 min for Stephan curve kinetics.

RESULTS

50% of patients developed a mean 5.7 (SEM: 1.2) WSLs. There were no differences in saliva microbiome species richness, Shannon alpha diversity or beta diversity between the groups. Capnocytophaga sputigena exclusively and Prevotella melaninogenica predominantly were found in WSL patients, while Streptococcus australis was negatively correlated with WSL development. Streptococcus mitis and Streptococcus anginosus were primarily present in healthy patients. There was no evidence to support the primary hypothesis.

CONCLUSIONS

While there were no differences in salivary pH or restitution kinetics following a sucrose challenge and no global microbial differences in WSL developers, our data showed change in salivary pH at 5 min associated with an abundance of acid-producing bacteria in saliva. The results suggest salivary pH modulation as a management strategy to inhibit the abundance of caries initiators. Our study may have uncovered the earliest predecessors to WSL/caries development.

Long-Term Chromatic Durability of White Spot Lesions through Employment of Infiltration Resin Treatment

Background and Objectives: White spot lesions (WSLs) denote regions of subsurface demineralization on the enamel that manifest as opaque and milky-white regions. Treatment for WSLs is essential for both clinical and aesthetic reasons. Resin infiltration has been identified as the most efficacious solution for alleviating WSLs, but studies with long-term monitoring are scarce. The aim of this clinical study is to assess the color change stability of the lesion after four years of implementing the resin infiltration technique. Materials and Methods: Forty non-cavity and unrestored white spot lesions (WSLs) were treated with the resin infiltration technique. The color of the WSLs and adjacent healthy enamel (SAE) was assessed using a spectrophotometer at T0 (baseline), T1 (after treatment), T2 (1 year after) and T3 (4 years after). The Wilcoxon test was utilized to determine the significance of the variation of color (ΔE) between WSLs and SAE over the observed time periods. Results: When comparing the color difference ΔE (WSLs-SAE) at T0-T1, the Wilcoxon test demonstarated a statistically significant difference (p < 0.05). For ΔE (WSLs-SAE) at T1-T2 and T1-T3, the color variation was not statistically significant (p = 0.305 and p = 0.337). Conclusions: The study's findings indicate that the resin infiltration technique is an effective solution for resolving the appearance of WSLs, and the results have demonstrated stability for a minimum of four years.

A Novel Coating of Orthodontic Archwires with Chlorhexidine Hexametaphosphate Nanoparticles

Statement of the Problem. The use of orthodontic fixed appliances may adversely affect oral health leading to demineralizing lesions and the development of gingival problems. Aims of the Study. The study aimed to coat orthodontic archwires with chlorhexidine hexametaphosphate nanoparticles (CHX-HMP NPs) and to evaluate the elusion of CHX from CHX-HMP NPs. Materials and Methods. A solution of CHX-HMP nanoparticles with an overall concentration of 5 mM for both CHX and HMP was prepared, characterized (using atomic force microscope and Fourier transformation infrared spectroscopy), and used to coat orthodontic stainless steel (SSW) and NiTi archwires (NiTiW). The coated segments were characterized (using scanning electron microscopy SEM with energy dispersive X-ray spectrometry and field emission SEM) and subjected to the elusion assessment. Results. After having their composition validated, the average size of the CHX-HMP NPs was assessed to be 51.21 nm, and the analysis revealed that the particles had both chlorine and phosphorus. After 30 minutes in the coating solution, NPs deposited on the surface of the SSW and NiTiW. A continuous release of soluble CHX in artificial saliva was detected from both SSW and NiTiW as long as the experiment lasted for 28 days without reaching a plateau. However, the release from coated NiTiW was significantly more than coated SSW at 7, 14, and 28 days. While at day 21, the release from coated SSW was slightly greater than that from the coated NiTiW. Conclusion. Orthodontic stainless steel and NiTi archwires can be successfully coated with CHX-HMP NPs and give sustained release of CHX along the examined period.

Comparative evaluation of prevention of demineralization of artificial enamel caries treated with two fluoride varnishes and 38% SDF in primary teeth: an in vitro study

BACKGROUND

This study aimed to compare the effect of Clinpro™ White varnish containing 5% sodium fluoride (NaF) and functionalized tricalcium phosphate, MI varnish containing 5% NaF and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and 38% Silver diamine fluoride (SDF) in preventing demineralization of treated white spot lesions (WSLs) in enamel of primary teeth.

METHODS

Forty-eight primary molars with artificial WSLs were allocated into four groups as follows: Group 1: Clinpro white varnish, Group 2: MI varnish, Group 3: SDF, and Group 4: control (no treatment). The three surface treatments were applied for 24 h and then enamel specimens were subjected to pH cycling. Thereafter, the mineral content of specimens was evaluated by Energy Dispersive X-ray Spectrometer and the lesion depth was assessed via Polarized Light Microscope. One-way ANOVA followed by Tukey's post hoc test were used at p ≤ 0.05 to identify significant differences.

RESULTS

Insignificant difference in mineral content was observed among treatment groups. Treatment groups exhibited significantly higher mineral content compared to control except for Fluoride (F). MI varnish showed the highest mean calcium (Ca) ion content (66.57 ± 0.63), and Ca/P (2.19 ± 0.11), followed by Clinpro white varnish, and SDF. MI varnish also displayed the highest phosphate (P) ion content (31.46 ± 0.56), followed by SDF (30.93 ± 1.02), and Clinpro white varnish (30.53 ± 2.19). Fluoride content was highest in SDF (0.93 ± 1.18), followed by MI (0.89 ± 0.34) and Clinpro (0.66 ± 0.68) varnishes. Significant difference in lesion depth was observed among all groups (p < 0.001). The lowest mean lesion depth (µm) was found in MI varnish (226.23 ± 44.25) which was significantly lower than Clinpro white varnish (285.43 ± 44.70), SDF (293.32 ± 46.82), and control (576.69 ± 42.66). Insignificant difference in lesion depth was found between SDF and Clinpro varnish.

CONCLUSIONS

In primary teeth, WSLs treated with MI varnish displayed better resistance to demineralization compared to WSLs treated with Clinpro white varnish and SDF.

MALDI-TOF/MS Profiling of Whole Saliva and Gingival Crevicular Fluid in Patients with the Invisalign System and Fixed Orthodontic Appliances

The movement of teeth by orthodontic treatment with the Invisalign (IN) system and fixed orthodontic appliances (FOA) is characterized by the reconstruction of periodontal ligaments, alveolar bone, and gingiva. A reflection of these phenomena can be found in the composition of gingival crevicular fluid (GCF). A total of 90 samples from 45 participants (45 whole saliva and 45 GCF), including 15 patients with FOA, 15 patients with IN, and 15 patients with oral health, were subjected to matrix-assisted laser desorption/ionization mass spectrometry (MALDI-TOF/MS) analysis. Mass fingerprints were generated for each sample. Three models were tested: a quick classifier (QC), a genetic algorithm (GA), and a supervised neural network (SNN). For both groups of samples (saliva and GCF), the GA model showed the highest recognition abilities of 88.89% (saliva) and 95.56% (GCF). Differences between the treated (FOA and IN) groups and the control group in saliva and GCF samples were determined using cluster analysis. In addition, we monitored the effect of long-term orthodontic treatment (after 6 months) in the lag phase of orthodontic tooth movement. The results show increased levels of inflammatory markers (α-defensins), which may indicate an ongoing inflammatory process even after 21 days from force application.

Twenty-year follow-up of functional treatment with a bionator appliance (part 2): a retrospective cephalometric analysis of skeletal and dentoskeletal changes

OBJECTIVES

To investigate skeletal and dentoskeletal changes 20 years after bionator treatment.

MATERIALS AND METHODS

Analog lateral cephalograms of 18 subjects treated with a bionator appliance during growth were digitized with a transmitted light scanner. Inclusion criteria were: increased overjet (≥4 mm), skeletal Class II, available lateral cephalograms before (T0), after (T1), and 20 years after (T2) treatment with only a Bionator. To assess standard cephalometric parameters, the software ivoris analyze was used. Data were analyzed using Friedman's two-way analysis of variance by ranks followed by Dunn's post hoc tests (P ≤ .05).

RESULTS

During therapy (T0-T1), ANB decreased significantly by 1.9° and remained unchanged long term. SNA slightly decreased (-0.6°) during treatment, SNB and SNPg increased (+1.4°, +1.7°). All three parameters showed a significant increase at T2 (+1.2°, +1.6°, +1.6°). Vertical measurements (ML-NL, ML-NSL, NL-NSL) remained almost unchanged during therapy. NL-NSL also was unchanged during the long-term interval; ML-NSL and ML-NL decreased significantly (-3.4°, -4.9°). During treatment, the maxillary incisors retroclined (OK1-NL: -1.6°, OK1-NA: -0.6°), the mandibular incisors proclined (UK1-ML: +3.5°, UK1-NB: +4.9°), neither significantly. Long term, there was a nonsignificant tendency toward proclination of upper (OK1-NL: +0.1°, OK1-NA: +0.7°) and retroclination of lower incisors (UK1-ML: -1.5°, UK1-NB: -5°).

CONCLUSIONS

Changes of ANB after bionator treatment without additional fixed appliances remained stable after 20 years. The observed long-term changes are probably consequences of well-known physiological and age-related processes.

In-vivo durability of Pro Seal in patients with fixed orthodontic appliances: A controlled clinical trial

BACKGROUND

This clinical trial aimed at studying the durability of an orthodontic sealant (Pro Seal) used on tooth surfaces for protection against white spot lesions.

METHODS

A total of 35 patients (18 females, 17 males; 17.57 ± 1.36 years) were recruited. Eligibility criteria included healthy patients of both sexes (age > 14 years), absence of labial caries, absence of defective enamel, absence of extensive restorations, and optimum oral hygiene. The participants received a single application of Pro Seal on the bonded teeth. The sealant covered the labial enamel surrounding the brackets. Participants were recalled monthly after sealant application, during which sealant layers were evaluated using an ultraviolet lamp. The assessment was realized using an index similar to the adhesive remnant index (ARI).

RESULTS

A total of 30 participants completed the trial. ARI values dropped significantly (P < 0.001) and reached <1.5 at T₁ on the index used. An ARI value of 2 was chosen as the threshold below which a tooth presented an insufficient sealant layer. The right and left sides of both jaws did not show any statistically significant difference (P > 0.05). ARI values of homolateral teeth revealed few statistically significant differences between upper and lower teeth. No statistically significant difference between the two sexes (P > 0.05) existed. No harm or disturbance was reported by any of the participants.

CONCLUSIONS

This study demonstrated that a single application of Pro Seal is effective for 4 weeks and should be renewed monthly. No interjaw, intrajaw, or intersex significant differences were found.

Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting

INTRODUCTION

The objective of this study was to determine the prevalence of white spot lesions (WSL) in orthodontic patients in an academic setting. Specific aims include using a novel combination to measure plaque accumulation (PA) and detect the association between WSL and PA and the associations between multiple independent variables.

METHODS

Cross-sectional data were collected on 111 patients. To enhance standardization, a combination of plaque-disclosing agents and standardized intraoral photographs was used to analyze plaque index (PI) and WSL for all teeth except molars. Factors including time in fixed appliances (FA), number of teeth, location of the lesions, and demographic information were reported. A multiple linear regression model was used to detect associations between the PI and WSL and the independent variables (P <0.05).

RESULTS

Approximately 79.3% of participants had at least one WSL, with a mean of 4 affected teeth per patient. A significant association was found between time in FA and the more severe PI reporting (P <0.001). There was no significant association between WSL and PI or the other variables. WSL was greater in the maxilla than in the mandible. PI was greater on the left than on the right side. Interexaminer reliability was assessed for PI and WSL (κ = 0.93 and 0.92).

CONCLUSIONS

The prevalence of WSL for orthodontic patients treated at this institution was greater than previously reported in the literature. In addition, the severity of PI was associated with increased time in FAs. Combining the proposed method of reporting PA facilitates standardization, calibration, and documentation in an academic environment.

Candida albicans enriched in orthodontic derived white spot lesions and shaped focal supragingival bacteriome

White spot lesions (WSLs) are common enamel infectious diseases in fixed orthodontic treatment, which might attribute to the dysbiosis of oral microbiome. However, the correlation of Candida albicans with oral bacteriome in WSLs still remains unrevealed. This study investigated the carriage of C. albicans and how it shaped the bacterial community in disease or healthy supragingival plaque, to explore the potential role of interkingdom interaction in orthodontic WSLs. In this study, 31 patients with WSLs (WSLs) and 23 healthy patients (Health) undergoing fixed orthodontic treatment were enrolled. The supragingival microbiota in both groups were determined using 16S rRNA gene sequencing. Colonization and abundance of C. albicans in the plaque were determined via culture-dependent and -independent methods. Among WSLs patients, the correlation of C. albicans and bacteriome was analyzed under QIIME2-based bioinformatics and Spearman's correlation coefficient. The raw reads were deposited into the NCBI Sequence Read Archive (SRA) database (Accession Number: SRP404186). Significant differences in microbial diversity as well as composition were observed between WSLs and Health groups. Leptotrichia remarkably enriched in the WSLs group, while Neisseria and Cardiobacterium significantly enriched in the Health group. In addition, 45% of WSLs patients were C. albicans carriers but none in patients without WSLs. Among all WSLs patients, beta diversity and microbial composition were distinguished between C. albicans carriers and non-carriers. In C. albicans carriers, Corynebacterium matruchotii and Streptococcus mutans significantly enriched whereas Saccharibacteria_TM7_G-1 significantly depleted. The abundance of C. albicans was positively associated with bacteria such as Streptococcus mutans, while the negative correlation was detected between C. albicans and several bacteria such as Cardiobacterium hominis and Streptococcus sanguinis. Our study elucidated the distinguished supragingival plaque microbiome between orthodontic patients with and without WSLs. C. albicans frequently existed and enriched in orthodontic derived WSLs. The carriage of C. albicans shape plaque bacterial community in demineralized lesions and might play roles in WSLs pathogenesis.

Evaluation of the Demineralization Development around Different Types of Orthodontic Brackets

The aim of this study was to compare the demineralizations of the enamel surfaces around different types of orthodontic brackets in an artificial cariogenic environment. A total of 90 extracted human maxillary first premolar teeth were used in this in vitro study. The teeth were divided into 6 groups, 5 study and 1 control, each consisting of 15 samples. Victory metal, Gemini metal, Clarity self-ligating ceramic, APC Clarity Advanced ceramic and Clarity Advanced ceramic brackets (3M Unitek, Monrovia, Calif) used in the study groups were bonded to the teeth with the direct technique. The gingival, occlusal and proximal enamel surfaces adjacent to the brackets were measured with a DIAGNOdent pen (KaVo, Biberach, Germany) (T0). Then, the teeth were placed in a cariogenic suspension environment containing Streptococcus mutans, sucrose and artificial saliva. The teeth were removed from the cariogenic suspension at the end of 28 days. Enamel surfaces were remeasured with DIAGNOdent and the values were recorded (T1). Whether the obtained data were homogeneously distributed or not was determined by the Kolmogorov-Smirnov test, within-group comparisons were performed with the Wilcoxon test, and between-group comparisons were performed with Mann-Whitney U and Kruskal-Wallis tests. Significance level was accepted as p < 0.05. In all groups, the demineralization values of the enamel surfaces in the gingival, proximal and occlusal surfaces adjacent to the brackets were significantly higher in the T1 period than in the T0 period (p < 0.05). In the T1 period of Gemini metal, Clarity self-ligating ceramic and Clarity advanced ceramic bracket groups, the demineralization values of the proximal enamel surfaces were found to be significantly higher than the Victory metal and APC Clarity Advanced ceramic bracket groups (p < 0.05). In the T1 period, the demineralization values of the occlusal enamel surfaces of the Victory metal, APC Clarity Advanced ceramic bracket groups and control group were significantly lower than the Gemini metal, Clarity self-ligating ceramic and Clarity Advanced ceramic bracket groups (p < 0.05). Significant increases in enamel demineralization values were observed as a consequence of increased retention areas for microbial dental plaque on enamel surfaces adjacent to the bracket. Considering the importance of minimizing enamel demineralization in fixed orthodontic treatments, less enamel demineralization in Victory metal and APC Clarity Advanced ceramic bracket groups showed that these brackets can be preferred in patients with poor oral hygiene.

Application of Silver Nanoparticles to Improve the Antibacterial Activity of Orthodontic Adhesives: An In Vitro Study

There is a significant change in the bacterial plaque populations in the oral cavity during and after orthodontic treatment. Numerous studies have demonstrated that 2−96% of patients could increase the risk of white spot lesions. Streptococcus mutans and Lactobacilli ssp. are responsible for these white spot lesions. In this work, silver nanoparticles (AgNPs) with a diameter of 11 nm and dispersed in water were impregnated onto three different commercial orthodontic adhesives at 535 μg/mL. The shear bond strength (SBS) was assessed on 180 human premolars and metallic brackets. The premolars were divided into six groups (three groups for the commercial adhesives and three groups for the adhesives with AgNPs). All the groups were tested for their bactericidal properties, and their MIC, MBC, and agar template diffusion assays were measured. After adding AgNPs, the SBS was not significantly modified for any adhesive (p > 0.05), and the forces measured during the SBS did not exceed the threshold of 6 to 8 MPa for clinical acceptability in all groups. An increase in the bactericidal properties against both S. mutans and L. acidophilus was measured when the adhesives were supplemented with AgNPs. It was concluded that AgNPs can be supplement commercial orthodontic adhesives without modifying their mechanical properties with improved bactericidal activity.

Aligner therapy in adolescents: first-year results on the impact of therapy on oral health-related quality of life and oral hygiene

OBJECTIVES

The aim of this multicenter clinical study was to examine the oral health-related quality of life and oral hygiene in adolescents before and during aligner therapy.

MATERIALS AND METHODS

Forty subjects (18 ♀, 22 ♂; mean age: 13.6 years) scheduled for aligner therapy (Invisalign® Teen) were given oral health-related quality of life questionnaires, Oral Health Impact Profile (OHIP-G14) and Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ), to complete within their treatment (visit 1: 0 start of therapy; visit 2: 0 + 4 weeks; visit 3: 0 + 10 weeks; visit 4: 0 + 6 months; visit 5: 0 + 1 year). To assess oral hygiene, a questionnaire to take home was used, and plaque level was evaluated with the Quigley-Hein Plaque Index (TMQH) modified by Turesky et al. RESULTS: The OHIP-G14 mean score before aligner therapy was 3.3 ± 3.2, and 4.9 ± 5.4 after 1 year. The PIDAQ showed a positive psychological change in the well-being, as well as a more effective at-home oral hygiene regime. On average, the TMQH remained at a low level (grade 2 of 0-5). The initial insertion of the aligners caused the most significant changes in all parameters (except TMQH).

CONCLUSION

Oral health-related quality of life is only slightly affected during the first year of aligner therapy in adolescents. Oral hygiene at home is intensified and there is no increased dental plaque accumulation.

CLINICAL RELEVANCE

Dentofacial esthetics is a subset of the so-called Oral H-Related Quality of Life (OHRQoL) which should be considered more during orthodontic therapy.

Streptococcus mutans levels in patients who received orthodontic brackets bonded using probiotic impregnated resin composite - a randomized clinical trial

To evaluate the effect of impregnating an orthodontic resin composite with probiotic bacteria (Lactobacillus rhamnosus GG) on the levels of Streptococcus mutans (S. mutans) in patients undergoing orthodontic treatment. Thirty patients were randomly selected and allotted by block randomization to two groups: an experimental group, who received brackets bonded with probiotic impregnated resin composite and a control group, who received brackets bonded with conventional light cure resin composite. Plaque samples were collected before (ET0 and CT0) and two months (ET1 and CT1) after bonding. Levels of S. mutans were assessed using the colony count method. Two months after bonding of the brackets, the S. mutans levels had decreased with statistical significance in the experimental group (p = 0.001), but not in the control group (p = 0.137). Impregnation of resin composite with probiotic bacteria for the purpose of preventing formation of white spot lesions on enamel holds promise. Long-term evaluation would be necessary to provide confirmatory results.

Effects of a flash-free system on dental plaque accumulation and bonding-debonding process: A clinical study

INTRODUCTION

The objectives of this study were to evaluate the effects of a flash-free (FF) System on (1) the amount of plaque accumulation around the braces on buccal surfaces of the teeth, (2) the time required for the placement of brackets, including the clean-up of the flash, (3) the amount of adhesive left on the tooth after debonding, and (4) time required for adhesive remnant clean-up.

METHODS

Thirty-six patients (aged 19.96 ± 5.74 years) were randomly distributed to receive adhesive precoat (APC)-FF and APC-Plus ceramic brackets on the maxillary right or left anterior 6 teeth. Bonding and debonding time were measured per segment in milliseconds. A plaque revealer agent was applied to discolor the dental plaque, and a modified plaque accumulation index was used to evaluate the amount of plaque at 2 different time points. An adhesive residue index was used after the debonding.

RESULTS

The mean bonding times were 138.87 seconds (8332.47 milliseconds) and 77.82 seconds (4669.31 milliseconds) for APC-Plus and APC-FF, respectively. The difference was statistically significant (P ≤0.001). The difference between the mean debonding times was not statistically significant. A significant difference was found between the adhesive residue index scores of the 2 systems (P ≤0.001). There was no statistically significant difference between plaque accumulation scores at first- and second-time points for both adhesive systems. APC-Plus score (0.94 ± 0.98) was higher than the APC-FF score (0.50 ± 0.91) on the incisal side at the second time point (P ≤0.05).

CONCLUSIONS

FF adhesives can be a good alternative to reduce chair time in bonding appointments.

Orthodontic resins loaded with niobium silicate particles: Impact of filler concentration on the physicochemical and biological properties

OBJECTIVES

White spot lesions (WSL) are prevalent in patients using orthodontic appliances. The presence of ion-releasing compounds in the tooth-appliance interface may limit enamel demineralization to control WSL incidence. Thus, this study aims to evaluate the mineral formation on SiNb-containing experimental orthodontic resins and the influence of these fillers on the physicochemical and biological properties of developed materials.

MATERIALS AND METHODS

The SiNb particles were synthesized via the sol-gel route and characterized by their molecular structure and morphology. Photopolymerizable orthodontic resins were produced with a 75 wt% Bis-GMA/25 wt% TEGDMA and 10 wt%, 20 wt%, or 30 wt% addition of SiNb. A control group was formulated without SiNb. These resins were tested for their degree of conversion, softening in solvent, cytotoxicity in fibroblasts, flexural strength, shear bond strength (SBS), and mineral deposition.

RESULTS

The addition of 10 wt% of SiNb did not impair the conversion of monomers, cytotoxicity, and flexural strength. All groups with SiNb addition presented similar softening in solvent. The presence of these particles did not affect the bond strength between metallic brackets and enamel, with SBS values ranging from 16.41 to 18.66 MPa. The mineral deposition was observed for all groups.

CONCLUSION

The use of niobium silicate as filler particles in resins may be a strategy for the adhesion of orthodontic appliances. The 10 wt% SiNb concentration resulted in a material with suitable physicochemical and biological properties while maintaining the bond strength to tooth enamel and promoting mineral deposition.

An In Vivo Study on the Development of Bacterial Microbiome on Clear Orthodontic Retainer

OBJECTIVES

The objective of this study was to see how the bacterial composition changes on clear orthodontic retainer over a 14-day period.

METHODS

Saliva and plaque samples collected from a clear retainer surface were obtained from five healthy volunteers receiving retainer treatment. Prior to clear retainer delivery, patients had not been wearing any other appliances. Patients were instructed to wear their clear retainer for the 14-day period, taking them off to eat and to clean them with a soft-bristle toothbrush. The bacterial composition was determined via Illumina MiSeq sequencing of the bacterial 16S rRNA. After bioinformatics processing using the QIIME pipeline, the intra- and intergroup biodiversity of the sample was analyzed.

RESULTS

The bacterial composition changed over a 14-day period in the saliva and on the clear retainer. When comparing the different phylum levels between saliva and clear retainer' microbiota, the Firmicutes were significantly increased 1.26-fold (p = 0.0194) and 1.34-fold (p = 0.0123) after 7 and 14 days of retainer treatment when compared to saliva, respectively. The Campylobacteriota were significantly decreased 1.80-fold (p = 0.05) in the clear retainer when compared to saliva at 7 days. At the genus level, several microbiota were significantly increased in relative abundance in the clear retainer after the 14-day period.

CONCLUSION

These findings reveal that the presence of a clear retainer in the mouth might lead to enamel changes or periodontal tissue destruction, especially after 14 days of use.

EFFICACY OF NOVEL BIOACTIVE GLASS IN THE TREATMENT OF ENAMEL WHITE SPOT LESIONS: A RANDOMIZED CONTROLLED TRIAL✰

OBJECTIVES

to evaluate the efficacy of 2 types of bioactive glass (45S5) compared to casein-phosphopeptide stabilized-amorphous calcium phosphate (CPP-ACP) in the treatment of orthodontically-induced white spot lesions (WSLs).

METHODS

Sixty post-orthodontic WSLs (ICDAS II score 2) were randomly allocated to a double blind randomized controlled trial with 3 parallel arms (n = 20). Test group I (Bio-BAG) received BiominF slurry and toothpaste, and test group II (N-BAG) received Novamin slurry and toothpaste. While the positive control group (CPP-ACP) received Recaldent paste. Products were applied daily in-office during week 1, and boosted by self-administered home application for 4 weeks (week 1-4). Standard oral hygiene care was performed by all participants twice daily during months 2-6. All patients were assessed for change in WSL dimensions using computer assisted analysis based on standardized digital intraoral photographs in addition to laser fluorescence DIAGNOdent assessment before treatment (T0) and at 1 week (T1), 1 month (T2), 3 months (T3,) and 6 months (T4) follow up periods.

RESULTS

Kruskal Wallis test was used (P < .05 for all). At T4, a statistically significant (P < .001) regression of WSL was disclosed in all 3 groups compared to baseline, and a highly significant lesion size percent reduction in Bio-BAG group compared to the control group (P < .001). The mean area of the lesions decreased by 64.8%, 32.2%, and 31.6% for groups I, II and III respectively (P = .001). DIAGNOdent findings largely reflected the clinical scores (Mean scores at baseline/T4 for groups I, II, and III respectively; 16.57/3.62, 16.93/7.90, 21.95/19.27). No adverse effects were reported.

CONCLUSIONS

The combined in-office and home-application of BiominF paste for 4 weeks resulted in greater esthetic improvements of post-orthodontic WSLs compared to Novamin and CPP-ACP. In addition, BiominF showed a significant reduction in fluorescence intensity which indicates potential lesion remineralization.

CLINICAL RELEVANCE

Post-orthodontic WSLs can be diminished using bioactive glass remineralization therapy.

Combined Effect of Fluoride Mouthwash and Sub-ablative Er:YAG Laser for Prevention of White Spot Lesions around Orthodontic Brackets

Background:

Development of white spot lesions (WSLs) around orthodontic brackets compromises esthetics and necessitates additional dental treatments.

Objectives:

This study aimed to assess the efficacy of fluoride mouthwash combined with Er:YAG laser irradiation for the prevention of WSLs around orthodontic brackets.

Methods:

Orthodontic brackets were bonded to 50 bovine incisors. The entire tooth surface was coated with acid-resistant varnish except for a margin around the brackets. The microhardness of the teeth was measured at the respective area using the Vickers hardness test. The teeth were then randomly divided into five groups (n=10) of control (Gc), Orthokin fluoride mouthwash (Gf), 100 mJ/cm2 Er:YAG laser (Gl), laser + mouthwash (Glf), and mouthwash + laser (Gfl). Then, the teeth underwent pH cycling according to the standard protocol for demineralization. The microhardness of the teeth was measured again, and the percentage of change in microhardness was calculated. The amount of calcium released during pH cycling was quantified using atomic absorption spectroscopy. Data were analyzed using one-way ANOVA and Tukey’s test.

Results:

Calcium release (indicative of demineralization) in the Gf, Gfl, and Glf groups was significantly lower than that in the Gc and Gl groups (P<0.05). The reduction in surface microhardness was also the same in the five groups with no significant difference (P>0.05).

Conclusion:

Fluoride mouthwash combined with Er:YAG laser or Er:YAG laser alone cannot decrease the incidence of WSLs around orthodontic brackets compared to fluoride mouthwash alone.

Multifunctional modification of orthodontic adhesives with ZnO quantum dots

OBJECTIVES

To develop a multifunctional orthodontic adhesive (QDA) using ZnO quantum-dots (ZnQDs) as modifier and investigate the antibacterial capability, fluorescence property as well as biocompatibility and bonding property.

METHODS

ZnQDs were synthesized using sol-gel method. XPS, XRD, FT-IR, HRTEM, SAED, DLS and spectrofluorimetry were used to characterize ZnQDs. ZnQDs were incorporated into Transbond XT adhesive paste with 20 %, 30 %, 40 % mass fraction, respectively, to form the multifunctional adhesives (QDAs). Antibacterial capability was evaluated with MTT kit, CFU count and Live/Dead Bacterial Staining Kit. Ultraviolet photography and spectrofluorimetry were used to confirm the fluorescence property of QDAs. Biocompatibility assay was performed on gingival fibroblasts and subcutaneous tissue of rats. Softening in solvent rate, shear bond strength and degree of conversion (DC) were measured.

RESULTS

The synthesized ZnQDs presented excellent crystallinity and fluorescence properties. MTT assay, CFU count and CLSM analysis indicated that QDAs had significant antibacterial activity compared with Transbond XT adhesive paste. CCK-8 assay and Live/Dead cell staining analysis denied the cytotoxicity of QDAs and histological analysis proved that QDAs all had no inflammatory irritation to subcutaneous tissue. Softening in solvent, shear bond strength and DC evaluations indicated that 20 % mixing ratio of ZnQDs could enhance the resistance to degradation without influencing the bond strength and DC. Ultraviolet photography and spectrofluorimetry analysis proved the fluorescence capability of QDAs.

SIGNIFICANCE

ZnQDs can impart antibacterial and fluorescence properties to orthodontic adhesives without affecting biocompatibility and bonding performance. QDAs can be multifunctional orthodontic adhesives to reduce bacterial adhesion around brackets and help orthodontists remove residual adhesives precisely when needed.

Evaluating changes in the color and luminosity of dental enamel after orthodontic treatment: A clinical study

The aims of this clinical study were to evaluate the Color change - ΔE (based on spectrophotometry and visual analysis) and luminosity - L* (based on spectrophotometry) of dental enamel surface (after orthodontic treatment) around the area where orthodontic brackets were fixed, based on different cementing materials such as a resin (R group) and resin-modified glass ionomer cement (RMGIC group). The split-mouth study initially comprised 14 patients. Orthodontic brackets were fixed to the upper central incisors with resin or RMGIC. The color of the buccal surface of each tooth was measured through spectrophotometry and visual examination before the bracket-fixation process. Four individuals were excluded during the follow-up; thus 10 patients were evaluated (n=10). Brackets were removed after 12 months of orthodontic treatment, tooth color measurement and visual examination were performed again, and Adhesive Remaining Index (ARI) was also measured. ΔE and L* results were subjected to Student's t-test and by repeated-measures analysis of variance, respectively (α=0.05). ARI data were analyzed in percentages. There was statistically significant difference in ΔE between groups; the R group showed statistically higher values of L* after orthodontic treatment. ARI of 2 and 3 prevailed in the RMGIC group, whereas the R group presented 0 and 1. After orthodontic treatment, the RMGIC group presented smaller changes in ΔE, and the increase in the white scale was observed on the enamel surface around the area where brackets were fixed in the R group. The visual analysis did not show color change on the evaluated teeth.

Bioinspired Anti-demineralization Enamel Coating for Orthodontics

White spot lesions and enamel cracks are the 2 most prominent diseases that occur after orthodontic treatment and are caused by enamel demineralization from accumulated bacterial biofilms and/or enamel damage caused by the removal of residual adhesive after bracket debonding. Inspired by the self-assembled amelogenin nanoribbons in enamel, we developed an enamel coating with a self-assembling antimicrobial peptide, D-GL13K, to simultaneously reduce demineralization and residual adhesive. The self-assembled amphiphilic nanoribbons significantly increased the hydrophobicity of the etched enamel, which reduced the permeability of the coated enamel surfaces as desired. The antimicrobial activity of this coating was evaluated against Streptococcus mutans by colony-forming unit counting and live/dead assays. The anti-demineralization effect was demonstrated by the reduced demineralization depth analyzed by optical coherence tomography and the increased Vickers hardness. The coatings did not reduce the shear bond strength but significantly reduced the adhesive remnant index score. This bioinspired enamel coating may provide a new strategy for preventing white spot lesions and enamel cracks after orthodontic treatment.

Short-term efficacy of caries resin infiltration during treatment with orthodontic fixed appliances. A randomized controlled trial

OBJECTIVES

Objective of this trial was to assess the masking results in initial caries lesions (ICL) that were resin infiltrated during fixed orthodontic treatment in comparison to contralateral teeth that were fluoridated only.

TRIAL DESIGN

A randomized, controlled, split-mouth trial.

METHODS

Adolescent patients (age range: 12-18 years) with fixed orthodontic appliances who had developed ICL [ICDAS 1 or 2 (International Caries Detection and Assessment System)] during orthodontic treatment were consecutively recruited and randomly assigned to either resin infiltration (Icon) with up to 3 etching procedures (Inf) or to a fluoride varnish (Tiefenfluorid) (FV). Both interventions were performed according to the manufacturer's recommendations. Outcome assessors were blinded to the applied intervention. Primary and secondary outcomes included the evaluation of the appearance of the ICL before (T0) and 1 week after (T1) treatment by digital photographs (ΔE), laser fluorescence readings (DD), and ICDAS scores.

BLINDING

Due to the treatment nature neither the operators nor the patients could be blinded. However, outcome assessors and the statistician were blinded.

RESULTS

Fifteen patients (9 female) with 60 ICL were included (mean age: 14.6 years). At baseline FV and Inf did not differ significantly in ΔE (median ΔE0,T (25th/75th percentiles):10.7(9.1/20.9): ΔE0,I:13.4(10.3/18.5); P = 0.469), DD (P = 0.867) and ICDAS (P = 0.521). One-week after treatment (T1) ΔE values (P < 0.001), DD values (P < 0.001), and ICDAS scores (P = 0.014) for Inf were significantly reduced, whereas ΔE values (P = 0.125) and ICDAS scores (P = 0.073) for FV remained unchanged.

LIMITATION

Natural remineralizing in the standard interventional control group cannot be observed yet, since up to 6 months are needed to naturally remineralize ICL.

CONCLUSIONS

Based on our short-term data, resin infiltration effectively masked ICL during treatment with fixed orthodontic appliances. Fluoridation was not able to immediately improve the visual appearance of ICL. Further longer-term assessment should focus not only on the aesthetic outcome, but also on the caries inhibitory effect of resin infiltration during treatment with fixed orthodontic appliances.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS-ID: DRKS00011797).