Comparison of the effect of three cements on prevention of enamel demineralization adjacent to orthodontic bands

White Spot Lesions in Fixed Orthodontics: A Literature Review on Etiology, Prevention, and Treatment

White spot lesions (WSLs) are a common complication after treatment using fixed orthodontic appliances. Decalcification of enamel surrounding fixed orthodontic appliances, known as WSLs, poses a significant aesthetic difficulty during and after treatment, as the purpose of fixed orthodontic therapy is to improve facial and dental appearance. Modern dentistry utilizes remineralization therapies to non-invasively treat WSLs to prevent the progression of disease and enhance the strength, appearance, and functionality of the affected tooth. This review aims to identify and assess the etiology, formation, and risk factors, as well as current treatment approaches used in achieving WSLs remineralization, induced by fixed orthodontic appliances. An electronic search on the PubMed and ScienceDirect databases was performed using a selected keyword. A total of 172 studies (from 2013 to 2023) were retrieved. Their references were also checked to find other relevant studies. Duplicate copies were excluded. After the abstract and full-text screening, only 39 studies were included. Even though numerous studies address the different treatment modalities for managing post-orthodontic WSLs, such as antiseptics; fluorides such as dentifrices, mouthwash, and varnish, and remineralizing agents such as casein phosphopeptides amorphous calcium phosphate, biomimetic self-assembling peptides, lasers, bleaching, microabrasion, and resin infiltration. There is a lack of evidence-based studies that examine the long-term effects of WSL treatment. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

Antimicrobial properties, mechanics, and fluoride release of ionomeric cements modified by red propolis

OBJECTIVES

To evaluate the antimicrobial activity, mechanical properties, and fluoride release capacity of glass ionomer cement (GIC) used for cementing orthodontic bands and modified by ethanolic extract of red propolis (EERP) in different concentrations.

MATERIALS AND METHODS

Two orthodontic GICs containing EERP at 10%, 25%, and 50%, were used. The following assays were carried out: cell viability tests against Streptococcus mutans and Candida albicans, diametral tensile strength, compressive strength, shear bond strength, microhardness, and fluoride release capacity. The statistical analyses of the antimicrobial tests, fluoride release, diametral tensile strength, compressive strength, and microhardness were performed using two-way analysis of variance and Tukey test (P < .05). Shear bond strength data were analyzed using one-way analysis of variance followed by Tukey test (P < .05).

RESULTS

At the concentrations of 25% and 50%, EERP was shown to be a promising antimicrobial agent incorporated into GICs against C albicans (P < .001) and S mutans (P < .001). The fluoride release capacity of the GICs was not affected, and the EERP concentration of 25% was the one that least affected the mechanical properties of the cements (P > .05).

CONCLUSIONS

The GICs containing EERP at 25% showed a significant increase in their antimicrobial activity against S mutans and C albicans, while mechanical properties and fluoride release remained without significant changes.

Novel Protein-Repellent and Antibacterial Resins and Cements to Inhibit Lesions and Protect Teeth

Orthodontic treatment is increasingly popular as people worldwide seek esthetics and better quality of life. In orthodontic treatment, complex appliances and retainers are placed in the patients’ mouths for at least one year, which often lead to biofilm plaque accumulation. This in turn increases the caries-inducing bacteria, decreases the pH of the retained plaque on an enamel surface, and causes white spot lesions (WSLs) in enamel. This article reviews the cutting-edge research on a new class of bioactive and therapeutic dental resins, cements, and adhesives that can inhibit biofilms and protect tooth structures. The novel approaches include the use of protein-repellent and anticaries polymeric dental cements containing 2-methacryloyloxyethyl phosphorylcholine (MPC) and dimethylaminododecyl methacrylate (DMAHDM); multifunctional resins that can inhibit enamel demineralization; protein-repellent and self-etching adhesives to greatly reduce oral biofilm growth; and novel polymethyl methacrylate resins to suppress oral biofilms and acid production. These new materials could reduce biofilm attachment, raise local biofilm pH, and facilitate the remineralization to protect the teeth. This novel class of dental resin with dual benefits of antibacterial and protein-repellent capabilities has the potential for a wide range of dental and biomedical applications to inhibit bacterial infection and protect the tissues.

Efficacy of Glass Ionomer Cements for Prevention of White Spot Lesions During Orthodontic Banding: A Randomized Clinical Trial

OBJECTIVES

This study aimed to compare the incidence of white spot lesions (WSLs) around orthodontic bands following the application of two glass ionomer (GI) cements namely GC Gold Label and GC Fuji Plus for six to 12 months.

MATERIALS AND METHODS

A total of 186 permanent first molars of orthodontic patients requiring banding of at least two permanent first molars were chosen. The teeth were examined for caries and presence of WSLs by visual inspection and by DIAGNOdent (scores 0-29). Orthodontic bands were randomly cemented to the right or left molars using GC Gold Label or GC Fuji Plus GI cements. Samples were randomly divided into three groups and bands were removed after six, nine and 12 months in groups 1, 2 and 3, respectively. The teeth were then examined for caries and presence of WSLs by visual inspection. DIAGNOdent was used on the buccal and lingual surfaces to determine the presence of WSLs. The data were statistically analyzed using one-way ANOVA, multivariate repeated measures ANOVA, the Kruskal Wallis and the Mann-Whitney tests.

RESULTS

Totally 174 teeth were evaluated. DIAGNOdent scores were not significantly different before cementation and after removal of bands in buccal and lingual surfaces of the teeth in the two cement groups. Lesions simulating WSLs were seen in 21 out of 174 teeth but DIAGNOdent scores were not indicative of caries.

CONCLUSION

Remarkable WSLs were not detected visually or by DIAGNOdent at six, nine or 12 months following the cementation of bands with two GI cements.

Microleakage under orthodontic bands cemented with nano-hydroxyapatite-modified glass ionomer

OBJECTIVES

To estimate the in vivo effect of nano-hydroxyapatite (HA) modification of banding glass-ionomer cement on microleakage under orthodontic bands.

MATERIALS AND METHODS

Eighty noncarious premolars scheduled for extraction in 20 orthodontic patients were randomly divided into four groups. Grouping was based on the ratio of nano-HA (0%, 5%, 10%, 15% by weight) added to the luting glass-ionomer cement (GIC) Ketac-Cem, which was used for cementation of prefabricated micro-etched orthodontic bands. Dye penetration method was used for microleakage evaluation at the cement-band and cement-enamel interfaces. Statistical evaluation was performed with a Kruskal-Wallis test and a Mann-Whitney U-test, and a Bonferroni-adjusted significance level was calculated.

RESULTS

Bands cemented with conventional GIC showed the highest microleakage scores in comparison to those cemented with nano-HA-modified GIC. No significant difference was found between teeth banded with 10% and 15% modified GIC.

CONCLUSIONS

Modification of the banding GIC with 15% nano-HA revealed a positive effect on reducing microleakage around orthodontic bands.