Comparative Study of Strategies to Reduce Demineralization around Orthodontic Brackets

Objectives: Demineralization around orthodontic brackets presents clinical and esthetic concerns to both patients and practitioners. This study aimed to compare the effectiveness of existing methods for preventing whitespot formation during orthodontic treatment in order to identify the most practical method for application in orthodontic treatment. Methods: 144 human tooth blocks were used. An orthodontic bracket was bonded to each block using composite resin. Blocks were randomly assigned to 12 groups based on the treatment to each group. 5% Sodium fluoride varnish (A-Brushed twice daily, B-Not brushed), 1.1% fluoride (Prevident^©) toothpaste (C-Brushed), Pro-seal^© sealant (D-Brushed, E-not brushed), MI Paste^© (F-Brushed, G-not brushed), 0.5% fluoride (ACT) mouthrinse (H-Brushed, I-Not brushed), Bracket with elastomeric (e-ring) ring (J-Brushed, K-not brushed), Self-ligating bracket (L-Brushed). The bracket-bearing blocks were exposed to mixed-organism (Streptoccocus mutans and Lactobacillus acidophilus) continuous flow biofilm model (artificial mouth system) at 37ºC for 28 days. Demineralization around the brackets was measured by quantifying the integrated fluorescent loss (DQ) using Quantitative Light-Induced Fluorescence (QLF). Intra-group paired-wise statistical analysis compared difference in brushed and non-brushed groups (n=12/group, α=0.05), while inter-group multiple analyses evaluated difference in mean DQ among the treatment groups, combining both brushed and non-brushed in each treatment group (n=24/group). Results: No statistically significant difference between brushed and non-brushed groups except with fluoride varnish groups (Non-brushed varnish statistically more protective than brushed). Inter-group comparison showed all groups to be more protective than e-ring (no treatment) groups. No difference between Self-ligating and e-ring groups, and between Varnish, Prevident, MIP and ACT groups. Conclusion: Using adjunct prevention method, in addition to good oral hygiene, provides greater protection against whitespot formation. An overall ranking of protection against demineralization is as follows:

Pro-seal > (Non-Brushed varnish > Brushed Varnish = Prevident = MIP = ACT) > Speed = E-ring.