Enamel demineralization around metal and ceramic brackets: an in vitro study

Naif A Almosa, Beshayer S Sibai, Olla A Rejjal, Nasser Alqahtani, Naif A Almosa, Beshayer S Sibai, Olla A Rejjal, Nasser Alqahtani

Abstract

Aim: To evaluate the degree of enamel demineralization of teeth bonded with ceramic and metal brackets.

Materials and methods: In this cross-sectional experimental in vitro study, 60 extracted human premolar teeth were selected according to the experimental criteria. They were divided into three groups; 20 premolar teeth in each group. Teeth in group 1 were bonded with "ceramic brackets", and teeth in group 2 were bonded with "metal brackets", while teeth in group 3 served as the "control group" without any brackets. Teeth in all groups were then immersed in demineralization media, de-bonded, sectioned into three parts (proximal 1, middle, and proximal 2), and evaluated to determine the level of enamel demineralization under a Scanning Electron Microscope.

Results: On tooth level, the results show that the control group has significantly less enamel demineralization compared to the other two experimental groups, with mean values of 145.3 µm and 192.7 µm, respectively (P=0.000). The mean value of enamel demineralization in the metal group is 55.93 µm, compared to 72.55 µm in the ceramic group, which is significantly less (P≤0.05), while there is no difference between the control and metal group with regard to enamel demineralization. On section level, the control group has significantly less enamel demineralization in all three sections compared to the ceramic group, while a significant difference is found in one of the proximal sections when compared with the metal group. Moreover, the ceramic group has significantly higher enamel demineralization in the middle section compared to the metal group (73.54 µm, 46.5 µm, respectively) (P=0.000), while there is no statistical significant difference between the two experimental groups in proximal sections.

Conclusion: In vitro, non-bonded teeth show least demineralization compared to the bonded teeth. Teeth bonded with ceramic brackets show significantly higher enamel demineralization compared to teeth bonded with metal brackets.

Keywords: adhesive; ceramic; decalcification; demineralization; metal; orthodontic brackets; orthodontic material; white spot lesions.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Low speed, double-sided diamond disk (ISOMET 2000 Precisions SAW).
Figure 2
Figure 2
Sectioned tooth (proximal 1, middle, proximal 2).
Figure 3
Figure 3
Sample of a sectioned tooth bonded with (A) ceramic, (B) metal, and (C) control under SEM. Abbreviation: SEM, Scanning Electron Microscopy.
Figure 4
Figure 4
Comparing enamel demineralization between ceramic and control groups in three different sections. Note:**Statistically significant difference.
Figure 5
Figure 5
Comparing enamel demineralization between the control and metal groups in three different sections. Note:*Statistically significant difference.
Figure 6
Figure 6
Comparing enamel demineralization between the ceramic and metal groups in three different sections. Note:**Statistically significant difference.

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