In Vitro Comparison of Fluoride, Magnesium, and Calcium Phosphate Materials on Prevention of White Spot Lesions around Orthodontic Brackets

Selda Lale, Hikmet Solak, Evren Hınçal, Levent Vahdettin, Selda Lale, Hikmet Solak, Evren Hınçal, Levent Vahdettin

Abstract

One common negative side effect of orthodontic treatment with fixed appliances is the development of white spot lesions (WSLs) around brackets. This study is aimed at comparing the efficacy of various oral hygiene practices in preventing enamel demineralization around orthodontic brackets under similar in vitro conditions. The study included 90 extracted bovine incisors, which were randomized into six groups: fluoride toothpaste (FT), nonfluoride toothpaste (NFT), fluoride varnish plus fluoride toothpaste (FV+FT), CPP-ACP varnish plus fluoride toothpaste (CPP-ACP+FT), medical minerals gel plus nonfluoride toothpaste (MMG+NFT), and no intervention (control). All groups were subjected to demineralization and remineralization cycles. Visual appraisals were used to evaluate the changes in the enamel surface appearance at the beginning and end of the experiment. The changes in the demineralization degree were evaluated by measuring the Ca+2 concentration in the demineralization solution at different time points. The majority of teeth in the CPP-ACP+FT group exhibited no shift in appearance, whereas in the other groups, a slight change in enamel translucency was observed. At all the time points, the Ca+2 concentration in the demineralization solution in the CPP-ACP+FT group was the least among all other groups. At day 5, MMG+NFT's preventive efficacy was significantly higher than FV+FT's, but at days 10, 15, and 19, their efficacy was similar. However, at all the time points, MMG+NFT's efficacy was significantly higher than that of control, whereas FV+FT's efficacy was decreased at days 10, 15, and 19 and was close to the efficacy of control. To fight WSLs, early diagnosis was of great importance and examination of the tooth surface after air-drying for 5 s was recommended.

Conflict of interest statement

The authors declare that there is no conflict of interest regarding the publication of this paper.

Copyright © 2020 Selda Lale et al.

Figures

Figure 1
Figure 1
Images of teeth before and after bonding the brackets. (a) Before bonding the bracket: nail varnish painted around the exposed enamel surface. (b) After bonding the bracket: exposed enamel around the bracket represents the area of interest.
Figure 2
Figure 2
The experimental procedure of this study.
Figure 3
Figure 3
Frequency distribution plots for the pre- and posttreatment visual scores for (a) control group, (b) FT group, (c) NFT group, (d) FV+FT group, (e) CPP-ACP+FT group, and (f) MMG+NFT group.
Figure 4
Figure 4
Ca loss measurement (mean ± sd; n = 15) plots of treatment groups for (a) day 5, (b) day 10, (c) day 15, and (d) day 19. Different letters are used in pairwise comparisons of groups.

References

    1. Julien K. C., Buschang P. H., Campbell P. M. Prevalence of white spot lesion formation during orthodontic treatment. The Angle Orthodontist. 2013;83(4):641–647. doi: 10.2319/071712-584.1.
    1. Lucchese A., Gherlone E. Prevalence of white-spot lesions before and during orthodontic treatment with fixed appliances. European Journal of Orthodontics. 2013;35(5):664–668. doi: 10.1093/ejo/cjs070.
    1. Tufekci E., Dixon J. S., Gunsolley J., Lindauer S. J. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. The Angle Orthodontist. 2011;81(2):206–210. doi: 10.2319/051710-262.1.
    1. do Nascimento L. E. A. G., Pithon M. M., dos Santos R. L., et al. Colonization of Streptococcus mutans on esthetic brackets: self-ligating vs conventional. American Journal of Orthodontics and Dentofacial Orthopedics. 2013;143(4):S72–S77. doi: 10.1016/j.ajodo.2012.07.017.
    1. Lovrov S., Hertrich K., Hirschfelder U. Enamel demineralization during fixed orthodontic treatment–incidence and correlation to various oral-hygiene parameters. Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopädie. 2007;68(5):353–363. doi: 10.1007/s00056-007-0714-1.
    1. Richter A. E., Arruda A. O., Peters M. C., Sohn W. Incidence of caries lesions among patients treated with comprehensive orthodontics. American Journal of Orthodontics and Dentofacial Orthopedics. 2011;139(5):657–664. doi: 10.1016/j.ajodo.2009.06.037.
    1. Benson P., Shah A., Millett D., Dyer F., Parkin N., Vine R. Fluorides, orthodontics and demineralization: a systematic review. Journal of Orthodontics. 2005;32(2):102–114. doi: 10.1179/146531205225021033.
    1. Hazelrigg C. O., Dean J. A., Fontana M. Fluoride varnish concentration gradient and its effect on enamel demineralization. Pediatric Dentistry. 2003;25(2):119–126.
    1. de Leeuw N. H. Resisting the onset of hydroxyapatite dissolution through the incorporation of fluoride. The Journal of Physical Chemistry B. 2004;108(6):1809–1811. doi: 10.1021/jp036784v.
    1. Vivaldi-Rodrigues G., Demito C. F., Bowman S. J., Ramos A. L. The effectiveness of a fluoride varnish in preventing the development of white spot lesions. World Journal of Orthodontics. 2006;7(2)
    1. Wierichs R. J., Stausberg S., Lausch J., Meyer-Lueckel H., Esteves-Oliveira M. Caries-preventive effect of naf, naf plus tcp, naf plus cpp-acp, and sdf varnishes on sound dentin and artificial dentin caries in vitro. Caries Research. 2018;52(3):199–211. doi: 10.1159/000484483.
    1. Behnan S. M., Arruda A. O., González-Cabezas C., Sohn W., Peters M. C. In-vitro evaluation of various treatments to prevent demineralization next to orthodontic brackets. American Journal of Orthodontics and Dentofacial Orthopedics. 2010;138(6):712.e1–712.e7. doi: 10.1016/j.ajodo.2010.05.014.
    1. Demito C., Vivaldi-Rodrigues G., Ramos A., Bowman S. The efficacy of a fluoride varnish in reducing enamel demineralization adjacent to orthodontic brackets: an in vitro study. Orthodontics & Craniofacial Research. 2004;7(4):205–210. doi: 10.1111/j.1601-6343.2004.00305.x.
    1. Farhadian N., Miresmaeili A., Eslami B., Mehrabi S. Effect of fluoride varnish on enamel demineralization around brackets: An in- vivo study. American Journal of Orthodontics and Dentofacial Orthopedics. 2008;133(4):S95–S98. doi: 10.1016/j.ajodo.2006.09.050.
    1. Reynolds E. Casein phosphopeptide-amorphous calcium phosphate: the scientific evidence. Advances in Dental Research. 2009;21(1):25–29. doi: 10.1177/0895937409335619.
    1. Nongonierma A. B., FitzGerald R. J. Biofunctional properties of caseinophosphopeptides in the oral cavity. Caries Research. 2012;46(3):234–267. doi: 10.1159/000338381.
    1. Cochrane N., Shen P., Yuan Y., Reynolds E. Ion release from calcium and fluoride containing dental varnishes. Australian Dental Journal. 2014;59(1):100–105. doi: 10.1111/adj.12144.
    1. Shen P., Bagheri R., Walker G., et al. Effect of calcium phosphate addition to fluoride containing dental varnishes on enamel demineralization. Australian Dental Journal. 2016;61(3):357–365. doi: 10.1111/adj.12385.
    1. Tuloglu N., Bayrak S., Tunc E. S., Ozer F. Effect of fluoride varnish with added casein phosphopeptide-amorphous calcium phosphate on the acid resistance of the primary enamel. BMC Oral Health. 2016;16(1):p. 103. doi: 10.1186/s12903-016-0299-4.
    1. Rechmann P., Bekmezian S., Rechmann B. M. T., Chaffee B. W., Featherstone J. D. B. MI Varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial. Clinical Oral Investigations. 2018;22(6):2229–2239. doi: 10.1007/s00784-017-2314-9.
    1. Wang X., Megert B., Hellwig E., Neuhaus K., Lussi A. Preventing erosion with novel agents. Journal of Dentistry. 2011;39(2):163–170.
    1. Ganss C., Von Hinckeldey J., Tolle A., Schulze K., Klimek J., Schlueter N. Efficacy of the stannous ion and a biopolymer in toothpastes on enamel erosion/abrasion. Journal of Dentistry. 2012;40(12):1036–1043. doi: 10.1016/j.jdent.2012.08.005.
    1. Buzalaf M. A. R., Magalhães A. C., Wiegand A. Erosive Tooth Wear. Volume 25. Karger Publishers; 2014. Alternatives to fluoride in the prevention and treatment of dental erosion; pp. 244–252.
    1. Kunin A. A., Belenova I. A., Kupets T. V. Evaluating the effectiveness of structural and metabolic tooth enamel reparation by magnesium-calcium remineralizing complex. EPMA Journal. 2014;5, article A122 doi: 10.1186/1878-5085-5-S1-A122.
    1. Ekstrand K., Ricketts D., Kidd E. Reproducibility and accuracy of three methods for assessment of demineralization depth of the occlusal surface: an in vitro examination. Caries Research. 1997;31(3):224–231. doi: 10.1159/000262404.
    1. Kajalkar R. V., Gaikwad A. D. Colorimetry based calcium measurement. International Journal of Engineering Research and Development. 2013;7(8):8–11.
    1. Munshi A., Reddy N., Shetty V. A comparitive evaluation of three fluoride varnishes: an in-vitro study. Journal-Indian Society of Pedodontics and Preventive Dentistry. 2001;19(3):92–102.
    1. Bourguignon C., Dupuy A. M., Coste T., Michel F., Cristol J. P. Evaluation of NM-BAPTA method for plasma total calcium measurement on Cobas 8000®. Clinical Biochemistry. 2014;47(7-8):636–639. doi: 10.1016/j.clinbiochem.2013.12.027.
    1. Pinto de Souza S. C. T., Araújo K. C., Barbosa J. R., Cancio V., Rocha A. A., Tostes M. A. Effect of dentifrice containing fTCP, CPP-ACP and fluoride in the prevention of enamel demineralization. Acta Odontologica Scandinavica. 2018;76(3):188–194. doi: 10.1080/00016357.2017.1401658.
    1. Pithon M. M., dos Santos M. J., Andrade C. S. S., et al. Effectiveness of varnish with CPP–ACP in prevention of caries lesions around orthodontic brackets: an OCT evaluation. European Journal of Orthodontics. 2015;37(2):177–182. doi: 10.1093/ejo/cju031.
    1. Featherstone J., Mellberg J. Relative rates of progress of artificial carious lesions in bovine, ovine and human enamel. Caries Research. 1981;15(1):109–114. doi: 10.1159/000260508.
    1. Worawongvasu R. A scanning electron microscopic study of enamel surfaces of incipient caries. Ultrastructural Pathology. 2015;39(6):408–412. doi: 10.3109/01913123.2015.1060284.
    1. Øgaard B. Seminars in orthodontics: 2008. Elsevier; 2008. White spot lesions during orthodontic treatment: mechanisms and fluoride preventive aspects; pp. 183–193.
    1. Robinson C., Shore R. C., Brookes S. J., Strafford S., Wood S. R., Kirkham J. The chemistry of enamel caries. Critical Reviews in Oral Biology & Medicine. 2000;11(4):481–495. doi: 10.1177/10454411000110040601.
    1. Dowker S. E. P., Anderson P., Elliott J. C., Gao X. J. Crystal chemistry and dissolution of calcium phosphate in dental enamel. Mineralogical Magazine. 1999;63(6):791–800. doi: 10.1180/002646199548934.
    1. Du M., Cheng N., Tai B., Jiang H., Li J., Bian Z. Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment. Clinical Oral Investigations. 2012;16(2):463–468. doi: 10.1007/s00784-011-0520-4.
    1. Lopatiene K., Borisovaite M., Lapenaite E. Prevention and treatment of white spot lesions during and after treatment with fixed orthodontic appliances: a systematic literature review. Journal of Oral and Maxillofacial Research. 2016;7(2, article e1) doi: 10.5037/jomr.2016.7201.
    1. Uysal T., Amasyali M., Koyuturk A., Ozcan S. Effects of different topical agents on enamel demineralization around orthodontic brackets: an in vivo and in vitro study. Australian Dental Journal. 2010;55(3):268–274. doi: 10.1111/j.1834-7819.2010.01233.x.
    1. Chadwick B. L., Roy J., Knox J., Treasure E. T. The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances: a systematic review. American Journal of Orthodontics and Dentofacial Orthopedics. 2005;128(5):601–6; quiz 670. doi: 10.1016/j.ajodo.2004.07.049.
    1. Wegehaupt F. J., Schleich J., Hamza B., Wiedemeier D., Attin T. Performance of a newly developed mineral gel system on erosive and erosive/abrasive enamel loss. An in vitro study. Swiss Dental Journal. 2018;128(10):790–797.
    1. Aoba T. The effect of fluoride on apatite structure and growth. Critical Reviews in Oral Biology & Medicine. 1997;8(2):136–153. doi: 10.1177/10454411970080020301.
    1. Memarpour M., Fakhraei E., Dadaein S., Vossoughi M. Efficacy of fluoride varnish and casein phosphopeptide-amorphous calcium phosphate for remineralization of primary teeth: a randomized clinical trial. Medical Principles and Practice. 2015;24(3):231–237. doi: 10.1159/000379750.
    1. Huang G. J., Roloff-Chiang B., Mills B. E., et al. Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics. 2013;143(1):31–41. doi: 10.1016/j.ajodo.2012.09.007.
    1. Øgaard B. Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment. American Journal of Orthodontics and Dentofacial Orthopedics. 1989;96(5):423–427. doi: 10.1016/0889-5406(89)90327-2.
    1. Linton J. L. Quantitative measurements of remineralization of incipient caries. American Journal of Orthodontics and Dentofacial Orthopedics. 1996;110(6):590–597. doi: 10.1016/s0889-5406(96)80034-5.
    1. Stecksén-Blicks C., Renfors G., Oscarson N., Bergstrand F., Twetman S. Caries-preventive effectiveness of a fluoride varnish: a randomized controlled trial in adolescents with fixed orthodontic appliances. Caries Research. 2007;41(6):455–459. doi: 10.1159/000107932.
    1. Schemehorn B., Wood G., McHale W., Winston A. Comparison of fluoride uptake into tooth enamel from two fluoride varnishes containing different calcium phosphate sources. Journal of Clinical Dentistry. 2011;22(2):51–54.
    1. Guclu Z. A., Alacam A., Coleman N. J. A 12-week assessment of the treatment of white spot lesions with CPP-ACP paste and/or fluoride varnish. BioMed Research International. 2016;2016:9. doi: 10.1155/2016/8357621.8357621
    1. Mohd Said S. N., Ekambaram M., Yiu C. K. Effect of different fluoride varnishes on remineralization of artificial enamel carious lesions. International Journal of Paediatric Dentistry. 2017;27(3):163–173. doi: 10.1111/ipd.12243.

Source: PubMed

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