title: Prevention of demineralization around orthodontic brackets in vitro.
abstract: BACKGROUND
  The demineralization of enamel adjacent to orthodontic brackets is a significant clinical problem. The purpose of this in-vitro study was to investigate the effect of sodium fluoride (Colgate Neutrafluor 9000 ppm) (NaF) and 10% casein phosphopeptide-amorphous calcium phosphate (GC Tooth Mousse) (TM) on enamel demineralization adjacent to orthodontic brackets.
  
  
  METHODS
  Forty specimens were sectioned from the buccal or lingual surfaces of extracted sound third molars. Twenty specimens had molar tubes bonded with composite resin (Transbond XT, 3M, St Paul, Minn) (CR), and 20 were bonded with resin-modified glass ionomer cement (Fuji Ortho LC, GC America, Alsip, Ill) (RMGIC). A 2-mm window for enamel demineralization was prepared. The specimens were randomly divided into 4 treatment groups: control, TM, TM/NaF (50/50 w/w), and NaF. The treatment solutions were placed around the bracket margins, and the specimens were immersed inverted into a carbopol demineralization solution at 37 degrees C. The enamel specimens were exposed for 96 hours, with the demineralization and topical solutions changed every 4 hours. Quantitative light-induced fluorescence (QLF) images were taken every 8 hours under controlled conditions. The difference in fluorescence (DeltaF) and the proportional DeltaF (%F) change between baseline and 96 hours was calculated.
  
  
  RESULTS
  RMGIC significantly reduced DeltaF and %F when compared with CR (ANOVA, P = .029 and P = .034, respectively). Application of TM with CR, NaF with CR, and TM/NaF with CR significantly reduced DeltaF and %F compared with the control CR (Tukey post-hoc test, P <.001). Application of TM/NaF with RMGIC significantly reduced DeltaF and %F compared with the control RMGIC (Tukey post-hoc test, P = .008, P = .019, respectively).
  
  
  CONCLUSIONS
  With the limitations of any in-vitro study, the following clinical conclusions can be drawn. The use of RMGIC alone can significantly decrease enamel demineralization compared with CR. The application of TM/NaF can provide significant additional prevention of enamel demineralization when RMGIC is used for bonding. The application of TM, NaF, or TM/NaF can significantly prevent enamel demineralization when CR is used for bonding. The use of both agents should be recommended for any at-risk orthodontic patient to provide preventive actions and potentially remineralize early (subclinical) enamel demineralization.
authors.affiliation: School of Dental Science, University of Melbourne, Victoria, Australia.
authors.forename: Theresia Rini
authors.initials: TR
authors.lastname: Sudjalim
authors.forename: Michael Geoffrey
authors.initials: MG
authors.lastname: Woods
authors.forename: David John
authors.initials: DJ
authors.lastname: Manton
authors.forename: Eric C
authors.initials: EC
authors.lastname: Reynolds
mesh_terms: D000180:Acrylic Resins; D000538:Aluminum Silicates; D000704:Analysis of Variance; D002327:Cariostatic Agents / Q000627:therapeutic use*; D002364:Caseins / Q000627:therapeutic use; D002484:Cementation / Q000379:methods; D003732:Dental Caries Activity Tests; D003743:Dental Enamel / Q000473:pathology; D005453:Fluorescence; D005899:Glass Ionomer Cements; D006801:Humans; D008027:Light; D008963:Molar; D016910:Orthodontic Brackets / Q000009:adverse effects*; D019279:Resin Cements; D012969:Sodium Fluoride / Q000627:therapeutic use*; D017001:Tooth Demineralization / Q000209:etiology / Q000517:prevention & control*
chemical_list: D000180:Acrylic Resins; D000538:Aluminum Silicates; D002327:Cariostatic Agents; D002364:Caseins; C095451:Fuji Ortho LC; D005899:Glass Ionomer Cements; D019279:Resin Cements; C477790:Transbond XT; C447032:casein phosphopeptide-amorphous calcium phosphate nanocomplex; D012969:Sodium Fluoride