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This study aimed to evaluate the effectiveness of different pain mitigation methods during orthodontic debonding and to evaluate pain sensitivity across various regions of the dentition. A total of 144 participants (50 males and 94 females) with metal brackets were randomly assigned to one of four groups: High-Frequency Vibration (V), Cotton Roll (CR), Elastomeric Wafer (EW), and Open Mouth group (OM). Pain levels were measured using the Visual Analog Scale (VAS) across different sextants of the dentition. The Kruskal-Wallis test and post hoc analyses were conducted to compare VAS scores between groups. The Mann-Whitney test was used to analyse sex-based differences. The V group, utilizing high-frequency vibration, had the lowest total VAS score, indicating superior pain relief compared to CR, EW, and OM groups. No significant difference was observed between the CR and EW groups. Median VAS scores were highest in the lower front sextant, followed by the upper front sextants, and lowest in the posterior regions, indicating greater pain sensitivity in the anterior regions during debonding. High-frequency vibration was the most effective method for reducing pain during orthodontic debonding, particularly in the anterior dental regions. Both CR and EW methods were also effective but to a lesser extent. These findings suggest that high-frequency vibration could significantly improve patient comfort during orthodontic procedures. Utilizing high-frequency vibration for orthodontic debonding can enhance patient comfort, especially in the more sensitive anterior dental regions, thereby potentially improving treatment compliance and experience.Trial registration: NCT05904587., (© 2024. The Author(s).)

Objective: To compare the levels of functional impairments, discomfort and satisfaction experienced by those treated with full-mouth customized lingual appliances (Lingual appliances), full-mouth self-ligating bracket (Labial appliances), or upper lingual and lower labial appliances (Mixed appliances) using questionnaires., Materials and Methods: Patients within one year of the end of treatment were included in the survey and given a questionnaire concerning different kinds of discomfort and difficulties during the treatment process. The questionnaires focused on the following aspects including speech difficulty, pain (lip, cheek or tongue), difficulty in chewing, difficulty in tooth brushing and overall aesthetics and comfortability. Ordinary one-way ANOVA Tukey's multiple comparison tests and Kruskal-Wallis tests were employed to analyze the data., Results: A total of 115 patients participated in the study. In terms of functional impairments and discomfort, the rate and degree of speech difficulty was significantly higher in the Lingual appliances Group than that in the Labial appliances Group. But there was no difference among the three groups for difficulty in chewing and tooth brushing. Both lingual and labial appliances caused a similar level of overall pain, however, those treated with lingual appliances experienced more tongue pain, and those treated with labial appliances experienced more cheek and lip pain. The most common sites of irritation were the tongue lateral and tongue tip in the Lingual appliances Group, tongue lateral and cheek in the Mixed appliances Group, and cheek and lower lip in the Labial appliances Group. In total, patients gave highest scores to mixed appliances for comfortability and lowest scores to labial appliances for aesthetics when it came to satisfaction., Conclusions: Lingual and labial appliances caused similar level of overall pain. Taking into account the overall comfortability, aesthetics and cost, the mixed appliances may be suitable for some patients who have aesthetic and comfort pursuits., (© 2024. The Author(s).)

Introduction: Fixed orthodontic appliances create areas of plaque stagnation leading to an increase in the volume, structure, and composition of plaque. This increases the chances of decalcification and white spot lesions. Oil pulling, an ancient practice involving swishing oil in the mouth, has demonstrated a significant reduction in plaque scores after 45 days, and a reduction in salivary Streptococcus mutans concentration in few studies done in nonorthodontic subjects. The aim was to compare the concentration of S. mutans in plaque around orthodontic brackets in patients using oil pulling with sesame oil and those on routine oral hygiene., Subjects and Methods: Twenty subjects requiring fixed orthodontic treatment were divided into two equal groups: Group A-Oil pulling and Group B-Control. All subjects were instructed to follow common oral hygiene methods and in addition, Group A was instructed to perform oil pulling for 30 days starting 1 month after placement of fixed appliances. Plaque specimens were collected from labial surfaces of maxillary lateral incisors and quantification of S. mutans was done using real-time polymerase chain reaction. Mean and standard deviations for descriptive statistics, paired, and unpaired sample t-tests were analyzed., Results: Comparison of S. mutans concentration between T1 and T2 demonstrated a significant difference in both control and study groups. The experimental group showed significantly lesser S. mutans concentration compared to the control group., Conclusions: Oil-pulling therapy with sesame oil resulted in a statistically significant reduction in the concentration of S. mutans in the plaque around orthodontic brackets., (Copyright © 2024 Copyright: © 2024 Journal of Indian Society of Pedodontics and Preventive Dentistry.)

Aims: This study aimed to assess the effect of G-CEM, a fluoride-releasing cement, on the development of white spot lesions (WSLs) and their severity around orthodontic brackets., Methods and Materials: This case-control study was conducted by reviewing 140 dental records of fixed orthodontic patients presenting to an orthodontic clinic. The patients were assigned to two groups ( n = 70). In group 1, Transbond XT resin cement, and in group 2, G-CEM had been used for bracket bonding. The frequency and severity of WSLs in each group were evaluated by assessing the available post-treatment photographs of patients and notes left by their orthodontist in their records in this regard. The number of teeth with WSLs in each patient was recorded, and the severity of lesions was categorised by Gorelick's analysis., Statistical Analysis: Comparisons were made using independent t -test, Wilcoxon test and Mann-Whitney test (alpha = 0.05)., Results: In both the maxilla and mandible, the prevalence of WSLs was significantly higher in the Transbond XT group than in the G-CEM group ( P = 0.01). The difference in frequency of WSLs between the maxilla and mandible was not significant within each group ( P > 0.05). Tooth #22 had the highest frequency of WSLs (11.4%) in the Transbond XT group, while teeth #12 and #36 had the highest frequency of WSLs (2.9%) in the G-CEM group. The difference in frequency of WSLs was not significant between males and females ( P > 0.05)., Conclusion: Bracket bonding with G-CEM fluoride-releasing cement significantly reduced the development of WSLs around orthodontic brackets., (Copyright © 2024 Copyright: © 2024 Indian Journal of Dental Research.)

Objective: This study aimed to evaluate enamel surface integrity and time consumed during residual cement removal after bracket debonding using different adhesive removal burs with and without a dental loupe., Material and Methods: Sixty human-extracted premolars were collected, cleaned, mounted, and prepared for orthodontic bracket bonding. Teeth were randomly divided into three main groups (n = 20) based on the adhesive removal method: tungsten carbide system (TC), sof-lex discs system (SD), and diamond system (DB) groups. Then, each group was subdivided into two subgroups (naked eye and magnifying loupe subgroups). The brackets were bonded and then debonded after 24 h, and the Adhesive Remnant Index (ARI) was assessed. The adhesive remnants were removed by different systems, and the final polishing was performed by Silicone OneGloss. The enamel surface roughness was evaluated before bracketing (T0), after residual cement removal (T1), and finally after polishing (T2) using surface Mitutoyo SJ-210 profilometry and Scanning Electron Microscopy (SEM) to determine the Enamel Damage Index (EDI) score. The time consumed for adhesive removal was recorded in seconds., Results: The Kruskal Wallis test showed a statistically significant difference in roughness values at T1 compared to T2 between subgroups (p < 0.001). When comparing EDI at T1 and T2, the Kruskal-Wallis H-test showed statistically significant differences in all subgroups. The pairwise comparisons revealed that EDI scores showed a statistically significant difference at T1 and T2 between DB vs. TC and SD (p = 0.015) but not between TC vs. SD (p = 1.000), indicating the highest roughness value observed in the DB group. The time for cement removal was significantly shorter in the magnifying loupe group than in the naked eye group and was shortest with the TC group, whereas the time was the longest with the DB group (p < 0.05)., Conclusion: All three systems were clinically satisfactory for residual orthodontic adhesive removal. However, TC system produced the lowest enamel roughness, while the DB system created the greatest. The polishing step created smoother surfaces regardless of the systems used for resin removal., (© 2024. The Author(s).)

Objective: To assess the in-vitro effect of single applications of CPP-ACP pastes and different fluoridated solutions on the prevention of dental caries around orthodontic brackets., Material and Methods: Tooth/bracket sets (n=65) were immersed in artificial saliva (1h at 37ºC) and randomly subjected to single applications (100µL; 1min) of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP emulsion), CPP-ACP with fluoride (CPP-ACPF emulsion), solutions of titanium tetrafluoride (TiF4) or sodium fluoride (NaF), or no treatment (CG). Multispecies biofilm (5 x 105 CFU/mL) was formed in the presence of 2% sucrose. After 24 h, the pH and the concentration of total soluble fluoride (TSF) were analyzed by culture medium. The presence of active white spot lesions (WSL) evaluated by macroscopic examination and the percent surface mineral loss (%SML) were analyzed. Also, the topography of enamel was detected by analysis of scanning electron microscopy (SEM). The data was assessed by chi-square, Kruskal-Wallis, and Mann-Whitney tests (p < 0.05)., Results: Fluoride-containing compounds led to a smaller pH reduction than did CPP-ACP and CG (p<0.05). There was difference in TSF between the groups (p<0.05), denoted as TiF4> NaF > CPP-ACPF > CPP-ACP > CG. Regarding the presence of WSL and %SML, the NaF group obtained lower values (p<0.05), while TiF4 and CPP-ACPF were similar (p>0.05). SEM demonstrated that fluoride-free groups had a larger surface dissolution., Conclusion: Fluoridated groups including solutions and CPP-ACPF were more effective than CPP-ACP in reducing enamel demineralization around orthodontic brackets after a single application.

Objectives: The objective of this systematic review and meta-analysis was to evaluate the effect of chewing gum on orthodontic pain and to determine the rate of bracket breakage associated with fixed orthodontic appliances., Methods: This review and its reporting were performed according to the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Six electronic databases were searched up to March 16, 2023, to identify relevant studies that met the inclusion and exclusion criteria. Furthermore, grey literature resources were searched. The Cochrane Collaboration Risk of Bias tool 2 was used to assess the quality of the included studies. Meta-analysis was conducted using RevMan, and sensitivity analysis and publication bias analysis were performed using STATA software. GRADE tool was used to evaluate the certainty of evidence., Results: Fifteen studies with 2116 participants were ultimately included in this review, and 14 studies were included in the meta-analysis. Compared with the blank group, chewing gum had a significant pain relieving effect at all times after fixation of the initial archwire (P ≤ 0.05). No significant difference was found between the chewing gum group and the analgesics group at any timepoints (P > 0.05). Only four studies evaluated the rate of bracket breakage and revealed that chewing gum did not increase the rate of bracket breakage. The sensitivity analysis showed that there was no significant difference in the pooled outcomes after the included studies were removed one at times, and Egger analysis revealed no significant publication bias in included studies (P > 0.05)., Conclusions: Chewing gum is a non-invasive, low-cost and convenient method that has a significant effect on relieving orthodontic pain and has no effect on the rate of bracket breakage. Therefore, chewing gum can be recommended as a suitable substitute for analgesics to reduce orthodontic pain., (© 2023. The Author(s).)

Objective: To establish consensus recommendations for clinicians to manage white spot lesions (WSLs) during orthodontic treatment., Materials and Methods: Three task force members reviewed the literature to identify best practices for minimizing WSLs during orthodontic treatment. Each draft statement was read to the task force members by a facilitator, followed by voting, accepting, or editing if necessary. The statements were then sent electronically by an independent third party (Magellan Medical Technology Consultants Inc, Minneapolis, Minn) to a previously formed content validation panel consisting of 20 independent private practitioners and clinical academicians for validation., Results: Twenty-one statements were developed and sent for content validation. While 19 statements achieved a content validation index (CVI) of 0.78, two items did not. These items were edited by the task force members based on qualitative feedback from content validation participants. Each of these revised statements did achieve a CVI of 0.78 on second evaluation from the content validation panelists and therefore were included in this document., Conclusion: To reduce the risk of WSLs, it is essential to implement individualized caries management measures based on a comprehensive assessment of the patient's oral and systemic health. Effective at-home and professional mechanical and chemical plaque control should be implemented for high-risk orthodontic patients. Fluoride to support prevention and materials such as orthodontic sealants should also be used to provide a physical barrier around the brackets in high-risk patients. By following these guidelines, orthodontic professionals can help promote oral health and minimize the need for restorative treatment., (© 2023 by The EH Angle Education and Research Foundation, Inc.)

Background: Nowadays bleaching procedures have gained popularity in orthodontic patients. Peroxide and Carbamide acids are the common agents which are used in in-office and at home bleaching techniques. Consequently, the Bonding adhesion to the enamel can be influenced by the orthodontic phase and the residual peroxide might interfere with the polymerization and the adhesion of the brackets. Frequent debonding of the brackets from teeth after the bleaching procedure could cause the lengthening of the therapy and promote irregularities on enamel surface derived from an additional bonding phase of the brackets. The aim of this systematic review is to appraise the influence regarding the effect of the bleaching procedure on the bond strength of orthodontic brackets., Methods: An electronic database search was performed. Search terms included: bleaching, brackets, adhesion; data were extracted and summarized. Risk of bias was assessed using the Chocrane risk of bias tool, adapted for in vitro studies., Results: A total of 8689 articles were screened and 11 studies met the inclusion criteria of this systematic review. 1000 teeth of human and bovine origin were analyzed for the shear bond strength (SBS) of stainless and ceramic brackets after the bleaching treatments. All the authors divided the groups in different subgroups with different bleaching agents and in different concentration. The SBS value allowed to demonstrate the necessity to delay the bonding of the brackets for two weeks after a bleaching treatment and its improvement when tooth mousse or antioxidants agents are used., Conclusions: The SBS values and the delay of the bonding procedure must be considered in dental practice and clinical strategies are necessary in order to avoid drawbacks which could cause the debonding of the brackets after bleaching due to the alterations of the dental substrate, thus interfering with the orthodontic treatments., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: To compare the development of white spot lesions (WSLs) during fixed orthodontic therapy among a conventional three-step bonding system, a self-etching primer bonding system, and a one-step adhesive bonding system., Materials and Methods: Seventy-five patients were randomly allocated into three groups (group 1, conventional bonding system, n = 25; group 2, self-etch primer, n = 25; group 3, primer mixed with adhesive composite, n = 25). Quantitative light-induced fluorescence (QLF) was used to assess WSL parameters. Images were captured and then analyzed before treatment and at 2 months and 4 months after bond up. Lesion area (pixels), mean fluorescence loss (ΔF), and the number of newly developed WSLs were compared within and among the three groups. The significance level was P ≤ .05., Results: The mean increase in lesion area was 31.3 ± 2.8 pixels, 38.4 ± 4.3 pixels, and 119.5 ± 5.3 pixels for groups 1, 2, and 3, respectively (P ≤ .001). For ΔF, the loss was 3.3% ± 0.3%, 4.4% ± 0.2%, and 6.6% ± 0.2% for groups 1, 2, and 3, respectively. These changes were significantly different (P ≤ .01 to P ≤ .001). The incidence of newly developed lesions was 9.5 WSLs in group 1, 10 WSLs in group 2, and 15.9 WSLs in group 3., Conclusions: The lack of primer contributed to the development of a larger number of and more severe WSLs., (© 2023 by the EH Angle Education and Research Foundation, Inc.)

Objectives: To compare the intensity, location, and short-term impact of the periodontal discomfort/pain, as well as the related functional parameters of bite force and masticatory efficiency, between self-ligating and conventional orthodontic appliances., Materials and Methods: In 20 patients referred for orthodontic treatment, samples were collected from the gingival sulcus to evaluate the level of substance P using enzyme-linked immunosorbent assay. Orthodontic devices were randomly bonded, with self-ligating appliances on one side and conventional brackets on the contralateral side. Pain threshold (PT), maximal bite force (MBF), and masticatory efficiency (ME) were assessed using standard validated techniques at the beginning of the treatment and 24 hours post-orthodontic activation with an 0.016-inch nickel-titanium wire., Results: There were no significant differences (P > .05) in the substance P levels, PT, MBF, and ME between the self-ligating and conventional orthodontic appliances., Conclusions: There was no difference between conventional and self-ligating appliances in the parameters of pain: substance P and pressure. Functional aspects, such as pain, discomfort, and masticatory efficiency, should not be considered when making a therapeutic decision regarding the use of self-ligating vs conventional orthodontic appliances., (© 2023 by The EH Angle Education and Research Foundation, Inc.)

Background: White spot lesions (WSLs) are the most common complications of fixed appliance orthodontic treatment., Objectives: To evaluate the effectiveness of calcium fluoride nanoparticles-containing orthodontic primer (nCaF2-primer) in preventing the incidence of WSLs during orthodontic treatment., Trial Design: Single-centre, double-blinded, split-mouth, randomized clinical trial., Methods: The sample involved 31 orthodontic patients (≥12 years). Participants were recruited using a simple nonstratified randomization. Data collection, measurements, and analysis were performed blindly. Outcome measures included comparing the effect of nCaF2-primer with control primer (Transbond) regarding the degree of demineralization (DIAGNOdent pen), Streptococcus mutans (S. mutans) bacterial counting [real-time polymerase chain reaction device (PCR)], and WSLs incidence (pre- and post-operative photographs). The measurements were performed before bonding, 1, 3, and 6 months after bonding and after appliance removal. A two-way repeated measure analysis of variance test (for DIAGNOdent pen scores), and Wilcoxon signed-rank test (for the difference between bacterial counting and WSLs incidence) were used (P < 0.05)., Results: Thirty-one patients were recruited and randomized (mean age 17.9 ± 2.45 years). For the primary outcome (DIAGNOdent pen scores) and secondary outcome of S. mutans counting: 31 patients (310 teeth for each group) were included in scoring at T1 and T3, and 30 patients (300 teeth) were included at T6. While for the photographic scores, 26 patients were included after bracket bonding. The demineralization scores showed significant differences at all-time intervals within the 6 months after bracket bonding which was more noticeable after the first month. There was a significant difference in bacterial count between the two primer groups at the T1 only. Regarding photographic scores, there were no significant differences in the WSLs incidence between the two primers groups after brackets removal. No harm was detected during treatment, except the usual pain/gingival irritation., Conclusions: nCaF2-primer effectively decreased demineralization scores within the 6 months after bracket bonding. Moreover, it significantly reduced S. mutans colonization after the first month. However, the tested primer did not have an extra advantage in preventing WSLs development at the clinical level after appliance removal., Trial Registration: The trial was registered with ClinicalTrials.gov on 8 May 2021 (registration number: NCT04994314)., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Despite the large number of studies on the effect of braces on teeth, there is no information on the dynamics of the state of the ultrastructure of the hard tissues of teeth during orthodontic treatment. The purpose of this study is to examine the state of the hard tissues of the teeth and carry out preventive measures to reduce the risk of complications in the process of orthodontic treatment using a non-removable device. Methods: For the in vitro study, 68 teeth were randomly divided into group A-no prophylactic treatment, and group B-treated with the fluorine varnish Tiefenfluorid. After 35 days, all the teeth were prepared for microscopic examination. The clinical study included 59 patients aged 12-17 years with orthodontic brackets. The split-mouth technique was used. The areas around the bracket of one-half of the oral cavity were treated with Tiefenfluorid every 6 months during the entire treatment period. The teeth of the second half of the oral cavity served as the control group. The data were processed in the SPSS19 package. Results: In vitro and clinical study results showed a statistically significant difference between the prophylactic and control groups of teeth in favor of the prophylactic group, where the statistical significance was p ≤ 0.01.

Background: Before the magnetic resonance imaging (MRI) examination fixed orthodontic devices, such as brackets and wires, cause challenges not only for the orthodontist but also for the radiologist. Essentially, the MRI-safe scan of the fixed orthodontic tools requires a proper guideline in clinical practice. Therefore, this systematic review aimed to examine all aspects of MRI-safe scan, including artifact, thermal, and debonding effects, to identify any existing gaps in knowledge in this regard and develop an evidence-based protocol., Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was used in this study. The clinical question in "PIO" format was: "Does MRI examination influence the temperature of the orthodontic devices, the size of artifacts, and the debonding force in patients who have fixed orthodontic bracket and/or wire?" The search process was carried out in PubMed, PubMed Central, Scopus, and Google Scholar databases. The search resulted in 1310 articles. After selection according to the eligibility criteria, 18 studies were analyzed by two reviewers. The risk of bias was determined using the Quality In Prognosis Studies tool., Results: Out of the eligible 18 studies, 10 articles examined the heating effect, 6 were about the debonding effect, and 11 measured the size of artifact regarding brackets and wires. Considering the quality assessment, the overall levels of evidence were high and medium. The published studies showed that heating and debonding effects during MRI exposure were not hazardous for patients. As some wires revealed higher temperature changes, it is suggested to remove the wire or insert a spacer between the appliances and the oral mucosa. Based on the material, ceramic and plastic brackets caused no relevant artifact and were MRI-safe. Stainless steel brackets and wires resulted in susceptibility artifacts in the orofacial region and could cause distortion in the frontal lobe, orbits, and pituitary gland. The retainer wires showed no relevant artifact., Conclusions: In conclusion, the thermal and debonding effects of the fixed orthodontic brackets and wires were irrelevant or resoluble; however, the size of the artifacts was clinically relevant and determined most significantly the feasibility of fixed brackets and wires in MRI examination., (© 2022. The Author(s).)

Background: The highly prevalent white spot lesions around orthodontic brackets necessitate introducing preventive materials without relying on patient compliance., Objective: To evaluate the antidemineralizing effect of two concentrations of xylitol varnish., Trial Design: Triple-blind, four-arm, parallel-group, single-center, randomized controlled clinical trial., Methods: A total of 120 orthodontic patients were randomly assigned to four groups (n = 30), using a computer-generated randomized block list. The treatment groups were: 10% xylitol, 20% xylitol, 5% fluoride, and placebo. Tooth demineralization was measured with DIAGNOdent at T1 (before treatment), followed by varnish application. At T2 (third month), the varnish was re-applied, and at the third (T2) and sixth (T3) months, and after treatment (T4), the demineralization was measured. The white spot lesion frequency was assessed visually after treatment. The participants, the clinician, and data assessors were all blinded to group assignments., Results: A total of 115 patients underwent per-protocol analyses. At T2, the mean DIAGNOdent numbers in the fluoride and 10% xylitol groups were significantly lower than the placebo group (P = 0.00), with a mean difference of 0.63 (95% CI, 0.15-1.10) and 0.5 (95% CI, 0.04-0.95), respectively. At T3, the fluoride and 10% xylitol groups had significantly lower mineral loss than the placebo group (P=0.046) with a mean difference of 0.52 (95% CI, 0.14-0.89) in the fluoride and 0.45 (95% CI, 0.03-0.86) in the 10% xylitol groups, respectively. However, at T4, only the mean for the 10% xylitol group was significantly different (P=0.049) from the placebo group, with a mean difference of 1.18 (95% CI, 0.42-1.93). Visual assessment showed that after treatment, the prevalence of white spot lesions in the fluoride (P=0.03) and 10% xylitol (P=0.00) groups was less than the placebo group with the odds ratio of 0.67 (95% CI, 0.46-0.96) and 0.43 (95% CI, 0.28-0.64), respectively., Conclusion: The 10% xylitol varnish short-term effects on caries control were significantly greater than 20% xylitol varnish and placebo but similar to fluoride varnish. However, the 10% xylitol long-term effect was almost better than fluoride varnish., Trial Registration: The protocol was registered at IRCT.ir under the code IRCT20180913041032N1., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To compare the efficacy of casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) MI Varnish (GC America, Inc, Alsip, IL) and ProSeal (Reliance Orthodontic Products, Itasca, IL) sealant in preventing the development of white spot lesions (WSLs) in orthodontic patients., Materials and Methods: This prospective randomized clinical trial included 40 orthodontic patients 12-17 years of age. One group had sealants placed on their anterior maxillary teeth, with reapplications every 3 months. The other group had MI Varnish applied every 4-6 weeks. WSL formation and oral hygiene were evaluated at the initial appointment before bonding (T1) and 12 months later (T2). Standardized digital photographs were analyzed using the enamel decalcification index (EDI). Statistical comparisons were made using independent and paired-sample t-tests as well as chi-square tests., Results: In this trial, 43% of patients and 15% of teeth developed new WSLs. Lateral incisors showed the highest incidence of decalcification and WSL formation. WSL formation and EDI score increases during treatment were significantly greater in the gingival region than in the mesial, distal, or incisal regions. Of the EDI scores at T2, 93.8% were 0 and 5.5% were 1. Poor oral hygiene at T2 showed a high positive predictive value (76%) for the development of WSLs. There were no statistically significant between-group differences for the development of WSLs., Conclusions: MI Varnish and ProSeal sealant provided similar levels of protection during the first 12 months of fixed orthodontic treatment. The severity of the WSLs that developed was minimal. WSLs were most likely to develop on lateral incisors and in the gingival regions of teeth, especially among patients with poorer oral hygiene., (© 2022 by The EH Angle Education and Research Foundation, Inc.)

Failure of brackets is a common problem in orthodontics. This affects the treatment time, cost, and compliance of the patient. This study was conducted to estimate the bracket failure rate and the related factors for the long term. Methodology. This ambidirectional cohort study included 150 nonsyndromic orthodontic patients undergoing fixed appliance therapy for the last two years. The same patients were followed for 7 months. Different variables related to bracket failure were evaluated. The available data were analyzed descriptively, and the Kaplan-Meier estimate was used to measure the bracket survival rate from the date of bonding to failure. Results . A total of 180 bracket bond failures in the 150 included patients (52.2% males and 47.8% females) with a median age of 17 years (range 10-25 years). 69% of brackets failures were reported within the first 6 months after bonding. About 58.3% of bracket failure was noticed in adolescent patients before the age of 18 years. The majority of the cohort (81.1%) has good oral hygiene. The failure rate in patients with normal overbite was 41.1%, in decreased overbite cases was 15%, while in deep bite cases the failure rate was 43.9% with a statistically significant difference. Adults show less bracket failure (41.7%) than adolescent patients (58.3%). More bracket failure was noted in the lower arch (55%) than the upper arch (45%), and there were more bond failures posteriorly (61%) than on the anterior teeth (39%). Majority (41.1%) of the bracket failed on round NiTi wires. Conclusion . The bracket failure rate was 6.4%, with most bracket failure occurring in the first 6 months after bonding with individual difference. There was more incidence of bond failure in an increased overbite, adolescents, lower arch, posterior teeth, and lighter alignment wires., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2022 Haris Khan et al.)

Background: To evaluate the difference in root resorption between standard torque self-ligating brackets and high torque self-ligating brackets in bimaxillary protrusion patients after orthodontic treatment., Methods: Pre-treatment and post-treatment Cone beam computed tomography (CBCT) of 32 patients (16 treated with the high torque DamonQ 0.022″ bracket and 16 with the 0.022″ standard torque self-ligating bracket) were selected. The first premolars were extracted from all patients before treatment. After mini-screw implants were inserted into the buccal region between the second premolar and first molar, 150 g of force was applied to retract the upper and lower anterior teeth to close the extraction space on each side. CBCT images of all patients were taken before and after treatment. Three-dimensional reconstruction of the maxillary central incisor, lateral incisor and canine was conducted with Mimics 20.0 software. The volumes of the roots were calculated using Gomagics Studio 12.0 software. The differences between the pre-treatment and post-treatment root volumes were statistically evaluated with a paired-samples t-test., Results: There was no statistically significant difference in root resorption degree between the two kinds of torque brackets. The patient's degree of root resorption in the high torque self-ligating group was greater than that in the standard torque group., Conclusions: There was no significant difference in root external apical resorption between the high torque self-ligating brackets and the standard torque self-ligating brackets in bimaxillary protrusion patients., (© 2022. The Author(s).)

This retrospective pilot study used a newly developed evaluation tool to assess the prevalence and incidence of White Spot Lesions (WSL) before and after multibracket appliance (MB) therapy. Digital photographs of 121 adolescent patients (63 ♂, 58 ♀) with metal brackets were analyzed retrospectively before and after MB therapy. The labial surfaces of anterior teeth, canine teeth, and premolars in the upper (UJ) and lower jaws (LJ) were evaluated using the Enamel Decalcification Index (EDI) by Banks and Richmond (Eur J Orthod, 16(1):19-25, 1994, levels 0-3) and a specially developed digitally scaled graticule with concentric circles to quantify the extent of WSL (in %). The statistical data analysis was based on crosstabulations and logistic regression. Before MB, 69.4% of the patients presented at least one WSL and 97.5% after, an increase of 28.1%. Before MB, 18.4% of the tooth surfaces (TS) showed an EDI level of 1-3. After MB, 51.8% of the TS featured WSL. 18.2% of the TS showed a WSL to the extent of ≥ 20-100% before and 52.3% after MB. The incidence in the UJ (71-79%) as well as the LJ (64-76%) was highest for the first and second premolars and lowest for LJ incisors (22-35%). The probability for developing a new distal WSL is higher than developing gingival, mesial or occlusal WSL. Labial MB therapy drastically increases the risk of developing WSL. We verified a concise quantification of the extent of labial WSL with the evaluation index., (© 2021. The Author(s).)

Background: Fluctuations in pH of saliva during a prolonged treatment course influences the enamel demineralization progress, which is one of the complications of fixed orthodontic treatment. This randomized clinical trial aimed to evaluate and compare the short-term effects of stainless steel (SS) versus elastomeric (EM) ligatures on salivary pH in patients scheduled for fixed orthodontic treatment., Methods: Seventy participants were enrolled in the study (54 female, 16 male) aged 19-36 years who met specific inclusion criteria. They were randomly selected and allocated into two equal groups through computer-generated randomization. All patients received fixed orthodontic treatment using conventional orthodontic brackets. Two commonly used archwire ligature methods were used: SS and EMs. An unstimulated (resting) salivary sample was collected before tying of the ligatures at T0 (baseline), 2 weeks, 6 (weeks), and 12 (weeks). Salivary pH was measured using a digital pH meter. The level of significance was set at p value < 0.05., Results: The salivary pH level was stable between T0 and T1 (6.72 ± 0.14), then significantly and progressively increased from T1 to T2 (6.78 ± 0.13) and from T2 to T3 (6.81 ± 0.14) with (p < 0.05) in the SS group. In the EM group, the salivary pH level was significantly decreased in all follow-up periods; T0 (6.77 ± 0.16), T1 (6.72 ± 0.14), T2 (6.67 ± 0.13) and T3 (6.64 ± 0.13)., Conclusion: The EM ligatures showed a significant decrease in salivary pH to an unfavorable level, which increased the risk of enamel demineralization. Therefore, EMs as ligature material is preferably should not be recommended in patients with high caries index or inadequate oral hygiene. Trial registration ANZCTR.org. (ACTRN12618001647224) http://www.anzctr.org.au/ACTRN12618001647224.aspx . Registration Date: 5/10/2018, "Retrospectively registered"., (© 2021. The Author(s).)

Aim: The aim of the current research was to evaluate the efficacy of different fluoride-releasing bonding products in preventing enamel demineralization around orthodontic brackets by using a scanning electron microscope (SEM)., Materials and Methods: This research was performed using 80 healthy human premolar teeth that were extracted in course of orthodontic therapy. Until use, the sample premolars were subjected to storage in 0.1% thymol. Each premolar was thereafter cleansed with pumice for 10 seconds. Stainless steel brackets for premolars were employed. The 80 samples were allocated at random to one of the four groups (20 in each) as follows: Group I, control; group II, Transbond Plus color change adhesive; group III, GC Fuji Ortho LC; and group IV, Vitremer. An hour following bonding, all samples were subjected to pH cycling at a temperature of 37°C for a 14-day period. The premolar teeth were assessed below SEM. Analysis was performed with the one-way analysis of variance. Statistical significance was set at a p -value less than 0.05., Results: The extreme area of demineralization was abridged by the use of Transbond ™ Plus color change adhesive (108.19 ± 0.68), trailed by GC Fuji Ortho LC (119.24 ± 0.37) use, Vitremer (121.56 ± 0.92) as well as the control group (141.88 ± 1.09) in that order. And there was a statistically significant difference found between the groups ( p <0.001). Tukey's honestly significant difference (HSD) was employed in an overall comparison of mean areas of enamel demineralization, which depicted that differences were significant statistically with the exception of group III and group IV., Conclusion: The current research came to a conclusion that the Transbond Plus color change adhesive group was more potent in significant inhibition of demineralization areas in comparison to GC Fuji Ortho LC group and Vitremer group., Clinical Significance: In course of fixed orthodontic therapy, demineralization of enamel is an inherent occurrence. Multiple approaches are being continually developed to avoid the formation of white spot lesions (WSLs) that compromise esthetics and cause deprived remineralization that enhances the menace of dental caries. Bonding agents that can release fluorides are thus considered highly efficacious.

Background: Orthodontic treatment poses an increased risk of plaque accumulation and demineralisation of enamel leading to white spot lesion around the brackets. This parallel arm trial aims to assess the degree of bacterial plaque formation adjacent to orthodontic brackets, following the application of a chitosan-based varnish or chlorhexidene-fluoride varnish., Methods: A total of 200 teeth from 20 patients undergoing fixed orthodontic therapy were assessed and biofilm formation around the brackets were recorded using the Bonded Bracket Index (Plaque index) at baseline and weekly for 6 weeks. The bacterial count and plaque pH at corresponding weekly intervals were also recorded. Following bracket bonding, the patients were cluster randomised to receive chitosan-based varnish-CHS (UNO Gel Bioschell, Germiphene corp., Brantford, Canada) or chlorhexidine-fluoride varnish-CFV (Cervitec F, Ivoclar Vivadent, Schaan, Liechtenstein) every week on the representative teeth respectively. BBI proportions were compared between groups at all time intervals using Chi square test. Mean plaque bacterial count and plaque pH were compared using Mann Whitney U test and Tukey's HSD test respectively., Results: Baseline characteristics were similar between the groups: Mean age was CHS = 23 and CFV = 21; male to female ratio was CHS = 5/5, CFV = 7/3. At the end of 6 weeks, chitosan-based varnish performed equal to chlorhexidine-fluoride varnish (P > 0.05) with 98% and 95% of teeth with acceptable scores respectively. The plaque bacterial count significantly reduced at 6 weeks for both varnish compared to the baseline; The value for CHS was 0.43 ± 0.4 × 10 4 and CFV was 0.77 ± 0.64 × 10 4  CFU (P < 0.05), with no difference between both the varnishes. Both varnishes had no effect on the plaque pH that remained neutral., Conclusion: This trial showed that both chitosan-based varnish and chlorhexidine-fluoride varnish reduced bacterial count, while the plaque pH remained neutral over a period of six weeks in patients undergoing fixed orthodontic therapy. The anti-plaque effects of the natural biopolymeric chitosan-based varnish was similar to that of chlorhexidine-fluoride varnish, a known chemotherapeutic agent. Registration: This trial protocol was registered with https://www.ctri.nic.in (CTRI/2019/05/018896). (Date of registration 02/05/2019)., Protocol: The protocol was not published before trial commencement., (© 2021. The Author(s).)

Objectives: To identify microorganisms isolated from patients wearing fixed orthodontic appliances and to evaluate the resistance of isolated bacterial strains to different antimicrobials., Materials and Methods: Seventeen healthy patients wearing a fixed orthodontic appliance (group 1) and six nonwearers (group 2, control group) were evaluated. The biofilm that formed around the orthodontic brackets was collected, and the samples were then plated in a chromogenic medium (chromIDT, bioMérieux). Colony-forming units (CFUs) were isolated and inoculated in blood-agar medium. Automated biochemical tests (VITEK 2, bioMérieux) were carried out to identify the genus and species of the microorganisms and the resistance provided by 43 drugs (37 antibacterial and 6 antifungal)., Results: The most prevalent microbial genera identified in group 1 were Streptococcus (24.0%), Staphylococcus (20.0%), Enterobacter (12.0%), Geobacillus (12.0%), and Candida (12.0%), and the most frequent species were Enterobacter cloacae complex (13.6%) and Staphylococcus hominis (13.6%). In group 2, the most prevalent genera were Streptococcus (57.1%), Staphylococcus (14.2%), Sphingomonas (14.2%), and Enterobacter (14.2%). With regard to antimicrobial resistance, 14 of 19 (74%) isolated bacterial strains were found to be resistant to at least 1 of the tested antimicrobials., Conclusions: The findings of the present study suggest that patients undergoing orthodontic treatment with fixed appliances have a more complex biofilm with a higher level of bacterial resistance., (© 2021 by The EH Angle Education and Research Foundation, Inc.)

To analyse clinical studies investigating coating agents such as sealants and other bonding materials to prevent the initiation or inhibit the progress of white spot lesions (WSL) during orthodontic treatment with fixed appliances. Electronic databases (Pubmed, CENTRAL, EMBASE) were screened for studies. No language restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Primary outcome included assessment of WSL with visual-tactile assessment and/or laser fluorescence measurements. Twenty-four studies with 1117 patients (age: 11-40 years) and 12,809 teeth were included. Overall, 34 different sealants or bonding materials were analysed. Fourteen studies analysed fluoride and 14 studies non-fluoride releasing materials. Meta-analysis for visual tactile assessment revealed that sealants significantly decreased the initiation of WSL compared to untreated control (RR [95%CI] = 0.70 [0.53; 0.93]; very low level of evidence). Materials releasing fluoride did not decrease initiation of WSL compared to those with no fluoride release (RR [95%CI] = 0.84 [0.70; 1.01]; very low level of evidence). For laser fluorescence measurements no meta-analysis could be performed. The use of sealants seems to be effective in preventing the initiation of post-orthodontic WSL. Furthermore, there is no evidence supporting that fluoride-releasing sealants or bonding materials are more effective than those without fluoride release. No gold standard prevention strategy to prevent WSL during treatment with fixed orthodontic appliances has been established yet. However, based on only a limited number of studies the use of sealants seems to be effective in preventing the initiation of post-orthodontic WSL., (© 2021. The Author(s).)

Background: Topical fluorides are commonly recommended to prevent the development of white spot lesion (WSL) during treatment with fixed orthodontic appliances (FOAs), but the certainty of evidence is low, and long-term effects of fluoride preventive methods to reduce lesions seem to be rare., Objective: To evaluate the long-term effectiveness of professional applications of a fluoride varnish containing 1.5% ammonium fluoride in preventing WSL development in adolescents undergoing multi-bracket orthodontic treatment., Subjects and Methods: We performed a randomized controlled trial in which 166 healthy adolescents (12-18 years) from three different clinics were enrolled and randomly allocated to a test or a placebo group. The randomization was performed by a computer program, generating sequence numbers in blocks of 15. The fluoride varnish or the non-fluoride placebo varnish was applied in a thin layer around the bracket base every sixth week during the course of the orthodontic treatment (mean duration 1.7 years). We scored the prevalence of WSL on the labial surfaces of the maxillary incisors, canines and premolars immediately after debonding (baseline) and approximately 1 year after debonding, from digital photos with aid of a four-step score. The examiners were not involved in the treatment of the patients and blinded for the group assignment., Results: One hundred and forty-eight patients were available at debonding and 142 of them could be re-examined after 1 year (71 in the test and 71 in the placebo group). The 1-year attrition rate was 4.0%. On patient level, the prevalence of post-orthodontic WSLs (score ≥ 2) dropped by over 50% during the follow-up with no significant difference between the groups. On surface level, there were significantly fewer remaining WSLs in the test group compared with the placebo group (4.5% versus 10.4%; relative risk 0.44, 95% confidence interval 0.28-0.68)., Limitations: The compliance with fluoride toothpaste was not checked, and the patients' general dentists may have instigated additional risk-based preventive measures. No cost-benefit analysis was carried out., Conclusions: This follow-up study displayed a small beneficial long-term effect of fluoride varnish in reducing WSL development during treatment with FOA., Registration: NCT03725020., Protocol: The protocol was not published before trial commencement., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: Pain is a problem during bracket removal, and more comfortable treatment is needed. This study examined the association of pain with the removal force required for ceramic brackets, compared with metal and plastic brackets, to determine which removal method resulted in less pain and discomfort., Methodology: 81 subjects (mean age, 25.1 years; 25 males and 56 females) were enrolled, from whom 1,235 brackets (407 ceramic, 432 plastic, and 396 metal) were removed. Measured teeth were distinguished at six segments. Pain was measured with a visual analogue scale (VAS) during the removal of each bracket. An additional grip was placed on the grips of debonding pliers with right-angled beaks; a mini loading cell sensor pinched by the grips was used to measure removal force during debonding. VAS and force values were statistically analyzed. The Kruskal-Wallis test followed by the Mann-Whitney U test with Bonferroni correction were performed for multiple comparisons; multiple regression analysis was also performed., Results: Forces in the upper and lower anterior segments were significantly smaller (p<0.05) than those in the other segments. Pain tended to be greater in the upper and lower anterior segments than in the posterior segments. In all segments, the removal force was greater for metal brackets than for plastic or ceramic brackets. Ceramic brackets caused significantly greater pain than plastic brackets for the upper and lower anterior segments. Debonding force was involved in the brackets, following adjustments for pain, upper left segment, age, and sex., Conclusions: Pain and discomfort are likely to occur during bracket debonding.

Methods: The current study includes 80 extracted premolars of human from the patient visiting for orthodontic treatment of Coorg Institute of Dental Sciences, Karnataka, India. The brackets were debonded using four different methods. The enamel surface damage after the procedure was assessed with the Enamel Surface Index (ESI); similarly, the Adhesive Remnant Index (ARI) score was used to determine the adhesive residual deposit. Scanning electron microscopy (SEM) was used to visualize better microporosities and micromechanical retention of adhesive remnants on the enamel surface. The normality of the data was tested using the Kolmogorov-Smirnov test. Depending upon the normality test result, the one-way ANOVA test or Kruskal-Wallis test was used to test the mean ESI and mean ARI differences among different debonding methods along with the appropriate post hoc tests. The necessary ethical clearance was obtained from the Ethics Committee of the institute., Results: The ultrasonic scaler (US) technique led to more significant enamel surface damage, with 13 (65%) samples in the ESI scores III and IV against the satisfactory surface in 2 (10%) samples with the ligature cutter (LC) technique (ESI-I) reflecting LC as a better technique. The ESI scores (III and IV) for debonding plier (DP) and thermal method (TM) reflected a higher value in 12 (60%) and 10 (50%) samples and caused more damage to the enamel surface as compared to the LC technique. The ARI score was highest (ARI-1 = 40%) with the LC technique, followed by the US (ARI-1 = 20%), TM (ARI-1 = 15%), and DP (ARI-1 = 5%) methods. We have observed a significant association ( p value <0.05) of the ARI score among four different debonding ways in terms of each tooth's residual adhesive after the bracket removal., Conclusion: The result establishes the LC technique as a more acceptable one as it causes minimal harm to the debonded surface. The adhesive left on the debonded area is also minimum as compared to the other three methods tested. Therefore, it can be suggested as an ideal method., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Neelutpal Bora et al.)

Objective: The objective of this split-mouth clinical trial was to compare bonding failure rates of metal brackets bonded with two different light-emitting diode (LED) light-curing lamps with different high-intensity power outputs., Materials and Methods: Forty patients were included for a total of 800 brackets that were randomly bonded (left and right sides in a 1:1 ratio) in maxillary and mandibular arches using two different LED devices. An LED of 3200 mW/cm2 and an LED of 5000 mW/cm2 were used in this split-mouth clinical trial. Bonding failures during the initial 6 months of orthodontic treatment were recorded as maxillary versus mandibular, anterior teeth versus posterior teeth, and left side versus right side., Results: Five dropouts were recorded for discontinuing orthodontic treatment and 700 brackets were analysed in total. The bonding failure rates for 3200 and 5000 mW/cm2 LEDs were 6.0 and 7.4 per cent, respectively (P = 0.450), which were not statistically significantly different. There were no significant differences in bracket survival rates between the LEDs used (P = 0.866). The posterior teeth presented a higher index of bond failures (odds ratio, 3.14; 95% confidence interval, 1.68-5.87; P < 0.001)., Limitations: Direct comparison was only done between two high-intensity LED lights rather than against conventionally used halogen lights., Conclusion: Similar bonding failures were recorded using both LED devices (3200 and 5000 mW/cm2). Significantly more bonding failures occurred in premolar teeth than in anterior teeth., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Introduction: Development of white spot lesions (WSLs) during orthodontic treatment is a common risk factor. Fixation of the orthodontic appliances with glass ionomer cements could reduce the prevalence of WSL's due to their fluoride release capacities. The purpose of this study was to evaluate differences of fluoride release properties from resin-modified and conventional glass ionomer cements (GICs)., Methods: The resin-modified GICs Fuji ORTHO LC (GC Orthodontics), Meron Plus QM (VOCO), as well as the conventional GICs Fuji ORTHO (GC Orthodontics), Meron (VOCO) and Ketac Cem Easymix (3M ESPE) were tested in this study. The different types of GICs were applied to hydroxyapatite discs according to the manufacturer's instructions and stored in a solution of TISAB III (Total Ionic Strength Adjustment Buffer III) and fluoride-free water at 37°C. Fluoride measurements were made after 5 minutes, 2 hours, 24 hours, 14 days, 28 days, 2 months, 3 months and 6 months. One factor analysis of variance (ANOVA) was used for the overall comparison of the cumulative fluoride release (from measurement times of 5 minutes to 6 months) between the different materials with the overall level of significance set to 0.05. Tukey's post hoc test was used for post hoc pairwise comparisons in the cumulative fluoride release between the different materials., Results: The cumulative fluoride release (mean ± sd) in descending order was: Fuji ORTHO LC (221.7 ± 10.29 ppm), Fuji ORTHO (191.5 ± 15.03 ppm), Meron Plus QM (173.0 ± 5.89 ppm), Meron (161.3 ± 7.84 ppm) and Ketac Cem Easymix (154.6 ± 6.09 ppm) within 6 months. Analysis of variance detected a significant difference in the cumulative fluoride release between at least two of the materials (rounded p-value < 0.001). Pairwise analysis with Tukey's post hoc test showed a significant difference in the cumulative fluoride release for all the comparisons except M and MPQM (p = 0.061) and KCE and M (p = 0.517)., Conclusion: Fluoride ions were released cumulatively over the entire test period for all products. When comparing the two products from the same company (Fuji ORTHO LC vs. Fuji ORTHO from GC Orthodontics Europe GmbH and Meron Plus QM vs. Meron from VOCO GmbH, Mannheim, Germany), it can be said that the resin-modified GICs have a higher release than conventional GICs. The highest individual fluoride release of all GICs was at 24 hours. A general statement, whether resin-modified or conventional GICs have a higher release of fluoride cannot be made., Competing Interests: The authors have declared that no competing interests exist.

Background: The mechanism of gingival growth that may occur during fixed orthodontic treatment is not yet fully understood and the amount of dental plaque is often incriminated. The objective of this study was to evaluate the prevalence of gingival growth during multi-attachment orthodontic treatment and to prioritize its predicting factors, especially the quantity of biofilm., Methods: This comprehensive cross-sectional descriptive study was conducted on orthodontic patients aged 9 to 30 years, in good health, treated by a fixed appliance. Periodontal clinical parameters such as plaque index, gingival index, probing pocket depth, periodontal phenotype and gingival enhancement index were recorded. Likewise, the brushing habits and the date of the last scaling were noted. The orthodontic parameters studied were the duration of the treatment, the type of bracket, the alloys used for the arches and the type of ligatures. Descriptive statistics were carried out, and variables presenting p value < 0.25 were included in a multivariate analysis to calculate the Odds Ratio (OR) of gingival enlargement"., Results: A total of 193 patients were included (16.38 ± 4.89 years). Gingival growth occurred for 49.7% of patients included. The predisposing factors for this pathology during fixed orthodontic treatment were conventional metal brackets (p = 0.021), mouth breathing (p = 0.040), male gender (p = 0.035), thick periodontal phenotype (p = 0.043), elastomeric ligations (p = 0.007), duration of treatment (p = 0.022) and presence of plaque (p = 0.004). After achievement of the logistic regression, only two factors remained related to gingival enlargement: metallic brackets (OR: 3.5, 95% CI: 1.1-10.55) and duration of treatment (OR: 2.03, 95% CI: 1.01-4.08). The amount of plaque would not be directly related to the development of gingival increase during orthodontic treatment., Conclusions: Among the predisposing factors that underlie gingival growth during multi-attachment therapy, the amount of plaque is not found. The qualitative assessment of the plaque and its evolution during treatment could clarify the role of the biofilm in the occurrence of gingival overgrowth.

Objective: This study aimed to evaluate the effects of Coca-Cola®, Sprite®, and Maaza® on Microleakage, shear bond strength (SBS) and adhesive remnants underneath orthodontic brackets., Materials and Methods: A total of 192 human premolar teeth were used in this study. The sample was divided into four groups: Artificial saliva (control) [Group 1], Coca-Cola [Group 2], Sprite [Group 3] and Maaza [Group 4]. All the samples were stored in artificial saliva and immersed in their respective testing media (except the control group) for 15 minutes 3 times a day, separated by intervals of 8 hours. The immersion cycle was repeated for 15 days. After the immersion cycle, 24 teeth from each group were tested for SBS and adhesive remnant index subsequently. The remaining 24 teeth from each group underwent dyeing with methylene blue and were analyzed stereomicroscopically to evaluate microleakage underneath the brackets. Kolmogorov-Smirnov and Shapiro normality tests were performed and homogeneity of variance was tested with the Levene test. One-way ANOVA and Kruskal-Wallis tests were carried out separately for SBS, ARI and microleakage. Statistical analyses were performed using SPSS 20 for Windows (SPSS Inc., Chicago) software., Results: Coca-Cola showed a significant reduction in SBS and microleakage (p < 0.05) compared to the other groups. ARI did not show any significant differences between any groups (p > 0.05). The mean microleakage scores were higher for the gingival side of the brackets compared to the incisal side. Both Sprite and Maaza showed significant differences compared to artificial saliva, despite the SBS not being statistically significant (p > 0.05)., Conclusions: A significant reduction of SBS was observed in Coca-Cola while increased microleakage was seen in all three drinks compared to artificial saliva., Competing Interests: None

Background: Conventional brackets are often used during orthodontic therapy of patients with malocclusion. The complex construction of such brackets greatly inhibits oral hygiene, which predisposes to increased carriage of microbiota. Orthodontic brackets could act as reservoir of yeast and predispose to oral candidosis. The aim of this study was to assess Candida prevalence and the role of oral hygiene during fixed appliance therapy. A further aim was to characterize the isolated yeasts according to their ability to form biofilms., Methods: Seventeen participants (average age 17 ± 7 years) were monitored by taking oral rinses and elastomeric ligature samples, and by evaluating the approximal plaque index (API) and gingival bleeding index (GBI) before and after placement of the orthodontic conventional brackets for 12 weeks. Isolated yeasts were counted and biofilm formation was evaluated., Results: One hundred and sixteen samples (67 oral rinses and 49 orthodontic elastomers) were collected. Ten patients (58.8% subjects) were Candida-carriers (two were colonized after bracket placement) and C. albicans was the most common species. The average number of yeasts in the oral cavity showed some fluctuation during the study, but in general had an upward trend (adj. R2 = 0.7967, p = 0.07025). A correlation was found between median number of yeasts and the periodontal indices (API, GBI). The average API values decreased in the Candida-carriers (adj. R 2  = 0.95; p = 0.01709), while average GBI values increased in the noncarriers (adj. R 2  = 0.92; p = 0.0256)., Conclusions: Treatment with orthodontic appliances promotes Candida yeast colonization, which is variable over time in terms of strain and species, with dominance of C. albicans, and without increased biofilm-forming activity. The API value decreases over time in carriers, and the GBI value increases in uncolonized patients, which may have predictive significance for the development of oral candidiasis during orthodontic treatment.

Enamel demineralisation can occur as a side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the efficacy of the self-assembling peptide P 11 -4 for remineralisation combined with fluorides, compared to application of fluoride varnish alone. De- and remineralisation was assessed by Quantitative light-induced fluorescence (QLF). Orthodontic brackets were bonded on 108 human enamel samples and white spot lesions were created. The samples were allocated randomly into three groups: Group I received no treatment, group II had a single application of fluoride varnish (22,600 ppm), and group III was treated with P 11 -4 following a single application of fluoride varnish. Quantitative light-induced fluorescence (QLF) measurements were performed at baseline, after demineralisation and after storage in remineralisation solution for 7 and 30 days. Non-parametric tests (Kruskal-Wallis test and Friedman test) were used for further analysis. After demineralisation, all samples showed a median ΔF -9.38% ± 2.79. After 30 days median ΔF values were as followed: group I = -9.04% ± 2.51, group II = -7.89 ± 2.07, group III = -6.08% ± 2.79). The median ΔF values differed significantly between all groups at all investigation times (p < 0.00001). Application of P 11 -4 with fluoride varnish was superior to the use of fluorides alone for remineralisation of enamel adjacent to brackets.

Introduction: The aim of this two-arm parallel trial was to evaluate enamel demineralization in fixed orthodontic treatment using an indirect bonding technique in comparison to a direct bonding technique by the quantitative light-induced fluorescence (QLF) method., Design, Settings and Participants: Fifty-six patients who needed fixed orthodontic treatment were randomly separated into either the direct bonding group or the indirect bonding group. The presence and extent of lesions on the buccal surfaces of all teeth, except the molar teeth, were assessed. The percentage of fluorescence loss (ΔF and ΔFmax), the degree of demineralization (ΔQ) and lesion area (WS area) were determined using the system's software. The data were analysed with the Wilcoxon signed-rank and Mann-Whitney U-tests (P < 0.05)., Interventions: Treatment with a direct bonding or an indirect bonding technique., Results: This study was completed with 25 patients in the indirect bonding group (12 females, 13 males; mean age: 15.42 ± 1.71 years) and 26 patients in the direct bonding group (12 females, 14 males; mean age: 14.73 ± 1.65 years). In the indirect bonding technique, a few teeth (especially mandibular left canine: 50.45 ± 93.48; 95% confidence interval: -12.35 and 113.26) were found to develop significant white spot lesion (WSL) formation (P < 0.05). However, the number of teeth with demineralization was higher in the direct bonding group (P < 0.05)., Conclusion: The bonding procedures used in the indirect bonding technique contribute to reducing the degree of WSL formation. Further, the use of flowable composite adhesives in this bonding process is more effective at reducing the appearance of WSLs than in cases where conventional composite adhesives are used., Limitations: The limitation of our trial may be the small sample size and the short follow-up time for the patients., Harms: No harms were detected during the study., Protocol: The protocol was not published before trial commencement., Registration: This trial was registered post hoc at 'Clinical Trials' (http://www.clinicaltrials.gov), registration number (ID): NCT03738839., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim: The aim of this study was to investigate the antidemineralization effect of composites containing silver and titanium dioxide (TiO 2 ) nanoparticles used for bonding brackets to tooth specimens., Materials and Methods: A total of 75 freshly extracted teeth were etched and primed and then randomly assigned to three adhesive groups: (1) conventional orthodontic adhesive, (2) conventional adhesive mixed with TiO 2 nanoparticles, and (3) conventional adhesive mixed with silver nanoparticles. In each group, brackets were bonded with the pertinent adhesive. Teeth were painted with varnish on all surfaces except a 2-mm rim around brackets. Specimens were subjected to a cariogenic process in a circulating microbial model inoculated with Streptococcus mutans and Lactobacillus casei for 12 days and subsequently sectioned for cross-sectional microhardness testing. In each specimen, enamel microhardness was determined in three locations: 25-30 μm and 1.5 mm away from the bracket and under the varnish-protected enamel. Hardness of enamel in the first two locations was reported as a percentage of the protected enamel hardness., Results: Enamel hardness was higher at 25-30 μm away from brackets in both the experimental groups ( p value < 0.05), and the nanoparticles acted similarly in this location ( p value = 0.992). At 1.5 mm away from the brackets, there was no difference between experimental and control groups ( p value > 0.05); the effect of TiO 2 attenuated in this location while silver remained as potent., Conclusion: Both nanoparticles resulted in decreased demineralization at 25-30 μm from the bracket but farther away the effect of TiO 2 was diminished., Clinical Significance: According to the results of this study, composites containing silver and TiO 2 nanoparticles can be suggested as anti-demineralization adhesives in case their biocompatibility is proved.

Aim: This literature review aims to update the evidence for prevention of white spot lesion (WSL) using orthodontic sealants among patients with fixed orthodontic appliances., Background: As a major issue among orthodontists, prolonged treatment duration increases the risk of plaque development around orthodontic brackets and bands. In consequence, this can lead to heightened risk for caries development and higher possibility of WSL development around fixed orthodontic brackets., Results: Increased prevalence of WSLs generally occurs during orthodontic treatment. This review explored various products of orthodontic sealants used to prevent WSL. Orthodontic sealants do not require patient compliance and thus will further lessen the burden among orthodontists as well as support enamel surface for a long period of time during treatment. Certain factors, however, are considered important in the efficacy of these sealants, such as antibacterial activity, color stability, resistance to acid and brush abrasion, and their effect on shear bond strength (SBS)., Conclusion: The review showed that the use of orthodontic sealants in preventing WSLs during and after fixed orthodontic treatment is significantly effective. However, the bioactive glass is deemed more effective against WSL development due to its ability to immediately repair enamel surface, low cytotoxicity, and high biocompatibility. Moreover, clinical studies on bioactive glass are still needed to determine its acceptability among patients with fixed orthodontic appliance., Clinical Significance: Development of WSL around the orthodontic brackets during treatment is a difficult task among orthodontists. As such, this review explored various strategies to effectively combat WSL development for good oral health and esthetics during orthodontic treatment.

Background: Self-applied and professional fluorides are key elements to limit caries-related side-effects during orthodontic treatment with fixed appliances., Objective: To evaluate the effectiveness of a new fluoride varnish formula containing 1.5% ammonium fluoride in preventing white spot lesions (WSLs) in adolescents undergoing multi-bracket orthodontic treatment., Subjects and Methods: The study employed a randomized controlled triple-blinded design with two parallel arms. One hundred eighty-two healthy adolescents (12-18 years) referred to three orthodontic specialist clinics were eligible and consecutively enrolled. Informed consent was obtained from 166 patients and they were randomly allocated to a test or a placebo group (with aid of a computer program, generating sequence numbers in blocks of 15). In the test group, fluoride varnish was applied in a thin layer around the bracket base every sixth week during the orthodontic treatment, while patients in the placebo group received a varnish without fluoride. The intervention started at onset of the fixed appliances and continued until debonding. The endpoint was prevalence and severity of WSLs on the labial surfaces of the maxillary incisors, canines, and premolars as scored from high-resolution pre- and post-treatment digital photos with aid of a four-level score., Results: One hundred forty-eight patients completed the trial, 75 in the test group and 73 in the placebo group (dropout rate 10.8%). The total prevalence of WSL's on subject level after debonding was 41.8% in the test group and 43.8% in the placebo group. The number of patients exhibiting more severe lesions (score 3 + 4) was higher in the placebo group (P < 0.05); the absolute risk reduction was 14% and the number needed to treat was 7.1., Limitations: The multicentre design with somewhat diverging routines at the different clinics may have increased risk for performance bias. No health-economic evaluation was carried out., Conclusions: Regular applications of an ammonium fluoride varnish reduced the prevalence of advanced WSL during treatment with fixed orthodontic appliances., Clinical Trial Registration: ClinicalTrials.gov (NCT03725020)., Protocol: The protocol was not published before trial commencement., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim: The present study aimed to assess the efficacy of different dental varnishes in prevention of demineralization of enamel along the orthodontic brackets., Materials and Methods: A total of 60 premolars that do not have caries and were extracted for orthodontic purposes were used in this study. Transbond™ Plus was used to bond premolar brackets onto the treated surface of enamel. The teeth were then divided into three groups. Group I: Profluorid varnish, group II: CPP-ACP varnish, and group III: Duraflor™ varnish. A Vickers diamond indenter was used to assess the microhardness of the surface of enamel at baseline, fourth day, and seventh day., Results: A slightly meaner surface microhardness (SMH; 334.20 ± 2.10) was seen in group III when compared with group I (332.16 ± 3.02) and group II (330.40 ± 2.02). The mean SMH was 342.02 ± 0.82 in group I on the fourth day which was slightly higher than that of the baseline values, followed by group III (339.48 ± 0.34) and group II (336.64 ± 1.14). No statistically significant differences were noted between the groups. A higher mean microhardness of 349.84 ± 0.66 was seen in group I on the seventh day, followed by group III (342.26 ± 1.08) and group II (338.18 ± 1.08). A statistically highly significant difference was seen between the groups., Conclusion: The present study concluded Profluorid varnish to have maximum potential to reduce demineralization of enamel followed by Duraflor and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) group., Clinical Significance: A most common clinical challenge encountered in orthodontic clinical practice is enamel demineralization or white spot lesion (WSL) development throughout the fixed appliance treatment. Thus, the information about several available varnishes is important to prevent demineralization in regular dental practice.

Objectives: To evaluate the effects of adhesive precoated (APC) flash-free brackets on enamel demineralization and periodontal status in patients during fixed orthodontic treatment., Materials and Methods: Thirty patients, age 12 to 18 years, who had Angle Class I or Class II malocclusion with mild to moderate crowding in the permanent dentition were selected for this study. APC flash-free and conventional ceramic brackets were bonded for a split-mouth study design. The quadrant allocation was randomized. Demineralization records were obtained immediately after bonding (T0), 1 month after bonding (T1), and 6 months after bonding (T2). Clinical periodontal measurements, including gingival index, plaque index, and bleeding upon probing, were obtained before bonding (T0) and at the same time points (T1 and T2). Data were analyzed using Mann-Whitney U and Friedman tests to compare parameters between groups and times., Results: Demineralization values decreased on most sides of the brackets for both groups between T0 and T1. In the conventional group, there was significantly higher demineralization on more sides compared with flash-free brackets between T1 and T2. With one exception, the decreased values were found in the incisal/occlusal sides of all brackets at T2. All periodontal parameters showed significant increases after 6 months of treatment in both groups. Intergroup comparison showed no significant differences in demineralization or periodontal measurements at any of the time points., Conclusions: The effects of APC flash-free and conventional brackets on enamel demineralization and periodontal health did not differ from each other., (© 2020 by The EH Angle Education and Research Foundation, Inc.)

This study aimed to evaluate the effect of self-assembling peptide P 11 -4 (SAP) in the therapy of initial smooth surface caries (white spot lesions, WSL) following orthodontic multibracket treatment. Twenty-three patients (13f/10m; average age 15.4 years) with at least two teeth with WSL were recruited for the randomised controlled clinical trial with split-mouth design. In opposite to the control teeth, the test teeth were treated with SAP on Day 0. The primary endpoint was the impedance measurement of WSL using customised tray to ensure reproducibility of the measurement location. The secondary endpoint was the morphometric measurement of WSL using a semi-automated approach to determine the WSL size in mm 2 . Treatment effects were adjusted for site-specific baseline values using mixed models adapted from the cross-over design. Test WSL showed a mean baseline impedance value of 46.7, which decreased to 21.1, 18.4, and 19.7 after 45, 90, and 180 days, respectively. Control WSL showed a mean baseline value of 42.0, which decreased to 35.0, 29.5, and 33.7, respectively. The overall treatment contrast was -13.7 (95% CI: -19.6 - -7.7; p < 0.001). For the secondary endpoint, the test WSL size decreased from 8.8 at baseline to 6.5 after 180 days. The control WSL decreased from 6.8 to 5.7, respectively. The related treatment contrast was -1.0 in favour of test WSL (95% CI: -1.6 - -0.5; p = 0.004). The treatment of initial carious lesions with self-assembling peptide P 11 -4 leads to superior remineralisation of the subsurface lesions compared with the control teeth.

Aim: This study aimed to investigate salivary concentrations of Streptococcus mutans (S. mutans) and some Lactobacilli, and plaque index (PI) in patients wearing fixed versus removable orthodontic appliances., Methods: A sample of 90 orthodontic patients (56 males and 34 females) was included in the study: 30 subjects (aged 21.5±1.5 years) were treated with removable clear aligners (CA), while for other 30 cases (aged 23.3±1.6 years) a fixed multibrackets appliance (MB) were utilized, and 30 patients (aged 18.2 ±1.5 years) wearied a removable positioner (RP). Salivary concentrations of S. mutans and Lactobacilli and PI were evaluated prior to start of the orthodontic treatment, after 3 months and 6 months., Results: After 6 months, 40% of MB patients (12 subjects over 30) showed a concentration of S. mutans associated to high risk of developing tooth decay (CFU/ml>10 5 ), differently from participants wearing removable appliances (odds ratio = 5.05; 95% C.I. = 1.72-14.78; chi-square = 9.64; p = 0.0019). The same trens was observed for the concentration of Lactobacilli (odds ratio = 4.33; 95% C.I. = 1.53-12.3; chi-square = 8.229; p = 0.004). In addition, over the duration of the study, CA patients maintained PI at 0 level, while MB patients experienced a statistically significant increasing trend of PI over time, and their PI became clinically/statistically relevant after 6 months, respect to CA and RP patients., Conclusions: Comparing all the data, while, after 6 months, only about 10% of CA patients and 13.3% of RP patients achieved a microbial colonization which may lead to high risk of caries development, about 40% of MB patients - and 20% after 3 months - showed a high level of vulnerability to developing caries, which require additional strategies for plaque control and microbial colonization to be employed., (© 2019 The Authors. Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

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., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Selda Lale et al.)

Background: White spot lesions (WSLs) are common adverse effects in fixed orthodontic treatment. Remineralising agents are widely used to prevent WSLs formation and are the first-line treatment for existing WSLs. Previous systematic reviews have evaluated the effectiveness of remineralisation agents in the management of WSLs. However, their conclusions were contradictory. The objective of this study will be to compare the effectiveness and safety of current remineralising agents used in the management of WSLs in patients treated with fixed orthodontic appliances in any orthodontic setting., Methods: Literature searches will be conducted in several electronic databases (from inception onwards): MEDLINE (via Ovid), Scopus, Embase, the Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), among others. Grey literature will be identified through searching clinical trials registries. Randomised controlled trials that compared the effectiveness of different remineralisation agents in the prevention and treatment of WSLs will be included. Two researchers will independently screen all citations, full-text articles, and abstract data. The study risk bias will be appraised using an appropriate tool. The primary outcomes will be WSLs incidence and severity of WSLs. Secondary outcomes will be subjective measures of WSLs and adverse effects. The mean difference (MD) and relative risk (RR) with corresponding 95% confidence intervals (CI) will be chosen as effect measures for continuous and binary outcomes, respectively. If feasible, fixed and random-effects pairwise meta-analyses and frequentist network meta-analyses will be conducted where appropriate., Discussion: This network meta-analysis will compare the effectiveness of remineralising agents in the prevention and treatment of orthodontically induced WSLs. By integrating the evidence from direct and indirect comparisons and ranking all evaluated interventions, our findings have the potential to help clinicians make more accurate treatment decisions., Systematic Review Registration: PROSPERO CRD42019116852, registered on March 15, 2019.

Background: Early dental decay or demineralised lesions (DLs, also known as white spot lesions) can appear on teeth during fixed orthodontic (brace) treatment. Fluoride reduces decay in susceptible individuals, including orthodontic patients. This review compared various forms of topical fluoride to prevent the development of DLs during orthodontic treatment. This is the second update of the Cochrane Review first published in 2004 and previously updated in 2013., Objectives: The primary objective was to evaluate whether topical fluoride reduces the proportion of orthodontic patients with new DLs after fixed appliances. The secondary objectives were to examine the effectiveness of different modes of topical fluoride delivery in reducing the proportions of orthodontic patients with new DLs, as well as the severity of lesions, in terms of number, size and colour. Participant-assessed outcomes, such as perception of DLs, and oral health-related quality of life data were to be included, as would reports of adverse effects., Search Methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 1 February 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library (searched 1 February 2019), MEDLINE Ovid (1946 to 1 February 2019), and Embase Ovid (1980 to 1 February 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases., Selection Criteria: Parallel-group, randomised controlled trials comparing the use of a fluoride-containing product versus a placebo, no treatment or a different type of fluoride treatment, in which the outcome of enamel demineralisation was assessed at the start and at the end of orthodontic treatment., Data Collection and Analysis: At least two review authors independently, in duplicate, conducted risk of bias assessments and extracted data. Authors of trials were contacted to obtain missing data or to ask for clarification of aspects of trial methodology. Cochrane's statistical guidelines were followed., Main Results: This update includes 10 studies and contains data from nine studies, comparing eight interventions, involving 1798 randomised participants (1580 analysed). One report contained insufficient information and the authors have been contacted. We assessed two studies as at low risk of bias, six at unclear risk of bias, and two at high risk of bias. Two placebo (non-fluoride) controlled studies, at low risk of bias, investigated the professional application of varnish (7700 or 10,000 parts per million (ppm) fluoride (F)), every six weeks and found insufficient evidence of a difference regarding its effectiveness in preventing new DLs (risk ratio (RR) 0.52, 95% confidence interval (CI) 0.14 to 1.93; 405 participants; low-certainty evidence). One placebo (non-fluoride) controlled study, at unclear risk of bias, provides a low level of certainty that fluoride foam (12,300 ppm F), professionally applied every two months, may reduce the incidence of new DLs (12% versus 49%) after fixed orthodontic treatment (RR 0.26, 95% CI 0.11 to 0.57; 95 participants). One study, at unclear risk of bias, also provides a low level of certainty that use of a high-concentration fluoride toothpaste (5000 ppm F) by patients may reduce the incidence of new DLs (18% versus 27%) compared with a conventional fluoride toothpaste (1450 ppm F) (RR 0.68, 95% CI 0.46 to 1.00; 380 participants). There was no evidence for a difference in the proportions of orthodontic patients with new DLs on the teeth after treatment with fixed orthodontic appliances for the following comparisons: - an amine fluoride and stannous fluoride toothpaste/mouthrinse combination versus a sodium fluoride toothpaste/mouthrinse, - an amine fluoride gel versus a non-fluoride placebo applied by participants at home once a week and by professional application every three months, - resin-modified glass ionomer cement versus light-cured composite resin for bonding orthodontic brackets, - a 250 ppm F mouthrinse versus 0 ppm F placebo mouthrinse, - the use of an intraoral fluoride-releasing glass bead device attached to the brace versus a daily fluoride mouthrinse. The last two comparisons involved studies that were assessed at high risk of bias, because a substantial number of participants were lost to follow-up. Unfortunately, although the internal validity and hence the quality of the studies has improved since the first version of the review, they have compared different interventions; therefore, the findings are only considered to provide low level of certainty, because none has been replicated by follow-up studies, in different settings, to confirm external validity. A patient-reported outcome, such as concern about the aesthetics of any DLs, was still not included as an outcome in any study. Reports of adverse effects from topical fluoride applications were rare and unlikely to be significant. One study involving fluoride-containing glass beads reported numerous breakages., Authors' Conclusions: This review found a low level of certainty that 12,300 ppm F foam applied by a professional every 6 to 8 weeks throughout fixed orthodontic treatment, might be effective in reducing the proportion of orthodontic patients with new DLs. In addition, there is a low level of certainty that the patient use of a high fluoride toothpaste (5000 ppm F) throughout orthodontic treatment, might be more effective than a conventional fluoride toothpaste. These two comparisons were based on single studies. There was insufficient evidence of a difference regarding the professional application of fluoride varnish (7700 or 10,000 ppm F). Further adequately powered, randomised controlled trials are required to increase the certainty of these findings and to determine the best means of preventing DLs in patients undergoing fixed orthodontic treatment. The most accurate means of assessing adherence with the use of fluoride products by patients and any possible adverse effects also need to be considered. Future studies should follow up participants beyond the end of orthodontic treatment to determine the effect of DLs on patient satisfaction with treatment., (Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background: This first-in-human study in Saudi orthodontic patients has evaluated the role of low-level laser therapy (LLLT) in pain perception (PP). The outcome of single application of LLLT with 4 different treatment modalities (TM) on PP are evaluated following orthodontic bracket bonding on maxilla., Materials and Methods: A prospective clinical intervention with implementation of parallel technique in each group, 32 orthodontic patients with ectopic canine requiring fixed orthodontic appliance were enrolled and randomly allocated to the 4 groups: LLLT + self-ligating (SL) bracket, LLLT + conventional (Conv.) bracket, non-LLLT + SL bracket, and non-LLLT + Conv. bracket. Orthodontic bracket bonding from 1st molar to 1st molar and superelastic 0.012 inch NiTi were applied for the maxilla. For each patient, maxillary 1st molar to molar received a single application of LLLT using a 940 nm Ga-Al-As laser device on 5 different points labially/buccally and palatally. Main outcome measure was the degree of PP score during the 1st week of orthodontic tooth movement (OTM) after 4 hours, 24 hours, 3 days, and 7 days of both LLLT and non-LLLT treatment applications. A questionnaire with an 11-point numeric rating scale (NRS) was used for PP., Results: Mean ± SD of PP in the LLLT + SL group was 3.33 ± 1.4, 3.58 ± 1.06, 2.31 ± 0.67, and 1.89 ± 0.54 in 4 hours, 24 hours, 3 days, and 7 days, respectively. Compared to all 4 TM groups, LLLT groups showed better PP. More statistically significant differences were found in LLLT groups. No harms were encountered., Limitations: The intervention provider and the patient were not blinded to the intervention., Conclusion: The LLLT + SL group revealed significantly promising benefits on PP during OTM., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Mohammad Khursheed Alam.)

Objective: To examine: (I) the current evidence of the impact of fixed orthodontic appliances on the development of halitosis in patients undergoing orthodontic treatment, and (II) the influence of different orthodontic bracket systems on halitosis., Material and Methods: Three electronic databases (PubMed, Scopus, and Cochrane Library) were searched prior to March 15, 2018. The review was systematically conducted and reported according to the Cochrane Handbook and the PRISMA statement. Only Randomised Clinical Trials (RCTs) were considered. Selected full-text papers were independently assessed by four investigators and any disagreements were resolved by consensus. The Cochrane Handbook was used to grade the risk of bias and the quality of evidence was rated according to GRADE., Results: Out of 363 identified studies, three RCTs on halitosis and fixed orthodontic appliances met the inclusion criteria. The risk of bias in the three studies was rated as high and the quality of evidence was rated as very low., Conclusions/clinical Implications: There is a lack of scientific evidence that subjects with fixed orthodontic appliances develop halitosis during treatment. Additional well-conducted RCTs with extended periods of assessment are needed as well as consensus concerning cut-off values for the diagnosis of halitosis.

Objective: To compare orthodontically induced inflammatory root resorption (OIIRR) and patient perception of pain during orthodontic treatment between 0.018-inch and 0.022-inch slot bracket systems., Subjects and Methods: Eligible participants aged 12 years or above were allocated to treatment with the 0.018-inch or 0.022-inch slot MBT appliance (3M Unitek, Monrovia, California, USA) using block randomization in groups of 10. OIIRR was assessed radiographically using standardized periapical radiographs before and after 9 months from the start of treatment. Patient perception of pain was assessed using a validated patient questionnaire at 6 months from the start of treatment. Parametric tests (t-test) and non-parametric tests (chi-square with Fisher's exact tests and Kruskal-Wallis test) assessed differences between the groups (P < 0.05). The correlation between severity of OIIRR and abnormal root morphology, history of dental trauma, and pain during treatment was assessed., Results: Of the 187 participants randomized (1:1 ratio), 34 withdrew or were excluded (protocol deviations or poor cooperation). There were 77 patients in the 0.018-inch slot group and 76 patients in the 0.022-inch slot group (overall mean age: 19.1 years). Baseline characteristics were similar between groups (P > 0.05). There was no significant difference in the severity of the OIIRR nor patient perception of pain between the two study groups (P = 0.115 and P = 0.08 respectively). The correlation between the severity of OIIRR and abnormal root morphology or history of dental trauma was not statistically significant (P = 0.086 and P = 0.313). Moreover, there was no significant correlation between the severity of OIIRR and pain during treatment (R = 0.045, P = 0.617)., Limitations: It was impossible to blind clinicians or patients to allocation, and oral hygiene and periodontal outcomes were not assessed., Conclusions: The effect of bracket slot size on the severity of OIIRR and patient perception of pain are not significant., Trial Registration: The trial was registered with ClinicalTrials.gov on 5 March 2014, registration number: NCT02080338., (© The Author(s) 2018. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The aim was to investigate the ability of self-assembling Peptide P11-4 Matrix (SAPM) to remineralize artificial initial caries lesions compared to the use of fluoride varnish. Volunteers were recruited for this randomised, cross-over in situ trial. Bovine specimens, half including orthodontic brackets, were recessed on the buccal aspects of mandibular appliances. Specimens included internal sound enamel control, a demineralised control and a part exposed during the in situ phase. Each phase lasted four weeks, followed by a one-week washout. Treatment groups were: A: negative control, no treatment,B: positive control, 22,600 ppm fluoride varnish,C: test group, 1,000 ppm SAPM. Laser fluorescence values (LF) were measured before/after demineralisation, and after the in situ period. Micro-CT analysis was used to assess mineral changes within the specimens after the in situ phase. In specimens without brackets, ΔLF values after in situ phase were: A: +5.28, B: +0.85, C: -2.89. Corresponding ΔLF for specimens with brackets were: A: +5.77, B: +1.30, C: -3.15. LF-values between groups significantly differed from each other (p < 0.0001) after the in situ phase. Micro-CT analysis yielded no significant difference among groups for specimens without brackets. For specimens with brackets, the test group showed significantly more remineralisation than the negative (p = 0.01) and positive control (p = 0.003). Within the limitations of the study, SAPM showed prevention of caries and remineralisation of enamel around orthodontic brackets.

Objective: The aim of this study was to evaluate patients' pain levels during four different debonding procedures. The null hypothesis was that the pain perception of the patients undergoing four different debonding applications was not statistically significant different., Material and Methods: One hundred and twenty orthodontic patients who underwent orthodontic debonding were included in this study. The patients were randomly divided into 4 groups according to technique used in the patients. Debonding groups were as follows: Group 1) Conventional debonding group, Group 2) Medication group (acetaminophen was given 1 hour before debonding), Group 3) Soft bite wax group, and Group 4) Soft acrylic bite wafer group. The patients' levels of anxiety and fear of pain were evaluated before debonding, and Numerical Rating Scale (NRS) was applied to evaluate their pain perception during debonding. Mann-Whitney U and Kruskal-Wallis tests were used to evaluate non-normally distributed data. Categorical data analysis were carried by chi-square and McNemar tests. The significance level was set at p<0.05., Results: Anxiety scores of the patients were not statistically significant between both genders and debonding groups. In the quadrants in which the patients were perceived, the highest pain level was in the left side of the mandible. The teeth in which the highest pain level was perceived were the lower left and upper right lateral incisors. Although there was no statistically significant difference among the pain scores of the patients in each group, quadrant scores of female patients showed significant differences, being the lowest scores in the soft bite wax group., Conclusions: Majority of the patients had no fear of pain before debonding. Pain levels of the patients in the conventional debonding group were not significantly different from those of the other groups, except quadrant scores of females in the soft bite wax group. The null hypothesis was accepted.

Objectives: To assess periodontal parameters and microbial species levels after orthodontic appliance placement in patients who received oral hygiene instructions and who were monitored and motivated throughout the study., Materials and Methods: The Periodontal Index was recorded and saliva collection was performed before (T0) and 30 (T1), 60 (T2), and 90 (T3) days after orthodontic appliance placement in 15 patients (mean age 17.53 ± 8.0 years). Analysis was carried out using checkerboard DNA-DNA hybridization. Nonparametric statistical analysis was performed., Results: The Periodontal Index did not change. The total amount of the purple and red complexes and Candida species showed a significant decrease from T2. The green, yellow, and orange complex showed a significant decrease at T3. The specific species analysis showed that Prevotella nigrescens, Pseudomonas putida, Fusobacterium periodonticum, Pseudomonas aeruginosa, Peptostreptococcus anaerobius, and Tanerella forsythia showed high incidence before bonding, and their levels decreased at T2 and T3. Only Porphyromonas gingivalis showed increased levels at T2 and displayed the highest level at T3. The Streptococcus group decreased their levels from T2 onward., Conclusions: A dynamic change in microbial levels was identified. The decrease in the levels of complexes present was only possible due to the mechanical method of oral hygiene implemented in this sample.