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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.)

Background: As the demands on esthetic orthodontic devices continue to increase, discoloration of colored elastomeric modules is still a concern for patients and orthodontics. Thus, we performed an in vivo study evaluating discoloration of stretched colored elastomeric modules (i.e., white, gray, and pink)., Materials and Methods: In all, 90 elastomeric modules of three different colors (white, gray and pink; 30 elastics from each color) were placed around brackets. The elastomeric modules were distributed and arranged randomly in the patients' four dental quadrants, and were removed after 1, 2, and 4 weeks. Color measurements were made before and after insertion into each patient's mouth. Digital images were taken with the camera of a mobile phone (iPhone X, Cupertino, CA, USA), and the variations in color were characterized using the Commission Internationale de l'Eclairage (CIE) color space system (L*a*b*) offered by Photoshop (Adobe, San Jose, CA, USA). Analysis of variance (ANOVA) and least significant difference (LSD) tests were used for statistical analyses., Results: The white elastomeric modules were most prone to discoloration, followed by the pink and then finally by the gray colored modules. The amount of discoloration resulting from a random diet practiced by the patients increased gradually (but was not significant) for all elastomeric modules studied and reach a peak after 2 weeks for the white and gray elastomeric modules, while discoloration of the pink elastomeric modules plateaued after 1 week., Conclusion: Colored elastomeric modules (e.g., white, gray, and pink) discolor to variable degrees over time. Thus, patients should be advised that the consumption of food and drinks may result in discoloration of the elastomeric modules., (© 2023. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

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.)

Background: Initial caries lesion (ICLs) adjacent to orthodontic brackets are the most common side effect of orthodontic treatment with fixed appliances. The reported prevalence is uncertain and varies considerably across studies, from 27% to 97%., Objectives: This paper was designed to evaluate and synthesize the available evidence on the prevalence and incidence rates of ICLs in relation to orthodontic treatment. Selection criteria: The review (Prospero protocol CRD42023412952) included randomized and non-randomized clinical trials of interventions, cohort studies, and cross-sectional studies, published after 1990 on the prevalence or incidence of ICLs during or after orthodontic treatment with fixed appliances. Search methods: Pubmed, Scopus, and Embase databases were searched from 1990 until 01 May 2023. The risk of bias assessment was performed with RoB 2 and ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Data collection and analysis: The proportion of individuals with ICLs, reported as the number/percentage of individuals/teeth with ICLs or mean number of ICLs per subject, were used to synthesize results., Results: The search yielded a total of 468 papers; 21 studies were included in the systematic review, 2 of which were not included in the meta-analysis. The prevalence rate [95%CI] of ICLs was 0.57% [0.48; 0.65] in 1448 patients, 0.22% [0.14; 0.33] in 11583 teeth, with a mean number of lesions equal to 2.24 [1.79; 2.70] in 484 patients evaluated. The incidence rate of new carious lesions developed during orthodontic treatment was 0.48% [0.33; 0.63] in 533 patients, 0.15% [0.08; 0.26] in 1890 teeth with a mean number of ICLs equal to 2.29 [1.12; 3.46] in 208 patients evaluated., Limitations: Although the high number of included studies and the overall good quality, there was a significant heterogeneity in the collected data., Conclusion: The prevalence and incidence rates of ICLs in subjects undergoing orthodontic treatment are quite high and raise some concerns in terms of risk assessment of orthodontic treatment. ICLs represent an alarming challenge for both patients and professionals. Effective caries prevention strategies during treatment need to be considered and implemented where appropriate., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Orthodontic Society.)

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.

Objective: To investigate the extent to which post-orthodontic white spot lesions (WSLs) change in appearance over a period of ≥15 years and whether an association with caries data exists., Subjects and Methods: Seventy-two patients treated with a Herbst-Multibracket appliance at age 14.0 ± 2.7 years for 20.1 ± 5.1 months who attended a recall 18.3 ± 2.9 years post-treatment. Post-treatment (T1) intraoral photographs were assessed by a panel of five dentists using a modified version of the WSL-Index by Gorelick. For affected incisors, photographs from before treatment (T0) and recall (T3) were evaluated. In addition, the WSL-Change Index by Pancherz and Muehlich was assessed for all adequately visible incisors considering T1, T2 (if available), and T3. Radiographic (T0, T1, and T2-if available) and clinical (T3) MFT data were used., Results: 37.5% of the patients exhibited WSLs on ≥ 1 incisor at T1; in total, 81 incisors (14.9%) were affected. At T3, 48% of the WSLs had improved. The modified WSL-Index decreased from 1.2 ± 0.4 to 0.8 ± 0.6 (P < .001), with a score 0 in 28% of the previously affected incisors. When comparing T2 vs. T3, additional improvement after T2 occurred in 11% of the teeth. While no difference existed at T0, the MFT values at T1, T2, and T3 were higher (P ≤ .05) in patients with WSLs at T1 than in those without., Limitations: The homogeneity of the subjects was limited and no patient-reported outcome was assessed., Conclusions: Long-term, post-orthodontic WSLs showed spontaneous full recovery in 28% and improvement in 48% of the teeth. Patients affected with WSLs exhibited higher post-treatment MFT values., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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.)

The high incidence of demineralization around orthodontic brackets has led to the development of preventive measures. Incorporation of antibacterial or remineralizing agents into orthodontic adhesives is an attractive method. This single-center, split-mouth, randomized controlled clinical trial was conducted to assess the effect of a modified composite containing TiO 2 nanoparticles on the Streptococcus mutans population and to prevent demineralization around orthodontic brackets. Each participant was assigned a random sequence (AB or BA). During the bonding session, the control lateral incisor was bonded with a conventional composite and the contralateral incisor was bonded with a composite containing nano TiO 2 particles (1%weight). The eligibility criteria included the presence of S. mutans in the dental plaque and absence of active caries, fractures or cracks. The S. mutans count in the dental plaque immediately around the brackets was evaluated at baseline and 1, 3, and 6 months after bonding. The specificity of the colonies was determined by PCR. The DIAGNOdent score was assessed at baseline and re-assessed every month up to the sixth month. Salivary samples were collected at T0, T1, and T3 to assess the amount of Ti released from the composite. The cytotoxicity of the modified composites was evaluated using an MTT assay. Participants, examiners, and data analyzers were blinded to the test and intervention groups. Forty-two patients ranging from 12 to 25 years were enrolled in this study. The amount of Ti released into saliva was insignificant and far below the toxic level. There was no significant difference between the S. mutans counts of the studied tooth S. mutans counts at any time point evaluated. DIAGNOdent scores on both sides increased significantly after the first month. However, this increase was higher on the test side (p < 0.001), and a significant difference of 2.6 scores remained throughout the study period. No severe adverse events were observed. Orthodontic composites containing TiO 2 nanoparticles may prevent demineralization induced around brackets during orthodontic treatment. However, the antibacterial effects were not statistically significant.Registration: The protocol was registered with the IRCT.ir (IRCT20140215016582N6)., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, 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.)

Purpose: Enamel demineralization can occur as a side effect during orthodontic treatment with fixed appliances and should be detected as early as possible. A new approach to assess demineralization is a system consisting of a photosensitive protein that binds to free calcium ions at the enamel surface. A camera is then used to visualize the bioluminescence spots. This in vitro study aimed to evaluate the ability of the bioluminescence technology to assess artificially demineralized enamel adjacent to various orthodontic brackets., Methods: In all, 108 human enamel samples were allocated randomly to groups with different orthodontic bracket material: stainless steel, titanium, ceramic. Initial lesions were created adjacent to the brackets. The samples were assessed by bioluminescence before and after demineralization. Images were assessed for presence of bioluminescence spots (yes/no). To quantify the bioluminescence measurements, the images' pixel values (P) were calculated within a defined area (F) adjacent to each bracket before and after demineralization. Quantitative light-induced fluorescence measurements (ΔF, ΔQ) were performed as the reference standard for demineralization., Results: After demineralization, bioluminescence spots were visible (yes/no decision) in 87% of the samples. The pixel analysis of the bioluminescence spots showed significantly higher pixel values after demineralization compared to baseline (p < 0.0001). The bracket material had no influence on the bioluminescence measurements. All samples showed fluorescence loss with a median ΔF of -9.52% (±3.15) and a median ΔQ of -1.01% × mm 2 (±3.34), respectively., Conclusion: The bioluminescence technology is a promising tool to demonstrate demineralization adjacent to different orthodontic brackets in vitro., (© 2021. The Author(s).)

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.)

Objective: To investigate and compare the effect of self-assembling peptide SAP (P 11-4 ), casein phosphopeptide-amorphous calcium phosphate fluoride paste (CPP-ACPF), and fluoride varnish (FV) on preventing enamel demineralization around orthodontic brackets., Material and Methods: Orthodontic brackets were bonded to the buccal surfaces of 80 freshly extracted human maxillary premolars. Teeth were randomly assigned to four groups (n=20) according to the remineralizing agent used as follows: SAP (P 11-4 ) group (Curodont™ Protect/Credentis), CPP-ACPF group (MI Paste Plus®/Recaldent™), fluoride varnish group (Profluoride varnish®/VOCO), and control group. All products were applied according to the manufacturer's instructions. Specimens were cycled in daily refreshed demineralizing and remineralizing solutions for 8h and 16h, respectively, for 28 days. The calcium/phosphorus ratio (Ca/P) and surface microhardness (SMH) were evaluated at baseline and at two and four weeks. Two-way ANOVA (analysis of variance), one-way ANOVA and repeated measures ANOVA were used for statistical analysis., Results: Two-way ANOVA demonstrated significant differences between remineralizing agents and time points. After 4 weeks, the SAP (P 11-4 ) group had had significantly higher Ca/P ratio and SMH (1.68±0.11 and 346.47±55.38) compared to other groups, followed by CPP-ACPF (1.52±0.19 and 283.53±64.75), FV (1.37±0.14 and 262.80±82.98), and the control group (1.31±0.10 and 213.00±41.95). Significantly higher Ca/P ratio and SMH were observed at 2 weeks in the control group (1.44±0.10 and 269.63±57.37) and FV group (1.52±0.09 and 321.17±55.24) compared to 4 weeks. No significant differences were found regarding Ca/P ratio and SMH at 2 weeks in the CPP-ACPF (1.55±0.15 and 295.14±53.88) and SAP P 11-4 groups (1.64±0.10 and 320.18±58.04) compared to 4 weeks., Conclusion: SAP (P 11-4 ) had the greatest remineralizing efficacy compared to FV and CPP-ACPF. Moreover, extended period of time improved the preventive efficacy of SAP (P 11-4 ) compared to the other regimens., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Purpose: The differentiation of resin remnants from enamel is a critical factor to minimize enamel damage after bracket debonding. This study was conducted to produce, and ascertain the efficacy of two colouring agents in minimizing enamel loss, adhesive and bonding remnants, and surface roughness after debonding., Methods: Two dyes containing annatto (orange colour) and curcumin (yellow colour) were produced. Seventy-two maxillary premolars were divided into three groups. After bracket bonding and debonding, the adhesive remnant was removed with a fine diamond bur. In groups 1 and 2, the orange and yellow dyes were utilized during the removal process, respectively. In group 3 (control) adhesive was removed with no colouring agent. The buccolingual dimension of the teeth was measured at the occlusal, middle, and apical areas, before bonding and after clean-up. The adhesive remnant index (ARI) and bonding remnant index (BRI) scores were recorded and the surface roughness parameters were measured. Data were analysed by ANOVA, Tukey, and Fisher's exact tests (α=0.05)., Results: Enamel loss was significantly lower in the groups cleaned by the use of colouring agents than that of the control group (P<0.05). No bonding agent was observed when the dyes were used, whereas 65% of teeth in the control group showed the remaining bonding material (P<0.001). There was no significant difference in ARI scores or surface roughness alterations among the study groups (P>0.05)., Conclusion: The two dyes produced in this study were effective in enhancing the visibility of residual resin materials and minimizing enamel loss during the clean-up process., (Copyright © 2023. Published by Elsevier Masson SAS.)

We report a case of a 15-year-old atopic patient presenting with delayed, severe ulcerative hypertrophic gingivitis after placement of orthodontic braces, which required removal of braces and restorative laser surgical procedures. Patch testing to multiple metals and chemicals showed weak positive reactions to steel bands and formaldehyde. The patient experienced urticarial, gingivitis, and other intraoral symptoms after patch testing and re-exposure to nickel-containing products. In contrast, nickel, cobalt, and cobalt-chromium (Co-Cr) bracket patch testing sites were negative. Nickel-caused contact dermatitis is Type IV delayed hypersensitivity reaction occurring at least 24 h after exposure. This reaction can result in intraoral blisters, ulcerations, eczematous and urticarial reactions of the face and more distant skin areas. This case illustrates the intraoral delayed response, symptom resolution after removing the braces, and brackets and local reactions upon subsequent nickel exposure, despite negative patch testing and lymphocyte stimulation test to nickel. This case further illustrates the difficulty associated with diagnosing nickel allergy.

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.

White spot lesions and enamel cracks are the 2 most prominent diseases that occur after orthodontic treatment and are caused by enamel demineralization from accumulated bacterial biofilms and/or enamel damage caused by the removal of residual adhesive after bracket debonding. Inspired by the self-assembled amelogenin nanoribbons in enamel, we developed an enamel coating with a self-assembling antimicrobial peptide, D-GL13K, to simultaneously reduce demineralization and residual adhesive. The self-assembled amphiphilic nanoribbons significantly increased the hydrophobicity of the etched enamel, which reduced the permeability of the coated enamel surfaces as desired. The antimicrobial activity of this coating was evaluated against Streptococcus mutans by colony-forming unit counting and live/dead assays. The anti-demineralization effect was demonstrated by the reduced demineralization depth analyzed by optical coherence tomography and the increased Vickers hardness. The coatings did not reduce the shear bond strength but significantly reduced the adhesive remnant index score. This bioinspired enamel coating may provide a new strategy for preventing white spot lesions and enamel cracks after orthodontic treatment.

Objectives: Differences in the mineral concentration (MC) level of dental enamel may represent a precursor of white spot lesions adjacent to fixed orthodontic brackets. The aim of the current in vitro study was to compare the MC level central, occlusal and cervical to orthodontic attachments., Methods and Materials: A total of 16 enamel blocks were obtained from sound human premolar samples extracted for orthodontic reasons. The buccal portion of the dental enamel blocks was divided into central, occlusal, and cervical regions and then imaged and measured to calculate the level of MC using quantitative X-ray microtomography methods (XMT) at each site., Results: There was a substantial variation in the mineral concentration with the lowest level being detected in the cervical region when compared with other regions. The MC of the gingival zone was significantly lower than that of the middle zone (P&lt;0.05) and was insignificantly lower than that of the occlusal zone., Conclusion: Within the limitations of the current study, it can be concluded that the cervical region of the permanent enamel had the lowest mineral concentration using XMT. The cervical region may therefore be more vulnerable to the development of white spot lesions (WSLs) adjacent to a fixed orthodontic appliance during orthodontic treatment., Clinical Significance: Using X-ray microtomography lower mineral concentration in the cervical region of the enamel was observed. This may make these areas particularly susceptible to demineralisation during fixed appliance-based orthodontic treatment and may influence the bond strength of fixed orthodontic attachments., (Copyright © 2022. Published by Elsevier Ltd.)

Background: The objective of this study was to investigate the impact of the COVID-19 pandemic on the prevalence and persistence of white spot lesions (WSLs) among patients treated with traditional braces., Methods: A group of 434 consecutively finished cases who had pretreatment and post-treatment digital photographs taken were included in this study. Each set of photographs was evaluated by two investigators to determine prepandemic and postlockdown WSLs, in addition to changes in oral hygiene (OH) and other risk factors., Results: There was a statistically significant difference in the development of WSLs pre-COVID-19 lockdown (PRL) versus post-COVID-19 lockdown (POL) (P < 0.001). The overall prevalence for the development of WSLs increased to 52.8% POL. For patients with good pretreatment OH, the risk of developing WSLs POL (42.0%) was two times greater than the rate in PRL (20.1%). For patients whose OH worsened during treatment, 81.2% of POL patients developed WSL compared with 69.6% of PRL patients. The incidence of WSLs was statistically greater in the maxillary anterior region POL than PRL, whereas the incidence in the mandibular anterior region did not reach statistical significance. The distribution of WSLs was greater POL for each tooth irrespective of the arch., Conclusions: Because of the COVID-19 pandemic, the prevalence of visible WSLs increased from 29.5% to 52.8%. Patients whose hygiene worsened during orthodontic treatment are at an increased risk of developing WSLs., (Copyright © 2022 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

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).)

Objectives: The study aimed to survey current strategies against enamel demineralization during multibracket therapy (MBT) and guide a prevention concept based on existing scientific evidence., Materials and Methods: The survey comprised questions on the prevention and management of white spot lesions (WSL). The questionnaire was sent via email to orthodontists working in practices and universities throughout Germany. The analysis involved descriptive statistics using the chi-square test (p < 0.05)., Results: A prevention protocol was used before MBT by 80.6% of the participants. Less than a quarter of the participants regularly applied topical fluoride (gel or varnish) during MBT. According to the respondents' assessment, the prevalence of WSL during MBT is 11.6%, mainly observed in 12- to 15-year-old male patients. Orthodontists graduating after 2000 tended to recommend and apply fluoride-containing materials more often than their senior colleagues (p = 0.039). Participants from private practices applied fluoride varnish or gel more frequently than those from university clinics (p = 0.013). Fluoridation was the most common (70.7%) treatment for WSL after MBT, followed by resin infiltration (21.2%). The majority (80.9%) of the participants favor a guideline for preventing WSL., Conclusions: WSL prevention during MBT is challenging. Males in puberty are predominantly affected. Younger orthodontists are more concerned about the prevention of WSL during MBT., Clinical Relevance: The non-negligible prevalence of individuals with WSL emphasizes the need for dental education and health care reform. This would help to implement standardized procedures and establish innovative applications., (© 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.)

Introduction: The aim was to investigate the type, incidence, and degree of orthodontic-related emergencies in orthodontic patients during the 2020 coronavirus disease 2019 pandemic and compare the different effects of clear aligner (CA) and fixed self-ligating appliances on the orthodontic emergency., Methods: The questionnaire was based on emergencies in orthodontics. The responses of 428 patients between the ages of 12 and 38 years (20.4 ± 7.03) in orthodontic treatment during 2020 were examined., Results: The gender, age, and the type of orthodontic appliance affect the incidence of orthodontic-related emergencies. Female or adolescent patients treated by self-ligating appliances showed a higher incidence of emergencies. The patients treated by CA exhibited a much lower incidence of emergency. Appliance detachment and mucosa injury were very common in respondents, whereas accidental ingestion and other rare emergencies were less common. The most common reason leading to appliance detachment was chewing hard food. Interestingly, the fixed self-ligating appliances group was also affected by the accidental detachment of appliances to a large extent. The CA and self-ligating groups showed an almost equal incidence of accidental ingestion. The most common foreign body was elastics in both groups. However, the self-ligating group could accidentally ingest dangerous foreign bodies, such as archwires, miniscrews, and welded attachments., Conclusions: Orthodontic-related emergencies were very common in patients. The CA could effectively reduce orthodontic-related emergencies. Dentists should raise patients' awareness of proper appliance care. A proper and standard protocol should be developed., (Copyright © 2021 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

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.)

Porpose: To investigate the effect of Insignia system in customized orthodontic treatment., Methods: A total of 71 patients with malocclusion undergoing orthodontic treatment in Dalian Stomatological Hospital from March 2018 to August 2019 were enrolled, and divided into two groups according to random number table methods. Patients in non-customized group received Damon Q self-locking brackets, while patients in customized group received individualized brackets combined with Insignia appliance. The patients were revisited every 8 weeks in initial phase and thereafter every 6 weeks. The clinical efficacy, number of visits, time required for treatment planning and treatment duration were compared between the two groups. The severity of malocclusion, changes after treatment and improvement before and after treatment were evaluated by peer assessment rating (PAR). The complications and loose brackets during treatment were observed. SPSS 20.0 software package was used to analyze the data., Results: The total effective rate of customized group was significantly higher than that of non-customized group (P＜0.05). No significant difference was found in treatment duration between the two groups(P＞0.05). The number of visits and time required for treatment planning of customized group were significantly longer than those of non-customized group(P＜0.05). After treatment, the midline, tooth dislocation, molar buccal occlusion, overbite, overjet and weighted PAR total scores increased in both groups, and the increase was more significant in customized group(P＜0.05). The gingival bleeding rate showed no significant difference between the two groups(P＞0.05), while the rate of loose brackets was significantly higher in customized group than in non-customized group (P＜0.05)., Conclusions: Compared with non-customized system, insignia customized system has more visits, longer treatment planning time and higher bracket loosening rate, but its effect is better. In general, it has little effect on the treatment duration and does not increase the bracket shedding rate.

Introduction: The lengthy period of time required is one of the main reasons patients refuse orthodontic treatment. In addition, treatment may have negative effects on periodontal tissues., Objective: This study aimed to evaluate the overall time needed for leveling and alignment and the periodontal indices in adult patients with severe crowding. Patients were treated using either self-ligating brackets associated with flapless corticotomy (SLBs + FC group), self-ligating brackets alone (SLBs group), or conventional brackets (CBs group) alone., Materials and Methods: A total of 57 adult patients (10 male patients, 47 female patients) referred to the Department of Orthodontics, the University of Damascus Dental School from August 2018 to March 2019, were enrolled in this trial. The patients were randomly allocated to 1 of 3 groups: CBs (mean age: 19.62 ± 2.42 years), SLBs (mean age: 19.98 ± 2.84 years), or SLBs + FC (mean age: 20.67 ± 2.59 years). The overall alignment time for the upper anterior teeth was calculated. The following periodontal parameters were measured at 5 assessment times: plaque index, gingival index, papillary bleeding index, and probing depth., Results: The average leveling and alignment time was 81.89 ± 9.49 days, 123 ± 10.69 days, and 165.25 ± 13.05 days for the SLBs + FC group, the SLBs group, and the CBs group, respectively. A significant reduction in the overall alignment duration was found in the SLBs + FC group by 50%, and in the SLBs group by 25%, compared to the control group, with a statistically significant difference among the 3 groups (P < 0.001). There were statistically significant differences in the periodontal indices (except probing depth) after 1 month, with values greater in the SLBs + FC group (P < 0.05)., Conclusions: Using self-ligating brackets in combination with flapless corticotomy may be effective in accelerating upper dental decrowding in adult patients, with a reduction of 50% of the normal treatment time using traditional brackets. Using self-ligating brackets alone reduced treatment time by 25%. The adjunctive flapless corticotomy did not cause clinically negative effects on the periodontal tissues., (Copyright © 2021 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.)

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).)

Background: Adverse effects can occur during orthodontic treatment., Objective: To evaluate the relationship between prevalence and severity of enamel demineralization using a laser-fluorescence device, with length of orthodontic treatment time., Method: A cross-sectional study was conducted in 60 patients in a university orthodontic clinic. A clinical examination to establish demineralization at four sites on each tooth (premolar to premolar) was performed using the DIAGNOdent pen. The dependent variable was enamel demineralization, from which the prevalence (at least one affected site), extension (percentage of affected teeth) and adjusted average (average of the mean DIAGNOdent values per tooth) were calculated. The length of time for orthodontic treatment was determined in months. Various sociodemographic and clinical covariates were included., Results: Average number of months under orthodontic treatment was 26.37 ± 24.81 months. Prevalence of enamel demineralization was 80.0%, its extension was 21.9% ± 17.2 and adjusted average of DIAGNOdent values was 6.09 ± 1.75. By quadrant, the teeth most affected were 14 (34.4%), 24 (25.0%), 31 (30.2%) and 44 (33.3%). No significant relationship (p> 0.05) was observed between enamel demineralization and length of time under orthodontic treatment., Conclusions: A high prevalence of dental demineralization was observed. In this sample, no relationship was observed between months under treatment and dental demineralization, or with other variables included in the study.

During orthodontic treatment, enamel demineralization can occur. Its early detection is the basis for efficient preventive measures to arrest or remineralize lesions. In the present study, the application of a novel blue hemoglobin-based liquid (BlueCheck) was evaluated as proof of concept for detection of artificially demineralized smooth surfaces. 60 samples from extracted human posterior teeth were randomly assigned to four groups (15 per group). In 30 of these samples (groups A and B), superficial enamel was removed to create a ground surface. On the surface of other 30 samples (group C and D), orthodontic metal brackets were bonded. On each surface, BC liquid was applied and rinsed with water after 3 min (baseline). All surfaces were checked by two independent observers for presence of blue areas. On each sample, one side was covered by nail varnish to protect this enamel part from demineralization. The samples were demineralized with lactic acid (pH 4.6) for 7 days (group A and C) and 14 days (group B and D), respectively. Mineral loss was determined using quantitative light-induced fluorescence after demineralization. BlueCheck dye was again applied on the samples and evaluated for presence of stained areas. Histological sections were prepared from randomly selected samples and lesion depth was measured. Kruskal-Wallis test was used for group comparison (α = 0.05). After demineralization, median ΔF value for all samples was -8.25% indicating the presence of an initial demineralization. The difference of ΔF values was not statistically significant between samples at 7 or 14 days of demineralization, nor for samples with and without orthodontic brackets (p = 0.13). At baseline, none of the sample surfaces showed discoloration, whereas a distinctive blue color was visible after demineralization in all samples exposed to acid-exposed areas, corresponding to 100% sensitivity. The internal control surfaces (without demineralization) did not show any staining, corresponding to 100% specificity. Histologically measured lesion depths ranged between 200 and 254 μm. In this in vitro study, staining of demineralized enamel surface areas were shown to be reliable. Based on our results, this easily applicable product seems useful to be an adjuvant method to clinical examination to monitor oral health during an orthodontic treatment on tooth surfaces after removal of dental biofilm., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

The premature detachment of orthodontic brackets has consequences for the patient and the practitioner. While the responsibility for the bonding protocol has been widely assessed, the responsibility of the patient is poorly understood. The main objective of the study was to look for patient-specific predictors of metal vestibular attachment detachments. An historical cohort study was carried out from adolescents having benefited from a fixed vestibular appliance treatment lasting 27 months +/- 3 months, having all teeth from first molar to first molar on arch to pose. Univariate and multivariate analyses were performed by logistic regression. 333 patients were included. In univariate analysis, boys tended to take off more than girls, patients in skeletal Class II more than those in Class I, those with at least two cooperative remarks more than those with less than two remarks. The percentage of patients with debonding increases with the number of hygiene remarks. Younger patients were more prone to debond than older patients. The "age" factor has a significant effect in multivariate analysis. Neither the vertical skeletal pattern nor the socio-economic level would intervene in the rate of debonding. The role of patient-specific factors in detachment should be put into perspective. The reliability of the results would be increased by a prospective study using validated indicators of compliance.

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.

This study aimed to evaluate the impact of fluoride-releasing 4-META/MMA-TBB resin on the degree of enamel demineralization typically detected around orthodontic brackets using μCT. Enamel-dentin blocks were prepared from bovine teeth. Brackets were attached with either 4-META/MMA-TBB resin (SBC), fluoride-releasing 4-META/MMA-TBB resin (SBF), or fluoride-releasing RMGIC (FLC). The specimens were subjected to demineralization (pH 4.5, 21 days) and scanned by μCT (0, 7, and 21 days). Fluoride ion release under the experimental conditions was measured. The degree of demineralization detected in SBF and FLC was significantly lower than that in SBC; there were no significant differences in the degree of demineralization detected in SBF and FLC. The level of fluoride ion detected in FLC was significantly higher than that detected in SBC. Fluoride-releasing 4-META/MMA-TBB resin protected against enamel demineralization around orthodontic brackets when compared to the results from the fluoride-free resin.

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.)

Adequate removal of residual bonded materials from the enamel surface after orthodontic bracket debonding is critical, since any remaining composite may compromise enamel surface morphology and esthetics. The following clinical case reports present the association of at-home dental bleaching using 10% carbamide peroxide and the removal of residual bonded material using a super fine, tapered diamond bur followed by the use of an enamel microabrasion product after orthodontic bracket debonding. The proposed treatment considerably improved the esthetics and successfully removed the grooves created during the removal of the bonding composite, resulting in a smooth enamel surface., (© Operative Dentistry, 2021.)

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.