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

Naif A Almosa,1 Beshayer S Sibai,2 Olla A Rejjal,3 Nasser Alqahtani1 1Department of Pediatric Dentistry and Orthodontics, King Saud University, Riyadh, Saudi Arabia; 2National Guard Hospital, Dammam, Saudi Arabia; 3State University of New York, Buffalo, NY, USA Aim: To evaluate the degree of enamel demineralization of teeth bonded with ceramic and metal brackets.Materials and methods: In this cross-sectional experimental in vitro study, 60 extracted human premolar teeth were selected according to the experimental criteria. They were divided into three groups; 20 premolar teeth in each group. Teeth in group 1 were bonded with “ceramic brackets”, and teeth in group 2 were bonded with “metal brackets”, while teeth in group 3 served as the “control group” without any brackets. Teeth in all groups were then immersed in demineralization media, de-bonded, sectioned into three parts (proximal 1, middle, and proximal 2), and evaluated to determine the level of enamel demineralization under a Scanning Electron Microscope.Results: On tooth level, the results show that the control group has significantly less enamel demineralization compared to the other two experimental groups, with mean values of 145.3 µm and 192.7 µm, respectively (P=0.000). The mean value of enamel demineralization in the metal group is 55.93 µm, compared to 72.55 µm in the ceramic group, which is significantly less (P≤0.05), while there is no difference between the control and metal group with regard to enamel demineralization. On section level, the control group has significantly less enamel demineralization in all three sections compared to the ceramic group, while a significant difference is found in one of the proximal sections when compared with the metal group. Moreover, the ceramic group has significantly higher enamel demineralization in the middle section compared to the metal group (73.54 µm, 46.5 µm, respectively) (P=0.000), while there is no statistical significant difference between the two experimental groups in proximal sections.Conclusion: In vitro, non-bonded teeth show least demineralization compared to the bonded teeth. Teeth bonded with ceramic brackets show significantly higher enamel demineralization compared to teeth bonded with metal brackets. Keywords: ceramic, demineralization, metal, orthodontic brackets, decalcification, white spot lesions, orthodontic material, adhesive