The most common negative effect of orthodontic treatment with fixed appliances is the development of incipient carious lesions around brackets. The objectives of this chapter are to present some of the results of two studies aiming: 1) to evaluate patients treated with comprehensive orthodontics to determine the incidence of new carious lesions during treatment; and 2) to investigate the potential of ACP-containing resin cement and other treatments (fluoride varnish, resin sealer, MI Paste) to prevent incipient carious lesions on bracketed teeth. In the first study, 350 orthodontic patients were selected randomly. The pre-and post-treatment photographs of the patients were examined to determine lesion development. The labial surface of each tooth was scored with a standardized system based on the International Caries Determination and Assessment System II. The independent variables were collected by chart abstraction. In the second study, 100 extracted human premolars were allocated randomly to five groups (N = 20). Brackets were bonded with ACP-cement (Aegis-Ortho), Transbond
XT (Control), Transbond XT followed by application of fluoride varnish (Vanish), resin sealer (Pro-seal) and CPP-ACP paste (MI Paste). All teeth were pH cycled for 15 days in demineralization solution and artificial saliva. The extent of demineralization in each group was assessed using Quantified Light-induced Fluorescence (QLF) and Confocal Laser Scanning Microscopy (CLSM). The incidence of patients who developed at least one new white-spot lesion during treatment was 73%. Treatment length was associated significantly with new white-spot lesion development. The independent variables of gender, age and extraction/non-extraction were not associated with lesion development. Fluorescence loss and lesion depth measurements demonstrated that the Pro-seal and Vanish groups had the least amount of demineralization. The control group showed the most demineralization. Although the MI Paste and Aegis-Ortho groups experienced less demineralization than controls, neither was significant statistically. Only the Pro-seal and Vanish groups had significantly smaller lesions than the control group for both QLF and CLSM. Thus, the development of new lesions appeared to be related to treatment duration and, to a lesser degree, to initial oral hygiene score. Light-cured filled sealer (Pro-seal) and the fluoride varnish (Vanish) have the potential to prevent enamel demineralization adjacent to orthodontic brackets exposed to cariogenic conditions.
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