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Efficacy of different strategies in protecting enamel against demineralization during fixed orthodontic treatment

Effizienz verschiedener Strategien zum Demineralisationsschutz während der Multibracket-Behandlung

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Background and objective

Sealant application is a common strategy for preventing enamel demineralization during multibracket treatment. The aim of this study was to assess the efficacy in enamel demineralization prevention of two fluoride-containing enamel varnishes compared to a non-fluoride varnish, weekly fluoride gel application, and a non-treated control group.

Materials and methods

Enamel specimens obtained from 75 human upper permanent incisors were randomly allocated to five trial groups (each n = 15): A), ProSeal (Reliance), B), Maximum Cure® (Reliance), C), CervitecPlus (Ivoclar Vivadent, Schaan, Liechtenstein), D) elmex® gelée (GABA, Lörrach, Germany), and E), a non-treated control group. Groups A–C received a baseline varnish application, whereas group D specimens received a once weekly gel application for 2 min. Six demineralization cycles per day were carried out for 5 min each using 0.05 M citric acid, with the specimens stored in remineralization solution between cycles. Lesion depth expressed in percentage fluorescence loss (Δ-F in %) compared to baseline (T0) was assessed quantitatively with light-induced fluorescence (QLF) after 3 (T1), 7 (T2), 14 (T3), and 30 (T4) days globally and for each time point, and analyzed for compounds using the Kruskal–Wallis test (α = 5%), and additional one-sample Wilcoxon tests for each time/compound combination (Bonferroni-corrected α-levels α* = 0.05/4 = 0.0125).

Results

Significant fluorescence loss revealing greater lesion depth was detected in the untreated controls (E) at T3, and in groups A (ProSeal) and C (CervitecPlus) at T4. No significant Δ-F changes were seen in the specimens from groups B (Maximum Cure®) and D (elmex® gelée).

Conclusion

Maximum Cure® sealant seems to offer efficient protection against demineralization during fixed orthodontic treatment, as does weekly application of elmex® fluoride gel.

Zusammenfassung

Hintergrund und Zielsetzung

Zur Prävention von Schmelzdemineralisationen während der Multibracket-Behandlung ist das Aufbringen von Versieglern üblich. Studienziel ist die Bestimmung der demineralisationsprotektiven Effizienz zweier fluoridhaltiger Versiegelungslacke im Vergleich zu einem nichtfluoridhaltigen Lack, einer wöchentlichen Fluoridgelapplikation und einer unbehandelten Kontrollgruppe.

Material und Methodik

Schmelzproben von 75 humanen, permanenten oberen Inzisivi wurden randomisiert 5 Studiengruppen zugeordnet (jeweils n = 15): A), ProSeal, B), Maximum Cure® (beide: Reliance Orthodontic Products, Itasca, IL, USA), C), CervitecPlus (Ivoclar Vivadent, Schaan, Liechtenstein), D), elmex® gelée (GABA, Lörrach, Deutschland), und E), einer unbehandelten Kontrollgruppe. Gemäß Herstellerangaben erhielten die Gruppen A bis C jeweils eine Baseline-Applikation, Gruppe D dagegen eine wöchentliche Gelapplikation für 2 Minuten. Sechs Demineralisationszyklen/Tag wurden für jeweils 5 Minuten mit 0,05 M Zitronensäure durchgeführt, bei zwischenzeitlicher Lagerung in einer Remineralisationslösung. Läsionstiefen wurden mittels lichtinduzierter Fluoreszenz (QLF) nach 3 (T1), 7 (T2), 14 (T3), und 30 (T4) Tagen als prozentualer Fluoreszenzabfall (Δ-F in %) mit den Baselinewerten (T0) quantitativ abgeglichen. Statistische Analysen erfolgten sowohl global als auch separat für jeden Zeitpunkt mit dem Kruskal-Wallis-Test (α = 5%) und zusätzlichen Wilcoxon-Tests für jede Zeitpunkt/Behandlungs-Kombination (Bonferroni-korrigiert α-Level α* = 0,05/4 = 0,0125).

Ergebnisse

Signifikante Fluoreszenzverluste (als Zeichen sich vertiefender Läsionen) wurden in der unbehandelten Kontrollgruppe (E) ab T3 und für die Gruppen A (ProSeal) und C (CervitecPlus) ab T4 verzeichnet. Keine signifikanten Δ-F-Veränderungen wurden in den Gruppen B (Maximum Cure®) und D (elmex® Gelèe) festgestellt.

Schlussfolgerung

Die Versiegelung mit Maximum Cure® scheint ebenso wie die wöchentliche Applikation des Fluoridgels elmex® einen effizienten Schutz gegen Demineralisation während der festsitzenden Behandlung zu bieten.

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Conflict of interest

The corresponding author states that there are no conflicts of interest.

Interessenkonflikt

Der korrespondierende Autor erklärt für sich und seine Koautoren, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Private Practice Hannover, Kirchröder Str. 77, Hannover, Germany

    M. Knösel

  2. University Medical Center Göttingen, Göttingen, Germany

    L. Forslund

  3. Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany

    K. Jung

  4. Department of Preventive Dentistry, Periodontology, and Cariology, University Medical Center Göttingen, Göttingen, Germany

    D. Ziebolz

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  1. M. Knösel
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  2. L. Forslund
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  3. K. Jung
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  4. D. Ziebolz
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Correspondence to M. Knösel.

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Knösel, M., Forslund, L., Jung, K. et al. Efficacy of different strategies in protecting enamel against demineralization during fixed orthodontic treatment. J Orofac Orthop 73, 194–203 (2012). https://doi.org/10.1007/s00056-012-0072-5

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  • DOI: https://doi.org/10.1007/s00056-012-0072-5

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