Skip to main content
SpringerLink
Log in

Influence of enamel sealing with a light-cured filled sealant before bracket bonding on the bond failure rate during fixed orthodontic therapy

Einfluss einer Schmelzversiegelung mit einem lichthärtenden, gefüllten Versiegler vor dem adhäsiven Kleben auf die Bracketverlustrate während festsitzender kieferorthopädischer Therapie

  • Original Article
  • Published:
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Purpose

Fluoride-containing adhesives for enamel sealing are commonly used for the prevention of white spot lesions during fixed orthodontic treatment. Thus, we examined whether enamel sealing with L.E.D. ProSeal® (Reliance Orthodontic Products Inc., Itasca, IL, USA) before bracket bonding increases the rate of bond failure during orthodontic treatment.

Methods

In 20 adolescents (11–16 years, 10 male/10 female) at the start of fixed therapy, self-ligating SmartClip™SL3 metal brackets (3M Unitek, Monovia, CA, USA) were bonded to cleaned and conditioned (40% H3PO4, 30 s) buccal enamel surfaces of all permanent teeth except molars using Transbond™ XT (3M Unitek). In a split-mouth design, either L.E.D. ProSeal® (1st/3rd quadrant) or Clinpro™ XT Varnish (2nd/4th quadrant; 3M Unitek) was applied to enamel surfaces before (ProSeal®) or after (Clinpro™ XT Varnish) bracket bonding (200 teeth each; light curing: 20 s, Ortholux™ Luminous, 3M Unitek). Cumulative bond failure as total number of teeth with bracket detachment since start of therapy was documented every 3 months for a total of 12 months.

Results

Cumulative bond failure was higher for enamel sealing before bonding from 6 months onward reaching significance at 12 months (34/200) compared to sealing after bonding (24/200): p = 0.038; Cramér’s V = 0.488; odds ratio (OR) = 1.5; relative risk (RR) = 1.4. The higher loss rate was limited to the lower arch, but evident within 3 months reaching significance at 9 and 12 months (p = 0.019/0.011, V = 0.636/0.630; OR = 1.7/1.75, RR = 1.5/1.6). In general, cumulative bond failure at 12 months was higher in the lower arch, but this was only significant for teeth sealed before bonding (p = 0.001, V = 0.303, OR = 3.4, RR = 2.8).

Conclusions

Enamel sealing with L.E.D. ProSeal® should be performed after bracket bonding to prevent increased bond failure and bracket loss in the lower dental arch.

Zusammenfassung

Zielsetzung

Eine Schmelzversiegelung mittels fluoridhaltiger Adhäsive zur Vermeidung von White-Spot-Läsionen hat in der festsitzenden kieferorthopädischen Therapie eine weite Verbreitung gefunden. In dieser Studie wurde untersucht, ob eine Versiegelung mittels L.E.D. ProSeal® (Reliance Orthodontic Products Inc., Itasca/IL, USA) vor dem adhäsiven Kleben von Brackets die Bracketverlustrate während der kieferorthopädischen Behandlung erhöht.

Methoden

Bei 20 jugendlichen Patienten (11–16 Jahre, 10 m., 10 w.) wurden zu Beginn einer festsitzenden Therapie selbstligierende SmartClip™-SL3-Metallbrackets (3M Unitek, Monovia/CA, USA) auf die gereinigten und konditionierten (40% H3PO4, 30 s) bukkalen Schmelzoberflächen aller bleibenden Zähne mit Ausnahme der Molaren adhäsiv geklebt (Transbond™ XT, 3M Unitek). In einem Split-Mouth-Design erfolgte eine Schmelzversiegelung mittels entweder L.E.D. ProSeal® (1./3. Quadrant) oder Clinpro™XT-Varnish (2./4. Quadrant; 3M Unitek) vor (ProSeal®) oder nach (Clinpro™XT) dem Kleben der Brackets (200 Zähne, Lichthärtung 20 s mit Ortholux™ Luminous, 3M Unitek). Die kumulative Bracketverlustrate als Gesamtzahl der Zähne mit Bracketablösung seit Therapiebeginn wurde alle 3 Monate für insgesamt 12 Monate dokumentiert.

Ergebnisse

Die kumulative Bracketverlustrate war für die Schmelzversiegelung vor gegenüber nach dem Kleben der Brackets ab 6 Monaten erhöht mit Signifikanz nach 12 Monaten (34/200 vs. 24/200): p = 0,038; Cramérs V = 0,488; OR (Odds Ratio) = 1,5; RR (relatives Risiko) = 1,4. Die höhere Verlustrate war auf den unteren Zahnbogen begrenzt, trat jedoch innerhalb von 3 Monaten auf und erreichte nach 9 sowie nach 12 Monaten Signifikanz (p = 0,019/0,011, V = 0,636/0,630; OR = 1,7/1,75, RR = 1,5/1,6). Im Allgemeinen war die kumulative Bracketverlustrate nach 12 Monaten im unteren Zahnbogen höher; signifikant war dies jedoch nur für Zähne, die vor dem Kleben der Brackets versiegelt worden waren (p = 0,001, V = 0,303, OR = 3,4, RR = 2,8).

Schlussfolgerungen

Eine Schmelzversiegelung mittels L.E.D. ProSeal® sollte nach dem Kleben von Brackets durchgeführt werden, um eine erhöhte Versagens- und Bracketverlustrate im unteren Zahnbogen zu vermeiden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1 Abb. 1

Similar content being viewed by others

References

  1. Al Mulla AH, Kharsa SA, Birkhed D (2010) Modified fluoride toothpaste technique reduces caries in orthodontic patients. A longitudinal, randomized clinical trial. Am J Orthod Dentofacial Orthop 138:285–291

    Article  PubMed  Google Scholar 

  2. Arici S, Alkan A, Arici N (2007) Comparison of different toothbrushing protocols in poor-toothbrushing orthodontic patients. Eur J Orthod 29:488–492

    Article  PubMed  Google Scholar 

  3. Benson PE, Parkin N, Dyer F et al (2013) Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD003809.pub3

    Article  PubMed  Google Scholar 

  4. Bishara SE, Oonsombat C, Soliman MMA et al (2005) Effects of using a new protective sealant on the bond strength of orthodontic brackets. Angle Orthod 75:243–246

    PubMed  Google Scholar 

  5. Cal-Neto JP, Miguel JAM, Zanella E (2006) Effect of a self-etching primer on shear bond strength of adhesive precoated brackets in vivo. Angle Orthod 76:127–131

    PubMed  Google Scholar 

  6. Chadwick BL, Roy J, Knox J et al (2005) The effect of topical fluorides on decalcification in patients with fixed orthodontic appliances. A systematic review. Am J Orthod Dentofacial Orthop 128:601–606 (quiz 670)

    Article  PubMed  Google Scholar 

  7. Chang HS, Walsh LJ, Freer TJ (1999) The effect of orthodontic treatment on salivary flow, pH, buffer capacity, and levels of mutans streptococci and lactobacilli. Aust Orthod J 15:229–234

    PubMed  Google Scholar 

  8. Chestnutt IG, Playle R, Hutchings S et al (2017) Fissure seal or fluoride varnish? A randomized trial of relative effectiveness. J Dent Res 96:754–761

    Article  PubMed  Google Scholar 

  9. El Bokle D, Munir H (2008) An in vitro study of the effect of Pro Seal varnish on the shear bond strength of orthodontic brackets. World J Orthod 9:141–146

    PubMed  Google Scholar 

  10. Frazier MC, Southard TE, Doster PM (1996) Prevention of enamel demineralization during orthodontic treatment. An in vitro study using pit and fissure sealants. Am J Orthod Dentofacial Orthop 110:459–465

    Article  PubMed  Google Scholar 

  11. Gorelick L, Geiger AM, Gwinnett AJ (1982) Incidence of white spot formation after bonding and banding. Am J Orthod 81:93–98

    Article  PubMed  Google Scholar 

  12. Hajrassie MKA, Khier SE (2007) In-vivo and in-vitro comparison of bond strengths of orthodontic brackets bonded to enamel and debonded at various times. Am J Orthod Dentofacial Orthop 131:384–390

    Article  PubMed  Google Scholar 

  13. Heymann GC, Grauer D (2013) A contemporary review of white spot lesions in orthodontics. J Esthet Restor Dent 25:85–95

    Article  PubMed  Google Scholar 

  14. Hujoel PP, Moulton LH (1988) Evaluation of test statistics in split-mouth clinical trials. J Periodont Res 23:378–380

    Article  PubMed  Google Scholar 

  15. Kirschneck C, Christl J‑J, Reicheneder C et al (2016) Efficacy of fluoride varnish for preventing white spot lesions and gingivitis during orthodontic treatment with fixed appliances—a prospective randomized controlled trial. Clin Oral Investig 20:2371–2378

    Article  PubMed  Google Scholar 

  16. Knösel M, Forslund L, Jung K et al (2012) Efficacy of different strategies in protecting enamel against demineralization during fixed orthodontic treatment. J Orofac Orthop 73:194–203

    Article  PubMed  Google Scholar 

  17. Korbmacher-Steiner HM, Schilling AF, Huck LG et al (2013) Laboratory evaluation of toothbrush/toothpaste abrasion resistance after smooth enamel surface sealing. Clin Oral Investig 17:765–774

    Article  PubMed  Google Scholar 

  18. Linklater RA, Gordon PH (2003) Bond failure patterns in vivo. Am J Orthod Dentofacial Orthop 123:534–539

    Article  PubMed  Google Scholar 

  19. Lowder PD, Foley T, Banting DW (2008) Bond strength of 4 orthodontic adhesives used with a caries-protective resin sealant. Am J Orthod Dentofacial Orthop 134:291–295

    Article  PubMed  Google Scholar 

  20. Migliorati M, Isaia L, Cassaro A et al (2015) Efficacy of professional hygiene and prophylaxis on preventing plaque increase in orthodontic patients with multibracket appliances. A systematic review. Eur J Orthod 37:297–307

    Article  PubMed  Google Scholar 

  21. Millett DT, Hallgren A, Cattanach D et al (1998) A 5‑year clinical review of bond failure with a light-cured resin adhesive. Angle Orthod 68:351–356

    PubMed  Google Scholar 

  22. Murfitt PG, Quick AN, Swain MV et al (2006) A randomised clinical trial to investigate bond failure rates using a self-etching primer. Eur J Orthod 28:444–449

    Article  PubMed  Google Scholar 

  23. Ogaard B (1989) Prevalence of white spot lesions in 19-year-olds. A study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofacial Orthop 96:423–427

    Article  PubMed  Google Scholar 

  24. O’Reilly MT, de Viñas JJ, Hatch JP (2013) Effectiveness of a sealant compared with no sealant in preventing enamel demineralization in patients with fixed orthodontic appliances. A prospective clinical trial. Am J Orthod Dentofacial Orthop 143:837–844

    Article  PubMed  Google Scholar 

  25. Paschos E, Geiger F‑J, Malyk Y et al (2016) Efficacy of four preventive measures against enamel demineralization at the bracket periphery-comparison of microhardness and confocal laser microscopy analysis. Clin Oral Investig 20:1355–1366

    Article  PubMed  Google Scholar 

  26. Pickett KL, Sadowsky PL, Jacobson A et al (2001) Orthodontic in vivo bond strength. Comparison with in vitro results. Angle Orthod 71:141–148

    PubMed  Google Scholar 

  27. Reicheneder C, Hofrichter B, Faltermeier A et al (2014) Shear bond strength of different retainer wires and bonding adhesives in consideration of the pretreatment process. Head Face Med 10:51

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rosenbach G, Cal-Neto JP, Oliveira SR et al (2007) Effect of enamel etching on tensile bond strength of brackets bonded in vivo with a resin-reinforced glass ionomer cement. Angle Orthod 77:113–116

    Article  PubMed  Google Scholar 

  29. Stecksén-Blicks C, Renfors G, Oscarson ND et al (2007) Caries-preventive effectiveness of a fluoride varnish. A randomized controlled trial in adolescents with fixed orthodontic appliances. Caries Res 41:455–459

    Article  PubMed  Google Scholar 

  30. Tarvade SM, Deshmukh AA, Daokar SG (2014) Evaluation of bond strength. An in vitro study using pro seal. J Int Oral Health 6:1–3

    PubMed  PubMed Central  Google Scholar 

  31. Underwood ML, Rawls HR, Zimmerman BF (1989) Clinical evaluation of a fluoride-exchanging resin as an orthodontic adhesive. Am J Orthod Dentofacial Orthop 96:93–99

    Article  PubMed  Google Scholar 

  32. van der Veen MH, Attin R, Schwestka-Polly R et al (2010) Caries outcomes after orthodontic treatment with fixed appliances. Do lingual brackets make a difference? Eur J Oral Sci 118:298–303

    Article  PubMed  Google Scholar 

  33. Varlik SK, Demirbaş E (2009) Effect of light-cured filled sealant on the bond failure rate of orthodontic brackets in vivo. Am J Orthod Dentofacial Orthop 135: 144.e1– 144.e4 (discussion 144–5)

    Google Scholar 

  34. Varlik SK, Ulusoy C (2009) Effect of light-cured filled sealant on shear bond strength of metal and ceramic brackets bonded with a resin-modified glass ionomer cement. Am J Orthod Dentofacial Orthop 135:194–198

    Article  PubMed  Google Scholar 

  35. Wenderoth CJ, Weinstein M, Borislow AJ (1999) Effectiveness of a fluoride-releasing sealant in reducing decalcification during orthodontic treatment. Am J Orthod Dentofacial Orthop 116:629–634

    Article  PubMed  Google Scholar 

  36. Whittaker DK (1982) Structural variations in the surface zone of human tooth enamel observed by scanning electron microscopy. Arch Oral Biol 27:383–392

    Article  PubMed  Google Scholar 

  37. Zachrisson BJ (1977) A posttreatment evaluation of direct bonding in orthodontics. Am J Orthod 71:173–189

    Article  PubMed  Google Scholar 

  38. Zachrisson BU, Heimgård E, Ruyter IE et al (1979) Problems with sealants for bracket bonding. Am J Orthod 75:641–649

    Article  PubMed  Google Scholar 

  39. Zingler S, Pritsch M, Wrede DJ et al (2014) A randomized clinical trial comparing the impact of different oral hygiene protocols and sealant applications on plaque, gingival, and caries index scores. Eur J Orthod 36:150–163

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was awarded with the Best Poster Award (Parallel Symposium) at the 90th Scientific Annual Meeting of the German Orthodontic Society in Bonn, 2017.

Author information

Authors and Affiliations

  1. Department of Orthodontics, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany

    Christian Kirschneck D.D.S., Ph.D, Carina Rohn D.D.S.,  Peter Proff MD, D.D.S., Ph.D &  Claudia Reicheneder D.D.S., Ph.D

Authors
  1. Christian Kirschneck D.D.S., Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carina Rohn D.D.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Proff MD, D.D.S., Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claudia Reicheneder D.D.S., Ph.D
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christian Kirschneck D.D.S., Ph.D.

Ethics declarations

Conflict of interest

C. Kirschneck, C. Rohn, P. Proff and C. Reicheneder declare that they have no competing interests.

Ethical standards

All procedures performed were in accordance with the ethical standards of the institutional ethics committee and the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from all individual participants included in the study and in addition, if underage, from their legal guardians.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kirschneck, C., Rohn, C., Proff, P. et al. Influence of enamel sealing with a light-cured filled sealant before bracket bonding on the bond failure rate during fixed orthodontic therapy. J Orofac Orthop 80, 136–143 (2019). https://doi.org/10.1007/s00056-019-00174-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00056-019-00174-w

Keywords

Schlüsselwörter

Search

Navigation