The Effects of Different Types of Surface Conditioning Methods on Enamel Demineralization: An In-vitro Rebonded Bracket Study

Year 2023, , 180 - 187, 31.08.2023

Kemal Can Acır , Orhan Çiçek , Nurhat Özkalaycı

https://doi.org/10.29058/mjwbs.1265876

Abstract

Aim: This study aimed to evaluate the effects of the conventional etching and primer (CEP) method and
the self-etching primer (SEP) method on demineralization while rebonding the brackets.
Material and Methods: Sixty extracted maxillary first premolar teeth were divided into 4 groups, each
containing 15 teeth. The teeth in Groups 1 and 2 were bonded using CEP, and those in Groups 3 and
4 were bonded using SEP. After the first bonding, adjacent surfaces of the brackets were measured
using DIAGNOdent pen, and demineralization values were recorded (T0). The teeth were kept in a
demineralization solution for 15 days in a 37°C incubator. Then, all brackets were debonded. The teeth
in Groups 1 and 3 were rebonded using CEP, and those in Groups 2 and 4 were rebonded using
SEP. In this way, via the enamel surface conditioning prior the first bonding and rebonding, the groups
were constructed as; Group 1 (CEP-CEP), Group 2 (CEP-SEP), Group 3 (SEP-CEP) and Group 4
(SEP-SEP). The teeth were kept in the same solutions by same way (T1). The Kolmogorov-Smirnov
test was used to determine whether or not the data were normally distributed, the Wilcoxon test was
used for comparisons within groups, and the Mann-Whitney U and Kruskal-Wallis tests were used for
comparisons between groups. p<0.05 was considered significant.
Results: At T1, the demineralization values in Group 1 obtained from all surfaces were found to be
significantly higher than those in Groups 3 and 4 (p<0.05). The amount of increase in demineralization
between T0 and T1 was observed to be the greatest on the gingival surfaces and the smallest on
occlusal surfaces in all groups. Regardless of the enamel surface measured, the mean increase in
values on all surfaces was the highest in Group 1 and the lowest in Group 4.
Conclusion: Considering the effects of orthodontic bracket rebonding on the enamel surface, the selfetching
primer method produces less enamel demineralization than the conventional etching and primer
method.

Keywords

Demineralization, rebonded bracket, diagnodent

Farklı Mine Yüzey Hazırlık İşlemlerinin Mine Demineralizasyonu Gelişimine Etkisinin Değerlendirilmesi: Bir İn-vitro Rebonded Braket Çalışması

Abstract

Amaç: Bu çalışma, yeniden yapıştırılan braketlerde geleneksel asitle pürüzlendirme yöntemi ile selfetching
primer yönteminin demineralizasyon üzerindeki etkilerini değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntemler: 60 adet çekilmiş maksiller birinci premolar diş, her biri 15’er diş içeren 4 gruba
ayrıldı. Braketler, Grup 1 ve 2’de asit ile pürüzlendirme ile, Grup 3 ve 4’te self-etching ile yapıştırıldı.
İlk yapıştırma işleminden sonra braketlerin komşu yüzeyleri DIAGNOdent pen kullanılarak ölçüldü
ve demineralizasyon değerleri kaydedildi (T0). Dişler 37°C inkübatörde 15 gün demineralizasyon
solüsyonunda bekletildi. Daha sonra tüm braketler koparıldı. Braketler, Grup 1 ve 3’teki dişlerde asitle pürüzlendirme ile, Grup 2 ve 4’teki dişlerde ise self-etching primer ile tekrar yapıştırıldı. Böylece, ilk yapıştırma ve tekrar yapıştırma öncesi
mine yüzey hazırlığı ile gruplar şu şekilde oluşturuldu; Grup 1 (asitle pürüzlendirme/asitle pürüzlendirme), Grup 2 (asitle pürüzlendirme/selfetching),
Grup 3 (self-etching/asitle pürüzlendirme) ve Grup 4 (self-etching/self-etching). Dişler aynı solüsyonlarda aynı şekilde bekletildi
(T1). Verilerin homojen dağılıp dağılmadığını belirlemek için Kolmogorov-Smirnov testi, grup içi karşılaştırmalarda Wilcoxon testi ve gruplar
arası karşılaştırmalarda Mann-Whitney U ve Kruskal-Wallis testleri kullanıldı. p<0.05 anlamlı kabul edildi.
Bulgular: T1 döneminde Grup 1’de tüm yüzeylerden elde edilen demineralizasyon değerleri Grup 3 ve 4’e göre anlamlı şekilde yüksek
bulundu (p<0.05). Tüm gruplarda T0 ve T1 arasındaki demineralizasyon artış miktarının en fazla gingival yüzeylerde, en az oklüzal
yüzeylerde olduğu görüldü. Ölçülen mine yüzeyinden bağımsız olarak, tüm yüzeylerdeki değerlerin artış ortalaması Grup 1’de en yüksek,
Grup 4’te en düşüktü.
Sonuç: Ortodontik braketlerin yeniden yapıştırılmasının mine yüzeyine etkileri göz önüne alındığında, self-etching primer yöntemi geleneksel
asitle pürüzlendirme yöntemine göre daha az mine demineralizasyonu oluşturur.

Keywords

Demineralizasyon, rebonded braket, diagnodent

References

• 1. Endo T, Ozoe R, Shinkai K, Aoyagi M, Kurokawa H, Katoh Y, Shimooka S. Shear bond strength of brackets rebonded with a fluoride-releasing and -recharging adhesive system. Angle Orthod 2009;79(3):564-570.
• 2. Bishara SE, VonWald L, Laffoon JF, Warren JJ. The effect of repeated bonding on the shear bond strength of a composite resin orthodontic adhesive. Angle Orthod 2000;70(6):435-443.
• 3. Roelofs T, Merkens N, Roelofs J, Bronkhorst E, Breuning H. A retrospective survey of the causes of bracket-and tube-bonding failures. Angle Orthod 2017;87(1):111-117.
• 4. Stasinopoulos D, Papageorgiou SN, Kirsch F, Daratsianos N, Jäger A, Bourauel C. Failure patterns of different bracket systems and their influence on treatment duration: A retrospective cohort study. Angle Orthod 2018;88(3):338-347.
• 5. Knaup I, Böddeker A, Tempel K, Weber E, Bartz JR, Rückbeil MV, Craveiro RB, Wagner Y, Wolf M. Analysing the potential of hydrophilic adhesive systems to optimise orthodontic bracket rebonding. Head Face Med 2020;16(1):1-8.
• 6. Öztoprak MO, Isik F, Sayınsu K, Arun T, Aydemir B. Effect of blood and saliva contamination on shear bond strength of brackets bonded with 4 adhesives. Am J Orthod Dentofacial Orthop 2007;131(2):238-242.
• 7. Dominguez GC, Tortamano A, Lopes LV de M, Catharino PCC, Morea C. A comparative clinical study of the failure rate of orthodontic brackets bonded with two adhesive systems: Conventional and self-etching primer (SEP). Dental Press J Orthod 2013;18:55-60.
• 8. Ajlouni R, Bishara SE, Oonsombat C, Denehy GE. Evaluation of modifying the bonding protocol of a new acid-etch primer on the shear bond strength of orthodontic brackets. Angle Orthod 2004;74(3):410-413.
• 9. Berk N, Başaran G, Özer T. Comparison of sandblasting, laser irradiation, and conventional acid etching for orthodontic bonding of molar tubes. Eur J Orthod 2008;30(2):183-189.
• 10. Montasser MA, Drummond JL, Roth JR, Al-Turki L, Evans CA. Rebonding of orthodontic brackets: Part II, an XPS and SEM study. Angle Orthod 2008;78(3):537-544.
• 11. Gorton J, Featherstone JDB. In vivo inhibition of demineralization around orthodontic brackets. Am J Orthod Dentofacial Orthop 2003;123(1):10-14.
• 12. Zhang QF, Yao H, Li ZY, Jin L, Wang HM. Optimal enamel conditioning strategy for rebonding orthodontic brackets: A laboratory study. Int J Clin Exp Med 2014;7(9):2705-2711.
• 13. Attin R, Stawarczyk B, Keçik D, Knösel M, Wiechmann D, Attin T. Shear bond strength of brackets to demineralize enamel after different pretreatment methods. Angle Orthod 2012;82(1):56- 61.
• 14. Dirie AR, Hajeer MY, Dabbas J, Al-Ibrahim HM. Evaluation of sandblasting with acid etching versus acid etching alone in the preparation of enamel for rebonding orthodontic brackets: An in vitro study and a randomized controlled trial. J World Fed Orthod 2021;10(1):3-8.
• 15. Geraldo-Martins VR, Lepri CP, Palma-Dibb RG. Influence of Er, Cr: YSGG laser irradiation on enamel caries prevention. Lasers Med Sci 2013;28:33-39.
• 16. Gorelick L, Geiger AM, Gwinnett AJ. Incidence of white spot formation after bonding and banding. Am J Orthod 1982;81(2):93-98.
• 17. O’reilly MM, Featherstone JDB. Demineralization and remineralization around orthodontic appliances: An in vivo study. Am J Orthod Dentofacial Orthop 1987;92(1):33-40.
• 18. Heymann GC, Grauer D. A contemporary review of white spot lesions in orthodontics. J Esthet Restor Dent 2013;25(2):85-95.
• 19. Øgaard B, Rølla G, Arends J. Orthodontic appliances and enamel demineralization: Part 1. Lesion development. Am J Orthod Dentofacial Orthop 1988;94(1):68-73.
• 20. Richter AE, Arruda AO, Peters MC, Sohn W. Incidence of caries lesions among patients treated with comprehensive orthodontics. Am J Orthod Dentofacial Orthop 2011;139(5):657- 664.
• 21. Lovius BBJ, Pender N, Hewage S, O’Dowling I, Tomkins A. A clinical trial of a light activated bonding material over an 18 month period. Br J Orthod 1987;14(1):11-20.
• 22. Nalbantgil D, Oztoprak MO, Cakan DG, Bozkurt K, Arun T. Prevention of demineralization around orthodontic brackets using two different fluoride varnishes. Eur J Dent 2013;7(01):41- 47.
• 23. Ahrari F, Poosti M, Motahari P. Enamel resistance to demineralization following Er: YAG laser etching for bonding orthodontic brackets. J Dent Res 2012;9(4):472-477.
• 24. Liu J fen, Liu Y, Stephen HCY. Optimal Er: YAG laser energy for preventing enamel demineralization. J Dent 2006;34(1):62- 66.
• 25. Paschos E, Kleinschrodt T, Clementino-Luedemann T, Huth KC, Hickel R, Kunzelmann KH, Rudzki-Janson I. Effect of different bonding agents on prevention of enamel demineralization around orthodontic brackets. Am J Orthod Dentofacial Orthop 2009;135(5):603-612.
• 26. Demito CF, Vivaldi‐Rodrigues G, Ramos AL, Bowman SJ. The efficacy of a fluoride varnish in reducing enamel demineralization adjacent to orthodontic brackets: An in vitro study. Orthod Craniofacial Res 2004;7(4):205-210.
• 27. Gillgrass TJ, Creanor SL, Foye RH, Millett DT. Varnish or polymeric coating for the prevention of demineralization? An ex vivo study. J Orthod 2001;28(4):291-295.
• 28. Baysal A, Yasa A, Sogut O, Ozturk MA, Uysal T. Effects of different orthodontic primers on enamel demineralization around orthodontic brackets. J Orofac Orthop 2015;76(5):421- 430.
• 29. Ghiz MA, Ngan P, Kao E, Martin C, Gunel E. Effects of sealant and self-etching primer on enamel decalcification. Part II: An in-vivo study. Am J Orthod Dentofacial Orthop 2009;135(2):206- 213.
• 30. Paschos E, Galosi T, Huth KC, Rudzki I, Wichelhaus A, Kunzelmann KH. Do bonding agents protect the bracketperiphery?— Evaluation by consecutive μCT scans and fluorescence measurements. Clin Oral Investig 2015;19(1):159- 168.
• 31. Visel D, Jäcker T, Jost-Brinkmann PG, Präger TM. Demineralization adjacent to orthodontic brackets after application of conventional and self-etching primer systems. J Orofac Orthop 2014;5(75):358-373.
• 32. Hess E, Campbell PM, Honeyman AL, Buschang PH. Determinants of enamel decalcification during simulated orthodontic treatment. Angle Orthod 2011;81(5):836-842.
• 33. Hosein I, Sherriff M, Ireland AJ. Enamel loss during bonding, debonding, and cleanup with use of a self-etching primer. Am J Orthod Dentofacial Orthop 2004;126(6):717-724.
• 34. Tan A, Çokakoğlu S. Effects of adhesive flash-free brackets on enamel demineralization and periodontal status. Angle Orthod 2020;90(3):339-346.
• 35. Pakshir H, Ajami S. Effect of enamel preparation and light curing methods on microleakage under orthodontic brackets. J Dent 2015;12(6):436-446.
• 36. Alavi S, Ehteshami A. Comparison of shear bond strength and enamel surface changing between the two-step etching and primer and self-etch primer methods in rebonding of orthodontic brackets: An in vitro study. J Dent Res 2019;16(4):239-244.