ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title In-vitro Evidence Shows that using Bioactive Bonding Agents May Help Prevent White Spot Lesions Following Orthodontic Treatment
Clinical Question In a patient receiving traditional wire and bracket orthodontics, will using a bioactive glass bonding agent reduce the incidence of white spot lesions after treatment, as compared to using traditional composite?
Clinical Bottom Line Using bioactive glass bonding agents (BAG-Bonds) may help prevent white spot lesions following orthodontic treatment. This is supported by in-vitro studies that showed that bioactive glass bonding agents help prevent enamel softening around wire brackets. Switching to these bonding agents would be within the capability of an orthodontic practice, and would be acceptable to the patient.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22765388Manfred/201322765388In-vitro
Key resultsA significant reduction in micro-hardness was found at 25 and 50µm depth at all distances (100, 200, and 300µm) from the bracket edge. No hardness differences were noted past the 125µm depth.
#2) 22007662Brown/201115 discs of bonding materialIn-vitro
Key resultsDiscs of BAG-Bond material were immersed in a simulated body fluid at cycling neutral and acidic pHs. The BAG-bonds showed differences in phosphate and calcium ions released at multiple time points from the control. The pH was also significantly altered.
Evidence Search ("Orthodontic Appliances"[Mesh]) AND "Dental Caries"[Mesh] AND "white spot lesions"[All Fields]
Comments on
The Evidence
In the Manfred article, 4 different BAG-Bonds were compared to a control bonding agent, each on 10 different extracted molars. Teeth were cycled through demineralizing and remineralizing pH solutions once per day for 14 days. Each group of teeth were the same at the start. Compliance was 100%, and no competing interests were indicated. It is not indicated if the results were analyzed blindly. This study was more valid than the Brown article, because it was preformed on teeth, rather than on bonding agent alone. In the Brown article, each disc was identically sized and shaped, and placed in the same amount of simulated body fluid. No competing interests, or blind analysis of the results were indicated. Results were determined by atomic absorption analysis, ultraviolet visible spectrometry, and ion-specific electrode. Due to the poor level of evidence, an RCT utilizing a split-mouth methodology (half of the mouth bonded with standard composite, half bonded with BAG-Bonds) would be needed before a definitive conclusion could be made.
Applicability The results of these studies indicate that BAG-Bonds may slightly decrease the prevalence of white spot lesions extremely close to the bracket following orthodontics, simply by switching the bonding agent.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords Orthodontics, white spot lesions, traditional wire, BAG-Bond, bioactive glass bonding agents, bonding agents, in-vitro, microhardness, composite
ID# 2419
Date of submission: 02/28/2013spacer
E-mail williamsrm@livemail.uthscsa.edu
Author Ross Williams
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk, DDS, MS
Faculty mentor/Co-author e-mail brykc@uthscsa.edu
Basic Science Rationale
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