Title Bioactive Glass Resins Containing Fluoride Can Prevent Formation of White Spot Lesions During Fixed Orthodontic Treatment
Clinical Question In patients receiving fixed orthodontic brackets, will orthodontic resins containing bioactive glass and fluoride reduce the number of white spot lesions when compared to conventional orthodontic resins?
Clinical Bottom Line Prevention of white spot lesions (WSLs) is successful when bioactive glass resins containing fluoride are used. WSLs following orthodontic treatment are unaesthetic and are also at risk for cavitation. Increased surface area of the brackets and bonding material increase the probability of plaque adhesion leading to WSLs. Although intensive oral hygiene regimes such as daily fluoride rinses and varnishes may help in prevention, they require a great deal of patient compliance. Bioactive glass resins containing fluoride (FBAGs) may reduce WSL formation while also not requiring strict patient compliance.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
31167432Nam/201920 extracted premolars without WSLs or demineralizationLaboratory study
Key resultsFluoride containing bioactive glass resins (FBAGs) were classified as FBAG1, FBAG3 and FBAG5, which have increasing amounts of fluoride in each compound, respectively. FBAGs, in general, showed higher antimicrobial activity and excellent anti-demineralization effects compared to conventional orthodontic resin. FBAG1, FBAG3 and FBAG5 also displayed increasing significant differences in anti-demineralization distances when compared to Transbond XT Low Flow (LV). LV showed anti-demineralization distances of 14.7um compared to FBAG5 at a distance of 229.3um.
31013602Nam/201920 extracted premolars without WSLs or demineralizationLaboratory study
Key resultsFluoride and graphite-containing bioactive glass (FGtBAG) showed greater antimicrobial properties and remineralization effects than traditional orthodontic resins such as CharmFil Flow (CF). The remineralization abilities of FGtBAG were significantly higher than the CF orthodontic resins. Using Duncan’s multiple comparison test, the remineralization abilities increased significantly as greater quantities of FGtBAG was added to the resin.
Evidence Search (((((bioactive glass) AND orthodontic bonding) AND resin) AND fluorinated)) AND demineralization
Comments on
The Evidence
Validity: Both studies by Nam are in vitro studies; therefore, they provide weaker evidence than clinical trials, especially randomized controlled trials and systematic reviews. The studies did show a significant increase in anti-demineralization properties when using bioactive glass resins containing fluoride. Perspective: The in vitro studies demonstrate a high potential for clinical success with bioactive glass resins containing fluoride to prevent white spot lesions while requiring less patient compliance. Clinical trials using these biomaterials will be necessary to determine how effective they can be. These studies showed that fluoride-containing bioactive glass (FBAG) resins showed sufficient bonding strengths and biological properties (along with other mechanical features) to be used as viable orthodontic resins. Overall, there is a need for more clinical research on this topic.
Applicability Enhanced antimicrobial and anti-demineralization properties play a key role in WSL prevention. Based on the results of these studies, orthodontic bonding resins containing bioactive glass and fluoride can decrease the prevalence of white spot lesions in vitro without the need for superior compliance on the part of the patient. Using an alternative orthodontic resin when bonding fixed orthodontic brackets is a simple task clinically and could be expected to be accepted by most clinicians.
Specialty (General Dentistry) (Orthodontics)
Keywords bioactive glass; white spot lesions; orthodontic bonding; fluoride; fixed brackets
ID# 3415
Date of submission 12/04/2019
E-mail cavayero@livemail.uthscsa.edu
Author Jordan Cavayero, DMD
Co-author(s) Michael Touloupas, DDS
Co-author(s) e-mail Touloupas@livemail.uthscsa.edu
Faculty mentor Dr. Ravikumar Anthony
Faculty mentor e-mail anthonyr@uthscsa.edu
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available