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The reported prevalence of decalcification in orthodontic patients varies from 2 to 96% mainly due to the lack of a standard examination technique. The aims of this study were: 1) to determine the prevalence of white spot lesions around brackets using visual examination and the DIAGNOdent; 2) to determine which teeth were the most susceptible to decalcification; and 3) to test the accuracy of the DIAGNOdent by comparing to the visual examination. The presence of white spot lesions was determined in two groups of patients who were 6 and 12 months into orthodontic treatment, respectively. The control group consisted of patients who were examined for white spot lesions immediately after having their braces placed on their teeth. The prevalence of white spot lesions was 38%, 46%, and 11% for the 6-month, 12-month, and control groups, respectively. There was a statistically significant correlation (r = 0.71) between the DIAGNOdent measurements and the visual examination.

Enamel damage and demineralisation are common complications associated with fixed orthodontic appliances. In particular, the clean-up of adhesive remnants after debonding is a recognised cause of enamel damage. Furthermore, fixed attachments offer retentive areas for accumulation of cariogenic bacteria leading to enamel demineralisation and formation of white spot lesions (WSLs). Bioactive glasses may be used to remove adhesives, preserving the integrity of the enamel surface, while also having the potential to induce enamel remineralisation, although their efficacy in both respects has received little attention. A systematic review evaluating the remineralisation potential of bioactive glasses was first undertaken. No prospective clinical studies were identified; however, a range of in vitro studies with heterogeneous designs were identified, largely providing encouraging results. A series of glasses was prepared with molar compositions similar to 45S5 (SylcTM; proprietary bioactive glass) but with constant fluoride, reduced silica and increased sodium and phosphate contents. These glasses were characterised in several tests and the most promising selected. This was designed with hardness lower than that of enamel and higher than orthodontic adhesives. Its effectiveness in terms of removal of composite- and glass ionomer- based orthodontic adhesives was evaluated against SylcTM and a tungsten carbide (TC) bur. This novel glass was subsequently used for remineralisation of artificially-induced orthodontic WSLs on extracted human teeth. The novel glass propelled via the air-abrasion system selectively removed adhesives without inducing tangible physical enamel damage compared to SylcTM and the conventional TC bur. It also remineralised WSLs with surface roughness and intensity of light backscattering similar to sound enamel. In addition, mineral deposits were detected on remineralised enamel surfaces; these acted as a protective layer on the enamel surface and improved its hardness. This layer was rich in calcium, phosphate, and fluoride; 19F MAS-NMR, confirmed the formation of fluorapatite. This is particularly beneficial since fluorapatite is more chemically stable than hydroxyapatite and has more resistance to acid attack. Hence, a promising bioactive glass has been developed.

Objectives: 1) To develop and investigate the bioactivities of a novel bioactive glass (BAG) composite designed as an orthodontic adhesive. 2) To investigate the preventive effect, and to test the bond strength of the adhesive. Methods: A novel, calcium and phosphate rich, and fluoride containing, bioactive glass (BAG) was prepared via the melt quench route and incorporated into an experimental resin to produce a light cured paste. The ratio of the resin to the powder was 20:80% respectively. The BAG powder was gradually replaced by a high fluoride and silica content glass (HSG) from 80%, to 60%, 50%, 40%, 25% and 0%. 90 disks (1.26mm thickness and 10mm diameter) were produced from each composition to be immersed in 3 solutions (demineralising artificial saliva pH=4 (AS4), remineralising artificial saliva pH=7 (AS7) and Tris buffer (TB) pH=7.3, 10 ml each. Measurements were taken at 10 time points (from 6 hours to 6 months) in 3 replicas in each solution. Ion release study was determined by ISE and ICP, and pH monitoring was conducted on the resulting solutions. Immersed disks were studied by FTIR, XRD, MAS-NMR and SEM for apatite formation. XMT were used to study the effects of this material on demineralisation/remineralisation in human enamel. Shear bond strength of the adhesive on bovine enamel were studied in different conditions using an Instron machine. Results: The pH increased with time for all the samples with BAG in all solutions and was linearly correlated to BAG loading. Ion release results revealed that the composite disks release up to 15ppm F-, 450ppm Ca2+ and 10ppm PO43- ions, and the release pattern is directly related to the immersion time, with the highest release found in AS4. FTIR spectra, XRD patterns and SEM images showed formation of apatite on all the BAG-resin disks, especially in AS4 and this increase with time. The MAS-NMR spectra indicated fluorapatite was also formed. The XMT studies showed that the novel material reduces demineralisation around the brackets by 80%. The shear bond strength of this novel material was comparable to that of Transbond XT. Conclusion: The novel BAG composites have significant long term releases of F-, Ca2+ and PO43- ions, especially in acidic conditions and form apatite (including FAP) in acidic and neutral solutions. This implies that the material has the potential as an orthodontic adhesive that can prevent white spot lesions around brackets.

Orthodontic treatment may cause an increase in the rate of enamel decalcification on tooth surfaces, producing White Spot Lesions (WSL). Orthodontic patients are at a higher risk for decalcification because orthodontic appliances retain food debris which leads to increased plaque formation. Dental plaque, an oral biofilm formed by factors including genetics, diet, hygiene, and environment, contains acid producing bacterial strains with a predominance of Mutans Streptococcus (MS). MS and others metabolize oral carbohydrates during ingestion, the byproducts of which acidify the biofilm to begin a process of enamel decalcification and formation of WSL. This study tests if patients in orthodontic treatment at Temple University can be used as subjects for further longitudinal study of WSL risk factors. Twenty patients between the ages of ten to eighteen after three months or greater of treatment were enrolled to determine if duration of treatment, hygiene, sense of coherence, obesity, diet frequencies, age and gender correlated with development of WSL. Of these, age is positively correlated with the number of untreated decayed surfaces. WSL and plaque levels may negatively correlate with increased brushing frequency and duration, while flossing frequency demonstrated a statistically significant negative correlation. This population may be suitable for further study because of its high incidence of WSL (75%), however difficulty in enrollment and patient attrition necessitates that future studies be modified. / Oral Biology

Introduction: Orthodontic treatment is meant to provide patients with stable occlusion and an esthetic smile, and often improves a patient's self-esteem. Unfortunately, and too often, an ideal orthodontic finish in terms of alignment and occlusion is tarnished by the appearance of white spot lesions on the facial surface of teeth after removing the fixed appliances. These white spots detract from the esthetics of a patient's smile. Purpose: The objective of this study was to evaluate the effectiveness of MI PasteTM (GC America, Alsip, Illinois), MI Paste PlusTM (GC America, Alsip, Illinois), and Topex RenewTM (Sultan Healthcare, Hackensack, NJ) in increasing remineralization and improving the esthetic appearance of white spot lesions in patients after treatment with fixed orthodontic appliances. In addition, at-home only versus in-office and at-home treatment protocols were evaluated. Methods and Materials: Thirty patients were enrolled in four treatment groups and a control group, with six patients in each group. The study lasted three months and results were analyzed with normal and QLF photographs. Results, Discussion, and Conclusion: Upon completion of this clinical study, the following conclusions can be drawn. First, the visible area and the fluorescence decrease of white spot lesions will both significantly lessen after orthodontic treatment regardless of products used, or even with a non-prescription fluoride toothpaste control. Second, there is some evidence that an at-home treatment protocol using Topex Renew, or a combination in-office and at-home treatment protocol with MI Paste Plus, may be more beneficial in reducing the appearance of white spot lesions after orthodontic treatment than other treatment protocols.

Aim: The aim of this study was to investigate if there is a beneficial effect on the prevalence of white spot lesions (WSL) in the mandibular and maxillary teeth when the teeth in the maxilla are treated with fluoride varnish compared to a placebo group. The null hypothesis was that there is no difference between the test and placebo group in development of WSL. Material and Method: 182 patients from three clinics in Scania county (Sweden) undergoing treatment with fixed orthodontic appliances were selected to participate, in the end 149 patients were included in the study. The patients were divided into two groups, one receiving a varnish of 7700 ppm fluoride (Fluor Protector S, Ivoclar Vivadent AG, Schaan, Liechtenstein) and one a placebo varnish. Pre- and post-treatment photos were taken and WSL was graded according to Gorelick index by two independent observers.  Results: No significant difference could be seen between the test and placebo group, neither on surface nor individual level. The results were based on both t-test and percentual calculations.  Conclusion: The null hypothesis could be accepted since no significant difference could be seen between the test or placebo group. Due to the loss of a number of patients, mainly because of loss in the original study and new exclusion criteria set by the authors, the results may have been conflicted. More research is therefore needed to draw any conclusions. / Syfte: Syftet med studien var att undersöka om det finns en effekt på förekomsten av white spot lesions (WSL) hos under- och överkäkens tänder när tänderna i överkäken behandlas med fluoridvarnish. Nollhypotesen sattes till att det inte finns någon skillnad mellan test- och placebogruppen i prevalens av WSL. Material och metod: Patienter från tre olika kliniker i Skåne deltog i studien, 149 av 182 deltagare fullföljde studien. Patienterna delades in i två grupper, en som fick ett fluoridvarnish med 7700 ppm fluorid (Fluor Protector S, Ivoclar Vivadent AG, Schaan, Liechtenstein) och en med placebovarnish. Kliniska foton togs innan samt efter behandling med fast apparatur som graderades och bedömdes enligt Gorelick-skalan för WSL av två oberoende observatörer. Resultat: Det fanns ingen signifikant skillnad mellan testgruppen och placebogruppen varken på individ- eller ytnivå. Resultatet baserades på både t-test och procentberäkningar. Slutsats: Nollhypotesen accepterades då ingen signifikant skillnad fanns mellan test- och placebogrupp. På grund av bortfall av patienter, både i originalstudien men även med anledning av exklusionskriterier satta för denna studie, kan resultatet ha påverkats. Mer forskning behövs därför för att dra några slutsatser.

Objectives: To determine whether treatment of demineralized enamel white spot lesions with CPP-ACP paste, CPP-ACFP paste or microabrasion technique decreases lesion depth in vitro. Additionally, to determine whether treatment of demineralized enamel white spot lesions with microabrasion technique in combination with CPP-ACP paste or CPP-ACFP paste decreases lesion depth greater than any of the three techniques alone. Background: White spot lesions (WSLs) after the removal of orthodontic appliances remain a problem for clinicians and patients. Previous studies suggest that application of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) may promote enamel remineralization. Recently, microabrasion of enamel was proposed as another treatment modality of white spot lesions. A review of literature showed that there was no comprehensive in vitro study that combined microabrasion, casein phosphopeptide amorphous calcium phosphate and casein phosphopeptide amorphous calcium fluoride phosphate for treatment of WSLs. Methods: A total of one hundred and twelve bovine incisor teeth were randomly assigned to seven treatment groups: 1. Control 1 (demineralization control), 2. Control 2 (remineralization solution control), 3. CPP-ACP paste, 4. CPP-ACFP paste, 5. Microabrasion, 6. Microabrasion with CPP- ACP paste, and 7. Microabrasion with CPP-ACFP paste. Teeth in all groups were placed in demineralizing solution for 96 hours to produce artificial caries-like lesions. At the end of the 96 hr period, teeth in Control 1 group were sectioned to establish adequate amount of demineralization. The rest of samples were treated with assigned regimen once a day for 10 days and stored in remineralization solution. At the end of ten days, teeth were sectioned with a hard tissue microtome and observed under polarized microscopy to analyze enamel lesion depth. One-way ANOVA at α=0.05 was performed to assess difference in lesion depth between groups followed with post hoc Tukey's test. Results: Statistical analysis showed a significant difference between groups (pConclusions: Based on the results from this study, we can conclude that: (1) treatment of WSLs with CPP-ACP paste, CPP-ACFP paste or microabrasion decreases lesion depth in vitro; (2) microabrasion in combination with CPP-ACP paste or CPP-ACFP paste did not decrease lesion depth greater than that observed with either paste technique alone; (3) both CPP-ACP and CPP-ACFP pastes in combination with microabrasion treatments showed greater decrease in lesion depth than microabrasion alone.

AN INVESTIGATION OF SURFACE CHARACTERISTICS OF ENAMEL TREATED WITH INFILTRATIVE RESIN: A SCANNING ELECTRON MICROSCOPY STUDY Danielle E. Easterly, Doctorate of Dental Surgery. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science in Dentistry at Virginia Commonwealth University. Virginia Commonwealth University. 2017. Director: Dr. Eser Tüfekçi D.D.S., M.S., Ph.D., M.S.H.A. Objective: To evaluate the microstructural changes of a resin infiltrant (ICON®, DMG America LLC, Englewood, NJ) after six months of simulated toothbrushing. Materials and Methods: Ten extracted third molars (n=10) were collected. Artificial white spot lesions were created and resin applied. Environmental SEM images at 250X and 500X were taken after application of Icon® (T1), and after six months of simulated toothbrushing (T2). Micrographs were evaluated for changes in surface characteristics. Results: SEM showed some changes in the surface characteristics of the resin after simulated toothbrushing. However, changes in presence of enamel rods, microcracks, or fractures were not statistically significant (p>0.05). The effects of polymerization shrinkage were noted on most samples in the form of clefts and fissures. Conclusions: Icon® resin seems to withstand challenge by toothbrush abrasion over a six-month period, with some evidence of microstructural wear.

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