Preface to COAST 2018 Innovators' Workshop: Bridging the biology and technology gap in orthodontics and craniofacial care.

OBJECTIVE: A third focused workshop explored how to transfer novel findings into clinical orthodontic practice. SETTING AND SAMPLE POPULATION: Participants met at the Scottsdale Plaza Resort, 12-16 September 2018 for the Consortium for Orthodontic Advances in Science and Technology 2018 Innovators' Workshop. Thirty speakers and four lunch-hour focus group leaders shared and exchanged information with approximately 45 registered attendees. MATERIAL AND METHODS: This Innovators' Workshop was organized according to five themed sessions which covered: (a) The relevance of genetics, biology and environment to therapeutic outcomes; (b) Application of bioinformatics in craniofacial research; (c) Regeneration with and for orthodontic treatment; (d) Technology in precision orthodontics; and (e) Muscle, joint, and airway: Growth, function and pain. RESULTS: The papers that comprise this supplemental issue exemplify the important outcomes of the 2018 COAST Workshop. In addition, matters identified as important needs include improved understanding of neural, skeletal and muscle tissue crosstalk in early craniofacial growth; standardized methods for three-dimensional radiographic and surface landmark and reference plane identification, measurements and serial superimpositioning techniques for use in the clinic; sharing and making available existing data sets (eg, cone beam computed tomography images, genotype-phenotype data); evidence of the usefulness and effectiveness of new devices; guidelines of what to measure to characterize the airway; more information about the influences of the soft tissues on craniofacial morphology; and information about effective digital work flows applied to clinical and educational settings. CONCLUSIONS: Progress in bridging the biology-technology gap has identified new needs for improvements in orthodontics and craniofacial care.

Early Weight Gain in Infants With Cleft Lip and Palate Treated With and Without Nasoalveolar Molding: A Retrospective Study.

OBJECTIVE: To assess weight gain of infants with cleft lip and/or palate (CL ± P) treated with nasoalveolar molding (NAM). DESIGN: Retrospective, case-control chart review. SETTING: Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon. PATIENTS, PARTICIPANTS: Infants with nonsyndromic CL ± P and noncleft controls. INTERVENTIONS: Prior to primary lip surgery, NAM was either included (+NAM) or not included (-NAM) in the cleft treatment protocol. MAIN OUTCOME MEASURE(S): Weight gain and percentage weight gain relative to initial weight were compared among +NAM, -NAM, and control groups from birth to 7 months and from birth to 36 months. RESULTS: Comparing +NAM and -NAM groups, no significant difference in weight or percentage weight gain was found in either time window. Compared to controls, from birth to 7 months, both CL ± P groups weighed less (P < .001), while percentage weight gain was greater for the +NAM (P < .001) and did not differ for -NAM. From birth to 36 months relative to controls, weight for +NAM showed no significant difference and -NAM weighed less (P < .01), while percentage weight gain was greater for both CL ± P groups (P < .001). CONCLUSIONS: Comparisons of CL ± P infants treated with and without NAM showed that with the NAM appliance, despite its added complexity, there was no adverse impact on weight gain. Comparisons to noncleft, control infants suggests that NAM treatment may have a beneficial impact on weight gain.

Association between obstructive sleep apnea syndrome and bone mineral density in adult orthodontic populations.

OBJECTIVE: To determine the association between obstructive sleep apnea syndrome (OSAS) and predicted bone mineral density (BMD) in adults presenting for orthodontic treatment. METHODS: This retrospective cross-sectional study included 38 adults divided into OSAS and non-OSAS groups. Using pre-treatment CBCT images, radiographic density (RD) of left and right lateral regions of the 1st cervical vertebrae and dens of the 2nd cervical vertebrae were measured as an indicator for BMD. RESULTS: When controlling for age, sex, and BMI, the mean RD was significantly lower in the OSAS group compared to the non-OSAS group (left CV1: 36.69 ± 84.50 vs. 81.67 ± 93.25 Hounsfield Units [HU], respectively, p = 0.031; right CV1: 30.59 ± 81.18 vs. 74.26 ± 91.81 HU, p = 0.045; dens: 159.25 ± 115.96 vs. 223.94 ± 106.09 HU, p = 0.038). CONCLUSION: Adults with OSAS have lower values for predicted BMD than those without OSAS.

Comparison of bleaching effects when applied to white-spot lesions before or after resin infiltration: An in vitro study.

BACKGROUND: The purpose of this study was to compare color alterations (ΔE) of white-spot lesions (WSLs) bleached before versus after resin infiltration (RI). METHODS: Using the facial surfaces of bovine maxillary incisors, WSLs were created and the teeth were allocated into 2 groups (n = 45/group): bleach then RI (B-RI group) and RI then bleach (RI-B group). To determine ΔE, Commission Internationale de l'Eclairage L∗ a∗ b∗ (L∗ represents lightness, ranging from black to white [0-100]; a∗ represents green to red chromaticity [-150-+100]; and b∗ represents blue to yellow chromaticity [-100-+150]) measurements were obtained at baseline, after WSL formation, and after RI and bleaching. Representative specimens were evaluated by means of scanning electron microscopy. Statistical analyses included the Mann-Whitney U and Wilcoxon signed rank tests (P ≤ .0016) and repeated measures analysis of variance (P ≤ .05). RESULTS: No differences in ΔE were found comparing B-RI with RI-B groups or when the B-RI group was compared with bleached enamel. A statistically significant difference was found when the RI-B group was compared with bleached enamel (ΔE, 0.81; P < .001), but the difference was deemed not clinically significant. Scanning electron microscopy revealed that bleaching after RI increased surface roughness of the resin. CONCLUSIONS: There were no clinically significant differences in ΔE of WSLs when bleach was applied before or after RI; however, applying bleaching agent after RI roughened the surface of the resin material. PRACTICAL IMPLICATIONS: Results indicate that ΔE were not clinically significantly different between WSLs bleached before versus after RI, although it is best to sequence bleaching before RI therapy, as bleaching after RI roughened the restoration's surface.

Accuracy and reliability of buccal bone height and thickness measurements from cone-beam computed tomography imaging.

INTRODUCTION: Cone-beam computed tomography (CBCT) imaging has broadened opportunities for examining morphologic aspects of the craniofacial complex, including alveolar bone, but limitations of the technology have yet to be defined. Through the use of comparisons with direct measurements, the purpose of this study was to investigate the accuracy and reliability of buccal alveolar bone height and thickness measurements derived from CBCT images. METHODS: Twelve embalmed cadaver heads (5 female, 7 male; mean age: 77 years) were scanned with an i-CAT 17-19 unit (Imaging Sciences International, Hatfield, Pa) at 0.3 mm voxel size. Buccal alveolar bone height and thickness measurements of 65 teeth were made in standardized radiographic slices and compared with direct measurements made by dissection. All measurements were repeated 3 times by 2 independent raters and examined for intrarater and interrater reliability. Measurement means were compared with 2-tailed t tests. Agreement between direct and CBCT measurements was assessed by concordance correlation coefficients, Pearson correlation coefficients, and Bland-Altman plots. RESULTS: Intrarater reliability was high as were interrater correlations for all measurements (≥0.97) except CBCT buccal bone thickness (0.90). CBCT measurements did not differ significantly from direct measurements, and there was no pattern of underestimation or overestimation. The mean absolute differences were 0.30 mm in buccal bone height and 0.13 mm in buccal bone thickness with 95% limits of agreement of -0.77 to 0.81 mm, and -0.32 to 0.38 mm, respectively. Agreement between the 2 methods was higher for the measurements of buccal bone height than buccal bone thickness, as demonstrated by concordance correlation coefficients of 0.98 and 0.86, respectively. CONCLUSIONS: For the protocol used in this study, CBCT can be used to quantitatively assess buccal bone height and buccal bone thickness with high precision and accuracy. Comparing the 2 sets of CBCT measurements, buccal bone height had greater reliability and agreement with direct measurements than did the buccal bone thickness measurements.

Porcelain surface alterations and refinishing after use of two orthodontic bonding methods.

OBJECTIVE: To compare porcelain surfaces at debonding after use of two surface preparation methods and to evaluate a method for restoring the surface. MATERIALS AND METHODS: Lava Ceram feldspathic porcelain discs (n = 40) underwent one of two surface treatments prior to bonding orthodontic brackets. Half the discs had sandblasting, hydrofluoric acid, and silane (SB + HF + S), and the other half, phosphoric acid and silane (PA + S). Brackets were debonded using bracket removing pliers, and resin was removed with a 12-fluted carbide bur. The surface was refinished using a porcelain polishing kit, followed by diamond polishing paste. Measurements for surface roughness (Ra), gloss, and color were made before bonding (baseline), after debonding, and after each step of refinishing. Surfaces were also examined by scanning electron microscopy (SEM). Data was analyzed with 2-way ANOVA followed by Tukey HSD tests (alpha = 0.05). RESULTS: The SB + HF + S bonding method increased Ra (0.160 to 1.121 microm), decreased gloss (41.3 to 3.7) and altered color (DeltaE = 4.37; P < .001). The PA + S method increased Ra (0.173 to 0.341 microm; P < .001), but the increase in Ra was significantly less than that caused by the SB + HF + S bonding method (P < . 001). The PA + S method caused insignificant changes in gloss (41.7 to 38.0) and color (DeltaE = 0.50). The measurements and SEM observations showed that changes were fully restored to baseline with refinishing. CONCLUSIONS: The PA + S method caused significantly less damage to porcelain than the SB + HF + S method. The refinishing protocol fully restored the porcelain surfaces.

Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions.

OBJECTIVE: To assess the efficacy and efficiency of treatment in adolescents presenting with mild malocclusions, comparing outcomes using clear aligners to fixed appliances. MATERIALS AND METHODS: Patients identified retrospectively and consecutively from one private practice had been treated with either clear aligners (Invisalign, Align Technology, Santa Clara, Calif) or fixed appliances (0.022 Damon, Ormco, Orange, Calif; n = 26/group). Assessments of occlusion were made using the American Board of Orthodontics Discrepancy Index (DI) for initial records and Cast-Radiograph Evaluation (CRE) for final records. Number of appointments, number of emergency visits, and overall treatment time were determined from chart reviews. Data were analyzed using Pearson's correlation, Wilcoxon rank tests, unpaired t-tests, and Chi-square tests, with significance set to P ≤ .05. RESULTS: Pretreatment, the aligner and fixed groups showed no significant difference in overall severity (DI: 11.9 ± 5.3 vs 11.6 ± 4.8) or in any individual DI category. Posttreatment scores showed finishes for the aligner group had fewer discrepancies from ideal relative to the fixed appliance group (CRE: 30.1 ± 8.3 vs 37.0 ± 9.3; P < .01). Patients treated with aligners had fewer appointments (13.7 ± 4.4 vs 19.3 ± 3.6; P < .0001), fewer emergency visits (0.8 ± 1.0 vs 3.6 ± 2.5; P < .0001), and shorter overall treatment time (16.9 ± 5.7 vs 23.4 ± 4.4 months; P < .0001). CONCLUSIONS: Outcomes for treatment of mild malocclusions in adolescents showed equivalent effectiveness of clear aligners compared to fixed appliances, with significantly improved results for clear aligner treatment in terms of tooth alignment, occlusal relations, and overjet. Assessment of the number of appointments, number of emergency visits, and overall treatment time showed better outcomes for treatment with clear aligners.

Plaque retention by self-ligating vs elastomeric orthodontic brackets: quantitative comparison of oral bacteria and detection with adenosine triphosphate-driven bioluminescence.

INTRODUCTION: Enamel decalcification is a common problem in orthodontics. The objectives of this randomized clinical study were to enumerate and compare plaque bacteria surrounding 2 bracket types, self-ligating (SL) vs elastomeric ligating (E), and to determine whether adenosine triphosphate (ATP)-driven bioluminescence could be used for rapid assessment of bacterial load in plaque. METHODS: Patients (ages, 11-17 years) were bonded with SL and E brackets in 14 maxillary and 12 mandibular arches by using a split-mouth design. Recall visits were at 1 and 5 weeks after bonding. Plaque specimens were assayed for oral bacteria and subjected to ATP-driven bioluminescence determinations with a luciferin-based assay. RESULTS: In most patients, teeth bonded with SL attachments had fewer bacteria in plaque than did teeth bonded with E brackets. At 1 and 5 weeks after bonding, the means for SL vs E brackets were statistically lower for total bacteria and oral streptococci (P <0.05). ATP bioluminescence values were statistically correlated to the total oral bacteria and oral streptococci, with correlation coefficients of 0.895 and 0.843, respectively. CONCLUSIONS: SL appliances promote reduced retention of oral bacteria, and ATP bioluminescence might be a useful tool in the rapid quantification of bacterial load and the assessment of oral hygiene during orthodontic treatment.

An in vitro comparison of ultraviolet versus white light in the detection of adhesive remnants during orthodontic debonding.

OBJECTIVES: To assess the effectiveness and efficiency of ultraviolet (UV) illumination compared to conventional white light in the detection of fluorescent-tagged adhesive remnants during orthodontic debonding. MATERIALS AND METHODS: Orthodontic brackets were bonded to extracted human premolars using one of two bonding resins having fluorescent properties (Pad Lock, Reliance Orthodontics, Itasca, Ill; Opal Bond MV, Opal Orthodontics, South Jordan, Utah; n = 40 each). The brackets were then debonded and, in each adhesive group, half the teeth had the remaining adhesive resin removed under illumination using the operatory light and the other half using a UV (395 nm) light emitting diode (LED) flashlight (n = 20/group). Time for teeth cleanup was recorded. Follow-up images were obtained under a dissecting microscope using UV illumination, and the surface area of adhesive remnants was calculated. Effectiveness of adhesive removal was also assessed using scanning electron microscopy imaging. Analysis of variance and Kruskal-Wallis tests were used to analyze time and adhesive remnants, respectively. RESULTS: Assessment using the dissecting microscope found groups using UV light during adhesive removal had statistically significantly lower amounts of adhesive remnants than groups using white light (P ≤ .01). Time for adhesive removal was significantly lower with Opal Bond MV adhesive using UV light when compared with the white light (P ≤ .01). Assessment by scanning electron microscopy showed that thin remnants of adhesive (<2 µm) remained undetected by UV illumination. CONCLUSIONS: UV light is more effective and tends to be more efficient than white light in the detection of fluorescent adhesive during orthodontic debonding. Although there are limitations, the use of UV LED lighting is a practical tool that aids in adhesive detection.

Patterns of dental care utilization among patients with temporomandibular disorders.

AIMS: To use data from a large health maintenance organization to specifically investigate dental utilization rates among patients with and without temporomandibular disorders (TMD). METHODS: Subjects were enrolled in Kaiser Permanente Northwest between 1998 and 2003. Two age- and gender-matched controls were selected for each subject who had a TMD diagnosis during the study period. Dental treatment was categorized using Current Dental Terminology (CDT) codes. Overall dental utilization rates were calculated, as well as rates based on age, gender, categories of treatment, and periods before and after TMD diagnoses. These rates were analyzed with t tests. RESULTS: TMD subjects utilized significantly more dental services than comparison subjects overall and for several dental categories. The difference was between 10% to 20%, or about 1 additional dental procedure per year. A positive linear relationship existed between dental utilization rates and age, with a significant increase in utilization for each ascending age cohort. Females had higher dental utilization rates than males in TMD and non-TMD groups and in all categories of dentistry. After a TMD diagnosis, major differences in utilization were not found when compared to patterns of treatment prior to the diagnosis. CONCLUSION: TMD subjects utilized 10% to 20% more dental services than non-TMD subjects. Gender and age were important factors with increased utilization in females and older patients. TMD diagnoses did not affect dental utilization patterns, indicating that most TMD patients continue to seek routine dental care.

An In Vivo and Cone Beam Computed Tomography Investigation of the Accuracy in Measuring Alveolar Bone Height and Detecting Dehiscence and Fenestration Defects.

PURPOSE: To investigate cone beam computed tomography (CBCT) accuracy in measuring facial bone height and detecting dehiscence and fenestration defects around teeth. MATERIALS AND METHODS: Patients who were treatment planned for periodontal flap or dental implant surgeries were enrolled (n = 25). CBCT imaging (Carestream CS 9300) was obtained at 0.09-mm voxels (n = 10 patients, 23 teeth) and at 0.18-mm voxels (n = 15 patients, 33 teeth). Facial bone height measurements, from cusp tip to crest of bone height along the long axis of the tooth, and presence or absence of dehiscence or fenestration defects were recorded from CBCT images in triplicates independently by two examiners. The corresponding clinical measurements were made at the time of surgery. Comparisons of CBCT and clinical measurements were made using paired t tests for teeth: anterior and posterior, maxillary and mandibular, with or without restorations, or root canal therapy. Level of agreement between investigators was assessed by concordance correlation coefficients (CCC), Pearson's correlation coefficient (PCC), and Cohen's Kappa. RESULTS: Comparing mean CBCT and clinical measurements, statistically significant differences were noted for 0.09-mm and 0.18-mm voxel sizes, for anterior and posterior teeth, for maxillary and mandibular teeth, for teeth with or without restorations, and for teeth without root canal therapy (P < .05). Clinical and CBCT measurements were similar for teeth with crowns and with root canal therapy (P > .05). CBCT measurements underestimated mean facial bone height from 0.33 ± 0.78 to 0.88 ± 1.14 mm (mean ± SD) and absolute facial bone height values from 0.56 ± 0.35 to 1.08 ± 0.92 mm. Intraexaminer and interexaminer reliability for measuring facial bone height ranged from poor to substantial (PCC = 0.78 to 0.97 and CCC = 0.63 to 0.96, respectively). Interexaminer reliability for detection of dehiscence and fenestration defects ranged from poor to moderate (Cohen's Kappa = -0.09 to 0.66). CONCLUSION: CBCT imaging underestimated facial bone height and overestimated the presence of dehiscence and fenestration defects.

Three cements used for orthodontic banding of porcelain molars.

OBJECTIVE: Objectives of this study were to (1) compare the mean shear-peel bond strength of orthodontic bands luted to porcelain molar denture teeth with glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), or compomer cement; (2) assess the amount of cement remaining on the teeth after debanding; and (3) compare the survival times of the cemented bands subject to mechanical fatigue. MATERIALS AND METHODS: Sixty banded denture teeth (20 per cement group) were used to determine shear-peel bond strength, and 30 banded denture teeth (10 per cement group) were used to determine fatigue survival time. Shear-peel bond strength was determined with a universal testing machine, and groups were compared by one-way analysis of variance. The amount of cement remaining on the teeth after band removal was scored, and a chi-square test was used to compare groups. Fatigue testing was conducted in a ball mill, and a log-rank test was used to compare differences in survival times. RESULTS: No differences were found in mean shear-peel bond strength among the three groups. The amount of cement remaining on the teeth varied between the compomer and GIC groups (P = .01), with more compomer cement remaining relative to GIC. The mean survival times of bands cemented with compomer or RMGIC were longer than for bands cemented with GIC (P < .001). CONCLUSION: The findings show that on porcelain teeth the band cements have comparable mean shear-peel bond strengths, but that band retention with RMGIC and compomer cement are superior to GIC when subjected to simulated mechanical fatigue.

Effectiveness of high irradiance for short-time exposures on polymerization of composite under metal brackets.

OBJECTIVE: To evaluate the effect of different curing modes available in a dental light-curing unit on degree of conversion (DC) of a composite photoactivated under a metal orthodontic bracket. MATERIALS AND METHODS: The average irradiance and total energy delivered by three curing modes (standard, high, and extra power) of a multiwave LED unit (Valo Cordless, Ultradent Products, South Jordan, Utah) were measured using the longest time available for each mode (20, 4, and 3 seconds, respectively). Brackets (n = 3/group) were bonded to molar epoxy resin replicas using each curing mode. Mesiodistal sections, 0.5 mm thick, were assessed using an infrared spectrometer microscope. Spectra of composite beneath the brackets were sequentially collected using the mapping tool in near-infrared (NIR)-transmittance mode. Composite conversion was mapped between the mesial and distal edges of the bracket base using 400-µm steps for a total of 10 measurements per specimen. Data from irradiance and total energy were analyzed by one-way ANOVA, while data of DC were analyzed with two-way repeated measures ANOVA (α = 0.05). RESULTS: The highest DC values were observed for standard power (mean 56%, P < .05), while no difference was observed between high (50%) and extra power (49%) modes. Regarding the site of measurement, higher DC was observed close to the bracket edges (52%, P < .05). CONCLUSIONS: The use of high irradiance for a short time slightly reduced the DC. The small magnitude of reduction suggests that use of a high irradiance protocol is a clinically valid approach when bonding metal brackets.

Measurement and comparison of bracket transfer accuracy of five indirect bonding techniques.

OBJECTIVE: To measure and compare bracket transfer accuracy of five indirect bonding (IDB) techniques. MATERIALS AND METHODS: Five IDB techniques were studied: double polyvinyl siloxane (double-PVS), double vacuum-form (double-VF), polyvinyl siloxane vacuum-form (PVS-VF), polyvinyl siloxane putty (PVS-putty), and single vacuum-form (single-VF). Brackets were bonded on 25 identical stone working models. IDB trays were fabricated over working models (n  =  5 per technique) to transfer brackets to another 25 identical stone patient models. The mesiodistal (M-D), occlusogingival (O-G), and faciolingual (F-L) positions of each bracket were measured on the working and patient models using digital photography (M-D, O-G) and calipers (F-L). Paired t-tests were used to compare bracket positions between working and patient models, and analysis of variance was used to compare bracket transfer accuracy among the five techniques. RESULTS: Between the working and patient models, double-VF had the most teeth with significant differences (n  =  6) and PVS-VF the fewest (n  =  1; P < .05). With one exception, all significant differences were ≤0.26 mm and most (65%) were ≤0.13 mm. When the techniques were compared, bracket transfer accuracy was similar for double-PVS, PVS-putty, and PVS-VF, whereas double-VF and single-VF showed significantly less accuracy in the O-G direction. CONCLUSIONS: Although overall differences in bracket position were relatively small, silicone-based trays had consistently high accuracy in transferring brackets, whereas methods that exclusively used vacuum-formed trays were less consistent.

A novel biomimetic orthodontic bonding agent helps prevent white spot lesions adjacent to brackets.

OBJECTIVE: To compare changes in enamel microhardness adjacent to orthodontic brackets after using bonding agents containing various compositions of bioactive glass compared to a traditional resin adhesive following a simulated caries challenge. MATERIALS AND METHODS: Extracted human third molars (n  =  10 per group) had orthodontic brackets bonded using one of four novel bioactive glass (BAG)-containing orthodontic bonding agents (BAG-Bonds) or commercially available Transbond-XT. The four new adhesives contained BAG in varying percentages incorporated into a traditional resin monomer mixture. Teeth were cycled through low-pH demineralizing and physiologic-pH remineralizing solutions once each day over 14 days. Microhardness was measured on longitudinal sections of the teeth 100, 200, and 300 µm from the bracket edge and beneath the brackets, at depths of 25 to 200 µm from the enamel surface. Normalized hardness values were compared using three-way analysis of variance. RESULTS: Significantly less reduction in enamel microhardness was found with the experimental adhesives at depths of 25 and 50 µm at all distances from the bracket edge. In all groups, there were no significant changes in enamel microhardness past 125-µm depth. Results varied with the different BAG-Bonds, with 81BAG-Bond showing the smallest decrease in enamel microhardness. CONCLUSIONS: The BAG-Bonds tested in this study showed a reduction in the amount of superficial enamel softening surrounding orthodontic brackets compared to a traditional bonding agent. The results indicate that clinically, BAG-Bonds may aid in maintaining enamel surface hardness, therefore helping prevent white spot lesions adjacent to orthodontic brackets.

Minimally invasive resin infiltration of arrested white-spot lesions: a randomized clinical trial.

BACKGROUND: The authors conducted a randomized, single-masked clinical trial involving patients who had completed orthodontic treatment to assess changes in the appearance of white-spot lesions (WSLs) that were treated with resin infiltration. METHODS: The authors divided affected teeth into control and treatment groups. In the treatment group, they restored teeth with WSLs by using resin infiltration. They evaluated changes in WSLs photographically by using a visual analog scale (VAS) (0 = no change, 100 = complete disappearance) and area measurements (in square millimeters). The authors analyzed the data by using two-way analysis of variance. RESULTS: The mean VAS ratings for treated teeth demonstrated marked improvement relative to that for control teeth immediately after treatment (67.7 versus 5.2, P < .001) and eight weeks later (65.9 versus 9.2, P < .001). The results for treated teeth showed a mean reduction in WSL area of 61.8 percent immediately after treatment and 60.9 percent eight weeks later, compared with a -3.3 percent change for control teeth immediately after treatment and a 1.0 percent reduction eight weeks later. CONCLUSIONS: Resin infiltration significantly improved the clinical appearance of WSLs, with stable results seen eight weeks after treatment. PRACTICAL IMPLICATIONS: Resin infiltration, a minimally invasive restorative treatment, was shown to be effective for WSLs that formed during orthodontic treatment.

Elastomeric-ligated vs self-ligating appliances: a pilot study examining microbial colonization and white spot lesion formation after 1 year of orthodontic treatment.

AIM: To (1) evaluate the use of adenosine triphosphate (ATP)-driven bioluminescence for quantification of total plaque bacteria in orthodontic patients, (2) compare plaque bacteria amounts at the bracket-tooth interface with use of elastomeric-ligated and self-ligating brackets after 1 year of orthodontic treatment, and (3) analyze formation of white spot lesions by photographic evaluation and laser-light fluorescence (DIAGNOdent). METHODS: Thirteen subjects had fixed orthodontic appliances placed where lateral incisors were bonded with either elastomeric-ligated or self-ligating brackets. Plaque bacteria were collected from incisor surfaces after 1 year and quantified using plating methods and ATP-driven bioluminescence. White spot lesions were evaluated by photographic and DIAGNOdent determinations. A 2 x 2 x 2 mixed-design ANOVA was conducted to determine differences in plaque retention between elastomeric-ligated and self-ligating brackets. RESULTS: ATP-driven bioluminescence values correlated to numbers of total plaque bacteria (r = 0.80). However, unlike findings published in the original pilot study, which described increased plaque retention with elastomeric-ligated brackets at 5 weeks postbonding, there were no significant differences in bacterial numbers or ATP-driven bioluminescence values surrounding the elastomeric-ligated vs self-ligating brackets after 1 year of orthodontic treatment. Based on photographic and DIAGNOdent determinations, white spot lesions were found relatively equally on teeth bonded with either bracket type. DIAGNOdent measurements were found to have moderate sensitivity (0.71) and good specificity (0.88) when compared to white spot lesions determined using photographic evaluation. CONCLUSION: ATP-driven bioluminescence can be used as an accurate assessment of total plaque bacteria in orthodontic patients. After 1 year of orthodontic treatment for patients in this pilot study, there appeared to be no differences in retention of plaque bacteria or white spot lesions comparing the bracket types. The use of DIAGNOdent has some limitations, but may prove to be useful to monitor white spot lesions longitudinally.

Ion release from a novel orthodontic resin bonding agent for the reduction and/or prevention of white spot lesions. An in vitro study.

OBJECTIVE: To measure ion release from four sol-gel bioactive glass-containing orthodontic resin bonding agents (BAG-Bonds) following immersion into simulated body fluid (SBF) at pH values of 4 and 7. MATERIALS AND METHODS: Four BAG-Bonds, two containing fluoride, were developed. Prepared in our laboratory, the BAG-Bonds were composed of a mixture of resin monomers and bioactive glasses (BAGs). Workability of the final BAG-Bonds determined the amount of filler added to each, and this varied according to BAG composition. Commercially available Transbond-XT was used as the control. Three disks (10 mm × 2 mm) of each material were individually suspended in 3.5 mL of SBF at pH 4 and pH 7. SBF was analyzed to measure pH and ions released at 1 hour, 10 hours, and 100 hours. Calcium was measured by atomic absorption analysis, phosphate by ultraviolet visible spectrometry, and fluoride by an ion-specific electrode. The data were compared using a three-way analysis of variance, with P ≤ .05. RESULTS: Significant differences in calcium and phosphate ion release were found between the four BAG-Bonds and the control at multiple time points. Significant changes in pH were also found. There was no measureable release of fluoride from any of the materials. CONCLUSIONS: The BAG-Bonds showed the capacity for buffering acidic oral environments and significant release of calcium ions into their surrounding environment, and they hold the potential to be biomimetic bonding agents that may reduce white spot lesion formation.