Combating white spot lesions via incorporation of remineralizing/ antibacterial additives into orthodontic adhesives: A review
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Abstract
Background: Orthodontic treatment with fixed appliances is frequently associated with difficulties in maintaining good oral hygiene and creation of plaque-retentive areas on tooth surfaces that are typically more prone to the development of caries; such drawbacks may result in white spot lesion (WSL) development that affects the esthetic outcome following bracket debonding. This review article focuses on orthodontic WSLs development, prevention, and remineralization potential via incorporating various remineralizing / antibacterial additives into orthodontic adhesives. Results: Unbalanced enamel demineralization and remineralization processes, along with rapid alterations in the dental plaque bacterial ecology, particularly acidogenic bacteria, are the causes of the start and progression of a carious lesion. Without significantly compromising an adhesive mechanical performance, several antibacterial and remineralizing substances have been added to orthodontic adhesives in an effort to reduce bacterial colonization and promote remineralization. Conclusions: Antibacterial and/or remineralizing substances were utilized as additives in the creation of innovative orthodontic adhesive systems to address white spot lesions (WSLs) and improve the ability of enamel remineralization. Compared to adding only one agent, including multiple agents in an orthodontic adhesive system may have a greater impact on lowering enamel demineralization and improving enamel remineralization during orthodontic therapy.
Received date: 15-06-2024
Accepted date: 18-08-2024
Published date: 15-06-2025
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References
Mitchell L. Decalcification during orthodontic treatment with fixed appliances-an overview. Br J Orthod. 1992;19(3):199-05.
Al-Duliamy MJ. In vivo plaque count of Streptococcus Mutans around orthodontic brackets bonded with two different adhesives. J Bagh Coll Dent. 2014;26:175-9.
Akin M, Tazcan M, Ileri Z, Basciftci FA. Incidence of White Spot Lesion During Fixed Orthodontic Treatment. Turk J Orthod. 2013;26(2):98-102.
Tufekci E, Dixon JS, Gunsolley JC, Lindauer SJ. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011;81(2):206-10.
Sonesson M, Twetman S. Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review. Eur J Orthod. 2023;45(5):485-90.
Torres CRG, Spinola MDS, Prado RFD, Rodrigues VA, Gutierrez NC, Borges AB. Efficacy of fluoride varnishes with different compositions on white spot lesions remineralization. Braz Dent Sci. 2021;24(3):1-7.
Flynn LN, Julien K, Noureldinc A, Buschangd PH. The efficacy of fluoride varnish vs a filled resin sealant for preventing white spot lesions during orthodontic treatment: A randomized clinical trial. Angle Orthod. 2022:92(2):204-12.
Ibrahim AI, Thompson VP, Deb S. A novel etchant system for orthodontic bracket bonding. Sci Rep. 2019;9:9579.
Ibrahim AI, Al-Hasani NR, Thompson VP, Deb S. In vitro bond strengths post thermal and fatigue load cycling of sapphire brackets bonded with self-etch primer and evaluation of enamel damage. J Clin Exp Dent. 2020;12(1):e22-e30.
Ibrahim AI, Al-Hasani NR, Thompson VP, Deb S. Resistance of bonded premolars to four artificial ageing models post enamel conditioning with a novel calcium-phosphate paste. J Clin Exp Dent. 2020;12(4):e317-e326.
Li X, Wang J, Joiner A, Chang J. The remineralisation of enamel: A review of the literature. J Dent. 2014;42:12-20.
Gorelick L, Geiger AM, Gwinnett AJ, Brook S, York N. Incidence of white spot formation after bonding and banding. Am J Orthod. 1982;81(2):93-8.
Fejerskov O, Kidd E. Dental caries: the disease and its clinical management, second ed., Copenhagen: Blackwell Munksgaard, 2003.
Bishara SE, Ostby AW. White Spot Lesions: Formation, Prevention, and Treatment. Semin Orthod. 2008;14(3):174-82.
Heymann GC, Grauer D. A contemporary review of white spot lesions in orthodontics. JERD. 2013;25(2):85-95.
Ogaard B. Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment. AJODO. 1989;96(5):423-27.
Mattousch TJH, Van Der Veen MH, Zentner A. Caries lesions after orthodontic treatment followed by quantitative light-induced fluorescence: A 2-year follow-up. Eur J Orthod. 2007;29(3):294-98.
Julien KC, Buschang PH, Campbell PM. Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod. 2013;83(4):641-7.
Featherstone JD. Remineralization, the natural caries repair process--the need for new approaches. Adv Dent Res. 2009;21(1):4-7.
Khoroushi M, Kachuie M. Prevention and treatment of white spot lesions in orthodontic patients. Contemp Clin Dent. 2017;8(1):11-9.
Hasan ZR, Al-Hasani NR, Malallah O. Color stability of nano resin-modified glass Ionomer restorative cement after acidic and basic medications challenge. JBCD. 2023;35(4):10-9.
Hasan ZR, Al-Hasani NR, Mahmood MA, Ibrahim AI. Effect of Amoxicillin and Azithromycin Suspensions on Microhardness of Sliver Reinforced and Nano Resin-Modified Glass Ionomers: An In Vitro Study. Dent Hypotheses. 2023;14(1):32-35.
Ionescu AC, Cazzaniga G, Ottobelli M, Garcia-Godoy F, Brambilla E. Substituted Nano-Hydroxyapatite Toothpastes Reduce Biofilm Formation on Enamel and Resin-Based Composite Surfaces. J Funct Biomater. 2020;11(36).
Malcangi G, Patano A, Morolla R, De Santis M, Piras F, Settanni V, et al. Analysis of Dental Enamel Remineralization: A Systematic Review of Technique Comparisons. Bioeng. 2023;10(4):472.
Derks A, Katsaros C, Frencken JE, Van’t Hof MA, Kuijpers-Jagtman AM. Caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances: A systematic review. Caries Res. 2004;38(5):413-20.
Kau CH, Wang J, Palombini A, Abou-Kheir N, Christou T. Effect of fluoride dentifrices on white spot lesions during orthodontic treatment: A randomized trial. Angle Orthod. 2019;89(3):365-71.
Lazar L, Vlasa A, Beresescu L, Bud A, Lazar AP, Matei L. et al. White Spot Lesions (WSLs)-Post-Orthodontic Occurrence, Management and Treatment Alternatives: A Narrative Review. J Clin Med. 2023;12(5):1908.
Benson PE, Shah AA, Millett DT, Dyer F, Parkin N, Vine RS. Fluorides, orthodontics and demineralization: A systematic review. J Orthod. 2005;32(2):102-14.
Hu H, Feng C, Jiang Z, Wang L, Shrestha S, Yan J, et al. Effectiveness of remineralizing agents in the prevention and reversal of orthodontically induced white spot lesions: a systematic review and network meta-analysis. Clin Oral Investig. 2020;24(12):4153-67.
Marinho VCC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. CDSR. 2013:(7).
Mattick C, Mitchell L, Chadwick S, Wright J. Fluoride-releasing elastomeric modules reduce decalcification: a randomized control trial. J Orthod. 2014;28(3):217-20.
Wiltshire WA. Determination of fluoride from fluoride-releasing elastomeric ligature ties. AJO-DO. 1996;110(4):383-7.
Kielbassa AM, Schulte-Monting J, Garcia-Godoy F, Meyer-Lueckel H. Initial in situ secondary caries formation: Effect of various fluoride-containing restorative materials. Oper Dent. 2003;28:765-72
Cagetti MG, Campus G, Milia E, Lingström P. A systematic review on fluoridated food in caries prevention. Acta Odontol Scand. 2013;71(3-4):381-7.
Kitasako Y, Sadr A, Shimada Y, Sumi Y, Tagami J. The Utility of Chewing Gum in Treating White Spot Lesions. Curr Oral Health Rep. 2016;3(2):111-6.
Sugiura M, Kitasako Y, Sadr A, Shimada Y, Sumi Y, Tagami J. White spot lesion remineralization by sugar-free chewing gum containing bio-available calcium and fluoride: A double-blind randomized controlled trial. J Dent. 2016;54:86-91.
Lim BS, Lee SJ, Lee JW, Ahn SJ. Quantitative analysis of adhesion of cariogenic streptococci to orthodontic raw materials. AJO-DO. 2008;133(6):882-8.
Underwood ML, Rawls HR, Zimmerman BF, Antonio S. Clinical evaluation of a fluoride-exchanging resin as an orthodontic adhesive. AJO-DO. 1989;96(2):93-9.
Yaseen MS, Agha NF, Jasim R. Fluoridated orthodontic adhesives: Implications of release and recharge and their impact on shear bond strength in demineralized tooth surfaces. J Dent Res Dent Clin Dent Prospects. 2023:17(3):142-8.
Guilger-Casagrande M, Lima Rde. Synthesis of Silver Nanoparticles Mediated by Fungi: A Review. Front bioeng biotechnol. 2019;7(287):1-16.
Kadhem DJ, Al Haidar AHM.J Antibacterial and cytotoxic effect of a novel biological Nano-silver fluoride synthesized from moringa oleifera leaf extract. JBCD. 2023;35(2):32-44.
Eslamian L, Borzabadi-Farahani A, Karimi S, Saadat S, Badiee MR. Evaluation of the shear bond strength and antibacterial activity of orthodontic adhesive containing silver nanoparticle, an in-vitro study.Nanomater.2020;10(8):1-8.
Yassaei S, Nasr A, Zandi H, Motallaei MN. Comparison of antibacterial effects of orthodontic composites containing different nanoparticles on streptococcus mutans at different times. Dental Press J Orthod. 2020;25(2):52-60. doi: 10.1590/2177-6709.25.2.052-060.oar.
Sánchez-Tito M, Tay LY. Antibacterial and white spot lesions preventive effect of an orthodontic resin modified with silver-nanoparticles. J Clin Exp Dent. 2021;13(7):685-91.
Hamouda IM. Current perspectives of nanoparticles in medical and dental biomaterials. J Biomed Res. 2012;26(3):143-51.
Shamaa M, Elwassefy N, Hafez A. Comparative Evaluation of The Antibacterial Effect of Ag & Cuo Nanoparticles Incorporation in Orthodontic Adhesive and Their Influence on Sbs. EDJ. 2023;69(3):1739-47.
Gutiérreza MF, Alegría-Acevedoa LF, Méndez-Bauera L, Bermudeza J, Dávila-Sáncheza A, Buvinic S, et al. Biological, mechanical and adhesive properties of universal adhesives containing zinc and copper nanoparticles. J Dent. 2019;(82):45-55.
Enax J, Epple M. Synthetic hydroxyapatite as a biomimetic oral care agent. Oral Health Prev Dent. 2018;16(1):7-19.
Zhou C, Zhang D, Bai Y, Li S. Casein phosphopeptide-amorphous calcium phosphate remineralization of primary teeth early enamel lesions. J Dent. 2014;42(1):21-9.
Reynolds EC. Casein phosphopeptide-amorphous calcium phosphate: the scientific evidence. Adv Dent res. 2009;21(1):25-29.
Hamba H, Nikaido T, Inoue G, Sadr A, Tagami J. Effects of CPP-ACP with sodium fluoride on inhibition of bovine enamel demineralization: A quantitative assessment using micro-computed tomography. J Dent. 2011;39(6):405-13.
Bakry AS, Abbassy MA. Increasing the efficiency of CPP-ACP to remineralize enamel white spot lesions J Dent. 2018:76:52-7.
Nozari A, Ajami S, Rafiei A, Niazi E. Impact of nano hydroxyapatite, nano silver fluoride and sodium fluoride varnish on primary enamel remineralization: An in vitro study. JCDR. 2017;11(9):97-100.
Bossù M, Saccucci M, Salucci A, Giorgio GD, Bruni E, Uccelletti D, et al. Enamel remineralization and repair results of Biomimetic Hydroxyapatite toothpaste on deciduous teeth: an effective option to fluoride toothpaste. J Nanobiotechnoly. 2019;17:17.
Rahmanpanah S, Seifi M, Gharavi Z, Sadighnia N, Amdjadi P. Evaluation of shear bond strength and enamel remineralizing effect of experimental orthodontic composite containing nano-hydroxyapatite: An in vitro study. Int Orthod. 2023;21(1):100725.
Raheem SS, Jehad, RS. Comparing the effectivenessof using three different re-mineralizing pastes on remineralisation of artificially induced white spot lesion. JBCD. 2023; 35(4):35-45.
Dorozhkin SV, Epple M. Biological and medical significance of calcium phosphates. Angew Chem Int Ed Engl .2002;41(17):3130-46.
Tavassoli-Hojjati S, Atai M, Haghgoo R, Rahimian-Imam S, Kameli S, Ahmaian-Babaki F, et al. Comparison of Various Concentrations of Tricalcium Phosphate Nanoparticles on Mechanical Properties and Remineralization of Fissure Sealants. J Dent. 2014;11:379-88.
Puig-Silla M, Montiel-Company JM, Almerich-Silla JM. Comparison of the remineralizing effect of a sodium fluoride mouthrinse versus a sodium mono-fluorophosphate and calcium mouthrinse: an in vitro study. Med Oral Patol Oral Cir Bucal. 2009;14:257-62.
Zaze AC, Dias AP, Sassaki KT, Delbem AC. The effects of low-fluoride toothpaste supplemented with calcium glycerophosphate on enamel demineralization. Clin Oral Investig. 2014;18:1619-24.
Walsh L. Contemporary technologies for remineralisation therapies: A review. Int Dent SA. 2009;11:6-16.
Dai LL, Mei ML. Chu CH, Lo ECM. Mechanisms of bioactive glass on caries management: A review. Mater. 2019;12(24):4183.
Zhang Y, Wang Z, Jiang T, Wang Y. Biomimetic regulation of dentine remineralization by amino acid in vitro. Dent Mater. 2019;35(2):298-309.
Lee SM, Yoo KH, Yoon SY, Kim IR, Park BS, Son WS, et al. Enamel anti-demineralization effect of orthodontic adhesive containing bioactive glass and graphene oxide: An in-vitro study. Mater. 2018;11(9):1728.
Nam HJ, Kim YM, Kwon YH, Kim IR, Park BS, Son WS, et al. Enamel surface remineralization effect by fluorinated graphite and bioactive glass-containing orthodontic bonding resin. Mater. 2019;12(8):1308.
Dai LL, Mei ML, Chu CH, Zhao IS, Lo ECM. Effect of strontium-doped bioactive glass on preventing formation of demineralized lesion. Mater. 2021;14(16).
Lopes PC, Carvalho T, Gomes ATPC, Veiga N, Blanco L, Correia MJ. et al. White spot lesions: diagnosis and treatment – a systematic review. BMC Oral Health. 2024;24(58).
Erbe C, Klukowska M, Tsaknaki I, Timm H, Grender J, Wehrbein H. Efficacy of 3 toothbrush treatments on plaque removal in orthodontic patients assessed with digital plaque imaging: A randomized controlled trial. AJO-DO. 2013;143(6):760-6.
Yaacob M, Worthington HV, Deacon SA, Deery C, Walmsley AD, Robinson PG and Glenny AM. 2014. Powered versus manual toothbrushing for oral health (Review). CDSR. 2014:6.
Attin R, Yetkiner E, Aykut-Yetkiner A, Knösel M, Attin T. Effect of chlorhexidine varnish application on streptococcus mutans colonisation in adolescent with fixed orthodontic appliancess. Aust orthod J. 2013;29:52-7.
Sonesson M, Brechter A, Abdulraheem S, Lindman R, Twetman S. Fluoride varnish for the prevention of white spot lesions during orthodontic treatment with fixed appliances: a randomized controlled trial, Eur J Orthod. 2020; 42(3):326-30.
Alabdullah MM, Nabawia A, Ajaj MA, Saltaji H. Effect of fluoride-releasing resin composite in white spot lesions prevention: a single-centre, split-mouth, randomized controlled trial. Eur J Orthod. 2017;1-7.
Benson PE, Parkin N, Dyer F, Millett DT, Germain P. Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment (Review). CDSR. 2019;11.
Ahna SJ, Lee SJ, Kookb JK, Lim BS. Experimental antimicrobial orthodontic adhesives using nanofillers and silver nanoparticles. Dent Mater. 2009;25:206-13.
Argueta-Figueroa L, Scougall-Vilchis RJ, Morales-Luckie RA, Olea-Mejía OF. An evaluation of the antibacterial properties and shear bond strength of copper nanoparticles as a nanofiller in orthodontic adhesive. Aust Orthod J. 2015;31(1):42-8.
Al-Batayneh OB, Jbarat RA, Al-Khateeb SN. Effect of application sequence of fluoride and CPP-ACP on remineralization of white spot lesions in primary teeth: An in-vitro study. Arch Oral Biol. 2017;(83):236-24.
Anggani HS, Arifani P, Siregar E. The color improvement of postdebonding white spot lesions after fuoride and casein phosphopeptide-amorphous calcium phosphate application. J Adv Pharm Technol Res. 2021;12(3):274-8.
Aref NS, Alrasheed MKH. Casein phosphopeptide amorphous calcium phosphate and universal adhesive resin as a complementary approach for management of white spot lesions: an in-vitro study. Prog Orthod. 2022;23:10.
Puleio F, Fiorillo L, Gorassini F, Iandolo A, Meto A, D’Amico C, et al. Systematic Review on White Spot Lesions Treatments. Eur J Dent. 2022;16(1):41-8.
Seyedmajidi S, Rajabnia R, Seyedmajidi M. Evaluation of antibacterial properties of hydroxyapatite/bioactive glass and fluorapatite/bioactive glass nanocomposite foams as a cellular scaffold of bone tissue. J Lab Physicians. 2018;10:265-70.
Garma NMH, Ibrahim AI. Development of a remineralizing calcium phosphate nanoparticle-containing self-etching system for orthodontic bonding. Clin Oral Invest. 2023;27:1483-97.
Garma NMH, Ibrahim AI. Bond Strength Survival of a Novel Calcium Phosphate-Enriched Orthodontic Self-Etching System after Various Ageing Protocols: An In Vitro Study. Int J Dent 2022;2022:9.
Kadhim HA, Deb S, Ibrahim AI. Performance of novel enamel-conditioning calcium-phosphate pastes for orthodontic bonding: An in vitro study. J Clin Exp Dent. 2023;15(2):102-09.
Kadhim HA, Deb S, Ibrahim AI. In vitro assessment of bracket adhesion post enamel conditioning with a novel etchant paste. JBCD. 2023; 35(1):1-9.
Burwell A, Jennings D, Muscle D, Greenspan DC. NovaMin and dentin hypersensitivity–in vitro evidence of efficacy. J Clin Dent. 2010;21:66-71.
Taha AA, Patel MP, Hill RG, Fleming PS. The effect of bioactive glasses on enamel remineralization: A systematic review. J Dent. 2017;67:9-17.
Madan N, Madan N, Sharma V, Pardal D, Madan N. Tooth remineralization using bio-active glass - A novel approach. J Adv Oral Res. 2011;2(2):45-50.
Prasad S, Ganisetti S, Jana A, Kant S, Sinha P, Tripathy S, et al. Elucidating the effect of CaF2 on structure, biocompatibility andantibacterial properties of S53P4 glass. J Alloys Compd. 2020;831:154704.
Nam HJ, Kim YM, Kwon YH, Yoo KH, Yoon SY, Kim IR, et al. Fluorinated bioactive glass nanoparticles: Enamel demineralization prevention and antibacterial effect of orthodontic bonding resin. Mater. 2019;12(11).
Wetzel R, Bartzoc O, Brauer DS. Influence of low amounts of zinc or magnesium substitution on ion release and apatite formation of Bioglass 45S5. J Mater Sci: Mater Med. 2020;31:86.
Ali S, Farooq I, Iqbal K. A review of the effect of various ions on the properties and the clinical applications of novel bioactive glasses in medicine and dentistry. Saudi Dent J. 2014;26(1):1-5.
Saffarpour, M., Maryam, M., Tahriri, M. Zakerzadeh, A. Efficacy of Modified Bioactive Glass for Dentin Remineralization and Obstruction of Dentinal Tubules. J Dent. 2017;14(4):212-22.
Alamri A, Salloot Z, Alshaia A, Ibrahim MS. The effect of bioactive glass-enhanced orthodontic bonding resins on prevention of demineralization: A systematic review. Molecules. 2020;25(2495):1-26.