ental plaque is a biofilm produced by a bacterial community that may be composed of over 700 species. One of the main components of this plaque is Streptococcus mutans (S. mutans), which is also considered to be the primary etiologic agent of human dental caries and plaque formation by interacting with other streptococci. 1-3 Orthodontic treat-ment predisposes plaque accumulation around the appliances due to difficulty in maintaining hygiene and the large number of sites available for colonization. Orthodontic materials and techniques to prevent decal-cification during orthodontic treatment have been the focus of research in recent years. Development of white spot lesions around brackets, however, is still a common occurrence, jeopardizing the health and esthetics of the teeth. 4-8 The incidence of white spot lesions in patients treated with fixed appli-ances was reported to be up to 50%; these can be seen as early as four weeks after band or bracket placement. 9, 10 Many methods can decrease or prevent white spot lesions: improving oral hygiene, modifying diet (low carbohydrate) and treating with topical fluoride. Most of these methods, however, rely on patient compliance, which is unreliable and is seen only in 13% of orthodontic patients. Attempts have been made to use compliance-free methods. 11 Prevention of metabolic activity of plaque bacteria, forming fluroapatite crystals, D and stimulating remineralization are some well-known caries control potential of fluoride-releasing agents. 12 Although varnishes provide a significant benefit to high caries risk patients, one drawback is that they often require multiple in-office applications. 13 Recently, it has been shown that an organo-selenium compounds covalently attached to different biomateri-als inhibited bacterial biofilms. 14 The catalytic mecha-nism by which selenium generates superoxide radicals has been previously described. 15 A recent study 14 confirmed that Organoselenium polymerized into dental sealant is effective in inhibiting bacterial attach-ment and biofilm formation by the two main oral pathogens, S. mutans and S. salivarius . In addition, it was claimed that this sealant is very durable , and can withstand the abrasion from daily tooth brushing. Clearly, the subject of decalcification is complex and of great importance to the orthodontic specialty. Based on the limitations of the in vitro studies and the insufficient in vivo studies regarding this aspect, the aims of this investigation were to evaluate and compare the in vivo, long term effectiveness of SeLECT™ Defense sealant and fluoride varnish in preventing demineralization of the enamel surround-ing orthodontic brackets, as measured with a laser fluorescence monitoring device. Our null hypothesis assumed that there were no statistically significant differences between both groups. Abstract Objectives: To compare the in vivo, long term effectiveness of SeLECT™ Defense and fluoride varnish in preventing demineralization of the enamel, as measured with a laser fluorescence monitoring device. Materials and Methods: Thirty patients (15 female, 15 male, ages 11-19 years) were selected with no visible demineralization. Metal brackets were bonded using a light cured composite adhesive. Baseline measurements of the enamel mineralization of each tooth, from second premolar to second premolar in both arches, were made with a laser fluorescence device (DIAGNOdent) after one weeek. SeLECT Defense™ and fluoride varnish were applied around the brackets using a split mouth technique. 274 teeth were included in each group. Laser fluores-cence readings were recorded again at three months and six months. The facial surface of each tooth was divided into four quadrants and the peak fluorescence measurement was recorded for each quadrant. Decalcification was calculated for each tooth by averaging the values from the four quadrants. Each quadrant was also appraised indi-vidually. Intragroup evaluation was performed by ANOVA for repeated measurements, with post hoc Bonferroni tests. Comparisons between the increases in decalcification from baseline to six months were assessed with Student’s t-test. Results: The varnished group showed more demineralization progression than the SeLECT Defense™ group at three and six months, although the difference was not statistically significant when the four quadrants were combined. Conclusion: SeLECT Defense™ may be a promising new anti-microbial sealant to decrease demineralization around orthodontic brackets. www.orthodontics.com Winter 2014 31
Journal of the American Orthodontic Society Winter 2014: Page 31
