BioMin can Remineralise White Spot Lesions Surrounding Orthodontic Brackets
- S. Alghamdi1*, I. M. Sankour1, H. Al-Harkan1, A. S. Bakry2, M. A. Abbassy3, S. Elsharkawy4,5,6, R. G. Hill 7
1General Dentist , 2 Conservative dentistry Department, King Abdulaziz University, 3 Department of Orthodontics, King Abdulaziz University, 4Institute of Bioengineering, Queen Mary University of London, London, E1 4NS, UK., 5 School of Engineering and Materials Science, Queen Mary University of London, London, E1 4NS, UK., 6 Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4NS, UK, 7Dental Physical Sciences Dental Institute Barts and the London QMUL London E1 4NS UK
Introduction and Background
One of the common side effects of fixed orthodontic treatment is development of white spot lesions (WSLs) around orthodontic brackets. This is due to the prolonged dental bio-film retention, as those areas might be inaccessible for cleaning. (Petsi et al. 2014). (Hench et al.1993) had introduced Bioglass 45S5 (BG) as a biocompatible material to soft and hard tissues. BG is a mixture of several minerals with different percentages of weight (SiO2, Na2O, CaO, P2O5) which is available in the form of powder. In the past few years BG was suggested to be used to treat dental enamel and dentin lesions by mixing the BG powder with diluted phosphoric acid to form BG paste. (Bakry et al. 2014), (Bakry et al. 2013). (Hill RG et al 2009) suggested that the addition of small amounts of calcium fluoride to the Bioglass would enhance the formation of an acid resistant fluoroapatite layer rather than the more soluble hydroxyapatite layer formed on top of the bioactive glass when it is exposed to simulated body fluids. Fluoride is known in the literature as a gold standard in treating and/or preventing the incidence of WSLs. (Shetty et al. 2016). Several studies were conducted to evaluate different fluoride application methods with various concentrations and application times. (Paschos et al. 2015). This study will examine the remineralization capacity of Biomin (fluoride containing bioactive glass) paste to remineralize white spot lesions associated with orthodontic treatment and compair it to the remineralization capacity of commercially available topical fluoride gel.
The aim of the current experiment is to evaluate the effect of Biomin and fluoride application on the remineralization of white spot lesions associated with orthodontic treatment, using the transmicroradiography (TMR) technique.
Materials & Methods
1. Specimen Preparation
60 extracted premolars were used. Cutting enamel discs from the buccal surfaces using Isomet. “ISOMET Low Speed Saw BUEHLER®”
Orthodontic brackets cemented on buccal surfaces via Transbond XT resin. The whole teeth were protected by acrylic resin and nail varnish leaving a 2 mm enamel treatment window around the orthodontic brackets. All specimens were challenged for 4 days using buffered demineralization solution pH 4.5.
2. TMR imaging
TMR images were taken from a central enamel lesion slice using an x-ray generator (CMR 2; Softex, Tokyo, Japan) at 25 kV voltage and 4 mA current for 20 min, with a Ni filter. The distance between the x-ray tube and the specimen was 15 cm.
Delta Z (The enamel mineral density loss)one way ANOVA (analysis of variance) results showed significant remineralization capacity of Biomin when compared to fluoride application. Connected bars are statistically significant P<0.05.
Previous studies showed the capability of BG to re-build the lost hydroxyapatite crystals in erosive enamel lesions, moreover, BG improved the mechanical properties of the sub-surface enamel lesions (Bakry et al. 2013, Bakry et al. 2014). In the current study, the TMR imaging was selected to provide accurate information about the remineralization capacity of a fluoride-containing bioactive glass (Biomin). TMR is considered one of the most accurate available techniques to determine the mineral densities and the lesion depths of subsurface enamel and dentin lesions. The findings of this study suggests that Biomin provides a potent remineralization capacity during the short experimental duration adopted in the current study when compared to the topical fluoride application.
The obtained results of the current study may be attributed to the deep penetration of the Calcium and Phosphate ions released from the Biomin containing a small concentration of fluoride when compared to the superficial penetration of the Fluoride ions abundant in the commercially available topical fluoride gel used in the current experiment. It is suggested that the high affinity of the fluoride ions to combine with calcium and phosphate hindered the deep penetration of the fluoride ions to the deep demineralized areas of the subsurface lesions examined in the current experiment
Conclusions & Recommendations
Biomin paste has a high capacity to remineralize white spot lesions associated with orthodontic brackets when compared to fluoride application. Future studies are needed to test the clinical remineralization capacity of Biomin paste.
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Enamel Demineralisation & Remineralisation
The BioMinF molecule is able to slowly release fluoride, calcium and phosphate ions over a period of 8 to 12 hours. Effectively reducing demineralisation and help to increase remineralisation of the tooth and fight decay.