Evaluation of the effects of different types of adhesives on enamel demineralization during fixed orthodontic treatment

Esra Bolat Gümüş¹ image, Zehra Damla Dalmış Demirağ2 Orcid, Zülfikar Zahit Çiftçi3 Orcid


It is aimed to the effect of the fluoride-containing adhesives, on the formation of WSL during orthodontic treatment, determining approach to subsequent cases or learning.

The effect of fluoride-containing adhesive on enamel demineralization was found to be no different than the conventional adhesive.

Oral hygiene habits of individuals and especially their hands which they used were effective on the results of the study.


Aim: This randomised controlled split-mouth study was aimed to evaluate and compare the efficacy of a fluoride-containing adhesive (Clearfil Tri-S Bond Plus, Kuraray Noritake, Otemachi, Japan) and a conventional adhesive (3M Unitek Transbond XT, Maplewood, USA) on enamel demineralisation in orthodontically treated patients. Methods: Sixteen healthy patients who had need for correction of dental crowding were included in the study. Bracket bonding was performed using different adhesives (fluoride-containing and conventional) at random for opposite half jaw in a split-mouth design. 190 control, 190 experimental teeth were examined for bracket failure, gingival index, plaque index and enamel mineralisation parameters. Enamel mineralisation levels for each tooth for pre- and post-treatment time periods were examined using ICDASII (International Caries Detection and Assessment System) criteria and the DIAGNOdent Pen (KaVo, Biberach, Germany). Results: DIAGNOdent scores were statistically higher in the left half jaw which were control group (C) in left handed patients (p=0.038), while the scores were found to be significantly higher in the right handed patient which ipsilateral jaw were experimental group (E) (p=0.003). Conclusions: The effect of fluoride-containing adhesive on enamel demineralization and WSL (white spot lesion) formation was found to be no different than the conventional adhesive.

Keywords: Adhesive; Demineralization; Periodontal Index; Dental White Spots

Author Affiliations

  1. DDS, PhD, Asst. Prof., Akdeniz University, Faculty of Dentistry, Department of Orthodontics, Antalya/Türkiye
  2. DDS, Doctorate student, Akdeniz University, Faculty of Dentistry, Department of Orthodontics, Antalya/Türkiye (Correspondence: damladalmis@gmail.com)
  3. DDS, PhD, Asst. Prof., Akdeniz University, Faculty of Dentistry, Department of Pedodontics, Antalya/Türkiye
  1. Yun-Wah Lau P, Wing-Kit WR. Risks and complications in orthodontic treatment. Hong Kong Dent J 2006; 3:15–22
  2. Bollen AM, Cunha-Cruz J, Bakko DW, Huang GJ, Hujoel PP. The effects of orthodontic therapy on periodontal health: a systematic review of controlled evidence. J Am Dent Assoc 2008;139:413–422
  3. Al-Jewair T, Suri S. Predictors of adolescent compliance with oral hygiene instructions during two-arch multibracket fixed orthodontic treatment. Angle Orthod 2011;81:525–531
  4. Cerroni S, Pasquantonio G, Condò R, Cerroni L. Orthodontic fixed appliance and periodontal status: An updated systematic review. Open Dent J 2018;12:614-622
  5. Chang, H. S., Walsh, L. J., & Freer, T. J. Enamel demineralization during orthodontic treatment. Aetiology and prevention. Aust Dent J 1997; 42: 322–327
  6. Biria M, Ghasemi SN, Sheikh-Al-Eslamian SM, Panahandeh N. Effect of topical fluoride on microshear bond strength of primary enamel to composite, microhardness of enamel and its surface morphology: An in vitro study. J Dent Res Dent Clin Dent Prospects 2019;13:305-310
  7. Tufekci E, Pennella DR, Mitchell JC, Best AM, Lindauer SJ. Efficacy of a fluoride-releasing orthodontic primer in reducing demineralization around brackets: an in-vivo study. Am J Orthod Dentofac Orthop 2014;146:207-224
  8. 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;39:634–640
  9. 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;89:365–371
  10. Nam, H. J, Kim, Y. M, Kwon, Y. H, Yoo, K. H, Yoon, S. Y, Kim, I. R. & Kim, Y. I. Fluorinated bioactive glass nanoparticles: enamel demineralization prevention and antibacterial effect of orthodontic bonding resin.Materials 2019;12:1813
  11. Poliçi P, Cerroni L, Condò R, Kërpi B, Arcuri C. The role of fluoride varnishes in preventing white spot lesions in fixed orthodontic treatment: A systematic review. Oral Implantol 2019;12:118-129
  12. Tasios T, Papageorgiou SN, Papadopoulos MA, Tsapas A, Haidich AB. Prevention of orthodontic enamel demineralization: A systematic review with meta-analyses. Orthod Craniofac Res 2019;22:225-235
  13. Khan AR, Fida M, Gul M. Decalcification and bond failure rate in resin modified glass ionomer cement versus conventional composite for orthodontic bonding: A systematic review & meta-analysis. Int Orthod 2020;18:32-40
  14. Benson P.E. Fluoride-containing materials and prevention of demineralization during orthodontic treatment-Which research method should we now use? Semin Orthodont 2010;16:293-301
  15. Weerasinghe DS, Nikaido T, Wettasinghe KA, Abayakoon JB, Tagami J. Micro-shear bond strength and morphological analysis of a self etching primer adhesive system to fluorosed enamel. J Dent 2005;33:419–426
  16. Adanır N, Turkkahraman H, Gungor AY. Effects of adhesion promoters on the shear bond strengths of orthodontic brackets to fluorosed enamel. Eur J Orthod 2009;31:276–280
  17. Ateyah N, Akpata ES. Factors affecting shear bond strength of composite resin to fluorosed human enamel. Oper Dent 2000;25:216–222
  18. Richter AE, Arruda AO, Peters MC, Sohn W. Incidence of caries orthodontics., lesions among patients treated with comprehensive. Am J Orthod Dentofac Orthop 2011;139:657–664
  19. Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:75-191
  20. Paschos E, Kurochkina N, Huth KC, Hansson CS, Rudzki-Janson I. Failure rate of brackets bonded with antimicrobial and fluoride-releasing, self-etching primer and the effect on prevention of enamel demineralization. Am J Orthod Dentofac Orthop 2009;135:613-620
  21. Kavo.com [Internet] 2023 [cited 2023 Feb 15]. Available from: https://www.kavo.com/dental-xray-machines-and-diagnostics/diagnodent-pen-diagnostic-devices#docs
  22. Wenderoth CJ, Weinstein M, Borislow AJ. Effectiveness of a fluoride-releasing sealant in reducing decalcification during orthodontic treatment. Am J Orthod Dentofac Orthop 1999;116:629–634.
  23. Arhun N, Arman A, Sesen C, Karabulut E, Korkmaz Y, Gokalp S. Shear bond strength of orthodontic brackets with 3 self-etch adhesives. Am J Orthod Dentofac Orthop 2006;129:547-550
  24. Harikrishnan P, Subha TS, Kavitha V, Gnanamani A. Microbial adhesion on orthodontic ligating materials: An in vitro assessment. Adv Microbiol 2013;3:108-114
  25. Srivastava K, Tikku T, Khanna R, Sachan K. Risk factors and management of white spot lesions in orthodontics. J Orthod Sci 2013;2:43-49
  26. Nascimento P, Fernandes M, Figueiredo F, Silva A. Fluoride- releasing materials to prevent white spot lesions around orthodontic brackets: A systematic Review. Braz Dent J 2016;27:101-107
  27. Benham AW, Campbell PM, Buschang PH. Effectiveness of pit and fissure sealants in reducing white spot lesions during orthodontic treatement: a pilot study. Angle Orthod 2009;79:338-345
  28. Millet DT, McCluskey L-A, McAuley F, Creanor SL, Newell J, Love J. A. comparative clinical trial of a compomer and a resin adhesive for orthodontic bonding. Angle Orthod 2000;70:233-240
  29. Özgöz M, Arabacı T, Sümbüllü M.A, Demir T. Relationship between handedness and toothbrush-related cervical dental abrasion in left- and right-handed individuals. J Dent Sci 2010;5:177-182
  30. Tezel A, Orbak R, Çanakçı V. The effect of right or left handedness on oral hygiene. Int J Neurosci 2001;109:1-9
  31. Çakur B, Yıldız M, Dane Ş, Zorba Y.O. The effect of right or left handedness on caries experience and oral hygiene. J Neurosci Rural Pract 2011;2:40-42
  32. Papageorgiou S.N, Xavier G.M, Cobourne MT, Eliades T. Effect of orthodontic treatment on the subgingival microbiota:A systematic review and meta-analysis. Orthod Craniofac Res 2018;21:175-185
  33. Kozak U, Sękowska A, Chałas R. The effect of regime oral-hygiene intervention on the incidence of new white spot lesions in teenagers treated with fixed orthodontic appliances.Int J Environ Res Public Health 2020; 17: 9460 
  34. Malik N.A, Al-Khadim A.H.A, Alauddin M.S, Desa S.N.F.M. The effectiveness of non-dominant hand in performing oral hygiene care. Mal J Med Health Sci 2020;16:63-68
  35. Tahmasbi S, Mousavi S, Behroozibakhsh M, Badiee M. Prevention of white spot lesions using three remineralizing agents: An in vitro comparative study. J Dent Res Dent Clin Dent Prospects 2019;13:36-42
  36. Comert S., Oz A. A. Clinical effect of a fluoride-releasing and rechargeable primer in reducing white spot lesions during orthodontic treatment. Am J Orthod Dentofac Orthop 2020;157:67–72
  37. Artun J, Brobakken B. O. Prevalence of carious white spots after orthodontic treatment with multibonded appliances. Eur J Orthod 1986;8:229-234

Article Info

Contemp Pediatr Dent 2023:4(1):1-14

Received: 26 January 2023

Accepted: 04 April 2023 

Online First: 19 April 2023


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					Esra Bolat Gümüş, Zehra Damla Dalmış Demirağ, Zülfikar Zahit Çiftçi. Evaluation of the effects of different types of adhesives on enamel demineralization during fixed orthodontic treatment. Contemp Pediatr Dent 2023:4(1):1-14.

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