Deproteinization of Tooth Enamel Surfaces to Prevent White Spot Lesions and Bracket Bond Failure

Orthodontic treatment success is jeopardized by the risk of development of white spot lesions (WSLs) around orthodontic brackets. Unfortunately, the formation of WSLs still remains a common complication during treatment in patients with poor oral hygiene. Nearly 75% of orthodontic patients are reported to develop enamel decalcification because of prolonged plaque retention around brackets. It is the orthodontist’s responsibility to minimize the risk of patients having enamel decalcifications as a consequence of orthodontic treatment. This can be achieved by using fluoride-releasing, resin-modified glass ionomer cement (RMGIC) to bond brackets, with deproteinization of the enamel surface prior to phosphoric acid etching.

Learning Objectives:

• Describe the incidence of new WSLs at the completion of orthodontic treatment.
• Explain why the enamel surfaces surrounding the bracket bases are protected from WSLs when brackets are bonded with RMGICs.
• Describe why enamel deproteinization with Clorox (5.25% Sodium Hypochlorite), prior to etching, increases bracket SBS, diminishing bracket bond failure incidence, both with composite resin and with RMGIC (Justus et al, Seminars in Orthodontics, March 2010).