Effects of different orthodontic adhesives and resin removal techniques on enamel color alteration

Objective: To investigate the color alterations in enamel following the use of different orthodontic bonding resins and adhesive residue–removal burs.Materials and Methods:Metal brackets were bonded to extracted human premolars (n  =  175) by using an etch-and-rinse adhesive system, a self-etch adhesive system (SEP), or a resin-modified glass ionomer cement (RMGIC). After 24 hours of photoaging, the brackets were removed and the adhesive residue on the tooth surfaces was cleaned with either a tungsten carbide bur or a Stainbuster bur. Tooth colors were measured with a spectrophotometer at baseline, after adhesive removal, and after additional photoaging. Color evaluation was made, and color differences induced by photoaging were calculated. Statistical evaluation was made using the Kruskal-Wallis test and the Mann-Whitney U-test, with Bonferroni correction.Results:All specimens showed discoloration at varying levels. The highest color change was observed in the etch-and-rinse adhesive/tungsten carbide bur group. When the etch-and-rinse and self-etch adhesives were used, adhesive-remnant removal with Stainbuster burs resulted in significantly lower discoloration. The type of bur did not affect the extent of enamel discoloration in the RMGIC group.Conclusions:Orthodontic treatment alters the original color of enamel, and both the adhesive system and the resin-removal methods are responsible for this change. When brackets are bonded with the etch-and-rinse system or the SEP, cleaning the adhesive residuals with Stainbuster burs is recommended for minimal change. RMGIC can be safely cleaned with tungsten carbide burs.     

Enamel surface roughness after debonding: Comparison of two different burs

Objective:To test the hypotheses that (1) there is no significant difference between the effects of two burs on the surface roughness of enamel after orthodontic debonding, and (2) there is no difference between resin removal times of the two burs.Materials and Methods:The crowns of 20 premolars were embedded in acrylic blocks, and the buccal surfaces were subjected to atomic force microscopy (AFM), with measurement of initial roughness values. The brackets were bonded with a light-cured adhesive and were debonded with a debonding plier. In half of samples, adhesive remnants were removed with a tungsten carbide bur, whereas a fiber-reinforced composite bur was used in the other half. The second AFM measurements were made after resin removal. Duration of removal procedures was also recorded. Results of roughness and duration measurements were analyzed with the use of repeated measurements analysis of variance and independent t-tests, respectively.Results:The two resin removal instruments had significantly different effects on enamel roughness; higher average roughness (Sa) (P < .001), root mean square roughness (Sq) (P  =  .046), and maximum roughness depth (Smax) (P < .001) values were obtained with use of the tungsten carbide bur. Time required for resin removal with the composite bur was significantly greater than time required with the carbide bur (P < .001).Conclusion:The hypothesis is rejected. The composite bur used for resin removal creates smoother surfaces after orthodontic bonding; however, the process takes longer than it does when the tungsten carbide bur is used.     

Micro-morphometric assessment of titanium plasma-sprayed coating removal using burs for the treatment of peri-implant disease

This study evaluated, in vitro, the effectiveness of diamond and carbide burs, and bur sequences to remove the plasma-sprayed titanium coating from IMZ fixture surfaces. Fifteen polishing procedures were tested. They included the use of 12, 16, 30 bladed carbide burs or bevered carbide burs and 30, 15, 8 microns mean-particles-size diamond burs. The treated surfaces were evaluated with profilometer and SEM. Worn burs and titanium debris produced by the grinding were observed with SEM. All procedures produce smoother surfaces than baseline plasma-sprayed surfaces for both Ra and Rz(DIN) parameters (P < 0.001). A roughening effect of the 8 microns mean-grit diamond bur and 30 bladed burs were noted. The single carbide burs produce polished surfaces affected by waviness. Waviness was minimized by sequence or diamond bur use. The carbide bur blades were variously damaged after their use. In contrast, the grit of diamond burs was observed to be clogged by titanium debris whose amount seemed to be inversely related to the diamond mean particle size. Debris produced by diamond burs was granular whereas that produced by carbide bladed burs showed needle or flake morphology. In conclusion, the most effective titanium plasma sprayed removal were obtained by 30 microns and 15 microns mean-particle-size diamond burs, i.e. 30 microns plus 15 microns diamond burs and carbide 12 plus 16 bladed burs used in sequence.     

两种方法去除正畸牙面树脂粘结剂的效果评价

目的 评价两种去除正畸粘结剂及处理釉质表面方法的效果,为临床去除釉质粘结剂提供参考。 方法 选择正畸拔除的前磨牙30个,常规粘结托槽后去除托槽,将其随机分为两组,每组15个,分别使用金钢砂车针和碳钨钻,磨除残留牙体表面粘结剂,记录操作所用时间,用抛光杯抛光后用原子力显微镜测定釉质表面的粗糙度。 结果 金刚砂车针和碳钨钻去除正畸粘结剂操作时间无明显差异, 实验结果显示用碳钨钻磨除粘结剂的釉质表面粗糙度明显小于金钢砂车针, 有明显统计学差异。结论 碳钨钻去除金属托槽粘结剂方法对牙面的影响小于金刚砂车针。     

Effectiveness of diamond-impregnated felt wheels for polishing a hybrid composite

The effectiveness of diamond-impregnated felt wheels for polishing the surfaces of a fine-particle hybrid composite was studied in relation to different finishing methods. Standardised composite specimens were finished with one or a series of two or three finishing diamonds (particle size 30, 15 and 8 μm), one or two tungsten carbide finishing burs (12- and 30-fluted) or with a finishing diamond followed by a tungsten carbide bur. The final polishing of all specimens was done with the diamond-impregnated felt wheel Diafix α. Treatment with Sof-Lex discs after the use of a finishing diamond served as a polishing standard for comparison. Evaluation of the final surfaces was done with profilometry and by scanning electron microscopy. The profilometric results showed that the type of pretreatment was decisive for the quality of the final polishing. Nearly all surfaces polished by the diamond-impregnated felt wheels were smoother than those treated by the flexible discs (P<0.01). The lowest roughness data were recorded following a pretreatment with a finishing diamond and a tungsten carbide finishing bur. After appropriate pretreatment, the hybrid composite surface was sufficiently polished with the diamond-impregnated felt wheels.     

Spectrophotometric analysis of dental bleaching after bonding and debonding of orthodontic brackets

IntroductionThe aim of this study was to evaluate the bleaching effect after aging simulation in teeth submitted to bonding and debonding of orthodontic brackets.Materials and methodsFor this study, 90 human premolars were selected, and randomly divided into 6 groups: control, bleaching, and other 4 groups submitted to bleaching after bonding and debonding brackets using different methods. Color measurement of sample through the CIE L*a*b* system was performed in three moments: T1 – after brackets debonding, T2 – after staining cycling, and T3 – after bleaching. For evaluation of results among the components L*, a* and b*, the two criteria analysis of variance and the multiple comparison Tukey test (p < 0.05) were used.ResultsStatistically significant difference was observed among the groups submitted to brackets bonding and debonding through self-conditioning adhesive system and tungsten drill, also the control and bleaching groups between the moments T1 e T2.ConclusionBonding and debonding brackets methods tested in this study showed influence on the sample color change, and after the tooth bleaching process, only the group without brackets previous bonding achieved the color value presented before the staining and aging of samples in the brackets absence.     

Different techniques of residual composite removal following debonding--time taken and surface enamel appearance.

Four different methods of in vitro residual composite removal following debonding performed by two different operators (an orthodontist and a hygienist) were assessed for enamel surface damage (using scanning electron microscopy) and the time involved. There was no difference in the quality of enamel surface appearance between the two operators, regardless of the method used for composite removal. There was a statistically significant difference (P less than 0.05) for the time taken for composite removal between the two operators using a tungsten carbide bur method only. It is suggested that an expanded duties auxiliary with the practical skills of the hygienist would be able to remove residual composite debris and produce a satisfactory polished enamel surface using tungsten carbide burs and aluminium oxide polishing discs, thus becoming a safe and cost-effective member of the orthodontic team.     

Analysis of surface roughness of glass-ionomer cements and compomer

The purpose of this study was to evaluate the surface roughness of two glass-ionomer cements (Vitremer and Chelon-Fil), and one compomer (Dyract) when submitted to different finishing/polishing procedures at different times. A hundred 80-sample discs were made of each material and randomly divided into six finishing/polishing groups: mylar strip (control); Sof-Lex discs; diamond burs; diamond burs/Sof-Lex discs; 30-fluted carbide bur; 30-fluted carbide bur/Sof-Lex discs. These procedures were carried out immediately after preparation of the samples, after 24 and 168 h. Average surface roughness (Ra) was measured with a profilometer and the values were compared using anova (P < 0.05). The smoothest surface for all materials was obtained when cured in contact with the mylar strip. All other tested products increased surface roughness of restorative materials, but Sof-lex discs lead to better results. The worst results were verified with diamond burs. The finishing/polishing procedures, when performed immediately, can improve the roughness of glass-ionomer cements but not of the compomer tested.     

Porcelain surface roughness, color and gloss changes after orthodontic bonding

The purpose of this study was to evaluate the alteration in surface characteristics after orthodontic debonding of two types of porcelain systems commonly used in prosthetic dentistry. For this purpose, porcelain specimens were fabricated from low-fusing (n = 20) and high-fusing (n = 20) porcelain. The baseline surface roughness, color, and gloss were evaluated using profilometry, color shade index, and gloss study. All specimens were bonded with brackets and debonded using a testing machine at a rate of 0.1 mm/minute crosshead speed. The porcelain surfaces were polished using a 12-fluted carbide composite removal bur (low-fusing, n = 20; high-fusing, n = 20). In addition, half of each porcelain group was further polished using a series of Sof-Lex discs (low-fusing, n = 10; high-fusing, n = 10). The postdebond porcelain surface characteristics roughness, color, and gloss were reevaluated and compared with baseline measurements. The results were analyzed with two-way analysis of variance and Tukey multiple comparisons test, with porcelain type (low-fusing or high-fusing) and polishing protocol (carbide bur or carbide bur and discs) serving as discriminate variables at alpha = 0.05 level of significance. Bonding and debonding increased all roughness parameters tested; however, no change was revealed between the two polishing protocols. Similarly, gloss and color index changes were significantly altered after resin grinding, regardless of the polishing method used. No difference was identified between the two porcelain types with respect to roughness, color index, or gloss. Orthodontic bonding alters the porcelain surfaces, and postdebond polishing does not restore the surface to the prebond state.     

The effects of tooth preparation on pressure measured in the pulp chamber: a laboratory study

PURPOSE: The purpose of this study was to determine pressure changes in the pulp space during tooth preparation with either diamond or tungsten carbide burs in a high-speed dental handpiece in the laboratory. MATERIALS AND METHODS: Twenty premolar teeth were collected and randomly assigned to two groups: group 1 received preparation with diamond burs and group 2 with tungsten carbide burs. The teeth were mounted on a pressure transducer and the pulp chambers were filled with saline. A 0.1-mm thickness of tooth tissue was removed from the proximal surface of each tooth, alternating dry and wet cutting, until the pulp chamber was exposed. Pressure and temperature changes were recorded during tooth preparation. RESULTS: At 0 to 1 mm of remaining dentin depth dry cutting with diamond and tungsten carbide burs generated a mean positive pulpal pressure of 12 kPa and 6 kPa, respectively. Wet cutting under the same conditions produced 0.6 kPa and 0.15 kPa, respectively. The difference between wet and dry cutting was highly significant (P < 0.001). Diamond burs produced significantly higher pressure increases than carbide burs at all levels for both wet and dry techniques (P < 0.05). When cutting farther than 2 mm from the pulp, tooth preparation created a mean 0.09-kPa pressure increase, which was not influenced by either coolant use or bur type. The temperature change was minimal during wet cutting and only minor temperature increases were recorded during dry cutting. CONCLUSION: From this laboratory study it is concluded that significant pressure changes occur in the pulp chamber during tooth preparation of extracted teeth when the remaining dentin thickness is less than 2 mm.     

Dental Burs—What Bur for Which Application? A Survey of Dental Schools

PURPOSE: The purpose of this study was to survey North American dental schools regarding recommendations for rotary instrumentation for fixed prosthodontic and operative procedures at the predoctoral and postgraduate level. MATERIALS AND METHODS: A 25-question survey was sent to 64 North American dental schools, of which 15 questions specifically related to rotary instrument recommendations. One questionnaire was addressed to the individual at each school having administrative responsibility for teaching tooth preparation techniques. A high response rate was assured by follow-up telephone calls and faxes. The distributions of bur recommendations for both predoctoral and advanced prosthodontic programs were analyzed by chi-squared tests at an a priori alpha = 0.05. RESULTS: Completed surveys were received from 58 of 64 dental schools, a response rate > 90%. Medium grit burs predominate in predoctoral education for gross tooth reduction for fixed prosthodontics, whereas coarse grit burs predominate at the graduate level (p < .05). The use of the diamond bur alone predominates for axial wall refinement, whereas the use of carbide burs or carbide burs in combination with diamond burs prevails for marginal refinement (p < .05). In predoctoral operative dentistry, recommendations for cavity outline form were similar at all dental schools (p > .05) and were principally tungsten carbide (WC) burs. Carbide burs are the instrument of choice for internal walls, but the WC bur alone or in combination with diamond burs is preferred for refining composite margins (p < .05). CONCLUSIONS: There is a broad consensus within North American dental schools on rotary instrumentation used by dental students. There is a greater use of coarser grit burs for gross tooth reduction in fixed prosthodontics at the postgraduate than predoctoral level.     

Porcelain Surface Alterations and Refinishing After Use of Two Orthodontic Bonding Methods

Objective:To compare porcelain surfaces at debonding after use of two surface preparation methods and to evaluate a method for restoring the surface.Materials and Methods:Lava Ceram feldspathic porcelain discs (n  =  40) underwent one of two surface treatments prior to bonding orthodontic brackets. Half the discs had sandblasting, hydrofluoric acid, and silane (SB + HF + S), and the other half, phosphoric acid and silane (PA + S). Brackets were debonded using bracket removing pliers, and resin was removed with a 12-fluted carbide bur. The surface was refinished using a porcelain polishing kit, followed by diamond polishing paste. Measurements for surface roughness (Ra), gloss, and color were made before bonding (baseline), after debonding, and after each step of refinishing. Surfaces were also examined by scanning electron microscopy (SEM). Data was analyzed with 2-way ANOVA followed by Tukey HSD tests (α  =  0.05).Results:The SB + HF + S bonding method increased Ra (0.160 to 1.121 µm), decreased gloss (41.3 to 3.7) and altered color (ΔE  =  4.37; P < .001). The PA + S method increased Ra (0.173 to 0.341 µm; P < .001), but the increase in Ra was significantly less than that caused by the SB + HF + S bonding method (P < . 001). The PA + S method caused insignificant changes in gloss (41.7 to 38.0) and color (ΔE  =  0.50). The measurements and SEM observations showed that changes were fully restored to baseline with refinishing.Conclusions:The PA + S method caused significantly less damage to porcelain than the SB + HF + S method. The refinishing protocol fully restored the porcelain surfaces.     

A pilot clinical study of Class III surgical patients facilitated by improved accelerated osteogenic orthodontic treatments

Objective:To evaluate if the improved accelerated osteogenic orthodontics (IAOO) procedure could speed Class III surgical patients'' preoperative orthodontic treatment duration and, if yes, to what extent. This study was also designed to determine whether or not an IAOO procedure affects the tooth-moving pattern during extraction space closure.Materials and Methods:The samples in this study consisted of 24 Class III surgical patients. Twelve skeletal Class III surgery patients served as an experimental group (group 1) and the others as a control group (group 2). Before treatment, the maxillary first premolars were removed. For group 1, after the maxillary dental arch was aligned and leveled (T2), IAOO procedures were performed in the maxillary alveolar bone. Except for this IAOO procedure in group 1, all 24 patients experienced similar combined orthodontic and orthognathic treatment. Study casts of the maxillary dentitions were made before orthodontic treatment (T1) and after extraction space closure (T3). All of the casts were laser scanned, and the amount of movement of the maxillary central incisor, canine, and first molar, as well as arch widths, were digitally measured and analyzed by using the three-dimensional model superimposition method.Results:The time durations T3–T2 were significantly reduced in group 1 by 8.65 ± 2.67 months and for T3–T1 were reduced by 6.39 ± 2.00 months (P < .001). Meanwhile, the tooth movement rates were all higher in group 1 (P < .05). There were no significant differences in the amount of teeth movement in the sagittal, vertical, and transverse dimensions between the two groups (P > .05).Conclusion:The IAOO can reduce the surgical orthodontic treatment time for the skeletal Class III surgical patient by more than half a year on average. The IAOO procedures do not save anchorage.     

Enamel Surface Roughness of Preferred Debonding and Polishing Protocols

Objective:: This study investigated the surface roughness of enamel after debonding and instrumentation with commonly used methods.

Methods:: Part I: a survey was sent to active members of the American Association of Orthodontists to determine popular bonding, debonding, and polishing protocols. Part II: brackets were bonded to the buccal surface of 30 extracted human premolar teeth. After debonding, residual adhesive was removed with 12-, 16-, and 20-fluted titanium carbide burs as based upon the survey results. The teeth were scanned with a surface profilometer for surface roughness. Part III: the teeth were further polished using a Reliance Renew polishing point or a prophy cup with pumice and rescanned for surface roughness.

Results:: Part I: the majority of respondents used a generic bracket-removing plier to remove fixed appliances (53%) and a high-speed handpiece for adhesive removal (85%). The most popular bur was a 12-fluted carbide bur without water spray. The majority of respondents used pumice paste and/or Reliance Renew points after adhesive removal. Part II: there was a significant difference in enamel surface roughness when 12-, 16-, and 20-fluted carbide burs were compared via surface profilometry. Part III: further polishing with a Reliance Renew point or a prophy cup and pumice did not provide a significantly smoother surface.

Conclusions:: The results show large variation in debonding and polishing techniques. Creating a smooth enamel surface is equally possible with 12- or 20-fluted carbide burs. Further polishing with pumice and prophy cup or Renew point does not provide an enamel smoother surface.     

Effect of different finishing and polishing techniques on the surface roughness of microfilled, hybrid and packable composite resins

This study examined the average surface roughness (Ra, microm) of 2 microfilled (Durafill and Perfection), 1 hybrid (Filtek Z250) and 2 packable composite resins (Surefil and Fill Magic), before (baseline) and after eight different finishing and polishing treatments. The surface roughness was assessed using a profilometer. Ten specimens of each composite resin were randomly subjected to one of the following finishing/polishing techniques: A -- carbide burs; B -- fine/extrafine diamond burs; C -- Sof-Lex aluminum oxide discs; D -- Super-Snap aluminum oxide discs; E -- rubber polishing points + fine/extrafine polishing pastes; F -- diamond burs + rubber polishing points + fine/extrafine polishing pastes; G -- diamond burs + Sof-Lex system; H -- diamond burs + Super-Snap system. Data were analyzed using two-way ANOVA and Tukey's HSD test. Significant differences (p<0.05) were detected among both the resins and the finishing/polishing techniques. For all resins, the use of diamond burs resulted in the greatest surface roughness (Ra: 0.69 to 1.44 microm). The lowest Ra means were obtained for the specimens treated with Sof-Lex discs (Ra: 0.11 to 0.25 microm). The Ra values of Durafill were lower than those of Perfection and Filtek Z250, and these in turn had lower Ra than the packable composite resins. Overall, the smoothest surfaces were obtained with the use the complete sequence of Sof-Lex discs. In areas that could not be reached by the aluminum oxide discs, the carbide burs and the association between rubber points and polishing pastes produced satisfactory surface smoothness for the packable and hybrid composite resins, respectively.     

Quantitative and qualitative analysis of particulate production during simulated clinical orthodontic debonds

ObjectivesThe objectives of this investigation were firstly to quantitatively and qualitatively determine particulate production during orthodontic debond and enamel cleanup procedures, and secondly to examine what methods can be employed to minimize operator exposure to such dust particles.MethodsA qualitative study was performed to determine the aerodynamic diameters and compositions of particulates produced during simulated clinical debonds and enamel cleanup procedures on extracted teeth. In each case the enamel was cleaned using tungsten carbide burs in either a high or slow speed handpiece, with or without water coolant spray, with or without high volume evacuation (HVE) or a face mask.ResultsThe use of a high speed handpiece with a tungsten carbide bur and water irrigation at enamel cleanup produced the greatest concentration of respirable particulates. Within this dust, calcium, phosphorus, aluminum and silicon were the most commonly found elements. The dust levels observed did not exceed limits advised for respirable dusts in general. However, the concentration of silica within the dusts created is unknown. The face mask and HVE were effective at reducing exposure to respirable particles, but the mask was most effective, reducing exposure by up to 96%.SignificanceA face mask is an effective means of reducing dust inhalation and is advised for all clinical procedures that produce dusts.     

Effect of injectable platelet-rich fibrin (i-PRF) on the rate of tooth movement:: A randomized clinical trial

ObjectivesTo evaluate the efficiency of injectable platelet-rich fibrin (i-PRF) in accelerating canine tooth movement and to examine levels of the matrix metalloproteinase-8 (MMP-8), interleukin-1β (IL-1β), receptor activator of nuclear factor kappa-light-chain-enhancer of activated B cells ligand (RANKL), and osteoprotegerin (OPG) in the gingival crevicular fluid during orthodontic treatment.Materials and MethodsTwenty patients (mean age = 21.4 ± 2.9 years) with Class II Division 1 malocclusion were included in a split-mouth study. The treatment plan for all patients was extraction of maxillary first premolars followed by canine distalization with closed-coil springs using 150 g of force on each side. The study group received i-PRF two times, with a 2-week interval, on one side of the maxilla. The contralateral side served as the control and did not receive i-PRF. Maxillary canine tooth movement was measured at five time points (T1–T5) on each side. Also, the activity of inflammatory cytokines was evaluated at three time points in the gingival crevicular fluid samples.ResultsThere was a significant difference in canine tooth movement between the two groups (P < .001). i-PRF significantly increased the rate of tooth movement, and stimulation in the levels of inflammatory cytokines supported this result (P < .001). The levels of cytokines changed in both groups between T1 and T2. The IL-1β, MMP8, and RANKL values were significantly increased in the study group compared with the control group, while the OPG values were significantly decreased.Conclusionsi-PRF-facilitated orthodontics is an effective and safe treatment modality to accelerate tooth movement, and this method can help shorten orthodontic treatment duration.     

Effect of Aging on the Microstructure and Optical Properties of Translucent ZrO 2 Ceramics

ObjectivesThe development and placement of translucent zirconia ceramics on the dental materials market is in full swing. This research aimed to investigate how aging protocols affect the microstructure, color parameters and translucency of a new-generation monolithic zirconia ceramic.Material and methodsTranslucent zirconia ceramics KATANA-Zirconia STML with different surface treatments (as sintered - control, glazed, polished) was tested using two aging protocols (hydrothermal degradation in autoclave at 134 °C and 2 bars for three hours, chemical degradation in four-percent acetic acid at 80 °C for 16 hours) in order to examine phase composition using X-ray diffraction analysis and ΔE, ΔL and ΔC color parameters through spectrophotometry. The translucency parameter (TP) was calculated using parameters L*, a* and b* on a black and white surface.ResultsRegardless of the surface treatment, aging protocols did not cause a tetragonal-to-monoclinic phase transformation, although hydrothermal degradation in the autoclave transformed the hybrid tetragonal-cubic structure of all specimens to a tetragonal one. All polished and glazed specimens during chemical degradation demonstrated a significant color change ΔE. Lightness ΔL significantly changed in polished specimens aged in the autoclave. In all specimens, ΔC underwent a change manifested through statistically insignificant yellowing. None of the aging protocols altered the translucency of specimens.ConclusionsAging, regardless of the final surface treatment, did not manifest a monoclinic phase in the specimens. A tetragonal-cubic microstructure dominates. Unlike polishing, glazing the surface of translucent zirconia ceramics contributed to minor changes in color, lightness and chromaticity. The translucency of translucent zirconia ceramics remains stable regardless of aging and surface treatment.     

Long-term follow-up of camouflage effects following resin infiltration of post orthodontic white-spot lesions in vivo

Objectives:To reassess the long-term camouflage effects of resin infiltration (Icon, DMG, Hamburg, Germany) of white spot lesions (WSL) and sound adjacent enamel (SAE) achieved in a previous trial. The null hypothesis was tested that there were no significantly different CIE-L*a*b*-ΔE-values between WSL and SAE areas of assessment after at least 24 months (T24) compared to those at baseline (T0).Materials and Methods:Of twenty subjects who received previous resin infiltration treatment of n_teeth = 111 nonrestored, noncavitated postorthodontic WSL after multibracket treatment during a randomized controlled trial and were contacted 20 months after baseline, eight subjects (trial teeth n_teeth = 40; m/f ratio 1/7; age range (mean; SD) 12–17 [15.25; 2.12] years); response rate: 40%) were available for follow-up after at least 24 months (T24). CIE-L*a*b* differences between summarized color and lightness values (ΔE_WSL/SAE) of WSL and SAE were assessed using a spectrophotometer and compared to baseline data assessed prior to infiltration (T0), and those after 6 (T6), and 12 (T12) months using paired t tests at a significance level of α = 5%.Results:T24 assessments were performed after a mean 33.86 (SD: 8.64; Min: 24; Max: 45) months following T0. Mean (SD) ΔE_WSL/SAE units of available teeth were 8.76 (5.33) at baseline; 5.5 (2.75) at T6; 5.2 (2.41) at T12; and 5.57 (2.6) at T24. Comparisons of T6, T12, and T24 with T0 yielded highly significant differences, whereas T6–T24 and T12–T24 differences were found to be not significant.Conclusions:Assimilation of infiltrated WSL to the color of adjacent enamel by resin infiltration is considered to be suitable for the long-term improvement in the esthetic appearance of postorthodontic WSL.     

Tooth movement,orofacial pain,and leptin,interleukin-1β, and tumor necrosis factor–α levels in obese adolescents

ObjectivesTo evaluate tooth movement, orofacial pain, and leptin, interleukin (IL)–1β, and tumor necrosis factor (TNF)–α cytokine levels in the gingival crevicular fluid (GCF) during orthodontic treatment in obese adolescents.Materials and MethodsParticipants included adolescent patients aged 12–18 years: group 1, obese (n = 30), and group 2, nonobese controls (n = 30). They were evaluated before (T₀) and after 1 hour (T₁), 24 hours (T₂), and 1 week (T₃) of fixed appliance bonding. Periodontal examination (T₀), collection of GCF (T_1, T_2, T₃), and evaluation of Little''s irregularity index (T_0, T₃) were performed, and a visual analog scale was used to measure pain (T_1, T_2, T₃). Evaluation of IL-1β, TNF-α, and leptin cytokines was performed using a Luminex assay. Mann-Whitney and t-tests were used for intergroup comparisons, and a generalized estimating equation and cluster analyses were used for comparisons among observation times (P < .05).ResultsThe obese group had a higher prevalence of probing depth of ≥4 mm and bleeding on probing. Orthodontic tooth movement was similar in both groups. Peak of pain was at T₂ in both groups and was higher in the obese patients. TNF-α showed a slight increase at T₁, followed by a gradual decrease at T₂ and T₃ in both groups. The obese group had a higher concentration of IL-1β before and during orthodontic treatment. There was no difference in tooth movement between obese and control patients during the first week of orthodontic treatment.ConclusionsObese adolescents had a greater subjective report of orofacial pain after 24 hours of orthodontic treatment and higher concentrations of IL-1β proinflammatory cytokine before and during tooth movement as compared with nonobese control adolescents.