Influence of resin infiltration pretreatment on the microleakage under orthodontic bracket (an in vitro study) Qibi LH, Hasan LA, Dewachi Z

ORIGINAL ARTICLE

Year : 2023 | Volume : 12 | Issue : 1 | Page : 43

Influence of resin infiltration pretreatment on the microleakage under orthodontic bracket (an in vitro study)

Leqaa H Qibi, Lamiaa A Hasan, Zaid Dewachi
Department of Pedodontics, Orthodontics, and Preventive Dentistry, College of Dentistry, Mosul University, Mosul, Iraq

Date of Submission	20-Oct-2022
Date of Decision	23-Nov-2022
Date of Acceptance	09-Jan-2023
Date of Web Publication	04-Sep-2023

Correspondence Address:
Leqaa H Qibi
Department of Pedodontics, Orthodontics, and Preventive Dentistry, College of Dentistry, Mosul University, Mosul
Iraq

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jos.jos_102_22

Abstract

OBJECTIVES: In order to assess the changes in tooth orthodontic adhesive interface microleakage after applying a caries resin penetrated to the sound enamel tooth surface in different storage media.
MATERIALS AND METHODS: A total of 60 human maxillary first premolars (orthodontic extraction) were collected by random separation of the teeth into two equal groups. The control group was classified into three subgroups (n = 10) (control in deionized water, control in milk, and control in energy drink), while the experimental one (treated with ICON) was categorized into three subgroups (n = 10) (ICON in deionized water, ICON in milk, and ICON in energy drink) incubation phase lasted three weeks in total.
RESULTS: A one-way analysis of variance (ANOVA) yielded a significant difference between all experimental subgroups (ICON in deionized water, ICON in milk, and ICON in energy drink) and control subgroups (control in deionized water, control in milk, and control in energy drink). The control group in the energy drink subgroup had the highest mean microleakage value when compared to the other subgroups, whereas the resin-infiltrated group in deionized water had the lowest mean value. According to the results of the T-test, ICON pre-treatment tooth samples had significantly lower mean values of microleakage than non-ICON tooth samples.
CONCLUSIONS: The adhesive system (control group) revealed that a resin infiltrate on a sound enamel surface prior to orthodontic bracket bonding reduced bracket tooth interface microleakage in all examined samples. The ICON-infiltrated surface was discovered to provide a secondary preventive strategy against white spot lesion development by reducing microleakage under brackets.

Keywords: Caries infiltration, enamel, ICON, microleakage, white spot lesion

How to cite this article:
Qibi LH, Hasan LA, Dewachi Z. Influence of resin infiltration pretreatment on the microleakage under orthodontic bracket (an in vitro study). J Orthodont Sci 2023;12:43

How to cite this URL:
Qibi LH, Hasan LA, Dewachi Z. Influence of resin infiltration pretreatment on the microleakage under orthodontic bracket (an in vitro study). J Orthodont Sci [serial online] 2023 [cited 2023 Sep 21];12:43. Available from: https://www.jorthodsci.org/text.asp?2023/12/1/43/385058

Introduction

Microleakage is a complicated situation with such a fixed orthodontic appliance therapy. It is a loss of marginal integrity that permits white opacity lesions to grow around and under the bracket, potentially resulting in a reduction of the bracket bonding strengths.^[1] White spot lesions are clinical and cosmetic issues characterized by enamel demineralization, tooth discoloration, corrosion, and bond strength deterioration.^[1]

Because orthodontic braces, bands, ligatures, and other orthodontic accessories are difficult to clean and increase bacterial biofilm accumulation on tooth surfaces, white spots develop around them.^[2],[3] White spot lesions have become more prevalent with fixed orthodontic appliances.^[4],[5] Oral hygiene, sex, orthodontic treatment time, wheat consumption, and diet all have an impact on the appearance of white spots lesions.^[6],[7] To avoid additional demineralization and cavitation, these lesions should be identified early.^[8] restorations, crowns, and veneers, which necessitate enamel reduction beyond the demineralized area, possibly even to the dentin,^[9] are among the options for treating white spot lesions. To remineralize these lesions on the surface, casein phosphopeptide amorphous calcium phosphate products such as MI Paste and MI Paste Plus, as well as fluoride dentifrice, mouthwash, gels, and varnishes, can be utilized.

Other materials and procedures, such as the use of (ICON) resin infiltration material, have recently been advocated.^[10],[11] Resin infiltrate is a substance with a low viscosity.^[12] The primary idea of resin infiltration is to use capillary forces to enter and enclose the porosity volume of underlying defects, replenishing missing minerals, enclosing hydroxyapatite crystals, and micromechanically joining the residual enamel prisms.^[13],[14] The current paper was designed to evaluate the changes in tooth-orthodontic adhesive interface microleakage at the occlusal and the gingival side in three different storage media (Deionized water, energy drink, and milk drink) after applying a caries resin penetrated to the sound enamel tooth surface.

Materials and Methods

The ethical approval was acquired by the UoM.Dent/DM.L.21/22 Institutional Review Committee.

Study sample design

A total of 60 human maxillary first premolars (orthodontic purposes) were used in the study. To avoid microbial growth, teeth were maintained at room temperature in a glass container in a solution of normal saline (Panther, UK) containing 0.1 percent thymol (Sigma, Poole, Dorset, UK) that was changed weekly.^[15],[16] The study excluded teeth having caries, enamel abnormalities, abrasions, attrition, fractures, or any other developmental problems.^[17] Buccal surfaces were scrubbed and polished for 10 seconds with a slow-speed handpiece (NSK, Japan), fluoride-free pumice, and a rubber polishing cup (China), then rinsed and dried with oil-free air steam for another 10 s.^[18],[19]

The teeth sample was divided equally into two main groups, with 30 teeth for each sample:

Group 1: control group samples of teeth not treated with ICON material.

Group 2: experimental group samples of teeth treated with ICON material.

Bracket bonding

In the control group, 37% phosphoric acid etching gel (Ivoclar, Vivadent, Schaan, Liechtenstein) was placed on the buccal enamel surface for 30 s, washed, and dried until the etched surface looked chalky white.^[20] Stainless-steel maxillary first premolar 0.022-slot Roth prescription brackets from American Orthodontics (USA) were used. The bracket's base area was determined to be 8.686 mm².^[21] Brackets were attached to the teeth using a thin coating of Heliosit adhesive (Ivoclar) applied to the buccal surface of the enamel in the middle third.^[20] A weight of 200 grams was applied to the bracket for 10 s.^[22] All unnecessary bonding excess around the bracket was cleaned. The adhesive was cured with a Viva Dent light curing unit with a light intensity greater than 500 mW/cm² and a wave length range of 400–500 nm.^[23] The light curing device was installed on a rod to standardize the distance between the light device and the brace base to 2 mm.^[24] The total curing time is 40 and 20 s for each of the mesial and distal sides of the bracket.^[25] Regarding the ICON group, ICON was applied according to the manufacturer as follows:

Apply ICON Etch. Let it sit for 2 min
Water rinsing for 30 s, then dry in a water oil free air.
ICON Dry is used. Lie on the site for 30 s to conduct a visual assessment. The whitish, opaque lesion discoloration must diminish significantly; otherwise, repeat steps 1–3. Dry with water oil free air.
Switch off the operatory light. Apply Icon Infiltrate. Let it sit for at least for 3 min. Maintain the wet lesion surface with an occasional twist of the syringe.
Disperse with air and floss. Light cure for 40 s.
Replace the applicator tip. Apply ICON Infiltrate. Let it sit for 1 minute Remove excess and floss. Light cure for 40 s and polish.

Heliosit adhesive and brackets were applied similarly to the control group. To inhibit microleakage from the pulp chamber, all tooth apices were coated with sticky wax to seal the root apices. To inhibit microleakage from other places of the tooth, clear nail varnish was applied in two layers on buccal tooth surfaces, except for 1 mm around the orthodontic bracket base.^[15],[26] [Table 1] shows the items utilized in this research.

Table 1: Material composition, Manufacturer

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Storage of control and experimental groups

The single mean formula [n = (Z r/D) 2] was used to calculate sample size.

n is the number of sample subjects, Z (constant) = 1.96 for 95% confidence, r is the standard deviation for other related studies = (0.213), and D (precision) = 0.2 unit. The resulting number was adjusted and the final sample size in each group = n + (n*0.2). Each group (control and experimental) was subdivided into three equal subgroups (n = 10) based on storage media as seen in [Table 2]:

Table 2: Storage media, PH, Ingredients

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Subgroup A: Deionized water is used to keep tooth samples immersed.

Subgroup B: Tooth samples are soaked in an energy drink for 15 min, three times per day at 2-h intervals.^[27] They were previously stored in deionized water.

Subgroup C: Tooth samples are dipped in milk drinks for 15 min, three times per day at 2-h intervals. They were previously stored in deionized water. The incubation phase lasted 3 weeks in total.^[27]

Evaluation of microleakage

Teeth were then submerged for 24 h at room temperature in a 0.5% solution of basic fuchsine (0.5 gm of powder dissolved in 100 ml distilled water). The samples were rinsed with water; the nail varnish and the superficial pigment were cleaned with a brush.^[26] At about the center of the bracket, a slow speed disk was used to segment each tooth in a buccolingual direction.^[15]

A light microscope was used to assess microleakage in millimeters at enamel adhesive contacts on the occlusal and gingival sides for all sections as shown in [Figure 1]. The same and other investigator randomly checked half of the samples again to quantify the microleakage. There were no significant variations in microleakage ratings between the first and second tests.

Figure 1: Under a light Microscope, microleakage at the enamel adhesive contact

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The following criteria were used to score the work^[21]:

Score 0: There is no dye penetration thru the adhesive-enamel contact.

Score 1: At the adhesive enamel contact, dye penetration is limited to 1 mm.

Score 2: At the adhesive enamel contact, dye infiltrates into the inner half (2 mm).

Score 3: At a depth of 3 mm, the dye penetrates the adhesive enamel contact.

Statistical analyses

Descriptive statistics were calculated for the all-teeth groups. The data showed normal distribution according to the Kolmogorov–Smirnov and the Shapiro–Wilks Normality test. A one-way analysis of variance (–ANOVA) was used to evaluate the significant differences in the microleakage at both the occlusal and gingival sides among the different storage media subgroups. Then the Tukey test was applied since the ANOVA showed significant differences.

A T-test was used to show if there is a significant difference in the microleakage mean between the ICON-treated teeth and those not treated with ICON (control). Statistical significance was judged to be P ≤ 0.05.

Results

A significant difference was revealed using ANOVA between all ICON-treated teeth subgroups (deionized water, energy drink, and milk drink), while the comparisons in control subgroups (without ICON treatment) that were stored in different storage media were shown a significant difference, see [Table 3] and [Table 4]. The T-test findings showed that the mean value differed by a significant amount of microleakage for ICON pre-treated tooth samples over those without ICON in the same storage media as shown in [Table 5]. The resin-infiltrated group in deionized water had the lowest mean value of microleakage. There was the greatest microleakage value in the energy drink subgroups in the control group when compared to the other subgroups, and there was a significant difference between all subgroups at P ≤ 0.05.

Table 3: Statistical analysis of microleakage for the control groups in different storage media

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Table 4: Statistical analysis of microleakage for experimental groups in different storage media

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Table 5: Statistical analysis of microleakage between the control and experimental groups that stored in the same storage media

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Discussion

There was a significant difference between all subgroups (deionized water, energy drink, and milk) in both the control and ICON pre-treated groups.

The impact contrast of the microleakage test between control and ICON pre-treated groups was shown in [Table 3] and [Table 4], where data point toward a highly significant difference at P ≤ 0.05 between all groups, and assessing the microleakage test with and without implementation of ICON, which was used as a preventative measure procedure on induced white spot lesions at the enamel surface,^[28],[29] [Table 5] shows a marked difference in microleakage between groups.

Since the energy drinks include acids, the energy drinks subgroup in the control group revealed the highest microleakage percentage at the adhesive enamel interface, which was consistent with the findings of Pulgaonkar and Chitra, (2021)^[30],[31] study in explaining a detrimental influence on the brackets. Enamel demineralization brings about enamel erosion and adhesive material loss, as well as an increase in microleakage behind the brackets; this might also be linked to the presence of high doses of refined carbs, which promote greater levels of acid. Furthermore, citric acid and citrate are capable of binding to calcium in the teeth, keeping the pH low for extended periods of time and promoting microleakage, as described by Oncag et al., 2005.^[32]

For the all-tested subgroups, gingival sides exhibited considerably greater microleakage than occlusal sides. This is consistent with the findings of Arhun et al., 2006^[33] who related variation to relative surface curvature, which might lead to higher adhesive on the gingival side. Microleakage can occur as a result of permeation, which is produced by a discrepancy in the thermal expansion coefficients of brackets, enamel, and adhesive. This is something that both Salman and Al-Ani, (2021) agree with.^[15]

After the control in energy drink, the control in milk group had a significant high microleakage. Because milk lipids are insoluble in water, they would attach to the surface of the bonded teeth. Fat accumulation weakens the resin and intensifies the microleakage. This is supported by Anicic et al. (2020).^[34]

ICON's low viscosity allows it to efficiently penetrate the tooth enamel. Microleakage in the ICON groups (ICON, ICON in milk, and ICON in energy drink) was lesser than in the other control subgroups, according to statistical analysis, which agrees with Li et al. (2021).^[35] The findings are related to the capacity of resin infiltration to successfully seal porous structures in the enamel and boost the ability of sound enamel surfaces to withstand acid erosion and demineralization, making it harder for external acids to access holes in the enamel. As a result, resin penetration may aid in preventing acid erosion and demineralization of dental enamel. Arnold et al. (2016)^[36] also found that adding resin infiltrate to enamel caries can supply and preserve enamel.

Conclusion

It was determined that the ICON-infiltrated surface might be used as a secondary preventative strategy against white spot lesion development in orthodontic patients by reducing microleakage under brackets. The acidic solution and fatty beverages increased microleakage under the orthodontic braces.

Acknowledgments

All thanks and appreciation is to the College of Dentistry, Mosul University, for its constant support.

Ethical approval

The ethical approval was acquired by the UOM.Dent.L.21/22 Institutional Review Committee.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Alkis H, Turkkahraman H, Adanir N. Microleakage under orthodontic brackets bonded with different adhesive systems. Eur J Dent 2015;9:117-21. [PUBMED] [Full text]
2.	Ali A, Ismail H, Amin K. Effect of nanosilver mouthwash on prevention of white spot lesions in patients undergoing fixed orthodontic treatment-A randomized double-blind clinical trial. J Dent Sci 2022;17:249-55.
3.	Attar HJ, Hacham I. Chlorhexidine effect on color of treated white spot lesion with remineralization materials (fluoride varnish, tooth mouse). J Oral Dent Res 2020;7:30-6.
4.	Heymann GC, Grauer D. A contemporary review of white spot lesions in orthodontics: White spot lesions in orthodontics. J Esthet Restor Dent 2013;25:85-95.
5.	Lale S, Solak H, Hınçal E, Vahdettin L. In vitro comparison of fluoride, magnesium, and calcium phosphate materials on prevention of white spot lesions around orthodontic brackets. BioMed Res Int 2020;2020:1989817.
6.	Sandra CD, Maria D, Ingrid MD, Vanessa HD, Katia VR. Preventing and arresting the appearance of white spot lesions around the bracket by applying fluoride varnish: A systematic review. Dentistry 2018;8:500.
7.	Baka ZM, Akin M, Ileri Z, Basciftci FA. Effects of remineralization procedures on shear bond strengths of brackets bonded to demineralized enamel surfaces with self-etch systems. Angle Orthod 2016;86:661-7.
8.	Neres ÉY, Moda MD, Chiba EK, Briso A, Pessan JP, Fagundes TC. Microhardness and roughness of infiltrated white spot lesions submitted to different challenges. Oper Dent 2017;42:428-35.
9.	Senestraro SV, Crowe JJ, Wang M, Vo A, Huang G, Ferracane J, et al. Minimally invasive resin infiltration of arrested white-spot lesions: A randomized clinical trial. J Am Dent Assoc 2013;144:997-1005.
10.	Zakizade M, Davoudi A, Akhavan A, Shirban F. Effect of resin infiltration technique on improving surface hardness of enamel lesions: A systematic review and meta-analysis. J Evid Based Dent Pract 2020;20:101405.
11.	El Meligy OAES, Alamoudi NM, Eldin Ibrahim ST, Felemban OM, Al-Tuwirqi AA. Effect of resin infiltration application on early proximal caries lesions in vitro. J Dent Sci 2021;16:296-303.
12.	Oliveira A, Felinto LT, Francisconi-Dos-Rios LF, Moi GP, Nahsan FPS. Dental bleaching, microabrasion, and resin infiltration: Case report of minimally invasive treatment of enamel hypoplasia. Int J Prosthodont 2020;33:105-10.
13.	Kashbour W, Gupta P, Worthington HV, Boyers D. Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev 2020;11:CD003067.
14.	Soveral M, Machado V, Botelho J, Mendes JJ, Manso C. Effect of resin infiltration on enamel: A systematic review and meta-analysis. J Funct Biomater 2021;12:48.
15.	Salman OL, Al-Ani RA. Evaluation of microleakage under sapphire brackets bonded with three different orthodontic adhesives after thermocycling and water storage (an in vitro study). Indian Forensic Med Toxicol 2021;15:1457-62.
16.	Alhamadi WW, Osman E, Saleh F, AL-Mayali AM, Alhumadi A, Alrufaye Z. Effect of resin infiltrant pretreatment on shear bond strength of metal orthodontic brackets in vitro study. Int J Dent Oral Health 2018;4:101-6.
17.	Vicente A, Ortiz AJ, Bravo LA. Microleakage beneath brackets bonded with flowable materials: Effect of thermocycling. Eur J Orthod 2009;31:390-6.
18.	Hasan LA. Evaluation the properties of orthodontic adhesive incorporated with nano-hydroxyapatite particles. Saudi Dent J 2021;33:1190-6.
19.	Cerone M, El-Badrawy W, Gong SG, Prakki A. Bond strength of universal self-etch 1-step adhesive systems for orthodontic brackets. J Can Dent Assoc 2019;85:j6.
20.	Bishara SE, VonWald L, Laffoon JF, Warren JJ. The effect of repeated bonding on the shear bond strength of a composite resin orthodontic adhesive. Angle Orthod 2000;70:455-41.
21.	Bhushan R, Jeri SY, Narayanamurthy S, Vrinda SM, Soans CR, Reddy H. Assessment of microleakage under stainless steel orthodontic brackets bonded with various adhesive systems: An in vitro study. J Contemp Dent Pract 2021;22:620-3.
22.	Bishara SE, Ostby AW, Laffoon JF, Warren JJ. Enamel cracks and ceramic brackets failure during debonding in vitro. Angle Orthod 2008;78:1178-83.
23.	Alexander SA. Effects of orthodontic attachments on the gingival health of permanent 2^nd molars. Am J Orthod Dentofac Orthop 1991;199:337-40.
24.	Jain A, Ray S, Mitra R, Chopra SS. Light cure tip distance and shear bond strength: Does it have any clinical significance? J Indian Orthod Soc 2013;47:135-42. [Full text]
25.	Al-Sarkhi RAK, Al-Groosh DH. The effects of enamel protective agents on shear bond strength after rebonding of stainless-steel orthodontic bracket (an in vitro study). J Baghdad Coll Dent 2017;29:170-6.
26.	Uysal T, Ulker M, Ramoglu SI, Ertas H. Microleakage under metallic and ceramic brackets bonded with orthodontic self-etching primer systems. Angle Orthod 2008;78:1089-94.
27.	Navarro R, Vicente A, Ortiz AJ, Bravo LA. The effects of two soft drinks on bond strength, bracket microleakage, and adhesive remnant on intact and sealed enamel. Eur J Orthod 2011;33:60-5.
28.	Prasada KL, Penta PK, Ramya KM. Spectrophotometric evaluation of white spot lesion treatment using novel resin infiltration material (ICON®). J Conserv Dent 2018;21:531-5. [PUBMED] [Full text]
29.	Behnaz M, Kasraei S, Yadegari Z, Zare F, Nahvi G. Effects of orthodontic bonding containing TiO2 and ZnO nanoparticles on prevention of white spot lesions: An in vitro study. Biointerface Appl Chem 2022;12:431-40.
30.	Pulgaonkar R, Chitra P. Stereomicroscopic analysis of microleakage, evaluation of shear bond strengths and adhesive remnants beneath orthodontic brackets under cyclic exposure to commonly consumed commercial “soft” drinks. Indian J Dent Res 2021;32:98-103. [PUBMED] [Full text]
31.	Qibi LH, Mohammad FA, Qasim AA. The effect of two acidic time exposure followed by remineralization process on roughness of dental enamel. Int J Dent Oral Sci 2021;8:2182-7.
32.	Oncag G, Tuncer AV, Tosun YS. Acidic soft drinks effects on the shear bond strength of orthodontic brackets and a scanning electron microscopy evaluation of the enamel. Angle Orthod 2005;75:247-53.
33.	Arhun N, Arman A, Cehreli SB, Arikan S, Karabulut E, Gulsahi K. Microleakage beneath ceramic and metal brackets bonded with a conventional and an antibacterial adhesive system. Angle Orthod 2006;76:1028-34.
34.	Anicic MS, Goracci C, Juloski J, Miletic I, Mestrovic S. The influence of resin infiltration pretreatment on orthodontic bonding to demineralized human enamel. Appl Sci 2020;10:2-8.
35.	Li M, Yang Z, Huang Y, Li Y, Zhou Z. In vitro effect of resin infiltrant on resistance of sound enamel surfaces in permanent teeth to demineralization. Peer J 2021;9:e12008.
36.	Arnold WH, Meyer AK, Naumova EA. Surface roughness of initial enamel caries lesions in human teeth after resin infiltration. Open Dent J 2016;10:505-15.