19 The selected fixed prosthodontic treatment, albeit invasive, was more conservative than other considered alternatives. Other treatment methods involving extractions of remaining teeth and placement selleck kinase inhibitor of removable prostheses or extractions of remaining teeth combined with implant-supported fixed or removable prosthodontics were considerably more radical and had greater incidence of clinical complications than conventional fixed and removable prosthodontics.20�C21 This patient wished to retain his natural dentition as much as possible.
One of the most difficult problems in orthodontic treatment with fixed appliances is the control of enamel demineralization around the brackets.1 The bands/brackets and the different orthodontic elements that are used (elastics, power chains, sleeves, springs) make the patient��s dental hygiene more difficult and the accumulation of plaque easier.
2 Studies have documented significant increases in oral bacteria during orthodontic treatment.3 Previous studies have shown that the rate of demineralization in orthodontic patients was higher than those without orthodontic treatment,4�C6 and teenagers were at higher risk of demineralization than adults.6 The prevalence of demineralization in orthodontic patients has been reported between 2% and 96%.4,7,8 It has been generally accepted that the combined application of fluoride regimes, oral hygiene instructions, and dietary control can contribute greatly to the inhibition of demineralization during fixed-appliance treatment.8,9 These methods, however, rely on patient compliance.
Other noncompliant methods have been created to deliver fluoride adjacent to orthodontic appliances.10 Fluoride varnishes have also been shown to decrease enamel demineralization in vitro and in clinical studies.11�C13 Fluoride varnish adheres to the enamel surface longer than other topical fluoride products and has been shown to be superior to the use of sodium fluoride and monofluorophosphate toothpastes, weekly acidulated phosphate fluoride gel application and daily sodium fluoride rinses because of its ability to increase fluoride uptake in enamel in vitro.14 Overall, the efficacy of regular application of fluoride varnish appears to reduce lesion formation on bracketed maxillary incisor teeth.15 Fluoride varnish also provides additional preventive benefits when brackets have been bonded with composite resin cement.
16 Resin-modified glass ionomer cements (RMGIC) have been developed that combine the desirable properties of composite resin shear bond strength (SBS) and AV-951 glass ionomer fluoride release.17 The RMGICs have been shown to release fluoride and decrease enamel demineralization.10,17 Several RMGICs have been evaluated for SBS, and two materials were found to have bond strengths comparable to composite resins: Fuji Ortho LC (GC America Inc., Chicago, Ill.) and Advance (Dentsply/Caulk, Dentsply International Inc., Milford, Del.).