Effect of fixed orthodontic appliances bonded with different etching techniques on tooth color: A prospective clinical study

doi:10.1016/j.ajodo.2013.02.020

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 144, Issue 1, July 2013, Pages 43-49

https://doi.org/10.1016/j.ajodo.2013.02.020 Get rights and content

Introduction

For most orthodontic patients, esthetic concerns are as important as functional demands. The purpose of this study was to assess the effect of self-etching primer and conventional acid etching on tooth color after orthodontic treatment.

Methods

A total of 34 patients were enrolled in a clinical trial and divided into 2 groups based on age: adolescents (≤17 years) and adults (>17 years). Tooth color of all maxillary and mandibular anterior teeth was measured before bonding and after debonding using a spectrophotometer (Vita Easyshade Compact; Vita Zahnfabrik, Bad Säckingen, Germany). Two types of etching techniques were used for orthodontic bonding, self-etching primer and conventional acid etching, in a randomized split-mouth design. Tooth color measurements were done according to the system of the Commission Internationale de l’Eclairage (lightness, red/green, and yellow/blue). The corresponding tooth color differences between pretreatment and posttreatment, etching groups, sexes, and age groups were calculated.

Results

Tooth color was significantly changed in all (L, a, b) color parameters (P <0.05). The lightness value decreased by 2.16 units, and the red/green and yellow/blue values increased by 0.32 and 1.78, respectively. The average tooth color difference after orthodontic treatment was 2.85 units. No significant difference was found between self-etching primer and conventional acid etching in their effects on tooth color (P >0.05). Men and adolescents had more color change than did girls and adults (P <0.05).

Conclusions

Fixed orthodontic appliances caused tooth color changes; self-etching primer and conventional acid etching had similar effects on tooth color; men and adolescents had greater color changes than did girls and adults.

Section snippets

Material and methods

This prospective clinical study was conducted on patients who required fixed orthodontic treatment. These patients received their orthodontic treatment at the dental teaching clinics of Jordan University of Science and Technology in Irbid, Jordan. Ethical approval for this study was obtained from the institutional review board.

Thirty-eight consecutive patients (24 female, 14 male; age range, 12-26 years; average age, 18 years 5 months) were included in this study. Consequently, the

Results

In the error testing, a significant correlation was found between the first and second readings (0.942), and there was no significant difference between the first and second readings using the paired t test, with a significance level of P = 0.893.

Treatment duration for all patients was 12 to 15 months. Since there was no significant variation in treatment duration between patients, it was not considered as a variable for statistical analysis.

The mean pretreatment values for the L, a, and

Discussion

In this prospective clinical study, we aimed to assess the effects of fixed orthodontic treatment, etching technique, and other factors such as age, sex, and tooth type on tooth color. The advantage of in-vivo studies over in-vitro ones is that in-vivo studies are better suited for observing the whole effect of an experiment; also, the results of in-vitro studies are always interpreted with caution because they lack the exact ability to simulate oral environment.

This study was based on

Conclusions

Within the limitations of this trial, the following conclusions were obtained.

1.
Fixed orthodontic treatment is associated with significant tooth color changes.
2.
Etching technique (self-etching primer and conventional phosphoric acid etching) showed no statistically significant difference in tooth color change after fixed orthodontic treatment.
3.
Tooth type had no statistically significant effect on tooth color change after fixed orthodontic treatment.
4.
Male patients had greater tooth color changes

References (42)

E. Isiksal et al.
Smile esthetics: perception and comparison of treated and untreated smiles
Am J Orthod Dentofacial Orthop
(2006)
T.P. van der Burgt et al.
A comparison of new and conventional methods for quantification of tooth color
J Prosthet Dent
(1990)
R.J. Goodkind et al.
Use of a fiber optic colorimeter for an in-vivo color measurement of 2830 anterior teeth
J Prosthet Dent
(1987)
F.F. Tung et al.
The repeatability of an intraoral dental colorimeter
J Prosthet Dent
(2002)
J.D. Da Silva et al.
Clinical performance of a newly developed spectrophotometric system on tooth color reproduction
J Prosthet Dent
(2008)
A. Karamouzos et al.
Tooth color assessment after orthodontic treatment: a prospective clinical trial
Am J Orthod Dentofacial Orthop
(2010)
I. Hosein et al.
Enamel loss during bonding, debonding, and cleanup with use of a self-etching primer
Am J Orthod Dentofacial Orthop
(2004)
J.D. Brewer et al.
Advance in color matching
Dent Clin North Am
(2004)
R.D. Douglas
Precision of in-vivo colorimetric assessments of teeth
J Prosthet Dent
(1997)
W.J. O'Brien et al.
Color distribution of three regions of extracted human teeth
Dent Mater
(1997)

A. Gardner et al.

Variations in acid-etch patterns with different acids and etch times

Am J Orthod Dentofacial Orthop

(2001)

B.U. Zachrisson et al.

Enamel surface appearance after various debonding techniques

Am J Orthod

(1979)

K.H. Chung

Effects of finishing and polishing procedures on the surface texture of resin composites

Dent Mater

(1994)

R. Maijer et al.

Corrosion of orthodontic bracket bases

Am J Orthod

(1982)

E. Mizrahi

A cross sectional study to determine prevalence and severity of enamel opacities in patients before and after orthodontic treatment

Am J Orthod

(1982)

E.F. Al Maaitah et al.

Factors affecting demineralization during orthodontic treatment: a post-hoc analysis of RCT recruits

Am J Orthod Dentofacial Orthop

(2011)

R.G. Craig

Restorative dental materials

(2006)

F.W. Billmeyer et al.

Principles of color technology

(1981)

R.S. Berns et al.

Billmeyer and Saltzman's principles of color technology

(2000)

R.D. Panariva et al.

Esthetic training in dentistry

(2004)

S. Paul et al.

Visual and spectrophotometric shade analysis of human teeth

J Dent Res

(2002)

Cited by (26)

Comparison of enamel surface roughness and color alteration after bracket debonding and polishing with 2 systems: A split-mouth clinical trial
2021, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
In this double-blind, split-mouth randomized clinical trial, the effects of 2 polishing systems on enamel SR and color were compared, providing clinically useful information. Despite previous qualitative and quantitative studies evaluating the enamel SR2-5 and color change6-11 after bracket removal, no previous clinical study evaluated the use of Sof-Lex Spiral Wheels for enamel polishing. Split-mouth studies offer the advantages of concurrent experimental and control assignment, limiting sample size requirements, and increasing precision.35
This split-mouth randomized clinical trial aimed to compare the enamel surface roughness (SR) and color alteration after bracket debonding and polishing using 2 systems.
After removal of excess adhesive using a 12-blade tungsten carbide bur on a low-speed handpiece, a randomized polishing procedure using Sof-Lex discs was applied on 1 side (n = 36) and Sof-Lex Spiral Wheels on the contralateral side (n = 36). Dental replicas were obtained with epoxy resin before bracket bonding and after tooth polishing. The SR was evaluated using a profilometer. The color was assessed using an Easyshade spectrophotometer before bracket bonding, immediately after tooth polishing, and 30 days after polishing. Two-way analysis of variance and t tests were applied for statistical analysis.
The SR of enamel showed similar results between the polishing systems (P = 0.309) and between moments (before bracket bonding and after tooth polishing) (P = 0.317). The color change was also similar between the polishing systems (P >0.05).
The Sof-Lex discs and Sof-Lex Spiral Wheel polishing systems used after removal of excess adhesive using a 12-blade tungsten carbide bur on a low-speed handpiece did not appear to significantly damage the enamel surface, and the color change was similar between them.
Long-term follow-up of enamel color changes after treatment with fixed orthodontic appliances
2018, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
Çörekçi et al17 reported that L* and a* values increased, and b* values decreased, ΔE values were between 1.12 and 3.34, and a visible color change occurred. Al Maaitah et al16 determined that L* values decreased, whereas a * and b * values increased, and the ΔE value was 2.85. No study in the literature has followed the enamel color changes due to fixed orthodontic treatment in the long term.
The aim of this study was the long-term follow-up of enamel color changes observed in the middle third of buccal tooth surfaces after treatment with fixed orthodontic appliances.
The study included 120 maxillary central and lateral incisors and canines of 20 subjects who had fixed orthodontic treatment. The Spectro Shade Micro device (MHT, Verona, Italy) was used to evaluate the color changes of the teeth. Measurements were made from the middle third of the buccal surfaces of the teeth after fixed orthodontic treatment and in month 3, month 6, and year 1 of the retention phase. The Commission Internationale de l'Echairage L* a* b* system that expresses the color coordinates in L*, a*, and b* symbols was used to determine the tooth color, and ΔE values between the time periods were calculated. Repeated measurement analysis of variance was used in evaluating the color changes.
The increases in ΔL values at 3 months, 6 months, and 1 year after treatment were statistically significant, whereas they were not statistically significant from months 3 to 6, month 3 to year 1, or month 6 to year 1. The decrease in Δa and the increase in Δb values were not statistically significant. ΔE values at all time periods were statistically significant within themselves, and the greatest change was observed 1 year after treatment. ΔE values were 1.52 to 3.57, and a visible but clinically acceptable color change occurred.
In the first 3 months, there was a significant increase in the lightness of the tooth color.
How long does treatment with fixed orthodontic appliances last? A systematic review
2016, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
Additional screening of reference lists returned another 22 articles for review. After a detailed assessment, which included contacting the relevant authors for further clarification of data relating to treatment duration, 114 studies were excluded (Appendix), and 25 remained (Fig 1; Table16-40). Twenty studies were RCTs, and 5 were controlled clinical trials (CCTs).
There is little agreement on the expected duration of a course of orthodontic treatment; however, a consensus appears to have emerged that fixed appliance treatment is overly lengthy. This has spawned numerous novel approaches directed at reducing the duration of treatment, occasionally with an acceptance that occlusal outcomes may be compromised. The aim of this study was to determine the mean duration and the number of visits required for comprehensive orthodontic treatment involving fixed appliances.
Multiple electronic databases were searched with no language restrictions, authors were contacted as required, and reference lists of potentially relevant studies were screened. Randomized controlled trials and nonrandomized prospective studies concerning fixed appliance treatment with treatment duration as an outcome measure were included. Data extraction and quality assessment were performed independently and in duplicate.
Twenty-five studies were included after screening: 20 randomized controlled trials and 5 controlled clinical trials. Twenty-two studies were eligible for meta-analysis after quality assessment. The mean treatment duration derived from the 22 included studies involving 1089 participants was 19.9 months (95% confidence interval, 19.58, 20.22 months). Sensitivity analyses were carried out including 3 additional studies, resulting in average duration of treatment of 20.02 months (95% confidence interval, 19.71, 20.32 months) based on data from 1211 participants. The mean number of required visits derived from 5 studies was 17.81 (95% confidence interval, 15.47, 20.15 visits).
Based on prospective studies carried out in university settings, comprehensive orthodontic treatment on average requires less than 2 years to complete.
Enamel alterations due to orthodontic treatment
2016, Orthodontic Applications of Biomaterials: A Clinical Guide
The discipline of orthodontics primarily aims, as its etymology suggests, to align malpositioned teeth and to correct malocclusions. To this end, the orthodontist’s only treatment modality is the application of force. To move teeth toward the desired position, bonding attachments such as brackets on dental enamel have proven to be an invaluable method to transmit the applied force and to secure bodily control over the teeth. Yet, in spite of the fixed appliance representing an important advancement as an orthodontic treatment technique, damage to enamel may occur during bonding or debonding, as well as in the course of the fixed appliance therapy itself. Some surface alterations are the direct consequence of iatrogenic manipulation of the enamel, whereas others are adverse effects owing to the modified conditions implicitly caused by the bonded device. This chapter aims to expose the evidence available on color, structure, composition, and roughness alterations of enamel induced by fixed appliance therapy.
Orthodontic treatment and dental diseases
2023, Chinese Journal of Stomatology
Comparison of Tooth Color and Enamel and Dentinal Thickness between Orthodontically Treated and Untreated Individuals
2023, Diagnostics

View all citing articles on Scopus

: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

View full text

Original articleEffect of fixed orthodontic appliances bonded with different etching techniques on tooth color: A prospective clinical study

Introduction

Methods

Results

Conclusions

Section snippets

Material and methods

Results

Discussion

Conclusions

Am J Orthod Dentofacial Orthop

J Prosthet Dent

J Prosthet Dent

J Prosthet Dent

J Prosthet Dent

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Dent Clin North Am

J Prosthet Dent

Dent Mater

Am J Orthod Dentofacial Orthop

Am J Orthod

Dent Mater

Am J Orthod

Am J Orthod

Am J Orthod Dentofacial Orthop

Restorative dental materials

Principles of color technology

Billmeyer and Saltzman's principles of color technology

Esthetic training in dentistry

Visual and spectrophotometric shade analysis of human teeth

J Dent Res

Original article
Effect of fixed orthodontic appliances bonded with different etching techniques on tooth color: A prospective clinical study