Filled and unfilled restorative materials to reduce enamel decalcification during fixed-appliance orthodontic treatment

Introduction: Enamel decalcification is a potential problem that can compromise the esthetic results of orthodontic treatment. Patient compliance with preventive measures is frequently inadequate to resolve this issue. The purpose of this study was to determine the effectiveness of sealing around the bracket periphery in reducing decalcification. Methods: Sixty extracted teeth were collected and randomized to 4 groups: group 1, bonded and then sealed around the bracket with an unfilled sealant material; group 2, bonded and then sealed with a filled, flowable composite material; group 3, bonded and sealed with excess bracket adhesive contoured at bracket periphery; and group 4, conventional treatment with excess bonding material removed and no additional protection at the bracket periphery. Each group was subjected to mechanical, thermal, and decalcification challenges to simulate in-vivo conditions. Results: Groups 1 and 2 had the lowest incidence of decalcification; however, decalcification was not statistically significantly reduced by the use of an additional restorative/bracket adhesive material. An incidental finding was a statistically significant loss of bracket adhesive material beneath the bracket pads of group 4. Conclusions: Prophylactic sealing around the orthodontic bracket pad periphery with an unfilled sealant or a filled flowable composite restorative material did not significantly reduce the incidence of decalcification.