Introduction
Enamel demineralization and caries, commonly correspond with the use of cemented bands and bonded brackets.1,2
Orthodontic bands are believed to cause more enamel demineralization than brackets as they are more difficult to clean due to their posterior position in the mouth, resulting in greater accumulation of plaque.3,4 The contributing factors to enamel demineralization include compromised oral hygiene, cement seal breakdown, inadequate band strength, physical properties, cement solubility in oral fluids and the type of the luting cement used. Enamel demineralization can be prevented or reduced by improving patient oral hygiene or using topical fluoride, but these measures depend on patient compliance and therefore are unreliable.5 Orthodontic cements most often used are zinc phosphate, zinc polycarboxylate, conventional glass ionomer cement (GIC), resin modified GIC and Acid modified composite resin.
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Zinc phosphate since it has been introduced in 1878,6 has become the gold standard by which other cements are compared because of its long and well-documented history of clinical use in band cementation.4 Zinc polycarboxylate cements, which react chemically with enamel and stainless steel were introduced to the orthodontic specialty in the early 1970. Both the laboratory studies6,7 and clinical studies8,9 found these cements to be suitable for band cementation.
GIC s introduced in 1971 by Wilson and Kent4 gain the adhesion from ionic or polar molecular interactions to tooth enamel and dentin as well as to stainless steel, which suggests their suitability as orthodontic luting cements.4,6 GICs form a stronger bond with enamel than with stainless steel, resulting in a position of bond failure mainly at the band-cement interface both in vitro and in vivo.10 This tends to leave a protective layer of cement over the enamel that may help to prevent demineralization under loose bands.11 The antibacterial activity and fluoride release shown by them have the clinical benefit toward preventing enamel demineralization during orthodontic treatment. It also demonstrates the ability to remineralize enamel.12
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Resin modified glass ionomer combines the properties of glass ionomers as well as additional strength afforded by its composite resin component.12,13 Setting is not only by the acid-base reaction, but also by a photochemical polymerization typical of composite resins.1,14 They do release fluoride into the enamel without losing cement strength.
Compomers being used recently are composed of ion leachable glass in polymeric matrix, set by a light cured resin reaction, not an acid base reaction and rely upon water diffusion into the set polymer. As these cements do not adhere chemically to the enamel like GICs, they tend to fail at the cement enamel interface, and consequently greater risk of stagnation areas, micro-leakage and demineralization.15
The type of cement is one of the important criteria, which influences the amount of enamel demineralization after post-orthodontic debanding, therefore it is important to study and assess the enamel demineralization potential of the orthodontic luting cements using scanning electron microscope (SEM).
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