Effectiveness of an indirect bonding technique in reducing plaque accumulation around braces

To evaluate if the use of an indirect braces bonding protocol for localized enamel etching and adhesive application could help reduce plaque accumulation and demineralization around the brackets compared with a conventional direct-bonding technique.

Thirty patients were bonded with a split-mouth approach: two randomly selected opposite quadrants were used as the test sides and the other two as control sides. During the first 6 months, the plaque presence around the braces was recorded monthly according to a plaque accumulation index (PAI), as was the presence of demineralization. PAI values were measured at each of the four bracket sides for every bonded tooth. Analysis of variance was used to identify significant differences between different bracket margins and between test and control sides.

Test and control sides differed significantly for PAI measurements from t(1) (1 month after bonding) to t(4) (4 months after bonding), with the highest value of significance (P < .001) at t(1) but with no significant differences from t(5) to t(7) (treatment end). Considering whole-mouth results, different bracket margin PAI scores did not differ significantly. PAI scores were higher at t(1) and progressively decreased during the treatment. At debonding, the onset of 21 new white spots was recorded overall for the control sides and eight new white spots for the test sides.

Especially during the first 4 months after brackets placement, this indirect bonding protocol allowed for significant reduction in plaque accumulation around the braces and reduced onset of white spots during the orthodontic treatment.