Influence of enamel sealing with a light-cured filled sealant before bracket bonding on the bond failure rate during fixed orthodontic therapy

Fluoride-containing adhesives for enamel sealing are commonly used for the prevention of white spot lesions during fixed orthodontic treatment. Thus, we examined whether enamel sealing with L.E.D. ProSeal® (Reliance Orthodontic Products Inc., Itasca, IL, USA) before bracket bonding increases the rate of bond failure during orthodontic treatment.

In 20 adolescents (11-16 years, 10 male/10 female) at the start of fixed therapy, self-ligating SmartClip™SL3 metal brackets (3M Unitek, Monovia, CA, USA) were bonded to cleaned and conditioned (40% H₃PO₄, 30 s) buccal enamel surfaces of all permanent teeth except molars using Transbond™ XT (3M Unitek). In a split-mouth design, either L.E.D. ProSeal® (1st/3rd quadrant) or Clinpro™ XT Varnish (2nd/4th quadrant; 3M Unitek) was applied to enamel surfaces before (ProSeal®) or after (Clinpro™ XT Varnish) bracket bonding (200 teeth each; light curing: 20 s, Ortholux™ Luminous, 3M Unitek). Cumulative bond failure as total number of teeth with bracket detachment since start of therapy was documented every 3 months for a total of 12 months.

Cumulative bond failure was higher for enamel sealing before bonding from 6 months onward reaching significance at 12 months (34/200) compared to sealing after bonding (24/200): p = 0.038; Cramér's V = 0.488; odds ratio (OR) = 1.5; relative risk (RR) = 1.4. The higher loss rate was limited to the lower arch, but evident within 3 months reaching significance at 9 and 12 months (p = 0.019/0.011, V = 0.636/0.630; OR = 1.7/1.75, RR = 1.5/1.6). In general, cumulative bond failure at 12 months was higher in the lower arch, but this was only significant for teeth sealed before bonding (p = 0.001, V = 0.303, OR = 3.4, RR = 2.8).

Enamel sealing with L.E.D. ProSeal® should be performed after bracket bonding to prevent increased bond failure and bracket loss in the lower dental arch.