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How to optimize bonding procedures on healthy and hypomineralized enamel in orthodontics?
Elisabeth Dursun1, Jean-Pierre Attal1
1UFR Odontologie, 1 rue Maurice Arnoux, 92120 Montrouge, France
Introduction:
Bonding to enamel is a daily problem for the orthodontist. While bonding to healthy enamel is nowadays well mastered, bonding to hypomineralized enamel is much less so. The aim of this article was to help the orthodontist to optimise bonding, whatever the clinical situation.
Material And Method:
Based on data from the literature, the clinical and microscopic characteristics of healthy and hypomineralised enamel, including amelogenesis imperfecta (AI), molar incisor hypomineralization (MIH), fluorosis or erosion will be described. Proposals for optimising bonding will then be identified and summarized.
Results:
Bonding to enamel is reliable, but the use of an etch-and-rinse mode (even with a universal adhesive) is recommended. For AI, MIH and fluorosis, the use of sodium hypochlorite after etching seems to significantly increase bonding. No treatment is needed for eroded enamel. However, deep resin infiltration for severe MIH or superficial resin infiltration for fluorosis would reduce the risk of enamel fracture during bracket removal.
Conclusion:
It is important to be aware of the characteristics of the dental substrate and the materials used to optimize procedures.
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