Enamel conservation orthodontic paradigm via treatment with newly developed remineralizing calcium-phosphate etchant...

To evaluate recently developed acidic calcium-phosphate (CaP) pastes as conservative enamel-conditioning systems for bracket bonding and investigate their effects on the shear bond strength, adhesive residues, and enamel damage in comparison to a conventional 37 % phosphoric acid (PA) gel.

Two experimental etchant pastes consisting of hydroxyapatite and monocalcium phosphate monohydrate were prepared by mixing them with 37 % and 10 % PA solutions, respectively. These were characterized using X-ray diffraction. Metal brackets were bonded to 90 freshly extracted human premolars and assigned to three groups, depending on etchant type: 37 % PA-gel (control) and the two experimental (HPA and MPA) pastes. Shear bond strengths (SBS), adhesive remnant index scores, and enamel damage for the three groups were compared at 24 h water storage and after 5000 thermocycles. Enamel etch pattern, surface damage, and CaP precipitation were evaluated through FE-SEM. Surface Vickers micro-hardness (VHN) following etching procedures was compared to the unetched enamel surface.

HPA and MPA pastes yielded significantly lower SBS values than 37 % PA-gel (p < 0.001), induced a milder etch pattern, unblemished enamel surfaces and CaP re-precipitation with no or minimal adhesive residues post-bracket debonding as compared to 37 % PA-gel. Moreover, the HPA paste-etched enamel revealed the highest (p < 0.001) micro-hardness value (232 VHN).

Enamel conditioning using the CaP pastes, particularly the HPA, may evoke CaP re-precipitation and cause minimal enamel damage, with greater efficiency at bracket debonding/enamel cleaning procedures. Furthermore, it yields low adhesive residues and potentially adequate bond strength for clinical performance in comparison to conventional PA gel.

Enamel etching with the developed paste prior to orthodontic bonding might lessen the development of white spot lesions during treatment, with the potential of reducing the prolonged chair time for clean-up and polishing usually required whenever PA is used.