Secondary ion mass spectrometry and X-ray microanalysis of hypomineralized enamel in human permanent first molars

Considerations in Orthodontic Bracket Adhesion to Hypomineralized Enamel

“…The www.intechopen.com patient's chief complaint, in conjunction with the biochemical and morpho-histological characteristics of the defects, may affect the prognosis and management. 3,12,13 The extent of the problem depends upon the number of the teeth involved and the severity of the defects (depth, size, color and enamel break-down). In addition, information of the patient's caries risk assessment, diet, oral hygiene and compliance can provide the clinician with an assessment of the risk for possible future complications such as: post-eruption breakdown of enamel around brackets and bands, objectionable color changes, higher risk of demineralization and caries, and the possible need to restore those lesions prior to the orthodontic treatment or shortly there after.…”

“…3,4 The clinician should attempt to preserve it as intact as possible. Most adhesive manufactures recommend cleaning teeth of organic enamel pellicle and plaque by using prophylaxis paste or pumice prior to adhesion of orthodontic brackets.…”

“…Yellow-brown defects have a propensity to be deeper and more porous, and therefore may necessitate more cautious handling than white and white-creamy defects. 3,4 In cases of large yellow-brown opacities that cause an esthetic problem aggressive removal of all defective enamel, and a composite resin restoration, may be considered prior to bracket adhesion. 5,22 If the clinician wishes to refrain from aggressive reduction of enamel, pretreatment with 5% sodium hypochlorite (NaOCl) to remove protein encasing the hydroxylapatite is suggested, 56,59-62 followed by a SEPBS.…”

“…The subsurface enamel is soft and porous. 3 The color of the opacities may reflect differences in hardness, porosity and mineral content. Yellow or yellow-brown demarcated opacities have lower hardness values and greater porosity.…”

“…Mostly they cross the entire bulk of enamel, as opposed to white and white-creamy defects, which are usually limited to the inner enamel, closer to the Dentino-Enamel Junction (DEJ). 3,4 Patients may complain of one or more of the following: poor esthetics, thermal and mechanical sensitivity, attrition, secondary caries, tooth discoloration, malocclusion and periodontal problems. 2,5 …”