Desmineralizacion Del Esmalte
Desmineralizacion Del Esmalte
Desmineralizacion Del Esmalte
orthodontic treatment
I3 Mizrahi
A cross-sectional study was carried out to determine the prevalence and severity of enamel opacities in patients
before and after orthodontic treatment. The sample consisted of 527 patients examined prior to and 269 patients
examined after completion of multibanded orthodontic treatment. The results showed that there was a significant
increase in both the prevalence (before, 72.3 per cent; after, 84.0 per cent) and severity (Opacity Index: before,
0.125; after, 0.200) following completion of orthodontic treatment. hAale patients experienced a significantly higher
increase in the severity of enamel opacities following orthodontic treatment. There was no significant sex
differential in the prevalence of enamel opacities either before or after orthodontic treatment. This study showed
that orthodontic treatment with multibanded appliances contributed to the development of new areas of enamel
demineralization and to an increase in the severity of enamel opacities as measured by the Opacity Index.
validity of such a statement becomes suspect. A cross- toothpaste containing fluoride compounds. The water
sectional study was, therefore, carried out to determine supply to the city and its environs contained 0.2 ppm
the prevalence and severity of enamel opacities in a fluoride (mean yearly average). All bands were ce-
group of patients prior to starting and after receiving mented with polycarboxylate cements.
orthodontic treatment.
Data on the distribution of enamel opacities in rela- Assessment
tion to different surfaces of the dentition and to indi- The opacities considered in this study were defined
vidual teeth will be presented in a subsequent publi- as any discrete area of white opaque enamel, including
cation. a line or a patch occurring on either the vestibular or
lingual surface of the crown.
RATIONALE For the purpose of this study, the scoring system
Following an approach similar to that used by was required to provide information on the location, ex-
Bach,lg, 2o it was considered essential to determine first tent, and prevalence of the lesion. Thus, the vestibular
the prevalence of enamel opacities in a sample of the and lingual surface of each tooth was divided into cervi-
general population of schoolchildren drawn from the cal, middle, and incisal (occlusal) thirds. No attempt
same geographic area and having a similar socioeco- was made to examine the interproximal surfaces.‘4-‘6
nomic background as the group of patients who were The severity of the opacity was based on its surface
referred for and who received orthodontic treatment. area and was scored from 0 to 3, similar to the system
The results recorded for the selected sample of the used by Curzon and Spector22 in 1977. The opacity was
general population have been reported.14-l6 scored for each third of the vestibular and lingual sur-
It was not the object of this study to assess the faces of each tooth as follows:
opacities on an etiologic basis. The criteria for record- 0 = No enamel opacity. An opacity of less than an
ing the condition were defined, and the assessments estimated 1 mm. in length or diameter was considered
were made on the basis of the definition as recom- absent.
mended by Al-Alousi and associates2i and not on the 1 = An opacity covering up to one-third of the sur-
basis of a presumed etiology. By comparing the preva- face area.
lence and severity of enamel opacities in samples that 2 = An opacity covering from one-third to hvo-
had not undergone orthodontic treatment with those thirds of the surface area.
that had, it was possible to determine the effect of 3 = An opacity covering from two-thirds to the full
orthodontic treatment on these parameters. surface area.
With the vestibular and lingual surfaces each con-
MATERIALS AND METHODS tributing a maximum score of 9, the total possible score
This study involved patients selected from my pri- for any one tooth was 18. It is accepted that, in a
vate practice and the results reflect only the situation in subjective assessment of this nature, variations in the
that practice. The cross-sectional study comprised a scoring of location and severity of certain lesions do
total of 796 patients divided into two groups. Group 1, occur. This type of error is common to all clinical sur-
consisting of 527 pretreatment patients (10,126 teeth), veys of this nature and can be compensated for only by
was made up of all patients referred for consultation adoption of a strict level of significance for the rejection
and possible treatment (mean age, 11.8 & 2.2 years). of the null hypothesis and continual monitoring of ex-
Group 2, totaling 269 patients (5,758 teeth), was made aminer reliability.
up of all patients who had completed treatment (mean The team for this study consisted of one examiner
age, 15.4 ? 1.6 years). All patients in Group 2 had and one chairside assistant. Special forms were de-
received comprehensive multiband orthodontic treat- signed for recording the data at clinical examination
ment with the Begg light-wire appliance. Before start- and to facilitate the subsequent transfer of the data onto
ing treatment, patients were required to have all neces- computer punch cards.
sary general dentistry completed and a topical fluoride Intra-examiner reliability was monitored by re-
application. After the bands were cemented, the pa- examining approximately 10 percent of the sample
tients were instructed concerning the importance of (seventy-five patients) within an 8-week period of the
good oral hygiene, good dietary habits, and correct initial examination.23
toothbrushing technique. These instructions were sup-
ported in the relevant booklets handed to the patient. Data analysis
No supplementary fluoride was administered during The recorded data were processed in an IBM 270/
treatment. However, patients were required to use a 158 computer using standard programs, including the
Table I. The numbers and percentages of Table II. The Opacity Index (median) and
patients with and without enamel opacities interquartile range for enamel opacities
in Groups 1 and 2 recorded for patients in Groups I and 2
/ Graup.s Groups
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