Comparative Evaluation of One-Step and Two-Step Orthodontic Bonding Systems on White Spot Lesion Formation: An In Vitro Study

Abstract

Introduction: Orthodontic treatment with fixed appliances often predisposes patients to enamel demineralization, clinically visible as white spot lesions (WSLs). These lesions develop in plaque-retentive areas created by attachments, bands, and arch-wires. Conventional bonding procedures (etchant, primer, and adhesive) play a critical role in minimizing WSLs by ensuring effective sealing of the enamel surface. Recently, simplified adhesive systems combining etchant with primer or primer with adhesive have been introduced to reduce clinical steps, chairside time, and contamination risks. However, limited evidence exists regarding their effectiveness in preventing WSL development.

Objectives To compare formation of white spot lesions in one step bonding system Vs two step bonding system. To compare formation of white spot lesions in one step bonding system Vs two step bonding system.

Methods: The study included 96 healthy extracted premolar teeth were randomly allocated into two groups (group A- one step bonding system and group B- two step bonding system). The group A were bonded with self-etching adhesive system combining etchant, primer, and bonding resin was applied according to manufacturer’s protocol. The group B were bonded with etch and rinse method. The teeth were disinfected by sodium hypochlorite solution and were bonded using two different bonding methods. Photographs were taken through Canon DSLR using lens 18-55. All the photographs were analyzed before treatment and 6 months after bonding. The newly formed white spot lesions were compared among two groups after 6 months interval.

  Results: The frequency distribution tables highlight the prevalence of WSL formation at different values for both           groups. The mean Gorelick score for Group A was 1.87 ± 0.63 and the mean Gorelick score for Group B was 0.92 ± 0.48. The majority of observations in Group 1 fall within a higher range, while Group 2 shows  comparatively lower frequency of WSL development. The comparative analysis using t-tests reveals a statistically significant difference between the two groups, as indicated by the p-value of 0.001, which confirms that the variation in mean WSL formation is not due to chance. Group A have more severe white spot lesions when compared with Group B    after interval of 6 months based on the visual examination score.