Lingual orthodontics for children and adolescents: improvement of the indirect bonding protocol

INTRODUCTION: Demineralization of the dental enamel is a finding associated with fixed orthodontic treatment. When an indirect bonding procedure is used in children and adolescents the area beneath the bracket base may be affected. AIM: To evaluate if the addition of an extra layer of a hydrophilic resin, to a conventional indirect bonding protocol, can reduce the incidence of demineralization beneath the bracket base. METHODS: 40 patients under 18 years of age were treated with completely customized lingual appliances. Two different bonding protocols were used either with or without the application of an additional layer of hydrophilic resin. Demineralization beneath the bracket base, after de-bonding, was evaluated by standardized intra-oral photographs. RESULTS: The addition of an extra layer of a hydrophilic resin helps to reduce the number of demineralized areas beneath the bracket bases significantly (three times less). The severity of the few remaining defects were minor and without any clinical consequence. CONCLUSION: When bonding a completely customized lingual appliance in children and adolescents, an extra layer of a hydrophilic resin should be added to the teeth.