Comparison of enamel demineralization and periodontal status between direct and digital indirect bonding techniques : A split-mouth clinical trial of direct vs. digital indirect bonding.

Objectives: This randomized clinical trial aimed to evaluate the effects of digital indirect bonding (DIB) compared to the direct bonding (DB) technique in terms of enamel demineralization and periodontal status.

Materials and methods: A total of 24 patients (17 females, 7 males) with a mean age of 13.83 ± 1.55 years were bonded using DB and DIB techniques using a split-mouth study design. Bonding techniques were randomly allocated to quadrants. Demineralization measurements were performed with the DIAGNOdent pen (Kavo, Biberach, Germany) from four sides (distal, gingival, mesial, and incisal/occlusal) of all brackets immediately after bonding, 1 month (T1), and 6 months (T2) after bonding. Periodontal measurements were taken before bonding and at the same time points (T1 and T2). Data were statistically analyzed with the Mann-Whitney U test to determine possible differences between groups.

Results: Incisal/occlusal sides exhibited the lowest demineralization values at T2. The gingival side of upper centrals, mesial side of upper laterals, and distal sides of upper first premolar and lower laterals brackets bonded with the DIB technique exhibited significantly increased demineralization compared with the DB technique from T0 to T2 (p < 0.05). Periodontal parameters increased 1 month after bonding and decreased during the follow-up. Bonding technique showed no statistically significant difference in plaque index, gingival index, and bleeding on probing values at any time interval.

Conclusion: There were many locations around the brackets with significantly higher demineralization after 6 months in patients who received digital indirect bonding compared to the DB group. Although periodontal health was generally adequate, complete removal of adhesive flash should be carefully carried out to decrease the risk of demineralization during indirect bonding technique with digital workflows.