Systematic decalcification prophylaxis during treatment with fixed appliances.

In a practical setting, 4 different prophylactic methods were compared with regard to their effects on the incidence of decalcification during orthodontic fixed appliance therapy and on the frequency of premature debonding resulting from imminent or already manifest decalcification. This study showed that the use of a system in which selection and care were oriented solely along the clinical impression was associated with the highest rate of decalcification and premature debonding. The findings were significantly better (p < 0.05), when a prophylactic regimen of oral hygiene was implemented which was based on patient selection (API < 30%) and regular oral hygiene check-ups during the treatment. When the DMFT index was considered in addition to the API value, and the number of the initial lesions at the beginning of treatment were included for selecting patients, the incidence of decalcification was significantly reduced even further (p < 0.05). A more comprehensive or "optimized prophylaxis" utilizing saliva test parameters and active prophylactic interventions implemented by a dental hygienist during the treatment phase also had a favorable impact on the main outcome parameters. The present findings indicate that decalcification can be markedly reduced by using a treatment regimen that targets the decalcification risk and a systematic, individualized prophylaxis during active treatment with fixed appliances.