Enamel demineralization after different methods of interproximal polishing

The aim of this in vitro study was to investigate the demineralization rate in human enamel after interproximal polishing (IPP) and to detect possible correlations with the IPP method used, with special emphasis on the surface characteristics of the enamel being treated.

This in vitro study tested five IPP systems (Profin Directional System®, Intensiv ProxoStrip®, OS discs®, ARS Safe-Tipped Bur Kit® and Ortho-Strips Set®) that are currently available on the market. Each of the five examination groups comprised 12 randomly selected teeth, while the control group consisted of six teeth. The teeth were placed in an artificial model for each group. The proximal contacts were then resolved by IPP. To allow detection of any surface characteristics, one surface was not further processed after IPP, while the other side was additionally polished. After IPP, the teeth were exposed to a pH-cycling model with alternating phases of demineralization and remineralization. Substance loss was analyzed using optical emission spectrometry. Data were subjected to simple analysis of variance (ANOVA) performed with Tukey’s test. Comparison between the groups with and without polishing was conducted using the t test for independent samples. The significance level was set at p < 0.05.

Demineralization significantly increased after IPP. The rates of demineralization differed significantly among the examination groups, with the greatest loss of substance being produced with Sheridan’s Air-Rotor Stripping® system (ARS; 145.34 ± 20.37 μm). In all of the examination groups, subsequent polishing of the surfaces did not significantly reduce the amount of demineralization (polished 119.64 ± 28.61 μm; unpolished 114.16 ± 28.61 μm).

No correlation between surface morphology and the degree of susceptibility of human enamel was detected. However, it must be taken into consideration that there was no potential bacterial colonization in this in vitro erosive set-up. Thus, in contrast to previous explanations, the outermost fluorapatite layer and the individual composition of the enamel may have a greater impact on the solubility of the enamel and the amount of enamel loss after IPP than the type of system used and the resulting surface texture.

Whenever the outermost layer of enamel is reduced, the practitioner must expect an increase in demineralization. Subsequent polishing does not appear to affect the amount of demineralization.