Correlation of enamel surface roughness, hardness, and demineralization following the use of orthodontic brackets

Correlation of enamel surface roughness, hardness, and demineralization following the use of orthodontic brackets | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Correlation of enamel surface roughness, hardness, and demineralization following the use of orthodontic brackets Rahaf Zawawi, Naif Almosa This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4567839/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to assess the correlation among altered enamel surface roughness, micro-hardness, and demineralization depth follwing the use of orthodontic brackets. Materials and methods Data of enamel surface roughness, micro-hardness, and demineralization depth were retrieved from two previous studies (each included 99 extracted human premolar teeth). Pearson’s correlation coefficient was used to evaluate the correlation between variables. Results There was a non- significant weak positive correlation between enamel surface roughness and demineralization depth (r = + 0.151, P = 0.134). A significantly moderate negative correlation was observed between enamel surface micro-hardness and demineralization depth (r = − 0.504, P < 0.001). In addition, a significantly weak negative correlation was observed between the enamel surface roughness and micro-hardness (r = − 0.289, P = 0.004). Conclusion Enamel surface properties could affect each other and influence demineralization penetration. Enamel surface roughness is inversely correlated with hardness, and its hardness is inversely correlated with the demineralization depth. Clinical relevance : Dental enamel demineralization is multifactorial; there is limited data regarding enamel surface characteristics contribution its demineralization. This paper focuses on evaluating the correlation between altered enamel surface roughness, micro-hardness, and demineralization depth following the use of orthodontic brackets; thus, the gained data will offer a valuable information for current orthodontic practice (toward a more preventive practice), future research, and material improvement. Dental Enamel Tooth Demineralization Dental White Spot Orthodontic Brackets Figures Figure 1 Figure 2 Introduction Dental enamel is composed of a high percentage of minerals and a well-packed crystalline structure, which imparts the enamel its unique physical properties and protects the dental substrate. (1,2) Dental caries is the most common oral disease, (3–6) which results from complex and multifactorial interactions among cariogenic bacteria, fermentable carbohydrates, and the host. (5,6) White spot lesions (WSLs) represent enamel demineralization at an early stage of lesion development. (6–10) WSLs are clinically identified by their rough texture and opaque white appearance. (6–10) Oral microorganisms and organic components aggregate and colonize the dental surfaces, forming dental plaques. (11) Cariogenic (or aciduric) bacteria, most commonly Streptococcus mutans and Lactobacillus, metabolize fermentable carbohydrates, producing hydrogen ions as a byproduct, and lowering the pH of the oral environment. (6,12,13) The persistent and episodic drop in pH causes enamel hydroxyapatite dissolution, mineral and crystal density loss, and surface porosity. (6,13) The incidence and prevalence rates of WSLs among orthodontic patients are considerably high (45.8% and 68.4%, respectively). (10) These inevitable rates are linked to orthodontic appliance-retentive areas and complicate oral hygiene maintenance and salivary and muscle cleansing activity. (14–19) Surface roughness refers to surface irregularities or height deviations at each point from the surface mean (arithmetical mean or roughness average [Ra]). (20) Higher enamel surface roughness results in enhanced bacterial adherence and plaque accumulation, thus causing enamel demineralization. (20–23) Surface hardness refers to the surface resistance to deformation. (24–26) A higher enamel hardness value is associated with the lower occurrence of demineralization, and higher remineralization potential. (27–31) Attin et al. (2003) and Tostes et al. (2013) concluded that although the reduced enamel hardness following demineralization will increase after remineralization, it will still be lower than that of the intact enamel, highlighting the importance of preserving the original enamel integrity and intactness. (32,33) Loss of enamel surface integrity, mineral loss, and the development of carious lesions result from alterations in enamel composition and surface properties. (22,34) Dental enamel exhibits a rougher surface, lower hardness, and deeper demineralization following the use of orthodontic brackets than non-bonded enamel, regardless of the bracket material, etchant type, or adhesive system used. (35–41) To the best of our knowledge, studies evaluating the relationship between altered enamel surface properties (roughness and hardness) and demineralization depth with orthodontic brackets are lacking. This study aimed to assess the correlation between altered enamel surface roughness, micro-hardness, and demineralization depth following the use of orthodontic brackets. The null hypothesis states that no correlation exists among altered enamel surface roughness, micro-hardness, and demineralization depth after orthodontic bracket use. The alternative hypothesis is that a correlation is present among altered enamel surface roughness, micro-hardness, and demineralization depth after orthodontic bracket use. Materials and Methods Sample/Data This study is a continuation of a doctoral thesis involving two studies. Data retrieved from these two previous studies were used as secondary quantitative data for this correlational study. These studies were approved by the Institutional Review Board of Health Sciences Colleges Research on Human Subjects, College of Medicine. Each study had a standardized sample size of 99 anonymous human premolar teeth extracted for orthodontic purposes, with standardized sample randomization (simple randomization), grouping methods, and bonding and debonding protocols. The methodology of both experimental studies is presented in Fig. 1 . Variables Measured Study I The enamel surface roughness was assessed using non-contact surface metrology and an imaging optical microscope (Contour GT-K 3D; Bruker, Tucson, AZ, USA) and recorded as Ra in µm. (41) Enamel surface micro-hardness was assessed using quasi-static indentation (Hysitron TI 750; Innovatest, Nihonbashi, Horidomecho Chuoku, Tokyo, Japan) with a 200 g force for 10 s, as indicated by the micro-Vickers hardness number (VHN). (41) Study II The enamel demineralization depth was assessed using scanning electron microscopy (JEOL 6060 LV Scanning Electron Microscope; JEOL, Tokyo, Japan) and ImageJ software (in µm) from the buccal surface to the deepest detection point for the right and left sections. (42) Statistical Analyses All statistical analyses were performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Pearson’s correlation was used to evaluate the correlation between the variables (surface roughness, surface micro-hardness, and demineralization depth) of the pooled data. Results For descriptive purposes, a cut-point of each variable (surface roughness, surface micro-hardness, and demineralization depth) was determined as the average of pooled data mean values. Pearson’s correlation suggested a weak positive correlation between the enamel surface roughness and demineralization depth, demonstrating that higher enamel surface roughness led to deeper demineralization. However, this correlation was statistically insignificant ( r = + 0.151, P = 0.134) (Table 1 ). This is reflected in Fig. 2 -A by the randomly scattered data around the roughness cut-point value. Table 1 Pearson correlation test ( ** : Statistically Significant with p < 0.01); Pearson Correlation Assessment Pearson Correlation Coefficient ( r ) p-value Enamel Surface Roughness and Demineralization Depth 0.151 0.134 Enamel Surface Micro-hardness and Demineralization Depth \(-\) 0.504 0.001 ** Enamel Surface Roughness and Micro-hardness \(-\) 0.289 0.004 ** A statistically significant and moderate negative correlation was observed between enamel surface micro-hardness and demineralization depth, where higher enamel surface micro-hardness resulted in shallower demineralization ( r = \(-\) 0.504, P < 0.001) (Table 1 ). This is reflected in Fig. 2 -B by the deepest demineralization readings that were mostly below the hardness cut-point value and vice versa, representing a negative correlation. A statistically significant and weak negative correlation was observed between enamel surface roughness and micro-hardness, where higher surface roughness resulted in lower surface micro-hardness ( r = \(-\) 0.289, P = 0.004) (Table 1 ). This is reflected in Fig. 2 -C by the roughest readings that were mostly below the hardness cut-point value and vice versa, representing a negative correlation. Discussion Alternation in enamel surface properties and demineralization are risk factors for orthodontic patients. (43) Studies evaluating the correlation between altered enamel surface properties (roughness and hardness) and demineralization depth following the use of orthodontic brackets are scarce. We assessed the correlation among altered enamel surface roughness, micro-hardness, and demineralization depth following the use of orthodontic brackets. Generally, enamel surface roughness is related to bacterial adherence and plaque accumulation. The extent of surface roughness is associated with higher bacterial adherence and plaque accumulation, facilitating acid production and demineralization. (20–23,44,45) However, studies evaluating the correlation of the enamel surface roughness attribution to its demineralization depth following orthodontic bracket use are limited. We found a weak positive correlation between enamel surface roughness and demineralization depth; however, this correlation was statistically insignificant. Teutle-Coyotecatl et al. (2022) reported higher bacterial adhesion in deciduous teeth (which are smoother) than in permanent teeth and postulated that enamel roughness could not be used to determine bacterial adhesion. However, they compared deciduous teeth to permanent teeth without orthodontic bracket use. (46) Kapur et al. (1961) concluded that roughened enamel surfaces increased the penetration rate of acidic buffers by 27%; however, the enamel was roughened intentionally using several methods, such as sandpaper disks, carborundum stones, and diamond disks. (47) Another study reported a similar finding of higher acid penetration with a rougher surface; however, their evaluation was performed after interproximal enamel reduction without bracket use. (48) Enamel surface roughness and demineralization are primarily related to and initiated by plaque and bacterial accumulation. (21,44) This could explain the non-significant correlation between enamel surface roughness and demineralization observed in this study, whose data were retrieved from in vitro studies (without a dental biofilm model). Moreover, bacterial adherence is influenced by several factors other than surface roughness, including surface electrostatic interactions, hydrophobic ion bonding, van der Waals forces, and host-related factors including saliva characteristics and oral hygiene. (49) This raises the question of which factors contribute more to bacterial adhesion to the enamel surface. The hardness of the enamel surface is representative of the enamel mineral content. Higher mineral loss is associated with lower hardness value (27,28,30,31,50–53) . Several studies have evaluated the relationship between hardness and enamel demineralization (without bracket bonding) and reported that harder enamel surfaces have shallower demineralization (28,52,54,55) . However, studies assessing the correlation of the enamel surface hardness attribution to its demineralization depth following orthodontic bracket use are scarce. This study found a statistically significant negative correlation between enamel surface micro-hardness and demineralization depth. This implies that lower enamel hardness leads to deeper enamel demineralization. This finding is crucial because enamel etching in preparation for bracket bonding significantly lowers the hardness, including total-etch and self-etch techniques. (39,41,56–58 . Alterations in the chemical composition caused by enamel apatite mineral reduction reduce the enamel surface hardness and permit rapid and deeper enamel demineralization. An additional assessment was performed in this study to evaluate the correlation between enamel surface roughness and micro-hardness. To the best of our knowledge, studies that have evaluated this aspect are unavailable. We found a statistically significant negative correlation between enamel surface roughness and micro-hardness, implying that higher surface roughness causes lower surface hardness. This could be explained by the enamel roughness introduced by the etching procedure, causing mineral loss and a porous enamel surface with dissolved prisms, (62,64–68) that would be less resistant to penetration, thus lowering the hardness value. (69) Dental enamel surface properties were found to be correlated with enamel demineralization penetration directly (surface hardness) and indirectly (surface roughness affecting the surface hardness). Accordingly, maintaining enamel surface properties preserves enamel integrity and limits the penetration of demineralization. This correlational study represents the association between the involved variables (enamel surface roughness, hardness, and demineralization); however, it could not predict the causality or determine the influence of different variables. Future studies evaluating these variables and the effect of oral hygiene on bacterial adhesion are warranted. In conclusion and onsidering the limitations of the retrieved data from in vitro studies, enamel surface properties were found to affect each other and influence demineralization depth as follows: Enamel surface roughness and demineralization depth are directly correlated; however, this association is insignificant. Enamel surface hardness is inversely correlated with enamel demineralization depth, i.e., a higher hardness value results in lower demineralization depth. The enamel surface roughness is inversely correlated with its hardness, i.e., a higher roughness value results in lower hardness. Declarations Conflicts of Interest Authors declare no conflict of interest Funding Declaration / Acknowledgments The authors would like to thank the College of Dentistry Research Center and Deanship of Scientific Research at King Saud University, Saudi Arabia for funding this research project (research project Reg. # PR 0117). Author Contribution RZ: Conceptualization, Methodology, Formal analysis, Investigation, Resources, Data Curation, Visualization, Writing-original, review & editing, Project administration, figers and table presentation. NA: Conceptualization, Methodology, Validation, Supervision, Writing – review & editing. Acknowledgement Authors acknowledge the College of Dentistry Research Center and Deanship of Scientific Research at King Saud University, Saudi Arabia for funding this research project (research project Reg. # PR 0117). Data Availability declaration This study is a continuation of a doctoral thesis involving two studies. Data retrieved from these two previous studies were used as secondary quantitative data for this correlational study. These studies were approved by the Institutional Review Board of Health Sciences Colleges Research on Human Subjects, College of Medicine. 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J orof orthoped 75(5):358–373 Habelitz S, Marshall SJ, Marshall GW Jr et al (2001) Mechanical properties of human dental enamel on the nanometre scale. Arch Oral Biol 46(2):173–183 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4567839","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":321974226,"identity":"21c184ae-dcc4-4bb6-b4c3-34176b4b3ab4","order_by":0,"name":"Rahaf Zawawi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwElEQVRIiWNgGAWjYBAC+2Yeg8N/GP7JGfCfMf/AUGOT2EBIi8HxHsPHDAxsxgbMPGYMDMfSiglrOXPG2BioJXEDSAtj0+F6wlpu5JhJMzDwpG9gZktjYGw4nEtQi/2M/G/SHxgkcoFa0h8QpcVOAmgL4z+DXOJtMZZ/Y/6bgSEh3YCZ+RhIC+EQM5wB9suBBIiWJiK0QL1/wHADM2MbQ8KxNKK1/JO37z/Y/uEDMVGJChJIUz4KRsEoGAWjABcAAH+FQav4vOAGAAAAAElFTkSuQmCC","orcid":"","institution":"King Saud University","correspondingAuthor":true,"prefix":"","firstName":"Rahaf","middleName":"","lastName":"Zawawi","suffix":""},{"id":321974229,"identity":"a39a3331-1912-45bb-b4c6-91017a810d48","order_by":1,"name":"Naif Almosa","email":"","orcid":"","institution":"King Saud University","correspondingAuthor":false,"prefix":"","firstName":"Naif","middleName":"","lastName":"Almosa","suffix":""}],"badges":[],"createdAt":"2024-06-12 06:09:37","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4567839/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4567839/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59677922,"identity":"74a6287f-20c4-448a-8251-8dad44d6539d","added_by":"auto","created_at":"2024-07-04 16:25:33","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":296823,"visible":true,"origin":"","legend":"\u003cp\u003eOriginal studies method sequence (\u003csup\u003e†\u003c/sup\u003e: Control group refers to non-bonded specimens, \u003csup\u003e††\u003c/sup\u003e: Standarized bonding materials and protocol, \u003csup\u003e†††\u003c/sup\u003e: Standarized deboning instruments and protocol)\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4567839/v1/44a8c2d1eb0c2159aa4a5a94.jpg"},{"id":59677919,"identity":"94ef9e78-a3d0-4d73-8dce-c658f2171ce7","added_by":"auto","created_at":"2024-07-04 16:25:32","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":368251,"visible":true,"origin":"","legend":"\u003cp\u003eCorrelation scatter plot (A. Scatter plot of enamel demineralization depth by surface roughness, B. Scatter plot enamel demineralization depth by surface micro-hardness, C. Scatter plot of enamel surface roughness by surface micro-hardness); dotted line represent axis cut-point\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4567839/v1/eecb47e79be6bc6f75fc0f0a.jpg"},{"id":60606829,"identity":"5ec7a88d-bc9c-49ea-8322-c5362418bccb","added_by":"auto","created_at":"2024-07-18 17:11:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1018490,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4567839/v1/482c351c-707b-46c5-a1bf-c5c41e5efad5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Correlation of enamel surface roughness, hardness, and demineralization following the use of orthodontic brackets","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental enamel is composed of a high percentage of minerals and a well-packed crystalline structure, which imparts the enamel its unique physical properties and protects the dental substrate. \u003csup\u003e(1,2)\u003c/sup\u003e Dental caries is the most common oral disease, \u003csup\u003e(3\u0026ndash;6)\u003c/sup\u003e which results from complex and multifactorial interactions among cariogenic bacteria, fermentable carbohydrates, and the host. \u003csup\u003e(5,6)\u003c/sup\u003e White spot lesions (WSLs) represent enamel demineralization at an early stage of lesion development. \u003csup\u003e(6\u0026ndash;10)\u003c/sup\u003e WSLs are clinically identified by their rough texture and opaque white appearance. \u003csup\u003e(6\u0026ndash;10)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOral microorganisms and organic components aggregate and colonize the dental surfaces, forming dental plaques. \u003csup\u003e(11)\u003c/sup\u003e Cariogenic (or aciduric) bacteria, most commonly \u003cem\u003eStreptococcus\u003c/em\u003e mutans and Lactobacillus, metabolize fermentable carbohydrates, producing hydrogen ions as a byproduct, and lowering the pH of the oral environment. \u003csup\u003e(6,12,13)\u003c/sup\u003e The persistent and episodic drop in pH causes enamel hydroxyapatite dissolution, mineral and crystal density loss, and surface porosity. \u003csup\u003e(6,13)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe incidence and prevalence rates of WSLs among orthodontic patients are considerably high (45.8% and 68.4%, respectively). \u003csup\u003e(10)\u003c/sup\u003e These inevitable rates are linked to orthodontic appliance-retentive areas and complicate oral hygiene maintenance and salivary and muscle cleansing activity. \u003csup\u003e(14\u0026ndash;19)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSurface roughness refers to surface irregularities or height deviations at each point from the surface mean (arithmetical mean or roughness average [Ra]). \u003csup\u003e(20)\u003c/sup\u003e Higher enamel surface roughness results in enhanced bacterial adherence and plaque accumulation, thus causing enamel demineralization. \u003csup\u003e(20\u0026ndash;23)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSurface hardness refers to the surface resistance to deformation. \u003csup\u003e(24\u0026ndash;26)\u003c/sup\u003e A higher enamel hardness value is associated with the lower occurrence of demineralization, and higher remineralization potential. \u003csup\u003e(27\u0026ndash;31)\u003c/sup\u003e Attin et al. (2003) and Tostes et al. (2013) concluded that although the reduced enamel hardness following demineralization will increase after remineralization, it will still be lower than that of the intact enamel, highlighting the importance of preserving the original enamel integrity and intactness. \u003csup\u003e(32,33)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eLoss of enamel surface integrity, mineral loss, and the development of carious lesions result from alterations in enamel composition and surface properties. \u003csup\u003e(22,34)\u003c/sup\u003e Dental enamel exhibits a rougher surface, lower hardness, and deeper demineralization following the use of orthodontic brackets than non-bonded enamel, regardless of the bracket material, etchant type, or adhesive system used. \u003csup\u003e(35\u0026ndash;41)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, studies evaluating the relationship between altered enamel surface properties (roughness and hardness) and demineralization depth with orthodontic brackets are lacking. This study aimed to assess the correlation between altered enamel surface roughness, micro-hardness, and demineralization depth following the use of orthodontic brackets. The null hypothesis states that no correlation exists among altered enamel surface roughness, micro-hardness, and demineralization depth after orthodontic bracket use. The alternative hypothesis is that a correlation is present among altered enamel surface roughness, micro-hardness, and demineralization depth after orthodontic bracket use.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSample/Data\u003c/h2\u003e \u003cp\u003eThis study is a continuation of a doctoral thesis involving two studies. Data retrieved from these two previous studies were used as secondary quantitative data for this correlational study. These studies were approved by the Institutional Review Board of Health Sciences Colleges Research on Human Subjects, College of Medicine. Each study had a standardized sample size of 99 anonymous human premolar teeth extracted for orthodontic purposes, with standardized sample randomization (simple randomization), grouping methods, and bonding and debonding protocols. The methodology of both experimental studies is presented in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eVariables Measured\u003c/h2\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003eStudy I\u003c/h2\u003e \u003cp\u003eThe enamel surface roughness was assessed using non-contact surface metrology and an imaging optical microscope (Contour GT-K 3D; Bruker, Tucson, AZ, USA) and recorded as Ra in \u0026micro;m. \u003csup\u003e(41)\u003c/sup\u003e Enamel surface micro-hardness was assessed using quasi-static indentation (Hysitron TI 750; Innovatest, Nihonbashi, Horidomecho Chuoku, Tokyo, Japan) with a 200 g force for 10 s, as indicated by the micro-Vickers hardness number (VHN). \u003csup\u003e(41)\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy II\u003c/h2\u003e \u003cp\u003eThe enamel demineralization depth was assessed using scanning electron microscopy (JEOL 6060 LV Scanning Electron Microscope; JEOL, Tokyo, Japan) and ImageJ software (in \u0026micro;m) from the buccal surface to the deepest detection point for the right and left sections. \u003csup\u003e(42)\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eAll statistical analyses were performed using SPSS version 26 (IBM Corp., Armonk, NY, USA). Pearson\u0026rsquo;s correlation was used to evaluate the correlation between the variables (surface roughness, surface micro-hardness, and demineralization depth) of the pooled data.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFor descriptive purposes, a cut-point of each variable (surface roughness, surface micro-hardness, and demineralization depth) was determined as the average of pooled data mean values. Pearson\u0026rsquo;s correlation suggested a weak positive correlation between the enamel surface roughness and demineralization depth, demonstrating that higher enamel surface roughness led to deeper demineralization. However, this correlation was statistically insignificant (\u003cem\u003er\u0026thinsp;=\u0026thinsp;+\u003c/em\u003e\u0026thinsp;0.151, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.134) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This is reflected in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e-A by the randomly scattered data around the roughness cut-point value.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation test (\u003csup\u003e**\u003c/sup\u003e: Statistically Significant with p\u0026thinsp;\u0026lt;\u0026thinsp;0.01);\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003ePearson Correlation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePearson Correlation Coefficient (\u003cem\u003er\u003c/em\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnamel Surface Roughness and Demineralization Depth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnamel Surface Micro-hardness and Demineralization Depth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003e0.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnamel Surface Roughness and Micro-hardness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003e0.289\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.004\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA statistically significant and moderate negative correlation was observed between enamel surface micro-hardness and demineralization depth, where higher enamel surface micro-hardness resulted in shallower demineralization (\u003cem\u003er =\u003c/em\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003e0.504, \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This is reflected in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e-B by the deepest demineralization readings that were mostly below the hardness cut-point value and vice versa, representing a negative correlation.\u003c/p\u003e \u003cp\u003eA statistically significant and weak negative correlation was observed between enamel surface roughness and micro-hardness, where higher surface roughness resulted in lower surface micro-hardness (\u003cem\u003er =\u003c/em\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(-\\)\u003c/span\u003e\u003c/span\u003e 0.289, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). This is reflected in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e-C by the roughest readings that were mostly below the hardness cut-point value and vice versa, representing a negative correlation.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAlternation in enamel surface properties and demineralization are risk factors for orthodontic patients. \u003csup\u003e(43)\u003c/sup\u003e Studies evaluating the correlation between altered enamel surface properties (roughness and hardness) and demineralization depth following the use of orthodontic brackets are scarce. We assessed the correlation among altered enamel surface roughness, micro-hardness, and demineralization depth following the use of orthodontic brackets.\u003c/p\u003e \u003cp\u003eGenerally, enamel surface roughness is related to bacterial adherence and plaque accumulation. The extent of surface roughness is associated with higher bacterial adherence and plaque accumulation, facilitating acid production and demineralization. \u003csup\u003e(20\u0026ndash;23,44,45)\u003c/sup\u003e However, studies evaluating the correlation of the enamel surface roughness attribution to its demineralization depth following orthodontic bracket use are limited. We found a weak positive correlation between enamel surface roughness and demineralization depth; however, this correlation was statistically insignificant.\u003c/p\u003e \u003cp\u003eTeutle-Coyotecatl et al. (2022) reported higher bacterial adhesion in deciduous teeth (which are smoother) than in permanent teeth and postulated that enamel roughness could not be used to determine bacterial adhesion. However, they compared deciduous teeth to permanent teeth without orthodontic bracket use. \u003csup\u003e(46)\u003c/sup\u003e Kapur et al. (1961) concluded that roughened enamel surfaces increased the penetration rate of acidic buffers by 27%; however, the enamel was roughened intentionally using several methods, such as sandpaper disks, carborundum stones, and diamond disks. \u003csup\u003e(47)\u003c/sup\u003e Another study reported a similar finding of higher acid penetration with a rougher surface; however, their evaluation was performed after interproximal enamel reduction without bracket use. \u003csup\u003e(48)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEnamel surface roughness and demineralization are primarily related to and initiated by plaque and bacterial accumulation. \u003csup\u003e(21,44)\u003c/sup\u003e This could explain the non-significant correlation between enamel surface roughness and demineralization observed in this study, whose data were retrieved from \u003cem\u003ein vitro\u003c/em\u003e studies (without a dental biofilm model). Moreover, bacterial adherence is influenced by several factors other than surface roughness, including surface electrostatic interactions, hydrophobic ion bonding, van der Waals forces, and host-related factors including saliva characteristics and oral hygiene. \u003csup\u003e(49)\u003c/sup\u003e This raises the question of which factors contribute more to bacterial adhesion to the enamel surface.\u003c/p\u003e \u003cp\u003eThe hardness of the enamel surface is representative of the enamel mineral content. Higher mineral loss is associated with lower hardness value \u003csup\u003e(27,28,30,31,50\u0026ndash;53)\u003c/sup\u003e. Several studies have evaluated the relationship between hardness and enamel demineralization (without bracket bonding) and reported that harder enamel surfaces have shallower demineralization \u003csup\u003e(28,52,54,55)\u003c/sup\u003e. However, studies assessing the correlation of the enamel surface hardness attribution to its demineralization depth following orthodontic bracket use are scarce.\u003c/p\u003e \u003cp\u003eThis study found a statistically significant negative correlation between enamel surface micro-hardness and demineralization depth. This implies that lower enamel hardness leads to deeper enamel demineralization. This finding is crucial because enamel etching in preparation for bracket bonding significantly lowers the hardness, including total-etch and self-etch techniques. \u003csup\u003e(39,41,56\u0026ndash;58\u003c/sup\u003e. Alterations in the chemical composition caused by enamel apatite mineral reduction reduce the enamel surface hardness and permit rapid and deeper enamel demineralization.\u003c/p\u003e \u003cp\u003eAn additional assessment was performed in this study to evaluate the correlation between enamel surface roughness and micro-hardness. To the best of our knowledge, studies that have evaluated this aspect are unavailable. We found a statistically significant negative correlation between enamel surface roughness and micro-hardness, implying that higher surface roughness causes lower surface hardness. This could be explained by the enamel roughness introduced by the etching procedure, causing mineral loss and a porous enamel surface with dissolved prisms, \u003csup\u003e(62,64\u0026ndash;68)\u003c/sup\u003e that would be less resistant to penetration, thus lowering the hardness value. \u003csup\u003e(69)\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDental enamel surface properties were found to be correlated with enamel demineralization penetration directly (surface hardness) and indirectly (surface roughness affecting the surface hardness). Accordingly, maintaining enamel surface properties preserves enamel integrity and limits the penetration of demineralization. This correlational study represents the association between the involved variables (enamel surface roughness, hardness, and demineralization); however, it could not predict the causality or determine the influence of different variables. Future studies evaluating these variables and the effect of oral hygiene on bacterial adhesion are warranted.\u003c/p\u003e \u003cp\u003eIn conclusion and onsidering the limitations of the retrieved data from \u003cem\u003ein vitro\u003c/em\u003e studies, enamel surface properties were found to affect each other and influence demineralization depth as follows:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eEnamel surface roughness and demineralization depth are directly correlated; however, this association is insignificant.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEnamel surface hardness is inversely correlated with enamel demineralization depth, i.e., a higher hardness value results in lower demineralization depth.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eThe enamel surface roughness is inversely correlated with its hardness, i.e., a higher roughness value results in lower hardness.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cspan lang=\"\"\u003eConflicts of Interest\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan lang=\"\"\u003eAuthors declare no conflict of interest\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cspan lang=\"\"\u003eFunding Declaration / Acknowledgments\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the College of Dentistry Research Center and Deanship of Scientific Research at King Saud University, Saudi Arabia for funding this research project (research project\u0026nbsp;\u003cspan lang=\"\"\u003eReg.\u0026nbsp;\u003c/span\u003e#\u0026nbsp;\u003cspan lang=\"\"\u003ePR 0117).\u003c/span\u003e\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eRZ: Conceptualization, Methodology, Formal analysis, Investigation, Resources, Data Curation, Visualization, Writing-original, review \u0026amp; editing, Project administration, figers and table presentation. NA: Conceptualization, Methodology, Validation, Supervision, Writing \u0026ndash; review \u0026amp; editing.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eAuthors acknowledge the College of Dentistry Research Center and Deanship of Scientific Research at King Saud University, Saudi Arabia for funding this research project (research project Reg. # PR 0117).\u003c/p\u003e\u003ch2\u003eData Availability declaration\u003c/h2\u003e\u003cp\u003eThis study is a continuation of a doctoral thesis involving two studies. Data retrieved from these two previous studies were used as secondary quantitative data for this correlational study. These studies were approved by the Institutional Review Board of Health Sciences Colleges Research on Human Subjects, College of Medicine. Both studies were published and their original data are available in the two references below (which are also cited within the manuscript text)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFincham AG, Moradian-Oldak J, Simmer JP (1999) The structural biology of the developing dental enamel matrix. J Struct Biol 126:270\u0026ndash;299\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimmer JP, Hu JCC (2001) Dental enamel formation and its impact on clinical dentistry. J Dent Educ 65:896\u0026ndash;905\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGibbons RJ, van Houte J (1975) Dent Caries Annu Rev Med 26:121\u0026ndash;136\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathur VP, Dhillon JK (2017) Dental caries: a disease which needs attention. 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Eur J Orthod 35(3):369\u0026ndash;374\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLacruz RS, Habelitz S, Wright JT et al (2017) Dental enamel formation and implications for oral health and disease. Physiol Rev 97:939\u0026ndash;993\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlmosa N, Sibai BS, Rejjal O et al (2019) Enamel demineralization around metal and ceramic brackets: an \u003cem\u003ein vitro\u003c/em\u003e study. Clin Cosmet Investig Dent 11:37\u0026ndash;43\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiu N (2010) An \u003cem\u003ein vitro\u003c/em\u003e study on the permeability of human dental enamel that is unetched, etched, treated with self-etching primer, or sealed. Theses Diss. University of California, San Francisco\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoel A, Singh A, Gupta T et al (2017) Evaluation of surface roughness of enamel after various bonding and clean-up procedures on enamel bonded with three different bonding agents: An \u003cem\u003ein vitro\u003c/em\u003e study. J Clin Exp Dent 9:608\u0026ndash;624\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamamci N, Akkurt A, Başaran G (2009) \u003cem\u003evitro\u003c/em\u003e evaluation of microleakage under orthodontic brackets using two different laser etching, self-etching and acid etching methods. Lasers Med Sci 25(6):811\u0026ndash;816\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKohda N, Iijima M, Brantley WA et al (2012) Effects of bonding materials on the mechanical properties of enamel around orthodontic brackets. Angle Orthod 82:187\u0026ndash;195\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNarendran S, Raghunath N (2019) Comparison of enamel demineralization around orthodontic brackets bonded with conventional etching, self-etch primer and antimicrobial monomer containing self-etch primer. Int J Adv Res ideas Innov Technol 5:176\u0026ndash;185\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan lang=\"\"\u003e\u0026nbsp;Zawawi, R. N., \u0026amp; Almosa, N. A. Assessment of enamel surface roughness and hardness with metal and ceramic orthodontic brackets using different etching and adhesive systems: An in vitro study. The Saudi dent J , 2023; 35(6), 641\u0026ndash;50. Doi: 10.1016/j.sdentj.2023.05.015. Epub 2023 May 24. PMID: 37817787; PMCID: PMC10562107.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan lang=\"\"\u003eZawawi R., Almosa N. Assessment of Enamel demineralization following the use of different orthodontic bracket materials, etchants, and adhesive systems: an in vitro study . J. Biomater. Tissue Eng. 2023;13, 837\u0026ndash;47.\u0026nbsp;\u003c/span\u003e\u003cspan lang=\"\"\u003eDoi.org/10.1166/jbt.2023.3322\u003c/span\u003e\u003cspan lang=\"\"\u003e.\u0026nbsp;\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIijima M, Muguruma T, Brantley WA et al (2010) Effect of bracket bonding on nanomechanical properties of enamel. Am J Orthod Dentofac Orthop 138:735\u0026ndash;740\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Cerqueira GA, Damasceno JE, Pedreira PR et al (2023) Roughness and microhardness of demineralized enamel treated with resinous infiltrants and subjected to an acid challenge: An \u003cem\u003ein vitro\u003c/em\u003e Study. 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PLoS ONE 15(3):e0229595\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSakaguchi R, Powers J (2012) Craig\u0026rsquo;s Restorative Dental Materials. Elsevier Inc.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlthagafi NM (2022) Impact of fluoride\u0026ndash;releasing orthodontic adhesives on the shear bond strength of orthodontic brackets to eroded enamel following different surface treatment protocols. J Orthodont Sci 11:3\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKielbassa AM, Wrbas KT, Schulte-M\u0026ouml;nting J et al (1999) Correlation of transversal microradiography and microhardness on in situ-induced demineralization in irradiated and nonirradiated human dental enamel. Arch Oral Biol 44(3):243\u0026ndash;251\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLin WT, Kitasako Y, Nakashima S et al (2017) A comparative study of the susceptibility of cut and uncut enamel to erosive demineralization. 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Int J Opt 1\u0026ndash;8\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAtash R, Fneiche A, Cetik S et al (2017) \u003cem\u003eIn vitro\u003c/em\u003e evaluation of microleakage under orthodontic brackets bonded with different adhesive systems. Eur J Dent 11:180\u0026ndash;185\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDelbem AC, Sassaki KT, Vieira AE et al (2009) Comparison of methods for evaluating mineral loss: hardness versus synchrotron microcomputed tomography. Caries Res 43(5):359\u0026ndash;365\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHoriuchi S, Kaneko K, Mori H et al (2009) Enamel bonding of self-etching and phosphoric acid-etching orthodontic adhesives in simulated clinical conditions: Debonding force and enamel surface. Dent Mater J 28:419\u0026ndash;425\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUysal T, Ulker M, Ramoglu SI et al (2008) Microleakage under metallic and ceramic brackets bonded with orthodontic self-etching primer systems. Angle Orthod 78:1089\u0026ndash;1094\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eApriani A, Naliani S, Djuanda R et al (2023) Surface roughness assessment with fluoride varnish application: An \u003cem\u003ein vitro\u003c/em\u003e study. Majalah Kedokteran Gigi 56(3):154\u0026ndash;159\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaysal A, Yasa B, Sogut O et al (2015) Effects of different orthodontic primers on enamel demineralization around orthodontic brackets. J Orofac Orthop 76:421\u0026ndash;430\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashimoto Y Hashimoto, Atomic force microscopy observation of enamel surfaces treated with self-etching primer. Dent Mater J \u003cem\u003e2\u003c/em\u003e013; 32, 181\u0026ndash;188\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIbrahim DFA, Hasmun NN, Liew YM et al (2023) Repeated etching cycles of resin infiltration up to nine cycles on demineralized enamel: surface roughness and esthetic \u003cem\u003eoutcomes-in\u003c/em\u003e vitro study. \u003cem\u003eChildren\u003c/em\u003e (Basel, Switzerland). ; 10(7), 1148\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVisel D, J\u0026auml;cker T, Jost-Brinkmann PG et al (2014) Demineralization adjacent to orthodontic brackets after application of conventional and self-etching primer systems. J orof orthoped 75(5):358\u0026ndash;373\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHabelitz S, Marshall SJ, Marshall GW Jr et al (2001) Mechanical properties of human dental enamel on the nanometre scale. Arch Oral Biol 46(2):173\u0026ndash;183\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Dental Enamel, Tooth Demineralization, Dental White Spot, Orthodontic Brackets","lastPublishedDoi":"10.21203/rs.3.rs-4567839/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4567839/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to assess the correlation among altered enamel surface roughness, micro-hardness, and demineralization depth follwing the use of orthodontic brackets.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003eData of enamel surface roughness, micro-hardness, and demineralization depth were retrieved from two previous studies (each included 99 extracted human premolar teeth). Pearson\u0026rsquo;s correlation coefficient was used to evaluate the correlation between variables.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was a non- significant weak positive correlation between enamel surface roughness and demineralization depth (r\u0026thinsp;=\u0026thinsp;+\u0026thinsp;0.151, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.134). A significantly moderate negative correlation was observed between enamel surface micro-hardness and demineralization depth (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.504, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In addition, a significantly weak negative correlation was observed between the enamel surface roughness and micro-hardness (r\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.289, \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eEnamel surface properties could affect each other and influence demineralization penetration. Enamel surface roughness is inversely correlated with hardness, and its hardness is inversely correlated with the demineralization depth. \u003cb\u003eClinical relevance\u003c/b\u003e: Dental enamel demineralization is multifactorial; there is limited data regarding enamel surface characteristics contribution its demineralization. This paper focuses on evaluating the correlation between altered enamel surface roughness, micro-hardness, and demineralization depth following the use of orthodontic brackets; thus, the gained data will offer a valuable information for current orthodontic practice (toward a more preventive practice), future research, and material improvement.\u003c/p\u003e","manuscriptTitle":"Correlation of enamel surface roughness, hardness, and demineralization following the use of orthodontic brackets","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-04 16:25:27","doi":"10.21203/rs.3.rs-4567839/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fb735363-8c6a-4b9e-901b-9a87bfa34b0d","owner":[],"postedDate":"July 4th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-18T17:03:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-04 16:25:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4567839","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4567839","identity":"rs-4567839","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}