Efficacy of Antimicrobial Agents in Orthodontic Adhesive Systems and Brackets: A Narrative Review

Objectives Development of white spot lesions (WSLs) in the course of orthodontic treatment would compromise the satisfaction of patients and clinicians. One suggested preventive strategy is to incorporate antimicrobial agents into orthodontic adhesive systems or to coat brackets with them. Several clinical and experimental studies have evaluated the effect of antimicrobial agents, but no consensus has been reached on the best preventive approach. Thus, the aim of this narrative review was to assess the clinical and experimental studies on the effect of incorporation of antimicrobial agents in orthodontic adhesives and brackets. Methods PubMed (Medline), Scopus, and Google Scholar were searched for related articles published from 1990 to 2020. Both clinical and experimental studies were included in this review. Results Different antimicrobial agents can be added to adhesive systems to prevent the formation of WSLs, and also preserve the bond strength of adhesives. Same as adhesive systems, coating of brackets with antibacterial agents can be performed to prevent bacterial proliferation and demineralization of enamel. Conclusion Antimicrobial agents incorporated in bonding systems or used for coating of brackets can confer antimicrobial properties with no significant negative effect on bonding properties. However, clinical and long-term studies are required to confirm their effectiveness and absence of side effects