A Rejoinder on “Research”

READERS’ FORUM A Rejoinder on “Research” One month after Fuji Ortho LC was introduced to the orthodontic profession in 1997, e-mail was displayed on the Internet warning orthodontists that brackets with this cement do not stay on the teeth after 6 months of usage. When we first saw these statements, we were confused because we were designated by the company to test the product, and we were the only orthodontists for 21⁄2 years to use the product. How was it possible for someone to state that they would not last longer than 6 months when it had only been available to the public for a brief time (only 1 or 2 months) before the e-mail was sent? It appeared that the intent was to discredit the product and discourage sales. We are now appalled again after reading in the November issue of the Journal, the article published by Gaworski, Weinstein, Borislow, and Braitman that describes a research project completed at the Albert Einstein Medical Center, Orthodontic Division, in Philadelphia (Am J Orthod Dentofacial Orthop 1999;116:518-521). The article describes the difference in decalcification of teeth after treatment, comparing Fuji Ortho LC hybridglass ionomer with Reliance Light Bond. The summary and conclusions of the article claim that 77% of the teeth bonded with Fuji exhibited some form of decalcification. We doubt that any orthodontist using any cement would have such a high percentage of decalcification. We challenge these findings. After more than 5 years and 1500 completed cases debonded in our office, we have observed only two cases where some decalcification was observed. It was either careless technique or record keeping at Einstein or some outside influence that led them to their conclusion. We think it’s disheartening that an established orthodontic graduate department could present such false and misleading information. We heartily invite the authors of this article to spend some time in our offices (which, by the way, are close to their university) in order to observe decalcification-free orthodontic treatment. They can also observe, contrary to their published results, no greater failure rate of bonded brackets while using Fuji compared with any composite. If we had the same results in our offices as they claim in their article, we certainly would not be able to use this bonding technique successfully on all of our patients as we are now doing. Indeed, we would not be deserving of our Board Certification in orthodontics. We find the advantages of speed, ease of bonding, elimination of the need to etch, and proven absence of decalcification cannot be matched by any other type of cement. Much like the indirect bonding technique that we developed and patented in 1975, and that is now widely used, we

predict that our new bonding procedure with Fuji will be universally used in the not-too-distant future. Elliott Silverman, DDS Linwood, NJ Morton Cohen Jenkintown, Pa

In reply: We would like to thank the editor for offering us an opportunity to respond to the letter from Drs Silverman and Cohen. Our study “Decalcification and bond failure: A comparison of a glass ionomer and a composite resin bonding system in vivo,” was undertaken as a postgraduate orthodontic resident research project at an accredited orthodontic program. The design of our prospective study was reviewed several times within the department and by the Albert Einstein Medical Center’s Research Committee to ensure that it would be performed in a fair and scientific manner. Comments from the AJO/DO referee consultants who reviewed our submission before publication complimented our protocol. In addition, no source of outside funding was used. We had no financial or special interests of any kind as to the particular outcome. Our goal was to conduct a scientific investigation of a newly announced product (Fuji Ortho LC) with that of a widely used composite resin-bonding agent (Reliance Light Bond). We entered into the investigation with enthusiasm as we felt Fuji Ortho LC offered a unique potential for clinical orthodontics. Our study was undertaken without bias, outside influence, or intent to present false and misleading information as stated in Drs Silverman and Cohen’s letter. Even though our findings speak for themselves, we offer a few additional comments. There has always been considerable variation in results when investigating decalcification rates.1-3 Therefore, when the study was designed we had each patient serve as his or her own control. The adjacent and contralateral teeth served as controls for each tested tooth. This way if a particular patient was more susceptible to decalcification, the same condition would exist for the control teeth and the tested teeth. The results clearly indicated that within each patient or as a group, the decalcification rates were comparable between the 2 bonding agents. Regarding the rate of bond failure, in addition to other studies reported in our article, recent studies have also shown that when Fuji Ortho LC is used without conditioning or etching, there is a significantly higher bond failure rate than traditional composite bonding agents or when Fuji Ortho LC is used with enamel preconditioning.4-7 Based on the manufacturer’s recommendation that etching was not necessary, we applied Fuji Ortho LC without etching or conditioning. On Dec 1, 1999, in response to our published study, we received

American Journal of Orthodontics and Dentofacial Orthopedics/March 2000

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