Enamel protection in pediatric patients using a bracket bonding agent with a bioactive monomer

Fixed-appliance therapy during occlusal guidance in children increases the risk of enamel demineralization, often presenting as white spot lesions (WSLs). This study evaluated the clinical performance of a hydroxyapatite-inducing coating (Bio Coat Ca) for preventing new WSLs and improving pre-existing hypomineralization in pediatric patients. This study evaluated 18 polycarbonate brackets bonded in three children undergoing occlusal guidance therapy. Bio Coat Ca was applied to labial enamel surfaces prior to bonding with Super Bond. Clinical outcomes included bracket retention, incidence of new WSLs, and changes in pre-existing hypomineralized enamel. Standardized intraoral photographs were analyzed using ImageJ to quantify lesion area ratios before and after treatment. Bracket survival was evaluated using Kaplan–Meier analysis. Of the 18 polycarbonate brackets evaluated, with five bond failures within 377 days (overall retention 72.2 %). This retention rate is comparable to previously reported outcomes for polycarbonate brackets, indicating that Bio Coat Ca does not compromise bonding performance. No new WSLs were observed in any case. Pre-existing hypomineralized areas decreased markedly, with lesion area ratios reduced to 11.76 %, 11.83 %, and 0.34 % in the three cases, respectively. A single application of a calcium-releasing bioactive coating prior to bracket bonding was associated with the absence of new WSLs and the improvement of pre-existing enamel hypomineralization in children, without compromising bracket adhesion. This approach may be particularly beneficial for pediatric patients with limited cooperation or special health care needs.