Recently, I read an article entitled “Effectiveness of a sealant compared with no sealant in preventing enamel demineralization in patients with fixed orthodontic appliances: a prospective clinical trial” by Dr O’Reilly et al, published in the June issue (O’Reilly MT, De Jesús-Viñas J, Hatch JP. Am J Orthod Dentofacial Orthop 2013;143:837-44).

While I was reading the article, several doubts arose in my mind, which I would be pleased to have answered by the authors, if possible.

What was the reason for using only anterior teeth for evaluating white spot lesions? It is known that the posterior teeth are more susceptible to the appearance of caries.

In my opinion, there was a lack of standardization in the sample: all brackets, ligatures, wires, and composites should have been the same. It is known that brackets with different configurations promote more or less debris accumulation, and this also applies to the method of ligating the wire to the channel. It would also be important to standardize the type of composite because although their manufacturers do not mention fluoride in their composition, fluoride is present in a high or low concentration in most composites because it is frequently used to stabilize the composition of the material.

Does bonding the brackets after having applied the sealant not favor sealant debonding around the bracket during the procedure of removing excess composite with a probe or a composite removal bur? Would it not be ideal to fabricate a template that would demarcate the correct site for bonding the bracket, isolating the area where the sealant would be applied?

Another concern is that the sealant had been polymerized twice. Would this conduct not alter the one recommended by the manufacturer?

Another doubt: Was the primer applied on the entire enamel surface, as was it done with the sealant? If not, how was this area isolated?

The fact that there were more children than adults worries me. Would the adults not have better control of hygiene than the children? Could the scarcity of women also not have altered the results?

I take the opportunity of closing these clarification questions to congratulate the authors on the study.