Aesthetic improvement of white spot lesions with resin and fluorine paint in orthodontic treatment

AimsThis study aimed to evaluate the visual improvement of resin infiltration of white spot lesions (WSL) during orthodontic treatment with the multibracket appliance (MBA) compared to fluoride varnish.MethodsPatients aged 12–17 years with at least one WSL with an International Caries Detection and Assessment System (ICDAS) score of 1–2 during an active MBA treatment were included and randomized to receive either resin infiltration (Icon) or fluoride application (Flairesse). Standardized digital images were obtained before, one-day, one-week, one-month, three-months and six-months after treatment using a DSLR camera and a matching polarization filter. A grey reference card was used for color standardization. A Matlab routine was used to measure the color difference between adjacent healthy enamel and treated WSL. The independent-samples t-test was used for intergroup and paired-samples t-test for intragroup comparison.ResultsImages of 116 teeth from 36 patients were analyzed. The ΔE for the “Icon” treated WSL was smaller (T1ICON = 5.0 ± 1.4) than in the fluoride group (T1Fluoride = 8.4 ± 3.2). Caries infiltration significantly improved the aesthetic appearance of WSL (p < 0.001), which remained satisfactory at six months (T5ICON = 5.2 ± 1.6).ConclusionWSL infiltration management during orthodontic treatment was superior to topical fluoridation in not only arresting the enamel lesions but also significantly improving the aesthetic appearance of demineralized regions around the brackets.Clinical relevanceWSL treatment in orthodontic patients is usually initiated after debonding. Research has shown that the earlier WSL is treated, the better the aesthetic outcome. There is limited data on the efficacy of resin infiltration of WSL during orthodontic treatment.

To evaluate the treatment efficacy of fluoride toothpaste alone and those of adjunctive use of resin infiltration, sodium fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSLs). Seventy-nine patients (356 teeth) with WSLs after orthodontic treatment were randomly allocated into four groups. The WSLs of the participants received resin infiltration only at baseline, and the other groups received fluoride varnish, CPP-ACP mousse, and placebo treatment every 6months, respectively. A toothpaste containing 1400ppm fluoride and toothbrushes were distributed to all participants, and oral hygiene instructions were provided. Photos of the teeth with WSL were taken to compare the change between groups which was measured by ImageJ software. Twelve months later, different degrees of reduction in the area of WSLs were observed in all groups. The percentage of lesion area reduction in WSLs in the resin infiltration group was 46.6%, which was significantly higher than that in fluoride varnish group (26.6%), CPP-ACP group (28.6%), and control group (29.8%), and the differences were statistically significant (p < 0.001). This study shows that after 1-year follow-up, the use of fluoride toothpaste, with or without the use of fluoride varnish or CPP-ACP, can reduce the area of WSLs. While resin infiltration can immediately improve dental aesthetics and continuously improved in 12months, resin infiltration groupshowed much better results than other groups. Clinical Trials Registration Number: ChiCTR2000032516. The use of fluoride toothpaste, with or without adjunctive use of fluoride varnish and CPP-ACP, can reduce the area of WSLs, while resin infiltration treatment has additional effect and can immediately improve dental aesthetics.

White spot lesions (WSLs) are an early sign of enamel demineralization, requiring effective non-invasive treatments to restore esthetics and prevent progression. This study aimed to evaluate the effectiveness of fluoride varnish (GC MI Varnish) and resin infiltration (Icon Vestibular) in terms of esthetic improvement, remineralization, and sensitivity reduction. The study is primarily addressed to general dental practitioners, pediatric dentists, orthodontists, and restorative specialists who routinely encounter white spot lesions (WSLs) in both adolescent and adult patients. It is also relevant to dental researchers and students interested in minimally invasive treatment strategies and advancements in enamel remineralization. A total of 47 patients with non-cavitated WSLs were randomly assigned to two treatment groups: Fluoride Group (n = 24) received topical fluoride varnish applications and Icon Group (n = 23) underwent resin infiltration treatment. Statistical analysis was performed using an independent t-test (p &lt; 0.05). The Icon Group showed an immediate reduction in white spot visibility (p &lt; 0.01), while the Fluoride Group demonstrated gradual esthetic improvement over three months (p &lt; 0.05). Fluoride varnish significantly enhanced enamel remineralization and reduced dentinal hypersensitivity (p &lt; 0.05), whereas resin infiltration primarily stabilized lesion progression without direct remineralization. Both fluoride varnish and resin infiltration are effective non-invasive treatments for WSLs, but their benefits differ. Resin infiltration offers immediate esthetic improvement, while fluoride varnish promotes long-term remineralization and sensitivity reduction.

Introduction: White spot lesions are the first clinical sign of dental caries, and they occur frequently in patients with orthodontic appliances. Currently, there are no systematic reviews that have evaluated fluoride varnish compared with other methods to prevent or arrest the development of dental caries. The aim of this systematic review (SR) was to evaluate the effectiveness of the use of fluoride varnish compared with other methods to prevent or arrest initial lesions of caries in patients with corrective orthodontics. Methods: A search was conducted for articles in the MEDLINE, EMBASE and Google Scholar databases. This SR included randomized clinical trials and prospective interventional studies that used fluoride varnish for the prevention and/or arrest of white spot lesions in orthodontic treatment or during the 3-month period after removal of orthodontic fixed appliances. To assess the risk of bias in the studies, we used the Cochrane collaboration tool. Results: The search strategy showed 115 possible eligible articles, and we included 10 articles in this SR. The reviewed studies showed high and moderate methodological quality. Four studies out of 10 agreed that fluoride varnish is as effective as the advised and guided oral hygiene technique. Overall, most of the included studies did not show significant advantages to fluoride varnish application in terms of preventing the development of white spots around orthodontic brackets when the patients were submitted to regular professional oral hygiene control. Conclusions: Fluoride varnish is an effective material to prevent and arrest white spot lesions in patients with orthodontic treatment.

EFFECTIVENESS OF RESIN INFILTRATION IN CARIES INHIBITION AND AESTHETIC APPEARANCE IMPROVEMENT OF WHITE-SPOT LESIONS: AN UMBRELLA REVIEW.

White spot lesions (WSLs) are frequently encountered after orthodontic treatment. Natural remineralization is often limited, necessitating supplementary treatments. This study evaluated the remineralizing effects of 10% xylitol varnish, 5% fluoride varnish, and placebo on WSLs after orthodontic treatment. This single-center, randomized, placebo-controlled, triple-blind clinical trial enrolled 84 patients (n = 28/group) aged 14‒25 years, who had developed WSLs after completing orthodontic treatment. The participants were randomly assigned to 5% fluoride varnish, 10% xylitol varnish, or placebo varnish groups. Randomization was performed using computer-generated block randomization. Participants, the clinician applying the varnishes and outcome assessors were all blinded to group allocation. Varnishes were applied every three months after debonding, and enamel mineralization was assessed using DIAGNOdent and visual scoring at baseline (T0), 6 months (T1), and 12 months (T2). Statistical analysis included the Kruskal-Wallis test, GEE modeling, and chi-squared test for WSL frequency (p < 0.05). Eighty-one participants were included in the intention-to-treat (ITT) and 76 in the per-protocol analyses. Significant improvements in mineral content were observed in all the groups after six (p = 0.007) and 12 months (p < 0.001). At T2, the fluoride group demonstrated a greater increase in enamel mineralization compared to the xylitol group (p= 0.045 in ITT, p = 0.063 in per-protocol). Visual assessment revealed significantly fewer WSLs in the fluoride group (12.1%) compared to the placebo group (25.1%) at T2 (OR = 0.41, 95% CI: 0.24-0.69, p = 0.001). No significant difference in WSL reduction was noted between the xylitol and placebo groups. Both fluoride and xylitol varnishes improved enamel mineralization, with fluoride showing superior long-term efficacy in reducing WSLs. These findings support using fluoride varnish after orthodontic treatment to prevent and manage WSLs. No harm was observed during this study. This trial was registered and approved by the Iranian Registry of Clinical Trials under the registration code IRCT20180913041032N2. This study was funded by Shiraz University of Medical Sciences.

Prospective, randomized, double-blind, multicenter clinical trial. Participants between 12 and 25 years old, who were generally healthy, with 2 or more white spot lesions on the labial surface of anterior dentition. 79 patients who developed white spot lesions (WSL) on the labial surface of anterior teeth following orthodontic treatment were randomly assigned to 4 intervention groups. Group 1 received 5% sodium fluoride varnish every 6 months, the second group received CPP-ACP every 6 months, thethird group was treated with resin infiltration at the initial visit followed by placebo every 6 months, and the final group which was the control group was coated with 1400 ppm fluoride toothpaste every 6 months. All the candidates were instructed to brush twice daily using a specific toothbrush and 1400 ppm fluoride toothpaste. The study lasted for 12 months, and photographs of the teeth with WSL were taken before and after completion of the intervention. Photographs were analyzed using ImageJ software to compare the changes in the percentage of WSL area to total tooth surface area among the four study groups. The distribution differences among groups were compared using nonparametric tests and differences between baseline and 1-year follow-up parameters were analyzed using paired chi-square tests. Reduction in the area of WSL were noted in all groups, with different levels of significance. The percentage reduction was 46.62% in the resin infiltration group and it was significantly higher than the remaining interventions. Fluoride varnish group had 26.57% reduction, the CPP-ACP group had 28.64% reduction and the control group had 29.75% reduction in the WSL area. Plaque index was noted to have significant correlation with the change in WSL area with higher plaque index scores demonstrating lesser reduction in WSL. The study found that resin infiltration significantly reduced the WSL area after 1-year follow-up. Fluoride toothpaste with or without CPP-ACP and fluoride varnish produced some therapeutic effects.

Background/Objectives: Dental caries, one of the most common oral diseases worldwide, represents a major public health concern. Contemporary dentistry has established several non-invasive approaches and resin infiltration, as a micro-invasive path, in the treatment of white spot lesions (WSLs). This study aimed to evaluate the effect of different WSL treatments on enamel surface microhardness. Materials and Methods: Seventy-five intact human premolars extracted upon orthodontic indication and the demineralizing solution composed of acetic acid, monopotassium phosphate and calcium chloride with pH = 4.4 and exposure time 96 h were used. The samples were randomly divided into five groups (n = 15): I-intact enamel (control group); II-artificial white spot lesion; III-artificial WSL treated with fluoride varnish; IV-artificial WSL treated with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste; V-resin-infiltrated artificial WSL. The surface microhardness was determined using the Oliver-Pharr method and a spherical indenter (Shimadzu Indenter, Kyoto, Japan). One-way analysis of variance (ANOVA) followed by a Post Hoc test (Bonferroni) was used with a level of significance set at p < 0.05. Results: Resin-infiltrated white spot lesions showed comparable microhardness mean value as the control group: 68.23 (±21.45) and 63.57 (±18.89), respectively (p > 0.05). Also, resin infiltration increased enamel microhardness compared to WSL values, with a statistically significant difference (p < 0.05). Fluoride varnish and CPP-ACP treatment resulted in equivalent values (50.84 ± 14.35 and 50.99 ± 15.31, respectively). Conclusions: Different WSL treatments (fluoride varnish, CPP-ACP and resin infiltration) produced comparable enamel microhardness values. Among the tested agents, resin infiltration resulted in higher microhardness values, while fluoride varnish and CPP-ACP demonstrated equivalent outcomes.

ObjectivesThe study aimed to survey current strategies against enamel demineralization during multibracket therapy (MBT) and guide a prevention concept based on existing scientific evidence.Materials and methodsThe survey comprised questions on the prevention and management of white spot lesions (WSL). The questionnaire was sent via email to orthodontists working in practices and universities throughout Germany. The analysis involved descriptive statistics using the chi-square test (p < 0.05).ResultsA prevention protocol was used before MBT by 80.6% of the participants. Less than a quarter of the participants regularly applied topical fluoride (gel or varnish) during MBT. According to the respondents’ assessment, the prevalence of WSL during MBT is 11.6%, mainly observed in 12- to 15-year-old male patients. Orthodontists graduating after 2000 tended to recommend and apply fluoride-containing materials more often than their senior colleagues (p = 0.039). Participants from private practices applied fluoride varnish or gel more frequently than those from university clinics (p = 0.013). Fluoridation was the most common (70.7%) treatment for WSL after MBT, followed by resin infiltration (21.2%). The majority (80.9%) of the participants favor a guideline for preventing WSL.ConclusionsWSL prevention during MBT is challenging. Males in puberty are predominantly affected. Younger orthodontists are more concerned about the prevention of WSL during MBT.Clinical relevance.The non-negligible prevalence of individuals with WSL emphasizes the need for dental education and health care reform. This would help to implement standardized procedures and establish innovative applications.

One of the risks that we find after orthodontic treatment is the secondary appearance of white spot lesions (WLS) after the removal of fixed multi-bracket appliances. Today, there are several treatment methods, resin infiltration being the most used in the most serious cases. The objective of this study is to carry out a systematic review and meta-analysis to determine the efficacy and stability in the variables of color and gloss, six months after resin infiltration. A comprehensive search was performed in the following databases: PubMed, Embase, Google Scholar, Scopus, Medline, and Web of Science. Articles published in the last 10 years were selected, including in vivo studies with a six-month follow-up. PRISMA guidelines were followed to carry out this systematic review. All studies where the application of resin was performed on carious lesions were discarded. Once the inclusion and exclusion criteria were applied, a final sample of four articles was obtained, on which the review and meta-analysis were carried out. Once examined, all authors considered that there was an immediate improvement in both variables. However, statistically significant differences were obtained in the color change outcome, but not in the brightness outcome in the subgroup analysis after six months of icon resin infiltration.

To compare the esthetic improvement between postorthodontic white-spot lesions (WSLs) treated by resin infiltration and microabrasion for 12 months. A total of 20 patients with 128 teeth with postorthodontic WSLs were recruited. A simple randomized, split-mouth, positive controlled design was used to allocate patients to resin infiltration or microabrasion groups. The lesion area ratio (R value) was calculated between the area of a WSL and the labial surface of the corresponding tooth based on standardized clinical photographs. The color change (ΔE) of each tooth was measured with a Crystaleye spectrophotometer (Olympus, Tokyo, Japan). Every measurement was taken before treatment (T0) and at different time points after treatment: 1 week (T1), 6 months (T6), and 12 months (T12). A total of 16 patients with 108 trial teeth were available at T12. Each group had 54 trial teeth. In both groups, there was a significant decrease in R value and ΔE between T1 and T0 (P < .0001). In the infiltration group, the R value and ΔE had no significant changes over time from T1 to T12. In the microabrasion group, the R value and ΔE decreased significantly from T1 to T6. The R value of resin infiltration was lower when compared with microabrasion at every recall point (P < .001). The ΔE had no significant differences between the two groups at any timepoint. Resin infiltration and microabrasion improved the esthetic appearance of WSLs and showed sufficient durability for 12 months. Resin infiltration showed a better esthetic improvement effect when compared with microabrasion at 12 months.

Background: White spot lesions (WSLs) are a problem commonly found in patients who use orthodontic devices. Fluoride varnish can reduce WSLs during orthodontic treatment with fixed appliances. The aim of this systematic review was to evaluate the efficacy of fluoride varnish compared with other agents for preventing WSLs during orthodontic treatment.&#x0D; Methods: Studies were searched from four databases- PubMed, Scopus, Web of Science and Cochrane Library- from January 1980 to May 2017; only studies with English abstracts were included.&#x0D; Results: Out of 432 studies searched from the databases, 33 studies were evaluated for eligibility. Of the 33 studies, 19 were excluded with reasons and 14 studies were included in the systematic review. Parameters of WSLs (decalcification score, prevalence, incidence, progression score, ΔQ and ΔZ and DiagnoDent (DD) pen score) were compared for the various treatments.&#x0D; Conclusions: Although there were some limitations for this systematic review study, the review showed that fluoride varnish combined with chlorhexidine (CHX) may be a good treatment for WSLs after orthodontic treatment, especially for a 6-month period, and that resin infiltration might also be effective for preventing WSLs. More studies are needed to further investigate these observations.

To clinically assess the efficacy of resin infiltration versus fluoride varnish for arresting white spot lesions (WSLs) on permanent teeth in children. Among the children referred to the our University, Faculty of Dentistry, Department of Pediatric Dentistry, 23 aged between 8-14 with 81 anterior WSLs were included in the study. The participants were randomly assigned to either the resin infiltration group or the fluoride varnish group. WSLs were assessed using a laser fluorescence device (DIAGNOdent pen, Kavo, Germany) and were characterized at baseline, immediately following resin infiltration application and at a 6-month follow-up. For the statistical analyses, the IBM SPSS Statistics 22 (IBM SPSS, Turkey) program was used to assess the findings of the study. Participant retention was 100% at 6 months. There was no significant difference between the two groups when baseline DIAGNOdent (DD) values were compared (P > 0.05). The reduction in 6-month follow-up DD values were statistically significant in both groups relative to baseline values. The 6-month values of the resin infiltration group were statistically lower than those of the fluoride varnish group (P = 0.028, P < 0.05). Resin infiltration and fluoride varnish are clinically feasible and efficacious methods for the treatment of anterior WSLs. The inhibition of caries progression by resin infiltration should now be considered an alternative to fluoride treatment.

The current study1 is a randomized controlled trial with two arm, multicenter and parallel group design. Study subjects were 38 orthodontic patients younger than 17 years who were being treated with metal braces. Patients with at least one white spot lesion (WSL) graded 1 to 2 according to the International Caries Detection and Assessment System (ICDAS) on the labial surface of permanent maxillary and mandibular canines and incisors were included for the trial. Teeth with carious lesions and restorations, anomalies of the enamel, and primary teeth were excluded. Patients were allocated by computer generated random sequence into resin infiltration and fluoride varnish intervention groups. Study subjects were blinded until the allocation, outcome assessors and statisticians remained blinded through the study, however the operators could not be blinded. Resin infiltration treatment involved removal of orthodontic wires and auxiliaries followed by cleaning the teeth with fluoride free prophylactic paste and completing the resin infiltration according to manufacturer's instructions. In the fluoride varnish group, a thin layer of the material was applied after isolating the teeth, and patients were asked not to eat or drink for 1 hour. This was continued twice a month for 6 months. Digital images of the teeth were obtained before, and 1 day (T1), 1 week (T2), 1 month (T3), 3 months (T4) and 6 months (T5) after treatment, using a DSLR camera and a matching polarization filter. The images were processed for calibration and color stability. Regions of interest representing WSL (white spot lesion) and SAE (sound adjacent enamel) were isolated in the images for comparison at different stages the images were captured. Statistical analysis was performed using SPSS version 28. Independent-samples t-test was utilized for comparison between the two groups, and paired-samples t-test for comparison within the groups. A statistical significance level of α = 0.05 was set. At T1, significant color difference was observed between white spot lesion and adjacent sound enamel in the resin infiltration group and it remained stable after 6 months. Whereas in the fluoride varnish group, there were no statistical differences from baseline to 6 months. A statistical difference of 3.27 CIELAB units (p < 0.001) was reported between the infiltration group and the fluoride group at T5. No significant changes were noted in SAE with respect to changes in lightness. Resin infiltration was found to be better at masking the demineralization produced by WSL and also enhanced the esthetic appearance of demineralized areas around the brackets. Resin infiltration did not produce any clinically visible effects in non-affected enamel. These changes remained stable for a period of 6 months.

The aim of this study was to evaluate the changes in opacities by applying resin infiltrate to developmental enamel opacities and applying resin infiltrate or fluoride varnish to white spot lesions (WSLs). A total of 132 teeth with WSLs and developmental enamel opacities were included in the study. WSLs were treated with resin infiltrate (Group 1) and fluoride varnish (Group 2), and developmental enamel opacities were treated with only resin infiltrate (Group 3). Lesions were evaluated in accordance with International Caries Detection and Assessment System (ICDAS II) criteria and DIAGNOdent Pen scores before applying the material (T0), just after the application (T1), and after 1 month (T2) and 3 months (T3). A significant decrease in DIAGNOdent Pen scores was observed in all the groups and the most important decrease was seen in Group 2 (P < 0.05). A significant decrease in ICDAS II scores was observed in Groups 2 and 3 (T0-T1) and Group 1 (T1-T2) (P < 0.05). DIAGNOdent pen scores decreased and the lesion was partially masked after resin infiltrate was applied to treat developmental enamel opacities; the resin infiltrate application, however, was more successful than fluoride varnish on WSLs. Treating WSLs with resin infiltrate was a good option due to shorter term esthetic recovery and high patient satisfaction.