Reduction in incidence of white spot lesions with lingual appliances.

Abstract

I want to make a few comments on the article “Lingual appliances reduce the incidence of white spot lesions during orthodontic multibracket treatment,” in the September issue (Wiechmann D, Klang E, Helms HJ, Knösel M. Am J Orthod Dentofacial Orthop 2015;148:414-22). This retrospective study analyzed a huge sample of patients, who were treated in one of the world's leading lingual orthodontic practices. Some important factors that affect the etiology of white spot lesions (WSLs) should have been reported, including the ligature type (continuous stainless steel or elastomeric power chain). This has been found to influence not only the archwire replacement speed, but also the plaque accumulation rate. Furthermore, the use of vestibular buttons for intra-arch and interarch elastics can facilitate the onset of labial WSLs.1Dalessandri D. Lazzaroni E. Migliorati M. Piancino M.G. Tonni I. Bonetti S. Self-ligating fully customized lingual appliance and chair-time reduction: a typodont study followed by a randomized clinical trial.Eur J Orthod. 2013; 35: 758-765Crossref PubMed Scopus (18) Google Scholar, 2Alves de Souza R. Borges de Araújo Magnani M.B. Nouer D.F. Oliveira da Silva C. Klein M.I. Sallum E.A. et al.Periodontal and microbiologic evaluation of 2 methods of archwire ligation: ligature wires and elastomeric rings.Am J Orthod Dentofacial Orthop. 2008; 134: 506-512Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar An important difference in the sample size between the preadolescent (90% of the sample) and adolescent (10% of the sample) groups means that every comparison between them is influenced by this. Furthermore, the period of adolescence is closely associated with the teenage years; therefore, using 13 or 14 years as the cutoff between preadolescence and adolescence would have obtained more balanced groups and probably different results of a statistical comparison. The influence of further possible confounding factors, such as oral hygiene status, nutritional habits, and fluoridation exposure, was also not considered, although this was declared in the Discussion section.3Migliorati M. Isaia L. Cassaro A. Rivetti A. Silvestrini-Biavati F. Gastaldo L. et al.Efficacy of professional hygiene and prophylaxis on preventing plaque increase in orthodontic patients with multibracket appliances: a systematic review.Eur J Orthod. 2015; 37: 297-307Crossref PubMed Scopus (59) Google Scholar, 4Laffranchi L. Zotti F. Bonetti S. Dalessandri D. Fontana P. Oral implications of the vegan diet: observational study.Minerva Stomatol. 2010; 59: 583-591PubMed Google Scholar A control group treated in the same clinic with a labial technique could have limited the impact of these confounding factors.5van der Veen M.H. Attin R. Schwestka-Polly R. Wiechmann D. Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference?.Eur J Oral Sci. 2010; 118: 298-303Crossref PubMed Scopus (58) Google Scholar Finally, with regard to the bracketing procedure, the application of a thin extra layer of a fluoride-releasing bonding resin should have been more emphasized. This aspect of the procedure demonstrated that it can significantly (up to 3 times) reduce the onset of WSLs. Therefore, this is an important factor in the marked differences found between labial and fully customized lingual multibracket appliances.6Beyling F. Schwestka-Polly R. Wiechmann D. Lingual orthodontics for children and adolescents: improvement of the indirect bonding protocol.Head Face Med. 2013; 9: 27Crossref PubMed Scopus (14) Google Scholar Lingual appliances reduce the incidence of white spot lesions during orthodontic multibracket treatmentAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 148Issue 3PreviewThe aim of this study was to assess the incidence of white spot lesions (WSLs) in subjects treated with customized lingual multibracket appliances—separately for maxillary anterior teeth 12 to 22 (according to the Fédération Dentaire Internationale numbering system) as well as for tooth groups 15 to 45, 16 to 46, and 17 to 47—and to determine the impact of patient-related and treatment-related variables on the frequencies of new WSLs. Full-Text PDF Authors' responseAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 149Issue 1PreviewWe were pleased that our study has awoken your interest. We want to thank you cordially for your comments and for allowing us to clarify some of the issues raised. Full-Text PDF