Post-orthodontic White Spot Lesions Research Articles

Evaluation and Compare Effectiveness and Durability of ICON Resin Infiltration and Acidulated Phosphorus Fluoride in Treatment of Post-Orthodontic White Spot Lesions

Evaluation and Compare Effectiveness and Durability of ICON Resin Infiltration and Acidulated Phosphorus Fluoride in Treatment of Post-Orthodontic White Spot Lesions

One Year Clinical Evaluation of White Spot Lesions with Newly Introduced Resin Modified Glass-Ionomer in Comparison to Resin Infiltration in Anterior Teeth: a split mouth randomized controlled clinical trial from Egypt

Objective: to compare the clinical performance of newly introduced resin modified glass ionomer varnish (Clinpro™ XT) versus resin infiltration in treatment of post-orthodontic white spot lesions. Material and Methods: Six participants (70 teeth) were enrolled with post-orthodontic white spot lesions. Randomization was performed according to patient selection for the sealed envelope containing which half will receive the control (resin infiltration (ICON, DMG) and the other will receive the intervention (resin modified glass-ionomer cement varnish (Clinpro™ XT, 3M)). Follow up was done after 1 day, 1 week, 1 month, and 3 months, 6 months and 12 months. The color was assessed by spectrophotometer while the degree of demineralization was measured by Diagnodent pen 2910. Patient satisfaction was assessed using (VAS) Visual analogue scale. Results: Regarding color change, significant improvement in lightness for ICON group, while Clinpro™ XT group, the change was insignificant. The demineralization data revealed significant decrease in demineralization with resin infiltration after immediate application. Clinpro™ XT showed also significant decrease after immediate assessment and significant increase in demineralization in 6 and 12 months. Conclusion: Resin infiltration can be considered more as an alternative treatment rather than fluoride varnish. Clinpro™ XTis considered as a preventive protocol, provided that renewal application is needed after 3 months. Keywords 3M Resin cement; Resin cements; Glass ionomer cements; Fluorides; Follow up studies; Glass ionomer.

Behandeling van postorthodontische wittevleklaesies

White spot lesions are early demineralisations and therefore constitute an impairment to healthy enamel. The emergence of white spot lesions is one of the main risks of damage during orthodontic treatment with fixed appliances. White spot lesions may partially recover, but will remain visible in most cases. The treatment for post-orthodontic white spot lesions is a step-by-step strategy. Treatment is aimed at remineralising the affected enamel, without hyper-mineralising the surface layer. Subsequently, treatment of post-orthodontic white spot lesions is aimed at reducing their visibility. Such treatment options focus on minimally invasive treatment techniques, before choosing an invasive treatment. More randomised clinical trials are needed to substantiate the evidence-based treatment of post-orthodontic white spot lesions. Clinical practice guidelines are being developed for the care and treatment of orthodontic white spot lesions.

Treatment of post-orthodontic white spot lesions

White spot lesions are early demineralisations and therefore constitute an impairment to healthy enamel. The emergence of white spot lesions is one of the main risks of damage during orthodontic treatment with fixed appliances. White spot lesions may partially recover, but will remain visible in most cases. The treatment for post-orthodontic white spot lesions is a step-by-step strategy. Treatment is aimed at remineralising the affected enamel, without hyper-mineralising the surface layer. Subsequently, treatment of post-orthodontic white spot lesions is aimed at reducing their visibility. Such treatment options focus on minimally invasive treatment techniques, before choosing an invasive treatment. More randomised clinical trials are needed to substantiate the evidence-based treatment of post-orthodontic white spot lesions. Clinical practice guidelines are being developed for the care and treatment of orthodontic white spot lesions.

Low-Viscosity Resin Infiltration Efficacy on Postorthodontic White Spot Lesions: A Quantitative Light-Induced Fluorescence Evaluation

The aim of this in vivo study was to evaluate the efficacy of low-viscosity light-cured resin infiltration on postorthodontic white spot lesions (WSLs) on incipient and advanced lesions using quantitative light-induced fluorescence (QLF). The study subjects were patients with clinically diagnosed postorthodontic WSLs (n=57). QLF images of the lesions were obtained using a QLF device (Inspektor-Pro, Amsterdam, The Netherlands) before any treatment. Images were processed using the built-in software (QLF patient v2.0.0.48), which produced fluorescence loss (ΔF1), lesion area (Area1), and impact (ΔF1 x Area1, ΔQ1) values. Lesions were categorized as incipient (-5<ΔF1<-12, n=14) or advanced (-12<ΔF1<-25, n=43). They were then infiltrated with low-viscosity resin (Icon-DMG, Hamburg, Germany) according to the manufacturer's instructions. QLF imaging was repeated (ΔF2, Area2, and ΔQ2) from the same aspects assured by the relative software. Kolmogorov-Smirnov, Wilcoxon, and Mann-Whitney tests were used for data evaluation. ΔF1 (-8.40±0.73) and Area1 (3.44±5.19) decreased to -6.58±0.88 and 0.18±0.33 for incipient lesions (p<0.001 and p=0.002, respectively). ΔF1 (-13.20±5.32) and Area1 (4.71±5.56) decreased to -7.51±2.7 and 0.29±1.86 for advanced lesions (p<0.001). When ΔF, lesion area, and ΔQ changes between the groups were compared, the decrease in ΔF was greater for advanced lesions (p<0.001), whereas the decrease in the lesion area and ΔQ was similar (p=0.690, p=0.291). Infiltration treatment provides improvement of WSLs in terms of fluorescence loss, lesion area, and impact for both incipient and advanced lesions, with the latter group presenting higher fluorescence loss reduction.

Is Bleaching Effective in Managing Post-orthodontic White-spot Lesions? A Systematic Review.

White spot lesions (WSL) are common side-effects of orthodontic treatment with fixed multi-bracketed appliances. The aim of this review was to find all available literature and critically assess the evidence for the efficacy of bleaching as a method to treat or alleviate post-orthodontic WSLs in permanent teeth. Electronic databases were screened for relevant literature with the aid of predetermined search strategies. All types of studies, including randomised or nonrandomised controlled trials (RCTs or CCTs), prospective and retrospective studies, as well as in vitro studies were considered eligible for inclusion. The reference lists of all included articles were hand searched for additional studies. Two authors independently performed study selection, data extraction, and risk of bias assessment. One RCT and 8 in vitro studies met the inclusion criteria. Seven studies were classified as having a high risk of bias while 2 in vitro studies were graded as having a moderate risk of bias. The results showed that bleaching of WSL can diminish colour disparities between carious and non-affected areas, but the certainty of the evidence was very low. The high degree of methodological heterogeneity precluded a valid interpretation of the results through pooled estimates. The findings from the present systematic review could not support or refute bleaching as an effective method for management of post-orthodontic WSLs. Because most of the studies in this field are in vitro and solid scientific evidence of low risk of bias is scare, further prospective in vivo studies are necessary.

Effect of fluoride varnish with functionalized tri-calcium phosphate on post-orthodontic white spot lesions: an investigator-blinded controlled trial.

To investigate the effect of a 5% sodium fluoride varnish with functionalized tri-calcium phosphate (fTCP) on post-orthodontic white spot lesions. A secondary aim was to study if the patients and their clinicians perceived clinical improvements. Fifty-nine patients with at least two visible WSLs on their maxillary incisors, canines, or first premolars present at the debonding of fixed appliances (baseline) were enrolled and assigned to a Varnish group (Clinpro White Varnish, 3M Espe) receiving topical applications at baseline and after 8 weeks, or a Control group treated with a fluoride-free mock product. The primary endpoint was white spot lesion appearance after 16 weeks, assessed from photographs using the modified ICDAS white spot lesion score (0 to 3). The patients and the dental examiners rated the white spot lesions subjectively with aid of a visual analog scale. Fifty-seven patients completed the study. After 16 weeks, 62% of the white spot lesions in the Varnish group were completely reversed (score 0) compared to 39% in the Control group. The treatment effect was statistically significant (OR 0.22; 95% CI 0.08 to 0.59, P = .003) after adjusting for baseline oral hygiene index and type of tooth. A significant correlation (P < .05) was observed between patients' and orthodontists' perception of the lesions. The 5% sodium fluoride varnish with fTCP appeared clinically effective in reversing post-orthodontic white spot lesions 16 weeks after debonding. The patients and the clinicians agreed on the obtained esthetic improvements.

Evaluation of the value of re-wetting prior to resin infiltration of post-orthodontic caries lesions

ObjectivesAssessment of the influence of colour changes during the re-wetting process as a possible predictor for the final result after resin infiltration to mask post-orthodontic white spot lesions. Materials and methodsResin infiltration (ICON; DMG, Hamburg, Germany) was performed according to the manufacturer’s recommendation with the exception of repeated, at maximum three etching procedures based on the subjective decision of the dentist during a so called re-wetting process using ethanol. The masking effect by ethanol as well as after resin infiltration was evaluated by digital images taken before, for nine seconds during re-wetting and one week after treatment using CIE L*a*b* colour space. ResultsTwenty-nine patients (16 female) with a total of 221 lesions (ICDAS 2) were included (mean age 16 years). Mean time after debonding the orthodontic appliances was ten weeks. Colour changes during re-wetting, evaluated in the first ten patients (71 lesions) showed a significant correlation between the minimum ΔE observed during re-wetting and the final ΔE after resin infiltration (r = 0.65, p < 0.001; Spearman correlation). The main drop in ΔE becomes visible after three seconds when performing the re-wetting process.Regarding the 221 lesions, resin infiltration significantly reduced the colour difference between sound and lesion areas from a baseline ΔE (25th/75th percentiles) of 10.9 (8.2/13.2) to a ΔE of 4 (2.1/5.8) after one week (p < 0.001). The number of etching procedures correlated significantly with baseline ΔE (p < 0.05). ConclusionsThe minimum ΔE observed during the re-wetting process seems to be a useful predictor for the final result of resin infiltration of post-orthodontic caries lesions. More prominent lesions with higher ΔE at baseline seem to require more erosion of the surface layer. In general, a significant and considerable clinical reduction of ΔE could be observed. Clinical significanceWe corroborate that resin infiltration technique is a very useful method to mask caries lesions having developed during treatment with fixed orthodontic appliances. Colour changes while re-wetting the lesions with ethanol seem to be a valuable indicator for the number of required etching procedures.

Comparison of potential long-term costs for preventive dentistry treatment of post-orthodontic labial versus lingual enamel cavitations and esthetically relevant white-spot lesions: a simulation study with different scenarios

BackgroundPost-orthodontic white-spot lesions (WSL) in esthetically relevant incisor and canine areas impair dentofacial esthetics, and preventive dentistry treatment is definitely required in case of enamel cavitations. The incidence of lingual post-orthodontic WSL and cavitation following lingual MB treatment has been reported to be distinctively decreased compared to labial MB treatment. Moreover, lingual WSL do not impair dentofacial esthetics. It was the objective of this study to calculate consequential costs of preventive dental care necessary to recover labial or lingual post-orthodontic cavitations as well as esthetically relevant WSL following either labial or lingual MB interventions.MethodsMB treatments (labial / lingual) were simulated in 1,000,000 patients between the ages of 12-18Y, with a median residual life time expectancy of 58Y based on local mortality tables. Range of MB Tx duration was 9–45 mo. Frequencies of post-orthodontic (labial / lingual) enamel damages were derived from large-scale WSL incidence studies. Anterior composite survival rates were based on a systematic review on the subject. Within the context of the German dental fee system (GOZ 2.3 and 3.5 fee increments), simulation of costs for enamel damage treatment and re-treatment (maximum: 5x) were based on single-surface composite restorations for lingual or labial cavitations and labial WSL treatment; and lingual WSL fluoridation.ResultsOverall mean total costs for Tx and re-Tx of both WSLs and cavitations may sum up to 1718.91 Eur in the high-cost (GOZ 3.5) scenario for conventional MB cases, versus 19.94 Eur for lingually treated cases, given that renewal of simulated single-surface restorations takes place at 15-year intervals. When focussing on patients diagnosed with least of one WSL, and/or cavitation, these mean costs increase up to 2332.35 Eur for conventionally treated MB patients, or 65.03 Eur for lingual MB patients.ConclusionCosts for repeated treatment of post-orthodontic enamel damages produced by conventional vestibular fixed appliances may easily exceed the initially higher costs associated with lingual orthodontic treatment. Judged economically in the long term, lingual MB Tx may be considered as a more cost-effective solution for a correction of malocclusion.

Management of post-orthodontic white spot lesions wıth resin infiltration technique: case report

Beyaz nokta lezyonları, sabit ortodontik braketlerin kullanımı sırasında yetersiz oral hijyen nedeniyle sık görülen önemli bir komplikasyondur. Rezin infiltrasyon (RI) tekniği, rezin materyalin beyaz lezyonun gövdesine infiltre edilmesini sağlayan ve klinik kullanımı yaygınlaşmakta olan bir minimal invaziv restoratif tedavi seçeneğidir. Bu olgu sunumunda, RI tekniğinin klinik uygulama yöntemi ve uzun dönem prognozunun bildirilmesi amaçlanmıştır. On altı yaşında kız hasta, ortodontik tedavi sonrası maksiller ve mandibular dişlerinin labial yüzeylerinde oluşan beyaz nokta lezyonları sebebiyle kliniğimize başvurmuştur. Beyaz lezyonlar, iki seansta RI tekniği (Icon, DMG) ile tedavi edilmiştir. Bu olguda RI tedavisi ile beyaz lezyonların klinik görünümünde belirgin olarak düzelme ve tatmin edici estetik sonuçlar elde edilmiştir. Yirmi dört aylık dönemde bu görünüm değişmeden stabil olarak korunmuş ve lezyonların ilerlemesi engellenmiştir.

Remineralization Effect of Eggshell Powder on Post-orthodontic White Spot Lesions Compared to CPP-ACP

Remineralization Effect of Eggshell Powder on Post-orthodontic White Spot Lesions Compared to CPP-ACP

Esthetic improvements of postorthodontic white-spot lesions treated with resin infiltration and microabrasion: A split-mouth, randomized clinical trial.

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.

Monitoring regression of post-orthodontic lesions with impedance spectroscopy: a pilot study.

To investigate if the alternating current impedance spectroscopy (ACIS) technology could be used to monitor remineralization of post-orthodontic white spot lesions (WSLs) after debonding of fixed orthodontic appliances. The study group consisted of 28 adolescents (aged 12-16 years) with at least two WSLs on their maxillary incisors, canines, or first premolars at debonding. Buccal surfaces (n = 194) were visually examined and scored with modified International Caries Detection and Assessment System (ICDAS) criteria and with the CarieScan Pro device by three examiners according to manufactures manual (test method). In addition, 31 surfaces with ICDAS = 0 were monitored by ACIS, serving as controls. Follow-up examinations were carried out after 8 and 16 weeks. Modified ICDAS scores, captured from digital photographs by three independent examiners, served as reference method. Four patients were lost to follow-up. Data were analysed in a mixed statistical model considering systematic effects of visit, tooth and observer, random effects of patients, and visits within patients. Over 50 per cent of all surfaces had marked WSL at baseline and the corresponding values at 8 and 16 weeks were 33 per cent and 22 per cent. The ACIS readings mirrored the visual scores; the baseline estimate (56.3) was significantly decreased after 8 weeks (P < 0.05). The lateral incisors exhibited the highest values whereas the lowest were recorded for the central incisors. ICDAS is not the same as a 'true' gold standard. The high prevalence of WSL may jeopardize the external validity. The ACIS technology may to some extent be used to monitor the regression of post-orthodontic WSLs.

Long-term follow-up of camouflage effects following resin infiltration of post orthodontic white-spot lesions in vivo.

To reassess the long-term camouflage effects of resin infiltration (Icon, DMG, Hamburg, Germany) of white spot lesions (WSL) and sound adjacent enamel (SAE) achieved in a previous trial. The null hypothesis was tested that there were no significantly different CIE-L*a*b*-ΔE-values between WSL and SAE areas of assessment after at least 24 months (T24) compared to those at baseline (T0). Of twenty subjects who received previous resin infiltration treatment of nteeth = 111 nonrestored, noncavitated postorthodontic WSL after multibracket treatment during a randomized controlled trial and were contacted 20 months after baseline, eight subjects (trial teeth nteeth = 40; m/f ratio 1/7; age range (mean; SD) 12-17 [15.25; 2.12] years); response rate: 40%) were available for follow-up after at least 24 months (T24). CIE-L*a*b* differences between summarized color and lightness values (ΔEWSL/SAE) of WSL and SAE were assessed using a spectrophotometer and compared to baseline data assessed prior to infiltration (T0), and those after 6 (T6), and 12 (T12) months using paired t tests at a significance level of α = 5%. T24 assessments were performed after a mean 33.86 (SD: 8.64; Min: 24; Max: 45) months following T0. Mean (SD) ΔEWSL/SAE units of available teeth were 8.76 (5.33) at baseline; 5.5 (2.75) at T6; 5.2 (2.41) at T12; and 5.57 (2.6) at T24. Comparisons of T6, T12, and T24 with T0 yielded highly significant differences, whereas T6-T24 and T12-T24 differences were found to be not significant. Assimilation of infiltrated WSL to the color of adjacent enamel by resin infiltration is considered to be suitable for the long-term improvement in the esthetic appearance of postorthodontic WSL.

Current Enamel Remineralization Therapies Have Limited Effects on Postorthodontic White Spot Lesions

Enamel remineralization therapies for treating postorthodontic white spot lesions: a systematic review. Fernández-Ferrer L, Vicente-Ruíz M, García-Sanz V, Montiel-Company JM, Paredes-Gallardo V, Almerich-Silla JM, Bellot-Arcís C. J Am Dent Assoc 2018; 149(9):778-86.e2. No financial support was reported. Systematic review.

Effectiveness of MI Paste Plus and Remin Pro on remineralization and color improvement of postorthodontic white spot lesions

This clinical trial investigated the effectiveness of two remineralizing creams on regression of white spot lesions (WSLs) after orthodontic therapy. The study included patients with WSLs on their upper anterior teeth who recently completed orthodontic treatment at the Department of Orthodontics of Mashhad Dental School and two private offices. The participants were randomly assigned into three groups by treatment: (1) a 12-week regimen of a cream containing casein phosphopeptide-amorphous calcium phosphate and fluoride (MI Paste Plus); (2) a 12-week regimen of a cream containing hydroxyapatite and fluoride (Remin Pro); and (3) usual home care (control). Thirty-nine patients participated and three withdrew. The main outcomes including area, mineral content, and color of WSLs were measured at enrolment and 4, 8, and 12 weeks later, respectively. Blinding was applied for outcome assessment only. The data were analyzed by analysis of variance and repeated measures analysis at the statistical significance of P < 0.05. Over a 3-month period, the application of both MI Paste Plus and Remin Pro caused significantly greater reduction in area and significantly higher increase in mineral content of WSLs compared to the control group (P < 0.05). The appearance of WSLs improved significantly in both experimental groups (P < 0.05), but not in the control group. No side effect was observed throughout the experiment. The application of either MI Paste Plus or Remin Pro was effective in reducing the area, increasing the mineral content and improving the appearance of demineralized enamel, indicating that these products could be recommended for managing postorthodontic WSLs.

Clinical evidence in the treatment of white spot lesions following fixed orthodontic therapy: a meta-analysis

Abstract Objective This systematic review aims to determine the most effective method of treatment to remineralise post-orthodontic white spot lesions (WSLs). Method Six databases were accessed and searched for articles. Screening and selection were conducted according to the PRISMA guidelines using predetermined inclusion and exclusion criteria. Two reviewers independently assessed and extracted identified studies and relevance disagreement was resolved through consensus. Experimental studies were included that involved (i) patients of any age who had WSLs after the removal of fixed appliances, (ii) any treatment to remineralise the WSLs compared with no treatment or a placebo, and (iii) measurement of the changes in enamel mineralisation status after treatment. Eligible articles were assessed for internal bias and underwent narrative synthesis. A meta-analysis using random-effects modelling was performed to calculate a pooled estimate and assess between-study variability using Cochran’s Q and I2. Results The nine articles included in this review were found to have a medium or high risk of bias. The qualitative assessment provided contrasting results between studies. The meta-analysis showed both CPP-ACP – pooled d of -0.28 (N = 5 studies; 95% CI = -0.48- -0.07) – and fluoride – pooled d of -0.25 (N = 4 studies; 95% CI = -0.48- -0.02) – to generate improvement in the enamel mineralisation status, with CPP-ACP producing more consistent results compared with fluoride. Conclusions The meta-analysis found that CPP-ACP and fluoride were effective in reducing post-orthodontic WSLs. Due to the heterogeneity of the included studies with regard to the fluoride concentrations and mode of delivery, the current meta-analysis could not accurately establish which remineralising agent, CPP-APP or fluoride, is more effective. Further high quality studies of long-term duration are required to determine best clinical practice.

Treatment of post-orthodontic white spot lesions by resin infiltration: a case series

Treatment of post-orthodontic white spot lesions by resin infiltration: a case series

Evaluation of the masking effect of resin infiltrant on post-orthodontic white spot lesions

Evaluation of the masking effect of resin infiltrant on post-orthodontic white spot lesions

Fluoride varnish and fluoride film reduce the area and increase the fluorescence of postorthodontic white-spot lesions

Fluoride varnish and fluoride film reduce the area and increase the fluorescence of postorthodontic white-spot lesions