Treatment Of White Spot Lesions Research Articles

Minimally Invasive Treatment of White Spot Lesions--A Systematic Review.

To evaluate the efficacy of minimally invasive methods for the treatment of white-spot lesions involving fluorides, CPP-ACP (casein phosphopeptide-stabilised amorphous calcium phosphate) and resin infiltration vs a placebo or control. According to predetermined criteria, four databases were searched for eligible studies. References of the selected articles and relevant reviews were searched for any missed publications. Eight randomised controlled trials were selected as eligible studies, and only qualitative analyses were performed because of the diversity of the interventions and outcome measures. Three studies showed significant effects of three different fluoride preparations and used DIAGNOdent and ICDAS to assess the white spot lesions. Both studies comparing resin infiltration to a placebo showed significant effects in treating white spot lesions. One study using CPP-ACP showed a significant improvement in the lesions post treatment. Evidence suggests minimally invasive treatment modalities of white spot lesions produced significant improvement in the appearance and regression of white spot lesions following treatment when compared to a control or placebo.

A review on preventive measures and treatment of white spot lesions in patients with fixed orthodontic appliances

Objective: One complication of fixed orthodontic treatment in patients with poor oral hygiene is development of demineralized enamel lesions compromising esthetics. This study aimed to review preventive measures and treatment of white spot lesions (WSLs) in patients with fixed orthodontic appliances. Review of Literature: In this review study, PubMed and Google Scholar databases were searched for articles published during 1964-2013 using the keywords “white spot lesions”, “demineralization”, “mastic gum”, “casein phosphopeptide amorphous calcium phosphate or CPP-ACP”, “chitosan” and “orthodontics”; 96 articles were evaluated. Conclusion: White spot lesions can be prevented by conventional plaque control and adjunct measures such as the use of fluoride-containing compounds, chlorhexidine (CHX), xylitol gums, chitosan compounds and laser. Low-concentration fluoride, CPP-ACP compounds and laser help remineralize these lesions. If not treated, bleaching, microabrasion and tooth restoration are the final solutions.

White spots on enamel: Treatment protocol by superficial or deep infiltration (part 2)

In this 2nd part, the current treatment of white spot lesions by erosion/infiltration is presented, beginning with a reminder of the principle of superficial infiltration, which enables most early carious lesions, fluorosis and post-traumatic lesions to be treated. However, this technique has met with frequent failures in cases of MIH or deep lesions of traumatic origin or those associated with fluorosis. For this reason a new deep infiltration technique is proposed: thanks to its global treatment concept, this enables all white spots to be treated. The place of whitening in these treatment options is discussed, with explanations of the main reasons for its failures.

Treatment of White Spot Lesions by Resin Infiltration

Aim: To review the scientific principles of the treatment of white spot lesions with the resin infiltration technique and to discuss its application and limitations. Methodology: A PubMed database research was conducted and limited to articles published in English between the years of 2008 and 2013. Twenty-six articles were selected out of 48. Discussion: The resin infiltration procedure is a promising minimally invasive dentistry technique. Resin infiltration produces a positive effect on aesthetics, preserves tooth structure, delays or even eliminates the need for a restorative treatment and eliminates the risk of post-operative sensitivity and pulp inflammation. Although it has recently been developed, the results are very satisfactory. However, investigation is still needed (particularly with longer follow-ups and larger samples) as well as the development of specific and simplified protocols.

White Spot Lesions in Orthodontic Patients: Formation, Prevention and Treatment

During fixed orthodontic treatment, white spot lesions (WSLs) may arise on the teeth as undesirable situation. The white spot lesions are defined as areas of demineralization of tooth enamel that can occur during the treatment with fixed orthodontic appliances, around brackets, tubes or orthodontic rings. Their location is mostly on the labino-gingival part of the tooth crown. The white spots can be seen even after 1 month of setting fixed appliances and in some patients after 6 or 12 months. This state of demineralization of enamel is a complication of orthodontic treatment and represents a major clinical problem that can compromise the results of successfully treated case. Orthodontic wont to improve not only function but also the aesthetic appearance of patients, so during the treatment these complications should be minimized. The most common reason for this phenomenon is inappropriate and poor oral hygiene. In this paper there is the contemporary review of risk factors for the formation, prevention and successful treatment of WSLs. For avoiding side effects of wearing orthodontic braces, for each patient, before setting fixed orthodontic appliances, training is require for maintaining excellent oral hygiene. In literature there are numerous studies for the prevention and treatment of white spot lesions. The use of fluoride (in toothpaste, gels and solutions for the mouth, in bonding materials for orthodontic braces, fluoride varnish), Casein phosphopeptide-amprphous calcium phosphate (CPP-ACP0 in topical crème and microabrasion can greatly contribute to the process of remineralization of enamel and successful treatment of WSL.

Effect of Microabrasion on Teeth Color

ABSTRACT Objective: The aim of this study is to evaluate the enamel color changes before and after microabrasion technique, which is treatment of white spot lesion by using the CIE L*a*b* system with spectrophotometer. Materials and Methods: Twenty patients with inactive white spot lesions after fixed orthodontic treatment were selected. Especially, only small size white spot areas on central incisors, excluding middle of teeth were accepted. The contents of the microabrasion mixture was 18% hydrochloric acid and pumice (smaller than 30% of buccal area of tooth). The method was applied 4 times for each tooth. The spectrophotometric data on the labial surfaces of teeth were recorded with Easyshade (Vita, Zahnfabrik, Bad Sackingen, Germany) at the center of incisors before and after microabrasion. In vivo spectrophotometric color evaluation was adopted for all patients, and all measurements were performed in the same clinic room under standardized lighting conditions. Color on the surfaces of individual tee...

MI Paste Plus and PreviDent Fluoride Varnish Appear No More Effective Than Normal Home Care for Improving the Appearance of White Spot Lesions

Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM, Starrett JL, Greenlee GM, Drangsholt RJ, Matunas JC. Am J Orthod Dentofacial Orthop 2013;143:31-41. Carmen Llena-Puy The authors' aim was to compare the effectiveness of MI Paste Plus and PreviDent fluoride varnish (22,600ppm of fluoride) with a standard oral hygiene regimen with toothpaste (1100ppm of fluoride; Colgate Oral Pharmaceuticals)--control group--in improving the appearance of white spot lesions (WSLs) after orthodontic treatment during 8 weeks of follow-up National Institute of Dental and Craniofacial Research Randomized controlled trial Level 1: Good-quality, patient-oriented evidence Not applicable.

Treatment of White Spot Lesions after Removal of Fixed Orthodontic Appliances

Treatment of White Spot Lesions after Removal of Fixed Orthodontic Appliances

A Contemporary Review of White Spot Lesions in Orthodontics

White spot lesions (WSL) associated with fixed orthodontic appliances are a common adverse effect of orthodontic treatment and represent a significant challenge to achieving esthetic excellence. The purpose of this article is to review the current evidence regarding diagnosis, risk assessment, prevention, intratreatment management, and postorthodontic treatment of WSL, and to provide clinical recommendations useful for both the orthodontist and the general dentist. Caries risk assessment should be incorporated into initial evaluations of orthodontic patients, and risk-specific prevention and management protocols can help to eliminate or minimize this clinical problem. There are multiple options for treatment of WSL, ranging from conservative to invasive techniques; the severity of lesions is a determinant of which option is most appropriate. White spot lesions associated with orthodontic treatment are a common problem that can be minimized with appropriate prevention, management, and treatment approaches.

Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: A randomized controlled trial

White spot lesions are a common sequela of orthodontic therapy. In this parallel-group randomized trial, we assessed the effectiveness of 2 agents commonly used to ameliorate white spot lesions compared with a normal home-care regimen. Patients aged 12 to 20 years were recruited from the offices of orthodontists and dentists who belonged to the Practice-based Research Collaborative in Evidence-based Dentistry network. The patients had their orthodontic appliances removed within the past 2 months and had at least 1 white spot lesion affecting their maxillary incisors. The subjects were randomized to 1 of 3 arms: (1) an 8-week regimen of MI Paste Plus (GC America, Alsip, Ill), (2) a single application of PreviDent fluoride varnish (Colgate Oral Pharmaceuticals, New York, NY), and (3) usual home care (control). Photographs were taken at enrollment and 8 weeks later. Two panels consisting of 5 dental professionals and 5 laypersons assessed the before-and-after pairs of photographs in a blinded fashion. Objective assessments and self-assessments were also performed. One hundred fifteen subjects completed the study; 34 were assigned to the MI Paste Plus group, 40 to the fluoride varnish group, and 41 to the control group. The mean improvements assessed by the professional panel were 21%, 29%, and 27% in the MI Paste Plus, fluoride varnish, and control groups, respectively.The results from the lay panel were 29%, 31%, and 25%, respectively. Objective improvements in the surface affected were 16%, 25%, and 17%, respectively; self-assessments of improvement were 37% in all 3 groups. No assessments indicated significant differences between subjects in the active arms compared with the control arm. MI Paste Plus and PreviDent fluoride varnish do not appear to be more effective than normal home care for improving the appearance of white spot lesions over an 8-week period.

Clinical color intensity of white spot lesions might be a better predictor of enamel demineralization depth than traditional clinical grading

The aims of this study were to calculate the volume of white spot lesions by using microcomputed tomography and to determine which clinical attribute of the white spot lesion could better predict its volume: the clinically visible white spot lesion surface area or its color intensity. White spot lesions were induced in 8 patients in vivo on 23 healthy premolars destined for extraction during orthodontic treatment by using specially designed plaque-retaining orthodontic bands. After 7 weeks, the premolars were extracted. After extraction, the resulting white spot lesions were photographed and clinically graded. The teeth were analyzed with microcomputed tomography. After 7 weeks, 70% of the teeth developed clinical white spot lesions. Clinically, the size of the lesions varied from minor to severe. Their volumes varied from 0 to 1.2931 mm(3). The traditional grades for white spot lesions correlated significantly with color intensity. A significant correlation was found between white spot lesion color intensity and lesion volume. This correlation was found to be better than that between the white spot lesion clinical score and lesion volume. Our results indicate that white spot lesion color intensity might predict the depth of enamel demineralization as well as or better than traditional white spot lesion scoring. Therefore, the dentist could use this information when planning treatment for white spot lesions.

Preventing and treating white-spot lesions associated with orthodontic treatment: A survey of general dentists and orthodontists

The authors investigated the prevention and treatment of white-spot lesions (WSLs) during and after orthodontic therapy from the perspective of general dentists and orthodontists.The authors administered a cross-sectional survey to general dentists (n = 191) and orthodontists (n = 305) in Virginia, Maryland and North Carolina.Sixty-nine percent of general dentists and 76 percent of orthodontists recommended in-office fluoride treatment for patients with severe WSLs immediately after orthodontic treatment. Sixty-nine percent of general dentists reported that they had treated WSLs during the previous year, and 37 percent of orthodontists reported that they had removed braces because of patients' poor oral hygiene. Sixty percent of orthodontists referred patients with WSLs to general dentists for treatment. Eighty-five percent of orthodontists responded that they encouraged patients to use a fluoride rinse as a preventive measure. More than one-third of general dentists indicated that severe WSLs after orthodontic treatment could have a negative effect on their perception of the treating orthodontist.WSLs are a common complication of orthodontic treatment and their presence can result in a negative perception of the treating orthodontist by the patient's general dentist. Clinical implications. General dentists and orthodontists should work together to prevent the development of WSLs in their patients. Treatment with fluoride supplements and motivating and training patients to practice good oral hygiene will help achieve this goal. Treatment after debonding should include the topical application of low concentrations of fluoride.

Development of white spot lesions during orthodontic treatment: Perceptions of patients, parents, orthodontists, and general dentists

Despite the many advances to improve the practice of orthodontics, white spot lesions, or decalcifications, remain a common complication in patients with poor oral hygiene. The purpose of this study was to assess the perceptions and level of awareness of patients, parents, orthodontists, and general dentists toward the development of white spot lesions during orthodontic treatment. This was a prospective epidemiologic survey of the perceptions of orthodontic patients (n = 315), parents (n = 279), orthodontists (n = 305), and general dentists (n = 191) regarding the significance, prevention, and treatment of white spot lesions. All surveyed groups indicated that white spot lesions detracted from the overall appearance of straight teeth, attributed primary responsibility for the prevention of white spot lesions to the patients themselves, and thought that the general dentist should be responsible for treating white spot lesions. Patients regarded themselves as ultimately responsible for the prevention of white spot lesions (P <0.05). The patients, parents, orthodontists, and general dentists had similar perceptions regarding the significance, prevention, and treatment of white spot lesions. All groups indicated that patients were the most responsible for the prevention of white spot lesions. Communication among patients, parents, orthodontists, and general dentists needs to improve to decrease the incidence of white spot lesions in the orthodontic population.

Treatment of white spot lesions with ACP paste and microabrasion

To examine the effects of application of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste and microabrasion treatment on the regression of white spot lesions (WSLs). Artificially-induced WSLs in bovine enamel were randomly assigned to one of four treatment groups: CPP-ACP paste only, microabrasion only, microabrasion and CPP-ACP, and a control. Samples were treated with each regimen twice daily for 2 weeks and stored in remineralizing solution between the treatments. Quantitative light-induced fluorescence was used to measure changes in fluorescence, which indicate changes in mineral content of WSLs immediately before (T1) and 2 weeks after treatment (T2). A two-within-subject factor analysis of variance was used to analyze the significance of any changes in mineral content of the lesions from T1 to T2. There was a statistically significant (P < .05) gain in fluorescence associated with the microabrasion only, as well as the microabrasion and CPP-ACP treatments. The changes in fluorescence for the CPP-ACP treatment alone were not statistically significant (P = .40). CPP-ACP paste alone does not significantly improve the fluorescence value (ie, the mineral content) of WSLs. Within the limitations of this in vitro study, microabrasion treatment with or without CPP-ACP improved the fluorescence and thus reduced WSLs.

Current treatment of white spot lesions

Current treatment of white spot lesions

Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment

The purpose of this study was to determine the efficacy of fluoride varnish (5% sodium fluoride, Duraphat(®), Colgate) in reverting white spot lesions (WSLs) after fixed orthodontic treatment. This study was a randomized, parallel group, controlled clinical trial. Using saline solution as control, 110 participants (mean age ± standard deviation: 16.6 ± 3.2 years) ranging from 12 to 22 years old were randomly assigned to either the test group (group 1) or the control group (group 2). Application of fluoride varnish or saline was applied onto tooth surfaces with WSLs every month during the first 6 months after debonding. The labial (buccal) surfaces of the teeth were assessed by the use of a DIAGNOdent pen (DD) at the baseline, 3- and 6-month follow-up visits. After 6 months, 96 subjects with a total of 209 study teeth (47 subjects, 104 teeth in group 1; 49 subjects, 105 teeth in group 2) remained. The WSLs had a mean DD reading at baseline of 17.66 ± 5.36 in group 1 and 16.19 ± 5.70 in group 2, which decreased by 5.78 and 2.44, respectively, at the 3-month follow-up visit and decreased by 7.56 and 3.09, respectively, at the 6-month follow-up visit. The mean baseline DD readings in the two groups were similar (t test, P > 0.05). There was statistically significant differences between the mean DD readings of the two groups at the 3-month (P < 0.05) and at the 6-month follow-up visits (P < 0.01). Topical fluoride varnish application is effective in reversing WSLs after debonding and should be advocated as a routine caries prevention measure after orthodontic treatment.

Novel treatment of white spot lesions: A report of two cases

This case report describes a technique used to treat smooth surface white spot lesions microinvasively. It is based on the infiltration of an initial enamel caries lesion with low-viscosity light-curing resins called infiltrants. The surface layer is eroded and desiccated, followed by resin infiltrant application. The resin penetrates into the lesion microporosities driven by capillary force and is hardened by light curing. Infiltrated lesions lose their whitish appearance and look similar to sound enamel. Additionally, the treatment prevents lesion progression. This technique might be an alternative to microabrasion and restorative treatment in treating of white spot lesions of esthetically relevant teeth.

Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate

This study aims to investigate the effect of topical applications of 10% casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSL) detected after treatment with fixed orthodontic appliances. Sixty healthy adolescents with ≥1 clinically visible WSL at debonding were recruited and randomly allocated to a randomised controlled trial with two parallel groups. The intervention group was instructed to topically apply a CPP-ACP -containing agent (Tooth Mousse, GC Europe) once daily and the subjects of the control group brushed their teeth with standard fluoride toothpaste. The intervention period was 4weeks and the endpoints were quantitative light-induced fluorescence (QLF) on buccal surfaces of the upper incisors, cuspids and first premolars and visual scoring from digital photos. The attrition rate was 15%, mostly due to technical errors, and 327 lesions were included in the final evaluation. A statistically significant (p < 0.05) regression of the WSL was disclosed in both study groups compared to baseline, but there was no difference between the groups. The mean area of the lesions decreased by 58% in the CPP-ACP group and 26% in the fluoride group (p = 0.06). The QLF findings were largely reflected by the clinical scores. No side effects were reported. Topical treatment of white spot lesions after debonding of orthodontic appliances with a casein phosphopeptide-stabilised amorphous calcium phosphate agent resulted in significantly reduced fluorescence and a reduced area of the lesions after 4weeks as assessed by QLF. The improvement was however not superior to the "natural" regression following daily use of fluoride toothpaste.

White Spot Lesions: Formation, Prevention, and Treatment

As oral hygiene becomes more difficult in patients with fixed orthodontic appliances, the decalcification of the enamel surface adjacent to these appliances is prevalent. Decalcification is manifested as a white spot lesion (WSL), and orthodontic patients develop significantly more WSLs than nonorthodontic patients. If WSLs are left untreated, they may progress to produce carious cavitations, and may also present esthetic problems. Thus, the prevention, diagnosis, and treatment of WSLs is crucial to minimize tooth decay as well as tooth discoloration that could compromise the esthetics of the smile.