Development Of White Spot Lesions Research Articles

Herbal Extract and White Spot Lesion: A Review

One of the most important complications of orthodontic treatment with fixed appliances is the development of white spot lesions (WSL) which represent the first clinical observation of dental caries. Fluoride is an efficient prophylaxis for WSL; however, its excessive use may lead to fluorosis. In addition, other chemicals (e.g., chlorhexidine) that have bactericidal effects may negatively affect the oral microflora. In the last decade, interest has shifted to using natural products that have beneficial effects on health. Using dental products (toothpaste, mouthwash, or oral gel) containing herbal extracts, has been shown to inhibit pathogenesis of cariogenic bacteria and consequently reduces enamel demineralization. Future longitudinal and in vivo studies are needed to explore the advantages and disadvantages of dental products containing herbs.

Cytotoxicity evaluation, antibacterial effect, and degree of conversion of QAM-containing adhesives.

The aim of this study was to evaluate the influence of adding quaternary ammonium methacrylates (QAMs) to experimental adhesives by assessing the degree of conversion (DC), cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. Two QAMs were added to an experimental adhesive: dimethylaminododecyl methacrylate bromododecane (DMADDM) or dimethylaminododecyl methacrylate bromohexadecane (DMAHDM) at three concentrations each: 1, 2.5, and 5 wt.%. Experimental adhesive without QAMs (control group) and commercially available Transbond XT Primer (3M Unitek, Monrovia, California, USA) were used for comparisons. The adhesives were tested for DC, cytotoxicity against keratinocytes and fibroblasts, and antibacterial activity against biofilm formation. DC, cytotoxicity against fibroblasts, and antibacterial activity were analyzed using one-way ANOVA and Tukey's multiple comparisons. Cytotoxicity against keratinocytes was evaluated using the Kruskal Wallis and Dunn's post-hoc (α = 5%) tests. Transbond showed lower DC as compared to 5% DMAHDM, 1% DMADDM, and 5% DMADDM (p < 0.05). However, all groups presented proper DC when compared to commercial adhesives in the literature. In the evaluation of cytotoxicity against keratinocytes, Transbond induced higher viability than 2.5 wt.% groups (p < 0.05). Against fibroblasts, Transbond induced higher viability as compared to 5 wt.% groups (p < 0.05). DMAHDM at 5 wt.% reduced biofilm formation when compared to all the other groups (p < 0.05). Despite their cytotoxic effect against keratinocytes, gingival fibroblasts showed higher viability. DMAHDM at 5 wt.% decreased Streptococcus mutans viability. The incorporation of DMAHDM at 5 wt.% may be a strategy for reducing the development of white spot lesions.

Evaluation of remineralizing efficiency of two calcium-based non-fluoridated remineralizing agents for the prevention of white spot lesions (WSL): A comparative FESEM &amp; EDS in-vitro study

This research work was designed to appraise and equate the remineralizing efficiency of two calcium-based phosphate delivery agents, Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) and Calcium Sucrose Phosphate (CaSP) for preventing the development of White Spot Lesions (WSL) around the orthodontic brackets. Forty orthodontically removed premolar teeth were randomly allocated to Group 1(n=20) - (CPP-ACP) and Group 2(n=20) - (CaSP). All the specimens were subjected to FESEM and EDS analysis before the initial demineralization phase and after 14 days of the pH cycling phase, to observe and record changes in surface topography and mineral content (Ca/P ratio % wt.). Statistical data for the Intragroup comparison were analyzed by using Paired sample t-test, whereas for the Intergroup comparison, an Unpaired t-test was performed. Furthermore, the One-way ANOVA test was applied for comparing Intragroup data and the Post-hoc Tukey test was applied to compare Intergroup data. Group 1 samples showed an 11.3%increase in remineralization and Group 2 samples showed a 21.3%increase in remineralization, indicating a statistically significant (p &amp;#60; 0.05) 11% of greater remineralizing efficiency of CaSP. The use of Calcium Sucrose Phosphate (CaSP) tooth cream around the orthodontic brackets seems to produce significantly better remineralization effects.

Pre-treatment oral microbiome analysis and salivary Stephan curve kinetics in white spot lesion development in orthodontic patients wearing fixed appliances. A pilot study

BackgroundWhite spot lesions (WSLs) are a formidable challenge during orthodontic treatment, affecting patients regardless of oral hygiene. Multifactorial in nature, amongst potential contributors to their development are the microbiome and salivary pH. The aim of our pilot study is to determine if pre-treatment differences in salivary Stephan curve kinetics and salivary microbiome features correlate with WSL development in orthodontic patients with fixed appliances. We hypothesize that non-oral hygiene determined differences in saliva could be predictive of WSL formation in this patient population through analysis of salivary Stephan curve kinetics, and that these differences would further manifest as changes in the oral microbiome.MethodsIn this prospective cohort study, twenty patients with initial simplified oral hygiene index scores of “good” that were planning to undergo orthodontic treatment with self-ligating fixed appliances for at least 12 months were enrolled. At pre-treatment stage, saliva was collected for microbiome analysis, and at 15-minute intervals after a sucrose rinse over 45 min for Stephan curve kinetics.Results50% of patients developed a mean 5.7 (SEM: 1.2) WSLs. There were no differences in saliva microbiome species richness, Shannon alpha diversity or beta diversity between the groups. Capnocytophaga sputigena exclusively and Prevotella melaninogenica predominantly were found in WSL patients, while Streptococcus australis was negatively correlated with WSL development. Streptococcus mitis and Streptococcus anginosus were primarily present in healthy patients. There was no evidence to support the primary hypothesis.ConclusionsWhile there were no differences in salivary pH or restitution kinetics following a sucrose challenge and no global microbial differences in WSL developers, our data showed change in salivary pH at 5 min associated with an abundance of acid-producing bacteria in saliva. The results suggest salivary pH modulation as a management strategy to inhibit the abundance of caries initiators. Our study may have uncovered the earliest predecessors to WSL/caries development.

Microbiome and metabolome associated with white spot lesions in patients treated with clear aligners.

White spot lesions (WSLs) have long been a noteworthy complication during orthodontic treatment. Recently, an increasing number of orthodontists have found that adolescents undergoing orthodontic treatment with clear aligners are at a higher risk of developing WSLs. The oral microbiota and metabolites are considered the etiologic and regulatory factors of WSLs, but the specific impact of clear aligners on the oral microbiota and metabolites is unknown. This study investigated the differences in the salivary microbiome and metabolome between adolescents with and without WSLs treated with clear aligners. Fifty-five adolescents (aged 11-18) with Invisalign appliances, 27 with and 28 without WSLs, were included. Saliva samples were analyzed using 16S rRNA gene sequencing and ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS); the data were further integrated for Spearman correlation analysis. The relative abundances of 14 taxa, including Actinobacteria, Actinomycetales, Rothia, Micrococcaceae, Subdoligranulum, Capnocytophaga, Azospira, Olsenella, Lachnoanaerobaculum, and Abiotrophia, were significantly higher in the WSL group than in the control group. Metabolomic analysis identified 27 potential biomarkers, and most were amino acids, including proline and glycine. The metabolites were implicated in 6 metabolic pathways, including alanine, aspartate and glutamate metabolism; glycine, serine and threonine metabolism; and aminoacyl-tRNA biosynthesis. There was a correlation between the salivary microbial and metabolomic datasets, reflecting the impact of clear aligners on the metabolic activity of the oral flora. A concordant increase in the levels of Lachnoanaerobaculum, Rothia, Subdoligranulum and some amino acids had predictive value for WSL development. In summary, when adolescents undergo long-term clear aligner therapy with poor oral hygiene habits, clear aligners can disrupt the balance of the oral microecosystem and lead to oral microbiota dysbiosis, thereby increasing the risk of developing WSLs. Our findings might contribute to the understanding of the pathogenesis of WSLs and provide candidate biomarkers for the diagnosis and treatment of WSLs associated with clear aligners.

Effect of patients' attitude and perception of oral hygiene on white spot lesion development and plaque accumulation during orthodontic treatment : Asurvey of patients with fixed appliances.

To explore the impact of oral hygiene practices, as well as beliefs and attitudes toward orthodontic treatment on white spot lesion (WSL) development and plaque accumulation in orthodontic patients. Atotal of 106individuals (61female, 45male) patients aged 10-49years who were treated with fixed appliances treatment completed a14-question survey regarding aspects of their oral hygiene (OH) and orthodontic visits. The number of teeth with WSL and the plaque indexes were recorded for each patient. Poisson regression and linear regression models were used to analyze the association of survey responses with the observed WSLs and plaque accumulation, respectively. Participants of both sexes reported similar beliefs about OH (66% agreed to the importance of OH statements), practiced proper OH (69% good practices), and reported asimilar perception regarding the quality of their OH routine and of their orthodontic treatment. However, in total, none of the findings was significantly related to the development of WSLs or plaque accumulation. Significantly fewer WSLs were observed in male patients who perceived themselves as having good control over OH. Female participants reported significantly higher expectations regarding posttreatment smile improvement compared to males. Overall, responses by male participants were deemed to be more accurate than those by female participants when related to WSL development and plaque accumulation. Our survey hints at apossible relationship between WSL formation and patients' sense of control over OH routine in males. Future studies should further explore the effect of sex on the attitude toward and perception of OH in orthodontic patients. This survey highlights the multifactorial nature of WSL development in orthodontic patients and the complexity of predicting patient compliance.

White Spot Lesions: Biomaterials, Workflows and Protocols

The development of White Spot Lesions (WSLs) after completion of treatment is immensely discouraging to a specialty whose ultimate goal is to improve dentofacial aesthetics. This paper highlights state-of-the-art biomaterials that are used in the prevention, progression and treatment of WSLs, in the form of workflows to guide a clinician in decision-making at different treatment timings; before, during and after treatment. Scholarly literature has been screened until November 2022 for studies that assessed WSLs management. The mechanism of action and recommended mode of application have been elaborated upon. Additionally, the level of evidence of each treatment modality at different treatment timings has been highlighted according to its hierarchy. Although various attempts have been made to prevent, minimize, or treat WSLs, no clear guidelines for the management of WSLs are deemed to be a standardized protocol. By integrating currently available evidence based-clinical data, this review provides systematic flowcharts to guide clinicians in the decision-making process and patients about the prevention and treatment of the WSLs.

Prevalence of White Spot Lesions in Patients Treated with Passive Selfligation Orthodontic Appliances: A Retrospective Study

Introduction: White Spot Lesions (WSLs), also known as “white opacity,” are the result of the demineralisation occurring on tooth surfaces in patients undergoing fixed orthodontic treatment. In addition to the various other factors, development of WSLs can also be influenced by the type of brackets and ligation employed. Aim: Evaluating the prevalence of WSL among patients who underwent fixed orthodontic treatment with passive self-ligation mechanotherapy. Materials and Methods: This retrospective study was conducted using photographic records of patients who received orthodontic treatment using a passive self-ligation system at Saveetha Dental College in Chennai, Tamil Nadu, India. The records of 97 patients in the age range of 10 to 30 years who received orthodontic treatment using the Damon self-ligating system regardless of gender were obtained from April 2016 to April 2021. The presence of WSL was investigated retrospectively before and after treatment. Modified Gorelick’s scale was used for scoring the lesions. Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS) software version 17.0 and paired t-tests were done. Results: Data of total of 97 subjects (45 females (46.39%) and 52 males (54.63%), mean age: 17.70±5.72 years) undergoing orthodontic treatment with self-ligation brackets was included in the study. The overall prevalence percent of WSLs in the study was 71.13%. The prevalence of WSLs among females was 70.5% and in males, it was 73%. There was no statistical significance for association between gender and severity of WSLs and there was a statistical significance for association of age group and severity of WSLs in upper lateral incisors and canines (p&lt;0.05). Conclusion: The most commonly involved teeth were upper central incisors and second premolars, and the overall WSLs incidence in subjects undergoing passive self-ligation therapy was 71.9 %. No influence of the gender was noted and severe lesions were commonly noted in maxillary lateral incisors of young individuals.

Influence of resin infiltration pretreatment on the microleakage under orthodontic bracket (an in vitro study).

In order to assess the changes in tooth orthodontic adhesive interface microleakage after applying a caries resin penetrated to the sound enamel tooth surface in different storage media. A total of 60 human maxillary first premolars (orthodontic extraction) were collected by random separation of the teeth into two equal groups. The control group was classified into three subgroups (n = 10) (control in deionized water, control in milk, and control in energy drink), while the experimental one (treated with ICON) was categorized into three subgroups (n = 10) (ICON in deionized water, ICON in milk, and ICON in energy drink) incubation phase lasted three weeks in total. A one-way analysis of variance (ANOVA) yielded a significant difference between all experimental subgroups (ICON in deionized water, ICON in milk, and ICON in energy drink) and control subgroups (control in deionized water, control in milk, and control in energy drink). The control group in the energy drink subgroup had the highest mean microleakage value when compared to the other subgroups, whereas the resin-infiltrated group in deionized water had the lowest mean value. According to the results of the T-test, ICON pre-treatment tooth samples had significantly lower mean values of microleakage than non-ICON tooth samples. The adhesive system (control group) revealed that a resin infiltrate on a sound enamel surface prior to orthodontic bracket bonding reduced bracket tooth interface microleakage in all examined samples. The ICON-infiltrated surface was discovered to provide a secondary preventive strategy against white spot lesion development by reducing microleakage under brackets.

Combined Effect of Fluoride Mouthwash and Sub-ablative Er:YAG Laser for Prevention of White Spot Lesions around Orthodontic Brackets

Background: Development of white spot lesions (WSLs) around orthodontic brackets compromises esthetics and necessitates additional dental treatments. Objectives: This study aimed to assess the efficacy of fluoride mouthwash combined with Er:YAG laser irradiation for the prevention of WSLs around orthodontic brackets. Methods: Orthodontic brackets were bonded to 50 bovine incisors. The entire tooth surface was coated with acid-resistant varnish except for a margin around the brackets. The microhardness of the teeth was measured at the respective area using the Vickers hardness test. The teeth were then randomly divided into five groups (n=10) of control (Gc), Orthokin fluoride mouthwash (Gf), 100 mJ/cm2 Er:YAG laser (Gl), laser + mouthwash (Glf), and mouthwash + laser (Gfl). Then, the teeth underwent pH cycling according to the standard protocol for demineralization. The microhardness of the teeth was measured again, and the percentage of change in microhardness was calculated. The amount of calcium released during pH cycling was quantified using atomic absorption spectroscopy. Data were analyzed using one-way ANOVA and Tukey’s test. Results: Calcium release (indicative of demineralization) in the Gf, Gfl, and Glf groups was significantly lower than that in the Gc and Gl groups (P&lt;0.05). The reduction in surface microhardness was also the same in the five groups with no significant difference (P&gt;0.05). Conclusion: Fluoride mouthwash combined with Er:YAG laser or Er:YAG laser alone cannot decrease the incidence of WSLs around orthodontic brackets compared to fluoride mouthwash alone.

Effects of an orthodontic primer containing amorphous fluorinated calcium phosphate nanoparticles on enamel white spot lesions

ObjectivesThe study investigated the effects of an orthodontic primer containing amorphous fluorinated calcium phosphate (AFCP) nanoparticles on enamel white spot lesions (WSLs). Materials and methodsThe AFCP nanoparticles were prepared and incorporated into Transbond XT Primer. Thirty-two human enamel slices were highly polished and randomly divided into four groups: no part covered (control), half covered with a primer containing 0 wt%, 25 wt%, and 35 wt% AFCP. Subsequently, samples were challenged by a modified pH-cycling and characterized by color measurement, micro-computed tomography, and scanning electron microscope (SEM). The bonding properties of the primers containing AFCP were assessed using shear bond strength test, and the mouse fibroblasts (L929) were employed to evaluate the cytotoxicity. ResultsWhen the enamel was challenged by pH cycling, 25 wt% and 35 wt% AFCP groups exhibited less color change (ΔE) and less mineral loss than the control and 0 wt% AFCP groups. The SEM images showed that the original microstructural integrity and mineral deposition rate of the enamel surface were better in the 25 wt% and 35 wt% AFCP groups. In particular, the 35 wt% AFCP group exhibited the best performance after 3 weeks of pH cycling. The shear bond strength and cell viability revealed no significant difference among the tested groups (P > 0.05). ConclusionUsing the primer containing 35 wt% AFCP might be a promising strategy for preventing the occurrence and development of WSLs during orthodontic treatment.

In vitro surface analysis of the brushing resistance of orthodontic sealants using two different profilometric evaluation methods

The enamel can be protected by applying orthodontic sealants at the bracket base to avoid the development of white spot lesions caused by inadequate oral hygiene. The aim of this study was to investigate the mechanical resistance of five commonly used orthodontic sealants against brushing in comparison to a positive group. Hydroxyapatite discs were bonded with a metal bracket and a piece of arch-wire was ligated in order to simulate a daily clinical situation (n = 48). Samples were divided into 6 groups of respectively 8 specimens. Sealants were applied around the bracket base according to manufacturer’s instructions. Following sealants were used: Group 1: Pro Seal (Reliance Orthodontic Products, Itasca, Illinois, USA); 2: Light Bond (Reliance Orthodontic Products, Itasca, Illinois, USA); 3: ClinproXT Varnish (3M ESPE, Seefeld, Germany); 4: ProtectoCaF2 Nano (BonaDent GmbH, Frankfurt am Main, Germany); 5: Fluor Protector and 6: Tetric EvoFlow (both Ivoclar Vivadent AG, Schaan Liechtenstein). Tooth brushing were simulated for 6 weeks and 6 months with an electric toothbrush. The sealant thickness was measured by mechanical (MP) and optical profilometry (OP) at baseline, after 6 weeks and after 6 months of brushing. Statistical analysis was performed according to two mixed linear models and post hoc Tukey–Kramer comparisons. The significance level was set at 5% (α ≤ 0.05). Pro Seal (MP: 9%; OP: 22%) and Light Bond (MP: 19%; OP: 16%) showed the lowest changes in sealant thickness after 6 months of simulated brushing. ClinproXT Varnish and Tetric EvoFlow recorded no statistically significant results (p > 0.05). The fluoride varnishes ProtectoCaF2 Nano and Fluor Protector could not be conclusively evaluated since the thickness of the sealants could not be determined at baseline. The results of both evaluation methods MP and OP are in good agreement. Pro Seal and Light Bond were resistant against tooth brushing and were able to adequately keep the bracket environment sealed even after 6 months. The two different measuring methods, MP and OP, provide a precise impression of the changes in the surface.

An assessment of mineral concentration of dental enamel neighbouring hypothetical orthodontic brackets using X-ray microtomography

ObjectivesDifferences in the mineral concentration (MC) level of dental enamel may represent a precursor of white spot lesions adjacent to fixed orthodontic brackets. The aim of the current in vitro study was to compare the MC level central, occlusal and cervical to orthodontic attachments. Methods and MaterialsA total of 16 enamel blocks were obtained from sound human premolar samples extracted for orthodontic reasons. The buccal portion of the dental enamel blocks was divided into central, occlusal, and cervical regions and then imaged and measured to calculate the level of MC using quantitative X-ray microtomography methods (XMT) at each site. ResultsThere was a substantial variation in the mineral concentration with the lowest level being detected in the cervical region when compared with other regions. The MC of the gingival zone was significantly lower than that of the middle zone (P<0.05) and was insignificantly lower than that of the occlusal zone. ConclusionWithin the limitations of the current study, it can be concluded that the cervical region of the permanent enamel had the lowest mineral concentration using XMT. The cervical region may therefore be more vulnerable to the development of white spot lesions (WSLs) adjacent to a fixed orthodontic appliance during orthodontic treatment. Clinical significanceUsing X-ray microtomography lower mineral concentration in the cervical region of the enamel was observed. This may make these areas particularly susceptible to demineralisation during fixed appliance-based orthodontic treatment and may influence the bond strength of fixed orthodontic attachments.

Quantifying the degree of white spot lesions on enamel caused by different commercial beverages using the Canary Caries Detection System: An in vitro study.

Background. The use of sports and energy drinks has drastically increased in the adolescent population. This population often is in orthodontic treatment, and the use of such drinks with poor oral hygiene promotes the development of white spot lesions (WSLs). Quantifying the degree of the lesion has been limited in the past. The hypothesis was that the Canary Caries Detection System could be used to quantify the degree of WSLs caused by different commercial beverages.Methods. A total of 105 extracted human premolars were divided into seven groups (n=15). Each group was tested in one of six beverages or a phosphate-buffered solution (control). The teeth were exposed to its beverage three times a day for 15 minutes for 28 days. Canary numbers and ambient light and fluorescent photographs were collected at baseline (T0 ) and on days 14 (T1 ) and 28 (T2 ).Results. The paired t test and one-way ANOVA found that T0 to T1 measurements were statistically significant (P<0.0015) and that T0 to T2 measurements were statistically significant (P<0.0001). Visually, the ambient light photographs and fluorescent photographs from T0 to T1 and T1 to T2 correlated with the increase in Canary numbers.Conclusion. This in vitro study revealed a statistically significant increase in the T0 to T1 Canary numbers and a statistically significant increase from T0 to T2 Canary numbers for all the test beverages. Changes in Canary numbers indicated significant changes in mineral density (i.e., demineralization) and development of WSLs on enamel after exposure to sports and energy beverages.

Prevalence of white spot lesions and risk factors associated with the COVID-19 pandemic

BackgroundThe objective of this study was to investigate the impact of the COVID-19 pandemic on the prevalence and persistence of white spot lesions (WSLs) among patients treated with traditional braces.MethodsA group of 434 consecutively finished cases who had pretreatment and post-treatment digital photographs taken were included in this study. Each set of photographs was evaluated by two investigators to determine prepandemic and postlockdown WSLs, in addition to changes in oral hygiene (OH) and other risk factors.ResultsThere was a statistically significant difference in the development of WSLs pre–COVID-19 lockdown (PRL) versus post–COVID-19 lockdown (POL) (P < 0.001). The overall prevalence for the development of WSLs increased to 52.8% POL. For patients with good pretreatment OH, the risk of developing WSLs POL (42.0%) was two times greater than the rate in PRL (20.1%). For patients whose OH worsened during treatment, 81.2% of POL patients developed WSL compared with 69.6% of PRL patients. The incidence of WSLs was statistically greater in the maxillary anterior region POL than PRL, whereas the incidence in the mandibular anterior region did not reach statistical significance. The distribution of WSLs was greater POL for each tooth irrespective of the arch.ConclusionsBecause of the COVID-19 pandemic, the prevalence of visible WSLs increased from 29.5% to 52.8%. Patients whose hygiene worsened during orthodontic treatment are at an increased risk of developing WSLs.

Impact of BMI on patients oral health and patients co-operation undergoing fixed orthodontic mechanotherapy

Over the last decades, overweight and obesity has become a problem in the economically developed world. The increasing number of overweight adults is alarming. During orthodontic therapy with fixed appliances, the development of white spot lesions (WSLs) is a relatively common negative side-effect. Concerning oral health, some evidence exists that there might be an association between overweight and an increased caries risk in children, but this relationship is not unambiguous. Therefore, the aim of this retrospective, explorative study was to compare normal, overweight, and obese orthodontic patients undergoing fixed appliance therapy. Therefore, it was concluded that an increased BMI appears to be a risk factor for less cooperation, a longer treatment duration, and more oral health-related problems during MB treatment, indicating that these patients require special attention during orthodontic therapy.

Perspectives of Orthodontists of the Diagnosis, Prevention, and Management of White Spot Lesions: A Qualitative Study.

ABSTRACTAims:Several factors influence the development of white spot lesions (WSLs), and one of these is fixed orthodontic appliances. This study aims to evaluate the awareness, preventive strategies, and management of WSLs among a group of Orthodontists.Materials and Methods:A qualitative methodology was applied; four focus groups made up a purposive sample from Orthodontists with various training backgrounds while working within the same healthcare services. Results:Three main themes emerged: awareness and ability to diagnose WSLs, perceived influences on the development of WSLs, and prevention and management strategies and barriers to care delivery. All focus groups agreed that there is a need for continuous prevention and preventive strategies of WSLs, particularly among orthodontic patients. There was also a consensus that orthodontic treatment should be delayed until WSLs are managed appropriately.Conclusions:Within the limitation of this study, WSLs were collectively agreed to be a significant issue during fixed orthodontic therapy, and continuous professional development for Orthodontists should include risk factors evaluation, diagnosis, prevention, and management of WSLs.

The efficacy of fluoride varnish vs a filled resin sealant for preventing white spot lesions during orthodontic treatment.

To compare the efficacy of casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) MI Varnish (GC America, Inc, Alsip, IL) and ProSeal (Reliance Orthodontic Products, Itasca, IL) sealant in preventing the development of white spot lesions (WSLs) in orthodontic patients. This prospective randomized clinical trial included 40 orthodontic patients 12-17 years of age. One group had sealants placed on their anterior maxillary teeth, with reapplications every 3 months. The other group had MI Varnish applied every 4-6 weeks. WSL formation and oral hygiene were evaluated at the initial appointment before bonding (T1) and 12 months later (T2). Standardized digital photographs were analyzed using the enamel decalcification index (EDI). Statistical comparisons were made using independent and paired-sample t-tests as well as chi-square tests. In this trial, 43% of patients and 15% of teeth developed new WSLs. Lateral incisors showed the highest incidence of decalcification and WSL formation. WSL formation and EDI score increases during treatment were significantly greater in the gingival region than in the mesial, distal, or incisal regions. Of the EDI scores at T2, 93.8% were 0 and 5.5% were 1. Poor oral hygiene at T2 showed a high positive predictive value (76%) for the development of WSLs. There were no statistically significant between-group differences for the development of WSLs. MI Varnish and ProSeal sealant provided similar levels of protection during the first 12 months of fixed orthodontic treatment. The severity of the WSLs that developed was minimal. WSLs were most likely to develop on lateral incisors and in the gingival regions of teeth, especially among patients with poorer oral hygiene.

Effect of Chlorhexidine Varnish and Fluoride Varnish on White Spot Lesions in Orthodontic Patients- a Systematic Review

Aim:The aim of this study is to critically review the studies that studied the effect of Chlorhexidine varnish and fluoride varnish on White Spot Lesion (WSL) in patients undergoing orthodontic treatment.Materials and Methods:The electronic database PubMed, The Cochrane Library, Medline, Embase, Google Scholar, Web of Knowledge along with a complimentary manual search of all orthodontic journals till the first week of December 2019 was searched. English language study performed on humans, randomized or nonrandomized clinical trials, comparing the effect of fluoride and chlorhexidine varnish on WSL was included in the review. Quality assessment of included studies was performed.Clinical Significance:The need for an adjunct oral hygiene aid to reduce the incidence and prevalence of white spot lesions in orthodontic patients is necessary. The use of these varnishes will aid in the same and thus make the adverse effects of fixed orthodontic treatment negligible.Review of Literature:Enamel demineralization is a significant risk associated with orthodontic treatment when oral hygiene is poor. Prevention of demineralization during orthodontic treatment is one of the greatest challenges faced by clinicians despite modern advances in caries prevention. The development of White Spot Lesions (WSLs) is attributed to prolonged plaque accumulation around the brackets.Results:The search identified a total of 3 studies that were included in this review. One study had Low risk of bias and the remaining 2 studies had moderate overall risk. Results showed that there was a reduction in the incidence of white spot lesions in orthodontic patients after application of chlorhexidine and Fluoride varnish.Conclusion:Low level evidence is available to conclude that the use of chlorhexidine varnishes and fluoride varnishes reduces the prevalence of white spot lesions in patients undergoing fixed orthodontic treatment. Due to its limitations, the results of this systematic review should be handled with caution and further well-planned Randomized Clinical Trial (RCT) are needed to provide a discrete conclusion.

The quality of etched enamel in different regions and tooth types and its significance in bonding and the development of white spot lesions.

To quantify differences in the etch quality of enamel within and between human teeth, which has not previously been attempted. The buccal right and left halves of 27 extracted human teeth were randomly allocated to scanning electron microscopy (SEM) or micro-computed tomography (μCT) for evaluation. The buccal surfaces were pumiced, etched with 37% phosphoric acid gel etchant for 15 seconds, rinsed, and air dried. Each tooth was divided into three regions (incisal, middle, and cervical) and viewed after etching at 1200× magnification with SEM. The μCT scans were taken before and after etching to calculate apparent and material mineral densities. SEM showed greater aprismatic enamel and poorer etch quality (ie, significantly less percentage enamel) for the posterior than anterior teeth and for the cervical region than for the incisal and middle regions of all teeth. Although there were no density differences prior to etching, μCT demonstrated that etching increased material density significantly more for the anterior than posterior teeth. Prior to etching, the enamel in the cervical regions was significantly less dense than the enamel in the middle or incisal regions. Etching significantly increased the material density of all three regions, which decreased initial regional differences. After etching, the apparent density of the cervical region remained significantly lower than the densities of the other two regions. Based on SEM and μCT, there is greater aprismatic enamel and inferior etch quality in the cervical regions of all tooth types and is clinically significant in explaining the failure of sealant retention and the propensity for white spot lesions.