White Spot Lesions In Orthodontics Research Articles

White spot lesions in orthodontics: consensus statements for prevention and management.

To establish consensus recommendations for clinicians to manage white spot lesions (WSLs) during orthodontic treatment. Three task force members reviewed the literature to identify best practices for minimizing WSLs during orthodontic treatment. Each draft statement was read to the task force members by a facilitator, followed by voting, accepting, or editing if necessary. The statements were then sent electronically by an independent third party (Magellan Medical Technology Consultants Inc, Minneapolis, Minn) to a previously formed content validation panel consisting of 20 independent private practitioners and clinical academicians for validation. Twenty-one statements were developed and sent for content validation. While 19 statements achieved a content validation index (CVI) of 0.78, two items did not. These items were edited by the task force members based on qualitative feedback from content validation participants. Each of these revised statements did achieve a CVI of 0.78 on second evaluation from the content validation panelists and therefore were included in this document. To reduce the risk of WSLs, it is essential to implement individualized caries management measures based on a comprehensive assessment of the patient's oral and systemic health. Effective at-home and professional mechanical and chemical plaque control should be implemented for high-risk orthodontic patients. Fluoride to support prevention and materials such as orthodontic sealants should also be used to provide a physical barrier around the brackets in high-risk patients. By following these guidelines, orthodontic professionals can help promote oral health and minimize the need for restorative treatment.

Applications of photothermally mediated nanohybrids for white spot lesions in orthodontics

In orthodontic treatment, cariogenic bacteria in the oral cavity are the main cause of enamel white spot lesions (WSLs). Therefore, to effectively prevent and treat WSLs, it is crucial to inhibit the cariogenic bacterial activity while promoting the remineralization of demineralized tooth enamel. However, fluoride preparations commonly used for the prevention and treatment of WSLs can induce dental fluorosis if ingested in excess, and their remineralization effect is limited by the residual hydroxyapatite (HAp) content and salivary Ca2+ and PO43- levels. In this study, we propose a strategy (CMCS/ACP@PDA) for antibacterial and remineralization of WSLs by a nanohybrid of carboxymethyl chitosan (CMCS)-stabilized amorphous calcium phosphate (ACP) loaded polydopamine nanoparticles (PDA NPs) based on biomimetic remineralization techniques and biocompatible near-infrared (NIR) photoactivation therapy. The nanohybrid utilizes the excellent photothermal conversion ability of polydopamine for antimicrobial purposes, while CMCS with its own positive and negative charges (-NH3+ and -COO-) acts as a biomimetic mineralizing agent to stabilize ACP, supplemented with abundant Ca2+ and PO43- for remineralization of demineralized enamel. The results showed that CMCS/ACP@PDA could effectively inhibit the adhesion of cariogenic Streptococcus mutants (S. mutants) with high bactericidal rates. In addition, the remineralization of demineralized enamel by nanohybrid was more effective after 7 days of in vitro mineralization. This study provides a theoretical and experimental basis for the use of CMCS/ACP@PDA nanohybrid materials as potential materials against WSLs.

Candida albicans enriched in orthodontic derived white spot lesions and shaped focal supragingival bacteriome.

White spot lesions (WSLs) are common enamel infectious diseases in fixed orthodontic treatment, which might attribute to the dysbiosis of oral microbiome. However, the correlation of Candida albicans with oral bacteriome in WSLs still remains unrevealed. This study investigated the carriage of C. albicans and how it shaped the bacterial community in disease or healthy supragingival plaque, to explore the potential role of interkingdom interaction in orthodontic WSLs. In this study, 31 patients with WSLs (WSLs) and 23 healthy patients (Health) undergoing fixed orthodontic treatment were enrolled. The supragingival microbiota in both groups were determined using 16S rRNA gene sequencing. Colonization and abundance of C. albicans in the plaque were determined via culture-dependent and -independent methods. Among WSLs patients, the correlation of C. albicans and bacteriome was analyzed under QIIME2-based bioinformatics and Spearman's correlation coefficient. The raw reads were deposited into the NCBI Sequence Read Archive (SRA) database (Accession Number: SRP404186). Significant differences in microbial diversity as well as composition were observed between WSLs and Health groups. Leptotrichia remarkably enriched in the WSLs group, while Neisseria and Cardiobacterium significantly enriched in the Health group. In addition, 45% of WSLs patients were C. albicans carriers but none in patients without WSLs. Among all WSLs patients, beta diversity and microbial composition were distinguished between C. albicans carriers and non-carriers. In C. albicans carriers, Corynebacterium matruchotii and Streptococcus mutans significantly enriched whereas Saccharibacteria_TM7_G-1 significantly depleted. The abundance of C. albicans was positively associated with bacteria such as Streptococcus mutans, while the negative correlation was detected between C. albicans and several bacteria such as Cardiobacterium hominis and Streptococcus sanguinis. Our study elucidated the distinguished supragingival plaque microbiome between orthodontic patients with and without WSLs. C. albicans frequently existed and enriched in orthodontic derived WSLs. The carriage of C. albicans shape plaque bacterial community in demineralized lesions and might play roles in WSLs pathogenesis.

EFFECTIVENESS OF RESIN INFILTRATION IN MANAGEMENT OF POST ORTHODONTIC WHITE SPOT LESIONS - A CLINICAL STUDY

Objective: To assess the effectiveness and durability of resin infiltration (ICON, DMG, Hamburg, Germany) in the management of post orthodontic white spot lesions. Material & Methods: A clinical trial was conducted among 30 children who had undergone fixed orthodontic therapy presented with white spot lesions (WSLs) on maxillary or mandibular incisors and canines after debonding. Identification of WSLs was done with International Caries Detection and Assessment System (ICDAS) II criteria. The clinical photographs recorded were used to measure the size of lesion. The color assessment of the lesion and sound adjacent enamel was recorded by using spectrophotometer. Area of the lesion was calculated using Image analyzing software. The selected samples were treated with Resin infiltration- Icon, DMG, Germany, The WSLs were evaluated immediately following resin infiltration, 1, 3, 6 and 12 months. Results: There was significant reduction in lesion area, and improvement in color of white spot lesions treated with resin infiltration. Conclusion: Resin Infiltration have desired and durable esthetic improvement in terms of reduction in the area as well as color of post orthodontic white spot lesions.

Management of Post Orthodontic White Spot Lesions Using Resin Infiltration and CPP-ACP Materials- A Clinical Study

The purpose of this present study was to assess and compare the effectiveness and durability of topical application of remineralizing agent Casein Phospho Peptide (CPP-ACP, Toothmousse, GC corporation, Germany, Europe) and Resin infiltration (ICON, DMG, Hamburg, Germany) in the management of post orthodontic white spot lesions. A Randomized Control clinical trial was conducted among 60 children who had undergone fixed orthodontic therapy presented with white spot lesions (WSLs) on maxillary or mandibular anteriors after debonding. Identification of WSLs was done with International Caries Detection and Assessment System (ICDAS II) criteria. The clinical photographs recorded were used to measure the size of lesion. The color assessment of the lesion and sound adjacent enamel was recorded by using spectrophotometer (Vita-Easy shade 4.0, VITA Zahnfabrik, Germany). Area of the lesion was calculated using Digimizer software (Digimizer, MedCalc Software, Belgium). The selected samples were randomly allocated into two groups: Group I- Resin infiltration- Icon, DMG, Germany, (n=30) and Group II- Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)-GC Toothmousse, GC Corporation, Germany, (n=30). The WSLs were evaluated immediately following resin infiltration, and in CPP-ACP group after 1 month. In both the groups lesions were evaluated at 1, 3, 6 and 12 months. There was significant reduction in lesion area, and improvement in color of white spot lesions with both of the treatment modalities. Both the resin infiltration and CPP-ACP have desired and durable esthetic improvement in terms of reduction in the area as well as color of post orthodontic white spot lesions.

White spot lesions in orthodontics: prevention and treatment. A descriptive review.

White spot lesions (WSL) are demineralizations of the enamel found on the tooth surfaces. WSL are considered incipient non-cavitated caries caused by bacterial plaque activity. Subjects with malocclusion such as dental crowding and fixed orthodontic appliances have a greater number of retention sites and consequently difficulty in cleaning and greater predisposition to caries. In fact, WSL are a frequent side effect of orthodontic fixed treatments. The prevention and resolution of this problem is the goal of any orthodontist because untreated WSL can lead to the formation of deeper dental caries and restorative treatment with consequent compromise of patient satisfaction with the aesthetic result obtained at the end of the orthodontic treatment. This review is intended not only for orthodontists but also for general and pediatric dentists who want to learn how to correctly prevent, and treat this unsightly problem. On the market there are many products sold to achieve this goal, some of them can be managed independently by the patient at home, others require the intervention of the dentist. The purpose of this literature review is to understand how these substances work, to identify with which of the currently most widespread the best results have been obtained and then to provide useful information to guide the clinician in choosing the most suitable one for the patient.

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.

Sealants and White Spot Lesions in Orthodontics: A Review

This literature review aims to update the evidence for prevention of white spot lesion (WSL) using orthodontic sealants among patients with fixed orthodontic appliances. As a major issue among orthodontists, prolonged treatment duration increases the risk of plaque development around orthodontic brackets and bands. In consequence, this can lead to heightened risk for caries development and higher possibility of WSL development around fixed orthodontic brackets. Increased prevalence of WSLs generally occurs during orthodontic treatment. This review explored various products of orthodontic sealants used to prevent WSL. Orthodontic sealants do not require patient compliance and thus will further lessen the burden among orthodontists as well as support enamel surface for a long period of time during treatment. Certain factors, however, are considered important in the efficacy of these sealants, such as antibacterial activity, color stability, resistance to acid and brush abrasion, and their effect on shear bond strength (SBS). The review showed that the use of orthodontic sealants in preventing WSLs during and after fixed orthodontic treatment is significantly effective. However, the bioactive glass is deemed more effective against WSL development due to its ability to immediately repair enamel surface, low cytotoxicity, and high biocompatibility. Moreover, clinical studies on bioactive glass are still needed to determine its acceptability among patients with fixed orthodontic appliance. Development of WSL around the orthodontic brackets during treatment is a difficult task among orthodontists. As such, this review explored various strategies to effectively combat WSL development for good oral health and esthetics during orthodontic treatment.

Novel rechargeable nano-CaF2 orthodontic cement with high levels of long-term fluoride release

ObjectivesFluoride-containing orthodontic cements are used to combat white spot lesions (WSLs) in enamel. However, the fluoride (F) ion releases from these cements are relatively low and short-term. The objectives of this study were to develop a novel rechargeable orthodontic cement with nanoparticles of calcium fluoride (nCaF2) to provide long-term and high levels of F release, and to investigate F recharge and physical and cytotoxic properties. MethodsThe nCaF2 with a mean particle size of 58 nm were synthesized using a spray-drying method. Pyromellitic glycerol dimethacrylate (PMGDM), ethoxylated bisphenol A dimethacrylate (EBPADMA), 2-hydroxyethyl methacrylate (HEMA) and bisphenol A glycidyl dimethacrylate (BisGMA) were used to prepare the cements (denoted PE and PEHB resins). A resin-modified glass ionomer (RMGI) served as control. Enamel shear bond strength (SBS), cytotoxicity, and F ion recharge and re-release were evaluated. ResultsnCaF2 cements had good SBS and excellent biocompatibility that were comparable to RMGI (p > 0.1). After a recharge for 1 min, the F re-release from PEHB + 30%nCaF2 cement was 80% higher than RMGI (p < 0.05). Increasing nCaF2 content from 20% to 30% greatly increased the F ion re-release (p < 0.05). The F ion re-release of nCaF2 cements did not decrease with increasing the number of recharge and re-release cycles (p > 0.1). ConclusionsA novel F ion-rechargeable orthodontic cement containing nCaF2 was developed with clinically acceptable enamel SBS, good biocompatibility, and sustained F ion recharge and re-release that were 1.8 folds that of a commercial RMGI. Clinical SignificanceNovel rechargeable nCaF2 orthodontic cement is promising to provide the needed long-term and high levels of F ion releases to inhibit WSLs in orthodontics.

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.

Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis.

Although orthodontic white spot lesions (WSLs) are one of the most often and most evident adverse effects of comprehensive fixed appliance treatment, the efficacy of interventions for WSLs has not yet been adequately assessed in an evidence-based manner. Aim of this systematic review was to assess the therapeutic and adverse effects of interventions to treat post-orthodontic WSLs from randomized trials in human patients. An unrestricted electronic search of eight databases from inception to May 2016. Randomized controlled trials assessing any interventions for post-orthodontic WSLs on human patients. After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs), including their 95% confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. A total of 20 unique studies and a total of 942 (42 per cent male and 58% per cent female) patients were included, with an average age of 16.2 years and a mean number of 8.2 WSLs (range 2.2 to 45.4) per patient. These were allocated to adjunct treatment with casein phosphopeptide-stabilized amorphous calcium phosphate creams, external tooth bleaching, low- or high-concentration fluoride films, gels, mouthrinses or varnishes, resin infiltration, miswak chewing sticks, bioactive glass toothpastse, or to no adjunct treatment (i.e. conventional oral hygiene). The monthly use of fluoride varnish was the best supplement to improve WSLs in terms of lesion area (1 trial; MD = -0.80 mm2; 95% CI = -1.10, -0.50 mm2; P < 0.05; high quality) and enamel fluorescence (3 trials; SMD = -0.92; 95% CI = -1.32, -0.52; P < 0.05; high quality), followed by the use of fluoride film. WSL treatment did not provide a considerable improvement in their clinical evaluation (3 trials; OR = 0.97; 95% CI = 0.60, 1.56; P > 0.05; moderate quality), with imprecision due to small sample size being the main limitation of existing evidence. Based on the existing trials, interventions for post-orthodontic WSLs, mainly fluoride varnish, seem to be effective, but further research is needed to elucidate their clinical relevance. PROSPERO (CRD42016037538).

Lack of reliable evidence of the effectiveness of remineralising agents for the treatment of post orthodontic white spot lesions

PubMed, Medline, Web of Science and the Cochrane Library databases were searched. Selection was conducted independently by two reviewers, only randomised controlled trials were included. Study quality was assessed using the Cochrane risk of bias approach. Data abstraction was carried out independently by two reviewers and qualitative summary presented, because of the heterogeneity of the interventions and outcome measures. Seven studies were included, all except one (of medium risk) were considered to be at high risk of bias. Three studies evaluated fluoride preparations (50-ppm sodium fluoride mouth rinse, 5% sodium fluoride varnish and 0.5% sodium fluoride chewing sticks). Four compared remineralising agents containing casein phosphopeptide amorphous calcium phosphate or casein phosphopeptide amorphous calcium fluoride phosphate. Based on the literature, there is a lack of reliable evidence to support the effectiveness of remineralising agents for the treatment of post orthodontic white spot lesions.

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.

Risk factors and management of white spot lesions in orthodontics.

The formation of white spot lesions or enamel demineralization around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which mars the result of a successfully completed case. This article is a contemporary review of the risk factors, preventive methods and fate of these orthodontics scars. The importance of excellent oral hygiene practice during fixed orthodontic treatment must be explained. Preventive programs must be emphasized to all orthodontic patients. Suggestions are offered in the literature for ways to prevent this condition from manifesting itself.

Investigation of an Advanced Material for the Infiltration of White Spot Lesions in Orthodontics

In the Romanian population, during the fixed orthodontic treatment, sometimes appear white spot lesions (WSLs). These are areas of demineralized enamel witch untreated lead to the formation of cavited carious lesions. Until now the therapy of choice for such lesions was fluoridation that proved itself inadequate in terms of aesthetics. The innovative solution of the German Firma DMG (Icon®) proposes the filling and reinforcing of the pore system of a WSL with a light-curable resin (Icon-Infiltrant). The purpose of this study was to assess whether the optical coherence tomography (OCT) can evaluate, in vitro, by en face scans the penetration of this advanced new material into natural enamel caries. We applied the classic therapeutic procedures proposed by the German company. After infiltration of the WSL we observed a deep resin penetration. Clinically there was a significant improvement in the aesthetics of the affected tooth surfaces and their evolution was stopped demonstrating that this technique is effective in the therapy of WSLs at patients with fixed orthodontic therapy. Also OCT proved to be a reliable technique for acquiring images of resin infiltrated WSLs recommending this technology for further fundamental studies in the field.