Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference? Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment. Incidence of caries lesions among patients treated with comprehensive orthodontics. Control of White Spot Lesions with Use of Fluoride Varnish or Chlorhexidine Gel During Orthodontic Treatment A Randomized Clinical Trial. Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months—a randomized placebo-controlled clinical trial. Part I: photographic data evaluation Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence. Effect of 1.23% acidulated phosphate fluoride foam on white spot lesions in orthodontic patients: a randomized trial. Minimally invasive resin infiltration of arrested white-spot lesions: a randomized clinical trial. Effect of fluoridated chewing sticks (Miswaks) on white spot lesions in postorthodontic patients. Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial In vitro quantification of white spot enamel lesions adjacent to fixed orthodontic appliances using quantitative light‐induced fluorescence and DIAGNOdent Changes in the oral environment after placement of lingual and labial orthodontic appliances Occurrence and severity of enamel decalcification adjacent to bracket bases and sub-bracket lesions during orthodontic treatment with two different lingual appliances Treatment of orthodontic white spot lesions with a remineralizing dentifrice applied by toothbrushing or mouth trays. Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment Effect of the probiotic bacterium Lactobacillus reuteri on white spot lesion development in orthodontic patients.
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 clinical ly visible WSL at debonding were recruited and r and omly allocated to a r and omised 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 st and ard fluoride toothpaste . The intervention period was 4 weeks 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 result ed in significantly reduced fluorescence and a reduced area of the lesions after 4 weeks as assessed by QLF . The improvement was however not superior to the “ natural ” regression following daily use of fluoride toothpaste Orthodontic treatment with fixed appliances is considered a risk factor for the development of  white spot caries lesions ( WSL ) . Traditionally , brackets are bonded to the buccal surfaces . Lingual brackets are developing rapidly and have become more readily available . Buccal surfaces are considered to be more caries prone than lingual surfaces . Furthermore , lingual brackets are shaped to fit the morphology of the teeth and seal almost the entire surface . In the present study we tested the hypothesis that lingual brackets result in a lower caries incidence than buccal brackets . We tested this hypothesis using a split-mouth design where subjects were allocated r and omly to a group receiving either buccal or lingual brackets on the maxillary teeth and the alternative bracket type in the m and ible . The results indicate that buccal surfaces are more prone to WSL development , especially when WSL existed before treatment . The number of WSL that developed or progressed on buccal surfaces was 4.8 times higher than the number of WSL that developed or progressed on lingual surfaces . When measured using quantitative light-induced fluorescence ( QLF ) , the increase in integrated fluorescence loss was 10.6 times higher buccally than lingually . We conclude that lingual brackets make a difference when caries lesion incidence is concerned INTRODUCTION White spots ( WS ) related to orthodontic treatment are severe cariologic and cosmetic complications , but they are shown to be partially reduced by remineralization or abrasion in short-term follow-ups . In this prospect i ve study , we quantitatively analyzed changes in WS in general and in treatment-related white spot lesions ( WSL ) during orthodontic treatment and at a 12-year follow-up after treatment . In addition , we quantitatively compared the effects of an acrylic bonding material vs a glass ionomer cement ( GIC ) on WSL . METHODS Sum areas of WS and WSL were calculated on scans of st and ardized photos of the vestibular surfaces of 4 teeth in consecutive orthodontic patients ( median treatment time , 1.7 years ) bonded with the 2 material s in a split-mouth design . Comparisons were made in 59 patients before treatment ( BF ) , at debonding ( T0 ) , at 1 year ( T1 ) , and at 2 years ( T2 ) , and in 30 patients at a 12-year follow-up ( T3 ) with the Friedman test followed by pairwise comparisons with the Wilcoxon matched-pairs signed rank test . Differences of the effects of acrylic vs GIC on the sum areas of WSL were tested for each observation period with the Mann-Whitney U test . RESULTS Increases in the sum areas of WS and WSL from BF to T0 ( P < 0.001 ) were followed by significant decreases at T1 ( P < 0.001 ) and T2 ( P < 0.01 for WS ; P < 0.001 for WSL ) . Significant changes were also found in the sum areas for WS at T3 compared with T2 ( P < 0.01 ) , but not for WSL ( P = 0.328 ) . The sum areas of WS and WSL at T3 did not return to BF levels ( P < 0.001 ) . Sum areas of WSL were higher for surfaces bonded with acrylic compared with GIC for each observation period from BF to T2 ( P > 0.001 ) , and from T2 to T3 ( P > 0.05 ) . CONCLUSIONS Although significantly reduced during the 12-year follow-up and significantly lower with the GIC than the acrylic material at bonding , WSL are a cariologic and cosmetic problem for many orthodontic patients INTRODUCTION Dental caries , specifically decalcified white-spot lesions ( WSL ) , is a well-known side-effect of orthodontic treatment . The incidence of labial incipient caries lesions and its relationship with various patient and treatment variables was investigated in patients treated with comprehensive orthodontics .  METHODS R and omly selected orthodontic patient records ( n = 350 ) were examined to determine incipient caries lesion development . Labial surfaces on pretreatment and posttreatment photographs were scored with a st and ardized scoring system . Independent variables were collected by chart abstract ion . RESULTS The incidence of patients who developed at least 1 new WSL during treatment was 72.9 % , and this incidence was 2.3 % for cavitated lesions . Treatment duration was significantly associated with new WSL development ( P = 0.03 ) . Development of WSL and cavitated lesions increased ( both , P < 0.00 ) despite increased attention to oral hygiene during treatment . Sex , age , extraction therapy , and various fluoridation sources were not associated with WSL development , but initial oral-hygiene score was moderately associated ( P < 0.06 ) . CONCLUSIONS The incidence of WSL in patients treated with comprehensive orthodontics  was significantly high , and the preventive therapy provided appeared to be ineffective . This widespread problem is alarming and warrants significant attention from both patients and providers that should result in greatly increased emphasis on effective caries prevention OBJECTIVE To compare the effectiveness of fluoride varnish and 2 % chlorhexidine gel for controlling active white spot lesions ( WSLs ) adjacent to orthodontic brackets . STUDY DESIGN Thirty-five orthodontic patients ( 17.2 ± 2.3 years old ) presenting 60 WSLs adjacent to orthodontic brackets were enrolled in this r and omized , blind , 3-armed and controlled clinical trial . The patients were r and omly allocated to 1 of 3 arms : ( 1 ) two applications of 5 % NaF varnish- F , with one-week interval , ( 2 ) two applications of 2 % chlorhexidine gel-CHX , with one-week interval and ( 3 ) usual home care-control ( CO ) . The WSLs were scored by using a DIAGNOdent pen . An independent examiner scored the surfaces using Nyvad criteria for caries assessment . RESULTS A total of thirty patients presenting 51 lesions completed the study . All treatments reduced the fluorescence values during the experimental period ; however , F induced faster remineralization  than CHX . After 3 months , 70.58 % were inactive considering all groups . DIAGNOdent pen and Nyvad presented a significant correlation . CONCLUSION After 3 months of treatment , F , CHX and CO were capable of controlling the WSLs adjacent to the orthodontic brackets . However , the treatment with F was capable of controlling the progression of the WSLs in a shorter period of time Background White spot lesions ( WSLs ) are a frequent side-effect of multibracket appliance treatment . The effect of local fluoridation on post-orthodontic WSL is however inconclusive . Objective Assessment of WSL changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment . Trial design R and omized , single-centre , double-blind , parallel-group , placebo-controlled study . Participants Patients with not less than 1 WSL ( modified score 1 or 2 ) on not less than 1 upper front teeth after debonding . Interventions Professional fluoride/placebo gel application during weeks 1 - 2 ; self-administered home application ( weeks 3 - 24 ) . Outcomes Photographic WSL assessment ( dimension and luminance ) of the upper front teeth ( T0-T5 ) . R and omization R and om assignment to test ( n = 23 ) or placebo group ( n = 23 ) using a sequentially numbered list ( r and om allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each ) . Recruitment The clinical study duration lasted from March 2011 to September 2013 . Blinding Unblinding was performed after complete data evaluation . Numbers analysed Intent-to-treat analysis set comprising 39 participants ( test : n = 21 , placebo : n = 18 ) . Outcome Dimensional WSL quantification showed limited reliability . Luminance improvement ( % ) of WSL , however , was seen after 6 months ( test/placebo : tooth 12 , 24.8/18.0 ; tooth 11 , 38.4/35.4 ; tooth 21 , 39.6/38.3 ; and tooth 22 , 15.2/25.0 ) . No statistically significant group difference existed . Data suggest that WSLs are difficult to measure with respect to reliability and repeatability and methods for monitoring WSLs in clinical trials require improvement/validation . Harms Similar adverse events occurred in both groups ; none was classified as possibly related to the study product . Limitations The number of dropouts was higher than expected and the socio-economic status was not assessed . Furthermore , the unknown level of compliance during the home application phase must be considered as limitation . Conclusion Based on the results of this study , no difference could be detected with respect to the development of WSL under post-orthodontic high-dose fluoride treatment . Registration The study was registered with Clinical Trials.gov ( Identifier : NCT01329731 ) . Protocol The protocol was n't published before trial commencement PURPOSE To investigate and compare the effects of a dental cream containing complexes of casein phosphoprotein-amorphous calcium phosphate ( CPP-ACP ) and fluoride mouthwashes on the regression of white spot lesions ( WSL ) . MATERIAL S AND METHODS The study group consisted of 26 healthy adolescents ( mean age 14.6 years ) exhibiting 60 teeth with 152 visible WSL sites on incisors and canines immediately after debonding of fixed orthodontic appliances . After bracket removal , professional tooth cleaning and drying , a visual scoring ( 0 - 4 ) and laser fluorescence ( LF ) readings were carried out . The patients were r and omly assigned to two different treatment protocol s with the aim of remineralising the lesions : A ) daily topical applications of a dental cream containing CPP-ACP ( Topacal ) for 3 months followed by a 3-month period of daily toothbrushing with fluori date d dentifrice , or B ) daily 0.05 % sodium fluoride mouthwash combined with fluori date d dentifrice for 6 months . The registration s were repeated after 1 , 3 , 6 and 12 months and follow-up data were compared with baseline with aid of chi-square and paired t-tests . RESULTS A significant improvement of the clinical WSL-scores was found over time in both groups , but there was a statistically significant difference ( p < 0.01 ) concerning the number of sites that totally disappeared after 12 months in favour of the CPP-ACP regime , 63 % compared with 25 % respectively . The clinical registration s were mirrored by a statistically significant decrease ( p < 0.05 ) in the LF readings at the 6- and 12-month follow-ups compared with baseline . No significant differences were displayed between the groups . CONCLUSIONS Clinical scoring and LF assessment suggested that both regimens could promote regression of WSL after debonding of fixed orthodontic appliances . The visual evaluation suggested an aesthetically more favourable outcome of the amorphous calcium phosphate treatments PURPOSE The decalcification of enamel is a serious clinical problem in orthodontic patients and is usually observed as white spot lesions surrounding brackets . This study 's purpose was to evaluate the effect of professionally applied 1.23 percent fluoride foam on reducing the formation of white spot lesions ( WSLs ) in patients with fixed orthodontic appliances . METHODS In a r and omized , double-blind , placebo-controlled trial , 100 participants were r and omly divided into two groups . The two groups received fluoride foam and placebo foam , respectively , every two months during the treatment . The examinations before bonding and after debonding were performed by one examiner and included the presence and severity of WSLs on incisors , canines , and premolars . RESULTS The incidence of WSLs was approximately 13 percent in the fluoride foam group and 51 percent in the placebo group ( P<.001 ) . The mean increment of WSLs score was significantly lower in the fluoride foam group ( 0.71 ± 2.80 ) than in the placebo group ( 4.36 ± 5.41 ; P<.001 ) . The preventive fraction was approximately 76 percent , and the number needed to treat was calculated as 2.6 . CONCLUSIONS Professional application of 1.23 percent fluoride foam during orthodontic treatment effectively reduced the development of white spot lesions . A prophylactic regimen based on the routine use of fluoride foam during orthodontic treatment is recommended BACKGROUND The authors conducted a r and omized , single-masked clinical trial involving patients who had completed orthodontic treatment to assess changes in the appearance of white-spot lesions ( WSLs ) that were treated with resin infiltration .  METHODS The authors divided affected teeth into control and treatment groups . In the treatment group , they restored teeth with WSLs by using resin infiltration . They evaluated changes in WSLs photographically by using a visual analog scale ( VAS ) ( 0 = no change , 100 = complete disappearance ) and area measurements ( in square millimeters ) . The authors analyzed the data by using two-way analysis of variance . RESULTS The mean VAS ratings for treated teeth demonstrated marked improvement relative to that for control teeth immediately after treatment ( 67.7 versus 5.2 , P < .001 ) and eight weeks later ( 65.9 versus 9.2 , P < .001 ) . The results for treated teeth showed a mean reduction in WSL area of 61.8 percent immediately after treatment and 60.9 percent eight weeks later , compared with a -3.3 percent change for control teeth immediately after treatment and a 1.0 percent reduction eight weeks later . CONCLUSIONS Resin infiltration significantly improved the clinical appearance of WSLs , with stable results seen eight weeks after treatment . PRACTICAL IMPLICATION S Resin infiltration , a minimally invasive restorative treatment , was shown to be effective for WSLs that formed during orthodontic treatment INTRODUCTION This article illustrates a new treatment method and evaluates the effect of the frequent use of fluori date d chewing sticks ( miswaks ) on the remineralization of white spot lesions ( WSLs ) diagnosed at debonding . METHODS Thirty-seven orthodontic patients ( mean age , 17.2 years ) , with a minimum of 4 WSLs on the buccal surfaces of the maxillary incisors , canines , premolars , and first molars after orthodontic therapy , were enrolled in a double-blind , r and omized , longitudinal trial lasting 6 weeks . The subjects were divided into 2 groups using fluori date d miswaks impregnated in 0.5 % sodium fluoride ( test group , n = 19 ) and nonfluori date d miswaks ( control group , n = 18 ) . A custom-made mouth tray , covering half of the maxillary dentition , was used while brushing with the miswaks 5 times per day . The WSLs were scored by using a DIAGNOdent pen ( KaVo , Biberach , Germany ) and with the International Caries Detection and Assessment System ( ICDAS II ) index , at baseline and 2 , 4 , and 6 weeks after debonding . RESULTS Both the DIAGNOdent readings and the ICDAS II index of the WSLs decreased in the test group on the uncovered side of the dentition but not on the covered side during the 6-week trial ( P < 0.0001 ) . There was also a slight improvement in the control group ( not significant ) . There was a strong correlation between the DIAGNOdent values and the ICDAS II index when all the data were pooled ( P < 0.001 ) . CONCLUSIONS The frequent use of fluori date d miswaks had a remineralizing effect on WSLs . The DIAGNOdent pen might be a useful tool for diagnosing and monitoring changes of WSLs over a relatively short period of time Background One of the most undesirable side effects of comprehensive orthodontic treatment is  white  spot lesions  ( WSLs ) . Despite many attempts at prevention of WSLs , its prevalence remains very high on debonding . There are many agents like fluoride toothpastes , fluoride varnishes , and fluoride mouth rinses , and casein phosphopeptide-amorphous calcium phosphate ( CPP-ACP ) is frequently used for the remineralization of WSLs . However , there is no consensus in the literature with respect to the success rates of these agents . Thus , the present study was design ed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs . Methods Forty-five subjects in the age range of 16–25 years having at least one post-orthodontic WSL were included in the study . All the subjects were r and omly divided into three groups ( toothpaste group , varnish group , and CPP-ACP group ) . The efficacy of various remineralizing agents on the remineralization of WSLs was evaluated clinical ly and by DIAGNOdent immediately after debonding and subsequently after 1 , 3 , and 6 months of their use . Results Twice daily use of fluoride toothpaste alone had no significant effect on remineralization of WSLs at various intervals of observations ( P = 0.078 ) . Application of fluoride varnish along with twice daily use of fluoride toothpaste for 6 months significantly decreased the severity of WSLs ( P < 0.01 ) . Twice daily use of CPP-ACP plus crème along with fluoride toothpaste had significant effect on remineralization of WSLs at the end of 6 months of observation ( P < 0.05 ) . Between the group comparison showed that the mean visual and DIAGNOdent scores at various time intervals of observations were decreased more when fluoride varnish and CPP-ACP crème were used in addition to daily use of fluoride toothpaste , but the differences were not statistically significant ( P > 0.05 ) . Conclusions The use of fluoride varnish and CPP-ACP plus crème in addition to twice daily use of fluoride toothpaste had no additional benefit in the remineralization of post-orthodontic WSLs The aims of this in vitro study were 2‐fold : 1 ) to evaluate two fluorescence methods ( DIAGNOdent and QLF ( quantitative light‐induced fluorescence ) ) for quantification of white spot lesions adjacent to fixed orthodontic appliances ; and 2 ) to determine the inter‐observer agreement of the DIAGNOdent and QLF methods for quantification of incipient enamel lesions adjacent to fixed orthodontic appliances . Forty‐one premolar teeth with visually sound smooth surfaces or visually white spot enamel lesions were included in the study .  Orthodontic brackets were fixed adjacent to the lesions , thus simulating the position of fixed appliances during orthodontic treatment . All teeth were measured using both the DIAGNOdent and QLF methods . Of the 41 teeth , 20 smooth surfaces were r and omly selected and analyzed by 4 operators using both DIAGNOdent and QLF . The teeth were sectioned into 300‐μm‐thick slices using a water‐cooled diamond saw and the slices manually ground to 80–100 μm thickness . Histopathology and transverse microradiography were performed to provide the gold st and ards for verification of lesion depth and mineral loss , respectively . The Spearman rank correlation coefficients between lesion depth determined by histopathology and the DIAGNOdent and QLF were 0.76 and 0.82 , respectively , whereas the Pearson correlation coefficients between mineral loss and the two methods were 0.64 and 0.84 , respectively . Inter‐observer agreement was found to be 0.80 and 0.93 for DIAGNOdent and QLF , respectively . In conclusion , QLF may be a suitable method for quantifying incipient carious lesions adjacent to fixed orthodontic appliances Background This study compared the oral hygiene and caries risk of patients treated with labial and lingual orthodontic appliances  throughout a prospect i ve evaluation of the status of the oral environment before and after bracket placement . Methods A total of 20 orthodontic patients aged 19 to 23 years were included in the study and were divided into two groups : 10 patients wore Roth labial appliance  ( American Orthodontics , Sheboygan , WI , USA ) and 10 patients wore STb lingual appliance  ( Ormco Corporation , Glendora , CA , USA ) . Plaque index ( PI ) , gingival bleeding index ( GBI ) , salivary flow rate , saliva buffer capacity , salivary pH , and Streptococcus mutans and Lactobacillus counts in saliva were determined at three time points : before orthodontic appliance placement ( T 0 ) , 4 weeks after bonding ( T 1 ) , and 8 weeks after bonding ( T 2 ) . After appliance placement , all patients were periodically educated to the oral hygiene procedures . Wilcoxon rank and Mann-Whitney U tests were used to determine intragroup and intergroup differences as regards qualitative data . To compare quantitative data between the groups , chi-square and Fisher 's exact tests were undertaken , while intragroup differences were tested with McNemar test . The level of statistical significance was set at p < 0.05 . Results Statistical analysis of the data obtained revealed a statistically significant difference between the data of T 0 and T 1 and the data of T 0 and T 2 of the PI scores and between T 0 and T 2 of the GBI scores in the group treated with the lingual appliance . The GBI value increased significantly between T 0 and T 1 but decreased significantly between T 1 and T 2 ( p < 0.01 ) in the group treated with labial appliance . S. mutans counts increased significantly between T 0 and T 2 in the saliva sample s of patients treated with lingual appliance . No statistically significant differences were found between S. mutans and Lactobacillus counts at the three terms of saliva collection in patients treated with labial appliance . No statistically significant differences were found between the two groups at the three time points as regards the salivary flow rate and saliva buffer capacity . Conclusions Lingual and labial orthodontic appliances showed a different potential in modifying the investigated clinical parameters : patients wearing STb lingual orthodontic appliance had more plaque retention 4 and 8 weeks after bonding , while there were more gingival inflammation and more S. mutans counts 8 weeks after bonding . No differences were found between the two groups as regards the Lactobacillus counts , the salivary flow rate , and saliva buffer capacity Summary Background : Using lingual enamel surfaces for bracket placement not only has esthetic advantages , but may also be suitable in terms of reducing frequencies of enamel decalcifications . Objective : To test the null-hypothesis that there is no significant difference in enamel decalcification or cavitation incidence adjacent to and beneath bracket bases between two  lingual multi-bracket ( MB ) appliances  that are different in terms of design , material composition , and manufacturing technology ( group A : WIN , DW-LingualSystems ; group B : Incognito , 3M-Unitek ) , taking into account patient- and treatment-related variables on white spot lesion ( WSL ) formation . Methods : St and ardized , digital , top-view photographs of 630 consecutive subjects ( 16214 teeth ; n Incognito = 237/6076 teeth ; n WIN = 393/10138 teeth ; mean age : 17.47±7.8 ; m/f 43.2/56.8 % ) with completed lingual MB treatment of the upper and lower permanent teeth 1–7 were screened for decalcification or cavitation adjacent to and beneath the bracket bases before and after treatment , scored from 0 to 7 . Non-parametric ANOVA was used for main effects ‘ appliance type ’ , ‘ gender ’ , ‘ treatment complexity ’ , ‘ grouped age ’ ( ≤16/>16 years ) , and ‘ treatment duration ’ as covariable , at an α-level of 5 % . Results : About 2.57 % [ 5.94 % ] of all teeth in group A [ B ] developed decalcifications . Subject-related incidence was 9.59 % [ 16.17 % ] for upper incisors in group A [ B ] , and 12.98 % [ 25.74 % ] for all teeth 16–46 . There were significant effects by gender , age , and treatment duration . Conclusion : The null-hypothesis was rejected : sub-bracket lesions were significantly less frequent in group A , while frequencies of WSL adjacent to brackets were not significantly affected by appliance type . In view of the overall low incidences of lingual post-orthodontic white-spot lesions , the use of lingual appliances is advocated as a valid strategy for a reduction of enamel decalcifications during orthodontic treatment This pilot study investigated the effect of a remineralizing fluoride dentifrice ( Enamelon ) on newly formed incipient carious lesions using two methods of application . Teenage orthodontic patients with obvious white spot lesions on their teeth were selected to begin treatment within 30 days after deb and ing . At baseline , the surface enamel of the test teeth was cleaned by air etching with 50 microns alumina at 150 psi .  Lesion size ( mm2 ) was measured using a calibrated periodontal probe and surface appearance was quantified as shiny ( 0 ) , dull ( 1 ) , or chalky ( 2 ) . Twice daily for 3 months , one group with a total of 27 lesions brushed with the remineralizing dentifrice , while a second group with 41 total lesions brushed and used a mouth tray to apply the paste directly to the lesions for 5 min . In order to promote treatment compliance , test group assignment was based on subject and parental preference . After 1 , 2 , and 3 months , lesion size was reduced by 5 % ( ns ) , 10 % ( p < 0.05 ) and 22 % ( p < 0.01 ) , respectively , for the brushing group , and 16 % ( p < 0.05 ) , 37 % ( p < 0.01 ) and 30 % ( p < 0.01 ) for the combined brushing and tray group , respectively . The dull appearance of the lesions treated by brushing improved slightly over 3 months . However , the lesions receiving combined brushing and tray applications became significantly ( p < 0.01 ) less dull by 28 % , 44 % and 61 % after 1 , 2 , and 3 months , respectively , indicating the formation of a shiny , intact surface layer . In conclusion , brushing with a remineralizing dentifrice significantly reduced the size of new orthodontic white spots within 2 months , while brushing combined with topical tray applications reduced lesion size within 1 month with concomitant formation of a shiny enamel surface layer . Thus , the combined brushing and mouth tray treatment significantly accelerated the remineralization process 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 r and omized , parallel group , controlled clinical trial . Using saline solution as control , 110 participants ( mean age ± st and ard deviation : 16.6 ± 3.2 years ) ranging from 12 to 22 years old were r and omly 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 BACKGROUND / OBJECTIVES The purpose of the study is to evaluate the effect of daily intake of lozenges containing probiotic bacteria on white spot lesion ( WSL ) formation as well as on salivary lactobacilli ( LB ) and mutans streptococci ( MS ) counts , in patients undergoing orthodontic treatment with fixed appliances . MATERIAL S/ METHODS A r and omized double-blind placebo-controlled study design with two parallel arms was employed . Patients ( n = 85 , mean age 15.9 years ) with maxillary braces on at least eight anterior teeth and a remaining treatment period of 7 - 24 months were finally enrolled and r and omly allocated to a test or placebo group . Subjects in the test group were instructed to take one probiotic lozenge containing two strains of Lactobacillus reuteri once daily . An identical lozenge without active bacteria was used in the placebo group . Dental plaque , WSL , and salivary MS and LB levels were recorded at baseline and immediately after debonding . RESULTS The groups were balanced at baseline . The mean duration of the intervention was 17 months and the total dropout rate was 10 per cent . There were no differences in the incidence of WSL between the groups at debonding . The patients had generally a neglected oral hygiene , both at baseline and at the follow-up . The levels of salivary LB were significantly reduced in both groups ( P < 0.05 ) at the time of debonding compared with baseline , while no alterations of the MS counts were unveiled . LIMITATIONS WSL were scored from photos that may not fully mirror the clinical situation . Chair-side tests estimate the counts of selected bacteria in saliva and do not reflect the entire microbiota . The invention was implemented approximately 6 months after the onset of the fixed appliances and some lesions may have been present at bonding . CONCLUSIONS / CLINICAL IMPLICATION S Daily intake of probiotic lozenges did not seem to affect the development of WSL during orthodontic treatment with fixed appliances
Conclusion Costs 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
Background Post-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 .