A longitudinal laser fluorescence study of white spot lesions in orthodontic patients

Evaluation of the effects of 2 different adhesive-coated bracket systems on white spot lesion formation

INTRODUCTION

This study evaluated the effects of 2 different adhesive-precoated (APC) bracket systems on white spot lesions (WSLs).

METHODS

The study had a split-mouth design, and 34 patients were included. The APC Flash-Free (FF) and APC II system brackets were used. At the end of the treatment, digital photographs of each tooth were taken, the WSLs were scored, and lesion areas were calculated. In the same session, the mineralization level of the teeth was measured by DIAGNOdent. The 2 bracket systems were compared in terms of bonding time.

RESULTS

There was no difference between the 2 groups regarding the number of WSLs or the size of the lesion areas. In the maxillary arch, 55.3% of the teeth in the FF group and 61.2% in the control group were healthy. In the mandibular arch, no lesions occurred in 61.2% of the teeth in the FF group and 64.7% of the control group. In the evaluation of DIAGNOdent measurements, WSL formation was detected in 3 teeth in the FF group and 4 in the control group. No statistically significant difference was found between the 2 groups. There was a significant difference between the 2 groups in the evaluation of bonding times.

CONCLUSIONS

The effects did not differ between FF and conventional brackets in patients undergoing fixed orthodontic treatment. The use of FF brackets significantly shortened the bonding time.

Methylene Blue Penetration of Resin Infiltration and Resin Sealant in Artificial White-Spot Lesions

OBJECTIVE

 This study determined the potency of resin infiltrations and resin sealant in impeding microleakage on artificial white-spot lesions (AWL) by methylene blue penetration.

MATERIALS AND METHODS

 Eighty AWL specimens were randomly separated into two groups for water storage for 24 hours (groups 1-4) and 20,000 cycles of thermocycling (TC) (groups 5-8). Each group was then separated into four subgroups (n = 10) based on the AWL surface treatments: (1) no Tx, (2) treated with resin infiltration (ICON, DMG, Hamburg, Germany), (3) treated with resin infiltration (Surface pre-reacted glass-ionomer (S-PRG) barrier coat, SHOFU, Kyoto, Japan), (4) treated with resin sealant (Clinpro sealant, 3M ESPE, Minnesota, United States). Nail varnish was covered to all samples, with the exception of a 4 × 4 mm2 patch on the buccal measurement region, which was subsequently submerged in a 2% methylene blue solution and cut into buccolingual sections. Stereomicroscope measurements were used to calculate methylene blue penetration scores.

STATISTICAL ANALYSIS

 The Kruskal-Wallis test and the Bonferroni post-hoc correction were performed to evaluate the data.

RESULTS

 Application of resin infiltrants and resin sealant reduced microleakage in AWL by methylene penetration both before and after thermal cycling. In addition, group 6 (ICON + TC) and group 7 (S-PRG + TC) had a significantly different value from group 8 (sealant + TC).

CONCLUSION

 Both the resin infiltration approach and the resin sealant seem to help seal AWL and might perhaps offer long-term defense against microleakage in AWL caused by methylene blue penetration. The greatest sealing and defense for microleakage in AWL were demonstrated by the resin infiltrations.

Aesthetic caries infiltration - Long-term masking efficacy after 6 years

OBJECTIVES

This study aimed to evaluate the masking efficacy of caries infiltration technique of initial caries lesions (ICL) six years after debonding and single treatment.

METHODS

In 10 adolescents, 74 ICL (ICDAS 2) in 74 teeth were treated by resin infiltration (Icon, DMG) at a mean (SD) of 1.2 (1.2) months after bracket removal. The etching procedure was performed up to 3 times. Standardized digital images were taken before treatment (T₀), seven days (T₇) and 6 years (T₂₁₉₀) after treatment. Outcomes included the evaluation of the color differences between carious and healthy enamel at T₀, T₇ and T₂₁₉₀ by quantitative colorimetric analysis (ΔE), ICDAS scores, quantitative light-induced fluorescence (QLF; ΔF,ΔQ,WS Area) and qualitative visual evaluation (5-point Likert-scale [deteriorated (1), unchanged (2), improved, but not satisfying (3), improved and no further treatment required (4), completely masked (5)).

RESULTS

The median color difference ΔΕ₀ (25^th/75^th percentiles) at T₀ was 10.3 (8.56/13.0). At T₇ a significant decrease was observed (ΔΕ₇=3.7 (2.0/5.8); p<0.001; Friedmann-test; ICDAS p<0.001; Chi-square test). No significant changes based on ΔΕ (p=0.972; Friedmann-test) and ICDAS grading (p=0.511, chi-square test) were observed between T₇ and T₂₁₉₀ (ΔΕ₂₁₉₀=2.9 (1.8/4.2)). Furthermore, at T₂₁₉₀ four experienced dentists classified 50% and 37% of the lesions as "improved and no further treatment required" and "completely masked", respectively (Fleiss kappa: T₂₁₉₀: 0.782 (substantial agreement)).

CONCLUSION

Aesthetic caries infiltration can effectively mask post-orthodontic initial caries lesions for at least 6 years. These results for most of the teeth could not only be observed by quantitative but also by qualitative analysis.

CLINICAL SIGNIFICANCE

Resin infiltration efficaciously masks post-orthodontic initial carious lesions. The optical improvement can be observed directly after treatment and remains stable for at six years.

Validation of clinical photography and a laser fluorescence device for assessment of enamel demineralization during multi-bracketed fixed orthodontic treatment

AIM

To compare the validity of DIAGNOdent pen™ 2190 and clinical photographs in the diagnosis (presence or absence) and assessment of white spot lesions (WSLs) during multi-bracketed fixed orthodontic treatment.

METHODS

A total of 1607 readings from 99 patients were obtained using DIAGNOdent pen™ 2190, clinical photographs, and visual assessment criteria to assess WSLs at 6 -, 12- and 18 months after bonding of brackets. Receiver operating characteristic curves were constructed, and areas under the curve (AUC) were calculated to assess the presence or absence of WSLs and distinguish the severity of WSLs as slight or severe. Sensitivities, specificities, and AUC were calculated for outcomes at an alpha of 0.05 and 95% confidence intervals (CIs).

RESULTS

The values of sensitivity and specificity of DIAGNOdent pen™ 2190 were found to be 0.78 and 0.83, respectively, to distinguish presence/absence of WSLs with good accuracy (AUC= 0.855; 95% CI: 0.820-0.889) and for digital photographs, accuracy was excellent (AUC= 0.973, 95% CI: 0.956-0.991) with sensitivity and specificity of 0.96 and 0.99, respectively. However, the accuracy of DIAGNOdent pen™ 2190 was poor (AUC= 0.543, 95% CI: 0.418-0.668) in delineating slight and severe WSLs with a sensitivity of 0.31 and specificity of 0.83; while the values of sensitivity and specificity for distinguishing slight or severe lesions for clinical photographs were 0.96 and 0.99, respectively with excellent accuracy (AUC=0.978, 95% CI: 0.936-1.000).

CONCLUSIONS

Clinical photographs had better validity than DIAGNOdent pen™ 2190 in diagnosis and assessment of severity of demineralized lesions during multi-bracketed fixed orthodontic treatment.

A novel method quantifying caries following orthodontic treatment

This retrospective pilot study used a newly developed evaluation tool to assess the prevalence and incidence of White Spot Lesions (WSL) before and after multibracket appliance (MB) therapy. Digital photographs of 121 adolescent patients (63 ♂, 58 ♀) with metal brackets were analyzed retrospectively before and after MB therapy. The labial surfaces of anterior teeth, canine teeth, and premolars in the upper (UJ) and lower jaws (LJ) were evaluated using the Enamel Decalcification Index (EDI) by Banks and Richmond (Eur J Orthod, 16(1):19-25, 1994, levels 0-3) and a specially developed digitally scaled graticule with concentric circles to quantify the extent of WSL (in %). The statistical data analysis was based on crosstabulations and logistic regression. Before MB, 69.4% of the patients presented at least one WSL and 97.5% after, an increase of 28.1%. Before MB, 18.4% of the tooth surfaces (TS) showed an EDI level of 1-3. After MB, 51.8% of the TS featured WSL. 18.2% of the TS showed a WSL to the extent of ≥ 20-100% before and 52.3% after MB. The incidence in the UJ (71-79%) as well as the LJ (64-76%) was highest for the first and second premolars and lowest for LJ incisors (22-35%). The probability for developing a new distal WSL is higher than developing gingival, mesial or occlusal WSL. Labial MB therapy drastically increases the risk of developing WSL. We verified a concise quantification of the extent of labial WSL with the evaluation index.

Benefits of Using Fluorescence Induced Theragnosis in Fixed Orthodontic Therapy: Status, Technology and Future Trends

Dental biofilm is often found to be the source of bacteria that releases toxins, peptides, lipopolysaccharides as well as organic acids, which lead to gingival inflammation and tooth caries. Further, the persistent plaque may result in the continued destruction of the surrounding soft and hard tissues. During fixed orthodontic therapy, arch-wires, brackets, and elastic modules have been shown to be sites of significant plaque accumulation, making it difficult for a patient to maintain proper oral hygiene. The problem most dentists face is that they cannot visualize this biofilm completely to be able to carry out efficient plaque removal. Visual assessment is, to date, the most common method for plaque visualization, and various indexes have been demonstrated to be sufficient for quantification of the amount of plaque present. However, the problem is that visual assessments are inconsistent, operator dependent and often subjective, which can lead to inconsistency in results. Fluorescence is one such method that can be explored for its use in effective plaque identification and removal. Literature has it that dentists and patients find it particularly useful for monitoring oral hygiene status during treatment. Fluorescence has the capability of offering clinical orthodontists and researchers a new method of detection of demineralization during orthodontic treatment, furthermore, for efficient removal of orthodontic adhesive cements, fluorescent light may be used in conjunction with high-speed burs to deliver fast, less time consuming, and safer results. The benefit of direct visual treatment using fluorescence enhanced theragnosis is that the patient receives controlled and guided therapy. It has multiple benefits, such as early diagnosis of caries, biofilm identification, and even helps to achieve improved treatment outcomes by better resin selection for esthetic procedures.

Use of bioluminescence measurements for detection of artificial demineralization adjacent to orthodontic brackets

PURPOSE

Enamel demineralization can occur as a side effect during orthodontic treatment with fixed appliances and should be detected as early as possible. A new approach to assess demineralization is a system consisting of a photosensitive protein that binds to free calcium ions at the enamel surface. A camera is then used to visualize the bioluminescence spots. This in vitro study aimed to evaluate the ability of the bioluminescence technology to assess artificially demineralized enamel adjacent to various orthodontic brackets.

METHODS

In all, 108 human enamel samples were allocated randomly to groups with different orthodontic bracket material: stainless steel, titanium, ceramic. Initial lesions were created adjacent to the brackets. The samples were assessed by bioluminescence before and after demineralization. Images were assessed for presence of bioluminescence spots (yes/no). To quantify the bioluminescence measurements, the images' pixel values (P) were calculated within a defined area (F) adjacent to each bracket before and after demineralization. Quantitative light-induced fluorescence measurements (ΔF, ΔQ) were performed as the reference standard for demineralization.

RESULTS

After demineralization, bioluminescence spots were visible (yes/no decision) in 87% of the samples. The pixel analysis of the bioluminescence spots showed significantly higher pixel values after demineralization compared to baseline (p < 0.0001). The bracket material had no influence on the bioluminescence measurements. All samples showed fluorescence loss with a median ΔF of -9.52% (±3.15) and a median ΔQ of -1.01% × mm² (±3.34), respectively.

CONCLUSION

The bioluminescence technology is a promising tool to demonstrate demineralization adjacent to different orthodontic brackets in vitro.

Microleakage of resin infiltration in artificial white-spot lesions

This study examined the effectiveness of resin infiltration in inhibiting microleakage from artificial white-spot lesions (AWL) in enamel. Fifty sound extracted premolars were selected and randomly divided into five groups (n = 10 each). Group 1 included sound teeth. In contrast, an AWL was created in all specimens in groups 2 to 5, as follows-Group 2: AWL with no treatment; Group 3: AWL treated with resin infiltration; Group 4: AWL treated with resin infiltration and 5,000 cycles of thermocycling; Group 5: AWL treated with resin infiltration and 10,000 cycles of thermocycling. All specimens were then coated with nail varnish, except for a 4 × 4 mm² area on the buccal surface (the measurement area), immersed in 2% methylene blue solution, and sectioned buccolingually. Microleakage was evaluated with a stereomicroscope. Data were analyzed by using the Kruskal-Wallis test and Bonferroni post-hoc correction. Application of resin infiltrant reduced microleakage in AWL. No microleakage was seen in Group 3, and differences between Groups 3, 4, and 5 were not significant (P > 0.05). The resin infiltration technique appears to aid in sealing enamel AWL and may help provide long-term protection against microleakage in enamel AWL.

Impact of self-assembling peptides in remineralisation of artificial early enamel lesions adjacent to orthodontic brackets

Enamel demineralisation can occur as a side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the efficacy of the self-assembling peptide P11-4 for remineralisation combined with fluorides, compared to application of fluoride varnish alone. De- and remineralisation was assessed by Quantitative light-induced fluorescence (QLF). Orthodontic brackets were bonded on 108 human enamel samples and white spot lesions were created. The samples were allocated randomly into three groups: Group I received no treatment, group II had a single application of fluoride varnish (22,600 ppm), and group III was treated with P11-4 following a single application of fluoride varnish. Quantitative light-induced fluorescence (QLF) measurements were performed at baseline, after demineralisation and after storage in remineralisation solution for 7 and 30 days. Non-parametric tests (Kruskal-Wallis test and Friedman test) were used for further analysis. After demineralisation, all samples showed a median ΔF -9.38% ± 2.79. After 30 days median ΔF values were as followed: group I = -9.04% ± 2.51, group II = -7.89 ± 2.07, group III = -6.08% ± 2.79). The median ΔF values differed significantly between all groups at all investigation times (p < 0.00001). Application of P11-4 with fluoride varnish was superior to the use of fluorides alone for remineralisation of enamel adjacent to brackets.

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

Objective

The aim of this in vivo study was to evaluate the efficacy of low-viscosity light-cured resin infiltration on postorthodontic white spot lesions (WSLs) on incipient and advanced lesions using quantitative light-induced fluorescence (QLF).

Methods

The study subjects were patients with clinically diagnosed postorthodontic WSLs (n=57). QLF images of the lesions were obtained using a QLF device (Inspektor-Pro, Amsterdam, The Netherlands) before any treatment. Images were processed using the built-in software (QLF patient v2.0.0.48), which produced fluorescence loss (ΔF¹), lesion area (Area¹), and impact (ΔF₁ x Area₁, ΔQ₁) values. Lesions were categorized as incipient (-5<ΔF₁<-12, n=14) or advanced (-12<ΔF₁<-25, n=43). They were then infiltrated with low-viscosity resin (Icon-DMG, Hamburg, Germany) according to the manufacturer's instructions. QLF imaging was repeated (ΔF₂, Area₂, and ΔQ₂) from the same aspects assured by the relative software. Kolmogorov-Smirnov, Wilcoxon, and Mann-Whitney tests were used for data evaluation.

Results

ΔF₁ (-8.40±0.73) and Area₁ (3.44±5.19) decreased to -6.58±0.88 and 0.18±0.33 for incipient lesions (p<0.001 and p=0.002, respectively). ΔF₁ (-13.20±5.32) and Area₁ (4.71±5.56) decreased to -7.51±2.7 and 0.29±1.86 for advanced lesions (p<0.001). When ΔF, lesion area, and ΔQ changes between the groups were compared, the decrease in ΔF was greater for advanced lesions (p<0.001), whereas the decrease in the lesion area and ΔQ was similar (p=0.690, p=0.291).

Conclusions

Infiltration treatment provides improvement of WSLs in terms of fluorescence loss, lesion area, and impact for both incipient and advanced lesions, with the latter group presenting higher fluorescence loss reduction.

A Comparative Evaluation of Remineralizing Potential of Three Commercially Available Remineralizing Agents: An In Vitro Study

Aim

An in vitro study to evaluate and compare the remineralization potential of commercially available remineralizing agents containing silver diamine fluoride (SDF), casein sucrose phosphate (CSP), casein phospho peptide-amorphous calcium phosphate (CPP-ACP) using DIAGNOdent.

Materials and methods

Thirty freshly extracted premolars for orthodontic treatment were collected. Specimens were randomly divided into 3 groups of 10 each: group I: SDF, group II: CSP, group III: CPP-ACP. The samples were subjected to DIAGNOdent analysis for recording the baseline values. Specimens were placed in demineralizing solution incubated at 37°C for 72 hours. DIAGNOdent values were recorded after demineralization. Following this, remineralization procedure was carried out using 3 different remineralizing agents: group I samples with SDF, group II with CSP, and group III with CPP-ACP. The remineralization procedure was performed to group I once and repeated for 14 days for group II and group III and storage solution was changed every 24 hours. The samples were subjected to DIAGNOdent analysis after 72 hours, 7 days, and 14 days and values were recorded.

Results

The data were analysed using Statistical Package for the Social Sciences (SPSS) with analysis of variance (ANOVA) and post hoc test. Intragroup comparison of DIAGNOdent readings showed a highly significant difference between baseline, postdemineralization, and postremineralization values. Among intergroup comparison, SDF showed maximum remineralization values followed by CSP and CPP-ACP, respectively.

Conclusion

Silver diamine fluoride, CSP, and CPP-ACP are proven to possess remineralization potential.

Clinical significance

A comparative evaluation of these three remineralizing agents will aid in identifying most potent and effective agent in treating initial caries lesions in an effective noninvasive and child-friendly manner.

How to cite this article

Vinod D, Gopalakrishnan A, Subramani SM, et al. A Comparative Evaluation of Remineralizing Potential of Three Commercially Available Remineralizing Agents: An In Vitro Study. Int J Clin Pediatr Dent 2020;13(1):61–65.

Spectrophotometric Evaluation of Enamel Color Variation Using Infiltration Resin Treatment of White Spot Lesions at One Year Follow-Up

The aim of this study is to evaluate the color changes and the stability at a 1-year follow-up of white spot lesions (WSLs) treated with an infiltrating technique by using etching and TEGDMA resin. The color of 22 white spot lesions and the sound adjacent enamel (SAE) were assessed with a spectrophotometer at T0 (baseline), T1 (after treatment), and T2 (1 year after). The color change ΔE (WSLs-SAE) at T0 vs. T1 were compared to evaluate the camouflage effect efficiency, and at T1 vs. T2 to assess the stability of outcomes. To evaluate the effect on the treatment outcome of gender, the presence or not of previous orthodontic treatment, WSLs onset more/less than 10 years, the age of the patient, and the ΔE WSL (T0 vs. T1) was analyzed. The difference between ΔE (WSLs-SAE) at T0 and T1 resulted in statistical significance (p < 0.01). No statistical difference was found between ΔE (WSLs-SAE) at T1 vs. T2. The variables considered showed no statistical differences in treatment outcomes. The results of our investigation show that the technique used is immediately effective and the camouflage effect keeps up and steady one year after treatment. Such results do not appear to be influenced by analyzed clinical variables.

Effect of CO2 laser (10.6 μm) and Remin Pro on microhardness of enamel white spot lesions

This study investigated the combined effect of CO₂ laser irradiation and Remin Pro paste on microhardness of enamel white spot lesions (WSLs). Seventy-eight intact premolars were randomly assigned into six groups and then stored in a demineralizing solution to create WSLs. Afterwards, the teeth in group 6 (negative control) remained untreated, while groups 1 and 4 were exposed to CO₂ laser irradiation (20 Hz, 1 W, 30 s) and Remin Pro paste, respectively. In groups 2 and 3, the teeth were exposed to laser either before (group 2) or after (group 3) Remin Pro application. The teeth in groups 1 to 5 were then immersed in artificial saliva for 90 days while subjected to fluoride mouthwash and weekly brushing. Finally, the teeth were sectioned, and Vickers microhardness was measured at the enamel surface and at 50, 100, and 150 μm from the surface. One sample of each group was also examined with scanning electron microscope (SEM). Data were analyzed by two-way analysis of variance (ANOVA) and Tukey's test. The significance was set at 0.05. Laser irradiation followed by Remin Pro application (group 2) caused a significant increase in total WSLs' microhardness compared with laser alone (group 1) and control groups (P < 0.05). Microhardness at depths of 100 and 150 μm was also significantly greater in group 2 compared with those of group 3 and control groups (P < 0.05). Combined application of CO₂ laser with Remin Pro paste, when laser is irradiated before the paste, is suggested for re-hardening of WSLs in deep layers of enamel.

Effect of Light-Curable Fluoride Varnish and Conventional Topical Fluoride Varnish on Prevention of Enamel Demineralization Adjacent to Orthodontic Brackets: A Comparative Study

Objectives: Various fluoride varnishes have shown promising result in preventing enamel demineralization around orthodontic brackets as they do not depend on patient compliance. The objective of the study was to compare the effect of light-curable fluoride varnish (Clinpro XT) and conventional topical fluoride varnish (Fluoritop SR) in preventing enamel demineralization adjacent to orthodontic brackets.

Methods: 20 patients who required extraction of four first premolars for orthodontic treatment were bonded with orthodontic brackets and each premolar received single application of Clinpro XT and Fluoritop SR fluoride varnish in 2 diagonally opposite quadrants and rest 2 premolars acted as control. The sample teeth were debonded and extracted after 1 month and 2 months of varnish application. The samples were sectioned using hard tissue microtome and evaluated under polarized light microscopy to measure the depth of demineralization.

Results: Kolmogorov Smirnov test showed normal distribution of data. Comparison between the study groups with depth of demineralization scores showed statistically significant variation in one-way analysis of variance test. Turkey’s multiple post hoc procedures showed statistically significant difference in the depth of demineralization between all the 3 groups after 1 month and 2 months. Dependent t test showed statistically significant increment in the depth of demineralization in all the 3 groups between 1 month and 2 months.

Conclusion: This study concluded that single application of both Fluoritop SR and Clinpro XT was effective in reducing significant depth of demineralization compared to control. Clinpro XT showed significantly less demineralization compared to Fluoritop SR after 1 month and 2 months of varnish application.

A comparative assessment of orthodontic treatment outcomes using the quantitative light-induced fluorescence (QLF) method between direct bonding and indirect bonding techniques in adolescents: a single-centre, single-blind randomized controlled trial

Introduction

The aim of this two-arm parallel trial was to evaluate enamel demineralization in fixed orthodontic treatment using an indirect bonding technique in comparison to a direct bonding technique by the quantitative light-induced fluorescence (QLF) method.

Design, settings and participants

Fifty-six patients who needed fixed orthodontic treatment were randomly separated into either the direct bonding group or the indirect bonding group. The presence and extent of lesions on the buccal surfaces of all teeth, except the molar teeth, were assessed. The percentage of fluorescence loss (ΔF and ΔFmax), the degree of demineralization (ΔQ) and lesion area (WS area) were determined using the system’s software. The data were analysed with the Wilcoxon signed-rank and Mann–Whitney U-tests (P &lt; 0.05).

Interventions

Treatment with a direct bonding or an indirect bonding technique.

Results

This study was completed with 25 patients in the indirect bonding group (12 females, 13 males; mean age: 15.42 ± 1.71 years) and 26 patients in the direct bonding group (12 females, 14 males; mean age: 14.73 ± 1.65 years). In the indirect bonding technique, a few teeth (especially mandibular left canine: 50.45 ± 93.48; 95% confidence interval: −12.35 and 113.26) were found to develop significant white spot lesion (WSL) formation (P &lt; 0.05). However, the number of teeth with demineralization was higher in the direct bonding group (P &lt; 0.05).

Conclusion

The bonding procedures used in the indirect bonding technique contribute to reducing the degree of WSL formation. Further, the use of flowable composite adhesives in this bonding process is more effective at reducing the appearance of WSLs than in cases where conventional composite adhesives are used.

Limitations

The limitation of our trial may be the small sample size and the short follow-up time for the patients.

Harms

No harms were detected during the study.

Protocol

The protocol was not published before trial commencement.

Registration

This trial was registered post hoc at ‘Clinical Trials’ (http://www.clinicaltrials.gov), registration number (ID): NCT03738839.

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

OBJECTIVES

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).

MATERIALS AND METHODS

Of twenty subjects who received previous resin infiltration treatment of n_teeth = 111 nonrestored, noncavitated postorthodontic WSL after multibracket treatment during a randomized controlled trial and were contacted 20 months after baseline, eight subjects (trial teeth n_teeth = 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 (ΔE_WSL/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%.

RESULTS

T24 assessments were performed after a mean 33.86 (SD: 8.64; Min: 24; Max: 45) months following T0. Mean (SD) ΔE_WSL/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.

CONCLUSIONS

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.

Assessing the Appearance and Fluorescence of Resin-Infiltrated White Spot Lesions With Caries Detection Devices

OBJECTIVE

This in vitro study examined the effectiveness of caries detector devices in assessing the ability of resin infiltration (RI) (Icon, DMG-Hamburg, Hamburg, Germany) to improve the optical properties of enamel white spot lesions (WSLs).

METHODS AND MATERIALS

Ten caries-free third molars were used. Photographs, a subjective visual assessment of the photographs, fluorescent camera (FC) images using the Spectra (Air Techniques, Melville, NY, USA), and laser fluorescent (LF) readings using the DIAGNOdent (KaVo, Biberach, Germany) were obtained from each tooth's buccal surface. Specimens were coated with nail polish leaving a rectangular window on the buccal surface and placed in pH 4.5 lactic acid gel for two weeks to create a WSL. The WSLs were analyzed by the same methods. RI was applied to half of each WSL; final photographs were then taken, and caries detector assessments were conducted. FC images were converted to grayscale, and the fluorescent image's brightness intensity was measured using ImageJ. Data were analyzed with analysis of variance and Tukey-Kramer honestly significant difference test. Significance was set at α=0.05.

RESULTS

Subjective assessment of the photographs showed that RI improved the appearance of the WSLs so that they resembled intact enamel. Mean FC-brightness intensities for intact, demineralized, and demineralized RI-treated areas were 159.6 ± 9.2, 123.4 ± 7.2, and 160.9 ± 11.5, respectively. There were no significant differences in fluorescent intensity between the intact and RI areas ( p=0.58). The demineralized areas had significantly lower fluorescent intensity than both the RI-treated and intact areas ( p<0.001). LF values did not differ significantly between intact, demineralized, or RI-treated areas.

CONCLUSIONS

This study demonstrates the ability of RI to restore artificial WSLs to the esthetics and fluorescence of intact enamel. The FC can be used to assess the optical properties of WSLs and the impact of RI on these properties.

Biological aspects of orthodontic tooth movement: A review of literature

This review of literature describes the cellular and molecular biology of orthodontic tooth movement, including various theories and effect of chemical mediators on tooth movement. The better understanding of the tooth movement mechanism will inspire the clinicians to design and implement effective appliances that will result in maximum benefits and minimum tissue damage to the patients. This paper also emphasizes the applied aspect of different medication and hormones, during orthodontic treatment, on the signaling molecules which produce bone remodeling.

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

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

Randomized, 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).

Randomization

Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random 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 ClinicalTrials.gov (Identifier: NCT01329731).

Protocol

The protocol wasn't published before trial commencement.

Red and Green Fluorescence from Oral Biofilms

Red and green autofluorescence have been observed from dental plaque after excitation by blue light. It has been suggested that this red fluorescence is related to caries and the cariogenic potential of dental plaque. Recently, it was suggested that red fluorescence may be related to gingivitis. Little is known about green fluorescence from biofilms. Therefore, we assessed the dynamics of red and green fluorescence in real-time during biofilm formation. In addition, the fluorescence patterns of biofilm formed from saliva of eight different donors are described under simulated gingivitis and caries conditions. Biofilm formation was analysed for 12 hours under flow conditions in a microfluidic BioFlux flow system with high performance microscopy using a camera to allow live cell imaging. For fluorescence images dedicated excitation and emission filters were used. Both green and red fluorescence were linearly related with the total biomass of the biofilms. All biofilms displayed to some extent green and red fluorescence, with higher red and green fluorescence intensities from biofilms grown in the presence of serum (gingivitis simulation) as compared to the sucrose grown biofilms (cariogenic simulation). Remarkably, cocci with long chain lengths, presumably streptococci, were observed in the biofilms. Green and red fluorescence were not found homogeneously distributed within the biofilms: highly fluorescent spots (both green and red) were visible throughout the biomass. An increase in red fluorescence from the in vitro biofilms appeared to be related to the clinical inflammatory response of the respective saliva donors, which was previously assessed during an in vivo period of performing no-oral hygiene. The BioFlux model proved to be a reliable model to assess biofilm fluorescence. With this model, a prediction can be made whether a patient will be prone to the development of gingivitis or caries.

Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial

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 designed 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 randomly 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 clinically 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.

Quantitative Light-induced Fluorescence-Digital as an oral hygiene evaluation tool to assess plaque accumulation and enamel demineralization in orthodontics

OBJECTIVE

  To assess the use of Quantitative Light-induced Fluorescence-Digital as an oral hygiene evaluation tool during orthodontic treatment.

MATERIALS AND METHODS

  In this prospective, randomized clinical trial, 33 patients undergoing fixed orthodontic appliance treatment were randomly allocated to receive oral hygiene reinforcement at four consecutive appointments using either white light (WL) or Quantitative Light-induced Fluorescence-Digital (QLF) images, taken with a device, as visual aids. Oral hygiene was recorded assessing the QLF images for demineralization, by fluorescence loss (ΔF), and plaque coverage (ΔR30). A debriefing questionnaire ascertained patient perspectives.

RESULTS

  There were no significant differences in demineralization (P  =  .56) or plaque accumulation (P  =  .82) between the WL and QLF groups from T0 to T4. There was no significant reduction in demineralization, ΔF, in the WL, or the QLF group from T0-T4 (P > .05); however, there was a significant reduction in ΔR30 plaque scores (P < .05). All the participants found being shown the images helpful, with 100% of the QLF group reflecting that it would be useful to have oral hygiene reinforcement for the full duration of treatment compared with 81% of the WL group (OR 2.3; P < .05).

CONCLUSIONS

  Quantitative Light-induced Fluorescence-Digital can be used to detect and monitor demineralization and plaque during orthodontics. Oral hygiene reinforcement at consecutive appointments using WL or QLF images as visual aids is effective in reducing plaque coverage. In terms of clinical benefits, QLF and WL images are of similar effectiveness; however, patients preferred the QLF images.

Critical evaluation of incidence and prevalence of white spot lesions during fixed orthodontic appliance treatment: A meta-analysis

OBJECTIVE

Development of dental caries, specifically, white spot lesions (WSLs), continues to be a well-recognized and troubling side effect of orthodontic fixed appliance therapy, despite vast improvement in preventive dental techniques and procedures. The aim of this meta-analysis is to evaluate, determine, and summarize the incidence and prevalence rates of WSLs during orthodontic treatment that have been published in the literature.

MATERIALS AND METHODS

According to predetermined criteria, databases were searched for appropriate studies. References of the selected articles and relevant reviews were searched for any missed publications.

RESULTS

In the 14 studies evaluated for WSLs, the incidence of new carious lesions formed during orthodontic treatment in patients was 45.8% and the prevalence of lesions in patients undergoing orthodontic treatment was 68.4%.

CONCLUSION

The incidence and prevalence rates of WSLs in patients undergoing orthodontic treatment are quite high and significant. This widespread problem of WSL development is an alarming challenge and warrants significant attention from both patients and providers, which should result in greatly increased emphasis on effective caries prevention.

Minimally invasive resin infiltration of arrested white-spot lesions: a randomized clinical trial

BACKGROUND

The authors conducted a randomized, 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 IMPLICATIONS

Resin infiltration, a minimally invasive restorative treatment, was shown to be effective for WSLs that formed during orthodontic treatment.

White spot lesions after orthodontic treatment assessed by clinical photographs and by quantitative light-induced fluorescence imaging; a retrospective study

OBJECTIVE

White spot lesions (WSL) are an important side-effect of orthodontic multi-bracket (MB) treatment. Standardized monitoring of such WSL may help in caries management.

MATERIALS AND METHODS

In this retrospective study the discriminatory power of caries assessment on routine digital oral photographs was compared to quantitative light-induced fluorescence (QLF) imaging in monitoring WSL development after debonding of orthodontic appliances. Oral and QLF photographs captured directly after debond (T1) and 1 year thereafter (T2) of 51 subjects, treated with full MB orthodontic appliances were used. Oral photographs were assessed by use of The International Caries Detection and Assessment System (ICDAS) at both time points independently and by side-by-side comparison to assess visual transition (VT). QLF photographs were categorized based on integrated fluorescence loss at T1 and T2.

RESULTS

At T1 433 and 384 lesions on 918 buccal surfaces were detected using ICDAS and QLF, respectively. For both methods these numbers were reduced at T2. Changes within ICDAS scores were recorded by VT and showed mainly lesion improvement within ICDAS score 2.

CONCLUSION

The oral and QLF photographs both showed regression of WSL after debonding of MB orthodontic appliances. The VT evaluation was found to have higher discriminatory power in comparison to ICDAS.

Camouflage effects following resin infiltration of postorthodontic white-spot lesions in vivo: One-year follow-up

OBJECTIVE

To assess camouflage effects by concealment of postorthodontic white-spot lesions (WSLs) to sound adjacent enamel (SAE) achieved over 12 months with resin infiltration (Icon, DMG, Hamburg, Germany).

METHODS

Twenty subjects (trial teeth nteeth = 111) who had received resin infiltration treatment of noncavitated postorthodontic WSLs were contacted for a 1-year follow-up assessment of CIE-L*a*b* colors (T12). Color and lightness (CIE-L*a*b*) data for WSLs and SAE were compared to baseline data assessed before infiltration (T0) and those assessed after 6 months (T6), using a spectrophotometer. The target parameter was the difference between the summarized color and lightness values (ΔEWSL/SAE). Intergroup (WSL, SAE) and intertime comparisons (T0 vs T6, T12) were performed using paired t-tests at a significance level of α = 5%.

RESULTS

Nine subjects (trial teeth nteeth = 49; male/female ratio 5/4; age range 13-19 years) were available at T12. After the highly significant reduction of ΔEWSL/SAE discrepancies between T0 and T6, analysis of 12-month records revealed color and lightness discrepancy of WSL vs SAE that was significantly decreased compared with baseline, indicating an assimilation of WSL color to SAE appearance after infiltration, while an additional reduction of discrepancies between T6 and T12 was not significant.

CONCLUSION

As color and lightness characteristics of the Icon infiltrant as well as the esthetic camouflage effects achieved by WSL infiltration were not altered significantly or clinically relevant after 12 months, the method of resin infiltration can be recommended for an enduring esthetic improvement of postorthodontic WSL.

Effects of near infrared laser radiation associated with photoabsorbing cream in preventing white spot lesions around orthodontic brackets: an in vitro study

OBJECTIVE

The present study aims to investigate the effect of a low-power infrared laser on the inhibition of bovine enamel demineralization around orthodontic brackets.

BACKGROUND DATA

Near infrared lasers have been suggested as alternative approaches because they may produce an increase in resistance to dental caries.

METHODS

Forty-eight blocks of enamel obtained from bovine incisor teeth were divided into six groups: Group 1 (control), without treatment; Group 2 (C), photoabsorbing cream; Group 3 (CF), photoabsorbing cream with fluoride; Group 4 (L), irradiation with low-level infrared laser (λ=830 nm) at an energy density of 4.47 J/cm2; Group 5 (L+C), photoabsorbing cream followed by low-level infrared laser irradiation; and Group 6 (L+CF), photoabsorbing cream with fluoride followed by low-level infrared laser irradiation. After these procedures, the enamel blocks received an assortment of orthodontic brackets and were then submitted to pH cycling to simulate a highly cariogenic challenge. The enamel surface demineralization around the orthodontic brackets, according to the different treatments, was quantified by fluorescence loss analysis by quantitative light-induced fluorescence (QLF). The fluorescence loss, expressed as ΔF (percentage of loss fluorescence), was statistically examined by analysis of variance and the Tukey test.

RESULTS

The control group (-10.48±2.85) was statistically similar to Group C (-14.52±7.80), which presented the lowest values of ΔF when compared with Groups FC (-3.67±3.21), L (-2.79±1.68), CL (-1.05±0:50), and CFL (-0.60±0:43). However, Groups FC, L, CL, and CFL showed no statistically significant differences among them.

CONCLUSIONS

It can be concluded that both the low-level infrared laser and photoabsorbing cream with fluoride were effective in inhibiting the development of caries in enamel around orthodontic brackets, even in situations of high cariogenic challenge.

White lesions after orthodontic treatment: does low fluoride make a difference?

OBJECTIVE

To compare and measure the changes in size of post-orthodontic demineralized white lesion enamel lesions treated with a low fluoride (50 ppm) versus a non-fluoride mouthrinse/toothpaste regime.

STUDY DESIGN

An experimental double-blind prospective randomized clinical controlled trial.

SETTING

A university dental school orthodontic clinic (Sheffield, UK).

PARTICIPANTS

Twenty-six patients identified as having post-orthodontic demineralized white lesions on removal of their fixed appliance. METHOD AND INTERVENTIONS: The participants were randomly and blindly assigned to either a low fluoride mouthrinse/toothpaste treatment regime or an inactive control. Computerized image analysis of calibrated photographic images taken under polarized light were used to measure the lesions.

OUTCOME MEASURES

Lesion size and proportion (DWL%t) and percentage reduction (ADPR) at debond, and at 12 and 26 weeks later.

RESULTS

Five participants dropped out of the study, 12 had the low fluoride regime and 9 did not. As a percentage of the total labial tooth area (DWL%t) the mean size of the lesions at debond was 8.1% (SD 3.7). After 12 weeks the mean size of lesion had reduced to 4.6% (SD 2.6), which was a significant reduction (p=0.03). After 26 weeks the mean size was 3.5% (SD 2.1), which was a very significant reduction (p<0.003). This confirmed statistically that post-orthodontic demineralized white lesions do reduce in size with time reflecting remineralization or other enamel surface changes. Intervention using a test low fluoride mouthrinse/toothpaste combination at 26 weeks showed an average difference percentage reduction (ADPR) of 54.3% (Upper 95% CI=62.08, Lower 95% CI=46.44%) compared with a non-active control combination, which showed an ADPR of 66.1% (Upper 95% CI=77.74, Lower 95% CI=54.51%). This failed to show any differences or therapeutic affect.

CONCLUSIONS

Post-orthodontic demineralized white lesions reduced in size during the 6 months following treatment by approximately half the original size. There was no clinical advantage in using the low fluoride formulation of mouthrinse/toothpaste in this study.

Remineralization effect of CPP-ACP and fluoride for white spot lesions in vitro

OBJECTIVES

This in vitro study compared the remineralization effect on white spot lesions of casein phosphopeptide-amorphous calcium phosphate crème, or CPP-ACP (MI Paste™), 1.1% NaF dentifrice containing 5000ppm of fluoride (ControlRX™), or CPP-ACP crème with 900ppm of fluoride (MI Paste Plus™) with that of a control.

METHODS

Artificial white spot lesions were created on smooth enamel surfaces of sound molars using a previously reported demineralization model. Specimens were randomly assigned to four treatments (n=35) with a pH-cycling model over 30 days: Control (no treatment); MI Paste (10% CPP-ACP crème); F5000 (1.1% NaF dentifrice); or MI Paste Plus (10% CPP-ACP plus 900ppm fluoride crème). Products were applied following manufacturers' directions. Changes in mean lesion depth expressed by percent fluorescence loss (ΔF%), and lesion area (mm(2)) from baseline to after treatment were measured with light-induced fluorescence (QLF). Mean values of each parameter were compared between groups (p<0.05).

RESULTS

The remineralization pattern for the F5000 group was unique with marked initial remineralization during the first 10 days and little subsequent change. Based on mean lesion area, the F5000 demonstrated greater remineralization than Control, MI Paste and MI Paste Plus groups. Based on mean fluorescence loss, the F5000 group showed improved remineralization relative to MI Paste Plus, but did not differ statistically from the Control at the end of 30 days.

CONCLUSIONS

The 1.1% NaF dentifrice demonstrated overall greater remineralization ability than 10% CPP-ACP crème. However, the 1.1% NaF dentifrice was only as effective as the Control to reduce fluorescence loss.

CLINICAL SIGNIFICANCE

This study showed that a 1.1% NaF dentifrice (5000ppm) demonstrated greater remineralization ability than the CPP-ACP topical tooth crème and that the addition of fluoride to its formulation seems to enhance remineralization. Saliva also has the ability to exert an important remineralization effect over time.

Demineralization adjacent to orthodontic brackets after application of conventional and self-etching primer systems

OBJECTIVES

The goal of this work was to compare the demineralization of enamel associated with two different self-etching primers and traditional acid etching.

MATERIALS AND METHODS

A total of 15 volunteers (23-32 years, 8 male and 7 female) were provided with a removable archwire/resin appliance to be worn 20 h/day for 28 days. The device was attached to the mandibular posterior teeth and included samples of human enamel (from extracted third molars) located in both posterior vestibules. Both sides featured the same distribution of samples, including one untreated control sample (group A) and three samples with brackets (Victory™ APC II) bonded to their surface after conditioning with a self-etching non-fluoride primer (iBond™ Gluma® Inside; group B), a self-etching fluoride-releasing primer (Transbond™ Plus; group C), or traditional acid-etching with 35% phosphoric acid and Transbond™ XT (group D). Mineral loss was assessed extraorally under standardized conditions using quantitative light-induced fluorescence (QLF) with a specialized camera system (Inspektor Pro). Results were expressed as relative fluorescence loss (ΔF in %). A baseline measurement (T0) was taken before the appliance was first inserted but with the brackets already bonded. Fluorescence loss was analyzed after 3 (T1), 7 (T2), 14 (T3), and 28 days (T4) and compared to the baseline loss (T0) for each of the four study groups (A to D). Kruskal-Wallis and Mann-Whitney U tests were used to compare the results for statistical significance.

RESULTS

The lowest percentages of fluorescence loss both at baseline and during the follow-up assessments was found in group C. While all three experimental groups (B, C, D) presented total decreases in fluorescence loss after 28 days, indicating remineralization, the decrease in group C was the largest. The Kruskal-Wallis test yielded no significant differences between the three groups other than a significantly lower percentage of fluorescence loss in group C than in group D during the last assessment (T4). The untreated samples of control enamel (group A) revealed increasing percentages of fluorescence loss over the entire study period.

CONCLUSION

Use of the self-etching primers (groups B and C) was not associated with patterns of enamel demineralization different from those noted after traditional etching with phosphoric acid (group D). The only significant difference we observed was between the self-etching fluoride-releasing primer (group C) and traditional etching (group D) at the final assessment (T4). Thus, the fluoride-releasing system Transbond™ Plus was advantageous.

Quantitative light-induced fluorescence to measure enamel remineralization in vitro

The aim of this study was to compare the ability of quantitative light-induced fluorescence (QLF) and surface microhardness (SMH) to measure the remineralization of enamel subsurface lesions, using a pH-cycling model including treatment with 0-ppm, 550-ppm or 1,100-ppm sodium fluoride (NaF) dentifrices.

METHODS

Subsurface lesions were created in human enamel specimens (n = 36) and exposed to a remineralization pH-cycling model for 14 days. The pH-cycling model was performed in an automated system where specimens were subjected to a demineralizing solution for 20 min and treatment for 1 min and were then remineralized for 7 h 39 min, 3 times daily. The treatments consisted of 3 NaF, silica-containing dentifrices (0 ppm F; 550 ppm F; 1,100 ppm F). The outcome variables were: change from baseline in surface hardness and percentage change from baseline in fluorescence. An ANCOVA explored differences between different treatment groups (at the p < 0.05 level). Associations between QLF and SMH were evaluated using Spearman's correlation coefficient.

RESULTS

The percentage SMH changes were 14.9 ± 2.1%, 56.6 ± 9.6% and 103.9 ± 14.6% for the 0-, 550- and 1,100-ppm F dentifrices, respectively. The percentage fluorescence changes were 15.6 ± 7.1%, 59.8 ± 11.9% and 85 ± 13.2%, respectively. The differences between all pairwise comparisons were statistically significant for both methods (p = 0.001). QLF correlated with SMH (r = 0.67).

CONCLUSIONS

Both the SMH and QLF methods demonstrated a significant F dose response for toothpaste in this in vitro remineralization model, and both methods were able to distinguish treatments with different F levels.

Durability of esthetic improvement following Icon resin infiltration of multibracket-induced white spot lesions compared with no therapy over 6 months: a single-center, split-mouth, randomized clinical trial

INTRODUCTION

White spot lesions that form during orthodontic treatment are a problem for patients and clinicians. Lesion infiltration with low-viscosity light-cured resin has been proposed as a treatment to inhibit further demineralization. The purpose of this study was to assess the durability of assimilation of white spot lesions and sound adjacent enamel achieved over 6 months with resin infiltration.

METHODS

Twenty-one consecutive subjects with 231 noncavitated, unrestored white spot lesions after multibracket treatment were recruited at the Department of Orthodontics, University of Göttingen (Germany), for lesion infiltration. A simple randomized, split-mouth, controlled design was used to allocate subjects to the treatment and control groups. In the treatment group, white spot lesion infiltration of the anterior teeth was performed with low-viscosity light-cured resin after enamel conditioning with a 15% HCl gel. Color and lightness of the white spot lesions and the sound adjacent enamel were assessed with a spectrophotometer before infiltration and after 1 day, 1 week, 4 weeks, 3 months, and 6 months, using the system of the Commission Internationale de l'Eclairage. Multifactorial analysis of variance with repeated measures and pair-wise comparisons were used to analyze the effects of infiltration and time elapsed on the color differences at an α level of 5% and a power of 80%.

RESULTS

Analysis of 20 subjects and 39 quadrants in each group (108 teeth in the control group; 111 teeth in the treatment group) showed that both parameters of treatment and time duration had globally a highly significant influence on the color difference values. Assimilation of white spot lesion color to the surrounding enamel after infiltration was stable with no significant changes over 6 months; the mean color difference of white spot lesions vs sound adjacent enamel (ΔE baseline vs 6 months) was 2.55 (95% confidence interval [CI], 1.431-3.678). The untreated control teeth showed no significant changes over 6 months compared with the baseline: mean (ΔE), 0.29 (95% CI, -0.335-0.928). No important adverse events or side effects were observed.

CONCLUSIONS

Resin infiltration improves the esthetic appearance of demineralized teeth. The results showed sufficient durability over 6 months.

Effect of fluoridated toothpaste on white spot lesions in postorthodontic patients

Introduction: This article illustrates a new treatment approach and evaluates the effect of use of fluoridated toothpaste on the remineralization of white spot lesions (WSLs) diagnosed at debonding.

Materials and methods: Thirty-one orthodontic patients (mean age: 19.6 years), with a minimum of four WSLs on the buccal surfaces of the maxillary and mandibular incisors, canines, premolars and first molars after orthodontic therapy, were enrolled in a double-blind, randomized, longitudinal trial lasting 8 weeks. The subjects were divided into two groups using fluoridated toothpaste (test group, n = 31) and nonfluoridated toothpaste (control group, n = 31). A custom-made mouth tray, covering the maxillary dentition, was used while brushing with the fluoridated toothpaste three times per day. Maxillary dentition acted as control and mandibular as the test. The WSLs were scored by using the International Caries Detection and Assessment System (ICDAS II) index, at baseline and 8 weeks after debonding.

Results: The ICDAS II index of the WSLs decreased in the test group in the mandibular dentition but not on the maxillary dentition during the 8-week trial (p < 0.0001). There was also a slight improvement in the control group (not significant).

Conclusion: The frequent use of fluoridated toothpaste had a remineralizing effect on WSLs.

How to cite this article: Agarwal A, Pandey H, Pandey L, Choudhary G. Effect of Fluoridated Toothpaste on White Spot Lesions in Postorthodontic Patients. Int J Clin Pediatr Dent 2013;6(2):85-88.

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

INTRODUCTION

White spot lesions are a common sequela of orthodontic therapy. In this parallel-group randomized trial, we assessed the effectiveness of 2 agents commonly used to ameliorate white spot lesions compared with a normal home-care regimen.

METHODS

Patients aged 12 to 20 years were recruited from the offices of orthodontists and dentists who belonged to the Practice-based Research Collaborative in Evidence-based Dentistry network. The patients had their orthodontic appliances removed within the past 2 months and had at least 1 white spot lesion affecting their maxillary incisors. The subjects were randomized to 1 of 3 arms: (1) an 8-week regimen of MI Paste Plus (GC America, Alsip, Ill), (2) a single application of PreviDent fluoride varnish (Colgate Oral Pharmaceuticals, New York, NY), and (3) usual home care (control). Photographs were taken at enrollment and 8 weeks later. Two panels consisting of 5 dental professionals and 5 laypersons assessed the before-and-after pairs of photographs in a blinded fashion. Objective assessments and self-assessments were also performed.

RESULTS

One hundred fifteen subjects completed the study; 34 were assigned to the MI Paste Plus group, 40 to the fluoride varnish group, and 41 to the control group. The mean improvements assessed by the professional panel were 21%, 29%, and 27% in the MI Paste Plus, fluoride varnish, and control groups, respectively.The results from the lay panel were 29%, 31%, and 25%, respectively. Objective improvements in the surface affected were 16%, 25%, and 17%, respectively; self-assessments of improvement were 37% in all 3 groups. No assessments indicated significant differences between subjects in the active arms compared with the control arm.

CONCLUSIONS

MI Paste Plus and PreviDent fluoride varnish do not appear to be more effective than normal home care for improving the appearance of white spot lesions over an 8-week period.

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.

CLINICAL SIGNIFICANCE

White spot lesions associated with orthodontic treatment are a common problem that can be minimized with appropriate prevention, management, and treatment approaches.

In vitro evaluation of the effects of a fluoride-releasing composite on enamel demineralization around brackets

OBJECTIVES

The aim of this in vitro study was to evaluate the effectiveness of a fluoride-releasing bonding agent in inhibiting enamel demineralization around orthodontic brackets after the exposure to a demineralizing solution.

MATERIALS AND METHODS

Twenty-six extracted upper molars were bonded with two different composites: Transbond XT (TXT) and Transbond Plus (TPlus), fluoride-releasing (both 3M Unitek, Monrovia, CA, USA). The samples were exposed to an acid lactic solution for three days and then subjected to Metallographic Optical Microscope (MOM) and Scanning Electron Microscope/Energy Dispersive X-Ray (SEM/EDX) analyses. Enamel surface was examined in different areas: un-treated, etched and primer-painted, un-treated area with no acid exposure, central area with bracket bonded. The maximum demineralization depths and the fluoride content at 100, 200 and 300 μm depth were evaluated.

RESULTS

MOM analysis showed statistically significant (p<0.001) differences in demineralization depth for TPlus group compared to TXT group with lower values for the first one. EDX analysis confirmed the presence of fluoride in TPlus group.

CONCLUSIONS

The fluoride content of TPlus appeared able to weakly reduce the enamel demineralization.

Performance of laser fluorescence devices and visual examination for the detection of occlusal caries in permanent molars

The aim of this study was to evaluate the diagnostic capabilities of a laser fluorescence tool DIAGNOdent (KaVo, Biberach, Germany) and two light-emitting diode fluorescence tools-Spectra Caries Detection Aid (AIR TECHNIQUES, Melville, NY), and SOPROLIFE light-induced fluorescence evaluator in daylight and blue florescence mode (SOPRO, ACTEON Group, La Ciotat, France)-in comparison to the caries detection and assessment system (ICDAS-II) in detection of caries lesions. In 100 subjects (age 23.4±10.6 years), 433 posterior permanent unrestored teeth were examined. On the occlusal surfaces, up to 1066 data points for each assessment method were available for statistical evaluation, including 1034 ICDAS scores (intra-examiner kappa=0.884). For the SOPROLIFE tool, a new caries-scoring system was developed. Per assessment tool each average score for one given ICDAS code was significantly different from the one for another ICDAS code. Normalized data linear regression revealed that both SOPROLIFE assessment tools allowed for best caries score discrimination followed by DIAGNOdent and Spectra Caries Detection Aid. The area under the receiver operating characteristics curve calculations showed the same grading sequence when cutoff point ICDAS codes 0-1-2 were grouped together. Sensitivity and specificity values at the same cutoff were calculated (DIAGNOdent 87/66, Spectra Caries Detection Aid 93/37, SOPROLIFE 93/63, SOPROLIFE blue fluorescence 95/55.).

MI Paste Plus to prevent demineralization in orthodontic patients: a prospective randomized controlled trial

INTRODUCTION

Enamel demineralization is a problem in orthodontics. Fluoride is partially effective in addressing this problem, but additional treatment options are needed. The objective of this prospective randomized controlled trial was to determine the effectiveness of a new product, MI Paste Plus (GC America, Alsip, Ill), in the prevention or reduction of white spot lesions in orthodontic patients.

METHODS

Sixty patients who were undergoing routine orthodontic treatment were recruited for this prospective randomized clinical trial. A double-blind method of randomization was used to determine whether each patient received the MI Paste Plus or a placebo paste (Tom's of Maine, Salisbury, United Kingdom). Each patient was asked to administer the paste by using a fluoride tray for a minimum of 3 to 5 minutes each day at night after brushing. Photographic records obtained in a light-controlled environment were used to record the presence or absence of white spot lesions in both groups. The enamel decalcification index was used to determine the number of white spot lesions per surface at each time interval. Patients were followed at 4-week intervals for 3 months. A scoring system from 0 to 6 was used to determine the level of caries or cavitations. This system was also used for each tooth at each time interval.

RESULTS

Fifty patients (26 using MI Paste Plus, 24 using the placebo paste) completed the study. The enamel decalcification index scores for all surfaces were 271 and 135 at the start of treatment and 126 and 258 at the end of treatment for the MI Paste Plus and placebo paste groups, respectively. The enamel decalcification index scores in the MI Paste Plus group reduced by 53.5%, whereas the placebo group increased by 91.1% during the study period. A 3-way analysis of variance (ANOVA) was done for the average enamel decalcification index scores. The surface type, the product/time interactions, and the product/surface interactions of the mean enamel decalcification index scores were significant (P <0.05).

CONCLUSIONS

MI Paste Plus helped prevent the development of new white spot lesions during orthodontic treatment and decreased the number of white spot lesions already present. The placebo paste had no preventive action on white spot development during orthodontic treatment; the number of lesions actually increased. MI Paste Plus reduced white spots on the gingival surfaces; the placebo paste had the opposite effect. The incisal surface effect on the mean enamel decalcification index scores over time and between products was highly significant. The incisal enamel decalcification index scores were consistently higher than those for the other surfaces (mesial, distal, and gingival).