A review on prevention and treatment of post-orthodontic white spot lesions - evidence-based methods and emerging technologies.

Private Practice, Stockholm, Sweden.
The Open Dentistry Journal 01/2011; 5:158-62. DOI: 10.2174/1874210601105010158
Source: PubMed

ABSTRACT The aim of this paper was to update the evidence for primary and secondary prevention (treatment) of white spot lesions (WSL) adjacent to fixed orthodontic appliances.
A search for relevant human clinical trials published in English between 2004 and March 2011 retrieved 25 publications that fulfilled the inclusion criteria. The papers were assessed for prevented fraction and/or absolute risk reduction when possible.
The findings consolidated the use of topical fluorides in addition to fluoride toothpaste as the best evidence-based way to avoid WSL. The mean prevented fraction based on 6 trials was 42.5% with a range from -4% to 73%. The recent papers provided the strongest support for regular professional applications of fluoride varnish around the bracket base during the course of orthodontic treatment. For the treatment of post-orthodontic WSL, home-care applications of a remineralizing cream, based on casein phosphopeptide-stabilized amorphous calcium phosphate, as adjunct to fluoride toothpaste could be beneficial but the findings were equivocal. For emerging technologies such as sugar alcohols and probiotics, still only studies with surrogate endpoints are available. Thus, further well-designed studies with standardized regimes and endpoints are needed before guidelines on the non-fluoride technologies can be recommended.

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    ABSTRACT: Background/Objectives:White spot lesions (WSLs) are unwelcome side effects of fixed appliances that compromise the treatment outcome. Recently, infiltration of WSLs has been introduced as a viable treatment alternative. The objective was to evaluate the colour improvement of WSLs and their stability against discolouration following infiltration, fluoride, or micro-abrasion treatments in vitro.Materials/Methods:Artificial WSLs were created in bovine enamel (N = 96) using acidic buffer solution (pH 5, 10 days) and were randomly allocated to four groups. Specimens were treated with infiltration (Icon, DMG), fluoride (Elmex Caries Protection, GABA), and micro-abrasion (Opalustre, Ultradent) or remained untreated (control). Groups were discoloured for 24 hours in tea or tea + citric acid. Colour components and visible colour change (L*, a*, b*, ΔE) were measured spectrophotometrically on following time points: baseline, after WSL formation, after treatment, and during discolouration (8, 16, and 24 hours). Data were analysed using Kruskal-Wallis and Mann-Whitney tests.Results:WSL formation increased (L*) in all groups. Only infiltration reduced this effect to baseline. Highest ΔE improvement was obtained by infiltration and micro-abrasion followed by fluoride. This improvement was stable only for infiltration during discolouration. L*, a*, and b* changed significantly during discolouration in all groups except infiltration. Within the same treatment group, discolouration solutions did not differ significantly.Limitations: In vitro testing cannot replicate the actual mode of colour improvement or stability but can be used for ranking materials and techniques.Conclusions/Implications:Infiltration and micro-abrasion treatments were capable of diminishing the whitish appearance of WSLs. Only infiltrated WSLs were stable following discolouration challenge.
    The European Journal of Orthodontics 01/2014; · 1.08 Impact Factor
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    ABSTRACT: Abstract Objective. This study investigated the efficacy of ozone on microflora of patients with fixed orthodontic appliances. Materials and methods. Ten subjects undergoing fixed appliance therapy were enrolled in the study. Before any application, two elastic ligatures were removed with the aid of a sterile probe from the premolar brackets on the upper right and lower left jaws for baseline bacteriological counts. Then ozone gas was applied for 180 s by running the device on prophylaxis mode with included mouth tray according to the manufacturer's recommendations on all brackets. After the ozone application, two other elastic ligatures were removed from the opposite sides of the mouth of the patients. One week after the application two more elastic samples, which were not changed in the previous session, were collected from the upper right and lower left premolar brackets. The elastic ligatures were immersed in transfer solutions and cultured to determine the Streptococcus mutans and Lactobacillus acidophilus. Statistical analysis of the data was obtained by paired Student's t-tests. Results. The ozone treatment reduced the S. mutans and L. acidophilus immediately after the application and these reductions were found to be statistically significant (p = 0.038 and p = 0.020). Both the S. mutans and L. acidophilus values increased by the 1-week period and the S. mutans values were significantly higher than the baseline values (p = 0.01). Conclusion. It can be concluded that the ozone treatment may have an instantaneous lethal effect on S. mutans and L. acidophilus; however, within the limitations of this study, a long-term preventive effect could not be observed.
    Acta odontologica Scandinavica 04/2013; · 1.41 Impact Factor
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    ABSTRACT: Abstract Objective. To test the stability of two conventional adhesives when combined with a low-viscosity caries infiltrant used for sealing sound enamel against toothbrush abrasion and acid challenge in vitro. Materials and methods. Bovine enamel discs (Ø = 3 mm) randomly assigned to three groups (n = 10/group) were etched with 37% phosphoric acid for 30 s and treated with resins of different monomer contents forming three test groups: (1) Untreated specimens (Control); (2) Infiltrant (Icon, DMG) + conventional enamel bonding adhesive (Heliobond, Ivoclar Vivadent); and (3) Infiltrant + conventional orthodontic adhesive (Transbond XT Primer, 3M Unitek). All specimens were immersed in hydrochloric acid (pH 2.6) for up to 9 days, during which they were exposed to 1825 toothbrush-strokes per day. Calcium dissolution was assessed using Arsenazo III method at 24-h intervals. Data were analyzed by Kruskal-Wallis and Wilcoxon signed ranks tests. Results. Cumulative calcium dissolution for the untreated specimens (39.75 ± 7.32 μmol/ml) exceeded the sealed groups (Icon + Heliobond: 23.44 ± 7.03 μmol/ml; Icon + Transbond XT Primer: 22.17 ± 5.34 μmol/ml). Untreated specimens presented a relatively constant calcium dissolution rate throughout the experimental period, whereas the sealed groups presented a gradual increase indicating weakening of the seal by toothbrush abrasion. Both sealed groups presented significantly lower daily calcium dissolution at all time points compared to the control, except for Group 2 on the last measurement day. Conclusions. Low-viscosity caries infiltrant application on sound enamel prior to conventional resin application provided a protective effect against enamel demineralization, but this effect was not stable when challenged mechanically by toothbrush abrasion.
    Acta odontologica Scandinavica. 05/2014;


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