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White spot lesions, cavities ( upper dentition ), and gingival inflammation ( lower dentition ) caused by orthodontic biofilms after removal of fixed orthodontic appliance
Source publication
Orthodontic treatment is highly popular for restoring functional and facial esthetics in juveniles and adults. As a downside, prevalence of biofilm-related complications is high. Objectives of this review are to (1) identify special features of biofilm formation in orthodontic patients and (2) emphasize the need for strong concerted action to preve...
Contexts in source publication
Context 1
... demineralization Enamel demineralization surrounding brackets is the most common side effect in orthodontics and can range from white spot lesions to cavitation upon bracket removal ( Fig. 4). This can occur on both vestibular and lingual surfaces, with the most affected sites being the bracket-adhesive-enamel junction on teeth at the esthetic region [14]. Enamel remineralization of white spot lesions can be achieved spontaneously by saliva or actively by fluoride or calcium-phosphate-based remineralization [23]. Whether complete remineralization occurs or not is related to the type and severity of the lesions [11]. White spot lesions can develop rapidly in susceptible individuals within the first month of treatment and can remain visible many years after debonding or in severe cases can appear as a permanent enamel scar [11]. Fast developing or soft lesions are mostly superficial enamel defects and may almost completely remineralize within a few weeks. In most patients, lesions develop gradually during treatment and remineralize extremely slowly. Micro-abrasion, in essence, an invasive method removing sound as well as diseased tissue, is an effective professional cosmetic measure to treat permanent enamel scarring [24], which may also take place spontaneously leading to a gradual regression of the white spot lesion. More severely, white spot lesions may turn into actual cavities, and not seldom, orthodontic appliances have to be removed before the treatment goal has been reached to prevent further demineralization. The long-term presence of white spot lesions or of composite restorations at labial surfaces of teeth, with the potential to turn into cavities or discolor, respectively, is the most prevalent biofilm-related complications in orthodontics, compromising facial esthetics after an often lengthy and costly orthodontic treatment. Soft tissue inflammation Almost all orthodontic patients ex- perience some degree of soft tissue inflammation (Fig. 4). Gingivitis during orthodontic treatment is often temporary and rarely progresses to periodontitis, although biofilms on retention sites increase the risk for periodontitis. Biofilms on temporary anchorage devices (Fig. 5), such as mini-screws, micro-implants, or mini-plates, can cause inflammation of surrounding soft tissues similar to peri-implantitis, especially on transgingival parts of the devices. These inflammations are associated with a 30 % increase in failure rate of the devices [25]. In addition, biofilms on the head of a temporary anchorage device may infect adjacent contacting mucosa resulting in aphthous ulceration forewarning a greater soft tissue inflammation [26]. Treatment of gingivitis or peri-implantitis in orthodontics includes local cleaning, application of antimicrobial-containing products, such as chlorhexidine, cetylpyridinium chloride, or triclosan preferably combined with brushing with a fluoridated toothpaste [26]. Other consequences of orthodontic biofilms Bacteremia caused by trauma during appliance placement or removal is usually transient and occurs with an incidence of up to 10 % during fixed appliance treatment [27] and 30 % at removal of fixed expansion appliances [28]. Biofilms may also affect the appliance itself and cause pitting and crevice corrosion of metallic biomaterials, affecting mechanical properties, surface roughness, or topographies of composite adhesives [29]. In- crease in roughness of the appliance materials due to biofilm is especially troublesome, since rougher surfaces promote biofilm formation [30], providing protective niches against environmental challenges. Hence, a vicious cycle develops in which biofilm formation amplifies itself and may eventually compromise the efficiency of clinical mechanics ...
Context 2
... demineralization Enamel demineralization surrounding brackets is the most common side effect in orthodontics and can range from white spot lesions to cavitation upon bracket removal ( Fig. 4). This can occur on both vestibular and lingual surfaces, with the most affected sites being the bracket-adhesive-enamel junction on teeth at the esthetic region [14]. Enamel remineralization of white spot lesions can be achieved spontaneously by saliva or actively by fluoride or calcium-phosphate-based remineralization [23]. Whether complete remineralization occurs or not is related to the type and severity of the lesions [11]. White spot lesions can develop rapidly in susceptible individuals within the first month of treatment and can remain visible many years after debonding or in severe cases can appear as a permanent enamel scar [11]. Fast developing or soft lesions are mostly superficial enamel defects and may almost completely remineralize within a few weeks. In most patients, lesions develop gradually during treatment and remineralize extremely slowly. Micro-abrasion, in essence, an invasive method removing sound as well as diseased tissue, is an effective professional cosmetic measure to treat permanent enamel scarring [24], which may also take place spontaneously leading to a gradual regression of the white spot lesion. More severely, white spot lesions may turn into actual cavities, and not seldom, orthodontic appliances have to be removed before the treatment goal has been reached to prevent further demineralization. The long-term presence of white spot lesions or of composite restorations at labial surfaces of teeth, with the potential to turn into cavities or discolor, respectively, is the most prevalent biofilm-related complications in orthodontics, compromising facial esthetics after an often lengthy and costly orthodontic treatment. Soft tissue inflammation Almost all orthodontic patients ex- perience some degree of soft tissue inflammation (Fig. 4). Gingivitis during orthodontic treatment is often temporary and rarely progresses to periodontitis, although biofilms on retention sites increase the risk for periodontitis. Biofilms on temporary anchorage devices (Fig. 5), such as mini-screws, micro-implants, or mini-plates, can cause inflammation of surrounding soft tissues similar to peri-implantitis, especially on transgingival parts of the devices. These inflammations are associated with a 30 % increase in failure rate of the devices [25]. In addition, biofilms on the head of a temporary anchorage device may infect adjacent contacting mucosa resulting in aphthous ulceration forewarning a greater soft tissue inflammation [26]. Treatment of gingivitis or peri-implantitis in orthodontics includes local cleaning, application of antimicrobial-containing products, such as chlorhexidine, cetylpyridinium chloride, or triclosan preferably combined with brushing with a fluoridated toothpaste [26]. Other consequences of orthodontic biofilms Bacteremia caused by trauma during appliance placement or removal is usually transient and occurs with an incidence of up to 10 % during fixed appliance treatment [27] and 30 % at removal of fixed expansion appliances [28]. Biofilms may also affect the appliance itself and cause pitting and crevice corrosion of metallic biomaterials, affecting mechanical properties, surface roughness, or topographies of composite adhesives [29]. In- crease in roughness of the appliance materials due to biofilm is especially troublesome, since rougher surfaces promote biofilm formation [30], providing protective niches against environmental challenges. Hence, a vicious cycle develops in which biofilm formation amplifies itself and may eventually compromise the efficiency of clinical mechanics ...
Similar publications
Objective:
To determine the prevalence and counts of Streptococcus mutans and Candida species in orthodontic fixed appliance therapy patients and comparison of the efficiency of manual and electronic toothbrushes on minimizing plaque by reducing S. mutans and Candida species in above-mentioned patients.
Materials and methods:
The study was carri...
Toothbrush is a well-known tool in oral care. Effective tooth brushing can help in the management of dental caries and periodontal disease. Familiarity of children with this device is important. Dentists and their assistant need adequate information about children's oral hygiene to educate them and their parents. The aim of this review was to pinpo...
The presence of fixed orthodontic appliances and its accessories tends to affect bacterial plaque removal, resulting in inadequate cleaning being performed by the patient. Thus, the aim of this systematic review and meta-analysis was to answer the following focal question: are the mechanical methods of oral cleaning effective for the reduction of b...
Background
Fixed orthodontic appliances on tooth surfaces, such as brackets and bands, complicate oral hygiene and increase plaque accumulation, contributing to gingivitis, periodontitis, and tooth decay. While manual toothbrushes are an essential part of oral hygiene, there is little clinical evidence to demonstrate how effective manual toothbrush...
Citations
... Furthermore, since this technique does not involve braces bonded on teeth that create retentive areas for dental plaque, a more effective mechanical cleaning occurs with masticatory function during clear aligner treatment. Moreover, braces can make toothbrushing more difficult and reduce natural self-cleansing by the saliva and the tongue [48]. Cantekin et al. [49] demonstrated high levels of dental plaque accumulation, gingival swelling, and gingival bleeding during orthodontic treatment with fixed appliances. ...
Background: The aim of the study is to compare the potential side effects of fixed orthodontic treatment (FOT) and clear aligner therapy (CAT). Methods: 27 individuals who were treated with clear aligners (20 Female, 7 Male; mean age: 22.57 ± 7.37) and 22 patients treated with braces (14 Female, 8 Male; mean age: 17.05 ± 4.51) formed the study group. The periodontal statuses of the patients were evaluated before treatment (T0), 3 months (T1) after, and at 6th month (T2) following the beginning of the treatment. The amount of root resorption in maxillary & mandibular incisors was evaluated using the ImageJ software on periapical radiographies taken with the paralleling technique. Pain experience and chewing function were also recorded during treatment. Results: The root lengths showed a significant decrease from T0 to T2 in both groups. Compared to CAT, greater amount of root resorption was noted with FOT (p < 0.05). The highest degrees of pain and the highest chewing difficulty scores were recorded at the 24th hour for both groups. The pain scores after the 2nd week in CAT were similar to those before the orthodontic treatment, while this amelioration occurred after the 1st month in FOT. Chewing function improved after the 2nd week in CAT and after the 1stweek in FOT. Periodontal status evaluation showed that there was no significant difference in probing depth between the groups for the maxillary teeth. However, higher probing depth values were observed for all mandibular teeth in FOT. The change in the plaque index and the levels of bleeding were higher for FOT at all time points. Conclusions: CAT has some advantages in terms of protecting periodontal health and controlling root resorption during orthodontic treatment. In terms of the patients' treatment experience, while the pain levels felt by the patients in the CAT group decreased faster, chewing performance improved more rapidly in the FOT group. Clinical Trial Registration: The study was registered with ClinicalTrials.gov as NCT06709287.
... White spot lesions histologically have two surfaces: the superficial surface layer and the sub-surface or body of the lesion layer. The superficial layer is remineralized due to the constant flow of salivary remineralizing proteins, whereas the underlying subsurface layer remains demineralized because the macromolecular salivary proteins do not penetrate the subsurface layer of the enamel [2]. Due to the continuous diffusion of acids, decalcification occurs in the enamel's subsurface layer, which in turn leads to cavitation in the enamel. ...
... [4][5][6] The high demand for treatment and the emergence of biofilm-related complications make orthodontic treatment a potential public health threat. 7 Fluoride is considered the gold standard and is a prominent remineralization agent used in the treatment of white spot lesions. It can reduce demineralization by 50% in orthodontically treated patients. ...
Introduction
The aim of this study was to evaluate the effects of fluoride-containing remineralization agents on enamel white spot lesions.
Methods and Materials
Twenty bovine incisors were cut mesio-distally and occluso-gingivally, creating 80 specimens, and divided into four groups (n=20/group): 1) control (no treatment); 2) fluoride varnish (Voco Profluoroid 5% NaF Varnish, VOCO Dental, Cuxhaven, Germany); 3) CPP-ACFP (MI Paste Plus with Recaldent, GC Corporation, Tokyo, Japan),; 4) self-assembling peptide (P11-4F, CURODONT Repair Fluoride Plus, Credentis AG, Windisch, Switzerland). After a three-week demineralization-remineralization cycle, white spot lesions were observed on the specimens. Before applying the remineralization agents, baseline demineralization values were determined using DIAGNOdent 2095, QLF-D Biluminator, SEM-EDS (KaVo Dental, Charlotte, NC, USA), and color values were measured by Vita EasyShade (Vita Zahnfabrik, Bad Säckingen, Germany). Remineralization agents were applied once, following the manufacturers’ instructions. The remineralization capacities of these agents and their effects on color change were evaluated at four time points: baseline (T0), demineralization (T1), and remineralization on the seventh (T2) and 30th (T3) days.
Results
After 30 days, CPP-ACFP and P11-4F showed significantly greater Ca (% by weight), F (% by weight), and Ca/P ratio than the fluoride varnish group (p<0.05). SEM images revealed that in the groups where the remineralization agent was applied, the pores and tubules were blocked, and the surfaces were covered, whereas these findings were not observed in the control group. Based on QLF-D Biluminator data, P11-4F application provided more successful fluorescence changes compared to CPP-ACFP and fluoride applications and was statistically more effective in reducing lesion volume and maximum fluorescence loss (p<0.05). Significant differences were observed among the four groups at the seventh (T2) and 30th days (T3) in the laser fluorescence evaluation with DIAGNOdent (p<0.05). On the seventh day, the fluoride group exhibited greater effectiveness than the control group, while on the 30th day, the CPPACFP group demonstrated superior improvement over the control group (p<0.05). According to color change results, applying a remineralization agent was found to be a statistically successful method in restoring the tooth’s original color (p<0.05). However, there were no significant differences among the treatment groups (p>0.05).
Conclusions
CPP-ACFP and P11-4F demonstrated positive effects on remineralization at the seventh and 30th days. Applying a remineralization agent is a viable option for blocking pores and tubules on demineralized enamel. The color change related to the use of the remineralization agent showed a positive effect over time.
... A formação do biofilme em pacientes ortodônticos é governada por mecanismos semelhantes aos comuns na cavidade oral. Contudo, o aparelho ortodôntico dificulta a correta higienização da superfície dentária e proporcionam superfícies adicionais a cavidade oral, às quais as bactérias podem aderir com facilidade e formar biofilme dental (REN et al., 2014). ...
... Os aparelhos ortodônticos fixos, incluem braquetes, bandas e fios e habitualmente são utilizados na terapia ortodôntica para correção do mau posicionamento dentário (REN et al., 2014). Esses componentes que formam o aparelho fixo, se deixados na superfície dentária por um longo período de tempo, facilitam o acúmulo de biofilme dental e tornam a escovação mais desafiadora e demorada. ...
A instalação de aparelhos ortodônticos fixos é um fator determinante para o acúmulo de biofilme na cavidade oral. A falta de controle adequado do biofilme nesses casos contribui para a modificação da composição do biofilme, favorecendo ao aparecimento de manifestações inflamatórias do tecido gengival, culminando no aumento gengival. Esta manifestação pode se tornar crônica uma vez que os tecidos gengivais aumentados se tornam um obstáculo aos procedimentos de controle do biofilme, gerando desconforto e insatisfação aos pacientes. Nesse contexto, o objetivo deste artigo é relatar um caso clínico de excisão cirúrgica de aumento gengival em paciente ortodôntico por meio da utilização do laser de alta potência. Paciente do sexo masculino, 18 anos de idade, melanoderma e portador de púrpura foi encaminhado por sua ortodontista para correção do aumento gengival. Diante do quadro apresentado foi planejada a terapia básica periodontal seguida de excisão cirúrgica do tecido gengival aumentado por meio do laser de alta potência de diodo. Após os procedimentos iniciais relacionados ao controle do biofilme foram executados dois tempos cirúrgicos seguidos de reforço das instruções de higiene oral. Considerando o estado sistêmico geral do paciente, concluímos que a excisão dos tecidos gengivais com o laser de alta potência possibilitou um procedimento confortável, proporcionando menor sangramento no trans e pós cirúrgico, resultando num padrão adequado de cicatrização.
... 2 Like the orthodontic bracket, the flexible splint can obstruct biofilm removal and oral hygiene maintenance. 54 Therefore, a patient who wears a splint can use an orthodontic toothbrush to clear his tooth, and fluoride varnish should be applied to a patient who wears a prolonged splint. ...
Traumatic dental injuries (TDIs) of teeth occur frequently in children and adolescents. TDIs that impact the periodontal tissues and alveolar tissue can be classified into concussion, subluxation, extrusive luxation, intrusive luxation, lateral luxation, and avulsion. In these TDIs, management of injured soft tissue, mainly periodontal ligament, and dental pulp, is crucial in maintaining the function and longevity of the injured teeth. Factors that need to be considered for management in laxation injuries include the maturation stage of the traumatic teeth, mobility, direction of displacement, distance of displacement, and whether there are alveolar fractures. In avulsion, the maturation stage of the permanent tooth, the out-socket time, storage media/condition of the avulsed tooth, and management of the PDL should also be considered. Especially, in this review, we have subdivided the immature tooth into the adolescent tooth (Nolla stage 9) and the very young tooth (Nolla stage 8 and below). This consensus paper aimed to discuss the impacts of those factors on the trauma management and prognosis of TDI to provide a streamlined guide for clinicians from clinical evaluation, diagnostic process, management plan decision, follow-up, and orthodontic treatment for tooth luxation and avulsion injuries.
... En este sentido, cualquier material colocado sobre algún soporte de tejido dental o bucal, ocasionará una dificultad adicional, para mantener las superficies buco-dentales libres de placa bacteriana. Tal es el caso de los dispositivos y aditamentos ortodónticos (4). En este contexto, la demanda de tratamientos de ortodoncia ha ido en aumento en todo el mundo, debido a sus alcances para corregir malposiciones dentarias, pero sobre todo, para corregir el aspecto estético. ...
Objective: To determine the dominant microbiota on elastic and metal orthodontic ligatures, as well as the degree of growth and proliferation, for use in interceptive orthodontics. Methods: Multiple cultures were generated and analyzed from samples from elastic and metallic ligatures from 5 orthodontic patients and after 4 weeks of treatment. Briefly, a total of 180 culture samples were cultured and analyzed using blood base agar, mannitol salt agar, chocolate agar, chromoagar, and McConkey agar. Statistical interpretation of the quantitative results was carried out. Results: It was found that metal ligatures presented lower bacterial growth and proliferation, regardless of the brand used, compared to elastic ligatures, including an equal time treatment period. Greater variability of microorganism species was evident in elastic ligations compared to metallic ligations. Conclusion: elastic ligation presents greater susceptibility for bacterial colonies generation than the metallic ligation. In turn, metallic ligation should be preferred to elastic ligation if possible and depending on the type of treatment, for its use at the orthodontic clinic.
... Studies have reported the incidence of new WSL during orthodontic treatment to be 45.8% and the prevalence in patients with previous orthodontic treatment to be 68.4%. 3 The reported prevalence rates of WSL during orthodontic treatment vary between 2 and 97% in different epidemiological studies [4,5]. Orthodontic treatment has been identified as a potential threat to public health due to treatment requirements and complications caused by biofilm accumulation [6]. ...
Objectives
The aim of this study was to evaluate the effect of in-vivo produced Nisin which is an antimicrobial peptide (AMP) added to adhesive resin on shear bond strength (SBS) and the adhesive remnant index (ARI) of orthodontic brackets.
Methods
Bacterial AMP was produced by fermentation and the ideal AMP/Bond concentration and antimicrobial efficacy of the mixture were tested. To evaluate the SBS and ARI scores of AMP-added adhesive resins, 80 maxillary premolar teeth extracted for orthodontic purposes were used and randomly assigned into 2 groups (n = 40). Group 1: Control Group (teeth bonded with standard adhesive resin); Group 2: Experimental Group (teeth bonded with AMP-added adhesive resin). Statistical analysis was performed using the SPSS package program and applying the Mann-Whitney U and Fisher’s exact tests. P < 0.05 was considered as statistically significant.
Results
Nisin synthesized in-vivo from Lactococcus lactis (L. lactis) (ATCC 7962) bacteria was provided to form a homogenous solution at an ideal concentration To find the minimum AMP/Bond mixture ratio that showed maximum antimicrobial activity, AMP and Bond mixtures were tested at various concentration levels between 1/160 and 1/2 (AMP/Bond). As a result, the optimum ratio was determined as 1/40. The antimicrobial efficacy of Nisin-added adhesive resin was tested against Streptococcus mutans (S. mutans) (ATCC 35,688) and Lactobacillus strains (cariogenic microorganisms). AMP formed a 2.7 cm diameter zone alone, while 1/40 AMP-bond mixture formed a 1.2 cm diameter zone. SBS values of the teeth bonded with Nisin added adhesive (17.49 ± 5.31) were significantly higher than the control group (14.54 ± 4.96) (P = 0.004). According to the four point scale, Nisin added adhesive provided a higher ARI score in favour of the adhesive and tooth compared to the control group (ARI = 3, n = 20).
Conclusions
Nisin produced from L. lactis (ATCC 7962) had greater antimicrobial effects after mixing with adhesive bond against cariogenic microorganisms S. mutans (ATCC 35,688) and Lactobacillus strains. Nisin added adhesive increased shear bond strength (SBS) of orthodontic brackets and ARI scores in favor of adhesive & teeth.
Clinical relevance
Clinicians should take into account that using Nisin-added adhesive resin in orthodontic treatments can provide prophylaxis against tooth decay, especially in patients with poor oral hygiene.
... Moreover, from the perspective of oral hygiene, brackets pose a more significant obstacle to effective plaque removal than aligner attachments, favoring biofilm accumulation [35], retaining more plaque, and impeding its effective removal. This difficulty consequently leads to more pronounced inflammation, potentially creating a positive feedback effect as the mechanical action exerted by dental aligners causes chronic inflammation. ...
Background: This article analyzes differences in microbiological parameters and periodontal health conditions among three patient groups: those undergoing conventional orthodontic treatment with fixed appliances, patients undergoing orthodontic treatment with clear aligners, and a control group receiving no treatment. Materials and Methods: In this study, 60 patients were enrolled. The microbiological analysis employed a qualitative and semi-quantitative methodology of bacterial morphotype analysis. Results: The analyses revealed a significant difference in favor of clear oral and periodontal health aligners. This could be attributed to better bacterial biofilm removal and reduced mechanical stress on the periodontal ligament, factors facilitated by the ease of clear aligner removal. Significant differences (p-value < 0.05) were observed for the Full-Mouth Plaque Score, Full-Mouth Bleeding Score, Plaque Index, and periodontal health assessment measurements. Conclusions: Although overall hygiene appears to be improved in patients in the aligners group compared to those treated with conventional orthodontic appliances, there are no statistically significant results regarding plaque composition. Microbiological aspects will be further addressed using more specific techniques in the follow-up of this research.
... During orthodontic treatment, the occurrence of enamel demineralization or white spot lesions is a common issue, affecting a significant percentage of orthodontic patients [1][2][3]. This is primarily due to poor oral hygiene compliance and the increased surfaces available for bacterial biofilm formation caused by fixed orthodontic appliances [1][2][3][4]. ...
... During orthodontic treatment, the occurrence of enamel demineralization or white spot lesions is a common issue, affecting a significant percentage of orthodontic patients [1][2][3]. This is primarily due to poor oral hygiene compliance and the increased surfaces available for bacterial biofilm formation caused by fixed orthodontic appliances [1][2][3][4]. Previous studies have suggested various methods to prevent or reduce the formation of white spot lesions, including oral hygiene instruction, selective acid etching technique, and fluoride application [5,6]. ...
Background
The formation of white spots, which represent early carious lesions, is a major issue with fixed orthodontics. The addition of remineralizing agents to orthodontic adhesives may prevent the formation of white spots. The aim of this study was to produce a composite orthodontic adhesive combined with nano-bioactive glass-silver (nBG@Ag) for bracket bonding to enamel and to investigate its cytotoxicity, antimicrobial activity, remineralization capability, and bond strength.
Methods
nBG@Ag was synthesized using the sol-gel method, and characterized using transmission electron microscopy (TEM), X-ray diffraction (XRD), and Fourier-transform infrared spectroscopy with an attenuated total reflectance attachment (ATR-FTIR). The cytotoxicity test (MTT) and antimicrobial activity of adhesives containing 1%, 3%, and 5% (wt/wt) nBG@Ag were evaluated, and the shear bond strength of the adhesives was measured using a universal testing machine. Remineralization was assessed through microhardness testing with a Vickers microhardness tester and scanning electron microscopy (SEM). Statistical analyses were conducted using the Shapiro-Wilk test, Levene test, one-way ANOVA, Robust-Welch test, Tukey HSD method, and two-way ANOVA.
Results
The biocompatibility of the adhesives was found to be high, as confirmed by the lack of significant differences in the cytotoxicity between the sample and control groups. Discs made from composites containing nBG@Ag exhibited a significant reduction in the growth of Streptococcus mutans (p < 0.05), and the antibacterial activity increased with higher percentages of nBG@Ag. The shear bond strength of the adhesives decreased significantly (p < 0.001) after the addition of nanoparticles, but it remained above the recommended value. The addition of nBG@Ag showed improvement in the microhardness of the teeth, although the differences in microhardness between the study groups were not statistically significant. The formation of hydroxyapatite deposits on the tooth surface was confirmed through SEM and energy-dispersive X-ray spectroscopy (EDX).
Conclusion
Adding nBG@Ag to orthodontic adhesives can be an effective approach to enhance antimicrobial activity and reduce enamel demineralization around the orthodontic brackets, without compromising biocompatibility and bond strength.
... Fixed appliance therapy is a predisposing factor for the onset of caries and WSLs. Irregular surfaces of brackets, wires, and bands limit the natural mechanisms of salivary self-cleaning, facilitate plaque accumulation, and complicate the maintenance of good oral hygiene [3]. ...
Fixed appliance (FA) therapy predisposes patients to white spot lesions (WSLs). The F-ACP complex (amorphous calcium phosphate nanoparticles enriched with carbonate and fluorine and coated with citrate) has been effective for in vitro enamel remineralization. The aim of this study was to evaluate the efficacy of the F-ACP complex in remineralizing WSLs after FA therapy. One hundred and six adolescents (aged 12–20 years) were randomized into study and control groups after FA therapy. Patients in the study group were advised to use dental mousse containing F-ACP applied within Essix retainers for six months. The presence of WSLs was recorded at baseline (T0), 3 months (T1), and 6 months (T2) according to the International Caries Detection and Assessment System (ICDAS). Visual Plaque Index (VPI) and Gingival Bleeding Index (GBI) were recorded. Among 106 study participants, 91 (52 and 39 in study and control groups, respectively) completed the study. The results showed that the ICDAS score was significantly lower (p < 0.001) in the study group than in the control group between T0 and T2. The application of mousse containing the F-ACP complex inside Essix retainers for six months is effective in remineralizing white spot lesions in patients after FA therapy without side effects.
