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 09/2011; 5(1):158-62. DOI: 10.2174/1874210601105010158
Source: PubMed


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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    • "However, patient compliance, which is a major factor determining the success of these methods decreases throughout the treatment period [10]. Thus, preventive measures that do not require compliance were considered to be more predictable in such high-risk patients [1] [5] [6]. Clinically it has been shown that once WSLs are formed, they do not completely disappear by means of remineralization treatment unless removed mechanically by microabrasion , infiltrated with a low-viscosity resin or treated in a restorative fashion [5,11,12]. "
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    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.
    Preview · Article · May 2014 · Acta Odontologica Scandinavica
    • "When an intraoral acid attack occurs, the calcium and phosphate ions are released to produce a supersaturated concentration of ions in the saliva, which then precipitates a calcium-phosphate compound onto the exposed tooth surface.[7879] Few studies showed that daily applications of the remineralizing cream could reverse the severity and visual appearance of postorthodontic WSL more effective than or at least as good as, fluoride toothpaste.[808182] The use of CPP-ACP can be more beneficial than fluoride rinse for postorthodontic remineralization.[83] "
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    ABSTRACT: The formation of white spot lesions or enamel demineralization around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which mars the result of a successfully completed case. This article is a contemporary review of the risk factors, preventive methods and fate of these orthodontics scars. The importance of excellent oral hygiene practice during fixed orthodontic treatment must be explained. Preventive programs must be emphasized to all orthodontic patients. Suggestions are offered in the literature for ways to prevent this condition from manifesting itself.
    No preview · Article · Apr 2013
    • "Following the formation of a highly colonized cariogenic micro-flora, neither tooth brushing nor increased fluoride delivery is capable of effectively preventing the demineralization process [1,2]. Thus, the use of an antimicrobial agent to suppress cariogenic bacteria, and thereby to inhibit the development of new caries lesions, seems to be a rational approach during orthodontic treatment [3,4]. "
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    ABSTRACT: OBJECTIVE: To investigate the effect of chlorhexidine applications in various forms and concentrations on adhesion and failure modes of metal brackets in vitro. MATERIAL AND METHODS: Ninety bovine enamel specimens were allocated to six groups (n=15). Metal brackets were bonded on all specimens after chlorhexidine pre-treatments forming the following groups: (1) untreated specimens (control); (2) 40% varnish (EC40, Biodent BV, Netherlands), remnants removed with brushing mimicking patient cleaning; (3) 40% varnish (EC40), remnants removed with brushing mimicking professional cleaning; (4) 1% varnish (Cervitec Plus, Ivoclar vivadent, Schaan, Liechtenstein), remnants not removed; (5) brushed with% 1 gel (Corsodyl, GlaxoSmithKline, Münchenbuchsee, Germany), remnants not removed; (6) immersed in 0.07% mouthrinse (Corsodyl, GlaxoSmithKline, Münchenbuchsee, Germany), remnant not rinsed. Debonding of brackets was performed using a universal testing machine. Data were analysed using one-way ANOVA and post-hoc Scheffé test. RESULTS: Group 4 performed significantly inferior than all the other groups and the control. Group 4 presented the highest number of adhesive failures at the enamel-resin interface whereas in other groups no failures at adhesive-resin interface was observed. CONCLUSION: Presence of chlorhexidine varnish prior to bracket bonding adversely affects adhesion. Concentration of chlorhexidine pre-treatment has no influence on shear bond strength.
    No preview · Article · Dec 2012 · Head & Face Medicine
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