Treatment management between orthodontists and general practitioners performing clear aligner therapy

Objective:To investigate differences in case selection, treatment management, and aligner treatment expertise between orthodontists and general practitioners.Materials and Methods:A parallel pair of original surveys with three sections (case selection, treatment management, and demographics) was sent to orthodontists (N = 1000) and general dentists (N = 1000) who were providers of aligner treatment.Results:Orthodontists had treated significantly more patients with aligners, had treated more patients with aligners in the previous 12 months, and had received more aligner training than general dentists (P < .0001). In general, case confidence increased with increasing experience for both orthodontists and general dentists. After adjusting for experience, there was a significant difference in aligner case confidence between orthodontists and general dentists for several malocclusions. General dentists were more confident than orthodontists in treating deep bite, severe crowding, and Class II malocclusions with aligners (P ≤ .0001). Significant differences were also found for all treatment management techniques except interproximal reduction.Conclusion:There was a significant difference in case selection, treatment management, and aligner expertise between orthodontists and general dentists, although the differences in case selection were small. Overall, it was shown that orthodontists and general dentists elected to treat a variety of moderate to severe malocclusions with aligners but with different utilization of recommended auxiliaries, perhaps demonstrating a difference in treatment goals.     

Discomfort associated with Invisalign and traditional brackets: A randomized,prospective trial

Objective:To evaluate differences in discomfort levels between patients treated with aligners and traditional fixed orthodontic appliances.Materials and Methods:This blinded, prospective, randomized equivalence two-arm parallel trial allocated 41 adult Class I nonextraction patients to either traditional fixed appliance (6 males and 12 females) or aligner (11 males and 12 females) treatment. Patients completed daily discomfort diaries following their initial treatment appointment, after 1 month and after 2 months. They recorded their levels of discomfort at rest, while chewing, and while biting, as well as their analgesic consumption and sleep disturbances.Results:Both treatment modalities demonstrated similar levels of initial discomfort. There were no significant sex differences. Patients in the traditional fixed appliances group reported significantly (P < .05) greater discomfort than patients in the aligner group during the first week of active treatment. There was significantly more discomfort while chewing than when at rest. Traditional patients also reported significantly more discomfort than aligner patients after the first and second monthly adjustment appointments. Discomfort after the subsequent adjustments was consistently lower than after the initial bonding or aligner delivery appointments. A higher percentage of patients in the fixed-appliance group reported taking analgesics during the first week for dental pain, but only the difference on day 2 was statistically significant.Conclusions:Patients treated with traditional fixed appliances reported greater discomfort and consumed more analgesics than patients treated with aligners. This trial was not registered.     

A randomized clinical trial comparing mandibular incisor proclination produced by fixed labial appliances and clear aligners

Objective:To compare the mandibular incisor proclination produced by fixed labial appliances and third generation clear aligners.Materials and Methods:Patients underwent a course of orthodontic treatment using either fixed labial appliances or clear aligners (Invisalign). Mandibular incisor proclination was measured by comparing pretreatment and near-end treatment lateral cephalograms. Eligibility criteria included adult patients with mild mandibular incisor crowding (<4 mm) and Class I skeletal bases (ANB, 1–4°). The main outcome was the cephalometric change in mandibular incisor inclination to the mandibular plane at the end of treatment. Eligible patients picking a sealed opaque envelope, which indicated their group allocation, was used to achieve randomization. Data was analyzed using a Welch two-sample t-test.Results:Forty-four patients (mean age, 26.4 ± 7.7 years) were randomized in a 1:1 ratio to either the fixed labial appliance or the clear aligner group. Baseline characteristics were similar for both groups: Fixed appliance mean crowding was 2.1 ± 1.3 mm vs clear aligner mean crowding, 2.5 ± 1.3 mm; pretreatment mean mandibular incisor inclination for the fixed appliance group was 90.8 ± 5.4° vs 91.6 ± 6.4° for the clear aligner group. Fixed appliances produced 5.3 ± 4.3° of mandibular incisor proclination. Clear aligners proclined the mandibular incisors by 3.4 ± 3.2°. The difference between the two groups was not statistically significant (P > .05).Conclusion:There was no difference in the amount of mandibular incisor proclination produced by clear aligners and fixed labial appliances in mild crowding cases.     

Effect of clear aligner therapy on the buccolingual inclination of mandibular canines and the intercanine distance

Objective:To compare the changes in buccolinugal inclination of mandibular canines and intercanine distance in patients treated with clear aligners to those treated with preadjusted edgewise appliances.Materials and Methods:The buccolingual inclination of mandibular canines and the intercanine distance were measured on pre- and posttreatment cone-beam computed tomograms of 30 patients who had been treated with clear aligners and 30 patients who had been treated with fixed preadjusted edgewise appliances. Differences between the aligner and fixed appliance groups and between pre- and posttreatment measurements were tested for statistical significance.Results:In both groups, most of the mandibular canines had positive buccolingual inclinations (ie, their crowns were positioned lateral to their roots) both before and after treatment. While there was no difference between the groups pretreatment, the posttreatment buccolingual inclination was significantly greater in the aligner group. In the fixed appliance group, the canines became more upright with treatment, while the buccolingual inclination did not change significantly in the clear aligner group. The intercanine distance did not differ between the groups either before or after treatment. However, it increased significantly over the course of treatment in the aligner group, whereas it did not change significantly in the fixed appliance group.Conclusions:Orthodontic treatment with clear aligners tends to increase the mandibular intercanine distance with little change in inclination in contrast to treatment with fixed appliances, which leaves the intercanine distance unchanged but leads to more upright mandibular canines.     

Prevalence of white spot lesion formation during orthodontic treatment

Purpose:To quantify the prevalence of white spot lesions (WSLs) on the anterior teeth and, secondarily, to evaluate risk factors and predictors.Materials and Methods:Digital photographs and records of 885 randomly chosen patients were evaluated before and after treatment. Chart information included gender, age, as well as banding and debanding dates. Fluorosis and oral hygiene before and after treatment were also evaluated. Preexisting and posttreatment WSLs were recorded and compared for all 12 anterior teeth. Risk ratios (RR) and absolute risk (AR) were calculated to determine the likelihood and risk of WSL formation.Results:Overall, 23.4% of the patients developed at least one WSL during their course of treatment. Maxillary anterior teeth were affected more than mandibular teeth. The maxillary laterals and canines and the mandibular canines were the most susceptible. There was no significant difference in WSLs between genders. Fluorosis, treatment time in excess of 36 months, poor pretreatment hygiene, hygiene changes during treatment, and preexisting WSLs were all significantly (P < .05) related to the development of WSLs. The highest risk of developing WSLs was associated with preexisting WSLs (RR = 3.40), followed by declines in oral hygiene during treatment (RR = 3.12) and poor pretreatment oral hygiene (RR = 2.83).Conclusions:Nearly 25% of the patients developed WSLs while in treatment, depending on fluorosis, treatment time, preexisting WSLs, and oral hygiene. Orthodontists need to be mindful of these risk factors when making treatment decisions.     

Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions

ObjectiveTo assess the efficacy and efficiency of treatment in adolescents presenting with mild malocclusions, comparing outcomes using clear aligners to fixed appliances.Materials and MethodsPatients identified retrospectively and consecutively from one private practice had been treated with either clear aligners (Invisalign, Align Technology, Santa Clara, Calif) or fixed appliances (0.022 Damon, Ormco, Orange, Calif; n = 26/group). Assessments of occlusion were made using the American Board of Orthodontics Discrepancy Index (DI) for initial records and Cast-Radiograph Evaluation (CRE) for final records. Number of appointments, number of emergency visits, and overall treatment time were determined from chart reviews. Data were analyzed using Pearson''s correlation, Wilcoxon rank tests, unpaired t-tests, and Chi-square tests, with significance set to P ≤ .05.ResultsPretreatment, the aligner and fixed groups showed no significant difference in overall severity (DI: 11.9 ± 5.3 vs 11.6 ± 4.8) or in any individual DI category. Posttreatment scores showed finishes for the aligner group had fewer discrepancies from ideal relative to the fixed appliance group (CRE: 30.1 ± 8.3 vs 37.0 ± 9.3; P < .01). Patients treated with aligners had fewer appointments (13.7 ± 4.4 vs 19.3 ± 3.6; P < .0001), fewer emergency visits (0.8 ± 1.0 vs 3.6 ± 2.5; P < .0001), and shorter overall treatment time (16.9 ± 5.7 vs 23.4 ± 4.4 months; P < .0001).ConclusionsOutcomes for treatment of mild malocclusions in adolescents showed equivalent effectiveness of clear aligners compared to fixed appliances, with significantly improved results for clear aligner treatment in terms of tooth alignment, occlusal relations, and overjet. Assessment of the number of appointments, number of emergency visits, and overall treatment time showed better outcomes for treatment with clear aligners.     

A practice-based evaluation of the prevalence and predisposing etiology of white spot lesions

ObjectiveTo use an alumni-centered, practice-based research network to evaluate white spot lesions (WSLs) among treated orthodontic patients.Materials and Methods:An initial survey was conducted to ascertain whether orthodontic alumni from Texas A&M University Baylor College of Dentistry were willing to participate. Twenty randomly selected alumni participated, providing 158 treated cases. Each alumnus (1) obtained internal review board consent; (2) submitted pre- and posttreatment photographs of 10 consecutively finished cases; (3) completed a treatment survey; and (4) had the patient/parent complete the American Dental Association (ADA) Caries Risk Assessment.Results:Almost 90% of the alumni surveyed were willing to participate in the practice-based research, primarily because a fellow alumnus asked them to. Approximately 28% of the patients developed WSLs. The average patient developed 2.4 white spots, affecting 12.7% of the teeth examined. WSLs were significantly (P < .001) more (2.3−3.2 times) likely for patients who were identified on the ADA Caries Risk Assessment. The risk of developing WSLs during treatment was also increased for those with fair (2.7 times) or poor (3.5 times) oral hygiene, poor gingival health (2.3 times), and extended treatment times (2.1 times).Conclusions:There is a substantial risk of developing WSLs among private practice patients, depending partially on the length of treatment. Patients at greatest risk can be identified prior to treatment based on the ADA Caries Risk Assessment, oral hygiene, and gingival health.     

Forces and moments delivered by novel,thinner PET-G aligners during labiopalatal bodily movement of a maxillary central incisor: An in vitro study

Objective:To evaluate whether overloading of teeth can be avoided by utilizing aligners with reduced thicknesses of 0.4 mm or 0.3 mm.Materials and Methods:The experimental setup included an acrylic maxillary jaw model with tooth 11 separated and fixed via a 3-D force-moment transducer to a hexapod for experimental movement. Aligners tested were fabricated on duplicate stone models using commercially available polyethylene terephthalate glycol (PET-G) foils with thicknesses between 0.5 and 0.75 mm, and novel 0.4-mm- and 0.3-mm-thick foils. With the test aligner seated, 11 was bodily displaced in a labiopalatal direction in the range of ±0.25 mm while all six force-and-moment components exerted on this tooth were registered.Results:With the thinnest commercially available 0.5-mm aligner, median forces of −7.89 N and 8.37 N were measured for the maximum 0.25-mm movement of 11 in a labial and palatal direction, respectively. In comparison, force values were 35% and 71% lower for the novel aligners with a thickness of 0.4 mm and 0.3 mm, respectively.Conclusions:Novel “leveling” aligners with reduced thickness may reduce overloading of individual teeth during aligner therapy. Due to form instability of 0.3-mm aligners, we suggest a novel sequence of 0.4–0.5–0.75 mm for aligner systems using several foil thicknesses for load graduation within single setup steps. This would combine low stiffness of the initial aligner and relatively constant load increases throughout the treatment.     

Forces and moments delivered by the PET-G aligner to a maxillary central incisor for palatal tipping and intrusion

Objective:To evaluate the effect of material thickness and width of the gingival edge on the forces and moments delivered by aligners prepared from Duran foil (PET-G) to a maxillary incisor during tipping and intrusion.Materials and Methods:Aligners prepared from PET-G of three material thicknesses (0.5, 0.625, and 0.75 mm) and three widths of gingival edges (0–1, 3–4, and 6–7 mm) were investigated during incisor palatal tipping and intrusion of 0.5 mm each. Forces and moments were measured with a six-component measuring device. The influence of aligner thickness and aligner extend on the force and moment development were tested for statistical significance (P < .05).Results:The F_x and F_z forces produced during palatal tipping and intrusion by the 0.75-mm aligner material was significantly higher than those produced by the 0.5-mm-thick material (P = .005 and P = .047, respectively). There was no statistical difference between aligner thickness of 0.5 and 0.625 mm and between 0.625 and 0.75 mm. The same behavior was observed for the palatal moment (M_y). The F_x and F_z forces produced during palatal tipping and intrusion by the aligner with an extension of 0–1 mm edge was significantly lower than that of the aligner with a larger extension (3–4 mm edge: P = .003; 6–7 mm: P = .001). However, there was no statistical difference between aligners with a 3–4-mm and a 6-mm edge. The same behavior was observed for the palatal moment (M_y).Conclusions:The forces and moments exerted by the PET-G aligner on teeth vary, depending on the material thickness, width of the aligner edge, and direction of tooth movement.     

Cephalometric comparison of adult anterior open bite treatment using clear aligners and fixed appliances

Objectives:To compare fixed appliances and clear aligner therapy in correcting anterior open bite and in controlling the vertical dimension in adult patients with hyperdivergent skeletal patterns.Materials and Methods:In this retrospective study, two treatment groups of adult (≥18 years old) hyperdivergent patients (mandibular plane angles of ≥38°) with anterior open bites were included: 17 fixed appliance patients and 36 clear aligner patients. Thirteen cephalometric measurements representing the vertical dimension were reported for each group. A two-sample t-test was used to assess differences in changes in mandibular plane angle and overbite between the two treatment groups.Results:There were no statistical differences found in the magnitude of overbite correction and the changes in any of the cephalometric measurements for vertical control. The clear aligner group showed a slightly greater amount of lower incisor extrusion (P = .009). The main mechanism of open bite correction was similar between the two treatment groups and was accomplished through retroclination of the upper and lower incisors while maintaining the vertical position of the upper and lower molars.Conclusions:Cephalometric comparison of anterior open bite correction and changes in the mandibular plane angle associated with use of clear aligners and fixed appliances did not demonstrate statistically significant differences in adult hyperdivergent patients.     

Comparison of alveolar bone thickness and height after slow expansion using quad-helix or clear aligners

ObjectiveThe study was conducted to investigate the thickness and height of the alveolar bone of individual teeth after slow maxillary expansion (SME) with quad helix or clear aligner appliances and hypothesized that there is no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners.Material and MethodsThis is a retrospective study; the records of 22 patients treated between December 2019 to April 2020 by dental arch expansion using either clear aligners or quad helix appliances were retrieved and studied. The results obtained through cone beam computed tomography (CBCTs) before and immediately after maxillary expansion (2 + 1 mm per side) were analyzed (11 in the Quad Helix group and 11 in the clear aligner). The data collected was analyzed using linear and angular measurements obtained through On-demand 3D App software. Furthermore, Statistical Package for Social Sciences (SPSS) version 25.0 was used to present the findings by mean and standard deviations, and Scheffe’s test was applied for comparing forces.ResultsThe results showed that the mean age of patients in the clear aligner group and Quad Helix was 16.27 ± 0.56 years and 15.5 ± 1.53 years, respectively. There was no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners. This is due to the findings that suggest that there was a decrease in bone height and bone width when treated with a quad helix as compared to clear alignment.ConclusionIt can be concluded that the quad helix SME treatment affects alveolar bone integrity; therefore, clear aligners might be better for treating patients than the quad helix.     

Volumetric cone-beam computed tomography evaluation and risk factor analysis of external apical root resorption with clear aligner therapy

ObjectivesTo investigate the prevalence and severity of external apical root resorption (EARR) volumetrically with clear aligner therapy using cone-beam computed tomography (CBCT) as well as determine the possible risk factors and develop a prediction model for EARR.Materials and MethodsIn this retrospective study, 320 incisors from 40 Class II patients treated with aligners (Invisalign) were included in this study. CBCT images were obtained at pretreatment (T0) and posttreatment (T1). Root volume was calculated by three-dimensional reconstruction of CBCT images, and apical tooth movement was measured from superimposed CBCT images. Changes in root volume were compared using paired t-tests, and the relationship between root volume loss and potential risk factors was analyzed by multiple linear regression.ResultsAll of the measured incisors showed root volume loss, with an average of 11.48 ± 6.70 mm³, and the prevalence of severe resorption was 0.625%. The prediction model for EARR included variables of posttreatment sagittal root position (SRP), extraction, tooth type, and apical intrusion and extrusion displacements, with an R² of 0.51. Age, sex, duration, pretreatment SRP, attachment, advancement, and retraction movements were excluded from the model.ConclusionsMost incisors showed mild to moderate resorption during aligner treatment; only a minimal percentage showed severe resorption. Posttreatment SRP (which showed the highest association with EARR), extraction, tooth type, and apical intrusion and extrusion displacements were risk factors for EARR.     

Esthetic improvements of postorthodontic white-spot lesions treated with resin infiltration and microabrasion: A split-mouth,randomized clinical trial

Objective:To compare the esthetic improvement between postorthodontic white-spot lesions (WSLs) treated by resin infiltration and microabrasion for 12 months.Materials and Methods:A total of 20 patients with 128 teeth with postorthodontic WSLs were recruited. A simple randomized, split-mouth, positive controlled design was used to allocate patients to resin infiltration or microabrasion groups. The lesion area ratio (R value) was calculated between the area of a WSL and the labial surface of the corresponding tooth based on standardized clinical photographs. The color change (ΔE) of each tooth was measured with a Crystaleye spectrophotometer (Olympus, Tokyo, Japan). Every measurement was taken before treatment (T0) and at different time points after treatment: 1 week (T1), 6 months (T6), and 12 months (T12).Results:A total of 16 patients with 108 trial teeth were available at T12. Each group had 54 trial teeth. In both groups, there was a significant decrease in R value and ΔE between T1 and T0 (P < .0001). In the infiltration group, the R value and ΔE had no significant changes over time from T1 to T12. In the microabrasion group, the R value and ΔE decreased significantly from T1 to T6. The R value of resin infiltration was lower when compared with microabrasion at every recall point (P < .001). The ΔE had no significant differences between the two groups at any timepoint.Conclusions:Resin infiltration and microabrasion improved the esthetic appearance of WSLs and showed sufficient durability for 12 months. Resin infiltration showed a better esthetic improvement effect when compared with microabrasion at 12 months.     

Preventing and treating white-spot lesions associated with orthodontic treatment: a survey of general dentists and orthodontists

BackgroundThe authors investigated the prevention and treatment of white-spot lesions (WSLs) during and after orthodontic therapy from the perspective of general dentists and orthodontists.MethodsThe authors administered a cross-sectional survey to general dentists (n = 191) and orthodontists (n = 305) in Virginia, Maryland and North Carolina.ResultsSixty-nine percent of general dentists and 76 percent of orthodontists recommended in-office fluoride treatment for patients with severe WSLs immediately after orthodontic treatment. Sixty-nine percent of general dentists reported that they had treated WSLs during the previous year, and 37 percent of orthodontists reported that they had removed braces because of patients' poor oral hygiene. Sixty percent of orthodontists referred patients with WSLs to general dentists for treatment. Eighty-five percent of orthodontists responded that they encouraged patients to use a fluoride rinse as a preventive measure. More than one-third of general dentists indicated that severe WSLs after orthodontic treatment could have a negative effect on their perception of the treating orthodontist.ConclusionsWSLs are a common complication of orthodontic treatment and their presence can result in a negative perception of the treating orthodontist by the patient's general dentist.Clinical implicationsGeneral dentists and orthodontists should work together to prevent the development of WSLs in their patients. Treatment with fluoride supplements and motivating and training patients to practice good oral hygiene will help achieve this goal. Treatment after debonding should include the topical application of low concentrations of fluoride.     

Esthetic comparison of white-spot lesion treatment modalities using spectrometry and fluorescence

Objective:To compare the esthetic improvements of white-spot lesions (WSLs) treated by fluoride, casein phosphopeptide amorphous calcium phosphate (CPP-ACP), or resin infiltration.Materials and Methods:WSLs were created on human enamel and randomly assigned to four groups: NaF (500 ppm), CPP-ACP, resin infiltration (Icon), or distilled deionized water (DDW; control group). The color change (ΔE) of each specimen was measured with a Crystaleye spectrophotometer, and fluorescence loss (ΔQ) was measured by quantitative light-induced fluorescence (QLF), at different time points after treatment: baseline (0 weeks), 2 weeks, 4 weeks, and 6 weeks.Results:The ΔE and ΔQ baseline values for the four groups before the treatments did not differ significantly. Icon treatment improved the WSL color significantly and gave the lowest ΔE (2.9 ± 1.2 on average) compared with other treatments (P < .01). The Icon treatment also resulted in a significant change in the ΔQ of WSLs compared with baseline (P < .01). In the NaF and CPP-ACP treatment groups, ΔQ showed significant recovery compared with the baseline values only after 4 weeks after treatment (P < .05).Conclusions:Resin infiltration is more effective than NaF or CPP-ACP in providing esthetic improvement of WSLs.     

A comparative study of two different clear aligner systems

Background

This study aims to compare the ‘Nuvola®’ system with ‘Fantasmino®’ system, examine their material properties, and define the indications for use of the aligners.

Methods

Two groups of patients were selected and were respectively treated with Nuvola® aligner and Fantasmino® system.

Results

The goal of treatment has been achieved with the two systems.

Conclusions

The two types of aligners have shown differences during the treatment. Fantasmino® system has elastic properties of high performance, but its size does not encourage compliance throughout the day. Nuvola® system determines good tooth movement and its size facilitates the patient’s collaboration. In both aligner systems, difficulties were found in the correction of torque information and rotations.     

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

BackgroundThe 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.MethodsThe 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.ResultsThe 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.ConclusionsResin infiltration significantly improved the clinical appearance of WSLs, with stable results seen eight weeks after treatment.Practical ImplicationsResin infiltration, a minimally invasive restorative treatment, was shown to be effective for WSLs that formed during orthodontic treatment.     

Comparative time efficiency of aligner therapy and conventional edgewise braces

Objective:To compare the time efficiency of aligner therapy (ALT) and conventional edgewise braces (CEB) based on large samples of patients treated by the same highly experienced orthodontist, with the same treatment goals for both groups of patients.Materials and Methods:The retrospective portion of the study evaluated 150 CEB patients who were matched, based on mandibular crowding and number of rotated teeth, to 150 ALT patients. All records were obtained at one orthodontist''s office. All of the patients had mild-to-moderate Class I malocclusions (≤5 mm incisor crowding) and were treated nonextraction. Age, gender, total treatment time, total number of appointments, types of appointments, materials used, mandibular crowding, and number of rotated teeth were recorded from the patients'' records. The prospective portion of the study timed the various types of appointments for both treatments with a stopwatch.Results:Compared to ALT, CEB required significantly (P < .01) more visits (approximately 4.0), a longer treatment duration (5.5 months), more emergency visits (1.0), greater emergency chair time (7.0 minutes), and greater total chair time (93.4 minutes). However, ALT showed significantly (P < .01) greater total material costs and required significantly more total doctor time than CEB (P < .01).Conclusions:Whether the greater time efficiency of ALT offsets the greater material costs and doctor time required depends on the experience of the orthodontist and the number of ALT case starts.     

Diagnosing the severity of buccal caries lesions in governmental and private orthodontic patients at debonding,using the ICDAS-II and the DIAGNOdent Pen

Objectives: To clinically evaluate the prevalence of buccal caries and white spot lesions (WSLs) at debonding in governmental and private orthodontic patients, using the International Caries Detection and Assessment System (ICDAS-II) and the DIAGNOdent Pen, and to study the correlation between the two methods.Materials and Methods:A cross-sectional study was carried out on the nonextracted premolars and anterior teeth of 89 orthodontic patients. They were recruited into two groups based on the treatment center they attended: governmental group (G; n  =  45) and private group (P; n  =  44). Immediately after debonding, the examination of buccal caries and WSLs on premolars and anterior teeth was carried out using the ICDAS-II and the DIAGNOdent Pen. Cross-tabulation was applied to study the correlation between the ICDAS-II index and the DIAGNOdent Pen by calculating the Spearman correlation coefficient.Results:The G group showed a significantly higher (P < .0001) prevalence of WSLs and/or buccal caries compared to that of the P group based on evaluation by the two methods. Based on ICDAS-II, 43% of the patients in the P group and 9% in the G group were free from any WSLs. In the G group, 22% of the patients had ≥16 lesions, whereas there were none for the P group. The Spearman correlation coefficient between the two methods was .71.Conclusions:The prevalence of caries and/or WSLs at debonding was significantly higher in the G group compared to the P group. The clinical index (ICDAS-II) showed a good correlation with the DIAGNOdent Pen.