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 n_teeth = 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 (ΔE_WSL/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 n_teeth = 49; male/female ratio 5/4; age range 13–19 years) were available at T12. After the highly significant reduction of ΔE_WSL/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. (Angle Orthod. 2015;85:374–380.)     

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.     

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.     

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.     

Evaluation of staining and color changes of a resin infiltration system

Objective:To analyze the staining and color changes of a resin infiltrant system used for management of white spot lesions (WSLs).Materials and Methods:WSLs were artificially created on left buccal halves of 48 extracted human teeth. These sites were then treated with resin infiltration (RI) while the right halves of the teeth remained as nonresin (NRI) areas. Six groups were formed (n = 8 teeth/group) and were exposed to the following: red wine, coffee, orange juice, combined staining agents, accelerated aging, and distilled water for 1 week. The teeth were then polished with a prophy cup and polishing paste. Color properties were assessed using a spectrophotometer at baseline (T0), after each exposure (T1), and after polishing (T2). Color difference (ΔE*) was calculated between each time point for both halves of the teeth (RI and NRI). Data were analyzed with a two-way analysis of variance with presence of resin infiltration and staining agents as the main effects for each time point pair. Multiple comparisons were made with a Bonferroni post hoc test. The level of significance was set at P < .05.Results:The red wine and combined staining agent groups caused the greatest color change between all intervals (P < .05). Significant interactions were recorded between resin infiltration application and staining agents at all time periods (P < .05). The presence of resin infiltration as a main effect did not affect color change between T0 and T2 (P > .05).Conclusions:RI areas showed higher staining susceptibility than did NRI areas. However, prophylaxis had a strong effect on reversing the discoloration of both RI and NRI areas.     

渗透树脂联合微研磨或联合美白用于氟斑牙治疗的美学效果分析

目的:分析渗透树脂联合微研磨或联合美白用于治疗氟斑牙的美学效果.方法:筛选符合纳入标准的氟斑牙患者24例(80颗患牙,TSIF =4),随机分为渗透树脂+微研磨组、渗透树脂+美白组,并进行相应处理.口内照相后使用图像软件分析患牙治疗前(baseline T0)、1周复诊(T2)、6月复诊(T3)不同时刻病损区域与周围正...     

The efficacy of fluoride varnish vs a filled resin sealant for preventing white spot lesions during orthodontic treatment:: A randomized clinical trial

ObjectivesTo compare the efficacy of casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) MI Varnish (GC America, Inc, Alsip, IL) and ProSeal (Reliance Orthodontic Products, Itasca, IL) sealant in preventing the development of white spot lesions (WSLs) in orthodontic patients.Materials and MethodsThis prospective randomized clinical trial included 40 orthodontic patients 12–17 years of age. One group had sealants placed on their anterior maxillary teeth, with reapplications every 3 months. The other group had MI Varnish applied every 4–6 weeks. WSL formation and oral hygiene were evaluated at the initial appointment before bonding (T1) and 12 months later (T2). Standardized digital photographs were analyzed using the enamel decalcification index (EDI). Statistical comparisons were made using independent and paired-sample t-tests as well as chi-square tests.ResultsIn this trial, 43% of patients and 15% of teeth developed new WSLs. Lateral incisors showed the highest incidence of decalcification and WSL formation. WSL formation and EDI score increases during treatment were significantly greater in the gingival region than in the mesial, distal, or incisal regions. Of the EDI scores at T2, 93.8% were 0 and 5.5% were 1. Poor oral hygiene at T2 showed a high positive predictive value (76%) for the development of WSLs. There were no statistically significant between-group differences for the development of WSLs.ConclusionsMI Varnish and ProSeal sealant provided similar levels of protection during the first 12 months of fixed orthodontic treatment. The severity of the WSLs that developed was minimal. WSLs were most likely to develop on lateral incisors and in the gingival regions of teeth, especially among patients with poorer oral hygiene.     

Do total or partial etching procedures effect the rate of white spot lesion formation? A single-center,randomized, controlled clinical trial

Objective:To determine whether total or partial etching procedures influence the appearance of white spot lesions (WSLs).Materials and Methods:This split-mouth, double-blind, controlled, randomized study included 20 patients (mean age 16.75 years), who had class I malocclusion, mild crowding, and satisfactory oral hygiene. A total of 40 maxillary quadrants were randomly allocated to be treated using a total etching (TE) or partial etching (PE) protocol. Quantitative light fluorescence images were captured at the beginning and at 3 (T1) and 6 (T2) months after beginning orthodontic treatmen, as well as when the debonding phase of orthodontic treatment was complete (T3). The presence of pre- and posttreatment WSLs was assessed with quantitative light fluorescence software and analyzed with Student''s t-test.Results:The analyses showed that, at T2, the total etching group had significantly higher ΔQ and A scores than the partial etching group (P < .05). The ΔF scores increased significantly at all timepoints in the TE group, but only at T1 and T3 in the PE group. However, no differences were noted at T3 between the TE and PE groups (P > .05). The inclusion of only right-handed people may have limited the generalizability of the findings. The absence of analyses of the plaque and gingivitis scores of patients was another limitation of this study.Conclusions:WSL formation was observed mostly in maxillary lateral incisor teeth irrespective of the etching technique. Although PE seems to be more successful in the first 6 months, no difference was observed between PE and TE in the long term for WSL formation.     

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.     

Effect of resin infiltration and microabrasion on the microhardness,surface roughness and morphology of incipient carious lesions

Objective: The effects of resin infiltration and microabrasion on incipient carious lesions by surface microhardness, roughness and morphological assessments, and resistance to further acid attack of treated lesions were evaluated.

Material and methods: Eighty artificially-induced incipient lesions were randomly divided into five groups (n?=?16): resin infiltration with an adhesive resin (Excite F, Ivoclar Vivadent, Schaan, Liechtenstein), resin infiltration with a resin infiltrant (Icon, DMG, Hamburg, Germany), microabrasion without polishing (Opalustre, Ultradent, South Jordan, UT, USA), microabrasion with polishing (Opalustre, Ultradent, Diamond Excel, FGM, Joinville, SC, Brazil), and distilled water (control group). All specimens were exposed to demineralization for another 10 d. Microhardness, roughness and morphological assessments were done at baseline, following initial demineralization, treatment and further demineralization. Data were analysed by the Kruskal–Wallis, Friedman’s and Bonferroni tests (p?Results: Enamel lesions treated with resin infiltrant and microabrasion demonstrated similar hardness values, with a nonsignificant difference compared with sound enamel. Resin infiltration demonstrated lower roughness values than those of microabrasion, and the values did not reach the values of sound enamel. Further demineralization for 10 d did not affect the hardness but increased the roughness of infiltrated and microabraded enamel surfaces. Polishing did not influence the roughness of microabraded enamel surfaces. After resin infiltration, porosities on enamel were sealed completely. The surface structure was similar to that of the enamel conditioning pattern for microabraded enamel lesions.

Conclusions: Within the limitations of this study, the icon infiltration and microabrasion technique appeared to be effective for improving microhardness. Icon appeared to provide reduced roughness, although not equal to sound enamel. Further research is needed to elucidate their clinical relevance.     

Shear bond strength evaluation of bonded molar tubes on fluorotic molars

Objective:To study the shear bond strength (SBS), sites of failure, and micromorphology of bonded molar tubes used on teeth affected by dental fluorosis.Materials and Methods:This in vitro study included 140 first molars classified according to Dean''s index for dental fluorosis. Samples were divided into seven groups: (1) healthy teeth etched for 15 seconds, (2) teeth with moderate fluorosis (MOF) etched for 15 seconds, (3) teeth with MOF etched for 150 seconds, (4) teeth with MOF microabrasion etched for 15 seconds, (5) teeth with severe fluorosis (SEF) etched for 15 seconds, (6) teeth with SEF etched for 150 seconds, and (7) teeth with SEF microabrasion etched for 15 seconds. All samples were incubated and were then submitted to the SBS test and evaluated with the modified adhesive remnant index (ARI) and analyzed by using a scanning electronic microscope.Results:The SBS mean value for healthy enamel was 20 ± 10.2 MPa. For the group with MOF, the etched 150-second mean value was the highest (19 ± 7.6 MPa); for the group with SEF treated with microabrasion and etched for 15 seconds, the mean value was (13 ± 4.1 MPa). Significant differences (P ≤ .05) were found in the ARI between healthy and fluorosed groups.Conclusions:Fluorotic enamel affects the adhesion of bonded molar tubes. The use of overetching in cases of MOF and the combination of microabrasion and etching in SEF provides a suitable adhesion for fixed appliance therapy.     

EFFECTIVENESS OF RESIN INFILTRATION IN CARIES INHIBITION AND AESTHETIC APPEARANCE IMPROVEMENT OF WHITE-SPOT LESIONS: AN UMBRELLA REVIEW

ObjectivesResin infiltration technique is a minimal interventive approach to manage white-spot lesions. The present umbrella review aimed to comprehensively appraise the previously published systematic reviews on the effectiveness of resin infiltration in arresting caries progression and improving the aesthetic appearance of white-spot lesions.Material and MethodsTen electronic databases were searched between January 1960 and May 2021. Only systematic reviews published in English on the use of resin infiltration in primary or permanent teeth were included. The degree of overlap across each review was calculated using the Corrected Covered Areas method and their evidence quality were assessed using A MeaSurement Tool to Assess systematic Reviews 2 assessment tool. Umbrella meta-analysis was carried out using a random-effects model.ResultsThirteen systematic reviews were chosen, but only eight were eligible for an umbrella meta-analysis. The overall Corrected Covered Areas value was very high (19.8%), whereas only three studies were classified as ‘High Quality’. Qualitative synthesis suggested that resin infiltration demonstrated acceptable aesthetic results, whereas quantitative analysis showed favourable outcomes in minimizing the risk of caries progression (RR: 0.32; 95% CI: 0.29-0.36). White-spot lesions treated with resin infiltrant in permanent teeth demonstrated a lower risk of caries progression (P < .001) than primary teeth. Overall, low data heterogeneity was observed (I²: 0%-20%). However, quantitative umbrella analysis on the aesthetic outcome was unable to perform due to limited data.ConclusionResin infiltration can be regarded as an effective treatment modality in minimizing the risk of caries progression and improving the aesthetic appearance of white-spot lesions. Future well-designed high-quality systematic reviews with long-term follow-up and more control of confounding variables are warranted.     

Effects of remineralization procedures on shear bond strengths of brackets bonded to demineralized enamel surfaces with self-etch systems

Objective:To compare the effects of different remineralization procedures on the surface roughness of teeth, shear bond strengths (SBSs), and Adhesive Remnant Index scores of self-etching primer (SEP) used to bond orthodontic brackets to previously treated demineralized enamel surfaces.Materials and Methods:A total of 140 extracted human premolar teeth were randomly divided into seven equal groups. Group I was the control group. A demineralization procedure was performed in the other six groups. A remineralization procedure was performed before bonding by using casein phosphopeptide-amorphous calcium phosphate, fluoride, a microabrasion mixture (18% hydrochloric acid-fine pumice), a microabrasion agent, and resin infiltration in groups III to VII. Brackets were bonded using a self-etching primer/adhesive system. The specimens were tested for SBS. The roughness and morphology of the enamel surfaces were analyzed using profilometer and scanning electron microscopy. Data were analyzed with analysis of variance, Tukey, and G-tests at the α  =  .05 level.Results:Significant differences were found in the SBS values among the seven groups (F  =  32.69, P  =  .003). The lowest SBS value was found in group II (2.62 ± 1.46 MPa). No significant differences were found between groups I, III, and VII, between groups III and IV, or between groups V and VI. The differences in the roughness values were statistically significant among the groups (P  =  .002).Conclusions:Remineralization procedures restore the decreased SBS of orthodontic brackets and decrease surface roughness caused by enamel demineralization. SEPs provide clinically acceptable SBS values for bonding orthodontic brackets to previously treated demineralized enamel surfaces.     

Incidence of white spot lesions among patients treated with clear aligners and traditional braces

Objectives:To compare the incidence of white spot lesions (WSLs) among patients treated with aligners and those treated with traditional braces.Materials and Methods:A group of 244 aligner patients (30.4 ± 14 years) was compared to a group of 206 patients (29.2 ± 11.5 years) treated with traditional fixed braces. Consecutive cases in the late mixed or permanent dentitions who had high-quality pre- and posttreatment digital photographs available were included in the study. Each set of photographs was independently evaluated by two investigators to determine pretreatment oral hygiene (OH), fluorosis, and WSLs, as well as changes in OH and WSLs during treatment.Results:Approximately 1.2% of the aligner patients developed WSLs, compared to 26% of the traditionally treated patients. The numbers of WSLs that developed were also significantly (P < .001) less among the aligner patients. The aligner patients developed three new WSLs, while the traditionally treated patients developed 174 WSLs. The incidence of WSLs was greater for the maxillary than for the mandibular teeth, and it was greater for the canines than for the incisors. For the patients treated with traditional braces, fair or poor pretreatment OH, worsening of OH during treatment, preexisting WSLs, and longer treatment duration significantly (P < .05) increased the risk of developing WSLs during treatment.Conclusions:Patients treated with aligners have less risk of developing WSLs than do patients treated with traditional braces, which could be partially due to shorter treatment duration, or better pretreatment OH.     

Treatment of white spot lesions with ACP paste and microabrasion

Abstract Objective: To examine the effects of application of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste and microabrasion treatment on the regression of white spot lesions (WSLs). Materials and Methods: Artificially-induced WSLs in bovine enamel were randomly assigned to one of four treatment groups: CPP-ACP paste only, microabrasion only, microabrasion and CPP-ACP, and a control. Samples were treated with each regimen twice daily for 2?weeks and stored in remineralizing solution between the treatments. Quantitative light-induced fluorescence was used to measure changes in fluorescence, which indicate changes in mineral content of WSLs immediately before (T1) and 2?weeks after treatment (T2). A two-within-subject factor analysis of variance was used to analyze the significance of any changes in mineral content of the lesions from T1 to T2. Results: There was a statistically significant (P < .05) gain in fluorescence associated with the microabrasion only, as well as the microabrasion and CPP-ACP treatments. The changes in fluorescence for the CPP-ACP treatment alone were not statistically significant (P = .40). Conclusions: CPP-ACP paste alone does not significantly improve the fluorescence value (ie, the mineral content) of WSLs. Within the limitations of this in vitro study, microabrasion treatment with or without CPP-ACP improved the fluorescence and thus reduced WSLs.     

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.     

Clinical evaluation of the remineralizing effect of a mouthguard and paste containing S-PRG filler on white spot lesions

ObjectivesWhite spot lesions (WSLs) are frequently observed on young permanent teeth. The aim of this clinical study was to evaluate the remineralizing effect of paste and a mouthguard containing surface pre-reacted glass-ionomer (S-PRG) filler by observing and measuring lesion area.Materials and methodsA total of 14 children (age range, 8–16 years) with WSLs involving 74 teeth attending Asahi University Medical & Dental Center were examined. Color- and size-matching stickers (Cas Match™, Bear Medic) were photographed with involved teeth. Mouthguards made of an S-PRG filler-containing ethylene-vinyl acetate sheet (sample; SHOFU) with S-PRG filler-containing paste (PRG Pro-Care Gel®; SHOFU) (PRG MG-Paste group) or without paste (PRG MG group; control) were applied to WSLs at bedtime.ResultsNo teeth required restoration due to caries progression during the experimental period. Mean reductions in lesion area at 6 months after treatment in the PRG MG-Paste group and PRG MG group were 1.66 ± 1.84 mm² and 0.81 ± 1.27 mm², respectively. Significant differences were observed between groups (p < 0.05). No significant difference in area reduction was seen between kinds of teeth involved, although significant differences in area reduction were observed among individual subjects.ConclusionThese results suggest that combined use of S-PRG filler-containing paste and a mouthguard is effective for remineralization of WSLs observed on numerous teeth.     

EFFICACY OF NOVEL BIOACTIVE GLASS IN THE TREATMENT OF ENAMEL WHITE SPOT LESIONS: A RANDOMIZED CONTROLLED TRIAL✰

Objectivesto evaluate the efficacy of 2 types of bioactive glass (45S5) compared to casein-phosphopeptide stabilized-amorphous calcium phosphate (CPP-ACP) in the treatment of orthodontically-induced white spot lesions (WSLs).MethodsSixty post-orthodontic WSLs (ICDAS II score 2) were randomly allocated to a double blind randomized controlled trial with 3 parallel arms (n = 20). Test group I (Bio-BAG) received BiominF slurry and toothpaste, and test group II (N-BAG) received Novamin slurry and toothpaste. While the positive control group (CPP-ACP) received Recaldent paste. Products were applied daily in-office during week 1, and boosted by self-administered home application for 4 weeks (week 1-4). Standard oral hygiene care was performed by all participants twice daily during months 2-6. All patients were assessed for change in WSL dimensions using computer assisted analysis based on standardized digital intraoral photographs in addition to laser fluorescence DIAGNOdent assessment before treatment (T0) and at 1 week (T1), 1 month (T2), 3 months (T3,) and 6 months (T4) follow up periods.ResultsKruskal Wallis test was used (P < .05 for all). At T4, a statistically significant (P < .001) regression of WSL was disclosed in all 3 groups compared to baseline, and a highly significant lesion size percent reduction in Bio-BAG group compared to the control group (P < .001). The mean area of the lesions decreased by 64.8%, 32.2%, and 31.6% for groups I, II and III respectively (P = .001). DIAGNOdent findings largely reflected the clinical scores (Mean scores at baseline/T4 for groups I, II, and III respectively; 16.57/3.62, 16.93/7.90, 21.95/19.27). No adverse effects were reported.ConclusionsThe combined in-office and home-application of BiominF paste for 4 weeks resulted in greater esthetic improvements of post-orthodontic WSLs compared to Novamin and CPP-ACP. In addition, BiominF showed a significant reduction in fluorescence intensity which indicates potential lesion remineralization.Clinical RelevancePost-orthodontic WSLs can be diminished using bioactive glass remineralization therapy.     

Comparison of bleaching effects when applied to white-spot lesions before or after resin infiltration: An in vitro study

BackgroundThe purpose of this study was to compare color alterations (ΔE) of white-spot lesions (WSLs) bleached before versus after resin infiltration (RI).MethodsUsing the facial surfaces of bovine maxillary incisors, WSLs were created and the teeth were allocated into 2 groups (n = 45/group): bleach then RI (B-RI group) and RI then bleach (RI-B group). To determine ΔE, Commission Internationale de l’Eclairage L1 a1 b1 (L1 represents lightness, ranging from black to white [0-100]; a1 represents green to red chromaticity [–150-+100]; and b1 represents blue to yellow chromaticity [–100-+150]) measurements were obtained at baseline, after WSL formation, and after RI and bleaching. Representative specimens were evaluated by means of scanning electron microscopy. Statistical analyses included the Mann-Whitney U and Wilcoxon signed rank tests (P ≤ .0016) and repeated measures analysis of variance (P ≤ .05).ResultsNo differences in ΔE were found comparing B-RI with RI-B groups or when the B-RI group was compared with bleached enamel. A statistically significant difference was found when the RI-B group was compared with bleached enamel (ΔE, 0.81; P < .001), but the difference was deemed not clinically significant. Scanning electron microscopy revealed that bleaching after RI increased surface roughness of the resin.ConclusionsThere were no clinically significant differences in ΔE of WSLs when bleach was applied before or after RI; however, applying bleaching agent after RI roughened the surface of the resin material.Practical ImplicationsResults indicate that ΔE were not clinically significantly different between WSLs bleached before versus after RI, although it is best to sequence bleaching before RI therapy, as bleaching after RI roughened the restoration’s surface.     

Effect of tooth surface coating material containing S-PRG filler on white spot lesions of young permanent teeth

Purpose

Pre-cavitation carious lesions recognized as white spot lesions (WSLs) are frequently observed on young permanent teeth. A more effective method to remineralize WSLs is needed to prevent not only caries progression, but also esthetic problems. Various coating materials for remineralization have been developed. The aim of this study was to evaluate the effect of a coating material (PRG Barrier Coat, SHOFU) containing surface pre-reacted glass-ionomer (PRG) filler to remineralize WSLs by measuring the area of lesions.