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Background: enamel demineralization is a common side effect of orthodontic therapy with fixed braces. The aim of the present in vitro study was to compare a conventional adhesive system and a modern adhesive system (APC Flash-Free [FF] technology) with regard to the demineralization of enamel by Streptococcus sobrinus (S. sobrinus). Methods: this in vitro study included premolar teeth and compared APC FF adhesive brackets (Group A, n = 15) with conventional adhesive brackets (Group B, n = 15) from the same company. Specimens were incubated with a positive control group (PCG, n = 5) and a negative control group (NCG, n = 5) in an S. sobrinus suspension for three weeks. To evaluate the grade of enamel demineralization, the samples were analyzed using a polarizing microscope. Results: the test specimens of group B with conventionally bonded bracket adhesive showed significantly greater (+10.8 μm) demineralization with regard to the penetration depth of the demineralization than the PCG (p = 0.012). Thus, there was a difference from group A with the new bracket adhesive of the FF brackets (+7.29 μm). Significantly, demineralization was more pronounced cervically than coronally in both groups, and it occurred cervically more frequently than grade 3 demineralization (p = 0.001). Conclusions: it seems plausible that new orthodontic bracket adhesives and the modern FF adhesive system positively contribute to the reduction in enamel demineralization during orthodontic treatment.

Background: The resin-based materials are used extensively in esthetic restorations but are.prone to color changes over time. Aims: To assess the discoloration effect of red tea, Arabic coffee, and black coffee on the resin infiltrated white spot lesions (WSL). Moreover, to investigate the impact of time (1d, 3d, and 7d) on the discoloration of the resin infiltrated WSLs. Materials and methods: Thirty-three extracted human premolar teeth were used to create WSLs, and ICON resin infiltration treatment was performed to obliterate the enamel pores. Teeth with resin infiltrated WSLs were sectioned into two halves by cutting mesio-distally and cross-sectionally at 1 mm below the CEJ. The resin infiltrated specimens was exposed to control (artificial saliva) and staining subgroups. Colour stability was assessed using the CIE L*a*b* system. Results: Analysis of variance (p

Objectives: This study aims to evaluate the effectiveness of topical fluoride application and diode laser-irradiation on the hardness of demineralized enamel and to evaluate the esthetic improvement of the white spot lesions (WSLs) using a visual analog scale (VAS). Materials and Methods: Artificial WSLs (3x3 mm) were created on the enamel surface of 45 human third molars. The teeth were randomly assigned into three groups (n = 15): group A, fluoride only; group B, combined therapy of fluoride and diode laser; and group C, control. Vicker’s hardness number (VHN) was measured at baseline, after demineralization and after treatment. To evaluate the esthetic improvement after treatment, 14 raters evaluated each group’s photographs using a 100-millimeter VAS. A one-way ANOVA or Brown-Forsythe and Games-Howell post hoc procedure were performed for statistical analysis. The level of significance was set at α = 0.05 for all tests. Results: Group A mean VHN was significantly higher than groups B and C, and group B was significantly higher than group C (P

Rapid maxillary expansion and use of a face mask have been successfully applied in growth spurt patients with skeletal class III malocclusion due to maxillary growth deficiency. Teeth that have not erupted into the mouth for various reasons are defined as impacted teeth. There are various treatment methods to treat these teeth. The incidence of white spot lesions defined as initial caries is increasing in patients with inadequate oral hygiene in orthodontic treatments.In this case report, orthopedic and orthodontic treatment of a patient with maxillary retrognathia and impacted upper left central incisor is presented, along with the treatment of white spot lesions that occur as a complication due to poor oral hygiene of the patient after the impacted tooth was treated. A 11 years and 5 months old female patient applied to the Orthodontic Clinic with the complaint that her upper jaw was behind and missing teeth. In the clinical and radiological evaluation, the skeletal class III of the patient due to maxillary retrognathia, dental class III, circular crossbite and impacted upper left central incisor were diagnosed. It was decided to treatment of the impacted tooth in fixed orthodontic treatment following rapid maxillary expansion and bringing upper jaw forward with a face mask. Circular crossbite, maxillary retrognathia and impacted upper left incisor were successfully treated. During fixed orthodontic treatment, white spot lesions were observed at the cole level of the maxillary anterior teeth due to inadequate oral hygiene. Fixed orthodontic treatment was finished because of the large number of white spot lesions and the prognosis of inadequate oral hygiene that increases the spread of white spot lesions on enamel surfaces.Conclusion: White spot lesions were successfully treated with direct composite restoration. A satisfactory aesthetic smile was achieved after orthopedic, orthodontic and restorative treatment., Hızlı üst çene genişletmesi ve yüz maskesi kullanımı, maksiller gelişim yetersizliğine bağlı iskeletsel sınıf III maloklüzyona sahip büyüme atılım dönemindeki hastalarda başarılı bir şekilde uygulanmaktadır. Ağız içerisine çeşitli sebeplerle sürememiş dişler gömülü diş olarak tanımlanmaktadır. Bu dişleri sürdürmek için çeşitli tedavi yöntemleri bulunmaktadır. Ortodontik tedavilerde yetersiz ağız hijyeni olan hastalarda, başlangıç çürüğü olarak tanımlanan beyaz nokta lezyonlarının görülme sıklığı artmaktadır. Bu vaka raporunda maksiller retrognatiye sahip üst sol santral kesici dişi gömülü bulunan hastanın ortopedik ve ortodontik tedavisi ile birlikte gömülü diş sürdürüldükten hastanın ağız hijyeni yetersizliğine bağlı bir komplikasyon olarak oluşan beyaz nokta lezyonlarının tedavisi sunulmaktadır. 11 yıl 5 ay yaşındaki kız hasta üst çenesinin geride ve eksik dişi olduğu şikayeti ile Ortodonti Kliniği’ne başvurdu. Yapılan klinik ve radyolojik değerlendirmede hastanın maksiller retrognatiye bağlı iskeletsel sınıf III, dişsel sınıf III, sirküler çapraz kapanış ve üst sol santral kesici dişin gömülü olduğu teşhis edildi. Hastaya hızlı üst çene genişletmesi ve yüz maskesiyle üst çenenin öne alınmasını takiben sabit ortodontik tedavi aşamasına geçilerek gömülü dişin sürdürülmesine karar verildi. Sirküler çapraz kapanış, maksiller retrognati ve gömülü üst sol kesici dişi sürdürülerek başarılı bir şekilde tedavi edildi. Sabit ortodontik tedavi sırasında yetersiz ağız hijyenine bağlı olarak üst çene ön dişlerin kole bölgesi seviyelerinde beyaz nokta lezyonları oluşumu gözlendi. Beyaz nokta lezyonların sayıca fazla dişte görülmesi ve yetersiz ağız hijyeninin beyaz nokta lezyonlarının mine yüzeylerindeki yayılımını arttırıcı prognozu nedeniyle sabit ortodontik tedavi sonlandırıldı.Sonuç: Beyaz nokta lezyonları direkt kompozit restorasyon ile başarılı bir şekilde tedavi edildi. Ortopedik, ortodontik ve restoratif tedaviden sonra memnun edici estetik bir gülüş sağlandı.

Alterations on the optical features of teeth may influence the aesthetical perception of the smile and generate dissatisfaction and negative impacts on quality of life. Enamel opacities are related to chromatic dental changes. White spot lesions due to caries and fluorosis are examples of clinical situations in which the enamel may present opacities caused by increased subsurface microporosities. Resin infiltration of smooth surfaces buccal opacities is a microinvasive approach to treat those cases, in which the subsurface micro porosities are infiltrated by a resin that presents a closer refractive index to sound enamel. Despite clinical reports and short-term studies showing some promising outcomes, the stability of the aesthetical results obtained with this kind of treatment, based on clinical trials with at least 6-months follow up, is still unclear. Therefore, the aim of this systematic review and meta-analysis is to evaluate the medium-term effects of resin infiltration on masking of dental enamel opacities.

Objective: This study was performed to evaluate the effect of three remineralizing agents’ (Curodont repair, Clinpro XT varnish, and Clinpro white varnish) application on the state and shade of white spot. Materials and methods: Twenty patients were included in this study. The state and shade of white spot lesions before the application of the remineralizing agents were assessed using two devices, which are the Diagnodent Pen and Vita easyshade V. The affected nearest right tooth to the midline was treated with Curodont™ Repair, while the affected nearest left tooth to the midline was treated using Clinpro™ XT Varnish, and the third right or left affected tooth was treated using Clinpro white varnish (3M ESPE Dental). After the application, each white spot lesion of the treated tooth was evaluated immediately, after three months and after six months. Results: Both Curodont™ Repair and Clinpro™ XT Varnish showed significant improvement in the state (p < 0.001) and shade (p < 0.001) of the lesions after application, both immediately and after three and six months, with no significant difference between the effect of both treatments (p=0.140 and p=0.985 respectively). Clinpro white varnish showed no significant improvement in the state and shade after application, immediately or after three and six months. Conclusion: Curodont™ Repair and Clinpro™ XT Varnish showed significant improvement in the progression white spot lesions. Clinpro white varnish showed no significant effect.

Aim: White spot lesions are the only carious process lesions that can be remineralized non-invasively. The focus of modern dentistry is stopping the caries process without unnecessary damaging the tooth structure. The present clinical trial aimed to assess the remineralizing effect of eggshell powder (ESP) compared to Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP) in carious post-orthodontic white spot lesions orthodontic treatment. Methodology: Twenty-Four patients were selected from the Clinic of Orthodontic Dentistry Department, Faculty of Dentistry, Cairo University. Patients were divided into two groups according to the treatment received either ESP gel or CPP-ACP paste (GC Tooth-Mousse). The participants were instructed to use pea size eggshell powder gel or GC Tooth Mousse on the teeth surfaces using a clean finger twice daily after brushing their teeth with Colgate Total Original Care toothpaste. WSLs were assessed at baseline, 1 month, 3months and 6 months by DIAGNOdent (Kavo, Germany). Results: Data were analyzed using Two-way ANOVA showed that there was no statistically significant difference in overall DIAGNOdent mean readings between ESP and GC Tooth Mousse groups at (P=0.136). Conclusion: Based on the data obtained in this study, it is suggested that ESP is effective and has a promising future in the treatment of post-orthodontic WSLs.

AIM: This study compared the impact of two resin infiltration systems on microhardness of demineralized enamel before and after an acidic challenge. MATERIALS AND METHODS: A total of forty human maxillary molar teeth were used in this study. Each tooth has 4 groups (four standardized windows onto each tooth). Group A1: Untreated sound enamel surface (positive control), Group A2: Artificially demineralized enamel surface (negative control), Group A3: Icon resin infiltrating to demineralized enamel, while Group A4: Single bond universal adhesive applied to the demineralized enamel surface. All teeth were immersed in a demineralizing solution. The groups (A3 and A4) were further subdivided into two subgroups according to acidic ethanol challenge Subgroup B1: Specimens tested before an acidic challenge and B2: Specimens tested after an acidic challenge. Vickers microhardness test was done for all groups. One-way analysis of variance (ANOVA) was used to study the difference between tested groups on mean microhardness within each group. Tukey’s post-hoc test was used for pair-wise comparison between the means when ANOVA test was performed, and the significance level was set at p ≤ 0.05. RESULTS: Icon resin infiltration and single bond universal adhesive showed significantly higher mean microhardness than negative control, but significantly lower mean microhardness than positive control. However, insignificant difference was found between icon and single bond universal adhesive. After the acidic challenge, icon resin infiltration showed significantly higher mean microhardness than negative control. However, single bond universal adhesive showed insignificant difference as compared to the negative control. CONCLUSION: After an acidic challenge, icon resin infiltration was more successful than single bond universal total-etch adhesive system in microhardness. RECOMMENDATION: Icon resin infiltration technique is a promising, noninvasive approach that prevents the progress of the carious lesion.

Objective: The aim of this study was to determine the quality and reliability of the information provided by YouTube™ videos about white spot lesion.Methods: YouTube™ videos were searched for the term 'white spot lesion' (WSL) by relevance. 142 videos about WSL were analyzed and 56 videos that met the inclusion criteria were evaluated. Video demographics (number of views, duration, number of likes, number of comments) viewing rate, primary purpose, video sources were determined and the reliability and the quality of the listed videos were evaluated with modified DISCERN (ModDISCERN) scale and the Global Quality Scale (GQS). Kruskall-Wallis, Mann–Whitney U test, Spearman’s correlation coefficients and Intra-class Correlation Coefficient were used for statistical analyses. Results: The majority of YouTube™ videos analyzed on WSL were uploaded by YouTube™ channels (50%), with 29% uploaded by dentists and 21% by companies. The mean/standard deviation (SD) ModDISCERN score, showing the reliability of the information in the videos, was 2.71±1.22; and the mean/SD GQS value showing the video quality was 2.71±1.14. 25% of the videos’ GQS value was >3, and the reliability of the information in these videos was significantly higher than the videos with a GQS of ≤3 (3.93 vs. 2.31; P, ÖZAmaç: Bu çalışmanın amacı, beyaz nokta lezyonları hakkındaki YouTube™ videolarının bilgi kalitesini ve güvenilirliğini değerlendirmektir.Gereç ve Yöntem: YouTube™ videoları alaka düzeyine göre 'beyaz nokta lezyonu' (BNL) terimi için arandı. BNL ile ilgili 142 video analiz edildi ve dahil edilme kriterlerini karşılayan 56 video çalışma kapsamında değerlendirildi. Video demografisi (görüntülenme sayısı, süresi, beğeni sayısı, yorum sayısı) izlenme oranı, video paylaşım amacı, video kaynakları belirlendi ve listelenen videoların güvenilirliği ve kalitesi Modifiye DISCERN (ModDISCERN) ölçeği ve Global Quality Skalası (GQS) ile değerlendirildi. İstatistiksel analizler için Kruskall-Wallis, Mann-Whitney U testi, Spearman korelasyon katsayıları ve Sınıf İçi Korelasyon Katsayısı kullanıldı.Bulgular: BNL hakkında analiz edilen YouTube™ videolarının çoğu YouTube™ kanalları tarafından (%50), %29'u diş hekimleri ve %21'i çeşitli firmalar tarafından yüklenmiştir. Videolardaki bilgilerin güvenirliğini gösteren ortalama/standart sapma (SS) ModDISCERN skoru 2.71±1.22; video kalitesini gösteren ortalama/SS GQS değeri ise 2.71±1.14 idi. Videoların %25'inin GQS değeri >3 idi ve bu videolardaki bilgilerin güvenilirliği, GQS'si ≤3 olan videolardan önemli ölçüde daha yüksekti (3.93'e karşı 2.31; P

Aim: The current study was conducted to evaluate the effectiveness of ginger and rosemary herbals versus sodium fluoride in remineralization of incipient enamel caries. Methodology: white spot lesions in anterior teeth of post orthodontic debanding patients received randomly two types of remineralizing agents, either ginger and rosemary gel or sodium fluoride varnish (bifluorid 10). White spot lesions were evaluated at base line one month and after 3, 6 months follow up periods by two blinded assessors to assess white spot lesion progression by Kavo DIAGNOdent. Results: Mann-Whitney test showed that there at baseline, sodium fluoride varnish group yielded similar readings as ginger and rosemary gel group (P=0.060). While at 1 month, ginger and rosemary gel group showed significantly higher readings compared to sodium fluoride varnish group (P

This study aimed to evaluate the sampling method for the detection of Ascaris suum larval DNA in chicken livers using real-time PCR. Chickens were inoculated with A. suum eggs of a single dose (Group A) or repeatedly low doses (Group B). White spots (WSs) were continuously observed on liver from day 3 after the last infection in Group B and day 14 in Group A. In Group A, larval DNA was detected in WS lesions (78.6%) at a significantly higher rate than in the remaining tissue samples (31.3%). In conclusion, applying WS lesions to the assay improved the detection rate of A. suum DNA in chicken livers, especially in the case of a single infection.

Statement of the Problem: Studies on the efficacy of erbium laser for enhancement of enamel resistance to acid attacks and its effects on fluoride uptake by the enamel are limited. Purpose: This study sought to assess and compare the effects of erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation and application of acidulated phosphate fluoride (APF) gel (alone and in combination) on remineralization of artificial white spot lesions (WSLs). Materials and Method: This in vitro, experimental study evaluated 90 buccal and lingual slabs of extracted human premolars. The specimens underwent pH cycling to induce WSLs. They were then randomly divided into 6 groups of caries-free positive control (c+), negative control with WSLs (ws), 1.23% APF gel applied on the enamel (F), Er:YAG laser irradiation (80 mJ, 10 Hz, and 8 J/cm2) of enamel (L), APF gel application followed by laser irradiation (FL), and laser irradiation followed by fluoride gel application (LF). The fluoride ion content of specimens was measured before and after the intervention using a potentiometer. Data were analyzed by ANOVA (p< 0.05). Results: APF gel application before/after laser irradiation maximally increased the fluoride uptake by the enamel (p= 0.000). Application of APF gel in group F and laser irradiation in group L increased fluoride uptake by the enamel, compared with groups 1 and 2 (p= 0.000). Laser- treated (L) and APF-treated (F) groups had no significant difference in this respect (p= 0.945). Maximum fluoride concentration was noted in combined laser and fluoride groups (FL=332.07ppm and LF=341.27ppm) with no significant difference between the two (p= 1.000). Conclusion: Er:YAG laser irradiation changes the chemical composition of enamel and probably promote its remineralization, especially when combined with APF gel application, which highlights its cariostatic potential.

Background- Early treatment of white spot lesions is essential to prevent the progression of the lesion. Aim - To evaluate and compare the remineralizing potential of CPP-ACP with fluoride (Casein Phospho Peptide-Amorphous Calcium Phosphate) and S-PRG fillers (Surface Pre reacted glass fillers) using atomic absorption spectroscopy and colorimetric method. Materials and methods- Forty sound human premolars were used in this study. They were divided into two groups (A & B), consisting of 20 samples in each. White spot lesions (WSLs) were established on the window (4x4 mm2) created on the buccal surfaces of the samples. Samples in group A were treated with casein phosphopeptide amorphous calcium phosphate (CPP-ACP) with fluoride, those of group B were treated with S-PRG Fillers. The sample teeth were immersed in a demineralizing solution for 4 days. All the samples were subjected to loss of mineral content (wt %), i.e., calcium, using atomic absorption spectroscopy and phosphorus using the colorimetric method. Results- Statistical analysis was performed using one?way analysis of variance, Tukey’s and paired t?tests. Group A exhibited the highest remineralizing potential, followed by Group B. Statistically, a significant difference (p=0.001) was observed between the two groups. Conclusion- There was a significant difference in remineralizing potential of CPP-ACP with fluoride and S-PRG Fillers. CPP-ACP with fluoride appears to be an effective technique in the remineralization of white spot lesions.

The aim of this systematic review was to evaluate the incidence of white spot lesion with clear aligners. Decalcification or whit spot lesion (WSL) is a white opacity seen on smooth surfaces because of retention of bacterial plaque. Recently, there has been an increase in the number of adults seeking orthodontic treatment that is both more esthetic and more comfortable. However, there are few studies reporting the prevalence of WSL with clear aligners. Clear aligner treatment provides various advantages in maintaining oral hygiene; therefore, this systematic review was conducted of all studies that reported the frequency of white spot lesion with clear aligner therapy. Literature research was conducted on different databases electronically by using specific inclusion and exclusion criteria, two independent investigators performed data extraction and analysis. Total 9,949 records were identified. However, only three articles met the criteria that were included in this systematic review. The quality assessment for included studies showed that all three studies had low quality. It was concluded that there is an increase in WSL after clear aligner therapy according to the available evidences, however, this increase is less than that reported for conventional orthodontic fixed appliances.

Introduction: Despite extensive research in various preventive technologies over the years, white spot lesion (WSL) development in association with orthodontic treatment with fixed appliances remains an unwanted clinical problem. Materials and Methods: This study was conducted to compare the efficacy of various cariostatic products available commercially that would help in prevention of white spot lesions. Total 120 healthy extracted premolars were taken and divided into a sample of four groups. GC Tooth Mousse, Clin pro and Anticay were compared for their protective efficiency. Three test groups had three different topical agents applied and the fourth group acted as a control. After the test materials were applied they were subjected to pH cycling using artificial saliva with a pH of 4.5 that acted as a demineralization agent and fluorescence was assessed using spectroscopy. Results: One way Anova and Student‘t’ test revealed the efficacy of all the three materials as cariostatic agents, GC Tooth Mousse and Anticay were revealed to have the best protective efficiency. Conclusion: GC Tooth Mousse and Anticay can be used by the orthodontic patients as an in home application product for the prevention of development of white spot lesions. Keywords: White spot lesions, Spectroscopy, Artificial Saliva, CPP-ACP, CaSP.

One of the main disadvantages of orthodontic treatment with fixed appliances is the formation of demineralisations around the brackets. These demineralisations develop because the brackets produce an increased number of plaque retention sites and a change in the oral environment, resulting in a different plaque composition. To prevent the formation of these demineralisations several methods are used during orthodontic treatment. Using additional fluoride is the best solution, for example, rinsing daily with a fluoride mouthwash, applying a fluoride varnish during every scheduled check-up, or using toothpaste with a high concentration of fluoride. The last 2 methods are less effectively incorporated in daily practice in the Netherlands due to financial or time factors. Additional measures, like using fluoride-releasing adhesives, CPP-ACP(F) or a chlorhexidine rinse appear to be less effective in reducing demineralisations. It is also important to provide specific oral hygiene and dietary instructions, based on an individual risk assessment.Een van de grootste nadelen van een orthodontische behandeling met vaste apparatuur is het ontstaan van demineralisaties rondom de brackets. Deze demineralisaties ontstaan doordat de brackets meer plaqueretentieplaatsen en een verandering van het mondmilieu opleveren, waardoor er een andere plaquesamenstelling in de mond is. Om deze demineralisaties tegen te gaan worden diverse methoden gebruikt gedurende een orthodontische behandeling. Het gebruik van extra fluoride blijkt het beste te werken, bijvoorbeeld het dagelijks spoelen met een fluoride mondspoelmiddel, het aanbrengen van een fluoridelak tijdens elke reguliere orthodontische controle of het gebruik van tandpasta met een hoge concentratie fluoride. De laatste 2 mogelijkheden worden in Nederland minder goed geïncorporeerd vanwege financiële of tijdsredenen. Aanvullende maatregelen, zoals het gebruik van fluoride afgevende adhesieven, caseïnefosfopeptide in combinatie met amorf calciumfosfaat of een chloorhexidine mondspoelmiddel lijken demineralisaties minder goed te verminderen. Daarnaast is het belangrijk gerichte mondhygiëne- en voedingsadviezen te geven, gebaseerd op een individuele risicoanalyse.

Summary Background Topical fluorides are commonly recommended to prevent the development of white spot lesion (WSL) during treatment with fixed orthodontic appliances (FOAs), but the certainty of evidence is low, and long-term effects of fluoride preventive methods to reduce lesions seem to be rare. Objective To evaluate the long-term effectiveness of professional applications of a fluoride varnish containing 1.5% ammonium fluoride in preventing WSL development in adolescents undergoing multi-bracket orthodontic treatment. Subjects and methods We performed a randomized controlled trial in which 166 healthy adolescents (12–18 years) from three different clinics were enrolled and randomly allocated to a test or a placebo group. The randomization was performed by a computer program, generating sequence numbers in blocks of 15. The fluoride varnish or the non-fluoride placebo varnish was applied in a thin layer around the bracket base every sixth week during the course of the orthodontic treatment (mean duration 1.7 years). We scored the prevalence of WSL on the labial surfaces of the maxillary incisors, canines and premolars immediately after debonding (baseline) and approximately 1 year after debonding, from digital photos with aid of a four-step score. The examiners were not involved in the treatment of the patients and blinded for the group assignment. Results One hundred and forty-eight patients were available at debonding and 142 of them could be re-examined after 1 year (71 in the test and 71 in the placebo group). The 1-year attrition rate was 4.0%. On patient level, the prevalence of post-orthodontic WSLs (score ≥ 2) dropped by over 50% during the follow-up with no significant difference between the groups. On surface level, there were significantly fewer remaining WSLs in the test group compared with the placebo group (4.5% versus 10.4%; relative risk 0.44, 95% confidence interval 0.28–0.68). Limitations The compliance with fluoride toothpaste was not checked, and the patients’ general dentists may have instigated additional risk-based preventive measures. No cost–benefit analysis was carried out. Conclusions This follow-up study displayed a small beneficial long-term effect of fluoride varnish in reducing WSL development during treatment with FOA. Registration NCT03725020. Protocol The protocol was not published before trial commencement.

Objective: To evaluate the color stability of artificial white spot lesions treated with three different surface treatments after immersion in staining solution. Materials and Methods: An artificial white spot lesion was created in the middle of the labial surface using demineralizing solution. Sixty-five bovine teeth were randomly assigned into 5 groups (n=13) according to surface treatment. G1: Enamel submitted to demineralization only. G2: Polished Enamel. G3: Demineralized enamel treated with low-viscosity resin infiltrant. G4: Demineralized enamel treated with CPP-ACP for 1 month. G5: Demineralized enamel treated with Artificial saliva for 1 month. All specimens were then immersed in a staining solution (coffee) for 8 weeks. Color measurements, using the CIE L*a*b* system, were done immediately after treatment and after 2, 4 and 8 weeks of immersion, by Spectrophotometry. Digital photographs were also taken at each stage to a representative specimen from each group. In addition, representative specimen for each group was evaluated using Polarized Light microscope. Color change (ΔE) was analyzed by two-way mixed ANOVA. Results: Resin infiltrant group exhibited the lowest color change values at all times of measurement, followed by CPP-ACP and polished enamel, while the highest color change values were recorded in samples without treatment. Conclusion: Resin infiltrant can be considered an effective treatment in masking and reducing long-term staining susceptibility of white spot lesions after treatment.

Introduction: The present study aimed to evaluate the effect of home bleaching on the color enhancement of white spot lesions (WSLs) after orthodontic treatment. Materials & Methods: This interventional semi-experimental study was conducted on 10 patients with inactive WSLs after orthodontic treatment who referred to Mashhad Dental School between May 2016 and May 2017. The tooth color was measured by a spectrophotometer at baseline and the color determination was performed in the area of ​​healthy enamel (F1) and the adjacent demineralized enamel (F2). Afterward, the teeth underwent home bleaching for 2 weeks. The color measurements were performed one day and one week after the treatment under the same condition. The color change of the healthy and demineralized groups at each time point was compared to each other; moreover, the color differences between healthy and demineralized areas were compared at the three different time points. The collected data were analyzed using an independent samples t-test and repeated measures ANOVA. Furthermore, a p-value of less than 0.05 was considered statistically significant. Results: The degree of color change before the treatment and one day after the treatment was greater in healthy enamel (9.28±3.29), compared to demineralized enamel (6.98±2.92). However, the results of the independent samples t-test revealed no significant difference between healthy and demineralized enamel regarding the color change at various time points (p < /em>>0.05). There was no significant difference between the color change of healthy (F1) and demineralized (F2) enamels at the three evaluated time points (p < /em>>0.05). Conclusion: Based on the results, under the conditions of this study, home bleaching was not an effective method for the color improvement of enamel WSLs after orthodontic treatment.

White spot lesions (WSL) and demineralization is a common complication after the orthodontic treatment. This study aims to explore and evaluate the clinical efficacy of fluoride and-fluoride, releasing self-etching adhesives on enamel demineralization and assess the influence of saliva as a predisposing factor for WSL. The study design is a randomized clinical trial. A sample size of 50 patients was taken, there are two groups for the study-Group A (Control Group)-Teeth on which orthodontic brackets are bonded with nonfluoride releasing self-etching adhesive (G Bond) which will be the control group. Group B (Experimental Group)-Teeth on which orthodontic brackets are bonded with Fluoride releasing self-etching adhesive (Bond Force) which will be the experimental group. Materials containing fluoride help to improve the oral health of the experimental group. However, using Paired t-test get mean and standard deviation values also estimate the correlation coefficient values; the mean effect is improved for non-fluoride patients. Products such as topical Fluoride are not the only factors that help to control the incidence of WSL.

Purpose: This study conducts an in vitro comparison of the depth of penetration of a resin infiltrant material (Icon), a two-step self-etch resin-based material (OptiBondTM XTR), and a solvent-free self-etch resin-based material (Bond-1SF) into white spot lesions (WSLs).Methodology: Through an in vitro clinical trial, a total of 60 human posterior teeth, free from caries, were collected. The buccal and lingual surfaces of each tooth were marked, resulting in a total of 120 samples of surfaces, which represented the operational sample size. The samples were randomly divided into four equal main groups (n = 30) according to the materials used. Group 1 (M1) was the control group. Group 2 (M2) was restored using Icon, Group 3 (M3) using OptiBondTM XTR, and Group 4 (M4) using Bond-1SF. Each group was divided into two equal groups (n = 15) according to the surface treatment, and the first group (W1) was subjected to surface treatment but the second group (W2) was not. The resin penetration depth was observed using confocal laser scanning microscopy.Findings: The highest penetration depth was recorded for Group 2 with surface treatment (M2W1), and the lowest was recorded for Group 4 without surface treatment (M4W2). An analysis of variance test revealed a statistically significant difference in the penetration depth of tested materials (p < 0.05).Conclusion: Icon shows the best penetration depth value in relation to WSLs, whereas Bond-1SF shows the worst. Surface treatment has a positive effect on the penetration depth of the resin-based materials.

Purpose: This study aimed at investigating the masking effect and depth of penetration of two resin infiltrants (ICON ® and unfilled adhesive resin) on artificial white spot lesions after different pretreatment methods (15% hydrochloric acid, 37% phosphoric acid and air abrasion through micro etcher) Materials and methods: Artificial white spot lesions were produced in enamel slabs from 60 freshly extracted permanent human anterior teeth (extracted from diabetic patients). The samples were divided into two main groups: resin infiltrant; ICON ® (B1) and adhesive resin bond; ONE-STEP® Universal Dental Adhesive (B2). Each group was subdivided into three subgroups according to the pretreatment used; (HCl 15%) was applied in (A1), (H3PO4 37%) was applied in (A2) and aluminum oxide particles (50/90 µm), through micro etcher was applied in (A3). The assessment of colour was performed by a spectrophotometer in three distinct stages: baseline, after the production of artificial caries and after infiltration treatment expressed in L*, a* and b* values. To analyze measurement results, the chromatism value, ΔE was used to quantify the overall differences of the colors. Results: All the test groups showed no statistically signifiant differences between each other where the highest value was recorded with the adhesive bond after micro-etching 2.250 ± 0.192 and the lowest value was recorded with the adhesive bond after HCl pre-treatment 1.710 ± 0.244 (Statistical significance is achieved when the P-value ≤ 0.05). Conclusion: Both tested infiltrants reacted similarly and the three tested pretreatment methods were equally effective.

Objectives To compare the effect of use of laser, casein phosphopeptide–amorphous calcium phosphate (CPP–ACP), and their combination on prevention of enamel demineralization using polarized light microscopy to assess lesion depth. Materials and Methods Eighty premolars were randomly allocated to four equal groups (n = 20): Group I: Control group, no preventive measures. Group II: CPP–ACP. Group III: Er,Cr:YSGG laser. Group IV: Er,Cr:YSGG laser followed by CPP–ACP. Specimens were subjected to thermocycling and brushing protocols equivalent to 1 year intraorally. Then, all teeth were subjected to acid challenge. Teeth were then sectioned longitudinally and examined under a polarized light microscope and lesion depth was measured. Results Group IV resulted in the least lesion depth with a significant difference between it and all other groups. CPP–ACP alone and laser alone also showed a significant difference in white spot lesion (WSL) depth compared to the control group; however, no significant difference was found between them. Conclusions The combined use of laser and CPP–ACP showed the best prevention against WSL development. The use of CPP–ACP or laser alone also resulted in a significant reduction in lesion depth but was significantly less than their combined use, with no significant difference between them.

Background Fluoride varnish with therapeutic tricalcium phosphate formulas such as Clinpro™ varnish has shown greater tendency in treating white spot lesions (WSLs) by inhibiting the progression of initial enamel lesions through the mineral exchange. The self-assembling peptide SAP11-4 (Curodont Repair, CDR) works on a different scale in treating WSLs by mimicking the enamel matrix and aiming to guided enamel regeneration. Aim To quantitatively and qualitatively compare the effectiveness of the SAP11-4 vs tricalcium posphate fluoride (TCPF) in remineralization of WSLs in young permanent teeth. Materials and methods Nine healthy patients were enrolled in this study. The trial was performed on 40 young permanent teeth in the initial demineralization stage. Teeth were randomly assigned to receive either TCPF (group I) or SAP11-4 (group II). Lesions were assessed at pretreatment, 3, and 6 months posttreatment quantitatively per laser fluorescence DIAGNOdent pen and qualitatively through the International Caries Detection and Assessment System (ICDAS) II. Results The result of the current study revealed a significant quantitative and qualitative increase in remineralization of WSLs in both groups and over time intervals. However, the WSL recovery was significantly better in the self-assembling peptide group, reflecting an excellent remineralization potential of the WSLs by the SAP11-4 compared to TCPF varnish. Conclusion Both TCPF and SAP11-4 were effective in treating WSLs. However, the success of guided enamel regeneration by the SAP11-4 through the biomineralization has proven superiority of this material compared to TCPF. Clinical significance Early detection of WSLs and minimal intervention through remineralizing agents can limit unnecessary tissue loss, further caries progression, and consequently prevent further harm to the patients. How to cite this article Kobeissi R, Badr SBY, Osman E. Effectiveness of Self-assembling Peptide P11-4 Compared to Tricalcium Phosphate Fluoride Varnish in remineralization of White Spot Lesions: A Clinical Randomized Trial. Int J Clin Pediatr Dent 2020;13(5):451-456.

Aim Investigation and evaluation of remineralization potential of functionalized tricalcium phosphate paste (fTCP) and casein phosphopeptide-amorphous calcium phosphate (CPP-ACPF) paste on artificially created white spot lesion on human primary and permanent enamel through scanning electron microscopy and microhardness assessment. Materials and methods Sixty freshly extracted primary and permanent teeth were selected and artificial white spot lesion were created by using standardized demineralizing solution. Remineralization was carried out using the test pastes. The assessment of demineralization and remineralization was done through a scanning electron microscope and microhardness assessment. Results Among the three groups, fTCP shows significantly higher increase in mean microhardness (p < 0.001) through ANOVA and the LSD post hoc test when compared to CPP-ACPF and control group. Also, the unpaired t-test showed that mean change in microhardness in permanent teeth was significantly higher than primary teeth in different time intervals for both experimental groups. Surface morphology was assessed through a scanning electron microscope. Conclusion Based on the results of the current study, f-TCP showed comparatively more remineralization potential than CPP-ACP with fluoride. How to cite this article Bhadoria N, Gunwal MK, Kukreja R, et al. An In Vitro Evaluation of Remineralization Potential of Functionalized Tricalcium Phosphate Paste and CPP-ACPF on Artificial White Spot Lesion in Primary and Permanent Enamel. Int J Clin Pediatr Dent 2020;13(6):579–584.

Aim The aim of the study was to assess the remineralizing efficacy of fluoride and its combination varnishes on white spot lesion (WSL) in children with early childhood caries (ECC). Materials and methods Sixty children with active WSL on primary maxillary anterior teeth were randomly selected. At baseline, the WSL activity was evaluated using ICDAS II [lesion activity assessment (LAA)] and its dimensions through photographic method. They were allocated to group I (GI) (5% NaF), group II (GII) [5% NaF with amorphous calcium phosphate (ACP)], and group III (GIII) [5% NaF with casein phosphopeptides - amorphous calcium phosphate (CPP -ACP)]. First, oral hygiene instructions and diet counseling were given followed by application of fluoride varnishes in their respective groups. The same parameters were recorded at follow-up of 2, 4, 12, and 24 weeks intervals. Data were collected and subjected to statistical analysis using Friedman Chi-square and Mann-Whitney tests. Results Overall, the active WSL changed to inactive over a period of 24 weeks in GI was 90%, GII was 95%, and 100% in GIII. There was a significant reduction in dimension of WSL in GI from 4.119 to 2.525 (p = 0.0001). Likewise, there was a significant reduction in dimension of WSL in GII and GIII from 4.586 to 3.258 and 4.696 to 1.2155, respectively (p = 0.0001, p = 0.0001). Comparatively, group III (MI varnish) showed statistically significant reduction in the dimension of WSL from baseline to 24 weeks (p = 0.002). But the results were statistically insignificant with change of active lesions to its inactivity (p = 0.349). Conclusion Fluoride varnish with CPP-ACP was found to be an effective preventive strategy in reversing WSL in children with ECC. Clinical relevance These combination varnishes could prove to be a promising preventive measure for pediatric dentists in reversing white spot lesions of ECC. Clinical trial registry NCT03360266. How to cite this article Radha S, Kayalvizhi G, Adimoulame S, et al. Comparative Evaluation of the Remineralizing Efficacy of Fluoride Varnish and its Combination Varnishes on White Spot Lesions in Children with ECC: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2020;13(4):311-317.

Introduction/Objective. The purpose of this study was to compare clinical efficacy of casein phosphopeptide ? amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACFP) with 0.05% NaF, and to assess their influence on the quality of life among individuals with Sjogren?s syndrome. Methods. Thirty patients were randomized into three groups treated with different remineralizing agents: CPP-ACP, CPP-ACFP, and 0.05% NaF. Oral health was evaluated at the beginning of the study, after 28 days (short-term effects), and after six months. The diagnosis of dental caries was performed using the decayed, missing, and filled teeth (DMFT) / decayed and filled surfaces (DFS) criteria. Enamel demineralization was visually examined using the white spot lesion index (Gorelick). The gingival health was evaluated with the gingival index (Loe?Silness). Assessment of oral hygiene was done using the simplified oral hygiene index (Greene?Vermilion). The Xerostomia Inventory was used to quantify dry-mouth symptoms. The oral health-related quality of life was analyzed using the short form of the Oral Health Impact Profile (OHIP-14). Results. During the evaluation period, caries increment was not significant. Considerable regression of white spot lesions was noted in all three experimental groups (p < 0.001). No significant improvement in gingival health and oral hygiene was observed. Physical pain was decreased in all three experimental groups, and subjective feeling of dry mouth was reduced in CPP-ACP and CPP-ACFP groups. Conclusion. CPP-ACP and CPP-ACFP may reduce the caries activity and relieve the dry-mouth symptoms in patients with Sjogren?s syndrome.

Aim To analyze the comparative change in pretreatment and posttreatment La*b* values of color in initial nonpitted white spot lesions of fluorosed teeth after resin infiltration with DMG-Icon spectrophotometrically with VITA easy shade. Materials and methods A total of 30 maxillary and mandibular permanent anterior teeth with mild, nonpitted white spot lesions (atleast one) of fluorosis [till grade IV of Thylstrup and Fejerskov (TF) index] in patients between 6 years and 14 years of age were included in the present study. Shade of selected tooth and its white spot lesion area was recorded using VITA 3D shade guide, both pre and postoperatively, i.e., after application of DMG Icon. This was followed by recording the change in corresponding La*b* values of tooth shade and white spot lesion spectrophotometrically using VITA Easy Shade. Results obtained were analyzed statistically. Results ΔE value of color change was found to be less than 3.7 in most of samples after resin infiltration and esthetically color change to naked eye was statistically significant (p value < 0.00001) postoperatively. Conclusion Resin infiltration with DMG Icon can improve the color of non-cavitated white spot lesions. The esthetic effect of this treatment was evident immediately after treatment. Moreover, no cavitation occurred after etching, even when the surface layer had been eroded completely. Clinical significance Achievement of esthetic results without loss of tooth structure and postoperative sensitivity. How to cite this article Dogra S, Goyal V, Gupta A, et al. Spectrophotometric Evaluation of Color Change in Tooth Enamel Defects Using Resin Infiltrate: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(2):150–154.

Amaç: Bu çalışmanın amacı, ortodontik tedavi sırasında titanyum dioksit nanopartiküllerinin mine yüzeyinde beyaz nokta lezyonlarının oluşumuna karşı antimikrobiyal etkisini değerlendirmektir. Gereç ve Yöntem: Bu çalışmada, ortodontik tedavi sırasında TiO2-NP'lerin beyaz nokta lezyonlarına etkisini ölçmek için 60 çekilmiş diş bir araya getirildi. Sağlam, çatlaklar, lekeler veya hipoplastik olmayan dişleri grup A ve Grup B olmak üzere iki gruba ayrıldı. Grup A'da, çalışma ortodontik braketlerin bağlanma işlemi sırasında TiO2-NP'leri uygulandı. Grup B, normal ortodontik bağ yapılan dişleri dahil edildi. Deney sonrası, bu numunelerin bukkal yüzeylerinin görüntüleri taramalı elektron mikroskobu kullanılarak alındı ve bakteri hücre sayımı kaydedildi ve sonuçları analiz edilip karşılaştırıldı. Bulgular: TiO2 -NP'nin ortodontik adeziv içine dahil edilmesinin, geleneksel ortodontik adeziv ile karşılaştırıldığında S.mutans bakteri varlığını önemli ölçüde azalttığı bulunmuştur. SEM altında, TiO2 içeren ortodontik adeziv içeren dişlerin, geleneksel ortodontik adeziv içeren dişlere kıyasla daha az mine lezyonu olduğu gösterilmiştir. Sonuç: Mevcut çalışmanın bulgularına göre TiO2-NP'ler umut verici bir antibakteriyel ajandır ve ortodontik tedavi sırasında WSL'lerin önlenmesinde önemli bir rol oynayabilir. Aim: The aim is to evaluate the antimicrobial effect of titanium dioxide nanoparticles against the formation of white spot lesions on the enamel surface during orthodontic treatment. Methods and Materials: This study consisted of 60 extracted teeth that were sound from caries, had no visible cracks, stains or hypoplastic areas on the buccal surface and were not previously treated with chemical agents. The samples were divided into two groups, group A and group B. In group A, the study applied TiO2-NPs during the bonding process of orthodontic brackets. Group B, contained teeth that underwent orthodontic bonding. Post-experimentation, the images of the buccal surfaces of these samples were taken using a SEM. The bacterial cell count was recorded and their outcomes were analyzed and compared. Results: It was found that incorporation of TiO2-NP into orthodontic adhesive dramatically reduced the presence of S.mutans bacterial count in comparison with conventional orthodontic adhesive. Under the SEM it was shown that teeth that contained the TiO2-NP incorporated orthodontic adhesive had fewer enamel lesions when compared to teeth that had conventional orthodontic adhesive. Conclusion: TiO2-NPs is a promising antibacterial agent, according to the findings of the current study, and it could play an important role in preventing WSLs during orthodontic treatment.

Background: Resin infiltration and bleaching have been used as minimally invasive methods for the treatment of white spot lesions (WSLs) following orthodontic treatment.Objective: To compare the color uniformity of the tooth with WSL treated with either resin infiltration or bleaching.Material and Methods: WSLs were created in the right middle buccal half of the enamel surface of 40 sound extracted human premolars. The teeth were randomly assigned to 2 groups (n = 20) treated with: (I) resin infiltration, (II) chemically activated office-bleaching. Color parameter of the lesion and the adjacent enamel were measured by spectrophotometer at 3 time points: baseline (T0), after WSL formation (T1), after treatment (T2) and color difference ΔE* was calculated. Each tooth was visually scored for color homogeneity.Results: ΔE* was significantly smaller after treatment in group I compared to group II [mean difference = 5.03 ± 1.11, P

Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz White Spot Lesions (WSLs) are a common iatrogenic finding along brackets used in orthodontic treatment. WSLs are frequently noticed as small opaque lesions with lessened radiolucency which might have a lasting unaesthetic effect. These lesions might range from small lines along bracket peripheries and less frequently might be observed as larger demineralized areas with or without cavitation. The development of WSLs is principally enhanced by the accumulated plaque around brackets due to a compromised oral hygiene that might be aggravated by the presence of dental crowding. Furthermore, The presence of fixed orthodontic apparatus leads to alteration in the oral microflora causing reduction in the PH level and increased bacterial adherence to the metal facade through electrostatic effect. There are several preferences for treatment of WSL, ranging from conservative approaches relying on remineralization to invasive techniques. The severity of lesions is a determinant of which option is most appropriate. The management of WSLs is based on remineralization strategies or in other situations on a minimal-invasive camouflage of the lesions. Although orthodontic WSLs are one of the most frequent and most visible adverse effects of comprehensive fixed appliance treatment, the efficacy of their intervention continues to be assessed in the literature and up to date there is no consensus on the best evidence-based approach to manage such lesions. Therefore, the aim of the present thesis is to review and critically appraise the contemporary evidence related to causes, diagnosis, prevention, risk evaluation and management of WSL associated with orthodontic appliances. Furthermore, clinical recommendations that might be useful for both the general dentist as well as the orthodontist. This literature review will be undertaken by searching the database engines, Pubmed, Medline, Google Scholar, B-on and Science Direct. The search will include the literature published inbetween 2005-2021.

Despite the large number of studies on the effect of braces on teeth, there is no information on the dynamics of the state of the ultrastructure of the hard tissues of teeth during orthodontic treatment. The purpose of this study is to examine the state of the hard tissues of the teeth and carry out preventive measures to reduce the risk of complications in the process of orthodontic treatment using a non-removable device. Methods: For the in vitro study, 68 teeth were randomly divided into group A—no prophylactic treatment, and group B—treated with the fluorine varnish Tiefenfluorid. After 35 days, all the teeth were prepared for microscopic examination. The clinical study included 59 patients aged 12–17 years with orthodontic brackets. The split-mouth technique was used. The areas around the bracket of one-half of the oral cavity were treated with Tiefenfluorid every 6 months during the entire treatment period. The teeth of the second half of the oral cavity served as the control group. The data were processed in the SPSS19 package. Results: In vitro and clinical study results showed a statistically significant difference between the prophylactic and control groups of teeth in favor of the prophylactic group, where the statistical significance was p ≤ 0.01.

Submitted by Ana Moreira (anadsmoreira@ufp.pt) on 2022-02-02T12:56:18Z No. of bitstreams: 1 PPG_35007.pdf: 744858 bytes, checksum: ae7676c2a447217fc56b75a864b29bc0 (MD5) Approved for entry into archive by azevedo@ufp.pt (azevedo@ufp.pt) on 2022-02-03T12:10:35Z (GMT) No. of bitstreams: 1 PPG_35007.pdf: 744858 bytes, checksum: ae7676c2a447217fc56b75a864b29bc0 (MD5) Made available in DSpace on 2022-02-03T12:10:35Z (GMT). No. of bitstreams: 1 PPG_35007.pdf: 744858 bytes, checksum: ae7676c2a447217fc56b75a864b29bc0 (MD5) Previous issue date: 2021-10-07

The difference in refractive index between the healthy enamel and the demineralized area generates a lesion with a milky white opaque appearance, clearly distinguishable from the surrounding healthy enamel. The aim of this systematic review was to evaluate if the infiltration technique is the most efficient treatment to resolve a white spot lesion when compared with remineralization and microabrasion techniques. The Population/Intervention/Comparison/Outcome question investigated: “in enamel WS lesion, the infiltration treatment compared to remineralization or microabrasion treatments is more or less effective in the camouflage effect?.” The research was performed on electronic databases, including Ovid MEDLINE, PubMed, and web of science. The search was conducted up to April 1, 2020. The scientific search engines produced 324 results. Only 14 were screened after screening. Based on the articles analyzed in this systematic review, the resin infiltration technique seems to be the most effective and predictable treatment for the aesthetic resolution of WSLs.

Khalid Almulhim,1 Abdul Samad Khan,1 Hanan Alabdulghani,2 Sara Albasarah,2 Yousif Al-Dulaijan,3 Faisal D al-Qarni3 1Department of Restorative Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 3Department of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaCorrespondence: Faisal D al-QarniDepartment of Substitutive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi ArabiaTel +966 13 333 1404Email fdalqarni@iau.edu.saPurpose: To evaluate the effect of ageing process and brushing on the color stability and surface roughness of white spot lesions treated with resin infiltration or remineralization.Patients and Methods: Artificial white spot lesions were created on the facial surface of extracted bovine teeth. Specimens were divided into three main groups based on treatment received: resin infiltration (Icon), MI Paste Plus (MI) or no treatment (control). Specimens underwent pH cycling for 7 days, followed by brushing with toothbrush simulator. Specimens were then immersed in three different solutions (water, cranberry juice, or coffee) for 7 days. Surface roughness (SR) and color stability (CS) assessments were performed at baseline and after each test. One-way and two-way ANOVA were used to calculate the statistical comparisons between the groups and significance considered at P < 0.05.Results: Icon group had the least color change after pH cycling, while MI showed the least color change after brushing test. Immersion in coffee produced the highest color change in all groups, followed by cranberry juice. Icon group had the best color stability when immersed in cranberry juice or coffee. Control and the MI treated specimens showed gradual increase of SR after pH cycling and brushing test, while Icon group had improved surface properties. Brushing test alone produced less color change in comparison with immersion in cranberry juice and coffee; however, brushing increased SR.Conclusion: Icon treatment showed superior color stability and surface roughness, compared to the control and the MI treated teeth. Brushing had less influence on color change compared to the immersion in cranberry juice or coffee.Keywords: white spot lesion, surface roughness, color stability, resin infiltration

The enamel white spot lesion is a common complication of orthodontic treatment with a high prevalence. This research aims to create an artificially induced white spot lesion, evaluate three different commercial products in terms of visual appeal, mineral reestablishment, and roughness, and determine which material can recover the initial structure. We created an artificially induced white spot lesion in extracted teeth. The materials used in the study were peptide p11-4 (CurodontTM Repair, Credentis AG), bioactive glass toothpaste (Biomin F, BioMin Technologies Limited), and local fluoridation (Tiefenfluorid, Humanchemie) in conjunction with low-level laser therapy (LLLT). To objectively assess the surface, the roughness, mineral content, and esthetic were measured. The roughness increased with a median difference of −0.233 µm in the bioactive glass group; the color parameter delta L decreased dramatically with a median difference of 5.9–6.7; and the cervical third increased the Ca-P mineral content above the starting stage. Each material contributed significantly to enamel consolidation, with peptide therapy providing the most encouraging results.

Submitted by Ana Moreira (anadsmoreira@ufp.pt) on 2021-10-26T08:35:50Z No. of bitstreams: 1 PPG_38380.pdf: 1312319 bytes, checksum: e25bc6a8a7a46113a5a41381a95588f1 (MD5) Approved for entry into archive by azevedo@ufp.pt (azevedo@ufp.pt) on 2021-10-26T14:06:49Z (GMT) No. of bitstreams: 1 PPG_38380.pdf: 1312319 bytes, checksum: e25bc6a8a7a46113a5a41381a95588f1 (MD5) Made available in DSpace on 2021-10-26T14:06:49Z (GMT). No. of bitstreams: 1 PPG_38380.pdf: 1312319 bytes, checksum: e25bc6a8a7a46113a5a41381a95588f1 (MD5) Previous issue date: 2021-07-08

Introduction: Enameldecalcification in the form of white spot lesion is a common complication seenin patients with fixed orthodontic appliances.Aims and Objective: To determine the prevalence of white spot lesionamongFixedorthodonticpatients,to compare the occurrence of WSL among the patients with lesser and greater duration of treatment, and to Fixed orthodontic compare between the gender groups.Materials & Method: A cross-sectional study was done to compare the prevalence of WSL between 300orthodontic patients and 100 non-orthodontic subjects. A further comparison was done between the meantreatment duration between orthodontic subjects of 6-18 months and >18 months, and between male and female samples. Subjects were visually examined on the second premolar to the second premolar in both maxillary andmandibulararchesusingGorelick'sWSL index. Descriptive statistics were calculated and independent t-test was used to compare the difference between the groups. The p-value

This research was designed to compare the thickness and the depth of penetration of two resin-based materials (Icon and one-step self-etch adhesive (Single Bond Universal)) in artificial white spot lesion (WSL) created on caries-free molar teeth, without and with surface treatment prior application of the resin-based materials at different storage time (one day, one week and one month). The 126 samples were randomly divided into three equal main groups (n=42) according to the resinous material (M); Group 1 (M1) was considerate to be control group. Group 2 (M2) was restored with Icon. Group 3 (M3) was restored with Single Bond Universal. Each group was divided into two equal subgroups (n=21) according to the surface treatment (W); Where the first subgroup (W1) was subjected to surface treatment while the second subgroup (W2) was without surface treatment. The samples were further divided into three divisions (n=7) according to the storage time (S). Division 1 (S1) was stored for one day. Division 2 (S2) was stored for one week. Division 3 (S3) was stored for one month. Each resin-based material was applied after creation of white spot lesion, according to the manufacture instruction. Buccal and lingual surface of each sample was used to measure the thickness of the resin-based materials using Optical profilometer while confocal laser scanning microscopy (CLSM) was used to measure the depth of penetration. The result of this study reveals that: the surface treatment prior application of Icon group improve the degree of penetration depth to get the highest value compared with the other groups while the thickness of the untreated surface prior application of Icon groups gives the thickest value compared with the thickness of the other groups. Conclusion; Icon is the best choice for treatment of (WSLs).

BACKGROUND: Post-orthodontic white-spot lesions (WSL) in esthetically relevant incisor and canine areas impair dentofacial esthetics, and preventive dentistry treatment is definitely required in case of enamel cavitations. The incidence of lingual post-orthodontic WSL and cavitation following lingual MB treatment has been reported to be distinctively decreased compared to labial MB treatment. Moreover, lingual WSL do not impair dentofacial esthetics. It was the objective of this study to calculate consequential costs of preventive dental care necessary to recover labial or lingual post-orthodontic cavitations as well as esthetically relevant WSL following either labial or lingual MB interventions. METHODS: MB treatments (labial / lingual) were simulated in 1,000,000 patients between the ages of 12-18Y, with a median residual life time expectancy of 58Y based on local mortality tables. Range of MB Tx duration was 9-45 mo. Frequencies of post-orthodontic (labial / lingual) enamel damages were derived from large-scale WSL incidence studies. Anterior composite survival rates were based on a systematic review on the subject. Within the context of the German dental fee system (GOZ 2.3 and 3.5 fee increments), simulation of costs for enamel damage treatment and re-treatment (maximum: 5x) were based on single-surface composite restorations for lingual or labial cavitations and labial WSL treatment; and lingual WSL fluoridation. RESULTS: Overall mean total costs for Tx and re-Tx of both WSLs and cavitations may sum up to 1718.91 Eur in the high-cost (GOZ 3.5) scenario for conventional MB cases, versus 19.94 Eur for lingually treated cases, given that renewal of simulated single-surface restorations takes place at 15-year intervals. When focussing on patients diagnosed with least of one WSL, and/or cavitation, these mean costs increase up to 2332.35 Eur for conventionally treated MB patients, or 65.03 Eur for lingual MB patients. CONCLUSION: Costs for repeated treatment of post-orthodontic enamel damages produced by conventional vestibular fixed appliances may easily exceed the initially higher costs associated with lingual orthodontic treatment. Judged economically in the long term, lingual MB Tx may be considered as a more cost-effective solution for a correction of malocclusion. peerReviewed

Background: Despite improved oral hygiene regime and availability of preventive formulations, dental caries continues to be a global dental problem. Calcium sucrose phosphate (CaSP) is a remineralizing agent with cariostatic action, which is commonly available in the form of tooth cream. Considering the paucity of evidence, this systematic literature review aims to evaluate the remineralizing efficacy of CaSP. Methodology: The review was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Various databases, including PubMed, Cochrane Central, and Google Scholar, were searched until March 15, 2018 and were assessed for inclusion by two independent reviewers. The primary outcome was to assess the remineralizing efficacy of CaSP, and the secondary outcome was to assess the potential of CaSP in arresting white spot lesion(s) on enamel. Results: Out of 2,876 articles, only 13 were qualified for inclusion. Included studies presented a low risk of bias for the following items: caries-free teeth or restoration, and adherence to manufacture’s instruction for the usage of remineralizing agent in the risk of bias scale. Ten studies reported an increase in the microhardness of enamel after CaSP application, and three studies reported the effect of CaSP on arresting white spot lesion(s). CaSP was found to be a better remineralizing agent in comparison to casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), casein phosphopeptide-amorphous calcium phosphate with fluoride (CPP-ACPF) and other remineralizing agents in terms of increasing microhardness of enamel. In addition, CaSP application was also found to have a beneficial effect in restoring the color of white spot lesion(s) to that of normal enamel. Conclusion: CaSP tooth cream was found to be an effective remineralizing agent, compared to others, such as CPP-ACP and CPP-ACPF, in terms of increasing the mean microhardness of enamel and arresting white spot lesion(s).

Along with whitening techniques, fixed orthodontic appliances (FOA) is currently one of the patients' favorite maneuvers looking for aesthetic appearance. Most of the time, FOA results are spectacular, but the appearance of demineralization and white spot lesions (WSL) around brackets is one of the great challenges for both the clinician and the patient. So it is important not to act to ease their appearance, by applying inappropriate enamel demin-eralization techniques to the FOA adhesion process. Material and method. For this study, 20 lower incisors were used and braces were bonded in the middle third of the vestibular aspect. For the application of the brackets, the bonding protocol and the manufacturers' indications have been respected. Only the enamel etching time was modified to allow the teeth to be divided into 3 groups: the first group, the etching time was 30 seconds, for the second 45 seconds and 60 seconds respectively for the third group. The teeth were kept in distilled water for one month and then the brackets were removed. The remaining composite areas on the teeth were kept. For SEM evaluation of the enamel / hybrid layer, the teeth were longitudinally sectioned using a diamond disk under water cooling and at low speed. Results. Increasing the etching time with phosphoric acid of the enamel over 30 sec, value that gives a favorable etching pattern for adhesion, has the consequence of forming a thicker hybrid layer after application of the primer. Conclusions. Etching of the enamel for 60 seconds with phosphoric acid is followed by the formation of a thick hybrid layer and the settlement of an unfavorable etching pattern. After brackets removing, the etched enamel surfaces can be remineralized with saliva ions, but the more aggressive the etching, the more incomplete the remineralization, favoring the installation of white spot lesions.

Early detection of caries is vital for demineralization reverse offering a less pain, as well as accurate and precise caries removal. In this study, the difference in optical properties of normal tissue and human caries lesion has been used for early diagnosis, using laser induced fluorescence spectroscopy. The human tooth sample was illuminated with visible band sources (488, 514 and 633 nm) with power 5 mW. The reflected and emitted light of tested sample was collected using hyperspectral camera in an attempt to generate multispectral images (cubic image). The variation of reflected and emitted power as function in wavelength was employed to generate characteristic spectrum of each tooth tissue. Human teeth caries tissue lesion releases its excess power by emitting fluorescence light producing chemical footprint signature; this signature is dependent on the elemental composition of tooth elements and caries state. This non-invasive, non-contact and non-ionizing imaging system with associated novel pattern recognition algorithm was employed to diagnose and classify dental (enamel and dentin), caries, and white spot lesion. It was reported that the perceived fluorescence emission is function of the illuminating wavelength. While enamel and dentin caries were distinguished and characterized at 633 nm illuminating wavelength; white spot lesion cannot be detected. The enamel caries, dentin caries, and white spot lesion were contoured and recognized at 488 nm and 514 nm wavelengths. Therefore full recognition was achieved through generated cubic image after sample irradiation at 488 nm and 514 nm. This non-invasive, non-contact, and non-ionizing imaging technique with customized image processing algorithm offered high sensitivity, high resolution, and early caries detection with optimum performance at 514 nm.

The present study compared two pH-cycling models designed to induce subsurface lesions (SLs) with a less demineralized surface layer on teeth, with the aim of developing new technologies for assessment of such lesions by examining the performance of confocal Raman microscopy for detection of white spot lesions (WSLs). Twelve sound premolars were exposed to two sets of model conditions (A, B) designed to induce SLs. Teeth on which white lesions had formed in vivo were used as positive controls. All specimens were inspected using an intraoral camera and Raman microscopy to detect small changes in the appearance and structure of the enamel. Changes in the natural color of the teeth during the treatment were recorded via the camera. Phosphate maps with their spectra were constructed from the phosphate peak at 960 cm-1. The depth of lesions was measured on the basis of variations in phosphate peak intensity. Protocol B was reliable for reproducing SLs in a relatively short period. Both protocols had intrinsic limitations in not completely simulating the complex intraoral conditions leading to WSL formation with respect to lesion depth and preservation of an intact surface layer. Raman microscopy can be considered the gold standard for analysis of hard tissue mineralization.

Introduction. White spot lesion is a demineralization of the enamel that appears as a white spot on the surfaces of the tooth. The cause of this spot is determined by the activity of the bacterial plaque and it represents the initial stage of a carious lesion. This lesion is a common side effect for patients with fixed orthodontic appliances mainly because of the brackets’ position that favors the accumulation of plaque that ultimately leads to the formation of the white spot.Methods. We conducted a search on a single database, PubMed. “Orthodontic”, “white spot lesions”, “enamel demineralization treatment” and “remineralization’’ were the search terms used. We found 324 articles, but we took in consideration only the ones from the last 10 years, which resulted in 223 articles.Results. The first step after research was article selection: first by scrutinizing the title and secondly by reviewing the abstracts or full texts. The exclusion criteria were: meta-analysis, reviews, original articles regarding prevention of white spot lesions and their prevalence or incidence. We included the articles that seemed relevant for the treatment of white spot lesions, made either on extracted teeth either on orthodontic patients. We found 75 articles to be eligible for this research and we eliminated 5 because of the lack of an abstract or full text and a further 22 were rejected because they did not fit the aforementioned criteria.Conclusion. Although some traditional methods for the treatment of white spot lesions seem to have undesirable results, nowadays with new technologies and thorough investigations in nanotechnology, the eradication of the lesion appears to be short term.

AIMS: of this cross sectional study is to specify the occurrence of white spot lesion (WSLs) in patients with orthodontic attachment in Erbil, Iraq. MATERIALS AND METHODS: This cross-sectional study was carried out on 20 subjects (7 male – 13 female) their age ranged between 12-34 years old. During fixed orthodontic treatment each tooth in four quadrants was examined by naked eye to detect the occurrence of WSLs from the 1 month to 6 month of treatment duration. RESULTS: The prevalence of WSL according to age, gender, and duration of the orthodontic treatment. The mean age of male were 19.43 (S.D= 6.37) and the mean age of female were 19.00 (S.D= 7.37) ; but statistically calculated non- significant (P-value >0.05). In the first visit the mostly affected teeth are upper right canine, upper left canine, and upper left lateral incisor, In second visit the most affected teeth are upper left canine, upper left lateral incisor, and lower right canine. In the third visit the mostly affected teeth are upper left canine, upper left lateral incisor, and lower right canine, In the fourth visit the most affected teeth are upper left canine and upper left lateral incisor. The frequency of WSLs increased with each visit of orthodontic treatment, the maximum occurrence of WSLs was found in the sixth visit (21.25%) followed by fifth visit (21%), fourth visit (19.25%), third visit (16.25%), second visit (13.75%), and finally first visit (7.25%). The mean of all visit equal to 16.45%. . CONCLUSION: 21.25% of patients in developing WSLs during orthodontic treatments were more attend in the upper than lower arch; they occurred most often on the upper left canine and upper left lateral incisor. There was statistically no significant male and female difference, females had a 65% of developing WSLs than males 35% (P-value

Background Enamel white spot lesions (WSLs), characterized by an opaque, matt, and chalky white appearance of enamel, are a sign of incipient caries. WSLs are common in orthodontic practice and can affect both the oral health and dental aesthetics of patients. Extensive studies have been conducted to evaluate the effectiveness of prevention or treatment for orthodontically induced enamel WSLs. However, substantial heterogeneity has been found in the outcomes used for the prevention and treatment of WSLs in literature, which prevents researchers from comparing and combining the results of different studies to draw more decisive conclusions. Therefore, we aim to develop a Core Outcome Set for trials on the prevention and treatment of Orthodontically induced enamel White Spot Lesions (COS-OWSL). Methods The development of COS-OWSL comprises four phases: (1) a scoping review to identify and summarize all existing outcomes that have been used in trials on the prevention or treatment of orthodontically induced WSLs; (2) qualitative interviews with orthodontic patients without (for prevention) and with WSL-affected teeth (for treatment) and relevant dental professionals to identify additional outcomes relevant to them; (3) Delphi surveys to collect opinions from key stakeholders including patients, dental professionals, and researchers and to reach a preliminary consensus; and (4) a consensus meeting to develop the final COS-OWSL. Discussion The COS-OWSL will be developed to facilitate the synthesis of evidence regarding the prevention and treatment of orthodontically induced WSLs and to promote the consistent use of relevant patient-important outcomes among future studies in this field. Trial registration Core Outcome Measures in Effectiveness Trials (COMET) initiative (the COS-WSL project) 1399

Background Fluoride varnish with therapeutic tricalcium phosphate formulas such as Clinpro™ varnish has shown greater tendency in treating white spot lesions (WSLs) by inhibiting the progression of initial enamel lesions through the mineral exchange. The self-assembling peptide SAP11-4 (Curodont Repair, CDR) works on a different scale in treating WSLs by mimicking the enamel matrix and aiming to guided enamel regeneration. Aim To quantitatively and qualitatively compare the effectiveness of the SAP11-4 vs tricalcium posphate fluoride (TCPF) in remineralization of WSLs in young permanent teeth. Materials and methods Nine healthy patients were enrolled in this study. The trial was performed on 40 young permanent teeth in the initial demineralization stage. Teeth were randomly assigned to receive either TCPF (group I) or SAP11-4 (group II). Lesions were assessed at pretreatment, 3, and 6 months posttreatment quantitatively per laser fluorescence DIAGNOdent pen and qualitatively through the International Caries Detection and Assessment System (ICDAS) II. Results The result of the current study revealed a significant quantitative and qualitative increase in remineralization of WSLs in both groups and over time intervals. However, the WSL recovery was significantly better in the self-assembling peptide group, reflecting an excellent remineralization potential of the WSLs by the SAP11-4 compared to TCPF varnish. Conclusion Both TCPF and SAP11-4 were effective in treating WSLs. However, the success of guided enamel regeneration by the SAP11-4 through the biomineralization has proven superiority of this material compared to TCPF. Clinical significance Early detection of WSLs and minimal intervention through remineralizing agents can limit unnecessary tissue loss, further caries progression, and consequently prevent further harm to the patients. How to cite this article Kobeissi R, Badr SBY, Osman E. Effectiveness of Self-assembling Peptide P11-4 Compared to Tricalcium Phosphate Fluoride Varnish in remineralization of White Spot Lesions: A Clinical Randomized Trial. Int J Clin Pediatr Dent 2020;13(5):451–456.

The aim of this chapter was to evaluate amount of calcium elution from bovine enamel due to single and short immersion into carbonated soft drink, to calculate depth of the eroded lesion, and to determine when to brush teeth after carbonated soft drink intake from the view point of preventing enamel abrasion. Four enamel specimens (4 mm width × 4 mm height × 5 mm thickness) were cut out of each bovine crown (a total of 8 bovine crowns were used), followed by making enamel samples by embedding them in quick cure resin. The enamel samples in each crown were randomly divided into 3 minutes of immersion (IM3), 6 minutes of immersion (IM6), 9 minutes of immersion (IM9), and 12 minutes of immersion (IM12) groups, and then, immersed in 5 mL of carbonated soft drink for respective immersion time. The amount of eluted calcium per unit area of the enamel surface was measured using atomic absorption spectrophotometry, and then, the depth of the demineralized lesion was calculated. Both the amount of eluted calcium and the lesion depth in the IM6, IM9, and IM12 groups was significantly higher than that in the IM3 group. Even in the IM12 group, the lesion depth ranged 0.05-0.35 µm. A white spot lesion that is remineralized by oral fluid was reported to range 50 - 600 µm, so the eroded lesion depth in this study was considered to be remineralized by saliva quickly, hence it was concluded that brushing just after single short time intake of carbonated soft drink hardly induce enamel abrasion.

O objetivo desta dissertação foi sintetizar e caracterizar o silicato de nióbio (SiNb) por meio do método sol-gel utilizando o pentacloreto de Nióbio (NbCl5) e o tetraetilortosilicato como precursor da sílica para ser utilizado como partícula de carga bioativa em uma resina adesiva ortodôntica com capacidade de minimizar o surgimento de lesões de mancha no esmalte dentário nas margens de acessórios colados para o tratamento ortodôntico. O silicato de nióbio produzido foi caracterizado utilizando a difração de raios X e a granulometria a laser. A resina adesiva ortodôntica foi desenvolvida utilizando Bis-GMA e TEGDMA com a incorporação de diferentes concentrações de SiNb (10, 20 e 30% em peso). Um grupo foi formulado sem a adição de SiNb (0%) e utilizado como controle. Esta resina foi avaliada quanto ao grau de conversão, amolecimento em solvente, citotoxicidade, resistência à flexão e resistência de união. A caracterização do silicato de nióbio mostrou moléculas de estrutura amorfa e partículas com tamanho médio de 11,43 µm e uma área de superfície de 509,204 m²/g. A avaliação da resina demonstrou uma redução no grau de conversão dos grupos com maiores concentrações de carga de SiNb (20 e 30%). Essa redução também foi vista nos valores de resistência à flexão nos grupos experimentais quando comparados ao grupo controle (p0,05). Conclui-se então que a utilização do silicato de nióbio como carga bioativa em uma resina adesiva ortodôntica pode ser uma opção interessante para o uso na prática clínica pela sua baixa influência nas propriedades mecânicas do material e visando sua capacidade de deposição mineral para evitar o surgimento de lesões de mancha branca no esmalte dentário durante o tratamento ortodôntico. The objective of this dissertation was to synthesize and characterize niobium silicate (SiNb) using the sol-gel method using Niobium pentachloride (NbCl5) and tetraethylortosilicate as a precursor to silica to be used as a bioactive charge particle in an orthodontic adhesive resin with the ability to minimize the appearance of white spot lesions on dental enamel on the margins of glued accessories for orthodontic treatment. Niobium silicate was characterized using X-ray diffraction and laser diffraction. The orthodontic adhesive resin was developed using Bis-GMA and TEGDMA with the incorporation of different SiNb concentration (10, 20 e 30% by weight). A group was formulated without the addition of SiNb (0%) and used as control. This resin was evaluated for degree of conversion, softening in solvent, cytotoxicity, flexural strength and shear bond strength. The characterization of niobium silicate showed amorphous structure molecules and an average particle size of 11.43 µm and a surface área of 509.204 m²/g. The evaluation of the resin showed a reduction in the degree of conversion of the groups with higher concentrations of SiNb load (20 and 30%). This reduction was also seen in the flexural strength values in the experimental groups when compared to the control group (p0,05). It is concluded that the use of niobium silicate as a bioactive filler in an orthodontic adhesive resin can be an interesting option for use in clinical practice due to its low influence on the mechanical properties of the material and aiming at its mineral deposition capacity, to prevent the appearance of white spot lesions on tooth enamel during orthodontic treatment.