Search

Background: White spot lesions represent the first stage of caries and their prevalence has been increasing in recent years, particularly in patients undergoing orthodontic treatment. DIferential diagnosis and lesion activity are essential to decide on the clinical approaches to treatment. The aim of this study is to understand if the new diagnostic tools such as fluorescence, microradiography and computed microtomography have the potential to change the conventional treatment of white spots". Methods: A systematic search of available studies in the literature was carried out, using PRISMA guidelines, in Pubmed and Scopus electronic databases and manually to identify relevant articles to answer the PICO question: "Do the new diagnostic tools have the potential to change the conventional treatment of white spots?". This systematic review included randomized controlled trials (RCT), cross-sectional and longitudinal studies complying with the following inclusion criteria: (i) studies in humans, (ii) studies about white spot lesions, (iii) studies published between 2012 and 2023, (iv) studies having both diagnosis and treatment and (v) studies with full text available. In this review we excluded other systematic reviews of clinical trials and in vitro studies. The RoB tool was used to assess the risk of bias. Results: The systematic literature search identified 143 potentially relevant references, which after applying the exclusion criteria, resulted in 20 articles. Regarding diagnostic methods, most articles found were based on conventional methods of visual examination (n:10) or fluorescence (n:7). The least referenced diagnostic techniques were based on the use of clinical photographs (n:2), cross-sectional microradiography (n:1) and computed microtomography (n:1). The use of DIAGNOdent was reported by 3 in vitro studies. With regard to therapies, most studies reported the use of infiltrating resin (n:7) and fluoride-based products (n:5). Other studies have reported the use of self-assembling peptide P11-4 (n:1), home care (n:1), casein phosphopeptide-amorphous calcium phosphate (n:2) and hydrochloric acid (n:1). Combination therapies were also considered. Conclusion: Diagnostic tool does not have the potential to change the form of treatment, whether it is a conventional method or a more differentiated one. [ABSTRACT FROM AUTHOR]

Objective: White spot lesions are initial sign of enamel caries that compromise esthetic appearance following orthodontic treatment. Thus, the systematic review was conducted to evaluate the remineralization potential of orthodontic adhesives on early-enamel lesions surrounding orthodontic bracket. Methods: Search strategy was performed through three databases (PubMed, Web of Science, and Scopus). A total number of 1712 studies were identified for being potentially relevant, 62 among them were further assessed. Finally, 24 studies were included in this systematic review after adopting the eligibility criteria. The methodologies used to assess enamel remineralization were micro-computed tomography, cross-sectional microhardness, and polarized light microscopy for evaluating remineralization extent; surface microhardness, color change, and laser-induced fluorescence for evaluating superficial surface mineralization; Fourier Transform InfraRed, and Energy Dispersive Spectroscopy technique for chemical characterization. Results: Bioactive glass (BAG), nano-hydroxyapatite (n-HAP), nano-amorphous calcium phosphate (n-ACP), nano-calcium fluoride (n-CaF2), fluorinated amorphous calcium phosphate nanoparticles (AFCP), and ammonium-based methacrylate monomer were incorporated into orthodontic adhesives. Seven out of the 24 included studies utilized commercially available orthodontic adhesives. While the remaining studies utilized experimental bioactive adhesives; 13 studies evaluated adhesives containing (BAG), two studies evaluated adhesives containing (n-ACP), one study evaluated adhesives containing (AFCP), and one study evaluated adhesives containing (n-HAP). Orthodontic adhesives containing the previously mentioned additives showed significant remineralization power compared to control group. Majority of studies that evaluated bioactive-based orthodontic adhesives revealed significant remineralization effect in comparison with their corresponding control groups. Out of 24 studies, 8 have assessed ion-release. However, few numbers of included studies evaluated the ion-release peak values. The output of most studies reported a significant increase of ion-release over time. Only one study reported a mark decrease of calcium and phosphate ions after 72 h. Following the high risk of bias in the majority of studies, and lack of standard evaluation protocol, meta-analysis was not conducted. Conclusion: The outcome of the included studies supports the effectiveness of incorporation of remineralizing agents into orthodontic adhesives. [ABSTRACT FROM AUTHOR]

Abstract Objective White spot lesions are initial sign of enamel caries that compromise esthetic appearance following orthodontic treatment. Thus, the systematic review was conducted to evaluate the remineralization potential of orthodontic adhesives on early-enamel lesions surrounding orthodontic bracket. Methods Search strategy was performed through three databases (PubMed, Web of Science, and Scopus). A total number of 1712 studies were identified for being potentially relevant, 62 among them were further assessed. Finally, 24 studies were included in this systematic review after adopting the eligibility criteria. The methodologies used to assess enamel remineralization were micro-computed tomography, cross-sectional microhardness, and polarized light microscopy for evaluating remineralization extent; surface microhardness, color change, and laser-induced fluorescence for evaluating superficial surface mineralization; Fourier Transform InfraRed, and Energy Dispersive Spectroscopy technique for chemical characterization. Results Bioactive glass (BAG), nano-hydroxyapatite (n-HAP), nano-amorphous calcium phosphate (n-ACP), nano-calcium fluoride (n-CaF2), fluorinated amorphous calcium phosphate nanoparticles (AFCP), and ammonium-based methacrylate monomer were incorporated into orthodontic adhesives. Seven out of the 24 included studies utilized commercially available orthodontic adhesives. While the remaining studies utilized experimental bioactive adhesives; 13 studies evaluated adhesives containing (BAG), two studies evaluated adhesives containing (n-ACP), one study evaluated adhesives containing (AFCP), and one study evaluated adhesives containing (n-HAP). Orthodontic adhesives containing the previously mentioned additives showed significant remineralization power compared to control group. Majority of studies that evaluated bioactive-based orthodontic adhesives revealed significant remineralization effect in comparison with their corresponding control groups. Out of 24 studies, 8 have assessed ion-release. However, few numbers of included studies evaluated the ion-release peak values. The output of most studies reported a significant increase of ion-release over time. Only one study reported a mark decrease of calcium and phosphate ions after 72 h. Following the high risk of bias in the majority of studies, and lack of standard evaluation protocol, meta-analysis was not conducted. Conclusion The outcome of the included studies supports the effectiveness of incorporation of remineralizing agents into orthodontic adhesives.

Introduction: White spot lesions are opaque, chalky white or yellowish discolorations on the surface of teeth that result from the demineralization of the tooth structure. Many methods, including SEM, XRD, and FTIR spectroscopy, are crucial for identifying and evaluating enamel white spot lesions. It is imperative to have a thorough grasp of the morphology, crystallographic structure, mineral composition, and chemical changes associated with enamel white spot lesions. Method: In vitro lesions were meticulously obtained by immersing extracted teeth in hydrochloric acid for a week and drying them using artificial caries. Characterization investigations were conducted with utmost precision and thoroughness using FTIR, XRD, and SEM, ensuring the reliability and validity of the results. Results: FTIR analysis revealed the existence of calcium oxide and hydroxyapatite, and SEM examination assisted in identifying differences in surface shape. The enamel's crystalline nature was revealed via XRD investigation. Conclusion: White spot lesions are associated with the development of deep caries. Advanced imaging strategies are needed for additional validation.

Abstract Background White spot lesions (WSL) are common side effects of orthodontic treatment with fixed appliances, in which the surface layer of enamel is demineralised. Thus, remineralisation, that is a partial or complete reversal, of these lesions can occur as they affect the surface enamel. Remineralisation with low-dose fluoride, in addition to optimal oral hygiene and diet, has been recommended to manage WSL. The aim of the planned trial is to assess the effectiveness of a fluoride-containing bioactive glass toothpaste (BioMin™) in its ability to remineralise post-orthodontic demineralised WSL. Methods A single-centre, double-blind randomised clinical trial to assess intervention with Bio-Min toothpaste on WSL forming on the teeth of young people completing orthodontic treatment. Discussion Remineralisation of WSL can vary depending on the individual and the site of the lesion. There is a range of oral fluoride delivery methods which include toothpastes, oral rinses, and gel preparations, which can aid remineralisation of these lesions. Identifying effective methods of remineralisation to manage this common and unsightly complication of fixed appliance therapy can improve the health and aesthetics of dentition. Trial registration ISRCTN.com International Standard Randomised Controlled Trials Number (ISRCTN) 14479893 . Registered on 14 May 2020

Purpose Evaluation of the efficacy of two novel formulations of arginine and theobromine in remineralizing artificial enamel defects using in vitro testing techniques- Microhardness and SEMMaterials and methods Enamel slabs measuring 3 mm by 3 mm by 1.5 mm were created using 11 healthy premolars that were excised for orthodontic treatment. Group 1 (control, treated with merely a remineralization solution), Group 2 (0.05% arginine in 10 ml distilled water), and Group 3 (2% theobromine in 10 ml distilled water) were the three groups to which the slabs were randomly allocated (n = 7 per group). The pH cycle was run for 14 days, starting with a 72-h demineralization period and ending with 11 days of remineralization in the corresponding solutions. Prior to and during remineralization, microhardness was measured, and surface features were assessed using scanning electron microscopy (SEM). Statistical analysis, including Paired T Test, one-way ANOVA, and post hoc Tukey tests, determined that the mean values were significant at the 0.05 level.Results The control group showed a mean microhardness increase from 192.09 ± 19.30 to 208.58 ± 5.76. The arginine group increased significantly from 217.20 ± 4.24 to 304.00 ± 15.96, and the theobromine group from 214.09 ± 7.67 to 283.14 ± 10.91. Statistical analysis indicated that both arginine and theobromine groups had significantly greater microhardness improvements compared to the control (p

Abstract Orthodontic adhesive doped with sulfur-modified TiO2 promotes antibacterial effect. The objective of the study was to characterize the physical, mechanical and antibacterial properties of the orthodontic bracket adhesive, doped with modified titanium dioxide nanoparticles. Sulfur-doped TiO2 was synthetized and morphological topography was analyzed with TEM and SEM imaging. The catalytic performance during the degradation of rhodamine B was assessed. Nanomaterial was added at four concentration (1, 3, 6, and 10 wt%) to a commercial orthodontic adhesive. The shear bond strength and microhardness of a resin-based orthodontic adhesive containing S-TiO2 were evaluated. The inhibitory effect of the pure and doped adhesives against Escherichia coli and Streptococcus mutans was examined. As the results, the highest antimicrobial activity and good adhesive properties were noticed for light-cured orthodontic adhesive doped with 3% of S-TiO2. In this case, orthodontic adhesives with strong and long-lasting bactericidal properties can be created through the incorporation of modified TiO2 without negatively influencing microhardnesses, and bonding ability. White spot lesion and demineralization, which occurs very often in patients during orthodontic treatment, can be therefore minimized.

Background: White spot lesions (WSL) are common side effects of orthodontic treatment with fixed appliances, in which the surface layer of enamel is demineralised. Thus, remineralisation, that is a partial or complete reversal, of these lesions can occur as they affect the surface enamel. Remineralisation with low-dose fluoride, in addition to optimal oral hygiene and diet, has been recommended to manage WSL. The aim of the planned trial is to assess the effectiveness of a fluoride-containing bioactive glass toothpaste (BioMin™) in its ability to remineralise post-orthodontic demineralised WSL. Methods: A single-centre, double-blind randomised clinical trial to assess intervention with Bio-Min toothpaste on WSL forming on the teeth of young people completing orthodontic treatment. Discussion: Remineralisation of WSL can vary depending on the individual and the site of the lesion. There is a range of oral fluoride delivery methods which include toothpastes, oral rinses, and gel preparations, which can aid remineralisation of these lesions. Identifying effective methods of remineralisation to manage this common and unsightly complication of fixed appliance therapy can improve the health and aesthetics of dentition. Trial registration: ISRCTN.com International Standard Randomised Controlled Trials Number (ISRCTN) 14479893. Registered on 14 May 2020 [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of various degrees of white spot lesions (WSLs) of maxillary anterior teeth on the aesthetic perception and treatment satisfaction among orthodontic patients, orthodontists and other dental specialists and to evaluate the differences among the three groups. Methods: A total of 45 orthodontic patients (OP), 45 orthodontists (OR) and 45 other dental specialists (OS) were recruited. Subjective evaluations of perceived aesthetics and treatment satisfaction were performed towards eight digitally generated photographs of maxillary anterior teeth with incremental degrees of WSLs using a numerical visual analogue scale (VAS) from 0 to 100. Data were collected and analysed with descriptive statistics, repeated one‐way analysis of variance and multivariable generalized estimating equations. Results: A total of 135 valid questionnaires were collected. Regarding aesthetic scores for WSLs, OP gave more positive scores than OR and OS (p <.05) towards excessive white spot formation without colouration and were more tolerant than OR (p <.05) towards excessive white spot formation with slight colouration. The level of treatment satisfaction for slight to severe WSLs without cavitation was higher in OP than OR. Patients with higher education levels had more negative scores for aesthetic perception and treatment satisfaction (p <.05). Patients who brushed teeth more frequently scored lower in treatment satisfaction (p <.05). Conclusions: Orthodontists were the most critical when evaluating aesthetics and treatment satisfaction for slight to severe WSLs without cavitation. For orthodontic patients, better oral hygiene habits and higher education levels were associated with more critical attitudes towards WSLs. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective. White spot lesions are one of the most common concerns of orthodontic therapy. The present study was accomplished to evaluate the ability of Magnesium gel at different concentration and diode laser in combination compared with commercially available 1.23% APF in color restoring of WSL on permanent teeth. Methods. 42 extracted sound upper premolar teeth were recruited for this study. WSL was artificially induced, until it appears in wet and dry condition on buccal surface of each tooth. Different approaches have been utilized for treatment WSL. 6 experimental groups were involved: Group A: Control, Group B: 0.5%MgCl2 gel, Group C: 1%MgCl2 gel, Group D: 0.5%MgCl2 gel and Diode laser, Group E: 1%MgCl2 gel and Diode laser and Group F: 1.23%APF. The difference between the displayed color and the original color standard (ΔE) was assessed by colorimeter. The surface topography of teeth samples from each tested group was examined by a SEM. Collected data were investigated using one-way ANOVA followed by Duncan post hoc test at p ≤0.05. Result. A significant difference in (ΔE) was noticed among groups (p = 0.006). Group (B) showed the lowest ΔE value (9.4 ± 1.6), followed by group (D) (10.2 ± 1.1), group (F) (10.4±2.6), group (A) (11.6 ± 1.3), group (C) (12.9 ± 2.3) and group (E) (13.2 ± 1.3). Conclusion. In present study, topical application of 0.5% MgCl2 gel ensure color reinstating compared to other groups. [ABSTRACT FROM AUTHOR]

Objective: White spot lesions are one of the most common problem during and after orthodontic therapy. The present study was accomplished to evaluate the ability of Magnesium gel at different concentration and diode laser in combination compared with commercially available 1.23%APF in color restoring of WSL on permanent teeth. Materials and Methods: In this in vitro study, 42 human caries-free premolar teeth were randomely divided into 6 experimental groups: Group A: Control (artificial saliva), Group B: 0.5%MgCl2 gel, Group C: 1%MgCl2 gel, Group D: 0.5%MgCl2 gel and Diode laser, Group E: 1%MgCl2 gel and Diode laser and Group F: 1.23%APF. The difference between the displayed color and the original color standard (ΔE) was assessed by colorimeter. The surface topography of teeth samples from each tested group was examined by a SEM. Collected data were investigated using one-way ANOVA followed by Duncan post hoc test at p ≤ 0.05. Result: A significant difference in (ΔE) was noticed among groups (p= 0.006). Group (B) showed the lowest ΔE value (9.4±1.6), followed by group (D) (10.2±1.1), group (F) (10.4±2.6), group (A) (11.6±1.3), group (C) (12.9 ±2.3) and group (E) (13.2±1.3). Conclusion: 0.5% magnesium gel is as 1.23% APF gel in color restoring of white spot lesion. No synergistic effect between materials and diode laser. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the efficacy of resin infiltration and bifluoride varnish in white spot lesions (WSLs) in children between the ages of 8 and 15. Methods and Results: This study was conducted at Alma Mater Europaea Campus College "Rezonanca" (Pristina, Kosovo) and enrolled 60 participants (34 females and 26 males) between the ages of 8 and 15 years with WSLs in the vestibular surface on permanent anterior teeth. The participants were randomly assigned to the resin infiltration (Icon®) group (Group 1, n=30) and the bifluoride varnish (F&A Biflu) group (Group 2, n=30). Both materials were applied on permanent anterior teeth with WSLs in enamel. WSLs were assessed using ICDAS-II (International Caries Detection and Assessment System) criteria by visual inspection, which were coded as 1 and 2. Lesions were evaluated before the material was applied (T0), just after application (T1), and at a 6-month follow-up (T2). A total of 173 teeth from 60 participants were included in our study. Group 1 showed a significant decrease in ICDAS-II scores throughout time intervals T0-T1 (P=0.001), T0-T2 (P=0.001), and T1-T2 (P=0.041). In Group 2, there was no visible difference between T0-T1 (P=1.00) but a significant decrease between T0-T2 (P=0.001) and T1-T2 (P=0.001). Comparisons between the two groups in relation to T0, T1, and T2 were analyzed using the independent samples t-test. Significant differences have been presented in two cases at T1 (P=0.001) and T2 (P=0.003). ICDAS-II scores decreased significantly in Group 1. Conclusion: The application of RI in WSLs was found to be more effective than the application of BFV. While the effects of BFV in WSLs persisted over time, the effect of RI was evident as soon as WSLs were treated. Moving forward, we recommend considering RI as a favorable option for WSL treatment. Future studies with long-term follow-ups are necessary to corroborate these results.

Fixed appliance (FA) therapy predisposes patients to white spot lesions (WSLs). The F-ACP complex (amorphous calcium phosphate nanoparticles enriched with carbonate and fluorine and coated with citrate) has been effective for in vitro enamel remineralization. The aim of this study was to evaluate the efficacy of the F-ACP complex in remineralizing WSLs after FA therapy. One hundred and six adolescents (aged 12–20 years) were randomized into study and control groups after FA therapy. Patients in the study group were advised to use dental mousse containing F-ACP applied within Essix retainers for six months. The presence of WSLs was recorded at baseline (T0), 3 months (T1), and 6 months (T2) according to the International Caries Detection and Assessment System (ICDAS). Visual Plaque Index (VPI) and Gingival Bleeding Index (GBI) were recorded. Among 106 study participants, 91 (52 and 39 in study and control groups, respectively) completed the study. The results showed that the ICDAS score was significantly lower (p < 0.001) in the study group than in the control group between T0 and T2. The application of mousse containing the F-ACP complex inside Essix retainers for six months is effective in remineralizing white spot lesions in patients after FA therapy without side effects. [ABSTRACT FROM AUTHOR]

In this preliminary study, a multidisciplinary method based on high-resolution analytical techniques (such as microcomputed tomography, Raman Microspectroscopy, scanning electron microscopy, and Vickers microhardness test) was exploited to evaluate the alterations that occur in human teeth at the initial stage of the carious lesion. To this purpose, six extracted molars displaying a natural white spot lesion (WSL) were investigated. Specific morphological, structural, and chemical parameters, such as the mineral density, indentation hardness, molecular and elemental composition, and surface micromorphology were obtained on the WSL, and the results were statistically compared (t-test, p < 0.05) to those of the sound enamel on the same tooth. In the WSL, with respect to the sound area, a decrease in the mineral density and crystallinity was detected together with differences in the molecular composition and surface microstructure, such as the occurrence of micropores and irregularities. Moreover, the elemental analysis highlighted in WSL showed a statistically significant decrease in Ca and P percentages. In conclusion, this multidisciplinary approach allows us to fully characterize the area of interest, providing a deeper knowledge of these enamel lesions, which could have important clinical implications. [ABSTRACT FROM AUTHOR]

To evaluate the changes in lesion depth and mineral density of resin infiltration-treated white spot lesions against a simulated oral environment using thermal and acidic challenges in vitro. Two enamel slabs were prepared from each buccal surface of permanent human premolars, for a total of 56 slabs. Artificial white spot lesions were induced. One specimen was treated with resin infiltration, while the other was used as an untreated control. A micro-CT was used to assess the lesion depth and mineral density of each specimen. Subsequently, all specimens were subjected to 10,000 cycles of thermocycling and pH cycling for 10 days before being re-evaluated using the micro-CT. Lesion depth and mineral density were examined and compared between before and after aging procedures within each group by the paired sample t -test. The independent samples t -test was utilized to compare lesion depth progression and percentage change of mineral density between groups. After aging, there was both a significant lesion depth progression and a mineral loss in the control and resin infiltration groups. Mean lesion depth progression was 132.88 ± 4.18 µm for the control group and 52.31 ± 4.16 µm for resin infiltration group. Percentage mineral density loss as a percentage for the control and resin infiltration groups were 16.1 ± 0.64 % and 8.83 ± 0.30 %, respectively. The resin infiltration group demonstrated a significantly lower mean lesion depth progression and percentage changes in mineral loss compared to the control group. The lesion depth and mineral density changes in the resin infiltrated-treated group were lower than untreated white spot lesions after aging procedures using thermal and acidic challenges. Resin infiltration is a promising approach to inhibit the progression of white spot lesions related to the initial stage of dental caries. [ABSTRACT FROM AUTHOR]

Background Initial caries lesion (ICLs) adjacent to orthodontic brackets are the most common side effect of orthodontic treatment with fixed appliances. The reported prevalence is uncertain and varies considerably across studies, from 27% to 97%. Objectives This paper was designed to evaluate and synthesize the available evidence on the prevalence and incidence rates of ICLs in relation to orthodontic treatment. Selection criteria: The review (Prospero protocol CRD42023412952) included randomized and non-randomized clinical trials of interventions, cohort studies, and cross-sectional studies, published after 1990 on the prevalence or incidence of ICLs during or after orthodontic treatment with fixed appliances. Search methods: Pubmed, Scopus, and Embase databases were searched from 1990 until 01 May 2023. The risk of bias assessment was performed with RoB 2 and ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Data collection and analysis: The proportion of individuals with ICLs, reported as the number/percentage of individuals/teeth with ICLs or mean number of ICLs per subject, were used to synthesize results. Results The search yielded a total of 468 papers; 21 studies were included in the systematic review, 2 of which were not included in the meta-analysis. The prevalence rate [95%CI] of ICLs was 0.57% [0.48; 0.65] in 1448 patients, 0.22% [0.14; 0.33] in 11583 teeth, with a mean number of lesions equal to 2.24 [1.79; 2.70] in 484 patients evaluated. The incidence rate of new carious lesions developed during orthodontic treatment was 0.48% [0.33; 0.63] in 533 patients, 0.15% [0.08; 0.26] in 1890 teeth with a mean number of ICLs equal to 2.29 [1.12; 3.46] in 208 patients evaluated. Limitations Although the high number of included studies and the overall good quality, there was a significant heterogeneity in the collected data. Conclusion The prevalence and incidence rates of ICLs in subjects undergoing orthodontic treatment are quite high and raise some concerns in terms of risk assessment of orthodontic treatment. ICLs represent an alarming challenge for both patients and professionals. Effective caries prevention strategies during treatment need to be considered and implemented where appropriate. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the effect of adding CPP-ACP into a daily-use toothpaste on the remineralization of enamel caries lesions.Methods: Thirty enamel blocks were obtained from bovine incisors. Each specimen was divided into three equal parts. One-third of each block was coated with varnish to serve as a sound control area, while the remaining two-thirds underwent a demineralization process. After demineralization, another one-third of the surface was varnished, leaving only one-third of the enamel to undergo remineralization. The enamel blocks were divided into three groups (n=10), according to the remineralization treatment applied as follows: Group 1: fluoride-containing toothpaste, Group 2: CPP-ACP-containing toothpaste, and Group 3: fluoride- and CPP–ACP–containing toothpaste. Remineralization was assessed through the Vickers microhardness test at various depths (20, 50, 120 and 200 µm). The data were analyzed by ANOVA and LSD test, and P< 0.05 was considered statistically significant.Results: There was a significant difference in remineralization efficacy between the groups at the depth of 20 µm (P 0.001). Pairwise comparisons revealed that the toothpaste containing both fluoride and CPP-ACP had a significantly greater microhardness than other experimental groups (P 0.05). No significant difference was observed between the study groups concerning microhardness at 50, 120 and 200 µm depths (P 0.05).Conclusions: CPP-ACP can serve as a suitable alternative to fluoride in daily-use toothpaste for enamel remineralization. The concurrent use of fluoride and CPP-ACP in toothpaste can generate a synergistic remineralizing effect at the enamel surface layer.

Abstract Background White spot lesions represent the first stage of caries and their prevalence has been increasing in recent years, particularly in patients undergoing orthodontic treatment. DIferential diagnosis and lesion activity are essential to decide on the clinical approaches to treatment. The aim of this study is to understand if the new diagnostic tools such as fluorescence, microradiography and computed microtomography have the potential to change the conventional treatment of white spots”. Methods A systematic search of available studies in the literature was carried out, using PRISMA guidelines, in Pubmed and Scopus electronic databases and manually to identify relevant articles to answer the PICO question: “Do the new diagnostic tools have the potential to change the conventional treatment of white spots?”. This systematic review included randomized controlled trials (RCT), cross-sectional and longitudinal studies complying with the following inclusion criteria: (i) studies in humans, (ii) studies about white spot lesions, (iii) studies published between 2012 and 2023, (iv) studies having both diagnosis and treatment and (v) studies with full text available. In this review we excluded other systematic reviews of clinical trials and in vitro studies. The RoB tool was used to assess the risk of bias. Results The systematic literature search identified 143 potentially relevant references, which after applying the exclusion criteria, resulted in 20 articles. Regarding diagnostic methods, most articles found were based on conventional methods of visual examination (n:10) or fluorescence (n:7). The least referenced diagnostic techniques were based on the use of clinical photographs (n:2), cross-sectional microradiography (n:1) and computed microtomography (n:1). The use of DIAGNOdent was reported by 3 in vitro studies. With regard to therapies, most studies reported the use of infiltrating resin (n:7) and fluoride-based products (n:5). Other studies have reported the use of self-assembling peptide P11-4 (n:1), home care (n:1), casein phosphopeptide-amorphous calcium phosphate (n:2) and hydrochloric acid (n:1). Combination therapies were also considered. Conclusion Diagnostic tool does not have the potential to change the form of treatment, whether it is a conventional method or a more differentiated one.

Objective: The purpose of this study was to investigate the effect of adding CPP-ACP into a daily-use toothpaste on the remineralization of enamel caries lesions. Methods: Thirty enamel blocks were obtained from bovine incisors. Each specimen was divided into three equal parts. One-third of each block was coated with varnish to serve as a sound control area, while the remaining two-thirds underwent a demineralization process. After demineralization, another one-third of the surface was varnished, leaving only one-third of the enamel to undergo remineralization. The enamel blocks were divided into three groups (n=10), according to the remineralization treatment applied as follows: Group 1: fluoride-containing toothpaste, Group 2: CPP-ACP-containing toothpaste, and Group 3: fluoride- and CPP-ACP-containing toothpaste. Remineralization was assessed through the Vickers microhardness test at various depths (20, 50, 120 and 200 µm). The data were analyzed by ANOVA and LSD test, and P< 0.05 was considered statistically significant. Results: There was a significant difference in remineralization efficacy between the groups at the depth of 20 µm (P<0.001). Pairwise comparisons revealed that the toothpaste containing both fluoride and CPP-ACP had a significantly greater microhardness than other experimental groups (P<0.05). No significant difference was observed between the study groups concerning microhardness at 50, 120 and 200 µm depths (P>0.05). Conclusions: CPP-ACP can serve as a suitable alternative to fluoride in daily-use toothpaste for enamel remineralization. The concurrent use of fluoride and CPP-ACP in toothpaste can generate a synergistic remineralizing effect at the enamel surface layer. [ABSTRACT FROM AUTHOR]

Introduction: Streptococcus mutans and Lactobacillus count is found to be higher in orthodontic patients and is one of the leading causes of white spot lesion formation. Probiotics are emerging as alternative methods of plaque control. Aims and Objectives: To determine the effects of different types of probiotics on S. mutans and Lactobacillus levels in saliva of orthodontic patients. Materials and Methods: A total of 140 subjects were divided into Control group (Group I) with 20 subjects and study group taking probiotics (Group II) with 120 subjects. Saliva samples were taken at baseline (T 0), after three weeks (T 1), and after six weeks (T 2). The samples were diluted and incubated on specific agar media plates. The colonies observed were expressed in colony forming units per milliliter (CFU/ml) of saliva. Group II was further subdivided into six subgroups based on probiotic intake with 20 subjects in each subgroup. Results: Statistically significant difference was found in salivary microbial counts in all the probiotic groups (p < 0.05). The highest reduction in count of S. mutans (653.00 ± 102.23 CFU/ml to 84.1 ± 30.48 CFU/ml) and Lactobacilli (87.35 ± 15.64 CFU/ml to 14.60 ± 8.28 CFU/ml) was seen in the lozenges group. Conclusion: Probiotics decrease the number of salivary S. mutans and Lactobacilli and lozenges could be considered for orthodontic fixed appliance patients. [ABSTRACT FROM AUTHOR]

This comprehensive review of 25 studies on white spot lesion (WSL) treatment in children highlights the effectiveness of resin infiltration (RI) and the potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) as prominent treatment options. These findings are underscored by comparative studies, emphasizing the importance of long-term effects and age-specific considerations in treatment planning. The diversity in study types and diagnostic methods underscores the need for personalized approaches to WSL management. While common conclusions emerge, such as the efficacy of CPP-ACP and RI, contrasting findings remind us of the complexity of WSL management. The call for further research, particularly long-term studies, indicates the evolving nature of this field and the need for refining treatment protocols. Moreover, these studies emphasize the significance of conservative approaches, including regular oral hygiene practices and minimally invasive interventions, as integral components of a holistic WSL treatment strategy.

Abstract Background To explore the relationship between changes in salivary cytokine levels and the occurrence of white spot lesions in adolescents receiving clear aligner orthodontic treatment and investigate the predictive value of various factors for lesion occurrence. Methods We retrospectively analyzed sixthy eight adolescent in the permanent dentition period, who received clear aligner orthodontics in our hospital were randomly divided into two groups according to the occurrence or aggravation of white spot lesions after treatment. The general condition of the oral cavity was analyzed, saliva was collected, and inflammation-related cytokines with varying transcription levels between groups were screened by transcriptome analysis. The expression levels of inflammatory cytokines in the saliva of the patients in the two groups were measured, and the risk factors for white spot lesions were screened by correlation analysis and binary logistic regression analysis. The value of the independent and combined application of risk factors for predicting the occurrence of white spot lesions in adolescent patients after invisible orthodontic treatment was analyzed by receiver operating characteristic (ROC) curve analysis. Results Transcriptome and GO and KEGG pathway analyses showed that there were differences in the transcription levels of inflammatory cytokines such as CXCL1, CXCL2, CXCL8, CCL3, CCL4, IL-1β and IL-2 between groups. The levels of CXCL8, CCL3, CCL4, IL-1β and IL-2 in the saliva of patients with white spot lesions were significantly higher in patients after invisible orthodontic treatment (P

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Background: To explore the relationship between changes in salivary cytokine levels and the occurrence of white spot lesions in adolescents receiving clear aligner orthodontic treatment and investigate the predictive value of various factors for lesion occurrence. Methods: We retrospectively analyzed sixthy eight adolescent in the permanent dentition period, who received clear aligner orthodontics in our hospital were randomly divided into two groups according to the occurrence or aggravation of white spot lesions after treatment. The general condition of the oral cavity was analyzed, saliva was collected, and inflammation-related cytokines with varying transcription levels between groups were screened by transcriptome analysis. The expression levels of inflammatory cytokines in the saliva of the patients in the two groups were measured, and the risk factors for white spot lesions were screened by correlation analysis and binary logistic regression analysis. The value of the independent and combined application of risk factors for predicting the occurrence of white spot lesions in adolescent patients after invisible orthodontic treatment was analyzed by receiver operating characteristic (ROC) curve analysis. Results: Transcriptome and GO and KEGG pathway analyses showed that there were differences in the transcription levels of inflammatory cytokines such as CXCL1, CXCL2, CXCL8, CCL3, CCL4, IL-1β and IL-2 between groups. The levels of CXCL8, CCL3, CCL4, IL-1β and IL-2 in the saliva of patients with white spot lesions were significantly higher in patients after invisible orthodontic treatment (P < 0.05). Correlation analysis and binary logistic regression analysis showed that elevated levels of CXCL8, IL-1β and IL-2 were independent risk factors for the occurrence of white spot lesions (P < 0.05). CXCL8 had the highest independent predictive value for the occurrence of white spot lesions (AUC = 0.773, P < 0.05), and the combination of IL-1β and IL-2 was also of high value in predicting the occurrence of white spot lesions. Conclusion: After invisible orthodontic treatment, the oral microenvironment, including inflammatory cytokine levels, in adolescent patients changes; in particular, the levels of inflammatory cytokines such as CXCLs and ILs change. CXCL8 expression is significantly associated with the occurrence of white spot lesions and is an important potential target for the prevention and treatment of white spot lesions in the future. [ABSTRACT FROM AUTHOR]

The article provides consensus recommendations for preventing and managing white spot lesions (WSLs) during orthodontic treatment, emphasizing the importance of individualized caries management measures and effective plaque control. Topics include caries risk assessment, selection of orthodontic treatment modality, use of fluoride, and transitional care after orthodontic treatment, addressing the multifaceted approach to minimize the risk of WSLs and promote oral health.

Objective To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment. Trial design Three-armed parallel-group randomized controlled trial. Methods The trial was performed with 270 adolescent orthodontic patients. Randomization was performed in blocks of 30, enrolling the patients into one of the following groups: the fluoride mouth rinse (FMR) group receiving 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; high-fluoride toothpaste (HFT) group receiving 5000 ppm F toothpaste; and the Control (CTR) group receiving 1450 ppm F toothpaste. Inclusion criteria were patients scheduled for treatment in both arches with fixed appliances and age between 12 and 20 years. The primary outcome variable was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after treatment, analysed by a blinded clinician. The analysis included all teeth or teeth in the aesthetic zone, i.e. all central incisors, lateral incisors, and canines. A random sample of 30 participants was assessed to check intra- and inter-reliability. For pairwise comparison between groups, Fisher's non-parametric permutation test was used for continuous variables. Blinding was employed during the caries registration and data analysis. Recruitment October 2010 to December 2012 Results In total, 270 patients were randomized, of which 22 were excluded during treatment. Therefore, 248 participants were included in the study. The number of patients with an increase of ≥1 DL, including only central- and lateral incisors and canines, during orthodontic treatment, was significantly lower in the HFT group, 51/85 60%, compared to the CTR group, 64/82 78%, RR 0.77 (CI 0.62; 0.95), P =.01 and in the FMR group, 47/81 58%, compared to the CTR group, RR 0.74 (CI 0.60; 0.92), P <.01. Conclusions To prevent demineralized lesions in the aesthetic zone, high-fluoride mouth rinse and high-fluoride toothpaste may be recommended. Limitations The protocol was not registered, and the present study did not use a double-blinded design. [ABSTRACT FROM AUTHOR]

Abstract Background White spot lesions (WSLs) are a formidable challenge during orthodontic treatment, affecting patients regardless of oral hygiene. Multifactorial in nature, amongst potential contributors to their development are the microbiome and salivary pH. The aim of our pilot study is to determine if pre-treatment differences in salivary Stephan curve kinetics and salivary microbiome features correlate with WSL development in orthodontic patients with fixed appliances. We hypothesize that non-oral hygiene determined differences in saliva could be predictive of WSL formation in this patient population through analysis of salivary Stephan curve kinetics, and that these differences would further manifest as changes in the oral microbiome. Methods In this prospective cohort study, twenty patients with initial simplified oral hygiene index scores of “good” that were planning to undergo orthodontic treatment with self-ligating fixed appliances for at least 12 months were enrolled. At pre-treatment stage, saliva was collected for microbiome analysis, and at 15-minute intervals after a sucrose rinse over 45 min for Stephan curve kinetics. Results 50% of patients developed a mean 5.7 (SEM: 1.2) WSLs. There were no differences in saliva microbiome species richness, Shannon alpha diversity or beta diversity between the groups. Capnocytophaga sputigena exclusively and Prevotella melaninogenica predominantly were found in WSL patients, while Streptococcus australis was negatively correlated with WSL development. Streptococcus mitis and Streptococcus anginosus were primarily present in healthy patients. There was no evidence to support the primary hypothesis. Conclusions While there were no differences in salivary pH or restitution kinetics following a sucrose challenge and no global microbial differences in WSL developers, our data showed change in salivary pH at 5 min associated with an abundance of acid-producing bacteria in saliva. The results suggest salivary pH modulation as a management strategy to inhibit the abundance of caries initiators. Our study may have uncovered the earliest predecessors to WSL/caries development.

Fixed appliance (FA) therapy predisposes patients to white spot lesions (WSLs). The F-ACP complex (amorphous calcium phosphate nanoparticles enriched with carbonate and fluorine and coated with citrate) has been effective for in vitro enamel remineralization. The aim of this study was to evaluate the efficacy of the F-ACP complex in remineralizing WSLs after FA therapy. One hundred and six adolescents (aged 12–20 years) were randomized into study and control groups after FA therapy. Patients in the study group were advised to use dental mousse containing F-ACP applied within Essix retainers for six months. The presence of WSLs was recorded at baseline (T0), 3 months (T1), and 6 months (T2) according to the International Caries Detection and Assessment System (ICDAS). Visual Plaque Index (VPI) and Gingival Bleeding Index (GBI) were recorded. Among 106 study participants, 91 (52 and 39 in study and control groups, respectively) completed the study. The results showed that the ICDAS score was significantly lower (p < 0.001) in the study group than in the control group between T0 and T2. The application of mousse containing the F-ACP complex inside Essix retainers for six months is effective in remineralizing white spot lesions in patients after FA therapy without side effects.

Objective: To investigate the effect of a 5% sodium fluoride varnish with functionalized tri-calcium phosphate (fTCP) on post-orthodontic white spot lesions. A secondary aim was to study if the patients and their clinicians perceived clinical improvements. Method and materials: Fifty-nine patients with at least two visible WSLs on their maxillary incisors, canines, or first premolars present at the debonding of fixed appliances (baseline) were enrolled and assigned to a Varnish group (Clinpro White Varnish, 3M Espe) receiving topical applications at baseline and after 8 weeks, or a Control group treated with a fluoride-free mock product. The primary endpoint was white spot lesion appearance after 16 weeks, assessed from photographs using the modified ICDAS white spot lesion score (0 to 3). The patients and the dental examiners rated the white spot lesions subjectively with aid of a visual analog scale. Results: Fifty-seven patients completed the study. After 16 weeks, 62% of the white spot lesions in the Varnish group were completely reversed (score 0) compared to 39% in the Control group. The treatment effect was statistically significant (OR 0.22; 95% CI 0.08 to 0.59, P = .003) after adjusting for baseline oral hygiene index and type of tooth. A significant correlation (P < .05) was observed between patients' and orthodontists' perception of the lesions. Conclusion: The 5% sodium fluoride varnish with fTCP appeared clinically effective in reversing post-orthodontic white spot lesions 16 weeks after debonding. The patients and the clinicians agreed on the obtained esthetic improvements. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate masking effects of resin infiltration on labial white spot lesions (WSL), by comparing the latter with a remineralization approach (using hydroxyapatite and fluorides) and conventional oral care (using fluoride-free toothpaste). Method and materials: Fifteen patients with at least three WSL were enrolled for a within-person randomized controlled trial, thus allowing for intrapersonal comparisons. Each WSL per tooth in every patient was randomly assigned to one of the following groups. Group 1: lesions were resin-infiltrated with Icon (RI; DMG); Group 2: Remin Pro (RP; VOCO) was used as remineralizing agent; and Group 3 (control): affected teeth were brushed with Complete Care toothpaste (CC; Himalaya). RP and CC were applied by means of a polishing brush, using a low-speed handpiece (5 min), and these procedures were repeated chairside thrice daily for 7 consecutive days. Digital photographs were captured before and after lesion treatment under standardized conditions. The CIE L*a*b* color system was used to analyze the optical outcome, and intrapersonal color differences were statistically evaluated. Results: Compared to RP and CC, RI showed prompt and subjectively satisfactory color improvements, and this was primarily driven by L* and b* shifts. Statistical analysis of the objective color differences (ΔE*) between the three groups revealed significant differences for RI vs RP (P = .029), RI vs CC (P < .001), and RP vs CC (P = .001). Conclusion: Resin infiltration is considered a time-effective treatment option for esthetically camouflaging WSL, while RP and CC failed to improve lesion appearance and oral health in the current short-term trial. [ABSTRACT FROM AUTHOR]

OBJECTIVES: In order to assess the changes in tooth orthodontic adhesive interface microleakage after applying a caries resin penetrated to the sound enamel tooth surface in different storage media. MATERIALS AND METHODS: A total of 60 human maxillary first premolars (orthodontic extraction) were collected by random separation of the teeth into two equal groups. The control group was classified into three subgroups (n = 10) (control in deionized water, control in milk, and control in energy drink), while the experimental one (treated with ICON) was categorized into three subgroups (n = 10) (ICON in deionized water, ICON in milk, and ICON in energy drink) incubation phase lasted three weeks in total. RESULTS: A one‑way analysis of variance (ANOVA) yielded a significant difference between all experimental subgroups (ICON in deionized water, ICON in milk, and ICON in energy drink) and control subgroups (control in deionized water, control in milk, and control in energy drink). The control group in the energy drink subgroup had the highest mean microleakage value when compared to the other subgroups, whereas the resin‑infiltrated group in deionized water had the lowest mean value. According to the results of the T‑test, ICON pre‑treatment tooth samples had significantly lower mean values of microleakage than non‑ICON tooth samples. CONCLUSIONS: The adhesive system (control group) revealed that a resin infiltrate on a sound enamel surface prior to orthodontic bracket bonding reduced bracket tooth interface microleakage in all examined samples. The ICON‑infiltrated surface was discovered to provide a secondary preventive strategy against white spot lesion development by reducing microleakage under brackets. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: White spot lesions are one of the most common side effects of orthodontic therapy with a multibracket appliance and may indicate a preliminary stage of caries, also known as initial caries. Several approaches may be utilized to prevent these lesions, such as reducing bacterial adhesion in the area surrounding the bracket. This bacterial colonization can be adversely affected by a number of local characteristics. In this context, the effects of excess dental adhesive in the bracket periphery were investigated by comparing a conventional bracket system with the APC flash-free bracket system. Materials and methods: Both bracket systems were applied to 24 extracted human premolars, and bacterial adhesion with Streptoccocus sobrinus (S. sobrinus) was performed for 24 h, 48 h, 7 d, and 14 d. After incubation, bacterial colonization was examined in specific areas by electron microscopy. Results: Overall, significantly fewer bacterial colonies were found in the adhesive area around the APC flash-free brackets (n = 507 ± 13 bacteria) than the conventionally bonded bracket systems (n = 850 ± 56 bacteria). This is a significant difference (**p = 0.004). However, APC flash-free brackets tend to create marginal gaps with more bacterial adhesion in this area than conventional bracket systems (n = 265 ± 31 bacteria). This bacterial accumulation in the marginal-gap area is also significant (*p = 0.029). Conclusion: A smooth adhesive surface with minimal adhesive excess is beneficial for reducing bacterial adhesion but also poses a risk of marginal gap formation with subsequent bacterial colonization, which can potentially trigger carious lesions. Clinical relevance: To reduce bacterial adhesion, the APC flash-free bracket adhesive system with low adhesive excess might be beneficial. APC flash-free brackets reduce the bacterial colonization in the bracket environment. A lower number of bacteria can minimize white spot lesions in the bracket environment. APC flash-free brackets tend to form marginal gaps between the bracket adhesive and the tooth. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to qualitatively and quantitatively assess the masking efficacy and color stability of resin infiltration on post-orthodontic ICL after 1 year. Materials and methods: In 17 adolescents, 112 ICL (ICDAS-1: n = 1; ICDAS-2: n = 111) in 112 teeth were treated by resin infiltration (Icon, DMG) 3 to 12 months after bracket removal. The etching procedure was performed up to 3 times. Standardized digital images were taken before treatment (T0), 7 days (T7) and 12 months (T365) after treatment. Outcomes included the evaluation of the color differences between infiltrated and healthy enamel at T0, T7, and T365 by quantitative (colorimetric analysis (ΔE), ICDAS scores) and qualitative methods (5-point Likert scale (deteriorated (1), unchanged (2), improved, but not satisfying (3), improved and no further treatment required (4), completely masked (5)).) Differences between time points were analyzed by using Friedman test (ΔΕ) and chi-square tests (ICDAS). Results: The median color difference (25th/75th percentiles) between carious and healthy enamel at baseline (ΔΕ0) was 10.2(7.7/13.6). A significant decrease was observed 7 days after treatment (ΔΕ7 = 3.1(1.8/5.0); p < 0.001; ICDAS; p < 0.001). No significant changes based on ΔΕ (p = 1.000), and ICDAS grade (p = 0.305) were observed between T7 and T365 (ΔΕ12 = 3.4 (1.8/4.9)). Furthermore, at T365 four experienced dentists classified 55% and 39% of the lesions as "improved and no further treatment required" and "completely masked," respectively (Fleiss kappa: T365 = 0.851 (almost perfect)). Conclusion: Resin infiltration efficaciously masked post-orthodontic ICL 7 days and 12 months after treatment. These results for most of the teeth could not only be observed by quantitative but also by qualitative analysis. Clinical relevance: Resin infiltration efficaciously masks post-orthodontic initial carious lesions. The optical improvement can be observed directly after treatment and remains stable for at least 12 months. [ABSTRACT FROM AUTHOR]

Background: White spot lesions (WSLs) are a formidable challenge during orthodontic treatment, affecting patients regardless of oral hygiene. Multifactorial in nature, amongst potential contributors to their development are the microbiome and salivary pH. The aim of our pilot study is to determine if pre-treatment differences in salivary Stephan curve kinetics and salivary microbiome features correlate with WSL development in orthodontic patients with fixed appliances. We hypothesize that non-oral hygiene determined differences in saliva could be predictive of WSL formation in this patient population through analysis of salivary Stephan curve kinetics, and that these differences would further manifest as changes in the oral microbiome. Methods: In this prospective cohort study, twenty patients with initial simplified oral hygiene index scores of "good" that were planning to undergo orthodontic treatment with self-ligating fixed appliances for at least 12 months were enrolled. At pre-treatment stage, saliva was collected for microbiome analysis, and at 15-minute intervals after a sucrose rinse over 45 min for Stephan curve kinetics. Results: 50% of patients developed a mean 5.7 (SEM: 1.2) WSLs. There were no differences in saliva microbiome species richness, Shannon alpha diversity or beta diversity between the groups. Capnocytophaga sputigena exclusively and Prevotella melaninogenica predominantly were found in WSL patients, while Streptococcus australis was negatively correlated with WSL development. Streptococcus mitis and Streptococcus anginosus were primarily present in healthy patients. There was no evidence to support the primary hypothesis. Conclusions: While there were no differences in salivary pH or restitution kinetics following a sucrose challenge and no global microbial differences in WSL developers, our data showed change in salivary pH at 5 min associated with an abundance of acid-producing bacteria in saliva. The results suggest salivary pH modulation as a management strategy to inhibit the abundance of caries initiators. Our study may have uncovered the earliest predecessors to WSL/caries development. [ABSTRACT FROM AUTHOR]

The demineralization process conditions the structure of the enamel and begins with a superficial decalcification procedure that makes the enamel surface porous and gives it a chalky appearance. White spot lesions (WSLs) are the first clinical sign that can be appreciated before caries evolves into cavitated lesions. The years of research have led to the testing of several remineralization techniques. This study's objective is to investigate and assess the various methods for remineralizing enamel. The dental enamel remineralization techniques have been evaluated. A literature search on PubMed, Scopus, and Web of Science was performed. After screening, identification, and eligibility processes 17 papers were selected for the qualitative analysis. This systematic review identified several materials that, whether used singly or in combination, can be effective in the process of remineralizing enamel. All methods have a potential for remineralization when they come into contact with tooth enamel surfaces that have early-stage caries (white spot lesions). From the studies conducted in the test, all of the substances used to which fluoride has been added contribute to remineralization. It is believed that by developing and researching new remineralization techniques, this process might develop even more successfully. [ABSTRACT FROM AUTHOR]

BACKGROUND: Demineralization of the enamel surface, which appears as white spot lesions during and after removal of the fixed orthodontic appliance, is the most common disadvantage of the orthodontic treatment course. Using the remineralizing agents during and after orthodontic treatment helps to avoid those enamel defects. OBJECTIVE: The present study aims to assess the remineralizing effect of the chicken eggshell powder on the demineralized enamel surfaces after debonding the orthodontic bracket system. MATERIALS AND METHODS: The current study was performed on 80 prepared premolar crowns embedded into acrylic molds. The samples were prepared to receive routine steps of the bonding process for the bracket system. The paste of the chicken eggshell powder was added to the samples after the debonding process. Scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) were used to evaluate the remineralization effect of the chicken eggshell powder. Also, the Vickers microhardness tester was used to assess the enamel surface microhardness. RESULTS: It was found that the mean value of the Ca/P ratio for the samples before bonding of the orthodontic bracket system was (4.17 ± 2.2). This value significantly decreased to (2 ± 1.3) after debonding of the orthodontic bracket system and then showed a significant increase to (4.79 ± 2.65) after remineralization. These results were assured by the values of the Vickers microhardness tester. CONCLUSION: The chicken eggshell powder has an excellent remineralization effect for the demineralized enamel surface after debonding the orthodontic enamel surface.

Introduction: Enamel demineralization expressed as white spot lesions (WSLs) has been reported to be associated with both fixed and removable orthodontic appliances. Case report: This case report described the management of a patient with clear aligner-related severe enamel demineralization using a modified resin infiltration technique. Microabrasion with Opalustre (Ultradent, Utah, USA) was performed to remove the remineralized enamel surface followed by repeated etching with ICON Etch (DMG, Hamburg, Germany) until the WSLs disappeared after ethanol application. A #12 blade could be used to check whether the superficial layer was demineralized enough for the resin to infiltrate. The ICON-Infiltrant (DMG, Hamburg, Germany) was applied to the etched enamel and light-cured. After treatment, all the WSLs showed improvement with the color nearly matching the adjacent sound enamel. Discussion: Modified resin infiltration technique combined with microabrasion could be an effective noninvasive method to treat severe enamel demineralization including shallow localized enamel breakdown. However, more clinical studies are required to assess the efficacy and safety of this method.

Purpose: To compare the therapeutic effects of the resin infiltration technique, self-assembling peptide (P11-4), and fluoride varnish application on white spot lesions (WSLs) on buccal surfaces based on LF pen measurements and LAA-ICDAS scores.Materials and Methods: The lesions of 113 patients from a total of 319 patients with at least four visible WSL on buccal surfaces were assessed by LAA-ICDAS and laser fluoresence (LF pen). To be included in the study, participants were required to have at least 4 buccal WLSs, each in different quadrants, with an LF pen score ≥ 8. Twenty-one patients were included in the study based on the laser fluoresence values. The lesions were randomly assigned into 4 groups (n = 21): IG (Icon), CRG (Curodont Repair), DG (Duraphat), and CG (control) groups. The treatment protocols were applied, but the control group received no treatment except regular brushing. Lesions were scored by LAA-ICDAS after 3 and 6 months and LF pen after 1 week, 3 and 6 months.Results: There was a statistically significant decrease in LF pen measurements of the control and the intervention groups after 6 months when compared to baseline. The greatest lesion regression was observed with IG (-23.25 ± 18.21), which differed statistically significantly from CRG (-8.15 ± 13.89), DG (-10.1 ± 10.31) and CG (-4.15 ± 9.72), followed by DG which differed statistically significantly from CG. Statistically significant differences were observed in the activity status of the lesions between baseline and 6 months, except for the control group.Conclusion: In this study, the lesion regression rates shown by mean LF pen values in all groups after six months encourages the management of non-cavitated smooth surface caries lesions with non-operative treatment approaches. Regular brushing and professional tooth cleaning seem to be effective for the management of WSLs on buccal surfaces, and resin infiltration or fluoride varnish might enhance the improvement of these lesions in moderate- to high-caries-risk individuals. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to systematically review the randomized clinical trials assessing the preventive effect of professional fluoride interventions on enamel demineralization in patients undergoing fixed orthodontic treatment.Methods: The electronic search was performed in PubMed and Cochrane library in September 2021. No restriction was set on the publication date. Randomized clinical trials assessing the preventive effect of fluoride varnish, gel, mouthwash, and high-fluoride toothpaste on white spot lesions compared to the control group by clinical or radiographic methods in more than 10 patients were included.Results: A total of 7 articles consisting of 1418 participants were included. In 4 articles, fluoride varnish (contained a range of 1000-50 000 ppm fluoride) was applied multiple times (4-20 times) in test groups. Their results indicated that the test groups significantly had lesser new white spot lesions or advanced white spot lesions. One study used fluoride varnish only once at the beginning of treatment and reported no significant difference in white spot lesions compared to the control group. Application of high-fluoride toothpaste as well as fluoride mouthwash, also, showed significantly lower white spot lesions. Three studies were included in the meta-analysis and revealed that the relative risk of white spot lesions was 0.64 (95% CI = 0.40 to 0.89; P < .01) in favor of fluoride varnishConclusion: Multiple applications (4-20 times) of fluoride varnish or daily use of fluoride mouthwash or high-fluoride toothpaste seem to reduce white spot lesions in patients undergoing orthodontic treatment. However, single use of fluoride varnish was not effective. Further research is needed to establish the required number of fluoride applications for the prevention of white spot lesions during orthodontic treatment.

Abstract Objectives White spot lesions (WSLs), as a side effect of orthodontic therapy, can be treated with fluoride varnish, with the difference in efficiency reported. Material and methods Patients with buccal WSLs were consecutively included in a randomized controlled double‐blind study. At first inspection and at three follow‐ups over 6 months, 0.1% fluoride varnish and placebo (water) were applied in the test group (N = 21) and control group (N = 21), respectively. The maximum laser fluorescence value (LFV) of WSLs was recorded using DIAGNOdent. Between the groups, differences in the mean numbers of WSLs and the mean LFV of WSLs per patient at different time points were analyzed with mixed‐design analysis of variance. Orthodontic therapy duration (OTD) was included in the model as a covariate. Results A decrease in the mean WSLs number and LFV was observed; however, there were no significant differences between study groups at any time point. OTD was in interaction only with LFV. Analysis showed a different pattern of mean LFV changes for patients with OTD of >48 months compared to patients with OTD of ≤24. Conclusion The changes in numbers of WSLs and LFV over the study period indicated regression of WSLs, but an additional effect of FV was not confirmed.

Although treatment with fixed or mobile appliances has become an important part of modern orthodontics, side effects such as white spot lesions (WSLs) have a negative impact on the aesthetic outcome of orthodontic treatment. The purpose of this article was to review current evidence on the diagnosis, risk assessment, prevention, management and post-orthodontic treatment of these lesions. Data collection was performed electronically, and the initial search using the keywords "white spot lesions", "orthodontics", "WSL", "enamel" and "demineralization" in different combinations resulted in 1032 articles for the two electronic databases used. Ultimately, a total of 47 manuscripts were considered relevant to the aim of this research and included in this review. The results of the review indicate that WSLs remain a significant problem during orthodontic treatment. According to studies in the literature, the severity of WSLs correlates to the duration of treatment. Using toothpaste with more than 1000 ppm fluoride at home reduces the frequency of WSL separation and regular application of varnishes in the office reduces the frequency of the occurrence of WSLs only in the context of maintaining a strict hygiene regime. The old hypothesis that elastomeric ligatures retain more dental plaque than metal ones has been refuted. There are no differences in the appearance of WSLs between conventional brackets and self-ligating brackets. Clear aligner mobile devices develop fewer WSLs but are more extensive as opposed to conventional fixed devices, while lingual orthodontic appliances have a lower incidence of WSLs, and the most effective device for preventing these lesions is WIN, followed by Incognito. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to compare the effectiveness of P14 self-assembling peptide (Curodont™ Repair [CR]) and fluoride varnish with xylitol-coated calcium phosphate (Embrace™ Varnish [EV]) on enamel permeability and in the management of white spot lesions (WSLs) in primary teeth. Methods: A clinical trial was conducted among 30 children aged three to five years with WSLs in 60 anterior teeth. They were randomly assigned to receive CR or EV. Preintervention and postintervention evaluation was done by International Caries Detection and Assessment System (ICDAS) and morphometric analysis. The secondary outcome was to assess the enamel permeability using scanning electron microscopy (SEM) of polyvinyl siloxane impressions. Results: A statistically significant reduction in the ICDAS scores (P=0.05) and percentage area of WSLs in morphometric analysis (P=0.008) was seen in the CR group after six months. No statistically significant difference was observed in the EV group after six months. The SEM evaluation did not show a significant reduction in the percentage area of droplets in both the CR and EV groups (P=0.06 and P=0.21, respectively). No significant difference was seen between EV and CR in the three parameters assessed. Conclusion: CurodontTM Repair is effective at remineralizing white spot lesions in primary teeth and can be considered as a remineralizing agent. [ABSTRACT FROM AUTHOR]

White spot lesions (WSLs) are common enamel infectious diseases in fixed orthodontic treatment, which might attribute to the dysbiosis of oral microbiome. However, the correlation of Candida albicans with oral bacteriome in WSLs still remains unrevealed. This study investigated the carriage of C. albicans and how it shaped the bacterial community in disease or healthy supragingival plaque, to explore the potential role of interkingdom interaction in orthodontic WSLs. In this study, 31 patients with WSLs (WSLs) and 23 healthy patients (Health) undergoing fixed orthodontic treatment were enrolled. The supragingival microbiota in both groups were determined using 16S rRNA gene sequencing. Colonization and abundance of C. albicans in the plaque were determined via culture-dependent and -independent methods. Among WSLs patients, the correlation of C. albicans and bacteriome was analyzed under QIIME2-based bioinformatics and Spearman's correlation coefficient. The raw reads were deposited into the NCBI Sequence Read Archive (SRA) database (Accession Number: SRP404186). Significant differences in microbial diversity as well as composition were observed between WSLs and Health groups. Leptotrichia remarkably enriched in the WSLs group, while Neisseria and Cardiobacterium significantly enriched in the Health group. In addition, 45% of WSLs patients were C. albicans carriers but none in patients without WSLs. Among all WSLs patients, beta diversity and microbial composition were distinguished between C. albicans carriers and non-carriers. In C. albicans carriers, Corynebacterium matruchotii and Streptococcus mutans significantly enriched whereas Saccharibacteria_TM7_G-1 significantly depleted. The abundance of C. albicans was positively associated with bacteria such as Streptococcus mutans, while the negative correlation was detected between C. albicans and several bacteria such as Cardiobacterium hominis and Streptococcus sanguinis. Our study elucidated the distinguished supragingival plaque microbiome between orthodontic patients with and without WSLs. C. albicans frequently existed and enriched in orthodontic derived WSLs. The carriage of C. albicans shape plaque bacterial community in demineralized lesions and might play roles in WSLs pathogenesis. [ABSTRACT FROM AUTHOR]

Abstract Background White spot lesion (WSL) is the most common consequence during and after orthodontic treatment. This study was conducted to investigate the ability of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) coupled with universal adhesive resin to treat white spot lesions. Material and methods Forty-five extracted premolars were sectioned to create 90 specimens. Seventy-five specimens were demineralized to generate artificially created WSLs. Different strategies have been applied for the management of the artificially created WSLs. Six experimental groups were employed: Group I: sound enamel (control), Group II: demineralized enamel (artificially-created WSLs), Group III: ICON resin-treated WSLs, Group IV: CPP-ACP-treated WSLs, Group V: universal adhesive resin-treated WSLs, and Group VI: CPP-ACP followed by universal adhesive resin-treated WSLs. Assessment of color stability using a spectrophotometer, surface microhardness using a Vickers tester, and surface roughness using a profilometer was done. The surface topography of representative specimens from each experimental group was inspected using a scanning electron microscope. Collected data were analyzed using one-way ANOVA followed by Tukey’s post hoc test at p ≤ 0.05. Results White spot lesions treated with CPP-ACP and subsequently coated with universal adhesive resin (Group VI) exhibited a significantly lower ΔE than both CPP-ACP (Group IV) and universal adhesive resin-treated (Group V) groups (p ≤ 0.05), but it was not significantly different from the ICON resin-treated group (Group III). For surface microhardness, WSLs treated with CPP-ACP and consequently coated with universal adhesive resin (Group VI) recorded the highest mean that was significantly different from both ICON resin (Group III) and universal adhesive resin-treated (Group V) groups (p ≤ 0.05). All the tested strategies (ICON resin, CPP-ACP, universal adhesive resin, and CPP-ACP followed by universal adhesive resin) significantly lowered the surface roughness of the WSLs (p ≤ 0.05), while no significant difference was detected among them. Conclusions Combining a considerable caries remineralizing program using CPP-ACP with subsequent universal adhesive resin infiltration could be a promising approach to manage WSLs efficiently through increasing surface microhardness and restoring esthetic while developing a smoother surface.