Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference?

Abstract

Orthodontic treatment with fixed appliances is considered a risk factor for the development of white spot caries lesions (WSL). Traditionally, brackets are bonded to the buccal surfaces. Lingual brackets are developing rapidly and have become more readily available. Buccal surfaces are considered to be more caries prone than lingual surfaces. Furthermore, lingual brackets are shaped to fit the morphology of the teeth and seal almost the entire surface. In the present study we tested the hypothesis that lingual brackets result in a lower caries incidence than buccal brackets. We tested this hypothesis using a split-mouth design where subjects were allocated randomly to a group receiving either buccal or lingual brackets on the maxillary teeth and the alternative bracket type in the mandible. The results indicate that buccal surfaces are more prone to WSL development, especially when WSL existed before treatment. The number of WSL that developed or progressed on buccal surfaces was 4.8 times higher than the number of WSL that developed or progressed on lingual surfaces. When measured using quantitative light-induced fluorescence (QLF), the increase in integrated fluorescence loss was 10.6 times higher buccally than lingually. We conclude that lingual brackets make a difference when caries lesion incidence is concerned.

Lingual orthodontic treatment duration: performance of two different completely customized multi-bracket appliances (Incognito and WIN) in groups with different treatment complexities

“…Previous research provides hints of a decreased incidence of WSL formation in subjects treated with lingual multi-bracket appliances when compared to labial fixed treatment [8]. In terms of prevention of those side-effects associated with longer treatment durations, the WIN appliance would clearly be the better choice, especially in cases of elevated malocclusion severity or treatment complexity.…”

“…From the perspective of reducing frequencies of enamel decalcification, the lingual bracket approach seems favorable [8], and reasons may be seen in enhanced saliva wetting and self-cleansing of enamel surfaces [9]. Moreover, considered as an esthetic benefit, lingual WSLs do not impair dentofacial appearance, which is otherwise a very frequent problem in finished cases treated with conventional labial-side MB.…”

Therapeutic accuracy of the completely customized lingual appliance WIN

“…In addition to advantages shown for patients, the risk of developing white spot lesions appears to be drastically reduced when using lingual compared to labial appliances [7, 8, 15, 17]. …”

Lingual orthodontics for children and adolescents: improvement of the indirect bonding protocol

“…Van der Veen et al [3], in a prospective randomized split-mouth study, showed the incidence of white spot lesions (WSL) on the buccal surfaces around the labial brackets, to be almost five times higher than developing or progressing lesions found on the lingual surfaces with lingual brackets. Additionally, besides the number of lesions, their severity as measured by the integrated calcium loss, was on average ten times higher with labial fixed appliances than with lingual fixed appliances [3].…”