Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial

Abstract

BackgroundOne of the most undesirable side effects of comprehensive orthodontic treatment is white spot lesions (WSLs). Despite many attempts at prevention of WSLs, its prevalence remains very high on debonding. There are many agents like fluoride toothpastes, fluoride varnishes, and fluoride mouth rinses, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is frequently used for the remineralization of WSLs. However, there is no consensus in the literature with respect to the success rates of these agents. Thus, the present study was designed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs.MethodsForty-five subjects in the age range of 16–25 years having at least one post-orthodontic WSL were included in the study. All the subjects were randomly divided into three groups (toothpaste group, varnish group, and CPP-ACP group). The efficacy of various remineralizing agents on the remineralization of WSLs was evaluated clinically and by DIAGNOdent immediately after debonding and subsequently after 1, 3, and 6 months of their use.ResultsTwice daily use of fluoride toothpaste alone had no significant effect on remineralization of WSLs at various intervals of observations (P = 0.078). Application of fluoride varnish along with twice daily use of fluoride toothpaste for 6 months significantly decreased the severity of WSLs (P < 0.01). Twice daily use of CPP-ACP plus crème along with fluoride toothpaste had significant effect on remineralization of WSLs at the end of 6 months of observation (P < 0.05). Between the group comparison showed that the mean visual and DIAGNOdent scores at various time intervals of observations were decreased more when fluoride varnish and CPP-ACP crème were used in addition to daily use of fluoride toothpaste, but the differences were not statistically significant (P > 0.05).ConclusionsThe use of fluoride varnish and CPP-ACP plus crème in addition to twice daily use of fluoride toothpaste had no additional benefit in the remineralization of post-orthodontic WSLs.

State of the Art Enamel Remineralization Systems: The Next Frontier in Caries Management

“…Many RCTs have demonstrated significantly better remineralizing and anticaries effects for CPP-ACP products compared to a placebo or a fluoride-containing product [Bailey et al, 2009;Guclu et al, 2016;Heravi et al, 2018;Juarez-Lopez et al, 2014;Krithikadatta et al, 2013;Llena et al, 2015;Morgan et al, 2008;Rao et al, 2009;Robertson et al, 2011]. However, other RCTs contradict the above studies as they did not report any superior added effect for CPP-ACP [Beerens et al, 2010;Brochner et al, 2011;Huang et al, 2013;Plonka et al, 2013;Singh et al, 2016;Sitthisettapong et al, 2012Sitthisettapong et al, , 2015. Published literature and systematic reviews also reach conflicting conclusions, with some reviews suggesting that CPP-ACP had significant remineralizing and caries preventive effects [Llena et al, 2009;Wang et al, 2017;Yengopal and Mickenautsch, 2009], while others conclude that the evidence to support its long-term remineralizing or synergistic effect with fluoride is limited [Azarpazhooh and Limeback, 2008;Fontana, 2016;Li et al, 2014;Raphael and Blinkhorn, 2015;Zero, 2009].…”

Efficacy of fluoride varnish for prevention of white spot lesions during orthodontic treatment with fixed appliances: A systematic review study

“…DD and visual scores at various time intervals of observation (prior to application, 1 month, 3 months and 6 months) for fluoride toothpaste, fluoride toothpaste + fluoride varnish, fluoride toothpaste + DiagnoDent pen, casein phosphopeptide (CPP), and amorphous calcium phosphate (CPP-ACP) were not different (P>0.05). Moreover, DD scores between treatment groups at various time intervals of observation were not different (P>0.05) (Singh et al, 2016).…”

Prevention and caries risk management in teenage and orthodontic patients

“…There is high level evidence from multiple systematic reviews supporting long‐term remineralising effects of CPP‐ACP on early caries lesions in vivo . Topically applied CPP‐ACP can reverse the appearance of enamel that has decalcified during fixed orthodontic treatment . The basis of this effect is that neutral ions such as CaHPO 4 0 are produced, which are localized at the tooth surface, allowing subsequent diffusion of these ions deep into the body of white spot lesion, such that remineralization occurs throughout the body of the lesion, restoring both its structure and the normal optical appearance of enamel .…”