Prevention and Treatment of White Spot Lesions During and After Treatment with Fixed Orthodontic Appliances: a Systematic Literature Review

Abstract

ObjectivesThe aim of the systematic literature review is to update the evidence for the prevention of white spot lesions, using materials containing fluoride and/or casein phosphopeptide-amorphous calcium phosphate during and after treatment with fixed orthodontic appliances.Material and MethodsInformation search for controlled studies on humans published between January 2008 and February 2016 was performed in PubMed, ScienceDirect, Embase, The Cochrane Library. Inclusion criteria were: the English language, study on humans, patients undergoing orthodontic treatment with fixed appliances, randomized or quasi-randomized controlled clinical studies fluoride-containing product or casein derivates used throughout the appliance therapy or straightaway after debonding.Results326 articles were reviewed (Embase 141, PubMed 129, ScienceDirect 41, Cochrane 15). Twelve clinical studies fulfilled all inclusion criteria. Use of fluoridated toothpaste had a remineralizing effect on white spot lesions (WSLs) (P < 0.05); fluoride varnish and casein supplements were effective in prevention and early treatment of WSLs (P < 0.05).ConclusionsEarly detection of white spot lesions during orthodontic treatment would allow implementing preventive measures to control the demineralization process before lesions progress. The systemic review has showed that the usage of fluoride and casein supplements in ameliorating white spot lesions during and after fixed orthodontic treatment is significantly effective. However the use of casein phosphopeptide-amorphous calcium phosphate can be more beneficial than fluoride rinse in the reduction of demineralization spots.

Novel Protein-Repellent and Antibacterial Resins and Cements to Inhibit Lesions and Protect Teeth

“…This in turn hinders the remineralization process and causes decalcification [2][3][4][5][6]. The first clinical evidence of demineralization in tooth enamel is seen as white spot lesions (WSLs), which are defined as the "subsurface enamel porosity from carious demineralization" that presents as "a milky white opacity" [1][2][3][7][8][9][10]. The incidence of WSLs in fixed orthodontic treatments is as high as 60.9%, and the demineralization can become noticeable around the brackets as early as 4 weeks after the beginning of multibracket appliance treatment [1,10].…”

A 12-Week Assessment of the Treatment of White Spot Lesions with CPP-ACP Paste and/or Fluoride Varnish

“…It is possible to reverse the early stages of enamel caries, during which the surface remains intact and the net dissolution of calcium and phosphate ions occurs from the body of the lesion [1–3]. A combination of good oral hygiene, dietary control, and fluoride therapy is a widely recommended strategy for the prevention and reversal of early caries.…”

Novel self-etching and antibacterial orthodontic adhesive containing dimethylaminohexadecyl methacrylate to inhibit enamel demineralization

“…First, etching enamel using the conventional 37% phosphoric acid can cause the loss of surface enamel and demineralization around the brackets 29) . Second, having orthodontic attachments to the teeth can make it difficult to maintain proper oral hygiene, and can prolong the plaque accumulation on tooth surfaces 30) . In addition, a decrease in local pH was found during the course of the treatment, which was produced by changes in the plaque's metabolism 31) .…”