Occurrence and severity of enamel decalcification adjacent to bracket bases and sub-bracket lesions during orthodontic treatment with two different lingual appliances Incidence of caries lesions among patients treated with comprehensive orthodontics. Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference? Effect of 1.23% acidulated phosphate fluoride foam on white spot lesions in orthodontic patients: a randomized trial. Effectiveness of high-fluoride toothpaste on enamel demineralization during orthodontic treatment-a multicenter randomized controlled trial. Comparison of oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances. Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment.
Summary Background : Using lingual enamel surfaces for bracket placement not only has esthetic advantages , but may also be suitable in terms of reducing frequencies of enamel decalcifications . Objective : To test the null-hypothesis that there is no significant difference in enamel decalcification or cavitation incidence adjacent to and beneath bracket bases between two  lingual multi-bracket ( MB ) appliances  that are different in terms of design , material composition , and manufacturing technology ( group A : WIN , DW-LingualSystems ; group B : Incognito , 3M-Unitek ) , taking into account patient- and treatment-related variables on white spot lesion ( WSL ) formation . Methods : St and ardized , digital , top-view photographs of 630 consecutive subjects ( 16214 teeth ; n Incognito = 237/6076 teeth ; n WIN = 393/10138 teeth ; mean age : 17.47±7.8 ; m/f 43.2/56.8 % ) with completed lingual MB treatment of the upper and lower permanent teeth 1–7 were screened for decalcification or cavitation adjacent to and beneath the bracket bases before and after treatment , scored from 0 to 7 . Non-parametric ANOVA was used for main effects ‘ appliance type ’ , ‘ gender ’ , ‘ treatment complexity ’ , ‘ grouped age ’ ( ≤16/>16 years ) , and ‘ treatment duration ’ as covariable , at an α-level of 5 % . Results : About 2.57 % [ 5.94 % ] of all teeth in group A [ B ] developed decalcifications . Subject-related incidence was 9.59 % [ 16.17 % ] for upper incisors in group A [ B ] , and 12.98 % [ 25.74 % ] for all teeth 16–46 . There were significant effects by gender , age , and treatment duration . Conclusion : The null-hypothesis was rejected : sub-bracket lesions were significantly less frequent in group A , while frequencies of WSL adjacent to brackets were not significantly affected by appliance type . In view of the overall low incidences of lingual post-orthodontic white-spot lesions , the use of lingual appliances is advocated as a valid strategy for a reduction of enamel decalcifications during orthodontic treatment INTRODUCTION Dental caries , specifically decalcified white-spot lesions ( WSL ) , is a well-known side-effect of orthodontic treatment . The incidence of labial incipient caries lesions and its relationship with various patient and treatment variables was investigated in patients treated with comprehensive orthodontics .  METHODS R and omly selected orthodontic patient records ( n = 350 ) were examined to determine incipient caries lesion development . Labial surfaces on pretreatment and posttreatment photographs were scored with a st and ardized scoring system . Independent variables were collected by chart abstract ion . RESULTS The incidence of patients who developed at least 1 new WSL during treatment was 72.9 % , and this incidence was 2.3 % for cavitated lesions . Treatment duration was significantly associated with new WSL development ( P = 0.03 ) . Development of WSL and cavitated lesions increased ( both , P < 0.00 ) despite increased attention to oral hygiene during treatment . Sex , age , extraction therapy , and various fluoridation sources were not associated with WSL development , but initial oral-hygiene score was moderately associated ( P < 0.06 ) . CONCLUSIONS The incidence of WSL in patients treated with comprehensive orthodontics  was significantly high , and the preventive therapy provided appeared to be ineffective . This widespread problem is alarming and warrants significant attention from both patients and providers that should result in greatly increased emphasis on effective caries prevention 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 r and omly to a group receiving either buccal or lingual brackets on the maxillary teeth and the alternative bracket type in the m and ible . 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 PURPOSE The decalcification of enamel is a serious clinical problem in orthodontic patients and is usually observed as white spot lesions surrounding brackets . This study 's purpose was to evaluate the effect of professionally applied 1.23 percent fluoride foam on reducing the formation of white spot lesions ( WSLs ) in patients with fixed orthodontic appliances . METHODS In a r and omized , double-blind , placebo-controlled trial , 100 participants were r and omly divided into two groups . The two groups received fluoride foam and placebo foam , respectively , every two months during the treatment . The examinations before bonding and after debonding were performed by one examiner and included the presence and severity of WSLs on incisors , canines , and premolars . RESULTS The incidence of WSLs was approximately 13 percent in the fluoride foam group and 51 percent in the placebo group ( P<.001 ) . The mean increment of WSLs score was significantly lower in the fluoride foam group ( 0.71 ± 2.80 ) than in the placebo group ( 4.36 ± 5.41 ; P<.001 ) . The preventive fraction was approximately 76 percent , and the number needed to treat was calculated as 2.6 . CONCLUSIONS Professional application of 1.23 percent fluoride foam during orthodontic treatment effectively reduced the development of white spot lesions . A prophylactic regimen based on the routine use of fluoride foam during orthodontic treatment is recommended OBJECTIVE To evaluate the effectiveness of daily tooth brushing with high-fluoride toothpaste on  white spot lesion ( WSL ) formation in adolescents during treatment with fixed orthodontic appliances ( FOA ) . MATERIAL S AND METHODS Four hundred and twenty-four healthy 11- to 16-year-old patients , referred to five Orthodontic Specialist Clinics , were r and omized to use either toothpaste containing 5000 ppm fluoride or regular toothpaste with 1450 ppm fluoride . To be eligible for inclusion , the patients had to be scheduled for bimaxillary treatment with FOA for an expected duration of at least 1 year . The primary and secondary outcome measures were prevalence and incidence of WSL , as registered from digital photos of the maxillary incisors , canines , and premolars taken before onset and immediately after debonding . The photos were evaluated separately by two blinded and calibrated clinicians using a 4-step score . A r and om sample of 50 cases was reassessed to check intra- and interexaminer reliability ( Kappa = 0.70 ; 0.74 ) . RESULTS The use of high-fluoride toothpaste result ed in fewer WSL ( P = 0.042 ) with a prevented fraction of 32 % . The lateral incisor was most commonly affected in both groups . CONCLUSION To prevent WSL during treatment of FOA , daily use of high-fluoride toothpaste may be recommended INTRODUCTION Our objective was to compare the oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances .  METHODS This was an age- and sex-matched prospect i ve longitudinal study of 60 adult patients treated with either labial or customized lingual fixed orthodontic appliances over a 3-month period . Ratings of oral impacts experienced and satisfaction were made on visual analog scales at 3 time points after appliance fixation . Variations in oral impacts and satisfaction over the trajectory of treatment were assessed . Area-under-the-curve analyses were conducted to assess variations in oral impacts and satisfaction between the groups . RESULTS All patients experienced oral impact disturbances , although these disturbances decreased over time ( P < 0.001 ) . Patients treated with customized lingual appliances reported more oral discomfort ( P < 0.001 ) , dietary changes ( P < 0.001 ) , swallowing difficulty ( P < 0.001 ) , speech disturbances ( P < 0.001 ) , and social problems ( P < 0.001 ) than did those in the other group . There was no significant difference between the groups regarding ratings of oral self-care , mastication , and satisfaction level of treatment ( P > 0.05 ) . CONCLUSIONS The findings indicate that oral impacts are commonly experienced during both labial and customized lingual fixed orthodontic therapies . However , the oral impacts decreased over the observational period . Patients treated with customized lingual appliances experienced more oral impacts . Both groups had similar levels of treatment satisfaction Background One 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 design ed 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 . Methods Forty-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 r and omly 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 clinical ly and by DIAGNOdent immediately after debonding and subsequently after 1 , 3 , and 6 months of their use . Results Twice 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 ) . Conclusions The 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 The purpose of this study was to determine the efficacy of fluoride varnish ( 5 % sodium fluoride , Duraphat ® , Colgate ) in reverting white spot lesions ( WSLs ) after fixed orthodontic treatment . This study was a r and omized , parallel group , controlled clinical trial . Using saline solution as control , 110 participants ( mean age ± st and ard deviation : 16.6 ± 3.2 years ) ranging from 12 to 22 years old were r and omly assigned to either the test group ( group 1 ) or the control group ( group 2 ) . Application of fluoride varnish or saline was applied onto tooth surfaces with WSLs every month during the first 6 months after debonding . The labial ( buccal ) surfaces of the teeth were assessed by the use of a DIAGNOdent pen ( DD ) at the baseline , 3- and 6-month follow-up visits . After 6 months , 96 subjects with a total of 209 study teeth ( 47 subjects , 104 teeth in group 1 ; 49 subjects , 105 teeth in group 2 ) remained . The WSLs had a mean DD reading at baseline of 17.66 ± 5.36 in group 1 and 16.19 ± 5.70 in group 2 , which decreased by 5.78 and 2.44 , respectively , at the 3-month follow-up visit and decreased by 7.56 and 3.09 , respectively , at the 6-month follow-up visit . The mean baseline DD readings in the two groups were similar ( t test , P > 0.05 ) . There was statistically significant differences between the mean DD readings of the two groups at the 3-month ( P < 0.05 ) and at the 6-month follow-up visits ( P < 0.01 ) . Topical fluoride varnish application is effective in reversing WSLs after debonding and should be advocated as a routine caries prevention measure after orthodontic treatment INTRODUCTION White spots ( WS ) related to orthodontic treatment are severe cariologic and cosmetic complications , but they are shown to be partially reduced by remineralization or abrasion in short-term follow-ups . In this prospect i ve study , we quantitatively analyzed changes in WS in general and in treatment-related white spot lesions ( WSL ) during orthodontic treatment and at a 12-year follow-up after treatment . In addition , we quantitatively compared the effects of an acrylic bonding material vs a glass ionomer cement ( GIC ) on WSL . METHODS Sum areas of WS and WSL were calculated on scans of st and ardized photos of the vestibular surfaces of 4 teeth in consecutive orthodontic patients ( median treatment time , 1.7 years ) bonded with the 2 material s in a split-mouth design . Comparisons were made in 59 patients before treatment ( BF ) , at debonding ( T0 ) , at 1 year ( T1 ) , and at 2 years ( T2 ) , and in 30 patients at a 12-year follow-up ( T3 ) with the Friedman test followed by pairwise comparisons with the Wilcoxon matched-pairs signed rank test . Differences of the effects of acrylic vs GIC on the sum areas of WSL were tested for each observation period with the Mann-Whitney U test . RESULTS Increases in the sum areas of WS and WSL from BF to T0 ( P < 0.001 ) were followed by significant decreases at T1 ( P < 0.001 ) and T2 ( P < 0.01 for WS ; P < 0.001 for WSL ) . Significant changes were also found in the sum areas for WS at T3 compared with T2 ( P < 0.01 ) , but not for WSL ( P = 0.328 ) . The sum areas of WS and WSL at T3 did not return to BF levels ( P < 0.001 ) . Sum areas of WSL were higher for surfaces bonded with acrylic compared with GIC for each observation period from BF to T2 ( P > 0.001 ) , and from T2 to T3 ( P > 0.05 ) . CONCLUSIONS Although significantly reduced during the 12-year follow-up and significantly lower with the GIC than the acrylic material at bonding , WSL are a cariologic and cosmetic problem for many orthodontic 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
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 .