Intervention of White Spot Lesions. A Contemporary Review of 20 years

@#White spot lesion is incipient caries and it manifests as white opacity lesion on the demineralised enamel surface. White spot lesions are a common adverse effect among post orthodontic patients. The prevalence of white spot lesions in post orthodontic patients varies from 2% to 97%. Therefore, it is imperative for dental practitioners to be able to manage white spot lesions. Thus, this article is a contemporary review on the management of white spot lesions. After reviewing this article, it comes to a consensus that non- invasive treatments should be the first line management of white spot lesions. Non-invasive treatments such as patient education, motivation, oral hygiene reinforcement, and attempts to remineralise with various forms of fluoride preparation should be prioritised in the treatment plan. If the white spot lesions fail to respond more invasive treatment options might be considered.

Effect of nonfluoridated remineralizing agents on initial enamel carious lesions: A systematic review

Background: Although fluoride enables remineralization, presence of calcium and phosphate ions is necessary to promote the process. So, various nonfluoridated remineralizing agents have been emerging to treat the noncavitated carious lesions. Aim: The aim of this systematic review was to assess the clinical effectiveness of nonfluoridated remineralizing agents on initial enamel carious lesions. Methods: Seven electronic databases were searched using the key words. In total, 158 human clinical trials were retrieved in the search from January 1950 to October 2016. Seventy-one repeated articles were excluded. Among the 87 articles obtained, 53 articles were eliminated after reading the title and abstracts. After assessing the full text, 28 articles were excluded. Three more studies were included from the cross references of the articles chosen. Results: All the nine trials included assessed the clinical effectiveness of casein phosphopeptide amorphous calcium phosphate (CPP ACP). They showed a positive effect of CPP ACP on the remineralization of white spot lesions. Conclusion: The use of CPP ACP resulted in significant reduction of the white spot lesion size measured using visual examination methods. This systematic review indicated a lack of reliable evidence supporting the clinical effectiveness of other commercially available nonfluoridated remineralizing agents.

Materiales bioactivos en la remineralización dentinaria / Bioactive materials in dentin remineralisation

El enfoque en el tratamiento de las lesiones cariosas que afectan el tejido dentinario se ha modificado de forma dramática en las últimas décadas. El conocimiento acerca de la etiología de la caries dental, la fisiopatología dentinaria y el desarrollo de biomateriales dentales y técnicas adhesivas, han confluido en tratamientos de mínima intervención.En virtud de esta nueva alternativa en el tratamiento de las lesiones dentinarias, es necesario evaluar la posible recuperación de la dentina mediante tratamientos remineralizantes y el desarrollo de materiales bioactivos que posibiliten la reparación o regeneración del tejido imitando los mecanismos fisiológicos de mineralización y recomponiendo las propiedades mecánicas originales del tejido, con el fin de obtener resultados clínicos exitosos basados en tratamientos con enfoque biomimético.

The focus of the treatment of carious lesions affecting dentin tissue has changed dramatically in recent decades. Knowledge about the etiology of dental caries, dentin pathophysiology and the development of dental biomaterials and adhesive techniques have resulted in minimal intervention treatments.Given this new alternative for treating dentin lesions, it is necessary to evaluate the potential recovery of dentin through mineralization treatments and the development of bioactive materials that facilitate the repair or regeneration of this tissue by imitating the physiological mechanisms of mineralization and recomposing the tissue´s original mechanical properties. This is done to obtain successful clinical results based on biomimetic treatments.

Measuring color change of tooth enamel by in vitro remineralization of white spot lesion / Medición del cambio de coloración del esmalte dental en la remineralización in vitro de la lesión incipiente de caries

Abstract: objective colour determination is based on calculating the colorimetricdistance (Delta E) within a colour space. So far, the most used colour space in dentistry is CIE L*a*b (Comission Internationale de l´Éclairage). CIE L*C*h* has been recently developed, showing a better correlation with the perception of the human eye. Objective: To determine the ability of an in vitro remineralisation substance to blend the colour of white spot lesions (WSL) with sound enamel, determining Delta E by using the CIE L*C*h* colour space. Methods: In vitro WSL was generated by immersing 10 samples obtained from human third molars in a demineralization solution for 72h. Amorphous calcium phosphate stabilized by casein phosphopeptide (CPP-ACP) was then applied for 60 days while maintaining the samples in artificial saliva at 37ºC. To evaluate the colour of enamel, images were taken from the samples placed in specifically designed silicone moulds after generating the WSL (pre-stage) and after remineralisation by scanning, applying the colorimetric distance equation (Delta E*CMC) according to the Colour Measurement Committee. Results: Treatment with CPP-ACP caused a significant Delta E decrease with respect to the pre-stage (p smaller than 0.001), while the analysis of parameters that make up the colour showed a reduction in the difference of hue (Delta H) (p smaller than 0.001) and brightness (Delta L) (p smaller than 0.01) after applying CPP-ACP. Discussion: CPP-ACP penetrated to the depth of the white spot lesion, making its appearance similar to that of the sound enamel, probably because of the formation of different mineral phases than that of the original structure, although pores were not completely filled.

Resumen: la determinación objetiva del color se basa en el cálculo de la distancia colorimétrica (Delta E) dentro de un espacio cromático. Hasta el momento el más usado en odontología ha sido CIE L*a*b (Comission Internationale de l´Éclairage). Recientemente se ha desarrollado CIE L*C*h*, que tiene mayor correspondencia con la percepción del ojo humano. Objetivo: evaluar la capacidad de una sustancia remineralizante de mimetizar el color de la mancha blanca (MB) in vitro con el esmalte sano, determinando Delta E mediante el espacio cromático CIE L*C*h*. Método: se generó la MB in vitro sumergiendo 10 muestras obtenidas de terceros molares humanos en solución desmineralizante durante 72 h., luego se aplicó pasta con fosfato de calcio amorfo estabilizado por fosfopéptidos de caseína (CPP-ACP) durante 60 días manteniendo las muestras en saliva artificial a 37ºC. Para evaluar el color, se obtuvieron imágenes de las muestras ubicadas en moldes de silicona confeccionadas ad hoc luego de generar la MB (etapa pre) y del protocolo remineralizante (etapa post) mediante escáner y se aplicó la ecuación de Distancia colorimétrica según Color Measurement Committee. (Delta E*CMC). Resultados: el tratamiento con CPP-ACP provocó una disminución significativa de Delta E respecto de la etapa pre (p menor que 0,001) mientras que el análisis de los parámetros que componen el color mostró disminución en la diferencia del tono (Delta H) (p menor que 0,001) y la luminosidad ( Delta L ) (p menor que 0,01) luego de aplicar CPP-ACP. Discusión: CPP-ACP penetró a la profundidad de la lesión, acercando la apariencia de la MB a la del esmalte sano, probablemente por la formación de fases minerales distintas a las de la estructura original aun cuando lo poros no hayan sido completamente rellenados.

How to Combat White Spot Lesion In Orthodonticcases - Review Study.

All over the world fixed orthodontic cases face a common problem –enamel hypoplasia that is white spot lesion. It can be remineralised by brushing with fluoridated toothpaste, fluoride mouth rinses and topical application of fluoride gel/foam. Efficiency of remineralisation is enhanced with daily usage of 0.05%(225ppm) sodium fluoride or 0.2% (900ppm) weekly; or with 0.4%Stannous Fluoride gel. But Stannous Fluoride stains the enamel. Enamel can also be remineralised with casein phosphopeptide-amorphous calcium phosphate(CCP-ACP). Remineralised white spot lesion can be bleached to mask the colour and can be microabraded followed by bleaching leaving a highly polished surface with calcium phosphate packed into the interprismatic enamel surface area.

Comparative Evaluation of Remineralisation Potential, Surface Structure And Adhesion Between Glass Inonomer And Calclum Hydroxide In Primary Teeth- An In Vivo Study.

The objective of the clinical study is to compare the remineralisation potential of Fuji IX with Dycal at different time intervals. 55 children in the age group of 9-13 years were selected with class I caries lesions in primary molars. Teeth with no obvious clinical signs and symptoms and a minimum dentine thickness of 0.5 to 1mm and no radiographic changes were selected. Teeth were divided into three groups – control and two experimental groups. The mineral content analysis was done with the help of EDAX. The minerals analysed were Sodium, Magnesium, Aluminium, Silica, Phosphorus, Chlorine , Calcium. Teeth in the control group showed lowest mineral content. In the experimental group Fuji IX demonstrated better remineralization potential than Dycal.

An evaluation of the monitor effect of a laser-fluorescent divice during executing the ozone-remineralization treatment to dental caries of deciduous tooth / 实用口腔医学杂志

Traditional atraumatic restorative treatment(ART) induces more successive diseases in the treatment of deciduous caries. Ignoring the disinfection and caries-affected dentin's remineralisation are the main reasons of such problem. Nowadays, Ozone-Remineralisation therapy has become one of the steps before restorative treatment. However, there is no quantitative standard to evaluate this therapy. Some researches had shown that the laser-fluorescent device (DIAGNOdent, Dd) has the advantages in monitoring caries treatment. We use DIAG-NOdent to monitor the effect of OZone-Remineralisation therapy before filling the restoration in the caves in this study, however, the results is delievered that DIAGNOdent has little advatages in monitoring the effect of this new therapy, because the data of DIAGNOdent had a large fluctuation.