Evaluating changes in the color and luminosity of dental enamel after orthodontic treatment: A clinical study

Abstract The aims of this clinical study were to evaluate the Color change - ΔE (based on spectrophotometry and visual analysis) and luminosity - L* (based on spectrophotometry) of dental enamel surface (after orthodontic treatment) around the area where orthodontic brackets were fixed, based on different cementing materials such as a resin (R group) and resin-modified glass ionomer cement (RMGIC group). The split-mouth study initially comprised 14 patients. Orthodontic brackets were fixed to the upper central incisors with resin or RMGIC. The color of the buccal surface of each tooth was measured through spectrophotometry and visual examination before the bracket-fixation process. Four individuals were excluded during the follow-up; thus 10 patients were evaluated (n=10). Brackets were removed after 12 months of orthodontic treatment, tooth color measurement and visual examination were performed again, and Adhesive Remaining Index (ARI) was also measured. ΔE and L* results were subjected to Student's t-test and by repeated-measures analysis of variance, respectively (α=0.05). ARI data were analyzed in percentages. There was statistically significant difference in ΔE between groups; the R group showed statistically higher values of L* after orthodontic treatment. ARI of 2 and 3 prevailed in the RMGIC group, whereas the R group presented 0 and 1. After orthodontic treatment, the RMGIC group presented smaller changes in ΔE, and the increase in the white scale was observed on the enamel surface around the area where brackets were fixed in the R group. The visual analysis did not show color change on the evaluated teeth.

Resumo Os objetivos deste estudo clínico foram avaliar a alteração de cor - ΔE (baseada em espectrofotometria e análise visual) e luminosidade - L* (baseada em espectrofotometria) da superfície do esmalte dentário (após tratamento ortodôntico) ao redor da área onde os braquetes ortodônticos foram fixados, com base em diferentes materiais de cimentação, como resina (grupo R) e cimento de ionômero de vidro modificado por resina (grupo RMGIC). Estudo boca dividida foi inicialmente composto por 14 pacientes. Os braquetes ortodônticos foram fixados nos incisivos centrais superiores com resina ou RMGIC. A cor da superfície vestibular de cada dente foi mensurada por espectrofotometria e avaliada por exame visual antes do processo de fixação dos braquetes. Quatro indivíduos foram excluídos durante o acompanhamento; assim, 10 pacientes foram avaliados (n=10). Os braquetes foram removidos após 12 meses de tratamento ortodôntico, a mensuração da cor do dente e o exame visual foram realizados novamente, e o Índice de Remanescente do Adesivo (IRA) também foi mensurado. Os resultados ΔE e L* foram submetidos ao teste t de Student e à análise de variância para medidas repetidas, respectivamente (α=0.05). Os dados do ARI foram analisados em porcentagens. Houve diferença estatisticamente significativa no ΔE entre os grupos; o grupo R apresentou valores estatisticamente maiores de L* após o tratamento ortodôntico. O IRA 2 e 3 prevaleceu no grupo RMGIC, enquanto o grupo R apresentou 0 e 1. Após o tratamento ortodôntico, o grupo RMGIC apresentou menores alterações no ΔE e o aumento da escala branca foi observado na superfície do esmalte ao redor da área onde os braquetes foram fixados no grupo R. A análise visual não mostrou mudança de cor nos dentes avaliados.

Characterization of sound enamel and natural white spot lesions / Caracterização de esmalte hígido e lesões de mancha branca naturais

Objective: To compare optical, morphological, chemical, and physical aspects of the sound enamel and white spot lesions (WSL) classified as ICDAS 2. Material and Methods: Seventeen human molars with one surface presenting WSL and a sound surface (2 x 2 mm window) were characterized by Quantitative light-induced fluorescence (QLF ®), Optical coherence tomography (OCT), microhardness, and Raman spectroscopy. The ANOVA and Tukey's test were used at 5% significance level. Results: The QLF comparison between distinct substrates yielded decreased ∆Q (integrated fluorescence loss) of -15,37%mm2 and -11,68% ∆F (fluorescence loss) for WSL. The OCT detected mean lesion depth of 174,43 µm. ANOVA could not detect differences in the optical attenuation coefficient between the substrates (p>0.05). Lower microhardness measures were observed in WSL than on sound enamel (p<0.05). The Raman spectra showed four vibrational phosphate bands (v1, v2, v3, v4), where the highest peak was at 960.3 cm-1(v1) for both substrates. However, a 40% decrease in phosphate (v1) was detected in WSL. The peak at 1071 cm-1 was higher for sound enamel, indicating the presence of a phosphate band instead of the B-type carbonate. The spectra showed higher intensity of the organic composition at 1295 cm-1 and 1450 cm -1 for WSL. Conclusion: Non-invasive QLF, OCT and Raman spectroscopy were able to distinguish differences in fluorescence, optical properties, and organic/inorganic components, respectively, between sound enamel and WSL, validated by the destructive microhardness analysis. (AU)

Objetivo: Comparar os aspectos ópticos, morfológicos, químicos e físicos do esmalte sadio e das lesões de mancha branca naturais, classificada como ICDAS 2. Material e métodos: Dezessete molares humanos com uma face apresentando uma lesão de mancha branca natural e outra face o esmalte hígido (2 x 2 mm) foram caracterizados utilizando a Fluorescência quantitativa induzida pela luz (QLF ®), Tomografia de coerência óptica (OCT), Microdureza e Espectroscopia Raman. A ANOVA e o teste de Tukey foram utilizados ao nível de significância de 5%. Resultados: A comparação entre os substratos distintos, utilizando o QLF ® demonstrou uma diminuição no ∆Q (perda de fluorescência integrada) de -15,37%mm2 e -11,68% de ∆F (Perda de fluorescência) para a lesão de mancha branca. O OCT detectou uma profundidade média de lesão de 174,43µm. A ANOVA não detectou diferenças no coeficiente de atenuação óptica entre os substratos (>0,05). Microdureza significantemente menor foi detectada nas lesões de mancha branca do que no esmalte sadio (p<0,05). Os espectros Raman mostraram quatro bandas vibracionais do fosfato (v1,v2,v3,v4), onde o maior pico foi em 960,3cm-1para ambos os substratos. No entanto, uma diminuição de 40% no fosfato (v1) foi detectada na lesão. O pico em 1071cm-1foi maior para o esmalte hígido, demonstrando tratar-se da banda do fosfato, ao invés do carbonato tipo B. Os espectros apresentaram maior intensidade da composição orgânica em 1295cm-1e 1450 cm-1para a lesão de mancha branca. Conclusão:Os métodos não invasivos QLF, OCT e espectroscopia Raman foram capazes dediferenciar a fluorescência, propriedades ópticas e conteúdo orgânico/inorgânico do esmalte sadio comparado com esmalte com lesões de mancha branca, sendo validado pela análise de microdureza. (AU)

Effect of resin infiltration and bleaching on surface roughness and microhardness of human enamel with induced white spot lesions / Efeito do infiltrante resinoso e do clareamento na rugosidade e microdureza de superfície do esmalte humano com lesões de mancha branca induzidas

Objective: To comparatively evaluate the effect of resin infiltration, bleaching and bleaching followed by resin infiltration on the surface roughness and microhardness of human enamel with induced white spot lesions (WSLs) and their resistance to acidic challenge. Material and Methods: Sixty human specimens were randomly divided into three groups (n=20) according to the treatment modality applied; group I Icon® resin infiltration, group II bleaching and group III bleaching followed by Icon® resin infiltration. For each treatment modality, 10 specimens were tested for surface roughness and another 10 for microhardness. WSLs were artificially induced in all specimens and after treatment, all specimens were subjected to acidic challenge. Surface roughness was measured by the tapping mode of the atomic force microscope (AFM) and microhardness was measured by digital Vickers hardness tester at baseline, after induction of WSLs, after treatment and after acidic challenge. Results: Groups I and III showed significant reduction in surface roughness after treatment, while group II showed significant increase. Groups I and III showed significant increase in the microhardness after treatment, while group II showed insignificant increase. The three tested groups showed significant increase in surface roughness values and significant reduction in microhardness after acidic challenge. Conclusion: Resin infiltration and bleaching followed by resin infiltration reduced the surface roughness and enhanced the microhardness of the WSLs. The three treatment modalities failed to resist acidic challenge resulting in increasing surface roughness and reducing microhardness. (AU)

Objetivo: Avaliar comparativamente o efeito do infiltrante resinoso, clareamento e clareamento seguido de infiltração resinosa sobre a rugosidade e microdureza superficial do esmalte humano com lesões de manchas brancas induzidas (WSLs) e sua resistência ao desafio erosivo. Material e Métodos: Sessenta espécimes humanos foram divididos aleatoriamente em três grupos (n = 20) de acordo com a modalidade de tratamento aplicada; grupo I infiltrante resinoso Icon®, grupo II clareamento e grupo III clareamento seguido de infiltração resinosa Icon®. Para cada modalidade de tratamento, 10 corpos-de-prova foram testados para rugosidade superficial e outros 10 para microdureza. WSLs foram artificialmente induzidos em todas as amostras e, após o tratamento, todas as amostras foram submetidas ao desafio erosivo. A rugosidade de superfície foi medida por microscopia de força atômica em modo de contato intermitente (AFM) e a microdureza Vickers foi medida inicialmente, após a indução de WSLs, após o tratamento e após o desafio ácido. Resultados: Os grupos I e III apresentaram redução significativa da rugosidade superficial após o tratamento, enquanto o grupo II apresentou aumento significativo. Os grupos I e III apresentaram aumento significativo na microdureza após o tratamento, enquanto o grupo II apresentou aumento insignificante. Os três grupos testados mostraram aumento significativo nos valores de rugosidade superficial e redução significativa na microdureza após o desafio erosivo. Conclusão: O infiltrante resinoso e o clareamento seguido de infiltração resinosa reduziram a rugosidade de superfície e aumentaram a microdureza dos WSLs. As três modalidades de tratamento falharam em resistir ao desafio erosivo, resultando em aumento da rugosidade de superfície e redução da microdureza.(AU)

In vitro study of chlorhexidine acetate compound mesoporous silica orthodontic modified binder resin / 口腔疾病防治

Objective@#The antibacterial properties and bonding strength of 3M orthodontic adhesive resin modified by chlorhexidine acetate (CHA) composite mesoporous silica were investigated.@*Methods@# CHA with different mass fractions was encapsulated in mesoporous silica nanoparticles (MSNs) (denoted CHA@MSNs). Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM) were used to characterize the samples. The 3M Z350XT flow resin was divided into 4 groups: group A: 3M+CHA@MSNs (0%); group B: 3M+CHA@MSNs (3%); group C: 3M+CHA@MSNs (5%); and group D: 3M+CHA@MSNs (6.4%), with mass scores of 0%, 3%, 5%, and 6.4%, respectively. The shear strength of the modified adhesive was tested by a universal electronic material testing machine, the adhesive residue was observed by a 10 × magnifying glass, and the adhesive Remnant index (ARI) was calculated. The four groups of modified adhesives were cultured with Streptococcus mutans. The OD540 value of the bacterial solution was measured by a spectrophotometer, and the amount of plaque attachment was observed by scanning electron microscopy to evaluate the antibacterial performance of the adhesives.@*Results@#Infrared spectroscopic analysis of CHA@MSNs showed that CHA was successfully loaded onto MSNs. Under scanning electron microscopy, it could be seen that, after Cha was combined with MSNs, the structure of MSNs changed, as the boundary was fuzzy and aggregated into a layered structure. A comparison of shear strength revealed a statistically significant difference between the groups containing CHA@MSNs and the groups without CHA@MSNs (P<0.05). The value of the shear strength in group D decreased the most, while there was no statistically significant difference between group B and group C (P > 0.05). There was no statistical significance across all groups (P > 0.05), suggesting that the addition of CHA@MSNs had little effect on the bracket shedding. The OD540 value of bacterial fluid indicated that the difference among groups A, B and C was statistically significant (P < 0.05), and the antibacterial effect of group C was the best; there was no statistically significant difference between group C and group D (P > 0.05).@*Conclusions@#Therefore, adding 5% CHA@MSN antibacterial agent significantly improved the antibacterial effect and did not affect the bond strength.

Research progress on the relationship between orthodontic treatment and the oral microbiome / 口腔疾病防治

@#With the deepening of research in oral microbiomics, an important relationship between changes in the oral microbiome and orthodontic treatment has been found. Orthodontic treatment will have an impact on the oral and systemic microbiome. The presence of oral appliances can change the quantity and quality of the oral microbiometo and increase the risk of oral and even systemic diseases in patients undergoing orthodontic treatment. Compared with fixed orthodontic treatment, clear aligners will not have a harmful impact on the structure of the oral microbiome, which is more conducive to maintain oral health during the orthodontic treatment process. In addition, different bracket types and materials can lead to different changes in the oral microbiome, and the occurrence and development of orthodontic-related diseases, such as white spot lesions, dental caries, gingivitis and periodontitis, are also related to changes in the oral microbiome. At present, the role of the oral microbiome in the process of orthodontic treatment needs to be further studied. Whether a change in the oral microbiome caused by orthodontic treatment can be restored after orthodontic treatment is still uncertain and needs more research. This paper reviews the research progress on the application of microbiomics in orthodontics, including the impact of fixed appliances and clear aligners on the microbiome and the relationship between orthodontic-related diseases and the oral microbiome.

Application of nanoparticles in preventing enamel demineralization during orthodontics / 口腔疾病防治

@#Enamel demineralization is one of the most common adverse reactions to orthodontic treatment. The existence of orthodontic appliances affects oral hygiene maintenance, which easily leads to plaque accumulation and oral flora dysbiosis, and cariogenic bacteria produce acid to cause enamel demineralization. It not only affects aesthetics but may develop into caries and endanger oral health. Therefore, enamel demineralization has become an urgent problem. Nanoparticles generally refer to solid particles with diameters of 1 to 100 nm and have unique physicochemical properties that provide a new strategy for preventing enamel demineralization during orthodontics. Reviewing the relevant literature, nanoparticles used for the prevention of enamel demineralization in orthodontics may be classified into antibacterial, remineralization and carrier-type nanoparticles according to their functions. Most research was performed on the application of nanoparticles to modify orthodontic adhesives for enhancement of antibacterial or remineralization properties, but some studies also focused on the modification of orthodontic appliances with nanoparticles for surface coating or overall doping to provide antimicrobial properties. The advantage of these two approaches is that they are not dependent on patient compliance. Nanoparticle-modified fluoride varnishes and nanocarriers loaded with antimicrobial or remineralization agents may be used to promote oral health care in orthodontic patients, which have a sustained preventive effect but depend on the cooperation of the patient. It was indicated that the small size effect of nanoparticles provides better performance, but there may be certain safety issues, and there is still some influence on the physicochemical properties of the modified materials themselves. These issues must be further explored. Although there are some limitations in the current studies, nanoparticles are expected to play an important role in the prevention of enamel demineralization during orthodontics in the future.

Oral health status after orthodontic treatment: a retrospective study / Estado de salud bucal después del tratamiento de ortodoncia: un estudio retrospectivo

ABSTRACT: Orthodontic appliances in the oral cavity may cause problems such as white spot lesions, dental plaque, periodontal disease and root resorption. The aim of this study was to investigate the association between orthodontic treatment and oral health parameters including visible dental plaque, gingival recession and white spot lesions (WSLs). A total of 170 patients (86 females, 84 males) were randomly selected to determine visible dental plaque, gingival recession and white spot lesions by using pre-treatment and post-treatment oral photographs. Except of previously extracted teeth, maxillary and mandibular incisors, canine, 1st and 2nd premolars and 1st molar were evaluated. There was a significant difference between the T0 (before treatment) and T1 (after treatment) groups in visible plaque (P< 0.001). The distribution of gingival recession frequencies according to Miller classification before treatment did not differ from the after treatment (P=082). A statistically significant increase in the severity of WSL was detected between the two time points (P< 0.001). Males have been shown to have higher WSL incidence after treatment. In conclusion, the present study showed that visible dental plaque and white spot lesions significant increase after orthodontic treatment. Considering the relationship between oral health and orthodontic treatment, clinicians and patients should know the risks and take precautions.

RESUMEN: Los aparatos de ortodoncia en la cavidad oral puede causar problemas como lesiones de mancha blanca, placa dental, enfermedad periodontal y reabsorción radicular. El objetivo de este estudio fue investigar la asociación entre el tratamiento de ortodoncia y los parámetros de salud bucal, incluida la placa dental visible, la recesión gingival y las lesiones de mancha blanca (LMB). Un total de 170 pacientes (86 mujeres, 84 hombres) fueron seleccionados al azar para determinar la placa dental visible, la recesión gingival y las lesiones de manchas blancas mediante el uso de fotografías orales antes y después del tratamiento. Excepto los dientes extraídos previamente, se evaluaron incisivos maxilares y mandibulares, caninos, premolares y primeros molares. Hubo una diferencia significativa entre los grupos T0 (antes del tratamiento) y T1 (después del tratamiento) en la placa visible (P<0.001). La distribución de las frecuencias de recesión gingival según la clasificación de Miller antes del tratamiento no mostraron diferencias significativas con respecto al postratamiento (P=0.082). Se detectó un aumento estadísticamente significativo en la gravedad de LMB entre los dos puntos de tiempo (P<0.001). Se ha demostrado que los hombres tienen una mayor incidencia de LMB después del tratamiento. En conclusión, el presente estudio mostró que la placa dental visible y las lesiones de manchas blancas aumentaron significativamente durante el tratamiento de ortodoncia. Teniendo en cuenta la relación entre la salud bucal y el tratamiento de ortodoncia, los médicos y los pacientes deben conocer los riesgos y tomar precauciones.

Evaluation of color changes of white spot lesions treated with three different treatment approaches: an in-vitro study

ABSTRACT Objective: To qualitatively and quantitatively assess the color changes effect and the color stability of the resin infiltrant on white spot lesions (WSLs), in comparison with nano-hydroxyapatite (nano-HA) toothpaste and microabrasion. Methods: WSLs were artificially created on sixty human premolars enamel surfaces and randomly assigned to equal four groups (n = 15 each): nano-HA toothpaste, microabrasion (Opalusture), resin infiltrant (Icon) treatment, or artificial saliva (control group). The color change (ΔE) of each specimen was measured by dental spectrophotometer (Vita Easyshade) at different time points: baseline, after WSLs' creation, after application of treatments, one month, three and six months after treatments application. Results: The ΔE value did not differ significantly for the four groups at baseline measurement before treatment (p> 0.05). Icon resin infiltrant improved the color of WSLs significantly immediately after its application, giving the lowest ΔE value (3.00 ± 0.59), when compared to other treatments (p< 0.001). There were no significant changes in ΔE (p> 0.05) for all groups during the follow up intervals (one month, three and six months after treatments application). Conclusion: Resin infiltrant can improve the color of WSLs and restore the natural appearance of enamel better than nano-HA toothpaste and microabrasion.

RESUMO Objetivo: avaliar qualitativamente e quantitativamente os efeitos nas mudanças e estabilidade da cor de lesões de mancha branca (LMBs), após tratamento com infiltração de resina, em comparação aos tratamentos com pasta de dentes com nanopartículas de hidroxiapatita (Nano-HA) e com microabrasão. Métodos: As LMBs foram criadas artificialmente em 60 superfícies de esmalte dentário de pré-molares humanos e aleatoriamente divididas em quatro grupos (n=15, cada): pasta de dentes Nano-HA, microabrasão (Opalusture), tratamento com infiltração de resina (Icon) e saliva artificial (grupo controle). A mudança de cor (ΔE) de cada espécime foi aferida com um espectrofotômetro odontológico (Vita Easyshade) em diferentes tempos: início do estudo, após a criação das LMBs, após a aplicação dos tratamentos, um mês, três meses e seis meses após a aplicação dos tratamentos. Resultados: Os valores de ΔE não diferiram significativamente entre os quatro grupos ao início do estudo (p > 0,05). A infiltração com resina Icon melhorou significativamente a coloração das LMBs imediatamente após a sua aplicação, com o menor valor de ΔE (3,00 ± 0,59), quando comparada às outras modalidades de tratamento (p < 0,001). Não houve mudanças significativas nos valores de ΔE (p > 0,05) em qualquer um dos grupos durante os intervalos de acompanhamento (um mês, três meses e seis meses após a aplicação do tratamento). Conclusão: A infiltração de resina é capaz de melhorar a coloração das LMBs e restaurar a aparência natural do esmalte de forma superior à pasta de dentes com Nano-HA e à microabrasão.

Agents to Maintain Tooth Integrity: An Equilibrium between Remineralization and Demineralization - A Review

Changing concepts of dentistry have the aim to manage initial caries lesions with the help of remineralizing agents in an attempt to arrest or revert the disease progression by the process of depositing calcium and phosphate ions in enamel and hence, gaining net mineral loss. Concentrating mainly on prevention and early intervention of caries, minimally invasive dentistry’s first basic principle is the remineralization of early carious lesions. The purpose of this article is to review current knowledge and technologies for tooth remineralization and their applications in clinical practices.

Remineralizing potential of CPP-ACP in white spot lesions – A systematic review

The aim of this systematic review was to assess the long term remineralizing potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) only in paste form compared with fluoride varnish, and or placebo in both naturally occurring and post-orthodontic white spot lesions in vivo. Data Sources: The literature search covered the electronic databases: PubMed and Google scholar from 2005-2016. Only articles published in English were included. Randomized control trials in which CPP-ACP delivered by paste form were included. All studies which met inclusion criteria underwent two independent reviews. Study Selection: Two ninety five articles were identified from the search after excluding duplications. Abstracts of forty one articles were reviewed independently. Twenty nine articles were excluded after reading abstract. Full text articles were retrieved for fifteen relevant studies. After reviewing articles independently, three articles were excluded after full text reading. Finally twelve studies were selected based on the eligibility criteria. The remineralizing effect of CPP-ACP were compared with placebo and fluoridated toothpaste and fluoride varnish in randomized control trial. Conclusion: A high level evidence of remineralizing potential of CPP-ACP on naturally occurring white spot lesion and WSL post orthodontic treatment was found in comparison with placebo/fluoridated toothpaste and fluoride varnish without any statistically significant difference. Well-designed RCTs are, therefore, required to improve the level of evidence in this area.

Colorimetric evaluation of white spot lesions following external bleaching with fluoridation: An in-vitro study / 대한치과교정학회지

OBJECTIVE: This study was performed to investigate the effects of external tooth bleaching with flouridation on the appearance of white spot lesions (WSLs) in vitro. METHODS: In total, 125 bracket-bonded bovine incisor enamel blocks with artificial WSLs were randomly divided into a control group and four treatment groups (home bleaching, home bleaching + fluoridation, in-office bleaching, and in-office bleaching + fluoridation). A spectroradiometer (SR) and digital images (DIs) were used to evaluate colorimetric parameters (Commission Internationale l'Eclairage L*a*b*) for all specimens. Color measurements were obtained before WSL formation (T1), after WSL formation (T2), and after completion of the external tooth bleaching treatment (T3). RESULTS: The SR-based color change after bleaching was significantly greater in the treatment groups than in the control group (p 0.05). CONCLUSIONS: The findings of this study suggested that external tooth bleaching with fluoridation can alleviate the conspicuity of WSLs.

Evaluation Of Changes In The Oral Environment With Lingual Orthodontic Appliances.

Background & Objective: Lingual orthodontics is gaining more popularity in orthodontic centers. The purpose of present study is to evaluate changes in the oral cavity with lingual orthodontic appliances. Methodology: The epidemiological study was conducted among 45 patients with lingual orthodontics. Before the start of orthodontic treatment all the patients received proper oral prophylaxis. The incidence of White Spot Lesions (WSLs), plaque accumulation and gingivitis were evaluated at the interval of one, six and twelve months using WSL index developed by Gorelick et al., (1982), Silness & Löe plaque index and Löe & Silness gingival index respectively. The Student’s t test and ANOVA test were used with a significance level of 5%. Results: The frequency of WSLs increased with the procedure of lingual orthodontics from first month (3.2%) to six (6.7%) and twelve months (7.9%). A significant increase in the plaque index (PI) and gingival index (GI) was observed from month one to twelve months. Overall mean of PI and GI was 2.07±0.809 and 1.67±0.929 respectively among the patients. Conclusion: The occurrence of dental plaque and gingival inflammation was mostly noticed in lingual orthodontic cases as it is difficult to remove the plaque deposits around the brackets in the lingual side.

Esthetic effect of resin infiltration for the treatment of post-orthodontic white spot lesions / 实用口腔医学杂志

Objective:To evaluate the effects of resin infiltration in the treatment of post-orthodontic white spot lesions (WSLs)and compare it with microabrasion.Methods:1 0 subjects with 66 teeth with noncavitated and unrestored WSLs after multibracket treatment were recruited.A simple randomized,split-mouth and controlled design was used to allocate WSLs to the resin infiltration and micro-abrasion groups(n =33).The area of the WSLs were measured photographically by using image analysis software before treatment (T0),1 week(T2)and 3 months(T3)after treatment.Data were analyzed with multifactorial analysis of the variances with repeated measures at an a level of 5% and a power of 80%.Results:The area of the white spot lesions(R)decreased significantly in both groups(P <0.05).At T3 the success rate of resin infiltration group(88.68%)was significantly higher than that of microabrasion group (64.67%)(P <0.05).Conclusion:Resin infiltration is more effective than microabrasion in the treatment of post-orthodontic WSLs.

Prevalencia de manchas blancas antes y después del tratamiento de ortodoncia / Prevalence of white spot lesions before and after orthodontic treatment

Resumen Introducción y objetivo: La aparatología de ortodoncia correctiva es un factor de riesgo para caries dental, facilitar su diagnóstico, prevención y control debe ser parte de la formación en esta especialidad. El propósito de este estudio fue evaluar la prevalencia de manchas blancas antes y después del tratamiento de ortodoncia en pacientes entre 10 y 22 años mediante fotografías digitales. Materiales y métodos: Se evaluaron fotografías iniciales y finales de 87 pacientes seleccionados, y modelos finales de 59 pacientes. La información recolectada fue: edad, sexo, tamaño de corona clínica, y presencia de manchas blancas en los 12 dientes anteriores; se utilizaron los criterios ICDAS para determinar la prevalencia de lesiones de mancha blanca (d2) y microcavidad en el esmalte (d3). Resultados: El 26,4% de los pacientes desarrolló lesiones de mancha blanca durante el tratamiento de ortodoncia, no hubo diferencias significativas en la distribución por cuadrantes ni por género, la prevalencia de manchas blancas fue mayor en el tercio gingival, en el canino superior derecho y en los dientes con tamaño de corona clínica más grande. Conclusión: La prevalencia de mancha blanca tuvo un aumento importante durante el tratamiento de ortodoncia con una distribución homogénea según sexo. El ortodoncista debe estar atento y orientar estrategias preventivas en sus pacientes.

Abstract Introduction and objective: Orthodontic fixed appliances are a risk factor for dental caries, and thus the understanding its prevention, diagnosis and treatment should be an integral part of specialty training in orthodontics. The purpose of this study was to evaluate the prevalence of white spot lesions before and after orthodontic treatment in patients between 10 and 22 years of age using digital photographs. Materials and methods: Initial and final photographs of 87 patients and final casts of 59 patients were evaluated. Chart information included: Age, sex, clinical crown size, and presence of white spot lesions in all 12 anterior teeth; ICDAS criteria was used to determine the prevalence of white spot lesions (d2) and enamel micro cavity (d3). Results: 26.4% of patients developed white spot lesions during orthodontic treatment; there was no significant difference in the distribution by quadrants or gender; the prevalence of white spot lesions was higher in gingival third, upper right canine and teeth with greater clinical crown size. Conclusion: Prevalence of white spot lesions increased during the orthodontic treatment with a homogenous distribution by sex. Orthodontists must to be alert and develop preventive strategies in these patients.

Modification of surface pretreatment of white spot lesions to improve the safety and efficacy of resin infiltration / 대한치과교정학회지

OBJECTIVE: A low-viscosity resin (infiltrant) was used to inhibit the progression of white spot lesions (WSLs) and resolve associated esthetic issues. An alternative pretreatment was explored to increase the pore volume of the surface layer of the WSLs. Also, the penetration effects of the infiltrant were evaluated for various pretreatments. METHODS: Sixty two artificial lesions were fabricated on bovine teeth. As a positive control, 15% HCl gel was applied for 120 seconds. Further, 37% H3PO4 gel was applied for 30 seconds using three methods. The samples were divided as follows: H3PO4 only group, H3PO4 sponge group, and H3PO4 brush group. The acid was gently rubbed with the applicators (i.e., a sponge or brush) throughout the application time. To compare the effects of resin infiltration, twenty paired halves of specimens were treated with an infiltrant (ICON(R)). RESULTS: Thicknesses of the removed surface layers and infiltrated areas were evaluated by confocal laser scanning microscope. The positive control and the 37% H3PO4 brush group failed to show significant differences in the removed thickness (p > 0.05); however, the mean percentage of the infiltrated area was higher in the 37% H3PO4 brush group (84.13 +/- 7.58%) than the positive control (63.51 +/- 7.62%, p < 0.001). Scanning electron microscope observations indicate higher pore volumes for the 37% H3PO4 brush group than for the positive control. CONCLUSIONS: Application of 37% H3PO4 with a brush for 30 seconds increased the pore volume of WSL surface layers and the percentage of infiltrated areas in comparison to the use of 15% HCl for 120 seconds.

Effects of various toothpastes on remineralization of white spot lesions / 대한치과교정학회지

OBJECTIVE: The purpose of this in vitro study was to examine the effects of fluoridated, casein phosphopeptide.amorphous calcium phosphate complex (CPP-ACP)-containing, and functionalized beta-tricalcium phosphate (fTCP)-containing toothpastes on remineralization of white spot lesions (WSLs) by using Quantitative light-induced fluorescence (QLF-D) Biluminator(TM) 2. METHODS: Forty-eight premolars, extracted for orthodontic reasons from 12 patients, with artificially induced WSLs were randomly and equally assigned to four treatment groups: fluoride (1,000 ppm), CPP-ACP, fTCP (with sodium fluoride), and control (deionized water) groups. Specimens were treated twice daily for 2 weeks and stored in saliva solution (1:1 mixture of artificial and human stimulated saliva) otherwise. QLF-D Biluminator(TM) 2 was used to measure changes in fluorescence, indicating alterations in the mineral contents of the WSLs, immediately before and after the 2 weeks of treatment. RESULTS: Fluorescence greatly increased in the fTCP and CPP-ACP groups compared with the fluoride and control groups, which did not show significant differences. CONCLUSIONS: fTCP- and CPP-ACP-containing toothpastes seem to be more effective in reducing WSLs than 1,000-ppm fluoride-containing toothpastes.

Efficiency of resin infiltration versus fluride varnish for treatment of post-orthodontic white spot lesions / 中国组织工程研究

BACKGROUND:White spot lesions caused by enamel demineralization are a common side effect of orthodontic treatment. Resin infiltration treatment for white spot lesions has obtained favorable effects, but there is no report on the difference between resin infiltration and fluoride varnish treatment for post-orthodontic white spot lesions. OBJECTIVE:To compare the efficiency of resin infiltration and fluride varnish for treatment of post-orthodontic white spot lesions. METHODS:Twenty-nine patients with post-orthodontic white spot lesions were randomly divided into two groups:one group accepted the resin infiltration treatment and the other group accepted fluoride varnish treatment. Frontal intraoral photos before treatment and 6 months after treatment were col ected for study. The difference in efficiency of resin infiltration and fluride varnish for treatment of post-orthodontic white spot lesion was analyzed and evaluated by both dentists and College students who were not engaged in oral medicine. RESULTS AND CONCLUSION:Except one patient treated with fluride varnish, al the patients completed the referral on schedule. There was significant improvement in the two groups after treatment (P<0.05). Resin infiltration treatment was better than fluoride varnish treatment in post-orthodontic white spot lesions. Thus, resin infiltration that requires fewer referrals and has better effects is an ideal therapy for post-orthodontic white spot lesions.

Penetración de tres adhesivos en lesionesinterproximales de caries de mancha blanca: estudio in vitro / Penetration of three adhesives in proximal white-spot carious lesions: an in vitro study

Introducción: el tratamiento de lesiones interproximales de caries temprana representa un reto en la concepción moderna de la cariología y la operatoria. Como respuesta, además del diagnóstico temprano, emergen nuevos materiales para controlar laprogresión de la caries temprana. El objetivo de este estudio fue evaluar in vitro el grado de penetración de tres adhesivos: Excite (Ivoclar-Vivadent), Prime & Bond NT (Dentsply) y Single Bond (3M-ESPE), en el sellado de lesiones interproximales no cavitacionales de mancha blanca.Métodos: 117 premolares humanos extraídos con lesión interproximal de mancha blanca I CDAS-II 2 montados enyeso, simulando la situación en cavidad oral, fueron asignados aleatoriamente a uno de los tres grupos; se sellaron las lesiones con cadamaterial previamente mezclado con azul de metileno; se obtuvieron secciones longitudinales de 250 μm y se analizaron en fotografíasobtenidas bajo estereomicroscopía. Se valoró cubrimiento total de la lesión, profundidad histológica de la lesión en zonas y en micrómetros y, penetración máxima del adhesivo. Resultados: se analizaron 116 dientes. Se encontró cubrimiento total de la lesión en52,5%; 75% se ubicaron en la mitad interna del esmalte, con profundidad promedio de 854 ± 493 μm. La máxima penetración promedio del adhesivoen la lesión fue de 697 ± 412 μm. No hubo diferencias estadísticamente significativas entre grupos para las variables (Kruskal Wallis y correlación de Spearman; p > 0,05). Conclusión:estos tres adhesivos de baja viscosidad, con alto contenido de TEGDMA y HEMA,lograron el cubrimiento y la penetración de material para el sellado de lesiones tempranas de caries interproximal.

Introduction: the treatment of early proximal carious lesions represents a challenge to modern conceptions of cariology and operative dentistry. The possible solutions include, besides an early diagnosis, development of new materials to control early cariesprogression. The objective of this in vitro study was to evaluate the degree of penetration of three adhesives: Excite (Ivoclar-Vivadent), Prime & Bond NT (Dentsply), and Single Bond (3M-ESPE), in the process of sealing white-spot non-cavitated proximal lesions. Methods: 117 extracted human premolars with ICDAS 2 white-spot non-cavitated proximal lesions mounted on plaster, to simulate oral cavityconditions, were randomly sorted out in each of the three groups. The lesions were sealed with each of the materials previously mixed with methylene blue; longitudinal sections of 250 μm were obtained, and they were later analyzed on photographs taken with a stereomicroscope. These variables were evaluated: total lesion coating, lesion’s histologic depth (in micrometers), and the adhesive’s maximum penetration.Results: a total of 116 teeth were analyzed. Entire lesion coating was found in 52.5% of the cases; 75% were located in the enamel’s internal half, with an average depth of 854 ± 493 μm. The adhesive’s maximum average lesion penetration was 697 ± 412 μm. No statistical significant differences were found among the groups (Kruskal Wallis and Spearman correlation; p > 0.05). Conclusion: these three low-viscosity adhesives with high amounts of TEGDMA and HEMA effectively achieved covering and penetrating of the material for sealing early proximal carious lesions.

Management of white spots: resin infiltration technique and microabrasion / 대한치과보존학회지

This case report compared the effectiveness of resin infiltration technique (Icon, DMG) with microabrasion (Opalustre, Ultradent Products, Inc.) in management of white spot lesions. It demonstrates that although neither microabrasion nor resin infiltration technique can remove white spot lesions completely, resin infiltration technique seems to be more effective than microabrasion. Therefore resin infiltration technique can be chosen preferentially for management of white spot lesions and caution should be taken for case selection.