ABSTRACT
White spot lesions are early demineralisations and therefore constitute an impairment to healthy enamel. The emergence of white spot lesions is one of the main risks of damage during orthodontic treatment with fixed appliances. White spot lesions may partially recover, but will remain visible in most cases. The treatment for post-orthodontic white spot lesions is a step-by-step strategy. Treatment is aimed at remineralising the affected enamel, without hyper-mineralising the surface layer. Subsequently, treatment of post-orthodontic white spot lesions is aimed at reducing their visibility. Such treatment options focus on minimally invasive treatment techniques, before choosing an invasive treatment. More randomised clinical trials are needed to substantiate the evidence-based treatment of post-orthodontic white spot lesions. Clinical practice guidelines are being developed for the care and treatment of orthodontic white spot lesions.
Subject(s)
Dental Caries , Dental Caries/etiology , Dental Caries/therapy , Dental Enamel , HumansABSTRACT
The effects of casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) paste vs. control paste on the remineralization of white spot caries lesions and on plaque composition were tested in a double-blind prospective randomized clinical trial. Fifty-four orthodontic patients, with multiple white spot lesions observed upon the removal of fixed appliances, were followed up for 3 months. Subjects were included and randomly assigned to either CPP-ACFP paste or control paste, for use supplementary to their normal oral hygiene. Caries regression was assessed on quantitative light-induced fluorescence (QLF) images captured directly after debonding and 6 and 12 wk thereafter. The total counts and proportions of aciduric bacteria, Streptococcus mutans, and Lactobacillus spp. were measured in plaque samples obtained just before debonding, and 6 and 12 wk afterwards. A significant decrease in fluorescence loss was found with respect to baseline for both groups and no difference was found between groups. The size of the lesion area did not change significantly over time or between the groups. The percentages of aciduric bacteria and of S. mutans decreased from 47.4 to 38.1% and from 9.6 to 6.6%, respectively. No differences were found between groups. We observed no clinical advantage for use of the CPP-ACFP paste supplementary to normal oral hygiene over the time span of 12 wk.
