Management of post-orthodontic white spot lesions: an updated systematic review.

Background/objectives: The management of post-orthodontic white spot lesions is based on remineralization strategies or a minimal-invasive camouflage of the lesions. Aim: The aim of this systematic review was to identify and assess the quality of evidence for the various clinical technologies. Search methods: Four databases were searched for relevant literature published in English between 2011 and 31 October 2015 according to a pre-determined PICO. Only controlled clinical studies were considered. Abstract lists and the selected full-text papers were independently examined by two reviewers and any differences were solved in consensus. The Cochrane handbook and the AMSTAR tool were used for grading the risk of bias. The quality of evidence was rated according to GRADE. Results: Out of 280 identified publications, seven studies on remineralization, micro-abrasion and resin infiltration met the inclusion criteria. Two of them were assessed with low risk of bias. No pooling of results was possible due to study heterogeneity. The quality of evidence for all technologies was graded as very low. Limitations: Only papers published in English with more than 20 adolescents or young adults were considered. Furthermore, a follow-up period of at least 8 weeks was required. The publication bias could not be assessed due to the paucity of included trials. Conclusions/clinical implications: There is a lack of reliable scientific evidence to support re-mineralizing or camouflaging strategies to manage post-orthodontic white spot lesions. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

A review on prevention and treatment of post-orthodontic white spot lesions - evidence-based methods and emerging technologies.

OBJECTIVE: The aim of this paper was to update the evidence for primary and secondary prevention (treatment) of white spot lesions (WSL) adjacent to fixed orthodontic appliances. MATERIAL AND METHODS: A search for relevant human clinical trials published in English between 2004 and March 2011 retrieved 25 publications that fulfilled the inclusion criteria. The papers were assessed for prevented fraction and/or absolute risk reduction when possible. RESULTS AND CONCLUSIONS: The findings consolidated the use of topical fluorides in addition to fluoride toothpaste as the best evidence-based way to avoid WSL. The mean prevented fraction based on 6 trials was 42.5% with a range from -4% to 73%. The recent papers provided the strongest support for regular professional applications of fluoride varnish around the bracket base during the course of orthodontic treatment. For the treatment of post-orthodontic WSL, home-care applications of a remineralizing cream, based on casein phosphopeptide-stabilized amorphous calcium phosphate, as adjunct to fluoride toothpaste could be beneficial but the findings were equivocal. For emerging technologies such as sugar alcohols and probiotics, still only studies with surrogate endpoints are available. Thus, further well-designed studies with standardized regimes and endpoints are needed before guidelines on the non-fluoride technologies can be recommended.

Effect of a hydrophobic tooth coating on gingival health, mutans streptococci, and enamel demineralization in adolescents with fixed orthodontic appliances.

The effect of an anti-adhesive enamel coating on plaque accumulation, gingival health, and enamel demineralization was evaluated in 39 adolescents undergoing treatment with fixed orthodontic appliances using a prospective split-mouth design. Immediately after bracket insertion, the polymer was randomly applied after enamel etching to the buccal surfaces of the teeth in the left or right upper quadrant, leaving the opposite quadrant as an untreated control (218 test and 216 control teeth). Reapplications were carried out every 3rd month during the course or the study. The following data were collected at baseline and at designated follow-ups: visible plaque index, total viable counts and proportion of mutans streptococci in plaque samples, gingival bleeding index, and amount of gingival crevicular fluid. The incidence of enamel demineralization adjacent to the appliances was scored clinically at the termination of the orthodontic treatment. The observation time ranged from 6-24 months, during which the participants used fluoride rinses and toothpaste daily. A slightly impaired gingival health and increased levels or mutans streptococci compared with baseline was disclosed during the treatment. Five subjects showed enamel demineralization on a total of 30 teeth at the time of de-bonding. The results indicated no statistically significant differences between the enamel-coated and untreated teeth with regard to the studied variables at any follow-up. In conclusion, the present findings did not support a clinically beneficial effect of the polymeric tooth coating in a low-caries group of adolescents treated with fixed orthodontic appliances.