Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part I: photographic data evaluation.

Background: White spot lesions (WSLs) are a frequent side-effect of multibracket appliance treatment. The effect of local fluoridation on post-orthodontic WSL is however inconclusive. Objective: Assessment of WSL changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment. Trial design: Randomized, single-centre, double-blind, parallel-group, placebo-controlled study. Participants: Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding. Interventions: Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24). Outcomes: Photographic WSL assessment (dimension and luminance) of the upper front teeth (T0-T5). Randomization: Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each). Recruitment: The clinical study duration lasted from March 2011 to September 2013. Blinding: Unblinding was performed after complete data evaluation. Numbers analysed: Intent-to-treat analysis set comprising 39 participants (test: n = 21, placebo: n = 18). Outcome: Dimensional WSL quantification showed limited reliability. Luminance improvement (%) of WSL, however, was seen after 6 months (test/placebo: tooth 12, 24.8/18.0; tooth 11, 38.4/35.4; tooth 21, 39.6/38.3; and tooth 22, 15.2/25.0). No statistically significant group difference existed. Data suggest that WSLs are difficult to measure with respect to reliability and repeatability and methods for monitoring WSLs in clinical trials require improvement/validation. Harms: Similar adverse events occurred in both groups; none was classified as possibly related to the study product. Limitations: The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation. Conclusion: Based on the results of this study, no difference could be detected with respect to the development of WSL under post-orthodontic high-dose fluoride treatment. Registration: The study was registered with ClinicalTrials.gov (Identifier: NCT01329731). Protocol: The protocol wasn't published before trial commencement.

Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part II: clinical data evaluation.

Background: White spot lesions (WSL) frequently occur as side-effect of multibracket appliance treatment. The clinical effects of local fluoridation on post-orthodontic WSL and oral health development are however inconclusive. Objective: In vivo monitoring of clinical WSL and oral health changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment. Trial design: Randomized, single-centre, double-blind, parallel-group, placebo-controlled study. Participants: Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding. Interventions: Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24). Outcomes: Clinical evaluation of WSL index, lesion activity, plaque index, gingival bleeding index, and decayed, missing, and filled teeth index as well as saliva buffer capacity and stimulated salivary flow rate (T0-T5). Randomization: Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each). Recruitment: The clinical study duration lasted from March 2011 to September 2013. Blinding: Unblinding was performed after complete data evaluation. Numbers analysed: Intention-to-treat analysis set comprised 39 participants (test: n = 21, placebo: n = 18). Outcome: No clinical parameter except stimulated salivary flow rate (fluoride group: 1.1ml/min, placebo group: 0.74ml/min; P = 0.022) showed a statistically significant group difference after 24 weeks. Harms: Several adverse events occurred similarly frequent in both groups; none was classified as possibly related to the study product. Limitations: The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation. Conclusion: Based on the results of this study, no clinical effect of post-orthodontic high-dose fluoride treatment on WSL and oral health changes could be detected. Registration: The study was registered with ClinicalTrials.gov (Identifier: NCT01329731). Protocol: The protocol wasn't published before trial commencement.

Occlusal stability after Herbst treatment of patients with retrognathic and prognathic facial types : A pilot study.

OBJECTIVES: The purpose of this study was to assess and compare occlusal changes induced by Herbst treatment and the stability of these changes in patients with retrognathic and prognathic facial types. PATIENTS AND METHODS: The sample comprised 11 retrognathic (SNA ≤76°, SNB ≤72°, ML/NSL ≥36°) and 10 prognathic (SNA ≥83°, SNB ≥80°, ML/NSL ≤32°) patients with Class II molar relationships of ≥0.5 cusp widths bilaterally or ≥1.0 cusp width unilaterally. Both groups involved similar distributions of skeletal maturity before treatment. Study parameters were assessed on casts reflecting the situations before treatment (T0), after Herbst treatment (T1), after multibracket treatment immediately following Herbst treatment (T2), and after a mean of 31.1 months of retention (T3). RESULTS: Sagittal molar relationships improved by 0.8 cusp widths in the retrognathic and by 0.7 cusp widths in the prognathic group during active treatment (T0-T2). Insignificant changes of ≤0,2 cusp widths were seen in both groups during retention (T2-T3). Overjet decreased by 8.6 mm in the retrognathic and by 5.5 mm in the prognathic group during T0-T2, and both groups showed clinically irrelevant amounts of relapse by 0.7 mm during T2-T3. Overbite improved by 1.2 mm in the retrognathic and by 2.5 mm in the prognathic group during T0-T2, reaching mean values of 1.0 mm or 1.4 mm by T2, which was followed by 0.2 mm or 1.1 mm of relapse during T2-T3. CONCLUSION: Treatment with a Herbst appliance seems to offer stable correction of the sagittal occlusal relationships in Class II patients with retrognathic or prognathic facial types, with the vertical changes being more pronounced in the prognathic cases.