Visual Assessment of Extent of White Spot Lesions in Subjects treated with Fixed Orthodontic Appliances: A Retrospective Study
Purva Verma, Ravindra K Jain
Fixed orthodontic appliance, Orthodontic treatment, White spot lesion
Citation Information :
Verma P, Jain RK. Visual Assessment of Extent of White Spot Lesions in Subjects treated with Fixed Orthodontic Appliances: A Retrospective Study. World J Dent 2022; 13 (3):245-249.
Aim: White spot lesions (WSLs) are invariably found in patients undergoing orthodontic treatment. The aim of this study was to assess the extent of WSLs in subjects treated with fixed orthodontic appliances for variable time duration.
Materials and methods: In this retrospective evaluation, photographic records of 205 subjects were assessed for extent of WSL using a surface area analysis app. The subjects were splitted into three groups based on duration of orthodontic treatment: Group A (n = 62): Patients who completed their treatment in 10–12 months; Group B (n = 68): Patients in whom orthodontic treatment was completed in 13–24 months, and Group C (n = 75): Patient with total treatment duration of 25–36 months. The measurements were made at two time points: T0, that is, pretreatment and T1, that is, postdebonding. Total dental area of maxillary teeth was calculated and areas involved with WSLs were calculated for each tooth. Extent of area involved was calculated using the formula: Area of WSL (T1)–Area of WSL (T0). Intragroup comparison was done using paired t-test, intergroup comparison was performed using one-way ANOVA.
Results: Intragroup comparison revealed significant difference in extent of WSL at T0 and T1 in all three groups (p-value < 0.05). Intergroup comparison at T1 revealed a significant difference amongst three groups for the extent of WSLs.
Conclusion: The extent of WSLs depends on the duration of orthodontic treatment. Increased duration of orthodontic treatment was associated with increased extent of WSLs as assessed on digital photographs using an application.
Clinical significance: Longer orthodontic treatment duration is associated with increase in progression of WSLs. Patients undergoing orthodontic treatment, especially for longer duration, must undergo regular oral prophylaxis and should be instructed and motivated to maintain good oral hygiene. Fluoridated mouthwash and remineralizing dentifrices must be incorporated in the daily oral hygiene regime of such patients.
Hasan SA. White spot lesions. Int J Clin Case Rep 2015. DOI: 10.5376/ijccr.2016.06.0001
Orthodontic-related white spot lesions. Dental Abstracts 2014;59:53–56. DOI: 10.1016/j.denabs.2013.09.025
Fatehulla KS, Hamasaeed OS, Abdulateef DS. The prevalence of enamel white spot lesions before and after fixed orthodontic treatment among patients attending Shorish Dental Center. Sulaimani Dent J 2015;2(1):57–60. DOI: 10.17656/sdj.10039
Benson P. Evaluation of white spot lesions on teeth with orthodontic brackets. Semin Orthod 2008;14(3):200–208. DOI: 10.1053/j.sodo.2008.03.005
Gorelick L, Geiger AM, John Gwinnett A. Incidence of white spot formation after bonding and banding. Am J Orthod 1982;81(2):93–98. DOI: 10.1016/0002-9416(82)90032-x
Bishara SE, Ostby AW. White spot lesions: formation, prevention, and treatment. Semin Orthod 2008;14:174–182. DOI: 10.1053/j.sodo.2008.03.002
Heymann GC, Grauer D. A contemporary review of white spot lesions in orthodontics. J Esthet Restor Dent 2013;25(2):85–95. DOI: 10.1111/jerd.12013
Julien KC, Buschang PH, Campbell PM. Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod 2013;83(4):641–647. DOI: 10.2319/071712-584.1
Øgaard B, Rølla G, Arends J. Orthodontic appliances and enamel demineralization. Am J Orthod Dentofacial Orthop 1988;94(1):68–73. DOI: 10.1016/0889-5406(88)90453-2
Baldyga P. In vivo investigation of enamel demineralization adjacent to orthodontic appliances three months after placement using DIAGNOdent. Am J Orthod Dentofacial Orthop 2005;128(2):264. DOI: 10.1016/j.ajodo.2005.05.009
Baffi M, de Almeida Rodrigues J, Lussi A. Traditional and novel caries detection methods. Contemporary Approach to Dental Caries 2012;105-128. DOI: 10.5772/38209
Hargreaves JA, Thompson GW. Ultraviolet light and dental caries in children. Caries Res 1989;23:389–392. DOI:10.1159/000261214
Al-Khateeb A, Forsberg CM, de Josselin de Jong E, et al. A longitudinal laser fluorescence study of white spot lesions in orthodontic patients. Am J Orthod Dentofacial Orthop 1998;113(6):595–602. DOI: 10.1016/s0889-5406(98)70218-5
Tranaeus S, Al-Khateeb S, Björkman S, et al. Application of quantitative light-induced fluorescence to monitor incipient lesions in caries-active children. A comparative study of remineralisation by fluoride varnish and professional cleaning. Eur J Oral Sci 2001;109(2):71–75. DOI: 10.1034/j.1600-0722.2001.00997.x
Almosa NA, Sibai BS, Rejjal O, et al. Enamel demineralization around metal and ceramic brackets: an in vitro study. Clin Cosmet Investig Dent 2019;11:37–43. DOI: 10.2147/CCIDE.S190893
Raju AS, Hegde NA, Reddy VP, et al. An in vivo study on bacterial colonization with metal, ceramic and self-ligating brackets: a scanning electron microscopy study. J Indian Orthod Soc 2013;47:88–96. DOI: 10.5005/jp–journals–10021–1135
Feu D, Catharino F, Duplat CB, et al. Esthetic perception and economic value of orthodontic appliances by lay Brazilian adults. Dental Press J Orthod 2012;17(5):102–114. DOI:10.1590/s2176–94512012000500015
Chapman JA, Roberts WE, Eckert GJ, Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic applianceset al. Am J Orthod Dentofacial Orthop 2010;138(2):188–194. DOI: 10.1016/j.ajodo.2008.10.019
Lucchese A, Gherlone E. Prevalence of white-spot lesions before and during orthodontic treatment with fixed appliances. Eur J Orthod 2013;35(5):664–668. DOI: 10.1093/ejo/cjs070
Boersma JG, van der Veen MH, Lagerweij MD, et al. Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors. Caries Res 2005;39(1):41–47. DOI: 10.1159/000081655
Brown MD, Campbell PM, Schneiderman ED, et al. A practice-based evaluation of the prevalence and predisposing etiology of white spot lesionset al. Angle Orthod 2016;86(2):181–186. DOI: 10.2319/041515-249.1
Jiang H, Tai BJ, Du MQ. Patterns and risk factors for white spot lesions in orthodontic patients with fixed appliances. Chin J Dent Res 2015;18(3):177–183. https://www.ncbi.nlm.nih.gov/pubmed/26485510
Bartsch A, Witt E, Sahm G, et al. Correlates of objective patient compliance with removable appliance wearet al. Am J Orthod Dentofacial Orthop 1993;104(4):378–386. DOI: 10.1016/S0889- 5406(05)81337-X
Nadar S, Dinesh SPS. A questionnaire study about oral hygiene awareness among orthodontic patients. Int J Orthod Rehabil 2016; 7(3):97–100. DOI: 10.4103/2349–5243.192531
Kozak U, Sękowska A, Chałas R. The effect of regime oral-hygiene intervention on the incidence of new white spot lesions in teenagers treated with fixed orthodontic appliances. Int J Environ Res Public Health 2020;17(24):9460. DOI: 10.3390/ijerph17249460
Imani MM, Safaei M, Afnaniesfandabad A, et al. Efficacy of CPP-ACP and CPP-ACPF for prevention and remineralization of white spot lesions in orthodontic patients: a systematic review of randomized controlled clinical trials. Acta Inform Med 2019;27(3):199–204. DOI: 10.5455/aim.2019.27.199-204
Hu H, Feng C, Jiang Z, et al. Effectiveness of remineralising agents in prevention and treatment of orthodontically induced white spot lesions: a protocol for a systematic review incorporating network meta-analysis. Syst Rev 2019;8(1):339. DOI: 10.1186/s13643-019-1253-8
Linjawi AI. Sealants and white spot lesions in orthodontics: a review. J Contemp Dent Pract 2020;21(7):808–814. https://www.ncbi.nlm.nih.gov/pubmed/33020368
Salamara O, Papadimitriou A, Mortensen D, et al. Effect of fluoride varnish with functionalized tri-calcium phosphate on post-orthodontic white spot lesions: an investigator-blinded controlled trial et al. Quintessence Int 2020;51(10):854–862. DOI: 10.3290/j.qi.a44810
Verma P, Pandian SM. Bionic effects of nano hydroxyapatite dentifrice on demineralised surface of enamel post orthodontic debonding: in-vivo split mouth study. Prog Orthod 2021;22(1):39. DOI: 10.1186/s40510-021-00381-5
Mahmoudzadeh M, Alijani S, Soufi LR, et al. Effect of CO2 laser on the prevention of white spot lesions during fixed orthodontic treatment: a randomized clinical trialet al. Turk J Orthod 2019;32(3):165–171. DOI: 10.5152/TurkJOrthod.2019.18052