title: Occurrence and severity of enamel decalcification adjacent to bracket bases and sub-bracket lesions during orthodontic treatment with two different lingual appliances 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 Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference? Lingual orthodontic treatment duration: performance of two different completely customized multi-bracket appliances (Incognito and WIN) in groups with different treatment complexities Incidence of caries lesions among patients treated with comprehensive orthodontics. Colour improvement and stability of white spot lesions following infiltration, micro-abrasion, or fluoride treatments in vitro. Efficacy of a fluoride-releasing orthodontic primer in reducing demineralization around brackets: an in-vivo study. Durability of esthetic improvement following Icon resin infiltration of multibracket-induced white spot lesions compared with no therapy over 6 months: a single-center, split-mouth, randomized clinical trial. Incidence of white spot formation after bonding and banding.
abstract: Summary Background : Using lingual enamel surfaces for bracket placement not only has esthetic advantages , but may also be suitable in terms of reducing frequencies of enamel decalcifications . Objective : To test the null-hypothesis that there is no significant difference in enamel decalcification or cavitation incidence adjacent to and beneath bracket bases between two  lingual multi-bracket ( MB ) appliances  that are different in terms of design , material composition , and manufacturing technology ( group A : WIN , DW-LingualSystems ; group B : Incognito , 3M-Unitek ) , taking into account patient- and treatment-related variables on white spot lesion ( WSL ) formation . Methods : St and ardized , digital , top-view photographs of 630 consecutive subjects ( 16214 teeth ; n Incognito = 237/6076 teeth ; n WIN = 393/10138 teeth ; mean age : 17.47±7.8 ; m/f 43.2/56.8 % ) with completed lingual MB treatment of the upper and lower permanent teeth 1–7 were screened for decalcification or cavitation adjacent to and beneath the bracket bases before and after treatment , scored from 0 to 7 . Non-parametric ANOVA was used for main effects ‘ appliance type ’ , ‘ gender ’ , ‘ treatment complexity ’ , ‘ grouped age ’ ( ≤16/>16 years ) , and ‘ treatment duration ’ as covariable , at an α-level of 5 % . Results : About 2.57 % [ 5.94 % ] of all teeth in group A [ B ] developed decalcifications . Subject-related incidence was 9.59 % [ 16.17 % ] for upper incisors in group A [ B ] , and 12.98 % [ 25.74 % ] for all teeth 16–46 . There were significant effects by gender , age , and treatment duration . Conclusion : The null-hypothesis was rejected : sub-bracket lesions were significantly less frequent in group A , while frequencies of WSL adjacent to brackets were not significantly affected by appliance type . In view of the overall low incidences of lingual post-orthodontic white-spot lesions , the use of lingual appliances is advocated as a valid strategy for a reduction of enamel decalcifications during orthodontic treatment 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 R and omized , 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 ) . R and omization R and om assignment to test ( n = 23 ) or placebo group ( n = 23 ) using a sequentially numbered list ( r and om 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 Clinical Trials.gov ( Identifier : NCT01329731 ) . Protocol The protocol was n't published before trial commencement Orthodontic treatment with fixed appliances is considered a risk factor for the development of  white spot caries lesions ( WSL ) . Traditionally , brackets are bonded to the buccal surfaces . Lingual brackets are developing rapidly and have become more readily available . Buccal surfaces are considered to be more caries prone than lingual surfaces . Furthermore , lingual brackets are shaped to fit the morphology of the teeth and seal almost the entire surface . In the present study we tested the hypothesis that lingual brackets result in a lower caries incidence than buccal brackets . We tested this hypothesis using a split-mouth design where subjects were allocated r and omly to a group receiving either buccal or lingual brackets on the maxillary teeth and the alternative bracket type in the m and ible . The results indicate that buccal surfaces are more prone to WSL development , especially when WSL existed before treatment . The number of WSL that developed or progressed on buccal surfaces was 4.8 times higher than the number of WSL that developed or progressed on lingual surfaces . When measured using quantitative light-induced fluorescence ( QLF ) , the increase in integrated fluorescence loss was 10.6 times higher buccally than lingually . We conclude that lingual brackets make a difference when caries lesion incidence is concerned Introduction The occurrence of side-effects of fixed orthodontic therapy , such as white-spot lesions and root resorption , are known to be significantly more frequent with increasing duration of treatment . Multi-bracket treatment should be as short as possible , in order to minimize the risks of collateral damage to teeth . The aim of this non-r and omized clinical trial was to compare treatment duration with each of two types of customized lingual orthodontic appliances ( Incognito , 3 M-Unitek ; WIN , DW LingualSystems ) , taking into account treatment complexity . The null-hypothesis was that there would be no significant difference in active orthodontic treatment duration between them . Methods Of 402 potentially eligible participants , a population sample of n = 376 subjects ( nIncognito = 220 ; nWIN = 156 ; m/f 172/204 ; mean age ± SD 17.3 ± 7.7Y ) treated in one orthodontic center ( Bad Essen , Germany ) with completely customized lingual appliances in upper and lower permanent dental arches was recruited with the inclusion criterion of initiated and completed lingual multi-bracket treatment within the assessment period of April 1st 2010 – Nov 30 , 2013 , and the exclusion criterion of less than 24 bracketed teeth . We used four-factorial ANOVA to assess the impact of the following factors : initial degree of severity of malocclusion ( mild to moderate , S1 ; severe , S2 ) , appliance type ( Incognito ; WIN ) , sex , and age group ( < = 16 ; > 16 Y ) on the duration of lingual multi-bracket treatment . Results Overall , mean treatment duration was 21.7 ( SD 7.2 ) months , which was significantly shorter for WIN for both sub-groups of treatment complexity ( S1 : 17.96 mo ; S2 : 20.49 mo ) compared to Incognito ( S1 : 22.7 mo ; S2 : 29.79 mo ) . ANOVA revealed a significant influence of the main effects ‘ appliance type ’ , and ‘ severity ’ , independent of each other . Therefore , the null-hypothesis was rejected . Conclusion In terms of treatment duration , the WIN appliance performed significantly better than the Incognito appliance . Consequently , subjects treated with the WIN appliance are expected to be exposed to lower risks of the typical side-effects associated with longer multi-bracket treatment duration s , such as root resorption and enamel decalcification INTRODUCTION Dental caries , specifically decalcified white-spot lesions ( WSL ) , is a well-known side-effect of orthodontic treatment . The incidence of labial incipient caries lesions and its relationship with various patient and treatment variables was investigated in patients treated with comprehensive orthodontics .  METHODS R and omly selected orthodontic patient records ( n = 350 ) were examined to determine incipient caries lesion development . Labial surfaces on pretreatment and posttreatment photographs were scored with a st and ardized scoring system . Independent variables were collected by chart abstract ion . RESULTS The incidence of patients who developed at least 1 new WSL during treatment was 72.9 % , and this incidence was 2.3 % for cavitated lesions . Treatment duration was significantly associated with new WSL development ( P = 0.03 ) . Development of WSL and cavitated lesions increased ( both , P < 0.00 ) despite increased attention to oral hygiene during treatment . Sex , age , extraction therapy , and various fluoridation sources were not associated with WSL development , but initial oral-hygiene score was moderately associated ( P < 0.06 ) . CONCLUSIONS The incidence of WSL in patients treated with comprehensive orthodontics  was significantly high , and the preventive therapy provided appeared to be ineffective . This widespread problem is alarming and warrants significant attention from both patients and providers that should result in greatly increased emphasis on effective caries prevention SUMMARY BACKGROUND / OBJECTIVES White spot lesions ( WSLs ) are unwelcome side effects of fixed appliances that compromise the treatment outcome . Recently , infiltration of WSLs has been introduced as a viable treatment alternative . The objective was to evaluate the colour improvement of WSLs and their stability against discolouration following infiltration , fluoride , or micro-abrasion treatments in vitro . MATERIAL S/ METHODS Artificial WSLs were created in bovine enamel ( N = 96 ) using acidic buffer solution ( pH 5 , 10 days ) and were r and omly allocated to four groups . Specimens were treated with infiltration ( Icon , DMG ) , fluoride ( Elmex Caries Protection , GABA ) , and micro-abrasion ( Opalustre , Ultradent ) or remained untreated ( control ) . Groups were discoloured for 24 hours in tea or tea + citric acid . Colour components and visible colour change ( L * , a * , b * , ΔE ) were measured spectrophotometrically on following time points : baseline , after WSL formation , after treatment , and during discolouration ( 8 , 16 , and 24 hours ) . Data were analysed using Kruskal-Wallis and Mann-Whitney tests . RESULTS WSL formation increased ( L * ) in all groups . Only infiltration reduced this effect to baseline . Highest ΔE improvement was obtained by infiltration and micro-abrasion followed by fluoride . This improvement was stable only for infiltration during discolouration . L * , a * , and b * changed significantly during discolouration in all groups except infiltration . Within the same treatment group , discolouration solutions did not differ significantly . LIMITATIONS In vitro testing can not replicate the actual mode of colour improvement or stability but can be used for ranking material s and techniques . CONCLUSIONS / IMPLICATION S Infiltration and micro-abrasion treatments were capable of diminishing the whitish appearance of WSLs . Only infiltrated WSLs were stable following discolouration challenge INTRODUCTION A new , highly filled primer is currently marketed as a fluoride delivery system effective in reducing white spot lesions in orthodontic patients . However , no studies in the literature support this cl aim . The purpose of this in-vivo study was to investigate the retention and the efficacy of this primer in reducing the formation of white spot lesions . METHODS In each patient for whom premolar extraction s were planned ( n = 22 ) , 1 premolar was r and omly chosen as the experimental tooth for the application of the fluoride delivery system ( Opal Seal ; Ultradent Products , South Jordan , Utah ) , and the contralateral tooth was assigned as the control to receive the st and ard treatment ( Transbond XT ; 3 M Unitek , Monrovia , Calif ) . After the bonding procedures , separators were placed around the premolar brackets to encourage plaque retention over 8 weeks . After the extraction s , the tooth surfaces were evaluated visually and with microhardness techniques for demineralization . Primer retention was also investigated . RESULTS There were no statistically significant differences in the numbers of white spot lesions between the 2 groups . The primer retention was calculated as 50 % . CONCLUSIONS The results indicated no significant difference between the efficacies of the fluoride-releasing primer and the control primer in reducing demineralization over the duration of the study INTRODUCTION White spot lesions that form during orthodontic treatment are a problem for patients and clinicians . Lesion infiltration with low-viscosity light-cured resin has been proposed as a treatment to inhibit further demineralization . The purpose of this study was to assess the durability of assimilation of white spot lesions and sound adjacent enamel achieved over 6 months with resin infiltration . METHODS Twenty-one consecutive subjects with 231 noncavitated , unrestored white spot lesions after multibracket treatment were recruited at the Department of Orthodontics , University of Göttingen ( Germany ) , for lesion infiltration . A simple r and omized , split-mouth , controlled design was used to allocate subjects to the treatment and control groups . In the treatment group , white spot lesion infiltration of the anterior teeth was performed with low-viscosity light-cured resin after enamel conditioning with a 15 % HCl gel .  Color and lightness of the white spot lesions and the sound adjacent enamel were assessed with a spectrophotometer before infiltration and after 1 day , 1 week , 4 weeks , 3 months , and 6 months , using the system of the Commission Internationale de l'Eclairage . Multifactorial analysis of variance with repeated measures and pair-wise comparisons were used to analyze the effects of infiltration and time elapsed on the color differences at an α level of 5 % and a power of 80 % . RESULTS Analysis of 20 subjects and 39 quadrants in each group ( 108 teeth in the control group ; 111 teeth in the treatment group ) showed that both parameters of treatment and time duration had globally a highly significant influence on the color difference values . Assimilation of white spot lesion color to the surrounding enamel after infiltration was stable with no significant changes over 6 months ; the mean color difference of white spot lesions vs sound adjacent enamel ( ΔE baseline vs 6 months ) was 2.55 ( 95 % confidence interval [ CI ] , 1.431 - 3.678 ) . The untreated control teeth showed no significant changes over 6 months compared with the baseline : mean ( ΔE ) , 0.29 ( 95 % CI , -0.335 - 0.928 ) . No important adverse events or side effects were observed . CONCLUSIONS Resin infiltration  improves the esthetic appearance of demineralized teeth . The results showed sufficient durability over 6 months White spot or areas of decalcification are carious lesions of varying extent . The incidence and severity of white spots after a full term of orthodontic treatment were studied among patients in the separate private practice s of two of the authors . To establish a base line of comparison , the presence of white spots in a r and om sample of untreated persons was observed . The incidence of white spots among patients treated by a multibonded technique  was recorded at the time of debonding . In addition , white spots were sought in the before- and after-treatment Kodachrome slides of persons whose maxillary incisors had been h and ed . It was found that individual teeth , b and ed or bonded , exhibited significantly more white spot formation than was found in the control group . For the teeth studied , there was no difference in white spot formation in those that were b and ed or bonded . The labiogingival area of the maxillary lateral incisors had the highest incidence of white spots . When studied by segments , the highest incidence occurred among the maxillary incisors ; the lowest was in the maxillary posterior segment . No white spots were found on the lingual surfaces of m and ibular canines and incisors after prolonged use of a canine-to-canine bonded retainer . These findings suggest a relationship between resistance to white spot formation and the rate of salivary flow . Despite the lack of any preventive fluoride program among the study groups , 50 % of the patients demonstrated resistance to white spot formation . The obvious degree of latrogenic damage during orthodontic treatment suggests the need for preventive programs using fluoride . Further clinical research is needed
target: Conclusion Costs for repeated treatment of post-orthodontic enamel damages produced by conventional vestibular fixed appliances may easily exceed the initially higher costs associated with lingual orthodontic treatment .
  Judged economically in the long term , lingual MB Tx may be considered as a more cost-effective solution for a correction of malocclusion
background: Background Post-orthodontic white-spot lesions ( WSL ) in esthetically relevant incisor and canine areas impair dentofacial esthetics , and preventive dentistry treatment is definitely required in case of enamel cavitations .
  The incidence of lingual post-orthodontic WSL and cavitation following lingual MB treatment has been reported to be distinctively decreased compared to labial MB treatment .
  Moreover , lingual WSL do not impair dentofacial esthetics .
  It was the objective of this study to calculate consequential costs of preventive dental care necessary to recover labial or lingual post-orthodontic cavitations as well as esthetically relevant WSL following either labial or lingual MB interventions .