Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment.
BACKGROUND
White spots (WS) related to orthodontic treatment are severe cariologic and cosmetic complications, but they are shown to be partially reduced by remineralization or abrasion in short-term follow-ups. In this prospective study, we quantitatively analyzed changes in WS in general and in treatment-related white spot lesions (WSL) during orthodontic treatment and at a 12-year follow-up after treatment. In addition, we quantitatively compared the effects of an acrylic bonding material vs a glass ionomer cement (GIC) on WSL.


METHODS
Sum areas of WS and WSL were calculated on scans of standardized photos of the vestibular surfaces of 4 teeth in consecutive orthodontic patients (median treatment time, 1.7 years) bonded with the 2 materials in a split-mouth design. Comparisons were made in 59 patients before treatment (BF), at debonding (T0), at 1 year (T1), and at 2 years (T2), and in 30 patients at a 12-year follow-up (T3) with the Friedman test followed by pairwise comparisons with the Wilcoxon matched-pairs signed rank test. Differences of the effects of acrylic vs GIC on the sum areas of WSL were tested for each observation period with the Mann-Whitney U test.


RESULTS
Increases in the sum areas of WS and WSL from BF to T0 (P <0.001) were followed by significant decreases at T1 (P <0.001) and T2 (P <0.01 for WS; P <0.001 for WSL). Significant changes were also found in the sum areas for WS at T3 compared with T2 (P <0.01), but not for WSL (P = 0.328). The sum areas of WS and WSL at T3 did not return to BF levels (P <0.001). Sum areas of WSL were higher for surfaces bonded with acrylic compared with GIC for each observation period from BF to T2 (P >0.001), and from T2 to T3 (P >0.05).


CONCLUSIONS
Although significantly reduced during the 12-year follow-up and significantly lower with the GIC than the acrylic material at bonding, WSL are a cariologic and cosmetic problem for many orthodontic patients.
Shungin
Dmitry
D
Department of Odontology/Orthodontics, Umeå University, Umeå, Sweden. dmsh0001@student.umu.se
Olsson
Alexandra Ioannidis
AI
Persson
Maurits
M
D000180:Acrylic Resins / Q000009:adverse effects / Q000737:chemistry; D000293:Adolescent; D002327:Cariostatic Agents / Q000008:administration & dosage / Q000737:chemistry; D001840:Dental Bonding / Q000009:adverse effects* / Q000379:methods; D003731:Dental Caries / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D017005:Dental Debonding; D003743:Dental Enamel / Q000473:pathology; D005260:Female; D005460:Fluorides, Topical / Q000008:administration & dosage / Q000737:chemistry; D005500:Follow-Up Studies; D005899:Glass Ionomer Cements / Q000009:adverse effects / Q000737:chemistry; D006801:Humans; D008297:Male; D009967:Orthodontic Appliances / Q000009:adverse effects*; D009971:Orthodontics, Corrective / Q000009:adverse effects / Q000295:instrumentation; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D017001:Tooth Demineralization / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control; D016896:Treatment Outcome; D055815:Young Adult
D000180:Acrylic Resins; D002327:Cariostatic Agents; D005460:Fluorides, Topical; D005899:Glass Ionomer Cements