title: White-spot lesions during multibracket appliance treatment: A challenge for clinical excellence.
abstract: BACKGROUND
  White-spot lesions (WSL) are one of the most undesired side effects of multibracket appliance treatment (MB). The aim of this study was to investigate the incidence and further course of WSL during and after MB.
  
  
  METHODS
  Four hundred patients (168 boys, 232 girls) meeting the inclusion criteria--all maxillary front teeth fully erupted and visible before treatment, no fillings or structural abnormalities, MB duration of at least 1 year, and retention period of at least 1 year--were selected. The patients' average age was 13.7 years (SD, 3.5), and the average MB time was 1.9 years (SD, 3.6). All patients received standardized general prophylactic instructions. A modification of the WSL index was used to evaluate the 4 maxillary front teeth on introral photos before and after treatment, and after retention.
  
  
  RESULTS
  Before treatment, 32.3% of the patients had WSL. After MB, 73.5% of the patients presented WSL. The incidence of WSL during MB was 60.9% of the patients. After treatment, most patients (63.3%) had mild lesions, but the remaining were affected severely with (26.9%) and without (9.9%) cavitations. Only 26% of the patients were free of WSL all the time. After the retention phase, most (57.1%) of the WSL patients after treatment showed improvement, 26% remained unchanged, and 16.7% deteriorated. Male WSL patients tended to show more severe WSL than did the girls. There was a tendency for increased WSL development during the adolescent years compared with the preadolescent and postadolescent age groups.
  
  
  CONCLUSIONS
  With only standardized general prophylactic measures, new WSL developing on the maxillary front teeth during MB remain a frequent undesired side effect, affecting 60.9% of patients and counteracting our efforts for clinical excellence.
authors: Department of Orthodontics, University of Giessen, Giessen, Germany.
authors: Mahmoud
authors: M
authors: Enaia
authors: Niko
authors: N
authors: Bock
authors: Sabine
authors: S
authors: Ruf
mesh_terms: D000293:Adolescent; D002327:Cariostatic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002648:Child; D003731:Dental Caries / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D005459:Fluorides / Q000627:therapeutic use; D006267:Health Education, Dental; D006801:Humans; D007180:Incisor / Q000473:pathology; D008297:Male; D008437:Maxilla; D016017:Odds Ratio; D009910:Oral Hygiene / Q000193:education* / Q000706:statistics & numerical data; D016910:Orthodontic Brackets / Q000009:adverse effects*; D023861:Photography, Dental; D012189:Retrospective Studies; D012737:Sex Factors
chemical_list: D002327:Cariostatic Agents; D005459:Fluorides