The prevalence of approximal caries in patients after fixed orthodontic treatment and in untreated subjects: a retrospective, cross-sectional study on bitewing radiographs

Caries and white spot lesion trajectories of orthodontic patients across an observation period of 20 years

OBJECTIVES

Fixed orthodontic appliances may increase the risk for caries and white spot lesions. The aim of this retrospective study was to determine the long-term associations between both in orthodontic patients.

MATERIALS AND METHODS

103 patients aged 36.6 ± 6.5 years whose fixed appliance orthodontic treatment had finished at least 15 years ago were included. Current clinical data and photographs (T3), panoramic x-ray and photographs from before treatment (T0), after debonding (T1) and at 2-year follow-up (T2) were available. Parameters of interest were dentine caries, "Missing/Filled Teeth" (MFT), "White Spot Lesion" (WSL) index and "Periodontal Screening and Recording" index (PSR; T3 only).

RESULTS

At T0, 30.4% had no caries experience decreasing to 25.6%, 22.4% and 6.8% at T1, T2 and T3 resp. The median MFT (95% CI) at T0, T1, T2 and T3 was 2 (1;3), 3 (2;4), 3 (2;4) and 7 (6;9) resp. increasing significantly at each time point (p < 0.001 each); 30.1% had WSL at debonding. Patients with caries experience at T0 had a 2.4-fold increased risk of WSL at debonding. Dentine caries, caries experience and WSL at T1 were significantly associated with incident caries at T2, but not at T3. PSR at T3 had a significant association with previous caries incidence and WSL.

CONCLUSIONS

Caries experience prior to orthodontic treatment may constitute a risk indicator for WSL, and caries experience and WSL at its end for caries incidence in the near term.

CLINICAL RELEVANCE

Present caries and WSL may help identifying orthodontic patients with special need for prevention and counselling.

Effect of a mouth rinse and a high-fluoride toothpaste on caries incidence in orthodontic patients: A randomized controlled trial

INTRODUCTION

The objective was to evaluate the effect of a fluoride mouth rinse and a high-fluoride toothpaste on caries incidence in patients undergoing orthodontic treatment with fixed appliances.

METHODS

In this 3-armed, parallel-group, randomized controlled trial, patients referred to the Specialist Clinic of Orthodontics, Mölndal, Sweden, were randomly allocated to 1 of the 3 groups. (1) Fluoride mouth rinse (FMR) group: 0.2 % sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; (2) High-fluoride tootpaste (HFT) group: 5000 ppm F toothpaste; and (3) Control (CTR) group: 1450 ppm F toothpaste. The generation of a randomization sequence was performed in blocks of 30. Inclusion criteria included patients scheduled for treatment with fixed appliances in the maxillary and mandibular arch aged 12-20 years. The primary outcome variable was the change in Decayed Initial Filled Surfaces (ΔDiFS) based on radiographs taken before and after the treatment. For statistical comparisons between groups, the Kruskal-Wallis test were used for continuous variables, whereas the Mann-Whitney U-test was used for pairwise group comparisons. Furthermore, the risk ratio (RR) and 95% confidence interval (CI) based on clinically relevant cutoffs (DiFS ≥2) were calculated to compare the increase of caries during orthodontic treatment between 2 groups. The Cochran-Mantel-Haenszel method was used to adjust RR for baseline values. Blinding was employed during the caries registration and the data analysis.

RESULTS

In total, 270 participants were randomized, with 15 patients dropping out, such that 255 patients were included in the statistical analyses. Recruitment was from October 2010 to December 2012. An increase in DiFS (≥1 DiFS) during treatment was observed in 48.3% of the FMR group, 42.0% of the HFT group, and 35.6% of the CTR group. There was no significant difference between the groups regarding increased DiFS (P = 0.17). The risk of increase in DiFS ≥2 during orthodontic treatment was 31.0% in the FMR group, 25.9% in the HFT group, and 18.4% in the CTR group. The RR for an increase of ≥2 DiFS during orthodontic treatment was 1.38 (95% CI, 0.81-2.34; P = 0.23) for FMR vs CTR, 1.21 (95% CI, 0.70-2.10; P = 0.51) for HFT vs CTR, and 0.93 (95% CI, 0.57-1.49; P = 0.76) for HFT vs FMR.

CONCLUSIONS

In patients who demonstrate a low prevalence of caries and are undergoing orthodontic treatment, daily use of high-fluoride toothpaste or fluoride mouth rinse in combination with regular toothpaste does not appear to significantly alter the caries incidence compared with the use of regular toothpaste.

TRIAL REGISTRATION

The trial was registered in the FoU i Sverige research database (http://www.fou.nu/is/sverige), with registration no. 236251.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

Local Research and Development Board for Gothenburg and South Bohuslän (grant no. 768531); and The Swedish Patent Revenue Fund (grant number EKF-780/19).

The Impact of Orthodontic Bands on the Marginal Periodontium of Maxillary First Molars: A Retrospective Cross-Sectional Radiographic Analysis

AIM

Available information on the effect of orthodontic treatment on crestal alveolar bone levels measured in radiographs is contradictory. The aim of this study was to compare the alveolar bone level and periodontal ligament space of banded upper first molars to untreated controls.

MATERIALS AND METHODS

This retrospective cross-sectional radiographic study investigated alveolar bone levels of upper first molars of an orthodontic test group and an untreated control group of comparable age (15-16.25 years), using existing bitewing radiographs.Eighty-six individuals were included in each group. Three parameters were measured mesially and distally on both sides of the patient as follows: I) Alveolar Bone Level (ABL): measured as the distance between the cemento-enamel junction and the alveolar crest, II) the Periodontal Ligament Space (PLS): measured as the most coronal distance between the alveolar crest and the tooth surface, and III) angle between the lines (alveolar crests mesial and distal) and (cemento-enamel junction mesial and distal).

RESULTS

The mean duration of the orthodontic treatment in the test group was 2.5 years. The periodontal ligament space was statistically significantly wider on mesial areas of right molars (mean 0.2 mm, p<0.01), but there was no statistically significant difference found in the three other areas (distal part of the right molar, mesial and distal parts of the left molar). There was a statistically significant mean alveolar bone loss in the right and left mesial areas, respectively accounting for 0.3 mm (p<0.001) and 0.2 mm (p<0.01). No statistically significant alveolar bone loss was measured on the distal surfaces of the upper molars. The angle was wider on both sides for the test group (right p<0.001 and left p<0.05).

CONCLUSIONS

A significant alveolar bone loss on the mesial tooth surface of upper first molars after orthodontic treatment was found with concurrent different levelling angles in the test group. On all other sites, no statistically significant changes were found. There was some minimal statistical significant alveolar bone loss after finishing treatment in patients who had orthodontic bands placed on their maxillary 1^st molars, but no clinical significance was found.