Remineralization of post-orthodontic white spot lesions with a fluoride varnish and a self-assembling P 11 - 4 peptides: a prospective in-vivo-study

OBJECTIVE

The objective was to evaluate the remineralization effects of fluoride varnish (Clinpro White varnish), self-assembling peptide (Curodont™ Repair) and their combined use on WSL after orthodontic treatment.

MATERIALS AND METHODS

Thirty-two subjects, aged of 10-18 (mean age 13.91 ± 2.92) with 107 post-orthodontic WSL were included in the study. Subjects were divided into four groups as control, tricalcium phosphate (TCP) containing fluoride varnish (Clinpro White varnish) group, self-assembling P11-4 peptides (Curodont™ Repair) group and combined application of the two products. At the beginning, each subjects' caries risk profile was assessed by evaluating diet cariogenicity, plaque index, gingival bleeding index and stimulated salivary flow rate. Before the application of the remineralization agents, WSL baseline demineralization values were determined with QLF Inspektor™ Pro, laser fluorescence using DIAGNOdent and color values were measured by Vita EasyShade. Remineralization data were obtained by measuring ΔF, ΔQ, and lesion area with QLF. The aesthetic improvement after the remineralization process was evaluated with a spectrophotometer at six weeks, three and six months.

RESULTS

No statistically significant differences were found between the groups in terms of criteria determining patients' caries risk profiles, DIAGNOdent data, and plaque index scores (p > 0.05). Intra-group evaluation following remineralization revealed statistically significant increases in ΔF and ΔQ with a decrease in lesion area for the fluoride varnish group at six months, for the peptide group at three months, and for the combined application group at three and six months (p < 0.05). In inter-group comparisons, ΔF and ΔQ values were found to be statistically significant only in the fluoride group at six months compared to the other groups (p < 0.05). While the L* value decreased significantly in all groups at six months, a statistically significant difference in ΔE* values was observed only in the control group between three and six months.

CONCLUSION

Fluoride varnish with TCP showed highest remineralization at 6 months, and the remineralization was positively affected in the short term (three months) after the use of self-assembling P11-4 peptides and their combined application.

CLINICAL RELEVANCE

Remineralization obtained after single application of agents tested in six months in-vivo showed parallel results. In an attempt to trigger subsurface remineralization, the combined use of fluoride with self-assembling peptides as biomimetic remineralization agent needs further evaluation.

Potential Clinical Applications of Ozone Therapy in Dental Specialties-A Literature Review, Supported by Own Observations

Apart from conventional treatment, dentists are increasingly relying on physical therapy modalities in their clinical practice. The aim of this literature review is to analyze the clinical relevance and potential uses of ozone in modern dentistry. The research question is geared towards detailing the multiple potential applications of ozone therapy in a range of dental specialties. Based on the available literature, accessed via the PubMed, Google Scholar, Scopus, and EBSCO databases, a detailed search of the electronic literature was performed for 2001-2022. Eligible studies were chosen according to inclusion and exclusion criteria, using keywords: ozone, ozone therapy, therapeutic applications, oxidants, dental disinfectants, oral medicine, physical therapy in dentistry. Out of 834 manuscripts, 273 studies were curated. A total of 70 publications were used in the final consideration. After assessing their quality, they were analyzed to determine the relevance and potential use of ozone in the various aspects of modern dentistry. Ozone therapy is used mainly as an adjunct to the primary clinical or pharmacological treatment. In some cases of oral mucosal disease, it has proven effective as a primary therapy. During the literature analysis, it was noted that ozone therapy in dentistry is a subject of ongoing research, and the results are not always consistent. The multitude of studies in the literature on the applications of ozone in dentistry reflects the search for its undiscovered physical therapeutic potential.

Ozone therapy in management and prevention of dental caries- A Review

Dental caries is the irreversible microbial disease of teeth causing demineralization of inorganic and destruction of organic. It is of serious concern as it can lead to pain due to various pulpal and periapical pathologies. It is a tedious job to prevent this dental caries which is very common dental problem with each and everyone. With new concepts emerging in prevention and management of caries, Ozone therapy is tool to prevent and manage dental caries. The use of ozone (O3) gas as a therapy is skeptical due to unstable structure. The main beneficial effect of ozone is its antibacterial effect against various bacteria. These antibacterial effects are even attributed to the prevention and management of caries. This therapy is of controversy as some prove this to be less or no effective or some prove to be more effective. This article reviews various benefits of ozone therapy in prevention and management of caries and also discussion on controversies to it.

Fluoride varnish, ozone and octenidine reduce the incidence of white spot lesions and caries during orthodontic treatment: randomized controlled trial

This randomized, parallel, controlled trial assessed the effect of fluoride varnish, ozone and octenidine on white spot lesions (WSLs) and caries during orthodontic treatment. Patients were enrolled between 1st September 2017 and 31st August 2020 at initiation of orthodontic treatment in Department of Interdisciplinary Dentistry Pomeranian Medical University in Szczecin, Poland. All participants were randomly assigned to four study and one control groups using number random generator. However, investigators were not blinded due to the nature of the study. Groups I, II, III, IV had professional cleaning and varnishing (5% NaF) every 4 weeks. Groups II and IV had in-office ozone therapy before varnishing, groups III and IV received domestic octenidine mouthrinse. Group K had no professional hygienic or prophylactic procedures. WSLs were assessed at T0 and then every 4 weeks (T1-T4) and caries-at T0 and T4. The specific objective was to assess the influence of fluoride varnish, ozone and octenidine on the incidence of white spot lesions and caries during orthodontic treatment. The primary outcome of this report was the highest number of WSLs in group K and the lowest percentage of patients with WSLs in group IV. Each group comprised 30 randomized participants; they were all analyzed. No WSLs were found at T0, but they were stated in all groups at T4. The numbers of patients with WSLs significantly increased between T0-T4 in groups I and K. Group IV had the lowest percentage of patients with WSLs in T1-T4. WSLs in group IV were found no earlier than at T2. Group K had the highest percentage of WSLs at T4: 26%. At T0 all the groups had DMFs above 0 with a significant increase at T4. No side effects of the introduced prophylaxis were observed in any group. Caries is an important problem of fixed orthodontic treatment. Even an extremely intensive prophylaxis could not completely prevent WSLs and caries. Simultaneous application of fluoride varnish, ozone gas exposure and octenidine appears to have a beneficial effect in limiting the development of WSLs.Trial registration: NCT04992481.

Outcomes used in trials regarding the prevention and treatment of orthodontically induced white spot lesions: A scoping review

INTRODUCTION

The objective was to identify and summarize the outcomes and evaluation methods used in clinical trials regarding the prevention and treatment of orthodontically induced white spot lesions (WSLs).

METHODS

Three electronic databases were searched to identify studies that were (1) clinical trials on prevention and/or treatment of orthodontically induced WSLs, (2) reported in English, and (3) published between January 2010 and October 2019. At least 2 authors assessed the eligibility and extracted the characteristics, outcomes, and evaluation methods from included studies. All disagreements were resolved through discussion.

RESULTS

Among 1328 studies identified, 51 were eligible and included. A total of 48 different outcomes and 11 different evaluation methods were used in these studies. The most frequently used outcomes were WSLs clinical visual examination scores (n = 22, 43.1%), DIAGNOdent values (n = 14; 27.5%), fluorescence loss measured with quantitative light-induced fluorescence (QLF) (n = 10; 19.6%), and lesion area measured with QLF (n = 10; 19.6%). The most frequently used evaluation methods were clinical examination (n = 25; 49.0%), visual inspection by photographs (n = 15; 29.4%), DIAGNOdent (n = 14; 27.5%), and QLF (n = 10; 19.6%). None of the included studies reported data on quality of life.

CONCLUSIONS

Substantial outcome heterogeneity exists among studies regarding the prevention and treatment of orthodontically induced WSLs. Most of the identified outcomes are aimed to assess morphologic changes of WSLs and may not reflect patient perspectives.

REGISTRATION

The Core Outcome Set for trials on the prevention and treatment of enamel White Spot Lesions (COS-WSL) project was registered in the COMET Initiative database (No. 1399).

Remineralization potential and caries preventive efficacy of CPP-ACP/Xylitol/Ozone/Bioactive glass and topical fluoride combined therapy versus fluoride mono-therapy - a systematic review and meta-analysis

OBJECTIVE

To compare the remineralization potential and caries preventive efficacy of CPP-ACP/bioactive glass/xylitol/ozone and topical fluoride (TF) combined therapy versus TF mono-therapy.

MATERIAL AND METHODS

Embase, PubMed, Scopus, Web of Science and Cochrane databases were searched. 4457 records were screened and 26 trials were included. Data from 16 trials was pooled using Review Manager 5.4. Level of significance was p < .05. The certainty of the evidence was evaluated using GRADE.

RESULTS

Pooled analysis of two trials for white spot lesions (WSLs) regression (SMD -0.6, 95% CI: [-1.07 to -0.14], p = .01) and three trials for post-intervention DIAGNOdent values (SMD -1.24, 95% CI: [-1.96 to -0.52], p = .0007) significantly favoured CPP-ACP-TF combined therapy over TF mono-therapy. The sub-group analysis for caries increment (SMD -0.14, 95% CI: [-0.21 to -0.07], p < .0001) and the post intervention S mutans count (SMD -0.42, 95% CI: [-0.62 to -0.23], p < .0001) significantly favours 'xylitol-TF' and 'CPP-ACP-TF' combined therapy respectively. The high/unclear risk of bias, imprecision and indirectness of the included trials presented a low certainty of evidence.

CONCLUSION

CPP-ACP-TF exhibits superiority over TF monotherapy in remineralizing existing lesions and demonstrates better antibacterial effect, whereas it is not more effective for preventing caries incidence. However, Xylitol exerts an added benefit over fluoride alone in preventing caries increment. The low-certainty evidence highlights the need for more good quality trials.

Effect of Chlorhexidine Varnish and Fluoride Varnish on White Spot Lesions in Orthodontic Patients- a Systematic Review

Aim:

The aim of this study is to critically review the studies that studied the effect of Chlorhexidine varnish and fluoride varnish on White Spot Lesion (WSL) in patients undergoing orthodontic treatment.

Materials and Methods:

The electronic database PubMed, The Cochrane Library, Medline, Embase, Google Scholar, Web of Knowledge along with a complimentary manual search of all orthodontic journals till the first week of December 2019 was searched. English language study performed on humans, randomized or nonrandomized clinical trials, comparing the effect of fluoride and chlorhexidine varnish on WSL was included in the review. Quality assessment of included studies was performed.

Clinical Significance:

The need for an adjunct oral hygiene aid to reduce the incidence and prevalence of white spot lesions in orthodontic patients is necessary. The use of these varnishes will aid in the same and thus make the adverse effects of fixed orthodontic treatment negligible.

Review of Literature:

Enamel demineralization is a significant risk associated with orthodontic treatment when oral hygiene is poor. Prevention of demineralization during orthodontic treatment is one of the greatest challenges faced by clinicians despite modern advances in caries prevention. The development of White Spot Lesions (WSLs) is attributed to prolonged plaque accumulation around the brackets.

Results:

The search identified a total of 3 studies that were included in this review. One study had Low risk of bias and the remaining 2 studies had moderate overall risk. Results showed that there was a reduction in the incidence of white spot lesions in orthodontic patients after application of chlorhexidine and Fluoride varnish.

Conclusion:

Low level evidence is available to conclude that the use of chlorhexidine varnishes and fluoride varnishes reduces the prevalence of white spot lesions in patients undergoing fixed orthodontic treatment. Due to its limitations, the results of this systematic review should be handled with caution and further well-planned Randomized Clinical Trial (RCT) are needed to provide a discrete conclusion.

Comparative evaluation of Icon® resin infiltration and Clinpro™ XT varnish on colour and fluorescence changes of white spot lesions: a randomized controlled trial

Background

The aim of this trial was to comparatively evaluate Icon® resin infiltration and Clinpro™ XT varnish in restoring aesthetics of white spot lesions (WSLs) present post-orthodontic treatment.

Materials and methods

Two hundred forty WSLs were detected in 193 teeth of 12 patients. The participants were analysed—before intervention (T₀), immediately after intervention (T₁), 3 months later (T₂) and 6 months later (T₃), with a 1:1 allocation ratio for the application of Icon® resin infiltration and Clinpro™ XT varnish. Using a computer-generated allocation sequence, block randomization was done. A spectrophotometer was used to assess the colour of WSLs and the adjacent enamel, while a DIAGNOdent® was used to assess the fluorescence loss.

Results

Immediately after the intervention, Icon® resin infiltration showed statistically significant better improvement than Clinpro™ XT varnish in restoring the colour (p = 0.000); however, at 3 (p = 0.001) and 6 months (p = 0.000), this was reversed. Except at 3 months, the fluorescence loss sequentially reduced more for Icon® resin infiltration (4.48 ± 1.42 at T₀ to 1.48 ± 0.81 at T₃) and was not statistically significant.

Conclusions

Clinpro™ XT varnish showed significantly better improvement than Icon® resin infiltration in restoring the colour and lightness of the WSLs at 3 and 6 months. The fluorescence loss significantly recovered with both intervention methods between immediate application and at 6 months. However, Clinpro™ XT varnish-treated WSLs showed a statistically significant difference compared to the adjacent sound enamel at 6 months.

Effects of Fluoride and Calcium Phosphate Materials on Remineralization of Mild and Severe White Spot Lesions

Fixed orthodontic treatments often lead to enamel demineralization and cause white spot lesions (WSLs). The aim of this study was to evaluate the mineralization degree of 2 types of WSLs based on ICDAS index and compare the remineralizing efficacy of 3 oral hygiene practices after 1 month and 3 months. 80 mild demineralized and 80 severe demineralized enamel specimens were randomized into three treatments: fluoride toothpaste (FT), fluoride varnish plus fluoride toothpaste (FV+FT), and CPP-ACP plus fluoride toothpaste (CPP-ACP+FT). Microhardness tester, DIAGNODent Pen 2190, and scanning electron microscope were used to evaluate the changes of mineralization degree. Both qualitative and quantitative indicators suggested that the mild and severe white spot lesions were different in the degree of mineralization. Severe WSLs demineralized much more seriously than mild lesions even after 3 months of treatment. Despite the variation in severity, both lesions had the same variation trend after each measure was applied: FT had weak therapeutic effect, FV + FT and CPP-ACP + FT were effective for remineralization. Their remineralizing efficacy was similar after 1 month, and combined use of CPP-ACP plus F toothpaste was more effective after 3 months. In order to fight WSLs, early diagnosis was of great importance, and examination of the tooth surface after air-dry for 5 seconds was recommended. Also, when WSLs were found, added remineralizing treatments were required.

Effects of Ozone and Prophylactic Antimicrobial Applications on Shear Bond Strength of Orthodontic Brackets

Objective

The present study aimed to evaluate the effects of ozone and prophylactic antimicrobial applications on the shear bond strengths and bond failure interfaces of orthodontic brackets.

Methods

Sixty human canine teeth were randomly divided into three groups (n=20), receiving the following treatments: Group I-pumice prophylaxis (Isler Dental, Ankara, Turkey)+37% orthophosphoric acid (Dentsply, Rio de Janeiro, Brazil)+Transbond XT primer and adhesive (3M Unitek, Monrovia, USA); Group II-prophylaxis paste (Topex, NJ, USA)+37% orthophosphoric acid (Dentsply, Rio de Janeiro, Brazil)+ Transbond XT primer and adhesive paste (3M Unitek, Monrovia, USA); and Group III-ozone application (Biozonix GmbH, Munich, Germany)+37% orthophosphoric acid (Dentsply, Rio de Janeiro, Brazil)+Transbond XT primer and adhesive (3M Unitek, Monrovia, USA). All specimens were stored at 37°C water for 24 h. Shear bond strength was assessed using a universal testing device (Autograph AGS-X; Shimadzu, Japan). Adhesive remnant index (ARI) scores were obtained through examination of teeth under stereomicroscope at 10× magnification after debonding.

Results

Shear bond strengths of orthodontic brackets were 16.10, 18.01, and 19.23 MPa for Groups I, II, and III, respectively. No statistically significant difference in shear bond strength of orthodontic brackets was found among the groups (p=0.273), based on Kruskal-Wallis analysis. Additionally, no significant difference was found in the ARI scores of each group using chi-square analysis (p=0.992).

Conclusion

Shear bond strength of orthodontic brackets and ARI scores was not found to be negatively impacted by ozone application.

Novel orthodontic cement containing dimethylaminohexadecyl methacrylate with strong antibacterial capability

Orthodontic treatments increase the incidence of white spot lesions. The objectives of this study were to develop an antibacterial orthodontic cement to inhibit demineralization, and to evaluate its enamel shear bond strength and anti-biofilm properties. Novel antibacterial monomer dimethylaminohexadecyl methacrylate (DMAHDM) was synthesized and incorporated into Transbond XT at 0, 1.5 and 3% by mass. Anti-biofilm activity was assessed using a human dental plaque microcosm biofilm model. Shear bond strength and adhesive remnant index were also tested. Biofilm activity precipitously dropped when contacting orthodontic cement with DMAHDM. Orthodontic cement containing 3% DMAHDM significantly reduced biofilm metabolic activity and lactic acid production (p<0.05), and decreased biofilm colony-forming unit (CFU) by two log. Water-aging for 90 days had no adverse influence on enamel shear bond strength (p>0.1). By incorporating DMAHDM into Transbond XT for the first time, the modified orthodontic cement obtained a strong antibacterial capability without compromising the enamel bond strength.

Prevention and Treatment of White Spot Lesions in Orthodontic Patients

Decalcification of enamel, appearing as white spot lesions (WSLs), around fixed orthodontic appliances is a major challenge during and after fixed orthodontic treatment by considering the fact that the goal of orthodontic treatment is to enhance facial and dental esthetic appearance. Banded or bonded teeth exhibit a significantly higher rate of WSLs compared to the controls with no braces as fixed appliances and the bonding materials promote retention of biofilms. These lesions are managed in the first step by establishing good oral hygiene habits and prophylaxis with topical fluorides, including high-fluoride toothpastes, fluoride mouthwashes, gels, varnishes, fluoride-containing bonding materials, and elastic ligatures. Recently, other materials and methods have been recommended, including the application of casein phosphopeptides-amorphous calcium phosphate, antiseptics, probiotics, polyols, sealants, laser, tooth bleaching agents, resin infiltration, and microabrasion. This article reviews the currently used methods to manage enamel demineralization during and after orthodontic treatment and the risk factors and preventive measures based on the latest evidence.

Efficacy of professional hygiene and prophylaxis on preventing plaque increase in orthodontic patients with multibracket appliances: a systematic review

BACKGROUND

Plaque increase is a troubling side-effect of fixed orthodontic therapy. This generally arise as a consequence of long-term difficulty in maintaining adequate oral hygiene while wearing multibracket appliances. Demineralization, also known as white spot, causes particular concern as it spoils the aesthetic outcome of the treatment itself, not to mention the integrity of the enamel.

OBJECTIVES

To collate the existing literature by evaluating the efficacy of dental hygienist intervention on plaque increase in fixed orthodontics patients.

MATERIALS AND METHODS

A targeted search of the Medline database (Entrez PubMed), EMBASE, and CENTRAL using relevant Medical Subject Headings was performed. The articles selected were all published before June 2013 and comprised randomized clinical trials, prospective longitudinal controlled clinical trials, and before/after studies onto the plaque increase of fixed appliances.

RESULTS

The search strategy yielded 630 articles. Following the application of inclusion and exclusion criteria, 10 articles qualified for the final review.

CONCLUSION

The quality of the retrieved researches ranged from low (one study) to high (one study). Six controlled trials were considered at unknown risk of bias. Data showed that regular patient motivation sessions and mechanical tooth cleaning by a professional dental hygienist help maintaining good oral hygiene during fixed orthodontics.

[White spot lesions and orthodontic treatment. Prevention and treatment]

Decalcification of the enamel surface adjacent to fixed orthodontic appliances, in the form of white spot lesions, is a common and frequent well-known side-effect of orthodontic treatment. Fixed appliances and the bonding materials increase the retention of biofilm and encourage the formation of white spot lesions. Management of these lesions begins with a good oral hygiene regime and needs to be associated with use of fluoride agents (fluoridated toothpaste, fluoride containing mouth rinse, gel, varnish, bonding materials, elastic ligature), CPP-ACP, antiseptics, LASER, tooth whitening, resin infiltration, micro-abrasion. The purpose of this review is to access the direct evidence regarding the prevention and management of white spot lesions during and after orthodontic treatment.

Demineralization adjacent to orthodontic brackets after application of conventional and self-etching primer systems

OBJECTIVES

The goal of this work was to compare the demineralization of enamel associated with two different self-etching primers and traditional acid etching.

MATERIALS AND METHODS

A total of 15 volunteers (23-32 years, 8 male and 7 female) were provided with a removable archwire/resin appliance to be worn 20 h/day for 28 days. The device was attached to the mandibular posterior teeth and included samples of human enamel (from extracted third molars) located in both posterior vestibules. Both sides featured the same distribution of samples, including one untreated control sample (group A) and three samples with brackets (Victory™ APC II) bonded to their surface after conditioning with a self-etching non-fluoride primer (iBond™ Gluma® Inside; group B), a self-etching fluoride-releasing primer (Transbond™ Plus; group C), or traditional acid-etching with 35% phosphoric acid and Transbond™ XT (group D). Mineral loss was assessed extraorally under standardized conditions using quantitative light-induced fluorescence (QLF) with a specialized camera system (Inspektor Pro). Results were expressed as relative fluorescence loss (ΔF in %). A baseline measurement (T0) was taken before the appliance was first inserted but with the brackets already bonded. Fluorescence loss was analyzed after 3 (T1), 7 (T2), 14 (T3), and 28 days (T4) and compared to the baseline loss (T0) for each of the four study groups (A to D). Kruskal-Wallis and Mann-Whitney U tests were used to compare the results for statistical significance.

RESULTS

The lowest percentages of fluorescence loss both at baseline and during the follow-up assessments was found in group C. While all three experimental groups (B, C, D) presented total decreases in fluorescence loss after 28 days, indicating remineralization, the decrease in group C was the largest. The Kruskal-Wallis test yielded no significant differences between the three groups other than a significantly lower percentage of fluorescence loss in group C than in group D during the last assessment (T4). The untreated samples of control enamel (group A) revealed increasing percentages of fluorescence loss over the entire study period.

CONCLUSION

Use of the self-etching primers (groups B and C) was not associated with patterns of enamel demineralization different from those noted after traditional etching with phosphoric acid (group D). The only significant difference we observed was between the self-etching fluoride-releasing primer (group C) and traditional etching (group D) at the final assessment (T4). Thus, the fluoride-releasing system Transbond™ Plus was advantageous.

Microhardness of enamel adjacent to orthodontic brackets after CO2 laser irradiation and fluoride application

This study evaluated the effectiveness of carbon dioxide (CO2) laser combined or not with fluoride application on the surface microhardness of enamel adjacent to orthodontic brackets. Fifteen human molars were selected from which 30 enamel fragments measuring 4 mm2 were obtained. The fragments were embedded in PCV tubes with acrylic resin and prepared using water abrasive paper, felt disks and alumina. Orthodontic brackets cut in half were bonded to enamel and 3 microhardness readings were performed on the adjacent surface, as follows: initial, after cariogenic challenge and final. The specimens were divided into the following 3 groups (n=10): Group C: control, Group L: irradiated with CO2 laser, and Group FL: topical fluoride application and CO2 laser irradiation. After initial reading, the specimens were placed in a demineralizing solution for 32 h and the second reading was to verify if demineralization was uniform in all groups. After the treatments, the specimens were submitted to DES-RE cycling for 8 days followed by final surface microhardness reading. The data were analyzed statistically using ANOVA and Duncan test (α=0.05). At the final measurement Group FL obtained higher microhardness value than Groups C and L (p<0.05). Groups L and FL were statistically superior to Group C (p<0.05). Irradiation with CO2 laser around orthodontic brackets combined or not with topical fluoride application was effective to increase the surface microhardness of enamel.

Antibacterial efficacy of prophylactic ozone treatment on patients with fixed orthodontic appliances

OBJECTIVE

This study investigated the efficacy of ozone on microflora of patients with fixed orthodontic appliances.

MATERIALS AND METHODS

Ten subjects undergoing fixed appliance therapy were enrolled in the study. Before any application, two elastic ligatures were removed with the aid of a sterile probe from the premolar brackets on the upper right and lower left jaws for baseline bacteriological counts. Then ozone gas was applied for 180 s by running the device on prophylaxis mode with included mouth tray according to the manufacturer's recommendations on all brackets. After the ozone application, two other elastic ligatures were removed from the opposite sides of the mouth of the patients. One week after the application two more elastic samples, which were not changed in the previous session, were collected from the upper right and lower left premolar brackets. The elastic ligatures were immersed in transfer solutions and cultured to determine the Streptococcus mutans and Lactobacillus acidophilus. Statistical analysis of the data was obtained by paired Student's t-tests.

RESULTS

The ozone treatment reduced the S. mutans and L. acidophilus immediately after the application and these reductions were found to be statistically significant (p = 0.038 and p = 0.020). Both the S. mutans and L. acidophilus values increased by the 1-week period and the S. mutans values were significantly higher than the baseline values (p = 0.01).

CONCLUSION

It can be concluded that the ozone treatment may have an instantaneous lethal effect on S. mutans and L. acidophilus; however, within the limitations of this study, a long-term preventive effect could not be observed.

Ozone therapy in the management and prevention of caries

The purpose of this article was to assess the effectiveness of ozone therapy in the management and prevention of caries, reviewing clinical and in vitro studies. Ozone has proven to be effective against gram-negative and gram-positive bacteria, viruses, and fungi. In dentistry, most of the published articles are based on ozone's antimicrobial effects and the treatment of caries. Most of the clinical studies reported ozone to be a promising alternative to conventional methods for caries management. However, a few studies have shown ozone to be insufficient for preventing caries and reducing microorganisms in open occlusal carious lesions. Ozone might be a useful tool to reduce and control oral infectious microorganisms in dental plaque and dental cavity. However, the results of in vitro studies are controversial; while some researchers reported that ozone therapy had a minimal or no effect on the viability of microorganisms, others suggested ozone to be highly effective in killing both gram-positive and gram-negative oral microorganisms. Therefore, more evidence is required before ozone can be accepted as an alternative to present methods for the management and prevention of caries.

Effect of fluoridated milk on enamel demineralization adjacent to fixed orthodontic appliances

OBJECTIVE

To investigate the effect of daily intake of fluoridated milk on enamel demineralization adjacent to fixed orthodontic brackets assessed with quantitative light-induced fluorescence (QLF).

MATERIALS AND METHODS

Sixty-four healthy adolescents (13-18 years) undergoing orthodontic treatment with fixed appliances were enrolled and randomly allocated to a randomized controlled trial with two parallel groups. The intervention group was instructed to drink one glass of milk (≈ 200 ml) supplemented with fluoride (5 ppm) once daily and the subjects of the control group to drink the same amount of milk without fluoride. The intervention period was 12 weeks and the end-point was mineral gain or loss in enamel, assessed by QLF on two selected sites from each individual. The attrition rate was 12.5% and 112 sites were included in the final evaluation.

RESULTS

There was no statistically significant difference between the groups concerning fluorescence (ΔF) values and lesion area (A mm(2)) at baseline. After 12 weeks, a significant decrease (p < 0.05) in ΔF was registered in the fluoridated milk group and a significant increase in the non-fluoride control group (p < 0.05). The mean reduction in the test group was somewhat lower (14%) than the increase in the control group (18%), but individual variations were evident. Only minor alterations of lesion area were recorded over the 12-week period and no statistically significant differences compared with baseline were found in any of the groups.

CONCLUSION

Daily intake of fluoridated milk may aid remineralization of white spot lesions adjacent to fixed orthodontic appliances.

Risk factors and management of white spot lesions in orthodontics

The formation of white spot lesions or enamel demineralization around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which mars the result of a successfully completed case. This article is a contemporary review of the risk factors, preventive methods and fate of these orthodontics scars. The importance of excellent oral hygiene practice during fixed orthodontic treatment must be explained. Preventive programs must be emphasized to all orthodontic patients. Suggestions are offered in the literature for ways to prevent this condition from manifesting itself.

Ozone and caries: a review of the literature

Ozone, either in gaseous form or as ozonated water, has been available for use as a treatment for dental caries for a decade. This paper reviews the literature on the subject by examining the findings of publications in the peer review literature. Eighteen papers were identified by a literature search. From the review of these, it was concluded that, while some laboratory studies and some short duration clinical studies have suggested that ozone may be effective in the treatment of root caries or killing of oral micro-organisms, the clinical evidence for the use of ozone in treatment of caries is not compelling.

A review on prevention and treatment of post-orthodontic white spot lesions - evidence-based methods and emerging technologies

Objective:

The aim of this paper was to update the evidence for primary and secondary prevention (treatment) of white spot lesions (WSL) adjacent to fixed orthodontic appliances.

Material and methods:

A search for relevant human clinical trials published in English between 2004 and March 2011 retrieved 25 publications that fulfilled the inclusion criteria. The papers were assessed for prevented fraction and/or absolute risk reduction when possible.

Results and conclusions:

The findings consolidated the use of topical fluorides in addition to fluoride toothpaste as the best evidence-based way to avoid WSL. The mean prevented fraction based on 6 trials was 42.5% with a range from -4% to 73%. The recent papers provided the strongest support for regular professional applications of fluoride varnish around the bracket base during the course of orthodontic treatment. For the treatment of post-orthodontic WSL, home-care applications of a remineralizing cream, based on casein phosphopeptide-stabilized amorphous calcium phosphate, as adjunct to fluoride toothpaste could be beneficial but the findings were equivocal. For emerging technologies such as sugar alcohols and probiotics, still only studies with surrogate endpoints are available. Thus, further well-designed studies with standardized regimes and endpoints are needed before guidelines on the non-fluoride technologies can be recommended.

[Risk of caries in orthodontics: descriptive study on 155 patients]

INTRODUCTION

The aim of this survey was to study the prevalence of tooth decay, to assess oral hygiene control, to analyze the different risk factors for caries in orthodontics, and to determine recommendations.

PATIENTS AND METHODS

We studied 155 patients managed in the unit, for three months and 19 days. The main indicators used were: the DMF index; Loe and Silness's gingival index, and Silness and Loe's plate index.

RESULTS

The plate index ranged between 0.08 and 2.4, with a mean of 1.12 ± 0.48; the gingival index ranged between 0 and 2, with a mean of 0.67 ± 0.43; the DMF index ranged between 0 and 21, with a mean of 5.77 ± 4.52.

DISCUSSION

The orthodontist has a major role to play in the prevention of caries before and after treatment. Recommendations and patient information should be adapted to risk for dental caries.

Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate

This study aims to investigate the effect of topical applications of 10% casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSL) detected after treatment with fixed orthodontic appliances. Sixty healthy adolescents with ≥1 clinically visible WSL at debonding were recruited and randomly allocated to a randomised controlled trial with two parallel groups. The intervention group was instructed to topically apply a CPP-ACP -containing agent (Tooth Mousse, GC Europe) once daily and the subjects of the control group brushed their teeth with standard fluoride toothpaste. The intervention period was 4 weeks and the endpoints were quantitative light-induced fluorescence (QLF) on buccal surfaces of the upper incisors, cuspids and first premolars and visual scoring from digital photos. The attrition rate was 15%, mostly due to technical errors, and 327 lesions were included in the final evaluation. A statistically significant (p < 0.05) regression of the WSL was disclosed in both study groups compared to baseline, but there was no difference between the groups. The mean area of the lesions decreased by 58% in the CPP-ACP group and 26% in the fluoride group (p = 0.06). The QLF findings were largely reflected by the clinical scores. No side effects were reported. Topical treatment of white spot lesions after debonding of orthodontic appliances with a casein phosphopeptide-stabilised amorphous calcium phosphate agent resulted in significantly reduced fluorescence and a reduced area of the lesions after 4 weeks as assessed by QLF. The improvement was however not superior to the "natural" regression following daily use of fluoride toothpaste.

Caries Detection Methods Based on Changes in Optical Properties between Healthy and Carious Tissue

A conservative, noninvasive or minimally invasive approach to clinical management of dental caries requires diagnostic techniques capable of detecting and quantifying lesions at an early stage, when progression can be arrested or reversed. Objective evidence of initiation of the disease can be detected in the form of distinct changes in the optical properties of the affected tooth structure. Caries detection methods based on changes in a specific optical property are collectively referred to as optically based methods. This paper presents a simple overview of the feasibility of three such technologies for quantitative or semiquantitative assessment of caries lesions. Two of the techniques are well-established: quantitative light-induced fluorescence, which is used primarily in caries research, and laser-induced fluorescence, a commercially available method used in clinical dental practice. The third technique, based on near-infrared transillumination of dental enamel is in the developmental stages.