European Journal of Orthodontics, 2017, 116–121

doi:10.1093/ejo/cjw023
Advance Access publication 30 March 2016

Systematic review

Management of post-orthodontic white spot

lesions: an updated systematic review
Mikael Sonesson1, Fredrik Bergstrand2, Sotiria Gizani3 and
Svante Twetman4
Department of Orthodontics, Faculty of Odontology, Malmö University, Sweden, 2Private Orthodontic Practice,
1

Stockholm, Sweden, 3Department of Paediatric Dentistry, Dental School, National and Kapodistrian University of
Athens, Greece, 4Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen,
Denmark

Correspondence to: Mikael Sonesson, Department of Orthodontics, Faculty of Odontology, Malmö University, Carl Gustavs
väg 34, SE-214 21 Malmö, Sweden. E-mail: [email protected]

Summary
Background/objectives:  The management of post-orthodontic white spot lesions is based on
remineralization strategies or a minimal-invasive camouflage of the lesions.
Aim:  The aim of this systematic review was to identify and assess the quality of evidence for the
various clinical technologies.
Search methods:  Four databases were searched for relevant literature published in English between
2011 and 31 October 2015 according to a pre-determined PICO. Only controlled clinical studies
were considered. Abstract lists and the selected full-text papers were independently examined
by two reviewers and any differences were solved in consensus. The Cochrane handbook and the
AMSTAR tool were used for grading the risk of bias. The quality of evidence was rated according
to GRADE.
Results:  Out of 280 identified publications, seven studies on remineralization, micro-abrasion
and resin infiltration met the inclusion criteria. Two of them were assessed with low risk of bias.
No pooling of results was possible due to study heterogeneity. The quality of evidence for all
technologies was graded as very low.
Limitations:  Only papers published in English with more than 20 adolescents or young adults
were considered. Furthermore, a follow-up period of at least 8 weeks was required. The publication
bias could not be assessed due to the paucity of included trials.
Conclusions/clinical implications: There is a lack of reliable scientific evidence to support re-
mineralizing or camouflaging strategies to manage post-orthodontic white spot lesions. Further
well-performed controlled clinical trials with long-term follow-up are needed to establish best
clinical practice.

Introduction outcome of the treatment; data indicate that such lesions have a
limited ability to improve after appliance removal and white spots
White spot lesion (WSL) development is a frequent side-effect to
can sometimes be detectable even 12  years after treatment (5–7).
treatment with fixed orthodontic appliances (1). The prevalence is
Although primary prevention must be in focus, two major strate-
reported to vary from 2 to 96%, depending on method and criteria
gies on how to deal with existing lesions after debonding have been
for detection as well as patient compliance with advocated pre-
suggested; remineralizing or masking the lesions (8,9). The first is
ventive measures (2–4). WSLs can seriously jeopardize the esthetic

© The Author 2016. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved.
116
For permissions, please email: [email protected]

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 M. Sonesson et al. 117

based on secondary prevention and reversing the lesions through Search strategy and inclusion criteria
remineralizing agents like topical fluoride, amorphous calcium Four electronic sources were searched from 2011 throughout 31
phosphate, or self-assembling peptides. The second strategy aims October 2015 for systematic reviews and original studies of poten-
to mask and improve the esthetic appearance of the teeth through tial interest; PubMed, The Cochrane Library and the Citation and
minimal-invasive measures, such as bleaching, micro-abrasion, or Trip Databases. In addition, https://clinicaltrials.gov/ was checked
resin infiltration. Since most published evaluations of the various for ongoing studies. The search terms were ‘enamel caries’, ‘fixed
technologies are made with aid of artificial lesions in vitro, the orthodontic appliances’, ‘fluoride’, ‘micro-abrasion’, ‘resin infiltra-
clinical benefits of the different strategies remain unclear. The aim tion’, ‘remineralization’, ‘tooth bleaching’ and ‘white spot lesions’
of the present paper was therefore to examine the current evidence in various combinations. The full search strategy is shown in
of effectiveness for clinical methods using remineralizing agents or Supplement 1. The abstract list, containing 280 hits, was indepen-
minimal-invasive techniques to manage post-orthodontic WSLs, dently assessed by two authors and papers of potential relevance
based on primary clinical trials and systematic reviews. This sys- were selected. Diverging opinions were solved in consensus. For each
tematic review is an update of a previous publication from our selected abstract, the information on related papers was checked in
research group (10) in which no firm evidence for any technology the database. To be considered for inclusion, a full description of a
was unveiled. controlled clinical trial (randomized or non-randomized) including
more than 20 subjects was required. Furthermore, a reported end-
point obtained at least after 8 weeks and expressed as continuous
Methods or categorical data was needed. Only papers published in English
The PICO was set up as follows; Population: adolescents and young were accepted. Papers describing in vitro and in situ studies with
adults (<30 years) with WSLs registered and scored within 3 months artificial WSLs were not taken into account. The reference lists of
after the debonding of fixed orthodontic appliances; Intervention: any the accepted papers and systematic reviews were hand-searched
intervention, except laminate veneers, with aim to reverse the post- for additional literature. A flow-chart of the inclusion of papers is
orthodontic lesions or to improve their esthetic appearance; Control: shown in Figure 1.
no treatment, placebo or best clinical practice; Outcome: extent, hard-
ness or appearance of WSLs with a follow-up period of at least 8 weeks, Data extraction
as assessed with visual clinical scores, photographs, caries detection Key data from the accepted studies were extracted independently by
devices or patient/therapist satisfaction. two authors and compiled in tables.

Figure 1.  Flow-chart of the included studies.

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 118 European Journal of Orthodontics, 2017, Vol. 39, No. 2

Quality assessment from China, two from USA, two from India, and one from Germany.
The quality of the selected publications was assessed according to The assessed quality is summarized in Table  2. Two of the papers
predetermined criteria for methodology and performance by two were assessed as being of low risk of bias (16, 18) while the rest
authors. The criteria of Cochrane handbook for interventions (11) appeared with high risk of bias. In addition, two systematic reviews
was used and the risk of bias for each original paper was graded as relevant for the topic were identified and both were considered being
‘low’, ‘moderate’, or ‘high’. Systematic reviews were assessed with of moderate to low risk of bias (21, 22). The excluded studies (23–42)
the AMSTAR tool as described by Mejàre et al. (12). The quality of with the main reason for exclusion are shown in Table 3.
evidence was rated with the GRADE tool (13) in four categories;
strong, moderate, low, and very low. Remineralizing agents
A systematic review based on seven included studies displayed a
Data synthesis lack of reliable evidence to support the effectiveness of remineral-
Due to the low number and diversity of the included studies, a nar- izing agents (fluoride and casein phosphopeptide-amorphous cal-
rative descriptive synthesis was carried out. Only studies with low or cium phosphate; CPP-ACP) for the management of post-orthodontic
moderate risk of bias were used for grading the quality of evidence. WSLs (21). This was recently confirmed in a systematic review by
Raphael and Blinkhorn (22). They found a tendency towards a ben-
efit for the use of CPP-ACP, with and without fluoride, but the qual-
Results ity of evidence was limited. We identified two primary studies not
Seven primary publications (14–20), describing eight clinical trials, included in the systematic review of Chen et al. (21) but both were
were included. Five studies were on remineralization agents (14–16, assessed with high risk of bias (14, 15). One study with low risk
19, 20), one on microabrasion (15) and two trials were on resin infil- of bias compared products with various concentrations of fluoride
tration (17, 18) as listed in Table 1. One study (15) evaluated the man- (varnish, mousse, adult toothpaste) but no differences in improving
agement of WSL both by remineralization agents and microabrasion, the appearance of WSLs was unveiled (16). The quality of evidence
thus 8 clinical trials were included. One trial was from Turkey, one was rated as very low (⊕ΟΟΟ) and the possible beneficial effect of

Table 1.  Summary of included studies. CPP-ACP, casein phosphor peptide - amorphous calcium phosphate nano-complexes; FTP, fluoride
toothpaste; FMR, fluoride mouth rinse; FU, follow-up; LF, laser fluorescence; S, statistically significant difference; SM, split-mouth.

Author, year n, Test/ctr FU Intervention Control Outcome Effect

Remineralization agents
  Agarwal, 2013 (14) 31 (SM) 8 weeks FTP Placebo Visual S
  Akin, 2012 (15) 20/20 6 months FMR No treatment Photo NS
20/20 6 months CPP-ACP No treatment Photo NS
  Du, 2012 (19) 47/49 6 months F-varnish Saline LF S
  Huang, 2013 (16) 34/41 8 weeks CPP-ACP* Home care** Photo NS
40/41 8 weeks F-varnish Home care** Photo NS
  Vashisht, 2013 (20) 29/31 3 months CPP-ACP FTP LF + Visual S
Microabrasion
  Akin, 2012 (15) 20/20 6 months Microabr. No treatment Photo S
Resin infiltration
  Knösel, 2013 (18) 21 (SM) 6 months Resin No treatment Spectro S
  Senestraro, 2014 (17) 20 (SM) 3 months Abr. + Resin No treatment Visual S

NS, no significant difference.

*Paste containing 900 ppm F.
**Including adult fluoride toothpaste.

Table 2.  Assessment of risk of bias for the included studies.

Type of bias

First author, year Selection Performance Detection Attrition Reporting Risk level*

Remineralization agents
  Agarwal, 2013 (14) Yes Yes Yes No Yes HR
  Akin, 2012 (15) Yes Yes Yes No Yes HR
  Du, 2012 (19) Unclear SB** Yes No Yes HR
  Huang, 2013 (16) No SB No No No LR
  Vashisht, 2013 (20) Yes Yes Yes No Yes HR
Microabrasion
  Akin, 2012 (15) Yes Yes Yes No Yes HR
Resin infiltration
  Knösel, 2013 (18) No No No No No LR
  Senestraro, 2014 (17) Yes Yes No Yes Yes HR

*HR, high risk of bias; LR, low risk of bias.

**SB, single blind.

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 M. Sonesson et al. 119

Table 3.  Excluded papers and main reason for their exclusion. CPP-ACP, casein phosphor peptide - amorphous calcium phosphate nano-
complexes; FOA, fixed orthodontic appliances.

First author, year Intervention Main reason for exclusion

Baeshen, 2011 (23) Fluoride Short follow-up

Ballard, 2013 (24) Mixed techniques Artificial lesions
Bröchner, 2011 (25) CPP-ACP Short follow-up
Caglaroglu, 2012 (26) Abrasion Description of technique
Eckstein, 2015 (27) Resin infiltration Small sample
Hammad, 2012 (28) Resin infiltration Small sample, short follow-up
Jahanbin, 2015 (29) Micro-abrasion Artificial lesions
Kim, 2011 (30) Resin infiltration Small sample, short follow-up
Krithikadatta, 2013 (31) CPP-ACP Occlusal lesions
Milly, 2014 (32) Bioactive glass Artificial lesions
Neuhaus, 2010 (33) Resin infiltration Case report
Paris, 2013 (34) Resin infiltration Artificial lesions
Pliska, 2012 (35) Abrasion + ACP Artificial lesions
Poosti, 2014 (36) Laser Artificial lesions
Robertson, 2011 (37) CPP-ACP Intervention during FOA
Torres, 2011 (38) Infiltration + fluoride Artificial lesions
Yetkiner, 2014 (39) Mixed techniques Artificial lesions
Yim, 2014 (40) Resin infiltration Artificial lesions
Yuan, 2014 (41) Methodology Artificial lesions
Wang, 2012 (42) CPP-ACP Intervention during FOA

re-mineralizing agents versus no treatment (natural remineraliza- well-performed clinical trials. The multiple narrative reviews that are
tion) remains a knowledge gap. available on the topic rely mainly on in vitro projects which, needless
to say, cannot adequately reflect or mimic the clinical situation. There
Bleaching were however some study limitations. First of all, only papers pub-
No recent studies concerning bleaching of post-orthodontic WSLs lished in English were accepted. Secondly, we required a minimum of
fulfilled the inclusion criteria. 20 independent subjects, not older than 30 years of age. The rationale
for this was to avoid studies with insufficient power and keep the age
span as homogenous as possible. Thirdly, the 8-week follow-up was a
Micro-abrasion
result of a compromise; we initially selected a minimum of 6 months
One study compared the effects of micro-abrasion (hydrochloric
but realized that important information would be lost in that case.
acid and pumice powder) with normal tooth brushing and found
The most common reasons for exclusion were the use of artificial
that the intervention performed in a superior way over a 6-month
lesions, very short follow-up and inadequate sample size. Thus, future
period (15). The study displayed however a high risk of bias and the
studies must be powered on the number of patients rather than the
quality of evidence was graded as very low (⊕ΟΟΟ).
number of WSL and employ a 1-year follow-up period after debond-
ing. It was not possible to estimate the risk of publication bias through
Resin infiltration a funnel plot due to paucity of included studies.
Two papers based on two split-mouth studies with resin infiltration A primary proactive preventive approach during treatment with
and describing follow-up periods of 8 weeks (17) and 6 months (18) fixed orthodontic appliances, even including early debonding, is of
were included. In one study, the lesions were pre-treated with a fine course best clinical practice. There is evidence of moderate quality to
grit polishing disc before the resin infiltration (17). The findings of suggest that fluoride varnish applications around the bracket base
both papers revealed an immediate improved esthetical appearance can prevent WSL development during treatment with fixed ortho-
of the WSL’s compared with untreated lesions. As only one small dontic appliances (43) but its use, being a high fluoride product, after
study with short follow-up was assessed with low risk of bias (18), debonding has been questioned (44, 45). In general pediatric den-
the evidence for resin infiltration was graded as very low (⊕ΟΟΟ). tistry, there is some evidence of effectiveness to treat early enamel
lesions with topical fluorides (46) but post-orthodontic lesions differ
in location and extent. High concentrations of fluoride may arrest
Discussion
remineralization through surface hyper-mineralization and increase
WSL development is a common side-effect to orthodontic treatment the risk of permanent brown organic staining, which might jeopard-
with fixed appliances and a toolbox for the management after debond- ize the esthetic treatment result. Interestingly, the study by Huang
ing is available for the informed clinician. This is the first review and coworkers (16) did not demonstrate any differences in WSL
investigating several approaches to post-management of WSL. It is improvement between a fluoride varnish application and normal
important to stress that all suggested strategies, including ‘no treat- home care with fluoride toothpaste when assessed by both clinicians
ment’, seem to result in lesion regression or a visual masking of the and lay persons. As natural saliva remineralization and self-applied
lesions (15, 16, 18). This systematic review, including several clinical fluoride toothpaste is the most cost-effective alternative to deal with
methods remineralizing or masking the lesions, was however unable the problem, this strategy must be regarded as the option of choice
to provide scientific support for any superior way to manage the post- in most cases (conditional recommendation). A watchful waiting of
orthodontic WSLs in an evidence-based context due to a paucity of at least 3–6  months after debonding is advocated but the patient

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 120 European Journal of Orthodontics, 2017, Vol. 39, No. 2

must be carefully re-instructed on the optimal use of the fluoride- rescence: a 2-year follow-up. European Journal of Orthodontics, 29, 294–
containing toothpaste twice daily and to avoid excessive rinsing with 298.
water after brushing (47). 7. Shungin, D., Olsson, A.I., Persson, M. (2010) Orthodontic treatment-
related white spot lesions: a 14-year prospective quantitative follow-up,
Micro-abrasion and resin infiltration are invasive and micro-
including bonding material assessment. American Journal of Orthodontics
invasive methods that obviously can camouflage more severe and
and Dentofacial Orthopedics, 138, 136. e1-8; discussion 136–137.
long-standing cases of post-orthodontic WSLs in an effective way.
8. Knösel, M., Attin, R., Becker, K., Attin, T. (2007) External bleaching effect
Both methods are however technique sensitive; the former must on the color and luminosity of inactive white-spot lesions after fixed
be repeated several times, while the latter normally is a single- orthodontic appliances. The Angle Orthodontist, 77, 646–652.
appointment treatment. The question whether or not surplus 9. Heymann, G.C., Grauer, D. (2013) A contemporary review of white spot
etching and/or non-removed bonding material could influence lesions in orthodontics. Journal of Esthetic Restorative Dentistry, 25, 85–
the outcome was only partially addressed in the included papers 95.
but seemed not to be a problem with the infiltration approach 10. Bergstrand, F., Twetman, S. (2011) A review on prevention and treatment
(18). However, since the follow-up period to date is limited to of post-orthodontic white spot lesions - evidence-based methods and
emerging technologies. The Open Dentistry Journal, 5, 158–162.
12  months (27) the long-term success rate is yet unknown. The
11. Higgins, J.P., Altman, D.G., Gøtzsche, P.C., Jüni, P., Moher, D., Oxman,
invasive methods should therefore be used selectively on the most
A.D., Savovic, J., Schulz, K.F., Weeks, L., Sterne, J.A.; Cochrane Bias Meth-
challenging esthetic cases or when the compliance with the advo-
ods Group; Cochrane Statistical Methods Group (2011) The Cochrane
cated homecare is proven insufficient during the first months after Collaboration’s tool for assessing risk of bias in randomised trials. British
debonding. Medical Journal, 343, d5928.
12. Mejàre, I.A., Klingberg, G., Mowafi, F.K., Stecksén-Blicks, C., Twetman,
S.H., Tranæus, S.H. (2015) A systematic map of systematic reviews in
Conclusion pediatric dentistry--what do we really know? Public Library of Science
Based on current literature, there is a lack of reliable evidence to One, 23, 10, e0117537.
13. Guyatt, G., et al. (2011) GRADE guidelines: 1. Introduction-GRADE evi-
support re-mineralizing or camouflaging strategies to manage post-
dence profiles and summary of findings tables. Journal of Clinical Epide-
orthodontic WSLs. Since daily use of fluoride toothpaste cannot be
miology, 64, 383–394.
withdrawn for ethical reasons, this must be considered as best clini-
14. Agarwal, A., Pandey, H., Pandey, L., Choudhary, G. (2013) Effect of fluori-
cal practice. Further well-conducted controlled clinical trials with dated toothpaste on white spot lesions in postorthodontic patients. Inter-
extended long-term follow-up are needed to establish best clinical national Journal of Clinical Pediatric Dentistry, 6, 85–88.
practice. 15. Akin, M., Basciftci, F.A. (2012) Can white spot lesions be treated effec-
tively? The Angle Orthodontist, 82, 770–775.
16. Huang, G.J., Roloff-Chiang, B., Mills, B.E., Shalchi, S., Spiekerman, C.,
Supplementary material Korpak, A.M., Starrett, J.L., Greenlee, G.M., Drangsholt, R.J., Matunas,
J.C. (2013) Effectiveness of MI Paste Plus and PreviDent fluoride varnish
Supplementary material is available at European Journal of
for treatment of white spot lesions: a randomized controlled trial. Ameri-
Orthodontics online.
can Journal of Orthodontics and Dentofacial Orthopedics, 143, 31–41.
17. Senestraro, S.V., Crowe, J.J., Wang, M., Vo, A., Huang, G., Ferracane, J.,
Covell, D.A. Jr (2013) Minimally invasive resin infiltration of arrested
Funding
white-spot lesions: a randomized clinical trial. The Journal of the Ameri-
The project was funded through the authors’ academic institutions. can Dental Association, 144, 997–1005.
18. Knösel, M., Eckstein, A., Helms, H.J. (2013) Durability of esthetic

improvement following Icon resin infiltration of multibracket-induced
Acknowledgements white spot lesions compared with no therapy over 6  months: a single-
The authors are thankful to Ms Hanna Wilhelmsson at the Malmö University center, split-mouth, randomized clinical trial. American Journal of Ortho-
for assisting the literature search. FB was a former consultant of 3M-Unitek, dontics and Dentofacial Orthopedics, 144, 86–96.
Stockholm, Sweden. 19. Du, M., Cheng, N., Tai, B., Jiang, H., Li, J., Bian, Z. (2012) Randomized
controlled trial on fluoride varnish application for treatment of white spot
lesion after fixed orthodontic treatment. Clinical Oral Investigations, 16,
References 463–468.
1. Chapman, J.A., Roberts, W.E., Eckert, G.J., Kula, K.S., González-Cabezas, 20. Vashisht, R., Indira, R., Ramachandran, S., Kumar, A., Srinivasan, M.R.
C. (2010) Risk factors for incidence and severity of white spot lesions (2013) Role of casein phosphopeptide amorphous calcium phosphate in
during treatment with fixed orthodontic appliances. American Journal of remineralization of white spot lesions and inhibition of Streptococcus
Orthodontics and Dentofacial Orthopedics, 138, 188–189. mutans? Journal of Conservative Dentistry: JCD, 16, 342–346.
2. Gorelick, L., Geiger, A.M., Gwinnett, A.J. (1982) Incidence of white spot 21. Chen, H., Liu, X., Dai, J., Jiang, Z., Guo, T., Ding, Y. (2013) Effect of
formation after bonding and banding. American Journal of Orthodontics, remineralizing agents on white spot lesions after orthodontic treatment:
81, 93–98. a systematic review. American Journal of Orthodontics and Dentofacial
3. Mitchell, L. (1992) Decalcification during orthodontic treatment with Orthopedics, 143, 376–382.
fixed appliances–an overview. British Journal of Orthodontics, 19, 199– 22. Raphael, S., Blinkhorn, A. (2015) Is there a place for Tooth Mousse in the
205. prevention and treatment of early dental caries? BMC Oral Health, 15, 13.
4. Tufekci, E., Dixon, J.S., Gunsolley, J.C., Lindauer, S.J. (2011) Prevalence of 23. Baeshen, H.A., Lingström, P., Birkhed, D. (2011) Effect of fluoridated
white spot lesions during orthodontic treatment with fixed appliances. The chewing sticks (Miswaks) on white spot lesions in postorthodontic
Angle Orthodontist, 81, 206–210. patients. American Journal of Orthodontics and Dentofacial Orthopedics,
5. Norevall, L.I., Marcusson, A., Persson, M. (1996) A clinical evaluation 140, 291–297.
of a glass ionomer cement as an orthodontic bonding adhesive compared 24. Ballard, R.W., Hagan, J.L., Phaup, A.N., Sarkar, N., Townsend, J.A., Arm-
with an acrylic resin. European Journal of Orthodontics, 18, 373–384. bruster, P.C. (2013) Evaluation of 3 commercially available materials for
6. Mattousch, T.J., van der Veen, M.H., Zentner, A. (2007) Caries lesions resolution of white spot lesions. American Journal of Orthodontics and
after orthodontic treatment followed by quantitative light-induced fluo- Dentofacial Orthopedics, 143, S78–84.

Downloaded from https://academic.oup.com/ejo/article-abstract/39/2/116/2629532

by Gadjah Mada University user
on 19 August 2018
 M. Sonesson et al. 121

25. Bröchner, A., Christensen, C., Kristensen, B., Tranæus, S., Karlsson, L., 37. Robertson, M.A., Kau, C.H., English, J.D., Lee, R.P., Powers, J., Nguyen,
Sonnesen, L., Twetman, S. (2011) Treatment of post-orthodontic white J.T. (2011) MI Paste Plus to prevent demineralization in orthodontic
spot lesions with casein phosphopeptide-stabilised amorphous calcium patients: a prospective randomized controlled trial. American Journal of
phosphate. Clinical Oral Investigations, 15, 369–373. Orthodontics and Dentofacial Orthopedics, 140, 660–668.
26. Caglaroglu, M., Gelgor, I.E. (2012) Microabrasion technique for treat- 38. Rocha Gomes Torres, C., Borges, A.B., Torres, L.M., Gomes, I.S., de

ment of demineralization after debonding. Journal of Clinical Orthodon- Oliveira, R.S. (2011) Effect of caries infiltration technique and fluoride
tics, 46, 734–737. therapy on the colour masking of white spot lesions. Journal of Dentistry,
27. Eckstein, A., Helms, H.J., Knösel, M. (2015) Camouflage effects following 39, 202–207.
resin infiltration of postorthodontic white-spot lesions in vivo: one-year 39. Yetkiner, E., Wegehaupt, F., Wiegand, A., Attin, R., Attin, T. (2014) Col-
follow-up. The Angle Orthodontist, 85, 374–380. our improvement and stability of white spot lesions following infiltra-
28. Hammad, S.M., El Banna, M., El Zayat, I., Mohsen, M.A. (2012) Effect of tion, micro-abrasion, or fluoride treatments in vitro. European Journal of
resin infiltration on white spot lesions after debonding orthodontic brack- Orthodontics, 36, 595–602.
ets. American Journal of Dentistry, 25, 3–8. 40. Yim, H.K., Min, J.H., Kwon, H.K., Kim, B.I. (2014) Modification of sur-
29. Jahanbin, A., Ameri, H., Shahabi, M., Ghazi, A. (2015) Management of face pretreatment of white spot lesions to improve the safety and efficacy
Post-orthodontic White Spot Lesions and Subsequent Enamel Discolora- of resin infiltration. Korean Journal of Orthodontics, 44, 195–202.
tion with Two Microabrasion Techniques. Journal of Dentistry (Shiraz), 41. Yuan, H., Li, J., Chen, L., Cheng, L., Cannon, R.D., Mei, L. (2014) Esthetic
16, 56–60. comparison of white-spot lesion treatment modalities using spectrometry
30. Kim, S., Kim, E.Y., Jeong, T.S., Kim, J.W. (2011) The evaluation of resin and fluorescence. The Angle Orthodontist, 84, 343–349.
infiltration for masking labial enamel white spot lesions. International 42. Wang, J.X., Yan, Y., Wang, X.J. (2012) Clinical evaluation of remineraliza-
Journal of Paediatric Dentistry, 21, 241–248. tion potential of casein phosphopeptide amorphous calcium phosphate
31. Krithikadatta, J., Fredrick, C., Abarajithan, M., Kandaswamy, D. (2013) nanocomplexes for enamel decalcification in orthodontics. Chinese Medi-
Remineralisation of occlusal white spot lesion with a combination of 10% cal Journal, 125, 4018–4021.
CPP-ACP and 0.2% sodium fluoride evaluated using Diagnodent: a pilot 43. Benson, P.E., Parkin, N., Dyer, F., Millett, D.T., Furness, S., Germain, P.
study. Oral Health & Preventive Dentistry, 11, 191–196. (2013) Fluorides for the prevention of early tooth decay (demineralised
32. Milly, H., Festy, F., Watson, T.F., Thompson, I., Banerjee, A. (2014) Enamel white lesions) during fixed brace treatment. The Cochrane Database of
white spot lesions can remineralise using bio-active glass and polyacrylic Systematic Reviews, 12, CD003809.
acid-modified bio-active glass powders. Journal of Dentistry, 42, 158–166. 44. Øgaard, B. (2008) White spot lesions during orthodontic treatment:

33. Neuhaus, K.W., Graf, M., Lussi, A., Katsaros, C. (2010) Late infiltration of mechanisms and fluoride preventive aspects. Seminars in Orthodontics,
post-orthodontic white spot lesions. Journal of Orofacial Orthopedics, 71, 14, 183–193.
442–447. 45. Willmot, D. (2008) White spot lesions after orthodontic treatment. Semi-
34. Paris, S., Schwendicke, F., Keltsch, J., Dörfer, C., Meyer-Lueckel, H. (2013) nars in Orthodontics, 14, 209–219.
Masking of white spot lesions by resin infiltration in vitro. Journal of Den- 46. Lenzi, T.L., Montagner, A.F., Soares, F.Z., De Oliveira Rocha, R. (2015)
tistry, 41, 28–34. Are topical fluorides effective for treating carious lesions?: a systematic
35. Pliska, B.T., Warner, G.A., Tantbirojn, D., Larson, B.E. (2012) Treat-
review and meta-analysis. The Journal of the American Dental Associa-
ment of white spot lesions with ACP paste and microabrasion. The Angle tion, Pii:S0002–8177.
Orthodontist, 82, 765–769. 47. Pitts, N., Duckworth, R.M., Marsh, P., Mutti, B., Parnell, C., Zero, D.
36. Poosti, M., Ahrari, F., Moosavi, H., Najjaran, H. (2014) The effect of (2012) Post-brushing rinsing for the control of dental caries: explora-
fractional CO2 laser irradiation on remineralization of enamel white spot tion of the available evidence to establish what advice we should give our
lesions. Lasers in Medical Science, 29, 1349–1355. patients. British Dental Journal, 212, 315–320.

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