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Abstract
Objective of ResearchTo compare the incidence and the severity of White Spot Lesions among clear aligners, self-ligating and conventional orthodontic brackets appliance systems after 9 and 18 months of orthodontic treatment in a randomized clinical trial.
Review of LiteratureRecently, the orthodontic patient population has expanded dramatically to include not only children and adolescents, but also adults. Such increase comes with a parallel trend in the demand of an aesthetic alternative to conventional fixed appliances. Apart from their unaesthetic appearance, conventional braces do have other negative issues such as compromising the ability of the patient to perform and maintain optimal oral hygiene, increased risk of periodontal breakdown as a result of plaque build-up, increased risk of root resorption, increased risk of white spot lesions, and the need of multiple follow-up visits as to reactivate and adjust the appliance. Of course, all these drawbacks of treatment are also major dentolegal concern for the operating practitioner. Perhaps white spot lesions “also known as early enamel caries or demineralization” are the most common iatrogenic side effect, among the aforementioned, of orthodontic treatment with highly variable occurrence reported in the literature ranging from 2-96%. According to Øgaard (1989), patients receiving fixed orthodontic treatment are more prone to white spot lesions as compared to those receiving no fixed appliances.
Orthodontic appliances including bands, brackets, and arch wires act as plaqueretentive factors hence increasing the chance plaque accumulation. Subsequently, the level of Streptococcus mutans,a cariogenic bacterium, rises in the oral environment. The presence of such species results in a constant lowering of the pH level of the oral cavity hence impairing the remineralization process while enhancing the demineralization of the tooth tissue. If such process continues for four weeks, then white spot lesions could be detected on the clinical level. Therefore, it seems logical that the reduction of plaque build-up would directly influence the development of white spot lesions.
Self-ligating brackets and clear aligner therapy are more recent advents in the field orthodontics when compared the conventional brackets. Manufacturers of these two different appliances claim that plaque retention is reduced in an attempt to address some of iatrogenic damage associated with conventional braces. Nonetheless, such claims are not based on strong clinical evidence. Currently, most of these assertions are based on case reports, case series, surveys, anecdotal reports and retrospective studies. In a pilot study, self-ligating brackets have been shown to reduce plaque retention when compared to conventional brackets 5-week post-treatment. After one-year follow-up of the same patients, neither plaque level nor white spot lesions showed statistical significance in the two different bracket types. However, the follow up study was weak with a sample size of 13 patients only.
