Clinical Oral Investigations

, Volume 23, Issue 2, pp 863–872 | Cite as

Remineralization capacity of carious and non-carious white spot lesions: clinical evaluation using ICDAS and SS-OCT

  • Yuichi KitasakoEmail author
  • Alireza Sadr
  • Yasushi Shimada
  • Masaomi Ikeda
  • Yasunori Sumi
  • Junji Tagami
Original Article



To assess the remineralization capacity of carious, non-carious, and combined white spot lesions (WSLs) using the ICDAS and SS-OCT.

Materials and methods

This clinical trial was based on a quasi-experimental design. Forty-two healthy subjects (median age 26.6 years), who visited university hospital and had at least one WSL with an ICDAS score of 2 or 1, were recruited. The subjects chewed a non-blind sugar-free gum containing bioavailable calcium and fluoride for 3 months. The remineralization capacities of carious and non-carious 121 WSLs were assessed using ICDAS by two calibrated non-blind examiners and optical boundary depth (BD) by SS-OCT at a monthly recall. The outcome variables, transitions of ICDAS score, mean BD, and mean BD recovery rate (RR%), were statistically analyzed using the chi-square test, two way-repeated measures ANOVA, and Wilcoxon rank sum test, respectively (alpha = 0.05).


Based on the visual inspection, OCT images at the baseline, 72 WSLs were purely carious, 20 were non-carious (developmental) lesions, while 29 were combined (carious-developmental). The responses of WSLs over time showed to be highly variable. There was a significant difference in transitions of ICDAS scores after 3 months between carious and non-carious WSLs (p < 0.05) and non-carious and combined WSLs (p < 0.05). Carious and combined WSLs underwent significant changes in the mean BD between baseline (161.8 ± 56.8 μm) and 2 months (130.7 ± 57.4 μm) or 3 months (119.1 ± 57.5 μm) (p < 0.05), while there was no significant difference between baseline (132.2 ± 26.2 μm) and 2 months (122.8 ± 24.1 μm) or 3 months (119.8 ± 22.6 μm) in non-carious WSLs (p > 0.05). There was a significant difference in mean RR% after 2 and 3 months between carious and non-carious WSLs (p < 0.05).


The remineralization capacity of WSL was variable among the cases and subjects, and depended on the WSLs history, etiology (carious, non-carious, or combined lesion) and structure (histological pattern).

Clinical relevance

Carious WSLs showed the highest remineralization potential.


Enamel White spot lesion Clinical trial Remineralization OCT 



The authors would like to thank all individual participants who took part in this study.


This study was funded by a Grant-in Aid for Scientific Research (grant number 16K11541) from the Japan Society for the Promotion of Science (JSPS).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Yuichi Kitasako
    • 1
    • 2
    Email author
  • Alireza Sadr
    • 3
  • Yasushi Shimada
    • 4
  • Masaomi Ikeda
    • 5
  • Yasunori Sumi
    • 6
  • Junji Tagami
    • 1
  1. 1.Cariology and Operative Dentistry, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
  2. 2.Dental clinic, Ministry of Foreign AffairsTokyoJapan
  3. 3.Biomimetics Biomaterials Biophotonics & Technology Laboratory, Department of Restorative DentistryUniversity of Washington School of DentistrySeattleUSA
  4. 4.Department of Operative Dentistry, Graduate school of Medicine and DentistryOkayama UniversityOkayamaJapan
  5. 5.Oral Prosthetic Engineering, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
  6. 6.Department of Advanced Medicine, National Hospital for Geriatric MedicineNational Center for Geriatrics and GerontologyObuJapan

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