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Comparative evaluation of four treatments for postorthodontic white spot lesions: a randomized controlled trial

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Abstract

Objectives

To evaluate the treatment efficacy of fluoride toothpaste alone and those of adjunctive use of resin infiltration, sodium fluoride varnish, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on white spot lesions (WSLs).

Materials and methods

Seventy-nine patients (356 teeth) with WSLs after orthodontic treatment were randomly allocated into four groups. The WSLs of the participants received resin infiltration only at baseline, and the other groups received fluoride varnish, CPP-ACP mousse, and placebo treatment every 6 months, respectively. A toothpaste containing 1400 ppm fluoride and toothbrushes were distributed to all participants, and oral hygiene instructions were provided. Photos of the teeth with WSL were taken to compare the change between groups which was measured by ImageJ software.

Results

Twelve months later, different degrees of reduction in the area of WSLs were observed in all groups. The percentage of lesion area reduction in WSLs in the resin infiltration group was 46.6%, which was significantly higher than that in fluoride varnish group (26.6%), CPP-ACP group (28.6%), and control group (29.8%), and the differences were statistically significant (p < 0.001).

Conclusions

This study shows that after 1-year follow-up, the use of fluoride toothpaste, with or without the use of fluoride varnish or CPP-ACP, can reduce the area of WSLs. While resin infiltration can immediately improve dental aesthetics and continuously improved in 12 months, resin infiltration group showed much better results than other groups.

Trial registration

Clinical Trials Registration Number: ChiCTR2000032516.

Clinical significance

The use of fluoride toothpaste, with or without adjunctive use of fluoride varnish and CPP-ACP, can reduce the area of WSLs, while resin infiltration treatment has additional effect and can immediately improve dental aesthetics.

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Data availability

The data that support the findings of this study are available from the corresponding author, Qinghui Zhi, upon reasonable request.

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Funding

This study was supported by First Class Hospital Clinical Trial Project in Guangdong Province (103007–6-2019-GSP-D).

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Authors and Affiliations

  1. Hospital of Stomatology, Sun Yat-Sen University, No. 56, Lingyuan Xi Road, Guangzhou, 510055, China

    Qiqiu Wang, Yang Zhou & Qinghui Zhi

  2. Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-Sen University, Guangzhou, China

    Qiqiu Wang, Yang Zhou & Qinghui Zhi

  3. Foshan Stomatological Hospital & School of Medicine, Foshan University, Foshan, China

    Tianqiang Cui

  4. School of Stomatology, Stomatological Hospital, Southern Medical University, Guangzhou, China

    Jianbo Li

  5. Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, China

    E. C. M. Lo

  6. Oral Disease Prevention Center of Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, China

    Gaofeng Hao

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  1. Qiqiu Wang
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Contributions

Dr. Qinghui Zhi and Dr. Gaofeng Hao designed the study and revised the manuscript. Dr. Qiqiu Wang and Dr. Yang Zhou carried out the clinical trial, organized the data, and wrote the first draft of the manuscript, Dr. Tianqiang Cui and Dr. Jianbo Li helped perform clinical trial implementation and facilitated constructive discussions. Prof. ECM Lo contributed significantly to protocol modification. All authors reviewed the manuscript.

Corresponding authors

Correspondence to Gaofeng Hao or Qinghui Zhi.

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Competing interests

The authors declare no competing interests.

Ethics 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. This clinical study was approved by the Ethics Committee of the Stomatological Hospital of Sun Yat-Sen University (KQEC-2020–01), and registered with the Chinese Clinical Trials Register (ChiCTR2000032516).

Informed consent

Written informed consent was obtained from all patients before they were included in the study.

Conflict of interest

The authors declare no competing interests.

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Qiqiu Wang and Yang Zhou contributed equally to this work.

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Wang, Q., Zhou, Y., Cui, T. et al. Comparative evaluation of four treatments for postorthodontic white spot lesions: a randomized controlled trial. Clin Oral Invest 27, 5957–5968 (2023). https://doi.org/10.1007/s00784-023-05209-6

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  • DOI: https://doi.org/10.1007/s00784-023-05209-6

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