Table 1 Characteristics of the 20 studies selected for this review
From: White spot lesions: diagnosis and treatment – a systematic review
Author | Study design | Type of participants | Nr of subjects | Age of participants | Intervention time | Diagnostic | Treatment | Outcomes | Conclusions |
|---|---|---|---|---|---|---|---|---|---|
Sedlakova Kondelova et al., 2020 [18] | RCT | Patients presenting 2 teeth with WSLs | 44 | 27 | 3 months | Clinical photographs | SAP P11-4 | SAP P11-4 lesions showed significant WSL size reduction compared to FV alone | Treatment of early buccal carious lesions with SAP P11-4 led to superior regression of caries decay compared to either placebo or FV |
Senestraro et al., 2013 [19] | RCT | Orthodontic patients | No information | No information | 8 weeks | Clinical photographs | RI | The results for treated teeth showed a mean reduction in WSL area of 61.8% immediately after treatment and 60.9% eight weeks later | Resin infiltration significantly improved the clinical appearance of WSLs |
Ciftci et al., 2018 [20] | RCT | No information | No information | No information | 3 months | Visual | RI, FV | A significant decrease in DIAGNOdent Pen scores was observed in all the groups | The RI application was more successful than FV on WSLs |
Hadler-Olsen et al., 2012 [21] | Cross-sectional | Orthodontic patients | 80 | 12-16 | 18 months | Visual | Home care | 23% of treated patients showed good compliance, 68% moderate compliance, and 9% poor compliance. | Individuals with good adherence developed fewer new WSLs than individuals with poor adherence |
Kirschneck et al., 2016 [22] | RCT | Adolescent orthodontic patients | 90 | No information | 20 weeks | Visual | Elmex® fluid and Fluor Protector S | Each treatment group showed a significant increase of the ICDAS index | A one-time application of FV at the start of orthodontic treatment did not provide any additional preventive advantage |
Huang, et al. 2013 [23] | RCT | Orthodontic patients | 115 | 12-20 | 8 weeks | Visual | MI paste plus, FV | The objective improvements in the affected surface were 16, 25 and 17% in the MI Paste Plus, fluoride varnish and control groups, respectively | MI Paste Plus and FV do not appear to be more effective than normal home care for improving the appearance of white spot lesions over an 8-week period. |
Hammad et al., 2012 [24] | Longitudinal | Orthodontic patients | 18 | No information | No information | Visual | RI | Results after Icon application showed that around 65-76% of the surface area of the WSLs was masked | The masking effect depends on lesions depths |
Krithikadatta et al., 2013 [25] | RCT | Patients with occlusal WSLs | 45 | No information | 30 days | Visual | CPP-ACP, CCP-ACP with fluoride, NaF mouthwash | All three remineralising agents heal WSL | All three remineralising agents heal WSL. |
Bock et al., 2017 [26] | RCT | Orthodontic patients | 39 | No information | 24 weeks | Visual | Fluoride gel | No statistically significant group difference existed | No significant positive effect of high-dose fluoride on post-orthodontic WSL development could be detected |
Rechmann et al., 2018 [27] | RCT | Orthodontic patients | 37 | No information | 12 months | Visual | MI paste plus, MI varnish | Salivary fluoride levels were significantly higher at 12 months for the experimental than for the control group | Applying daily MIPP and quarterly MIV resulted in no statistically significant differences in ICDAS |
Roig-Vanaclocha et al., 2020 [28] | Cross- sectional | No information | No information | No information | No information | Visual | HCL | When each application was evaluated with the initial situation of the untreated tooth, we observed that 6.6% HCl removes more enamel than 15% HCl | Both HCl-based products are adequate options for treating white spot lesions |
Giray et al., 2018 [29] | GRCT | WSLs on permanent teeth in children | 23 | 8-14 | 6 months | Visual and fluorescence | RI, FV | The values of the RV group were statistically lower than those of the FV group | RI and FV are clinically feasible and efficacious methods for the treatment of anterior WSLs |
Marouane et al., 2021 [30] | Cross- sectional | Patients with MIH lesions on permanent anterior teeth | No information | No information | No information | Fluorescence | RI | A non-linear correlation was observed indicating that the IPx was rapid at the beginning of resin application, decreasing over time | MIH-lesion type and the ‘ethanol test’ were reliable predictive factors for the application time needed for infiltrating MIH lesions on permanent anterior teeth |
Marouane et al., 2020 [31] | Case report | Patients with enamel opacities related to MIH | No information | No information | 1 week | Fluorescence | RI | The lesions showed a clearly improved esthetic integration and had almost disappeared | Transillumination was also reliable in monitoring the progression of the infiltration until complete saturation of the porous enamel |
Sezici et al., 2020 [32] | Cross- sectional | Orthodontic patients | 57 | No information | No information | Fluorescence | RI | Fluorescence of WSLs improved significantly following infiltration treatment in both groups | Immediate infiltration of clinically diagnosed WSLs can be the primary choice of treatment in orthodontic patients with poor oral hygiene and low remineralization expectancy |
Tassery et al., 2013 [33] | Cross- sectional | Patients with carie | No information | No information | No information | Fluorescence | RI | The objectives of preserving the natural tooth structure are achieved | Combining the ultraconservative, restorative approach with a substantial caries risk assessment and caries management with remineralization programme may provide therapeutic benefits |
Kabaktchieva et al., 2014 [34] | Longitudinal | Patients with carie | No information | No information | 1 year | Fluorescence | RI | The lesion progression could be detected very precisely. When the demineralization is slight Icon fills all the pores in the body of the lesion and the camera detects sound tissues | LIF method applied with SoproLife camera is more accurate than visual examination. LIF method for single tooth is more accurate in following up the effect of non-operative treatment of smooth surfaces lesions than using digital images. ICON is a material that stops the progression of non-cavitated smooth surfaces carious lesions and make the aesthetic result better |
Perrini et al., 2016 [35] | RCT | Orthodontic patients | 24 | No information | No information | DIAGNOdent | FV | The varnished anterior teeth showed a statistically significant reduction in demineralization compared with their unvarnished counterparts | Periodic application of FV can offer some protection against WSLs, but not to a statistically significant degree if the patients have excellent oral hygiene |
Du et al., 2012 [36] | RCT | Orthodontic patients | 110 | 12-22 | 6 months | DIAGNOdent | FV | There was statistically significant differences between the mean DD readings of the two groups at the 3-month (P < 0.05) and at the 6-month follow-up visits (P < 0.01). | Topical FV application is effective in reversing WSLs after debonding and should be advocated as a routine caries prevention measure after orthodontic treatment |
Aykut-Yetkiner et al., 2014 [37] | RCT | Children exhibiting at least 1 WSL | 60 | No information | 3 months | DIAGNOdent | CPP-ACP | In both groups, the mutans counts were decreased | CPP-ACP had a slight remineralization effect on the WSL |