WHITE SPOT LESIONS AFTER ORTHODONTIC TREATMENT, DIAGNOSTIC METHODS AND QUANTITATIVE LIGHT-INDUCED FLUORESCENCE (QLF)

Abstract

The fixed appliances used in orthodontic treatment cause the patient to hardly maintain oral hygiene procedures. This is the reason that demineralization is more common in orthodontic patients than normal population. White spot lesions are early caries lesions that indicate demineralization. White spot lesions are non cavitated areas of decalsification that occur as a result of the reduction in the mineral density by prolonged plaque accumulation on the affected surface and are limited to enamel but have a more porous surface than the sound enamel. White spot lesions are the first phase of caries formation and they can remineralize and have a normal or at least acceptable appereance after the orthodontic treatment. However, some of the lesions don’t remineralize and look aesthetically undesirable or can form cavities when left untreated. Thus, it is important to diagnose white spot lesions early, prevent their development and choose the proper treatment. There are various methods for the diagnosis of white spot lesions. Altough the visual method, radiographic method are the most widely known ones, there are current methods like direct digital radiography, electrical conductivity measurement, fiber optic transillumination, ultrasound, alternating current impedance spectroscopy, laser fluorescence, quantitative light induced fluorescence (QLF). This review gives information about white spot lesions, the effect of the orthodontic treatment in white spot formation, diagnostic methods and Quantitative lightinduced fluorescence (QLF)

Keywords

• White spot lesions,demineralization,QLF

ORTODONTİK TEDAVİYLE OLUŞAN BEYAZ NOKTA LEZYONLARI, TEŞHİS YÖNTEMLERİ VE KANTİTATİF IŞIK ETKİLİ FLORESANS (QLF)

Abstract

Sabit ortodontik tedavide kullanılan apareyler, hastaların oral hijyen prosedürlerini devam ettirmesini zorlaştırır. Bu nedenle sabit ortodontik tedavi gören hastalarda demineralizasyonların görülme sıklığı, tedavi görmeyen bireylere oranla artmaktadır. Beyaz nokta lezyonları, oluşan demineralizasyonların göster- gesi olarak ortaya çıkan başlangıç çürük lezyonlarıdır. Etkilenen yüzeyde uzamış plak birikimi sonucunda oluşan beyaz nokta lezyonları, mine ile sınırlı fakat yüzeyi sağlıklı mineden daha pöröz yapıda olan, mineral yoğunluğunun azalmasıyla meydana gelen ve kavitasyon göstermeyen dekalsifikasyon alanlarıdır. Çürük oluşumunun ilk safhası olan beyaz nokta lez- yonları, ortodontik tedaviden sonra remineralize ola- bilir, normal ya da en azından kabul edilebilir bir görü- nüme sahip olabilir. Ancak bazı lezyonlar remineralize olmaz ve estetik olarak istenmeyen bir görüntü oluşturabilir veya tedavi edilmediklerinde ilerleyip kavitasyon oluşturabilir. Bu nedenle bu lezyonları erken dönemde tespit ederek, ilerlemesini önlemek ve doğru tedaviyi seçmek önemlidir. Beyaz nokta lezyonlarının teşhis edilmesi için birçok yöntem vardır. Bunlardan en bilinenleri görsel yöntem, ayna-sondla muayene ve radyografik yöntem olmakla beraber direkt dijital radyografi, elektriksel iletkenlik ölçümü, fiber optik transillüminasyon, sonografi, alternatif akım empedans spektroskopi, lazer floresans, kantitatif ışık etkili floresans (QLF) gibi güncel metodlar da mevcuttur. Bu derlemede beyaz nokta lezyonları, oluşumlarında ortodontik tedavinin etkisi, teşhis metodları ve teşhis metodlarından biri olan Kantitatif Işık Etkili Floresans (QLF) hakkında bilgi verilmektedir.

Keywords

• Beyaz nokta lezyonları, demineralizasyon, QLF

References

1. Mizrahi E. Enamel demineralization following orthodontic treatment. Am J Orthod 1982; 82: 62- 7.
2. Arends J, Christoffersen J. The nature of early caries lesions in enamel. J Dent Res 1986; 65: 2- 11.
3. Le Geros RZ. Chemical and crystallographic events in the caries process. J Dent Res 1990; 69: 567- 74.
4. Mellberg JR, Ripa LW. Formation of dental caries. In Fluoride in Preventive Dentistry. Theory and Clinical Applications. Chicago, Quintessence Publishing Co 1983; 15-40.
5. Øgaard B, Rolla G, Arends J. Orthodontic appliances and enamel demineralization. Part 1: Lesion development. Am J Orthod 1985; 94: 68- 73.
6. Bishara SE, Ostby AW. White spot lesions: formation, prevention, and treatment. Semin Orthod 2008; 14: 174-82.
7. Chatterjee R, Kleinberg I. Effect of orthodontic band placement on the chemical composition of human incisor tooth plaque. Arch Oral Biol 1979;
8. Bloom RH, Brown LR. A study of the effects of orthodontic appliances on the oral microbial flora. Oral Surg 1964; 17: 658-67.

9. Balensefien JW, Madonia JV. Study of dental plaque in orthodontic patients. J Dent Res 1970; 49: 320-4.
10. Lundstrom F, Krasse B. Streptococcus mutans and lactobacilli frequency in orthodontic patients; the effect of chlorhexidine treatments. Eur J Orthod 1987; 9: 109-16.
11. Øgaard B. Prevalence of white spot lesions in 19- year olds: a study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod 1989; 96: 423-7.
12. O’Reilly M, Featherstone J. Demineralisation and remineralisation around orthodontic appliances-an in vivo study. Am J Orthod 1987; 92: 33-40.
13. Gorelick L, Geiger AM, Gwinnet AJ. Incidence of white spot formation after bonding and banding. Am J Orthod 1982; 81: 93-8.
14. Vorhies AB, Donly KJ, Staley RN, Wefel JS. Enamel demineralization adjacent to orthodontic brackets bonded with hybrid glass ionomer cements: an in vitro study. Am J Orthod 1998; 114: 668-74.
15. Øgaard B. White spot lesions during orthodontic treatment: mechanisms and fluoride preventive aspects. Semin Orthod 2008; 14: 183-93.
16. Artun J, Thylstrup A. A clinical and scanning electron microscopic study of surface changes of incipient caries lesions after debonding. Scand J Dent Res 1968; 94: 193-201.
17. Benson P. Evaluation of white spot lesions on teeth with orthodontic brackets. Semin Orthod 2008; 14: 200-8.
18. Ekstrand KR, Ricketts DN, Kidd EA. Reproducibility andaccuracy of three methods for assessment of demineralizationdepth of the occlusal surface: an in vitro examination. Caries Res 1997; 31: 224-31.
19. Ekstrand K, Qvist V, Thylstrup A. Light microscope study of the effect of probing in occlusal surfaces. Caries Res 1987; 21: 368-74.
20. Hintze H, Wenzel A. Clinically undetected dental caries assessed by bitewing screening in children with little caries experience. Dentomaxillofac Radiol 1994; 23: 19-23.
21. Weerheijm KL, Groen HJ, Bast AJ, Kieft JA, Eijkman MA, van Amerongen WE. Clinically undetected occlusal dentine caries: a radiographic comparison. Caries Res 1992; 26: 305-9. 22. Herbert
22. H.Frommer.:Radiology for dental
23. auxillieries 7th edn, Mosby, New York. 2001; 267- 71.
24. Verdonschot EH, Kuijpers JM, Polder BJ, De Leng- Worm MH, Bronkhorst EM. Effects of digital grey- scale modification on the diagnosis of small approximal carious lesions. Journal of Dentistry 1992; 20: 44-9
25. Per Axelson Diagnosis and Risk Detection of Dental Caries. Quintessence Pub Germany 2000; 179-247.
26. Cochrane NJ, Saranathan S., Cai F, Cross KJ, Enamel Reynolds Remineralisation with Casein Phosphopeptide Stabilised Solutions of Calcium, Phosphate and Fluoride. Caries Res 2008; 42: 88-97 Lesion 26. Bocutoğlu Ö, Harorlı A. Diş hekimliği radyolojisindeki yeni gelişmeler. Atatürk Üni Diş Hek Fak Derg 1993; 3: 45-6.
27. Huysmans M, Longbottom C, Pitts N. Electrical methods in occlusal caries diagnosis: An in vitro comparison with visual inspection and bite-wing radiography. Caries Res 1997; 32: 324-9.
28. Lussi A, Imwinkelried S, Pitts N, Longbottom C, Reich E. Performance and reproducibility of a laser fluorescence system for detection of occlusal caries in vitro. Caries Res 1999; 33: 261-6.
29. Friedman J. Marcus MI Transillumination of the oral cavity with the use of fiberoptics JADA 1970; 80: 801-9.
30. Basting RT, Serra MC. Occlusal caries: Diagnosing and noninvasive treatments. Quint Int 1999; 30: 174-8.
31. Lussi A. Comparision of different methods for diagnosis of fissurecaries cavitation. Caries Res 1993; 27: 409-16.
32. Angmar- Manson B, Bosch JJ. Advances in methods for diagnosing coronal caries- a review. Adv Dent Res 1993; 7: 70-9.
33. Stookey GK, Jackson RD,Ferreira Zandona AG,Analoui M.:Dental caries diagnosis. Dent Clin North Am 1999; 43: 665-77
34. Ersöz E., Oktay N.:Alternatif çürük teşhis yöntemleri. Atatürk Üni Diş Hek Fak Derg 2002; 12: 56-63.
35. Longbottom C, Huysmans MC, Pitts NB, Los P, Bruce PG. Detection of dental decay and its extent using a.c. impedance spectroscopy. Nat Med 1996; 2: 235-7
36. Schneiderman A, Elbaum M, Schultz T.: Assesment of dental caries with DIFOTI: In vitro study. Caries Res 1997; 31: 103-10.
37. Ng SY, Ferguson MWJ, Payne PA, Slater P. Ultrasonic studies of unblemished and artificially demineralized enamel in extracted human teeth, A new method for detecting early caries. J Dent 1988; 16: 201-9.
38. Çalışkan Yanıkoğlu F, Ozturk F, Hayran O, Analoui M, Stookey GK.Detection of natural white spot lesions by an ultrasonic system. Caries Res 2000; 34: 225-32.
39. Korkut B, Tağtekin DA, Yanıkoğlu FÇ. Diş çürüklerinin erken teşhisi ve teşhiste yeni yöntemler: QLF, Diagnodent, elektriksel iletkenlik ve ultrasonik sistem. Ege Üniversitesi Diş Hekimliği Fakültesi Dergisi 2011; 32: 55-67.
40. Bjelkhagen H,Sundstrom F,Angmar-Mansson
41. B.:Early detection of enamel caries by the
42. luminiscence excited by visible light.Sweed Dent
43. 6:1-7,1982. In Stookey GK,Jackson RD,Ferreira
44. Zandona AG and Analoui M.Dental caries
45. diagnosis. Dent Clin North Am 1999; 43: 665-77.
46. Lussi A, Megert B, Longbottom C, Reich E, Francescut P. Clinical performance of a laser fluorescence device for detection of occlusal caries lesions. Eur J Oral Sci 2001; 109: 14–9.
47. Hafstrom-Bjorkman A.:Comparison longitudinal microradiography for quantative assesment of in vitro enamel caries. Caries Res 1992; 26: 241-7. F,Josselin of flourescence and
48. Angmar-Mansson B, Al-khateebj, Traneus J. Caries diagnosis. J. Dent Educ 1998; 62: 771-9.
49. Lussi A, Hibst R, Paulus R. DIAGNOdent: An optical method for caries detection. J Dent Res 2004; 83: 80-3.
50. Ferreira Zandona AG, Isaacs RL, van der Veen MH, Stookey GK. Indiana pilot clinical study of quantitive light fluorescence, in Early Detection of Dental Caries II: Proceedings of the 4th Annual Indiana Conference, Stookey GK, Editor, Indiana University School of Dentistry: Indianapolis, Ind. USA 2000; 219-30.
51. Heinrich-Weltzien R, Küsnisch J, van der Veen MH, de Josselin de Jong E. Quantitive light-induced fluorescence (QLF) – A potential method for the dental practitioner. Quintessence International 2003; 34: 181-8.
52. König K, Hibst R, Meyer H, Flemming G, Schneckenburger H, "Laser-induced autofluores- cence of carious regions of human teeth and caries-involved bacteria," Dental Applications of Lasers 1993; 2080: 170-80.
53. Lennon AM, Buchalla W, Brune L, Zimmermann O, Gross U, Attin T, "The ability of selected oral microorganisms to emit red fluorescence," Caries Research 2006; 40: 2-5.
54. Coulthwaite L, Pretty IA, Smith PW, Higham SM, Verran J, "Qlf is not readily suitable for in vivo denture plaque assessment," J Dent 2009; 39: 898-901.
55. Van der Veen MH, Buchalla W and de Josselin de Jong E, "QLF™ Technologies: Recent Advances," in Early Detection of Dental Caries III: Proceedings of the 6th Indiana Conference. Stookey GK (ed.), Indianapolis, IN, USA, 2003.
56. Kambara M, Uemura M and Doi T, "Results of clinical trial of fluoride dentifrices using QLF," in Early Detection of Dental Caries III: Proceedings of the 6th Indiana Conference. Stookey GK (ed.), Indianapolis, IN, USA, 2003.
57. Shi XQ, Tranaeus S and Angmar-Månsson B, "Clinical Caries Studies using QLF," in Early Detection of Dental Caries III: Proceedings of the 6th Indiana Conference. Stookey GK (ed.), Indianapolis, IN, USA, 2003.
58. Gonzalez-Cabezas C, Fontana M, Gomes- Moosbauer D and Stookey GK, "Early detection of secondary caries using quantitative, light-induced fluorescence," Oper Dent 2003; 28: 415-22. Parisius pedodontology, Quality Practice 2011; 3: 42-5.
59. Van der Veen MH, Mattousch T, Boersma JG, " Longitudinal development of caries lesions after orthodontic treatment evaluated by quantitative light-induced fluorescence," Am J Orthod 2007;