Decalcification of enamel surface after orthodontic treatment

Daniel Ziskind Israel

Volume 1, Number 1 November 2002

Decalcification of enamel surface after removing the orthodontic appliance may present a serious esthetic problem. (1) Any condition between incipient to severe caries lesion can be expected. Active caries presents the severe case, whereas white spot present mainly an esthetic problem. Prevention is as always, the best option. It was found that cement type and surface area appear to influence cumulative fluoride release characteristics after 30 days. (2) However, the effect of fluoride releasing orthodontic adhesives seems to be effective only in the short term. (3) The esthetic treatment of this uninvited condition should be performed in a progressive treatment approach. Prior to any treatment, the control over possible caries activity should be achieved. Mouth rinsing with fluoride solution should be administrated in order to support a desirable remineralization process of the affected area.

Bleaching is the first choice for treatment of a small white spot (fig 1a,b). Lightening the unaffected enamel around the affected area will mask the white defect. The oxidizing process takes place due to water peroxide breakdown in a combined photo and anionic dissociation mechanism. Accelerating the chemical reaction and enhancing the penetration into the tooth structure can be achieved by adding light and heat to the equation. It was found that; short-arc plasma lamp emitting light in the range of 400-505nm significantly lightened the color of teeth. More then that, the authors also concluded that the light appear to have tooth-whitening effect by itself (4).

Fig 1:  White spots before(a) and after (b) tooth whitening with combination of
peroxide and light. Lightening the unaffected enamel around the affected area
will mask the white defect. Pay attention to the white spot in the arrow area.

The use of laser energy is relatively novel approach for whitening teeth. This method presents some advantages over other methods. The procedure can be completed in a single appointment enabling the dentist to focus the bleaching procedure on single tooth or even a selected

part of a tooth. Grinding out the surface using a fine diamond bur or applying the microabrasion technique can treat persistent esthetic problem. However, these methods are useful in cases of shallow white spot lesion. Using an abrasive medium in combination with the bleaching agent might damage the labial surface (fig 2). 

Conservative restoration, Laminates and Crowns using Composite resin or Ceramic materials will provide the final solution.

Fig 2: The prognosis of the microabrasion
method is determined by the depth of the
white spot lesion (White triangle)

References:

1. Ogaard B. Prevalence of white spot lesions in 19-yearolds: a study on untreated  and orthodontically treated persons 5 years after treatment. Am J Orthod  dentofacial Orthop. 1989 Nov;96(5):423-7.

2. Caves CR. Millett DT, Creanor SL. Foye RH, Gilmour WH. Fluoride release from orthodontic band cement-a comparison of two in vitro models. J. of Dentistry 31, 19-24, 2003

3. Thiradilok S, Luppanapornlarp S, and Pengrux N. The effect of fluoride releasing orthodontic adhesives on the prevention of enamel decalcification. J. of Dental

Research 82, Special Issue B, Abstract no. 1000, 2003.

4. Tavares M, Stultz J, Newman M, Smith V, Kent R, Carpino E, Goodson JM. Light augments tooth whitening with peroxide. J Am Dent Assoc. 2003;134:167-75.

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Dr. Silvia Geron D.M.D., M.Sc
Dr. Rafi Romano D.M.D., M.Sc
Dr. Pablo Echarri D.M.D., M.Sc