Prevention and Treatment of White Spot Lesions in Orthodontic Patients
OBJECTIVE The purpose of the study was to evaluate the effect of bleaching on teeth with white spot lesions. METHODS AND MATERIALS Carious lesions with standardized whiteness were produced on the buccal and lingual surfaces of human premolars by pH cycling. Specimens were subjected to four experimental conditions (n=20/group) as follows: group 1, control; group 2, caries formation followed by remineralization using fluoride-containing casein phosphopeptide-amorphous calcium phosphate (CPP-ACP; Tooth Mousse Plus, GC, Tokyo, Japan); group 3, caries formation followed by bleaching using 10% carbamide peroxide; and group 4, caries formation followed by both bleaching and remineralization. The CIE L(*)a(*)b(*) color values were measured with a spectroradiometer, the mineral content was measured with electron probe microanalysis (EPMA) on the cross-sectional surface of each specimen, and the Knoop hardness test was carried out along the EPMA scan line. Two-way analysis of variance was performed with Tukey post hoc comparison. RESULTS The change in the CIE color values was not significantly different between the caries-formed (ΔE(*)=7.03) and the bleached enamel (ΔE(*)=7.60). Bleaching of the carious enamel extended the whiteness (ΔE(*)=3.38) without additional mineral loss (p<0.05). The remineralization treatment significantly increased the calcium (Ca), phosphate (P), and fluoride content of the subsurface lesion area (p<0.05). The cross-sectional microhardness values correlated well with the Ca and P content (R>0.80). CONCLUSIONS Bleaching reduced the color disparities between sound and carious enamel without deteriorating the chemical and mechanical properties. The application of CPP-ACP paste enhanced mineral deposition in the subsurface lesion area of carious enamel.