Comparing Aligner and Multibracket Therapy in The Evaluation of White Spot Lesions

Abstract Background: This study used the Enamel Decalcification Index (EDI) by Banks and Richmond (1994) to investigate the severity and development of white spot lesions (WSL) before and after multi bracket (MB) and aligner (Invisalign teen®) therapy. The extent of WSL was recorded using the newly developed evaluation aid crosshair.Methods: Photographs of 121 subjects before and after MB therapy (58 female and 63 male) with an average age of 12.5 ±2.1 years and of 42 aligner therapy subjects (18 female and 24 male) with the average age of 14 ±1.8 years were examined. All subjects received standardized oral hygiene instructions. The vestibular tooth surfaces of the incisors, canines, and premolars were examined with the Enamel Decalcification Index (EDI) of Banks and Richmond (grades 0-3), and the extent of WSL was assessed with the graticule using circle segments in percent. All statistical analysis was performed using frequency tables, cross-tabulations, and logistic regression.Results:69% of subjects had at least one WSL before MB therapy, while 98% had WSL after MB therapy. 98% of subjects had at least one WSL, which is an incidence of 29%. 17% of subjects had WSL before aligner therapy, and 52% had WSL after aligner therapy. This concludes an incidence of 43%. 18% of tooth surfaces had WSL before MB therapy and 52% had them after. 99% of tooth surfaces examined before aligner therapy had no WSL, and 91% of tooth surfaces stayed free of WSL after therapy. The prevalence of WSL was higher on the canines and premolars than on the incisors before and after both MB and aligner therapy. Aligner therapy had a significantly higher WSL prevalence and incidence on the maxillary teeth. The oral, mesial, and distal surfaces were significantly more likely to have WSL after MB therapy (prevalence) than the gingival tooth surface. The tooth surfaces most notably affected by WSL, in order from highest to lowest impact, were the distal tooth surfaces, the mesial tooth surface and the gingival tooth surfaces (incidence). Areas around rectangular attachments are more likely to be affected by WSL compared to tooth surfaces without. The study on gender distribution in MB therapy showed that the development of WSL was far higher in adolescent males than in females, though age did not prove to be an influencing factor.Conclusion: This study concludes that the treatment with aligners can successfully reduce the formation of white spot lesions in comparison to MB treatment.