Conservative management of white spot lesions in orthodontic patients

AIM: To evaluate the efficacy of conservative approaches for managing white spot lesions (WSLs) in orthodontic patients, focusing on non-invasive treatments that preserve enamel integrity and enhance aesthetics. MATERIALS AND METHODS: A comprehensive review of WSL management strategies was conducted using databases such as Web of Science, PubMed, Google Scholar, and ScienceDirect, emphasizing non-operative interventions before, during, and after orthodontic treatment. Case reports from the Department of Preventive and Pediatric Dentistry, Lithuanian University of Health Sciences were analyzed, where resin infiltration with ICON® (DMG America) was used to treat WSLs pre- and post-orthodontic therapy. The impact of resin infiltration on enamel remineralization and aesthetic outcomes was assessed. RESULTS: The literature review showed that, prior to orthodontic treatment, patient education on optimal oral hygiene and the use of fluoride-based products (toothpaste, mouth rinses, varnishes, gels, and foams), alongside calcium-phosphate systems and preventive measures (e.g., probiotics, polyols, antiseptics, and nanohydroxyapatite), is beneficial for WSL management. During treatment, regular professional cleanings, reinforcement of oral hygiene, and the application of high concentration fluoride products, fluoride-releasing materials, CPP-ACP, polyols, chlorhexidine, and self-assembling peptides are recommended. After treatment, promoting natural remineralization through good oral hygiene and remineralizing agents is key. For severe lesions, minimally invasive treatments like resin infiltration, micro-abrasion, and bleaching may be considered. Resin infiltration with ICON® has been shown to improve the aesthetic appearance and structural integrity of enamel, reducing lesion visibility and enhancing remineralization. This technique also provides a barrier against further demineralization, thus preserving dental structures during orthodontic treatment. CONCLUSIONS: Effective management of WSLs should adopt a multifactorial approach, emphasizing the prevention of demineralization, biofilm inhibition, and remineralization. Resin infiltration with ICON® is an effective and minimally invasive solution for managing WSLs in orthodontic patients, addressing both functional and cosmetic concerns.