Comparing Digital and Fluorescent Imaging for Detecting White Spot Lesions in Orthodontic Patients

BACKGROUND: To perform orthodontic movements, brackets and ligatures must be placed on the teeth that facilitate plaque accumulation, which can lead to the formation of demineralization lesions. AIM: The purpose of this comparative study was to detect and measure WSLs using digital and fluorescence-based methods in patients with malocclusions treated with fixed orthodontic appliances (brackets). DESIGN: Seventeen patients, age 10-20 years old, 10 girls (58.8%), 7 boys (41.2%), and 273 teeth were analyzed. Their selection was based on six criteria: 1) no vestibular caries or fillings, 2) no dental fluorosis, 3) no hypocalcified teeth, 4) no tetracycline-stained teeth, 5) no endocrine disorders, and 6) no participation in other experiments. RESULTS: Digital photography identified a higher number of WSLs than VistaCam Proof at both time points, while agreement between methods was low (Kappa = 0.33 at T0; 0.17 at T1), indicating different lesion detection profiles. CONCLUSIONS: Digital photography and VistaCam Proof showed different WSL detection patterns and low inter-method agreement. These findings suggest that the two methods are not interchangeable in longitudinal orthodontic monitoring. In the absence of an independent reference standard, the findings should be interpreted in terms of differences in lesion detection and agreement between methods rather than diagnostic performance.