{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:30:40Z","timestamp":1788535840715,"version":"build-2803163510"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T00:00:00Z","timestamp":1703116800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"German Society of Dentistry and Oral Medicine"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To investigate the extent to which post-orthodontic white spot lesions (WSLs) change in appearance over a period of \u226515 years and whether an association with caries data exists.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Subjects and Methods<\/jats:title>\n                  <jats:p>Seventy-two patients treated with a Herbst-Multibracket appliance at age 14.0 \u00b1 2.7 years for 20.1 \u00b1 5.1 months who attended a recall 18.3 \u00b1 2.9 years post-treatment. Post-treatment (T1) intraoral photographs were assessed by a panel of five dentists using a modified version of the WSL-Index by Gorelick. For affected incisors, photographs from before treatment (T0) and recall (T3) were evaluated. In addition, the WSL-Change Index by Pancherz and Muehlich was assessed for all adequately visible incisors considering T1, T2 (if available), and T3. Radiographic (T0, T1, and T2\u2014if available) and clinical (T3) MFT data were used.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>37.5% of the patients exhibited WSLs on \u2265 1 incisor at T1; in total, 81 incisors (14.9%) were affected. At T3, 48% of the WSLs had improved. The modified WSL-Index decreased from 1.2 \u00b1 0.4 to 0.8 \u00b1 0.6 (P &amp;lt; .001), with a score 0 in 28% of the previously affected incisors. When comparing T2 vs. T3, additional improvement after T2 occurred in 11% of the teeth. While no difference existed at T0, the MFT values at T1, T2, and T3 were higher (P \u2264 .05) in patients with WSLs at T1 than in those without.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Limitations<\/jats:title>\n                  <jats:p>The homogeneity of the subjects was limited and no patient-reported outcome was assessed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Long-term, post-orthodontic WSLs showed spontaneous full recovery in 28% and improvement in 48% of the teeth. Patients affected with WSLs exhibited higher post-treatment MFT values.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejo\/cjad070","type":"journal-article","created":{"date-parts":[[2023,12,22]],"date-time":"2023-12-22T00:33:36Z","timestamp":1703205216000},"source":"Crossref","is-referenced-by-count":7,"title":["White spot lesions after fixed appliance treatment\u2014Can we expect spontaneous long-term (\u226515 years) improvement?"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2978-0605","authenticated-orcid":false,"given":"Niko Christian","family":"Bock","sequence":"first","affiliation":[{"name":"Department of Orthodontics, University of Giessen , Giessen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"von Bremen","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University of Giessen , Giessen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4929-9213","authenticated-orcid":false,"given":"Katharina","family":"Klaus","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University of Giessen , Giessen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nelly","family":"Schulz-Weidner","sequence":"additional","affiliation":[{"name":"Department of Pediatric Dentistry, University of Giessen , Giessen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Ganss","sequence":"additional","affiliation":[{"name":"Department of Operative Dentistry, Endodontology, and Paediatric Dentistry, University of Marburg , Marburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Ruf","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, University of Giessen , Giessen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,21]]},"reference":[{"key":"2024011114304832700_CIT0001","first-page":"21347","article-title":"A novel method quantifying caries following orthodontic treatment","volume-title":"Sci Rep","author":"Erbe","year":"2021"},{"key":"2024011114304832700_CIT0002","first-page":"41","article-title":"Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors","volume-title":"Caries Res","author":"Boersma","year":"2005"},{"key":"2024011114304832700_CIT0003","first-page":"e17","article-title":"White-spot lesions during multibracket appliance treatment: a challenge for clinical excellence","volume-title":"Am J Orthod Dentofacial Orthop","author":"Enaia","year":"2011"},{"key":"2024011114304832700_CIT0004","first-page":"353","article-title":"Enamel demineralization during fixed orthodontic treatment - incidence and correlation to various oral-hygiene parameters","volume-title":"J Orofac Orthop","author":"Lovrov","year":"2007"},{"key":"2024011114304832700_CIT0005","first-page":"678","article-title":"Effectiveness of high-fluoride toothpaste on enamel demineralization during orthodontic treatment-a multicenter randomized controlled trial","volume-title":"Eur J Orthod","author":"Sonesson","year":"2014"},{"key":"2024011114304832700_CIT0006","first-page":"455","article-title":"Caries-preventive effectiveness of a fluoride varnish: a randomized controlled trial in adolescents with fixed orthodontic appliances","volume-title":"Caries Res","author":"Stecks\u00e9n-Blicks","year":"2007"},{"key":"2024011114304832700_CIT0007","first-page":"186","article-title":"A prospective, randomized placebo-controlled clinical trial on the effects of a fluoride rinse on white spot lesion development and bleeding in orthodontic patients","volume-title":"Eur J Oral Sci","author":"van der Kaaij","year":"2015"},{"key":"2024011114304832700_CIT0008","first-page":"19","article-title":"Enamel sealants: a clinical evaluation of their value during fixed appliance therapy","volume-title":"Eur J Orthod","author":"Banks","year":"1994"},{"key":"2024011114304832700_CIT0009","first-page":"188","article-title":"Risk factors for incidence and severity of white spot lesions during treatment with fixed orthodontic appliances","volume-title":"Am J Orthod Dentofacial Orthop","author":"Chapman","year":"2010"},{"key":"2024011114304832700_CIT0010","first-page":"37","article-title":"Effect of a hydrophobic tooth coating on gingival health, mutans streptococci, and enamel demineralization in adolescents with fixed orthodontic appliances","volume-title":"Acta Odontol Scand","author":"Fornell","year":"2002"},{"key":"2024011114304832700_CIT0011","first-page":"633","article-title":"The incidence of caries and white spot lesions in orthodontically treated adolescents with a comprehensive caries prophylactic regimen--a prospective study","volume-title":"Eur J Orthod","author":"Hadler-Olsen","year":"2012"},{"key":"2024011114304832700_CIT0012","first-page":"204","article-title":"The efficacy of fluoride varnish vs a filled resin sealant for preventing white spot lesions during orthodontic treatment","volume-title":"Angle Orthod","author":"Flynn","year":"2022"},{"key":"2024011114304832700_CIT0013","first-page":"29","article-title":"The effect of a fluoride program on white spot formation during orthodontic treatment","volume-title":"Am J Orthod Dentofacial Orthop","author":"Geiger","year":"1988"},{"key":"2024011114304832700_CIT0014","first-page":"93","article-title":"Incidence of white spot formation after bonding and banding","volume-title":"Am J Orthod","author":"Gorelick","year":"1982"},{"key":"2024011114304832700_CIT0015","first-page":"e4","article-title":"Factors affecting the formation, severity and location of white spot lesions during orthodontic treatment with fixed appliances","volume-title":"J Oral Maxillofac Res","author":"Khalaf","year":"2014"},{"key":"2024011114304832700_CIT0016","first-page":"664","article-title":"Prevalence of white-spot lesions before and during orthodontic treatment with fixed appliances","volume-title":"Eur J Orthod","author":"Lucchese","year":"2013"},{"key":"2024011114304832700_CIT0020","first-page":"641","article-title":"Prevalence of white spot lesion formation during orthodontic treatment","volume-title":"Angle Orthod","author":"Julien","year":"2013"},{"key":"2024011114304832700_CIT0021","first-page":"e12470","article-title":"Risk assessments in orthodontic patients developing white spot lesions","volume-title":"J Invest Clin Dent","author":"Leeper","year":"2019"},{"key":"2024011114304832700_CIT0022","first-page":"386","article-title":"Impact of body mass index on oral health during orthodontic treatment: an explorative pilot study","volume-title":"Eur J Orthod","author":"von Bremen","year":"2016"},{"key":"2024011114304832700_CIT0017","first-page":"181","article-title":"Factors affecting demineralization during orthodontic treatment: a post-hoc analysis of RCT recruits","volume-title":"Am J Orthod Dentofacial Orthop","author":"Al Maaitah","year":"2011"},{"key":"2024011114304832700_CIT0018","first-page":"458","article-title":"Orthodontics and enamel demineralization: clinical study of risk factors","volume-title":"Int Orthod","author":"Benkaddour","year":"2014"},{"key":"2024011114304832700_CIT0019","first-page":"181","article-title":"A practice-based evaluation of the prevalence and predisposing etiology of white spot lesions","volume-title":"Angle Orthod","author":"Brown","year":"2016"},{"key":"2024011114304832700_CIT0023","first-page":"171","article-title":"Enamel opacities and dental esthetics","volume-title":"J Public Health Dent","author":"Ellwood","year":"1995"},{"key":"2024011114304832700_CIT0024","first-page":"136.e1","article-title":"Orthodontic treatment-related white spot lesions: a 14-year prospective quantitative follow-up, including bonding material assessment","volume-title":"Am J Orthod Dentofacial Orthop","author":"Shungin","year":"2010"},{"key":"2024011114304832700_CIT0025","first-page":"9277","article-title":"Changes in the color and brightness of white spots associated with orthodontic treatment 6 months after the application of infiltrative resins: systematic review and meta-analysis","volume-title":"Int J Environ Res Public Health","author":"Baptista-S\u00e1nchez","year":"2022"},{"key":"2024011114304832700_CIT0026","first-page":"4711","article-title":"Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a systematic review and meta-analysis","volume-title":"Clin Oral Investig","author":"Bourouni","year":"2021"},{"key":"2024011114304832700_CIT0027","first-page":"241","article-title":"The evaluation of resin infiltration for masking labial enamel white spot lesions","volume-title":"Int J Paediatr Dent","author":"Kim","year":"2011"},{"key":"2024011114304832700_CIT0028","first-page":"101723","article-title":"Effectiveness of resin infiltration in caries inhibition and aesthetic appearance improvement of white-spot lesions: an umbrella review","volume-title":"J Evid Based Dent Pract","author":"Lin","year":"2022"},{"key":"2024011114304832700_CIT0029","first-page":"e28","article-title":"Masking of white spot lesions by resin infiltration in vitro","volume-title":"J Dent","author":"Paris","year":"2013"},{"key":"2024011114304832700_CIT0030","first-page":"765","article-title":"Treatment of white spot lesions with ACP paste and microabrasion","volume-title":"Angle Orthod","author":"Pliska","year":"2012"},{"key":"2024011114304832700_CIT0031","first-page":"181","article-title":"The hydrochloric acid-pumice microabrasion technique in the treatment of post-orthodontic decalcification","volume-title":"Br J Orthod","author":"Welbury","year":"1993"},{"key":"2024011114304832700_CIT0032","first-page":"2","article-title":"Is bleaching effective in managing post-orthodontic white-spot lesions? a systematic review","volume-title":"Oral Health Prev Dent","author":"Gizani","year":"2020"},{"key":"2024011114304832700_CIT0033","first-page":"646","article-title":"External bleaching effect on the color and luminosity of inactive white-spot lesions after fixed orthodontic appliances","volume-title":"Angle Orthod","author":"Kn\u00f6sel","year":"2007"},{"key":"2024011114304832700_CIT0034","first-page":"144","article-title":"Changes in white spot lesions following post-orthodontic weekly application of 125 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial Part I: photographic data evaluation","volume-title":"Eur J Orthod","author":"Bock","year":"2017"},{"key":"2024011114304832700_CIT0035","first-page":"144","article-title":"Changes in white spot lesions following post-orthodontic weekly application of 125 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial Part II: clinical data evaluation","volume-title":"Eur J Orthod","author":"Bock","year":"2017"},{"key":"2024011114304832700_CIT0036","first-page":"463","article-title":"Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment","volume-title":"Clin Oral Investig","author":"Du","year":"2012"},{"key":"2024011114304832700_CIT0037","first-page":"4153","article-title":"Effectiveness of remineralizing agents in the prevention and reversal of orthodontically induced white spot lesions: a systematic review and network meta-analysis","volume-title":"Clin Oral Investig","author":"Hu","year":"2020"},{"key":"2024011114304832700_CIT0038","first-page":"270","article-title":"Remineralisation of enamel lesions with daily applications of a high-concentration fluoride gel and a fluoridated toothpaste: an in situ study","volume-title":"Caries Res","author":"Lagerweij","year":"2002"},{"key":"2024011114304832700_CIT0039","first-page":"661","article-title":"Effectiveness of self-applied topical fluorides against enamel white spot lesions from multi-bracketed fixed orthodontic treatment: a systematic review","volume-title":"Eur J Orthod","author":"Sardana","year":"2019"},{"key":"2024011114304832700_CIT0040","first-page":"1148","article-title":"Regression of post-orthodontic lesions by a remineralizing cream","volume-title":"J Dent Res","author":"Bailey","year":"2009"},{"key":"2024011114304832700_CIT0041","first-page":"305","article-title":"Effectiveness of different adjunctive interventions in the management of orthodontically induced white spot lesions: a systematic review of systematic reviews and meta-analyses","volume-title":"Dent Med Probl","author":"Bakdach","year":"2020"},{"key":"2024011114304832700_CIT0042","first-page":"551","article-title":"Acid resistance of enamel subsurface lesions remineralized by a sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate","volume-title":"Caries Res","author":"Iijima","year":"2004"},{"key":"2024011114304832700_CIT0043","doi-asserted-by":"crossref","DOI":"10.1186\/s12903-019-0977-0","article-title":"Evaluation of the efficacy of casein phosphopeptide-amorphous calcium phosphate on remineralization of white spot lesions in vitro and clinical research: a systematic review and meta-analysis","volume-title":"BMC Oral Health","author":"Ma","year":"2019"},{"key":"2024011114304832700_CIT0044","first-page":"e12391","article-title":"Effectiveness of casein phosphopeptide-amorphous calcium phosphate-containing products in the prevention and treatment of white spot lesions in orthodontic patients: a systematic review","volume-title":"J Invest Clin Dent","author":"Pithon","year":"2019"},{"key":"2024011114304832700_CIT0045","first-page":"402","article-title":"Remineralization potential and caries preventive efficacy of CPP-ACP\/Xylitol\/Ozone\/Bioactive glass and topical fluoride combined therapy versus fluoride mono-therapy - a systematic review and meta-analysis","volume-title":"Acta Odontol Scand","author":"Sharda","year":"2021"},{"key":"2024011114304832700_CIT0046","first-page":"101725","article-title":"Efficacy of novel bioactive glass in the treatment of enamel white spot lesions: a randomized controlled trial","volume-title":"J Evid Based Dent Pract","author":"Salah","year":"2022"},{"key":"2024011114304832700_CIT0047","first-page":"11","article-title":"Is resin infiltration an effective esthetic treatment for enamel development defects and white spot lesions? A systematic review","volume-title":"J Dent","author":"Borges","year":"2017"},{"key":"2024011114304832700_CIT0048","first-page":"778","article-title":"Enamel remineralization therapies for treating postorthodontic white-spot lesions: a systematic review","volume-title":"J Am Dent Assoc","author":"Fern\u00e1ndez-Ferrer","year":"2018"},{"key":"2024011114304832700_CIT0049","first-page":"122","article-title":"Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis","volume-title":"Eur J Orthod","author":"H\u00f6chli","year":"2017"},{"key":"2024011114304832700_CIT0050","first-page":"41","article-title":"Systematic review on white spot lesions treatments","volume-title":"Eur J Dent","author":"Puleio","year":"2022"},{"key":"2024011114304832700_CIT0051","first-page":"116","article-title":"Management of post-orthodontic white spot lesions: an updated systematic review","volume-title":"Eur J Orthod","author":"Sonesson","year":"2017"},{"key":"2024011114304832700_CIT0052","first-page":"595","article-title":"A longitudinal laser fluorescence study of white spot lesions in orthodontic patients","volume-title":"Am J Orthod Dentofacial Orthop","author":"Al-Khateeb","year":"1998"},{"key":"2024011114304832700_CIT0053","first-page":"123","article-title":"Orthodontic appliances and enamel demineralization Part 2 Prevention and treatment of lesions","volume-title":"Am J Orthod Dentofacial Orthop","author":"\u00d8gaard","year":"1988"},{"key":"2024011114304832700_CIT0054","first-page":"223","article-title":"Longitudinal development of caries lesions after orthodontic treatment evaluated by quantitative light-induced fluorescence","volume-title":"Am J Orthod Dentofacial Orthop","author":"van der Veen","year":"2007"},{"key":"2024011114304832700_CIT0055","first-page":"235","article-title":"White lesions after orthodontic treatment: does low fluoride make a difference","volume-title":"J Orthod","author":"Willmot","year":"2004"},{"key":"2024011114304832700_CIT0056","first-page":"28","article-title":"Effects of combined application of antimicrobial and fluoride varnishes in orthodontic patients","volume-title":"Am J Orthod Dentofacial Orthop","author":"\u00d8gaard","year":"2001"},{"key":"2024011114304832700_CIT0057","first-page":"139","article-title":"Entwicklung von Karies bei kieferorthop\u00e4discher Behandlung mit festsitzenden Apparaturen Ein Vergleich von Z\u00e4hnen mit und ohne Kariesvorsch\u00e4digungen","volume":"11","author":"Pancherz","year":"1997","journal-title":"Kieferorthopaedie"},{"key":"2024011114304832700_CIT0058","first-page":"751","article-title":"Studies on dental caries: I Dental status and dental needs of elementary schoolchildren","volume-title":"Public Health Reports (1896-1970)","author":"Klein","year":"1938"},{"key":"2024011114304832700_CIT0059","first-page":"65","article-title":"Decalcification in relation to brackets bonded with glass ionomer cement or a resin adhesive","volume-title":"Angle Orthod","author":"Millett","year":"1999"},{"key":"2024011114304832700_CIT0060","first-page":"233","article-title":"White spot reduction when using glass ionomer cement for bonding in orthodontics: a longitudinal and comparative study","volume-title":"Eur J Orthod","author":"Marcusson","year":"1997"},{"key":"2024011114304832700_CIT0061","first-page":"359","article-title":"Incidence of white spot lesions among patients treated with clear aligners and traditional braces","volume-title":"Angle Orthod","author":"Buschang","year":"2019"},{"key":"2024011114304832700_CIT0062","first-page":"837","article-title":"Effectiveness of a sealant compared with no sealant in preventing enamel demineralization in patients with fixed orthodontic appliances: a prospective clinical trial","volume-title":"Am J Orthod Dentofacial Orthop","author":"O\u2019Reilly","year":"2013"},{"key":"2024011114304832700_CIT0063","first-page":"54","article-title":"Ultrastructural changes in the translucent and dark zones of early enamel caries","volume-title":"J Oral Pathol Med","author":"Orams","year":"1980"},{"key":"2024011114304832700_CIT0064","first-page":"201","article-title":"Crystallographic and structural alterations in the mineral phase of human enamel with carious attacks","volume-title":"J Oral Pathol Med","author":"Aoba","year":"1982"},{"key":"2024011114304832700_CIT0065","first-page":"380","article-title":"Profilometric and microradiographic studies on the effects of toothpaste and acidic gel abrasivity on sound and demineralized bovine dental enamel","volume-title":"Caries Res","author":"Kielbassa","year":"2005"},{"key":"2024011114304832700_CIT0066","first-page":"690","article-title":"Removal of white spot lesions by controlled acid-pumice abrasion","volume":"23","author":"Kamp","year":"1989","journal-title":"J Clin Orthod"},{"key":"2024011114304832700_CIT0067","first-page":"96","article-title":"Long-term effects of Class II orthodontic treatment on oral-health","volume-title":"J Orofac Orthop","author":"Bock","year":"2018"}],"container-title":["European Journal of Orthodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejo\/article-pdf\/46\/1\/cjad070\/55440796\/cjad070.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejo\/article-pdf\/46\/1\/cjad070\/55440796\/cjad070.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,11]],"date-time":"2024-01-11T15:07:03Z","timestamp":1704985623000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejo\/article\/doi\/10.1093\/ejo\/cjad070\/7490831"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,21]]},"references-count":67,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ejo\/cjad070","relation":{},"ISSN":["0141-5387","1460-2210"],"issn-type":[{"value":"0141-5387","type":"print"},{"value":"1460-2210","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,1,1]]},"published":{"date-parts":[[2023,12,21]]},"article-number":"cjad070"}}