Introduction: Orthodontic treatment is meant to provide patients with stable occlusion and an esthetic smile, and often improves a patient's self-esteem. Unfortunately, and too often, an ideal orthodontic finish in terms of alignment and occlusion is tarnished by the appearance of white spot lesions on the facial surface of teeth after removing the fixed appliances. These white spots detract from the esthetics of a patient's smile. Purpose: The objective of this study was to evaluate the effectiveness of MI PasteTM (GC America, Alsip, Illinois), MI Paste PlusTM (GC America, Alsip, Illinois), and Topex RenewTM (Sultan Healthcare, Hackensack, NJ) in increasing remineralization and improving the esthetic appearance of white spot lesions in patients after treatment with fixed orthodontic appliances. In addition, at-home only versus in-office and at-home treatment protocols were evaluated. Methods and Materials: Thirty patients were enrolled in four treatment groups and a control group, with six patients in each group. The study lasted three months and results were analyzed with normal and QLF photographs. Results, Discussion, and Conclusion: Upon completion of this clinical study, the following conclusions can be drawn. First, the visible area and the fluorescence decrease of white spot lesions will both significantly lessen after orthodontic treatment regardless of products used, or even with a non-prescription fluoride toothpaste control. Second, there is some evidence that an at-home treatment protocol using Topex Renew, or a combination in-office and at-home treatment protocol with MI Paste Plus, may be more beneficial in reducing the appearance of white spot lesions after orthodontic treatment than other treatment protocols.

Purpose: The purpose of this study is to evaluate the effectiveness of MI Paste Plus™ in increasing remineralization and improving the esthetic appearance of white spot lesions in patients who have been treated with fixed orthodontic appliances. Material and Methods: A total of twelve subject participants aged twelve to twenty years were selected in this pilot study. The six treatment group subjects were treated with MI Paste PlusTM every three weeks in-office (4 applications) and via invisible retainer every night for a total of 12 weeks. The in-office application consisted of a 1 minute 35% phosphoric acid and a 5 minute MI Paste PlusTM contact time. At home, the subjects went about their routine oral hygiene practices, but added MI Paste PlusTM to their invisible retainer before bedtime which was worn throughout the night. Photographs and quantitative light-induced fluorescence (QLF) were used to calculate white spot lesion area and ∆F values respectively. Results: A significant difference was found in the control group for the area of the white spot lesion in antimere teeth #6 and #11. When analyzing the white spot lesion area in the treatment group, significant differences were found in tooth #6, antimere teeth #6 and #11, antimere teeth #8 and #9, as well as all teeth. ∆F values for all teeth in both the control and treatment groups were significant. Conclusion: In-office and at home treatment with MI Paste Plus™ showed a statistically significant reduction in photographic lesion area when compared to controls. Both MI Paste Plus™ and a fluoride toothpaste will provide some remineralization of white spot lesions.

AIM: The aim of this study is to compare, in a randomized clinical trial, the appearance improvement of white spot carious lesions (WSL) treated with resin infiltration (RI) – ICON®, 5% sodium fluoride (22,600 parts per million (ppm) with fluoride varnish (FV), and to assess the synergistic effect of adding Casein Phosphopeptide-Amorphous Calcium Phosphate- MI Paste® (MIP) to these treatment modalities. METHODS: Forty subjects with unrestored WSL, after debanding fixed orthodontic appliances, were recruited from the Department of Orthodontics, Henry M. Goldman School of Dental Medicine, Boston University. A randomized, split-mouth, and double-blind clinical trial design was used to allocate subjects to resin infiltration and fluoride varnish without MI Paste® (RI and FV), 20 patients, and resin infiltration and fluoride varnish with MI Paste® (RI-MIP and FV-MIP), 20 patients. Patients in the MI Paste® present treatment group given 6-weeks supply of MI Paste®. The assessment methods were: 1) patient self-assessment, 2) expert panel subjective assessment, 3) clinical caries assessment using the International Caries Detection and Assessment System (ICDAS), and 4) actual lesion size assessment. Treatment efficacy was assessed after 4-6 weeks of application. The appearance improvement was analyzed at α level of 5% and a power of 90%. RESULTS: Over 4-6 weeks, RI treatment appeared to have a higher mean difference between baseline and follow-up compared to fluoride varnish with a statistically significant difference across all assessment methods. The patient self-assessment mean difference was 1.07 (±1.49); 95% CI [0.59 - 1.55], the expert panel subjective assessment mean difference was 0.75 (±1.06); 95% CI [0.61 - 0.88], the ICDAS mean difference was 0.38 (± 0.43); 95% CI [0.24 - 0.52], and the actual size assessment mean difference was 0.07 (±0.16); 95% CI [0.01 - 0.12]. There was no statistically significant difference between the mean differences between RI and RI-MIP, nor between FV and FV-MIP across all assessment methods. CONCLUSION: The results indicate that RI is significantly better in improving the appearance of WSLs when compared to FV. There is little evidence that use of MIP adds to the improvement of the appearance of WSL in conjunction with either modality. / 2019-09-26T00:00:00Z

Objectives: To determine whether treatment of demineralized enamel white spot lesions with CPP-ACP paste, CPP-ACFP paste or microabrasion technique decreases lesion depth in vitro. Additionally, to determine whether treatment of demineralized enamel white spot lesions with microabrasion technique in combination with CPP-ACP paste or CPP-ACFP paste decreases lesion depth greater than any of the three techniques alone. Background: White spot lesions (WSLs) after the removal of orthodontic appliances remain a problem for clinicians and patients. Previous studies suggest that application of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) and casein phosphopeptide amorphous calcium fluoride phosphate (CPP-ACFP) may promote enamel remineralization. Recently, microabrasion of enamel was proposed as another treatment modality of white spot lesions. A review of literature showed that there was no comprehensive in vitro study that combined microabrasion, casein phosphopeptide amorphous calcium phosphate and casein phosphopeptide amorphous calcium fluoride phosphate for treatment of WSLs. Methods: A total of one hundred and twelve bovine incisor teeth were randomly assigned to seven treatment groups: 1. Control 1 (demineralization control), 2. Control 2 (remineralization solution control), 3. CPP-ACP paste, 4. CPP-ACFP paste, 5. Microabrasion, 6. Microabrasion with CPP- ACP paste, and 7. Microabrasion with CPP-ACFP paste. Teeth in all groups were placed in demineralizing solution for 96 hours to produce artificial caries-like lesions. At the end of the 96 hr period, teeth in Control 1 group were sectioned to establish adequate amount of demineralization. The rest of samples were treated with assigned regimen once a day for 10 days and stored in remineralization solution. At the end of ten days, teeth were sectioned with a hard tissue microtome and observed under polarized microscopy to analyze enamel lesion depth. One-way ANOVA at α=0.05 was performed to assess difference in lesion depth between groups followed with post hoc Tukey's test. Results: Statistical analysis showed a significant difference between groups (pConclusions: Based on the results from this study, we can conclude that: (1) treatment of WSLs with CPP-ACP paste, CPP-ACFP paste or microabrasion decreases lesion depth in vitro; (2) microabrasion in combination with CPP-ACP paste or CPP-ACFP paste did not decrease lesion depth greater than that observed with either paste technique alone; (3) both CPP-ACP and CPP-ACFP pastes in combination with microabrasion treatments showed greater decrease in lesion depth than microabrasion alone.

Purpose: This in vitro study evaluated the effectiveness of using a 37% phosphoric acid liquid etchant along with MI Paste Plus™ powered technology compared to using MI Paste Plus™ alone or to an artificially created saliva solution in decreasing the demineralization and enhancing the remineralization of artificial carious lesions created on extracted human teeth. The teeth were analyzed and compared using polarized light microscopy, quantitative light-induced fluorescence, and digital photography. Materials and Methods: One hundred three recently extracted non-carious human third molar teeth without observable white-spot lesions, decalcification, or dental fluorosis were selected for this twelve day study and randomly divided into four treatment groups as follows: Group 1 (Control) - Artificial saliva solution (27 teeth) Group 2 (MIP) - MI Paste Plus™ application for 30 minutes daily for 12 days (26 teeth) Group 3 (15MIP) - 15 second etch every third day and MI Paste Plus™ application for 30 minutes daily for 12 days (25 teeth) Group 4 (1MIP) - 1 minute etch on day one ONLY and application of MI Paste Plus™ for 30 minutes daily for 12 days (25 teeth). Results: Results of one<–>way ANOVA revealed there was a significant effect for the type of treatment on the lesion depth (p = 0.0027). The post-hoc Tukey-Kramer's test indicated there was a statistically significant difference between the two groups (15MIP and 1MIP) that incorporated an acid etch in combination with MI Paste Plus™ and the group with exposure to MI Paste Plus™ alone (MIP). In addition, results of one<–>way ANOVA showed that there was no statistically significant effect for type of treatment on the change in fluorescence (p = 0.1417) or the change in density (p = 0.1934). Conclusions: The results of the present study revealed there was a significant effect for the type of treatment on the lesion depth (p = 0.0027). However, the only significant difference found was between the two groups (15MIP and 1MIP) that incorporated an acid etch in combination with MI Paste Plus™ and the group with exposure to MI Paste Plus™ alone (MIP). Thus, daily applications of MI Paste Plus™, with or without an acid etch, did not produce a statistically significant difference in mean lesion depth when compared to the control (artificial saliva group). In addition, the results of the present study showed that there was no statistically significant effect for type of treatment on the change in fluorescence (p = 0.1417) or the change in density (p = 0.1934). Further research is needed to evaluate MI Paste Plus™ capability in prevention of demineralization and/or enhancement of remineralization by conducting randomized clinical trials.

White Spot lesions are a common iatrogenic occurrence on patients who are treated with fixed orthodontic appliances. There is a dynamic chemical interaction between enamel and saliva at the tooth surface that allow a lesion to have phase changes involving demineralization of enamel and remineralization. This is due to calcium and phosphate dissolved in saliva that is deposited onto the tooth surface or removed depending on the surrounding pH. Caseinphosphopeptide-amorphous calcium phosphate (CPP-ACP) is gaining popularity in dentistry as a way to increase the available level of calcium and phosphate in plaque and saliva to improve the chemical gradient so that if favors remineralization. The aim of our investigation is to search the available current literature and formulate a recommendation for use of CPP-ACP in orthodontics. Publications from the following electronic databases were searched: PubMed, Web of Science, Cochrane Library and Science Direct. Searches from August 2010 to April 1st 2012 were performed under the terms "MI Paste OR Recaldent OR caseinphosphopeptide-amorphous calcium phosphate OR CPP-ACP or tooth mousse". The searches yielded 155 articles, These were reviewed for relevance based on inclusion and exclusion criteria. Articles with inappropriate study design or no outcome measures at both baseline and end point were also excluded. 13 articles were deemed of relevance with a high quality study design and were included in this study for evaluation. The current literature suggests a preventative treatment regimen in which MI Paste Plus is used. It should be delivered once daily prior to bed after oral hygiene for 3 minutes in a fluoride tray, throughout orthodontic treatment. It should be recommended for high risk patients determined by poor oral hygiene, as seen by the inability to remove plaque from teeth and appliances. This protocol may prevent or assist in the remineralization of enamel white spot lesions during and after orthodontic treatment. / Oral Biology