A systematic review was performed of published data on the caries-inhibiting effect of preventive measures during orthodontic treatment with fixed appliances. The purpose was to develop evidence-based recommendations about the most effective means of preventing white spot lesions in orthodontic patients. The 15 studies included were divided into four groups based on comparable preventive measures: fluoride, chlorhexidine, sealants and bonding materials. The caries-inhibiting effect of the preventive measures was expressed by the prevented fraction (PF). The overall PF of the fluoride-releasing bonding materials was 20% (SEM 0.09). This effect was, however, not statistically significant. It was impossible to calculate an overall PF for the other preventive measures, but the tendency of their caries-inhibiting effect has been described. The use of toothpaste and gel with a high fluoride concentration of 1,500–5,000 ppm or of complementary chlorhexidine during orthodontic treatment showed a demineralisation-inhibiting tendency. The use of a polymeric tooth coating on the tooth surface around the brackets showed almost no demineralisation-inhibiting effect. Many publications had to be excluded from this systematic review because of improper research designs. Future clinical trials are needed to give evidence- based advice on the optimal caries-prevention strategy.

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Objective: To investigate the use of image analysis for diagnosis and quantification of artificial white spot lesions on digital photographs before and after removal of orthodontic brackets. Materials and Methods: Enamel demineralization was artificially induced on the labial surface of 20 teeth bonded with orthodontic brackets. Standardized digital photographs were taken at angles of 90Њ and 110Њ to the labial surface, before and after bracket removal. All images were analyzed by two observers using image-processing software, and the area of the white spot lesion was calculated. Reproducibility was assessed by the Pearson correlation coefficient for interobserver reliability and by the paired t-test for differences between observers. Differences between the known and the measured demineralization area were tested using the t-test. Differences between both stages and angles were assessed by application of the paired t-test. Results: Reproducibility was very good for all measurements. For the photographs taken at an angle of 110Њ, there was a statistically significant but clinically irrelevant difference between the observers. The difference between the surface measured and the true surface was dependent on the stages and angles but was always Ͻ1 mm 2 . Conclusion: Image analysis is a reproducible and reliable method for quantification of artificial enamel demineralization around orthodontic brackets.

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