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At baseline, the teeth were prophylactically cleaned. Using dental light reflector, visual inspection of tooth surfaces for white-spot lesions was undertaken with tooth surfaces initially wet and again after 5 sec of drying with a gentle air stream, lesions were diagnosed. Multiple lesions could be recorded per tooth. Each lesion was scored according to ICDAS II (Topping & Pitts, 2009) for severity. Activity was assessed according to the Ekstrand et al., 2009 (Table 1). Lesions scored by codes 1, 1a, 2, 2a and 3 where selected at the baseline visit. At review visits (4, 8, and 12 weeks), the procedure was repeated for lesions identified at baseline. If a lesion ceased to fulfill the lesion criteria, it was scored 0 (sound enamel). Examinations were conducted by one dentist with prior clinical trial experience. Following two sessions of training and standardization with handouts, slides and live participants, the calibration examinations resulted in intra-examiner kappa values of 0.92.

Laser fluorescence (LF) examination was performed using DIAGNOdent (Kavo, Biberach, Germany). It is a laser-based instrument developed for detection and quantification of dental caries on smooth surfaces and occlusal surfaces. It operates with a diode laser having a wavelength of 655 nm and 1 mW peak power. The light is transmitted through a descendent optic fiber to a handheld probe with a beveled tip with a fiber optic eye, signal is finally processed and presented on the display between 0 and 99. DIAGNOdent consists of two probes, probe A for occlusal caries detection and probe B for smooth surface. In this study, both probe were used, A for the occlusal WSLs and B for the smooth surfaces WSLs. The instrument was calibrated according to manufacturer's instructions. Probe was place perpendicular to the test site and rotated along the WSL to completely scan the area, under cotton roll isolation and after air drying with an air syringe. Three measurements were taken and the mean of them was considered as a final base line value and at review visits (4, 8, and 12 weeks).

code

Detection criteria (ICDAS II)

code

Activity criteria modified by Ekstrand et al. (2009)

0

(sound enamel)

0

(sound enamel)

1

Opacity or discolouration visible after air-drying > 5 sec

1a

white or yellow spot rough and soft

1i

white or brown spot smooth and hard

2

Opacity or discolouration distinctly visible without air-drying

2a

white or yellow spot rough and opaque

2i

white or brown spot smooth and hard

3

Localized enamel breakdown with no visible dentin or underlying shadow

Table 1. Scores and activity criteria to assess coronal caries lesions on occlusal surfaces on permanent teeth

Table 1. Scores and activity criteria to assess coronal caries lesions on occlusal surfaces on permanent teeth

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