A myriad of in-vivo and in-vitro studies have been carried out to study the efficacy of preventive measures against white spot lesion formation during orthodontic treatment. Fluoride varnish has by far the strongest evidence base. The potential of fluoride varnish has been evaluated in-vitro (Adriens et al., 1990; van der Linden and Dermaut, 1998; Todd et al., 1999; Demito et al., 2004) as well as in-vivo (Vivaldi-Rodrigues et al., 2006; 0gaard et al., 2001). Generally, investigations carried out in-vitro indicate a moderate to strong beneficial effect of the tested varnishes on enamel demineralization. Two in-vivo studies have emerged. In a split-mouth prospective study, there was 44.3% less demineralization noted for teeth that had been treated every 12 weeks with fluoride varnish during orthodontic treatment (Vivaldi-Rodrigues et al., 2006). In a double-blinded randomized placebo-controlled trial, Stecksen-Blicks et al. reported that although fluoride varnish did not totally prevent white spot lesion formation, the incidence was significantly reduced in the fluoride varnish group. In addition to differences in study design, the frequency of fluoride application also varied among the studies. Stecksen et al. applied the fluoride varnish at six week intervals, the typical appointment interval for most orthodontic patients.
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