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Original Research

Open Access

Management of Post Orthodontic White Spot Lesions Using Resin Infiltration and CPP-ACP Materials- A Clinical Study

  • Louis Solaman Simon1,*,
  • Jayanta Kumar Dash1
  • Deepika U1
  • Shilpa Philip2
  • Sukanya Sarangi3

1Dept of Pediatric and Preventive dentistry S.C.B Dental College and Hospital, Cuttack, India

2Dept of Periodontics and Implantology,Mahatma Gandhi Postgraduate Institute of Dental Sciences, Puducherry, India

3Hi-Tech Dental College, Bhubaneswar, Odisha, India

DOI: 10.17796/1053-4625-46.1.12 Vol.46,Issue 1,January 2022 pp.70-74

Published: 01 January 2022

*Corresponding Author(s): Louis Solaman Simon E-mail:


Objectives: The purpose of this present study was to assess and compare the effectiveness and durability of topical application of remineralizing agent Casein Phospho Peptide (CPP-ACP, Toothmousse, GC corporation, Germany, Europe) and Resin infiltration (ICON, DMG, Hamburg, Germany) in the management of post orthodontic white spot lesions. Study design: A Randomized Control clinical trial was conducted among 60 children who had undergone fixed orthodontic therapy presented with white spot lesions (WSLs) on maxillary or mandibular anteriors after debonding. Identification of WSLs was done with International Caries Detection and Assessment System (ICDAS II) criteria. The clinical photographs recorded were used to measure the size of lesion. The color assessment of the lesion and sound adjacent enamel was recorded by using spectrophotometer (Vita-Easy shade 4.0, VITA Zahnfabrik, Germany). Area of the lesion was calculated using Digimizer software (Digimizer, MedCalc Software, Belgium). The selected samples were randomly allocated into two groups: Group I- Resin infiltration- Icon, DMG, Germany, (n=30) and Group II- Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)–GC Toothmousse, GC Corporation, Germany, (n=30). The WSLs were evaluated immediately following resin infiltration, and in CPP-ACP group after 1 month. In both the groups lesions were evaluated at 1, 3, 6 and 12 months. Results: There was significant reduction in lesion area, and improvement in color of white spot lesions with both of the treatment modalities. Conclusion: Both the resin infiltration and CPP-ACP have desired and durable esthetic improvement in terms of reduction in the area as well as color of post orthodontic white spot lesions.


White Spot Lesions (WSLs); Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP); International Caries Detection and Assessment System (ICDAS II)

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Louis Solaman Simon,Jayanta Kumar Dash,Deepika U,Shilpa Philip,Sukanya Sarangi. Management of Post Orthodontic White Spot Lesions Using Resin Infiltration and CPP-ACP Materials- A Clinical Study. Journal of Clinical Pediatric Dentistry. 2022. 46(1);70-74.


1. Gavrilovic I. White spot lesions in orthodontic patients: Formation, prevention and treatment. Oral Hyg Health 2014; 5:1-3

2. Reilly MMO, Featherstone JDB. Demineralization and remineralization around orthodontic appliances: Eur J Orthod Dentofacial Orthop.1987;92:33-40

3. Sudjalim TR, Woods M, Manton DJ. Prevention of white spot lesions in orthodontic practice: a contemporary review. Aust Dent J 2006;51:284-89

4. Ogaard B. White spot lesions during orthodontic treatment: mechanisms and fluoride preventive aspects. Semin orthod 2008;14;183-93

5. Summit JB. Fundamentals of operative dentistry: A contemporary approach, Quintessence:1-36

6. Ogaard B, Rolla G, Arends J, Tencate JM. Orthodontic appliances and enamel demineralisation. Part 2: prevention and treatment of lesions. Am J orthod Dentofac Orthop 1988;94:123-8

7. Cochrane NJ, Cai F, Huq NL, Burrow MF, Reynolds EC. New approaches to enhanced remineralization of tooth enamel. J Dent Res 2010;1-11

8. Munjal D, Garg S, Dhindsa A, Sidhu GK, Sethi HS. Assessment of white spot lesions and in vivo evaluation of the effect of CPP-ACP on white spot lesions in permanent molars of children. Journal of clinical and diagnostic research. 2016;10(6):149-54

9. Guclu ZA, Alacam A, Coleman NJ. A 12 week assessment of the treatment of white spot lesions with CPP-ACP paste and/ or fluoride varnish. Biomed Research International.2016; 1-9

10. Andersson A, Larsson S, hallgren A, Petersson LG, Twetman S. Effect of a dental cream containing amorphous calcium phosphate complexes on white spot lesion regression by laser fluorescence.Quintessence.2007; 5(3)229-37

11. Brochner A, Christensen C, Kristensen B, tranieus S, Karlsson L, Sonnesen L, Twetman S. Treatment of post orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate. Clin Oral Invest.2010;1-5

12. Bailey DL, Adams CG, Tsao CE, Hyslop A, Escobar K, Manton DJ, Reynolds EC, Morgan MV. Regression of post orthodontic lesions by a remineralizing cream. J Dent Res.2009;88 (12):1148-53

13. Paris S, Meyer L H, Kielbassa AM. Resin infiltration of natural enamel caries lesions. J Dent Res 2007;86:662-66

14. Neuhaus KW, Graf M, Lussi A, Katsaros C. Late infiltration of post orthodontic white spot lesions. J Orofac Orthop 2010; 71:442-47

15. Arnold WH, Gaengler P. Light and electron microscopy of infiltration of resin into initial caries lesions- a new methodological approach. Journal of microscopy 2012;245:26-33

16. Torres CRG, Borges AB, Torres LMS, Gomes IS, Olieveira RSD. Effect of caries infiltration technique and fluoride therapy on microhardness of enamel carious lesions. Journal of dentistry.2011;202-07

17. Mahran AA, Fahim FH, Hafez HS, Elkaderkadry WA. Treatment of post orthodontic white spot lesions by resin infiltration. Journal of dental and medical sciences.2017;16 (11):80-84

18. Senestraro SV, Crowe JJ, Wang M, Vo A, Huang G, Ferracane J, Covell DA. Minimally invasive resin infiltration of arrested white spot lesions. http:/ 2013;997-1005

19. Knosel M, Eckstein A, Helms HJ. Long term follow up of camouflage effects following resin infiltration of post orthodontic white spot lesions in vivo. Angle orthodontist.2019;89(1):33-39

20. Kim S, Kim EY, Jeong TS, Kim JW. The evaluation of resin infiltration for masking labial enamel white spot lesions. International journal of pediatric dentistry. 2011; 241-48

21. Prasada KL, Penta PK, Ramya KM. Spectrophotometric evaluation of white spot lesion treatment using novel resin infiltration material (ICON). J Conserv Dent. 2018;21:531-5

22. Groisman S, Borzino L, Olival A, Borzino T, Gorvino M, Toledo M. Effects of Casein Phosphopeptide-Amorphous Calcium Fluoride on white spot lesions during orthodontic treatment: One year follow up-Tooth mousse in white spot during orthodontic treatment. J Dent Oral Disord Ther. 2015;2(2):1-4

23. Morgan MV, Bailey DL, Adams GC, Tsao C, Hyslop A, Escobar K, Manton D, Reynolds EC. Clinical trial of Tooth mousse on white spot lesions. Cooperative research centre for oral health science. 2008;2:1-4

24. Farishta S, Sharma S, Baxi S, Sahu VPA, Singh S, Singh K. Prevalence of white spot lesions during the procedure of fixed orthodontic treatment. IJOCR. 2015;3:20-24

25. Lundstorm F, Krasse B. Streptococcus mutans and lactobacilli frequency in orthodontic patients; the effect of chlorhexidine treatments. Eur J Orthod 1987;9:109-16

26. Newbrun E. Cariology. 3rd edn.Chicago: Quintessence.1989:29-61

27. Ismail AI. Visual and visuotactile detection of dental caries. J Dent Res. 2004;83:56- 66

28. Corciolani G, Vichi A. Repeatability of color reading with a clinical and laboratory spectrophotometer. International Dentistry SA. 8(5):62-70

29. Murphy TC, Willmot DR, Rodd HD. Management of postorthodontic demineralised white lesions with microabrasion: A quantitative assessment. Am J orthod Dentofacial Orthop. 2007;13:27-33

30. Reynolds EC. Remineralization of Enamel Subsurface Lesions by Casein Phosphopeptide-stabilized Calcium Phosphate Solutions. J Dent Res.1997;76(9): 1587-95

31. Arneberg P, Giersten E, Emberland H, Ogaard B. Intra oral variations in total plaque fluoride related to plaque pH: A study in orthodontic patients. Caries Res. 1997;31:451-56

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