الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Summary
The orthodontic success of an ideal occlusion is often tarnished by the appearance of WSLs on the facial surface of teeth after removing the fixed appliances.
Several studies have reported a significant increase in the prevalence and severity of demineralization after orthodontic therapy compared with controls.2,3,4
The opaque white appearance of the enamel lesion was reported due to subsurface demineralization with an increase in porosity and consequential changes in the optical properties of the enamel.
Evidence supporting the reversal (remineralization) of early lesions has come from in vitro and in situ studies of partially demineralized enamel and, to a lesser extent, from direct clinical trials Zero, 199925. However, there are several challenges for establishing the clinical effectiveness of remineralization agents Zero, 200626. They must rapidly precipitate on partially demineralized tooth structure and transform into a stable apatite that is resistant to subsequent bacterial acid and erosive challenges. 25 26
Saliva plays a critical role by its salivary components in controlling the equilibrium between de- and remineralization. These protective properties of saliva include salivary clearance, buffering power, and degree of saturation with respect to tooth mineral.38
The aim of this study was to compare the effect of weekly application of Fluoride varnish, xylitol varnish and casein phosphopeptides amorphous calcium phosphate paste on the appearance and dimensions of the white spot lesions after debonding, as well as compare their effect on the pH and concentration of calcium in saliva.
Sixty children from 10 to 16 years of age who have just finished their orthodontic treatment and with white spot lesions on the labial surface of permanent anterior teeth were selected from the Orthodontic Clinic Faculty of Dentistry Ain Shams University.
Clinical examination was performed by same operator for all patients including examination of gingival tissues condition, evaluation of the degree of oral cleanliness and examination of WSLs using the ICDAS II and Photographic Assessment.
Clinical examination together with photographic assessment was performed at the beginning of the study period and every month for six months through out the study period.
After examination, the children were randomly assigned to one of the four intervention groups.
Each therapeutic material was applied weekly according to its manufacturer’s instructions in the Pediatric clinic, Faculty of Dentistry Ain Shams University.
Digital images were captured, analyzed, and compared with baseline data.
Three salivary samples were collected in this study the first was resting salivary sample at the beginning of the study before any meals, early in the morning and 1 ml of the saliva was taken for salivary pH determination by pH indicator. Application of the therapeutic material was performed and patients were asked to wait for an hour after which a secondary salivary sample was taken. A third salivary sample was taken after one week.
Salivary samples were transferred immediately to the laboratory and calcium concentration was determined using atomic absorption spectrometry before and after application of the therapeutic material, while measurement of pH was repeated every three months.
The results of this study showed that there was a great decrease in total surface area of WSLs in F, X and CCP groups in comparison to control group through out the follow up periods and the differences between the therapeutic groups and control group were highly statistically significant.
F group showed decrease in Ca level after 1hr and return to baseline value after one week and differences were statistically significant. Also X group showed increase in Ca level after 1hr but it showed increase in Ca level after one week and differences were statistically.
CPP group showed increase in Ca level after 1hr and return to baseline value after one week and differences were statistically significant.
There was increase in salivary pH in the three groups after three and six months of application of the therapeutic material in relation to base line pH despite individual variations throughout the study period, but this increase was not significant.
Also it was observed that the X group raises the pH more than the other two groups after six months which may be due to the increase in salivary flow in this group but also this increase was not significant.
There was major reduction in the PI, GI in all groups after 6 months this reduction was found to be statistically significant in all groups except in control group.
Reduction in the PI, GI in the control group could be related to the effect of prophylaxis performed, motivation and oral hygiene instructions.