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Multiple post-orthodontic interproximal initial carious lesions

  • 2
  • Dr. Alisha Gray
  • USA
  • Product: Curodont Repair Fluoride Plus
Before
  • Figure 1: Interproximal carious lesions in enamel of multiple teeth, diagnosed on February 2023; lesions put on watch. CRFP applied after 6 months on September 2023.
After
  • Figure 2: 6 months post-treatment with CRFP (February 2024), the bitewing x-ray revealed reduction in the sizes of the lesions

Patient Presentation and examination: 

  • Personal information: 14-year-old male
  • Dental history: Recently completed fixed orthodontic treatment, during which the patient used a prescription-strength toothpaste. 
  • Radiographic examination: On a bite-wing radiograph, multiple radiolucencies in the enamel of #13 (distal), #14 (mesial), #18 (mesial), and #19 (distal), were observed (Figure 1)

Diagnosis: 

#13 : Initial caries extending to the outer half of enamel (E1) on the distal surface
#14: Initial caries extending to the outer half of enamel (E1) on the mesial surface
#18 : Initial caries extending to the inner half of enamel (E2) on the mesial surface
#19 : Initial caries extending to the outer half of enamel (E1) on the distal surface

Treatment:

  • After diagnosis, the patient was put on a ‘watch’ for 6 months. 
  • At the 6-month recall, the lesions were treated with Curodont Repair Fluoride Plus, followed by 5% fluoride varnish. 
  • Advised to continue using a prescription-strength toothpaste (prescribed during the orthodontic treatment)

Follow-up: At the 6-month post-treatment follow-up, the following observations were made: (Figure 2)

  • #18: Reduction in lesion size to E1, indicative of remineralization 
  • #13, #14, and #19: Reduction in lesion sizes to E0, indicative of complete remineralization.

Take-away: Fixed orthodontic treatment is often associated with development of new caries lesions, due to the increased difficulty in optimum oral hygiene maintenance.* The ‘watch and wait’ approach can put patients at the risk of caries progression and its sequelae. Proactive treatment with Curodont Repair Fluoride Plus, even in the same appointment as the diagnosis,  can help remineralize these initial lesions.

*Richter AE et al. Am J Orthod Dentofacial Orthop. 2011;139:657-64

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