Effectiveness of Fluoride Varnishes for White Spot Lesion Prevention and Remineralization during Orthodontic Treatment: A Randomized Controlled Trial

Introduction: This study investigated the effectiveness of titanium tetrafluoride (TiF₄) varnish compared to sodium fluoride (NaF) varnish for preventing and remineralizing white spot lesions (WSLs) in individuals undergoing orthodontic treatment. Methods: This randomized, placebo-controlled, and double-blinded study was conducted with sixty-five adolescents who were selected based on caries activity and then randomized into three parallel groups: G1 (placebo varnish), G2 (5% NaF varnish), and G3 (4% TiF₄ varnish). Volunteers received varnish application weekly for the first 4 weeks, after 6 (T1) and 12 (T2) months. The measured outcomes included prevention of new WSLs and reversal/progression of WSLs, assessed by Nyvad and International Caries Detection and Assessment System (ICDAS) indices, as well as quantitative light-induced fluorescence. χ², ANOVA, and Kruskall-Wallis tests were applied. The level of significance was set at 0.05, and post hoc Bonferroni test for p values was performed to correct for multiple comparisons. Results: 1,274 teeth were included; 70.5% were Nyvad 0, and 29.5% were Nyvad 1, with no differences between the groups at baseline (T0). Regarding ICDAS, 70.5% were ICDAS 0, 21.6% were ICDAS 1, and 7.9% were ICDAS 2. G1 showed an increasing prevalence of WSLs at T1 and maintained stable at T2; G2 exhibited a decline at T2, while G3 experienced a decrease at T1 and T2 (p < 0.01). Incidence of WSLs at T2 was 10.2% (G1), 5.6% (G2), and 1.4% (G3). The percentage of teeth initially scored as Nyvad 0 that progressed to Nyvad 1 was 13%, 6.8%, and 1% for G1, G2, and G3, respectively. Conversely, the percentage of teeth initially scored as Nyvad 1 that regressed to Nyvad 0 or Nyvad 2 (T0–T2) was 14%, 49.3%, and 74.4%, respectively (p < 0.001). As for the ICDAS index, regression was observed in 6.5%, 17.8%, and 24%, while progression was observed in 14.9%, 7.7% and 0.9% for G1, G2, and G3, respectively (p < 0.001). Significant differences among the 3 groups for integrated fluorescence loss (mean ± SD, G1: −14.28 ± 9.47, G2: −11.10 ± 11.49, and G3: −6.77 ± 11.00) were found at T2 (p < 0.01). Conclusion: Both varnishes demonstrated the ability to prevent and remineralize WSLs. However, TiF₄ varnish exhibited the most effective control over WSLs during the 12-month orthodontic treatment.

This study examined the effectiveness of two fluoride varnishes, titanium tetrafluoride (TiF₄) and sodium fluoride (NaF), in preventing and remineralizing white spot lesions (WSLs) in individuals undergoing orthodontic treatment. We conducted a double-blinded, placebo-controlled trial with 65 adolescents randomized into three groups: placebo, NaF, and TiF₄ varnish. These varnishes were applied weekly for the first month and then at 6 and 12 months. Our findings indicate that TiF₄ varnish was the most effective in preventing new WSLs and promoting the remineralization of existing ones. The incidence of WSLs after 12 months was lowest in the TiF₄ group (1.4%), followed by the NaF group (5.6%), and highest in the placebo group (10.2%). The placebo group exhibited a continuous increase in WSLs, while the NaF group showed improvement only at 12 months, and the TiF₄ group demonstrated improvement at both 6 and 12 months. All groups experienced reduced visible plaque, with no significant differences between the groups. In terms of remineralization, TiF₄ varnish demonstrated substantial improvements, with the best results observed at 12 months. In conclusion, TiF₄ varnish proved most effective in preventing and remineralizing WSLs in a 12-month follow-up during orthodontic treatment. These results suggest that TiF₄ varnish offers promise in managing WSLs in orthodontic patients. This study’s findings have significant implications for the prevention and management of dental caries.