Incidence of white spot lesions among patients treated with clear aligners and traditional braces. Academic Article uri icon


  • OBJECTIVES: To compare the incidence of white spot lesions (WSLs) among patients treated with aligners and those treated with traditional braces. MATERIALS AND METHODS: A group of 244 aligner patients (30.4 14 years) was compared to a group of 206 patients (29.2 11.5 years) treated with traditional fixed braces. Consecutive cases in the late mixed or permanent dentitions who had high-quality pre- and posttreatment digital photographs available were included in the study. Each set of photographs was independently evaluated by two investigators to determine pretreatment oral hygiene (OH), fluorosis, and WSLs, as well as changes in OH and WSLs during treatment. RESULTS: Approximately 1.2% of the aligner patients developed WSLs, compared to 26% of the traditionally treated patients. The numbers of WSLs that developed were also significantly (P < .001) less among the aligner patients. The aligner patients developed three new WSLs, while the traditionally treated patients developed 174 WSLs. The incidence of WSLs was greater for the maxillary than for the mandibular teeth, and it was greater for the canines than for the incisors. For the patients treated with traditional braces, fair or poor pretreatment OH, worsening of OH during treatment, preexisting WSLs, and longer treatment duration significantly (P < .05) increased the risk of developing WSLs during treatment. CONCLUSIONS: Patients treated with aligners have less risk of developing WSLs than do patients treated with traditional braces, which could be partially due to shorter treatment duration, or better pretreatment OH.

published proceedings

  • Angle Orthod

altmetric score

  • 21

author list (cited authors)

  • Buschang, P. H., Chastain, D., Keylor, C. L., Crosby, D., & Julien, K. C.

citation count

  • 29

complete list of authors

  • Buschang, Peter H||Chastain, David||Keylor, Cameron L||Crosby, Doug||Julien, Katie C

publication date

  • May 2019