Vol 11, Special issue 1, 2018 Online - 2455-3891 Print - 0974-2441 ‘ICPCR’ hosted by Faculty of Pharmacy, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia 03 November 2017 COLOR CHANGES OF POST-DEBONDING WHITE SPOT LESION AFTER MICROABRASION TECHNIQUE WITH FLUORIDE AND CASEIN PHOSPHOPEPTIDE-AMORPHOUS CALCIUM PHOSPHATE APPLICATION IRENE PRATAMI ANGRIAWAN 1 , HARU SETYO ANGGANI 2 *, NADA ISMAH 3 Department of Orthodontics, Faculty of Dentistry, Universitas Indonesia, Jakarta, Indonesia. Email: drg.irene@gmail.com Received: 07 March 2018, Revised and Accepted: 25 March 2018 ABSTRACT Objective: The prevalence of enamel demineralization among patients after orthodontic treatment is about 50%, which begins with the formation of white spot lesions. The presence of these lesions causes esthetic problems. The aim of this study was to quantify the color changes in post-debonding white spot lesions after microabrasion technique with fluoride and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application. Materials and Methods: This study used 42 first premolar teeth that had been extracted, then were soaked for 96 h in a demineralization solution (pH 4, 37°C) to form an artificial white spot lesions. Samples were randomly divided into three treatment groups (n=14): (A) Microabrasion technique only; (B) microabrasion technique with 10% CPP-ACP paste application; and (C) microabrasion technique with 1.23% APF gel application. All groups were assigned to pH cycling for 10 days. The color change was determined using spectrophotometer at 3 different time points, which were measured before and after production of the artificial white spot lesions, and after the artificial white spot lesions were treated. Results: This study showed that there was a significant difference in the color of the artificial white spot lesions after microabrasion technique with CPP-ACP application. Conclusion: Microabrasion technique with CPP-ACP application was giving better result in changing the color of white spot lesions than only microabrasion technique and microabrasion technique with fluoride application. Keywords: Color change, White spot lesion, Microabrasion technique, Fluoride, Casein phosphopeptide-amorphous calcium phosphate. INTRODUCTION Orthodontic treatment is a treatment for correcting malocclusions that will improve patient’s mastication function, speech, and esthetic. Orthodontic treatment also enhances the patient’s confidence [1]. However, in addition to these benefits, orthodontic treatment, especially with fixed orthodontic appliances, also has side effects which include damage to the enamel hard tissue and tooth-supporting tissues [2]. One of the most common enamel hard tissue damages that occur during and after orthodontic treatment is the demineralization of enamel. Several research reports show that the prevalence of enamel demineralization occurs in 50% of patients with fixed orthodontic treatment. Another study said that after 5-year post-orthodontic treatment, patients had incidence of a higher enamel opacity compared to the orthodontic-treated control group. The efforts to reduce the possibility of side effects of enamel demineralization are to educate patients and provide information about the importance of maintaining oral health during orthodontic treatment [2]. Email demineralization initially occurs when enamel porosity increased so that has a chalky white clinical appearance, up to the loss of its translucency. This appearance is called a white spot lesion. Conservative treatment to white spot lesions generally aims to remineralize the lesion with fluoride and calcium applications, which can penetrate into white spot lesions [3]. The use of mouthwash containing 0.05% of fluoride daily has been proven effective when the patient has adherence to the dentist’s instructions [2,4]. The fluoride application is said to form fluorapatite on the enamel hard tissue structure. However, this fluorapatite can still be demineralized at a critical pH 4.5 [5]. Therefore, the other management of white spot lesions is developed by reactivating superficial enamel substrates through mechanical and chemical abrasion. One of the most studied methods for treating white spot lesions is the enamel remineralization using milk derivatives, which is casein phosphopeptide-amorphous calcium phosphate (CPP-ACP). The results of remineralized white spot lesions with CPP-ACP were considered better than with fluoride [3,6]. While the management of white spot lesions is developing, microabrasion technique which was performed before fluoride or CPP-ACP application is found. This action is expected to be able to eliminate white spot lesions without involving any invasive restorative procedures. Whereas, fluoride and CPP-ACP applications will produce enamel remineralization as a corrective effort for white spot lesions [3]. The purpose of treating white spot lesions is to improve the quality of the enamel tissue that can be assessed from the hardness, surface smoothness, and color changes [7-9]. A research by Austin et al., in 2016, studied about the effects of demineralization and remineralization on enamel hardness and texture using confocal laser scanning microscope. The results of this study indicate that after the demineralization process, there is a decrease in hardness and a significant increase in enamel texture roughness. However, after a 6 h of remineralization, the email hardness has recovered as it was before demineralization. The texture of enamel also improved although not statistically significant [9]. Improving the quality of the enamel in white spot lesion is also assessed by the color change. White spot lesions are more chalk white than normal enamel tissue color which can disrupt the esthetic appearance. Therefore, enamel remineralization in the treatment of white spot lesions is expected to produce an improved color change or close to normal surrounding enamel tissue color. Previous findings revealed that the application of CPP-ACP compared with the application of fluoride produces a color difference in white spot lesions clinically, but not statistically significant. Research on color change in white spot enamel lesions after microabrasion techniques followed by fluoride Research Article © 2018 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4. 0/) DOI: http://dx.doi.org/10.22159/ajpcr.2018.v11s1.26605