Are There Really Fewer WSLs With Invisalign Than Traditional Braces?

Objectives: The primary goal was to evaluate differences in white spot lesions (WSL’s) between patients treated with Invisalign and traditional braces.
Methods: Digital photographs and records of 187 patients (120 females and 67 males 26.8± 9.1 years) treated with Invisalign and 89 patients (51 females and 38 males 25.1± 12.3 years) treated with traditional braces were evaluated pre- and post-treatment. Chart information included gender, age, banding and debanding dates. Fluorosis and oral hygiene before/after treatment were also evaluated. WSL’s, both pre-existing and post-treatment, were recorded and compared for all 12 anterior teeth.
Results: There were no statistically significant between-group differences in pretreatment age or in pretreatment oral hygiene. Significantly (p<.001) more patients in the traditional than Invisalign group developed at least one WSL (15.7% vs 0.5%). The total number of teeth that developed WSLs during treatment was also significantly (p<.001) greater in the traditional (21.3%) than Invisalign (1.1%) group. The maxillary canines and laterals, and the mandibular canines, were the most susceptible. Poor pre-treatment hygiene (p=.002), worsening hygiene during treatment (p<.001), treatment duration (p=.004) and pre-existing WSL’s (p<.001) were related to the development of WSL’s during treatment.
Conclusions: Patients treated with Invisalign developed significantly fewer WSLs during treatment than patients treated with traditional braces. Treatment duration, oral hygiene and pre-existing WSL are risk factors for the development of WSLs during treatment.