An Innovative Tool for Assessment of White Spot Lesion (WSL)

Objectives: During fixed orthodontic mechanotherapy, increased stagnation area around brackets causes plaque accumulation on surfaces which are normally less susceptible, causing WSL in arc shaped pattern in those area. Its various sequelae also needs evaluation since it could aid in early detection of its progression. Pre-existing WSL indices generate inference for individual tooth rather than for an individual as a whole. Later one could possibly aid in individualized treatment planning. Also, no indices till date measure both, size and sequelae of such pattern at the same time. We tend to develop a versatile tool to eliminate these limitations.
Methods: Patients (n = 10) undergoing Fixed Orthodontic Mechanotherapy (age13-25yrs) in Department of Orthodontics(treatment duration 12-36 months), were included after ethical approval. Under natural light,(Day 0) each labial surface of 12 anterior teeth (total 120 labial surfaces) divided into 8 boxes and were visualized by Principal examiner (1st data) and co-examiner( 2nd data) and various individualized grades were given for size and severity, based on Grading Criteria. Same patient was re-evaluated (Day 7) by principal examiner, 3rd data was recorded. All three data were secured by third examiner and final inference was derived. 1st data and 2nd data for inter-examiner agreement, 1st data and 3rd data intra-examiner agreement were compared. Biostatistics applied(Stuart Maxwell test, p<0.05) .
Results: Stuart Maxwell test for marginal homogenicity applied. Discordance was non-significant for both intra-examiner(p=0.99) and inter-examiner agreement (p=0.99). Highly significant results were thus obtained.
Conclusions: Orthodontic WSL Index is one of its kind till now and could be reliable tool in future. Reliability is yet to be verified with a larger sample size. In future, we also tend to digitize this tool,quantify WSL under microscopic examination and formulate patient specific treatment planning for WSL based on individualized inference.