M Beerens

118 CHAPTER 7 Chapter 2 White spot lesions after orthodontic treatment assessed by clinical photographs and by quantitative light-induced fluorescence imaging; a retrospective study. Standardised monitoring of the severity of WSL over time is useful for clinical decisionmaking in themanagement of WSL. This retrospective study evaluates and usesstandardized monitoring methods to assess changes in WSL in post- treatment orthodontic patients over a 12 months period. Two methods were compared: 1. Routinely taken clinical oral photographs were analysed by both scoring visual changes and International Caries Detection and Assessment System (ICDAS)-criteria; and 2. QLF images analysed by computer software. Fifty-one subjects were included and photographs taken with either method were recorded directly after debonding (T1) and one year later (T2). The oral photographs from both time points were assessed independently by ICDAS and by comparing the clinical oral photographs taken over time to assess visual transition (VT). The QLF images were categorized based on the integrated fluorescence loss at the two time points (T1 and T2). A total of 918 formerly bracketed surfaces were analysed. ICDAS scoring on oral photographs detected 433 lesions while QLF imaging detected 384 lesions. The oral photographs and QLF images both revealed improvement of the WSL over the 12 month period. If a lesion was detected, an ICDAS score 2 was scored most often at both points in time. Changes were seen but the ICDAS scoring system was not sensitive enough to reveal the changes in WSL over time, in other words ICDAS assessment on clinical oral photographs did not have sufficient discriminatory power to reveal changes in WSL. Contrarily, comparing respective clinical oral photographs taken over time provides discriminatory power in assessing changes in WSL severity. This method of monitoring WSL over time is useful for clinical decision making in the management of WSL.