Comparison of three orthodontic bonding systems in white spot lesion development: a randomized clinical trial

Objectives: To compare the development of white spot lesions (WSLs) during fixed orthodontic therapy among a conventional three-step bonding system, a self-etching primer bonding system, and a one-step adhesive bonding system. Materials and Methods: Seventy-five patients were randomly allocated into three groups (group 1, conventional bonding system, n = 25; group 2, self-etch primer, n = 25; group 3, primer mixed with adhesive composite, n = 25). Quantitative light-induced fluorescence (QLF) was used to assess WSL parameters. Images were captured and then analyzed before treatment and at 2 months and 4 months after bond up. Lesion area (pixels), mean fluorescence loss (DF), and the number of newly developed WSLs were compared within and among the three groups. The significance level was P < .05. Results: The mean increase in lesion area was 31.3 +/- 2.8 pixels, 38.4 +/- 4.3 pixels, and 119.5 +/- 5.3 pixels for groups 1, 2, and 3, respectively (P < .001). For DF, the loss was 3.3% +/- 0.3%, 4.4% +/- 0.2%, and 6.6% +/- 0.2% for groups 1, 2, and 3, respectively. These changes were significantly different (P < .01 to P < .001). The incidence of newly developed lesions was 9.5 WSLs in group 1, 10 WSLs in group 2, and 15.9 WSLs in group 3. Conclusions: The lack of primer contributed to the development of a larger number of and more severe WSLs. (Angle Orthod. 2023;93:531-537.)