A Phase 4 interventional study of MI Varnish and Control group in White Spot Lesion and Orthodontic Treatment, sponsored by University of Alabama at Birmingham. Completed. Open to participants aged 10 Years to 50 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2023-06-26.
Sponsored by University of Alabama at Birmingham · Phase 4, Interventional, and Prevention
The current study aimed to determine if MI Varnish has an effect in preventing the formation of white spot lesions for patients undergoing orthodontic treatment. 33 subjects were prospectively recruited for the project as the MI Varnish group, with a control group of 29 orthodontically treated subjects who received routine treatment and oral hygiene regimes.Difference in prevention of white spot formation between the control and the study groups were evaluated through photographic records and clinical examination by using the Enamel Decalcification Index (EDI) scores.
Orthodontists face two common iatrogenic treatment side effects, root resorption and enamel decalcification, with the latter occurring at a much higher frequency. While the processes that lead to enamel demineralization are understood, methods to diminish or perhaps eliminate degradation of enamel surfaces are being searched for. A new product, MI Varnish, is current available and has been shown in some initial case reports to be useful in reducing white spot lesions. It contains a special milk-derived protein RECALDENT TM (CPP-ACP) in which the casein phosphopeptides (CPP) bind to teeth, dentin, and oral mucosa while the amorphous calcium phosphate (ACP) releases calcium and phosphate. The current study aimed to determine if MI Varnish has an effect in preventing the formation of white spot lesions for patients undergoing orthodontic treatment. 33 subjects were prospectively recruited for the project as the MI Varnish group, with a control group of 29 orthodontically treated subjects who received routine treatment and oral hygiene regimes. The study group received the MI Varnish on the day of bracket bonding. Subjects were recalled initially for 4 weeks (twice) and then at 3 monthly intervals. Difference in prevention of white spot formation between the control and the study groups were evaluated through photographic records and clinical examination by using the Enamel Decalcification Index (EDI) scores.
Exclusion Criteria:
33 subjects were prospectively recruited for the project in the MI Varnish group. All subjects will be patients seeking orthodontic treatment at the Department of Orthodontics, UAB. MI Varnish were applied on their teeth initially for 4 weeks (twice) and then 3 monthly intervals.
Drug: MI Varnish
A control group was comprised of 29 orthodontically treated subjects who received routine treatment and oral hygiene regimes. All subjects will be patients seeking orthodontic treatment at the Department of Orthodontics, School of Dentistry, University of Alabama at Birmingham. No intervention for this group.
Other: Control group
MI Varnish with RECALDENT™ (CPP-ACP) enhances enamel acid resistance and boosts salivary fluoride levels. This product remains on the teeth longer than other fluoride varnishes and contains high levels of fluoride and calcium released in the oral cavity. The difference is in the RECALDENT™ (CPP-ACP), which makes MI Varnish a natural and unique choice for your patients. Casein phosphopeptides (CPP) naturally occurs in milk casein; Amorphous Calcium Phosphate (ACP), which is found in the RECALDENT™, is also the source of calcium and phosphate. In the oral cavity, CPP binds to oral surfaces such as teeth, dentin, oral mucosa and biofilm. Calcium and phosphate ions are the building blocks for healthy teeth and MI Varnish delivers bioavailable calcium and phosphate ions into the saliva.
Participants received routine treatment and oral hygiene regimes. No intervention for this group.
Enamel Decalcification Index (EDI) Scores
Photographic records will be used to determine the improvements in the white spot lesions. A standard intra-oral photographic camera will be utilized and the photographs will be taken in a light controlled environment and photographs will be captured in a pre-set photographic protocol. The Enamel decalcification index (EDI) will be used to determine the number of white spot lesions present at each time frame.Enamel decalcification index calculation: The facial surface of each tooth was divided into 4 areas (m, Mesial; g, gingival; d, distal; o, occlusal). A score was allocated for each area of each tooth: 0, no decalcification, to 3, decalcifications covering 100% of the area at each time period. Analysis was done at the tooth level, aggregating the enamel decalcification scores from all four areas, creating an EDI for each tooth ranging potentially from 0 to 12. Higher EDI scores indicate more decalcification of teeth and represent a worse outcome.
Time frame: Photographs were taken for 4 times at monthly intervals. EDI scores were measured and assessed at 1, 2, 3 and 4 months, Month 4 reported. The duration of the observation is an average of 4 months.
| Milestone | MI Varnish Group | Control Group |
|---|---|---|
| Started | 33 | 29 |
| Completed | 26 | 29 |
| Not completed | 7 | 0 |
Photographic records will be used to determine the improvements in the white spot lesions. A standard intra-oral photographic camera will be utilized and the photographs will be taken in a light controlled environment and photographs will be captured in a pre-set photographic protocol. The Enamel decalcification index (EDI) will be used to determine the number of white spot lesions present at each time frame.Enamel decalcification index calculation: The facial surface of each tooth was divided into 4 areas (m, Mesial; g, gingival; d, distal; o, occlusal). A score was allocated for each area of each tooth: 0, no decalcification, to 3, decalcifications covering 100% of the area at each time period. Analysis was done at the tooth level, aggregating the enamel decalcification scores from all four areas, creating an EDI for each tooth ranging potentially from 0 to 12. Higher EDI scores indicate more decalcification of teeth and represent a worse outcome.
| scores on a scale | MI Varnish Group | Control Group |
|---|---|---|
| Total EDI score of 1-month visit | 1.038 (0.268 to 1.809) | 1 (0.382 to 1.618) |
| Total EDI score of 2-month visit | 1.308 (0.138 to 2.477) | 2.724 (0.769 to 4.679) |
| Total EDI score of 3-month visit | 1.923 (0.382 to 3.464) | 3.966 (1.662 to 6.269) |
| Total EDI score of 4-month visit | 2.692 (0.778 to 4.607) | 5.897 (3.028 to 8.765) |
Collected over During and within 6 months from the end of the treatment.. Non-serious events are listed at a 5% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| MI Varnish Group | 0/33 (0%) | 0/33 (0%) | 0/33 (0%) |
| Control Group | 0/29 (0%) | 0/29 (0%) | 0/29 (0%) |
| Age, Continuous(years) | MI Varnish Group | Control Group | Total |
|---|---|---|---|
| Mean | 29.5 ± 6.7 | 28.5 ± 5.2 | 29 ± 5.94 |
| Sex: Female, Male(Participants) | MI Varnish Group | Control Group | Total |
|---|---|---|---|
| Female | 16 | 16 | 32 |
| Male | 10 | 13 | 23 |
| Region of Enrollment(Participants) | MI Varnish Group | Control Group | Total |
|---|---|---|---|
| Central America | 18 | 20 | 38 |
| Africa | 6 | 9 | 15 |
| China | 2 | 0 | 2 |
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University of Alabama at Birmingham