White spot lesions (WSLs) are the earliest clinical sign of enamel demineralisation and a frequent adverse outcome of fixed orthodontic therapy. Their development is multifactorial, reflecting an interaction between appliance, biofilm, and patient factors.
This mini review summarises and critically evaluates the evidence published since 2018 on the contribution of fixed orthodontic appliances to the development of WSLs, with attention to pathogenesis, risk factors, and clinical implications.
A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science. Articles published between January 1, 2018 and September 30, 2025, were screened. Selected pre-2018 studies were retained for background on enamel demineralisation, biofilm behaviour, and orthodontic bonding. Search terms combined controlled vocabulary (MeSH) and free text keywords linked by Boolean operators, including "white spot lesions", "enamel demineralization", "fixed orthodontic appliances", "orthodontic brackets", "biofilm", and "oral hygiene". The initial search was not restricted by language, but only English-language full texts were retained during eligibility screening.
WSLs may develop at any stage of fixed orthodontic therapy, but the majority appear within the first three to six months after appliance placement. Lesions are observed most often on the labial and cervical enamel adjacent to brackets. Reported drivers include plaque retention around appliance components, an acidogenic and aciduric biofilm shift (dysbiosis), iatrogenic enamel changes from acid etching, and patient-level factors such as oral hygiene, diet, and treatment duration.
The change in the oral environment created by fixed appliances is necessary but not sufficient for WSL development. Patient-related factors, particularly oral hygiene and dietary behaviour, modulate the appliance-related risk. The first three to six months after bonding is the period of greatest enamel vulnerability and the optimal window for individualised preventive intensification.
WSLs are common but largely preventable. Risk-based, individualised preventive programmes initiated at the start of treatment, combined with sound bonding technique and careful biofilm control, are essential for protecting enamel and safeguarding the aesthetic outcome of fixed orthodontic therapy.
Citation: Alba Kamberi, Enida Petro, Elsena Mataj, Sara Ghanim, Adela Alushi. The impact of fixed orthodontic appliances on the development of white spot lesions: A mini review[J]. Journal of Dentistry and Multidisciplinary Sciences, 2026, 2(1): 30-38. doi: 10.3934/jdms.2026005
White spot lesions (WSLs) are the earliest clinical sign of enamel demineralisation and a frequent adverse outcome of fixed orthodontic therapy. Their development is multifactorial, reflecting an interaction between appliance, biofilm, and patient factors.
This mini review summarises and critically evaluates the evidence published since 2018 on the contribution of fixed orthodontic appliances to the development of WSLs, with attention to pathogenesis, risk factors, and clinical implications.
A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science. Articles published between January 1, 2018 and September 30, 2025, were screened. Selected pre-2018 studies were retained for background on enamel demineralisation, biofilm behaviour, and orthodontic bonding. Search terms combined controlled vocabulary (MeSH) and free text keywords linked by Boolean operators, including "white spot lesions", "enamel demineralization", "fixed orthodontic appliances", "orthodontic brackets", "biofilm", and "oral hygiene". The initial search was not restricted by language, but only English-language full texts were retained during eligibility screening.
WSLs may develop at any stage of fixed orthodontic therapy, but the majority appear within the first three to six months after appliance placement. Lesions are observed most often on the labial and cervical enamel adjacent to brackets. Reported drivers include plaque retention around appliance components, an acidogenic and aciduric biofilm shift (dysbiosis), iatrogenic enamel changes from acid etching, and patient-level factors such as oral hygiene, diet, and treatment duration.
The change in the oral environment created by fixed appliances is necessary but not sufficient for WSL development. Patient-related factors, particularly oral hygiene and dietary behaviour, modulate the appliance-related risk. The first three to six months after bonding is the period of greatest enamel vulnerability and the optimal window for individualised preventive intensification.
WSLs are common but largely preventable. Risk-based, individualised preventive programmes initiated at the start of treatment, combined with sound bonding technique and careful biofilm control, are essential for protecting enamel and safeguarding the aesthetic outcome of fixed orthodontic therapy.
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Alba Kamberi, Enida Petro, Elsena Mataj, Sara Ghanim, Adela Alushi. The impact of fixed orthodontic appliances on the development of white spot lesions: A mini review[J]. Journal of Dentistry and Multidisciplinary Sciences, 2026, 2(1): 30-38. doi: 10.3934/jdms.2026005
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