Impact of Lingual Attachment on WSL Development in Clear Aligner Patients: A Randomized Controlled Clinical Trial

Impact of Lingual Attachment Placement on White Spot Lesion Development in Clear Aligner Orthodontic Patients : A Randomized Controlled Clinical Trial

White spot lesions (WSLs) are a common esthetic complication during orthodontic treatment. While clear aligners (CAs) generally reduce WSL risk compared to fixed appliances, composite attachments remain plaque-retentive sites. This two-arm clinical trial investigated the effect of shifting attachments to lingual surfaces on WSL development.

A randomized controlled trial was conducted on 52 patients (18-35 years) undergoing CA therapy. Participants were allocated to two groups (n=26) for each: conventional buccal attachments (control) and lingual/palatal attachments (intervention). WSLs and plaque were assessed at baseline (T0) and six months (T1) using quantitative light-induced fluorescence (QLF). Outcomes included lesion area (pixels), mean fluorescence loss (ΔF), maximum depth (ΔFmax), and plaque index (ΔR30). Statistical analysis employed paired and independent t-tests, chi-square, and multivariable regression (α<0.05).

Inclusion Criteria:

• Medically fit young adults
• The patient should have mild to moderate crowding or spacing of teeth.
• The treatment plan should be non-extraction.
• Patients should have optimum oral hygiene before beginning the treatment.
• The patient may have a maximum of three teeth with either fillings or dental prostheses.

(According to the British national institute of health, NIH 2016).

Exclusion Criteria:

• Patients with defective enamel, generalized enamel disorder, or extensive dental restorations.
• Patients with syndromes or orofacial anomalies.
• Patients with salivary gland diseases or taking medications that may affect oral flora or salivary functions.
• Patients who are pregnant or diabetic.
• Patients use mouth rinses or any extra form of fluoride other than toothpaste.