A 3.5-year follow-up of an unusual case of rampant caries during clear aligner treatment

If patients follow the clinician’s recommendations, clear aligner orthodontic appliances cover the teeth for 20 to 22 hr daily. If oral hygiene is inadequate, bacterial plaque will lay extensively between the tooth surface and the clear aligner and lead to an increased risk of white spot lesions (WSL) and dental caries. Information regarding enamel WSL or caries formation in patients treated with clear aligners has not been widely discussed. This report describes an unusual case of rampant caries and enamel demineralisation in an adolescent due to poor oral hygiene during clear aligner orthodontic treatment. All enamel surfaces were chalky white, fragile, and rough, while approximately 1/4 to 1/2 incisal enamel was lost on most teeth. Interestingly, the exposed dentine presented a mamelon-like shape even though enamel was lost from some lower incisors. This case report discusses different WSL/caries management methods using clear aligners and a 3.5-year follow-up of the patient.