Prevention of orthodontic enamel demineralization: A systematic review with meta‐analyses

Tasios, Thomas; Papageorgiou, Spyridon N.; Papadopoulos, Moschos A.; Τσάπας, Απόστολος; Haidich, Anna‐Bettina

doi:10.1111/ocr.12322

Cited by 47 publications

(47 citation statements)

References 53 publications

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“…Some of these interventions have been shown to reduce the incidence of WSL 23 , 26 , 27 . Indeed, two systematic reviews revealed that sealants were associated with reduced WSL incidence than no sealant 28 , 29 . However, only up to eight studies were included in each systematic review although there are more clinical studies that analyse coating agents.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis

Kamber

Meyer-Lueckel

Kloukos

et al. 2021

Sci Rep

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To analyse clinical studies investigating coating agents such as sealants and other bonding materials to prevent the initiation or inhibit the progress of white spot lesions (WSL) during orthodontic treatment with fixed appliances. Electronic databases (Pubmed, CENTRAL, EMBASE) were screened for studies. No language restrictions were applied. Study selection, data extraction and quality assessment were done in duplicate. Primary outcome included assessment of WSL with visual-tactile assessment and/or laser fluorescence measurements. Twenty-four studies with 1117 patients (age: 11–40 years) and 12,809 teeth were included. Overall, 34 different sealants or bonding materials were analysed. Fourteen studies analysed fluoride and 14 studies non-fluoride releasing materials. Meta-analysis for visual tactile assessment revealed that sealants significantly decreased the initiation of WSL compared to untreated control (RR [95%CI] = 0.70 [0.53; 0.93]; very low level of evidence). Materials releasing fluoride did not decrease initiation of WSL compared to those with no fluoride release (RR [95%CI] = 0.84 [0.70; 1.01]; very low level of evidence). For laser fluorescence measurements no meta-analysis could be performed. The use of sealants seems to be effective in preventing the initiation of post-orthodontic WSL. Furthermore, there is no evidence supporting that fluoride-releasing sealants or bonding materials are more effective than those without fluoride release. No gold standard prevention strategy to prevent WSL during treatment with fixed orthodontic appliances has been established yet. However, based on only a limited number of studies the use of sealants seems to be effective in preventing the initiation of post-orthodontic WSL.

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Section: Introductionmentioning

confidence: 99%

Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis

Kamber

Meyer-Lueckel

Kloukos

et al. 2021

Sci Rep

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“…Together with pit and fissure sealants 5 and parent’s motivation 6 the application of fluoride is the oldest aid for caries prevention 7 . It was reported in a recent meta-analysis 8 that active patient reminders and flat surface sealants or fluoride varnish around orthodontic brackets might be associated with reduced white-spot-lesion burden, but the authors conclude that further research is needed. As another novel approach the use of bioactive glass (Biomin F paste) was shown to be an effective method for enamel remineralisation 9 .…”

Section: Introductionmentioning

confidence: 93%

Impact of self-assembling peptides in remineralisation of artificial early enamel lesions adjacent to orthodontic brackets

Jablonski-Momeni

Nothelfer

Morawietz

et al. 2020

Sci Rep

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Enamel demineralisation can occur as a side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the efficacy of the self-assembling peptide P11-4 for remineralisation combined with fluorides, compared to application of fluoride varnish alone. De- and remineralisation was assessed by Quantitative light-induced fluorescence (QLF). Orthodontic brackets were bonded on 108 human enamel samples and white spot lesions were created. The samples were allocated randomly into three groups: Group I received no treatment, group II had a single application of fluoride varnish (22,600 ppm), and group III was treated with P11-4 following a single application of fluoride varnish. Quantitative light-induced fluorescence (QLF) measurements were performed at baseline, after demineralisation and after storage in remineralisation solution for 7 and 30 days. Non-parametric tests (Kruskal–Wallis test and Friedman test) were used for further analysis. After demineralisation, all samples showed a median ΔF -9.38% ± 2.79. After 30 days median ΔF values were as followed: group I = -9.04% ± 2.51, group II = -7.89 ± 2.07, group III = -6.08% ± 2.79). The median ΔF values differed significantly between all groups at all investigation times (p < 0.00001). Application of P11-4 with fluoride varnish was superior to the use of fluorides alone for remineralisation of enamel adjacent to brackets.

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“…It is widely accepted that orthodontic treatment lasts for a long time; an average treatment with fixed appliances approximately lasts 24.9 months [ 10 ]. Considering that long-treatment times are a burden to the patients and are associated with various adverse effects [ 11 , 12 ], the ability to predict treatment duration and accordingly inform patients in advance is an essential skill for orthodontists [ 13 ] and lies in the interest of both orthodontists and patients. In that context, patients’ age might be an important factor in predicting treatment duration.…”

Section: Introductionmentioning

confidence: 99%

Duration of orthodontic treatment with fixed appliances in adolescents and adults: a systematic review with meta-analysis

et al. 2020

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Objectives Adults with fixed orthodontic appliances are increasing nowadays. Compared with adolescents, adults present biological differences that might influence treatment duration. Therefore, the aim of the study was to compare duration of treatment with fixed appliances between adults and adolescents. Materials and methods Eight databases were searched up to September 2019 for randomized and non-randomized clinical studies comparing treatment duration with fixed appliances in adolescents and adult patients. After duplicate study selection, data extraction, and risk of bias assessment with the Cochrane ROBINS-I tool, random effects meta-analyses of mean differences (MD) and their 95% confidence intervals (CIs) were performed, followed by assessment of the quality of evidence with GRADE. Results A total of 11 unique studies (one prospective and 10 retrospective non-randomized) with 2969 adolescents and 1380 adult patients were finally included. Meta-analysis of 7 studies found no significant difference in the duration of comprehensive treatment with fixed appliances (MD = − 0.8 month; 95% CI = − 4.2 to 2.6 months; P = 0.65; I2 = 92%) between adults and adolescents. Similarly, both distalization of upper first molars with skeletal anchorage for class II correction and the retraction of canines into the premolar extraction spaces lasted similarly long among adults and adolescents. On the other hand, alignment of palatally displaced canines lasted considerably longer in adults compared to adolescents (1 study; MD = 3.8 months; 95% CI = 1.4 to 6.2 months; P = 0.002). The quality of evidence for the meta-analysis was low due to the inclusion of non-randomized studies with considerable risk of bias. Conclusions While existing evidence does not indicate a difference in the overall duration of treatment with fixed appliances between adults and adolescents, the alignment of palatally displaced canines lasted significantly longer in adults. However, our confidence in these estimates is low due to the risk of bias in the included studies. Trial registration PROSPERO: (CRD42019148169)

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Prevention of orthodontic enamel demineralization: A systematic review with meta‐analyses

Cited by 47 publications

References 53 publications

Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis

Efficacy of sealants and bonding materials during fixed orthodontic treatment to prevent enamel demineralization: a systematic review and meta-analysis

Impact of self-assembling peptides in remineralisation of artificial early enamel lesions adjacent to orthodontic brackets

Duration of orthodontic treatment with fixed appliances in adolescents and adults: a systematic review with meta-analysis

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