Abstract
Abstract Objective This systematic review aims to determine the most effective method of treatment to remineralise post-orthodontic white spot lesions (WSLs). Method Six databases were accessed and searched for articles. Screening and selection were conducted according to the PRISMA guidelines using predetermined inclusion and exclusion criteria. Two reviewers independently assessed and extracted identified studies and relevance disagreement was resolved through consensus. Experimental studies were included that involved (i) patients of any age who had WSLs after the removal of fixed appliances, (ii) any treatment to remineralise the WSLs compared with no treatment or a placebo, and (iii) measurement of the changes in enamel mineralisation status after treatment. Eligible articles were assessed for internal bias and underwent narrative synthesis. A meta-analysis using random-effects modelling was performed to calculate a pooled estimate and assess between-study variability using Cochran’s Q and I2. Results The nine articles included in this review were found to have a medium or high risk of bias. The qualitative assessment provided contrasting results between studies. The meta-analysis showed both CPP-ACP – pooled d of -0.28 (N = 5 studies; 95% CI = -0.48- -0.07) – and fluoride – pooled d of -0.25 (N = 4 studies; 95% CI = -0.48- -0.02) – to generate improvement in the enamel mineralisation status, with CPP-ACP producing more consistent results compared with fluoride. Conclusions The meta-analysis found that CPP-ACP and fluoride were effective in reducing post-orthodontic WSLs. Due to the heterogeneity of the included studies with regard to the fluoride concentrations and mode of delivery, the current meta-analysis could not accurately establish which remineralising agent, CPP-APP or fluoride, is more effective. Further high quality studies of long-term duration are required to determine best clinical practice.
Highlights
White spot lesions (WSLs) are localised porosities of subsurface enamel caused by demineralisation.[1]
Prevalence studies carried out using Quantitative lightinduced fluorescence (QLF) reported that WSLs were found in 97% of post-orthodontic cases.[6]
The present systematic review incorporating a meta-analysis of the pooled data focused on determining the most effective method of remineralising post-orthodontic WSLs
Summary
White spot lesions (WSLs) are localised porosities of subsurface enamel caused by demineralisation.[1]. Various indices have been used to quantify the severity of WSLs.[3] Quantitative lightinduced fluorescence (QLF) is a commonly used and highly sensitive diagnostic tool that utilises the Australasian Orthodontic Journal Volume 34 No 1 May 2018. WSLs are considered the most common iatrogenic complication of orthodontic treatment as the introduction of fixed appliances can unfavourably alter the oral environment.[5] Prevalence studies carried out using QLF reported that WSLs were found in 97% of post-orthodontic cases.[6] Orthodontic brackets, ligatures and bands physically obstruct effective cleaning in the area around these appliances and reduce the natural self-cleansing effect, giving rise to prolonged plaque accumulation and retention.[7,8] the imbalance between the processes of demineralisation and remineralisation of enamel results in the creation of opaque hypocalcified lesions.[2] While demineralisation usually decreases after the removal of fixed orthodontic appliances, some lesions persist and result in compromised aesthetics.[1] In severe cases, WSLs may progress to cavitated carious lesions and require invasive restorative intervention.[9] effective treatment following fixed orthodontic therapy is necessary to reverse and remineralise these potentially disastrous and unsightly lesions
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