Effectiveness of different adjunctive interventions in the management of orthodontically induced white spot lesions: A systematic review of systematic reviews and meta-analyses.

Wesam Bakdach,Rania Hadad

doi:10.17219/dmp/118330

Abstract

The purposes of this review were to appraise the current evidence on the management of orthodontically induced white spot lesions (OIWSLs) and to choose the best evidence from among conflicting systematic reviews. The published literature was searched from inception through November 2019 in 5 databases. Only systematic reviews and/or meta-analyses were eligible for inclusion. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2). The Jadad decision algorithm was applied to choose the best available evidence from among discordant reviews. Thirteen publications were included. The interventions reported in the management of OIWSLs were topical fluorides, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-containing products, fluoridecontaining bonding materials, laser therapy, resin infiltration, and micro-abrasion. The methodological quality of the reviews ranged between moderate and critically low according to the AMSTAR-2 tool. Based on the Jadad decision algorithm criteria, topical fluorides yielded a 25-30% prevention of OIWSLs; however, their effect on reversing OIWSLs was unclear. The CPP-ACP products were effective in both preventing and reversing OIWSLs. No differences were noted between fluoride-releasing adhesives and conventional adhesives. Laser irradiation was effective in preventing OIWSLs, with some concerns about the argon laser at a certain setting. Finally, there is a lack of reliable evidence supporting the efficacy of resin infiltration or micro-abrasion due to the limited number of available studies. Based on the currently available information, topical fluorides and laser irradiation are effective in preventing OIWSLs. The CPP-ACP products are effective in preventing and reversing OIWSLs. Fluoride-releasing adhesives have no effect on OIWSL prevention.

Highlights

Achieving optimal occlusion with minimal treatment complications is an essential demand for orthodontic treatment.[1]
The results showed positive effects of the fluoride products and casein derivatives on preventing orthodontically induced white spot lesions (OIWSLs) (4 out of 6 studies revealed the effectiveness of the fluoride products in preventing OIWSLs; 3 out of 5 studies revealed the effectiveness of casein derivatives in preventing OIWSLs)
The results indicated that fluorides led to a 25–30% reduction in the incidence of OIWSLs; their effect on reversing lesions was unclear due to concerns in interpreting the DIAGNOdent values

Summary

Introduction

Achieving optimal occlusion with minimal treatment complications is an essential demand for orthodontic treatment.[1]. Induced white spot lesions (OIWSLs) are considered one of the most prominent complications, with a prevalence of 68.4% in patients undergoing multi-bracketed fixed orthodontic treatment.[2]. This high percentage of prevalence is due to the irregular and non-uniform surfaces of fixed appliances, which can encourage plaque stagnation and limit natural self-cleansing mechanisms (Fig. 1,2).[3–5]. Patients seek orthodontic treatment in an attempt to improve function and esthetics.[4]. These common white, chalky, opaque spots with limited spontaneous reversibility may seriously jeopardize esthetic appearance and the patient’s satisfaction with the results of treatment.[4,6,7]. These common white, chalky, opaque spots with limited spontaneous reversibility may seriously jeopardize esthetic appearance and the patient’s satisfaction with the results of treatment.[4,6,7] Worse still, untreated white spot lesions (WSLs) may lead to tooth cavitation, requiring a subsequent restorative procedure.[8]

Methods

Results

Discussion

Conclusion