White spot lesions in clear aligner therapy as compared with multi-bracket system: A Systematic Review

Abstract

To evaluate incidence of white spot lesions in clear aligner treatment compared with fixed appliance therapy.Electronic databases (PubMed, Cochrane Collaboration Oral Health group database of clinical trials, Web of Science, Science Direct, Scopus) and manual search of gray literature were conducted up to September 2021. Both randomized and non-randomized controlled studies were considered for review purposes. Study selection, data extraction, quality assessment (RoB 2.0 and ROBINS-I) was performed according to the Cochrane Handbook for Systematic Reviews of Intervention. Due to the presence of high heterogeneity only qualitative analysis has been done.Out of 479 retrieved literature, 3 studies fulfilled the eligibility criteria and were included in the analysis. Studies were evaluated at low to high risk of bias. On qualitative analysis, a total of 160 new white spot lesions were developed in the clear aligner group and 362 new lesions were found in the fixed orthodontic group (P <0.001). In addition, the surface area of white spot lesion in the clear aligner group was more than the fixed appliance group but the deepest lesion was still found in the fixed appliance group. Incidence and severity of white spot lesion was found more in the fixed appliance group as compared to the clear aligner group. However, more low risk of bias studies with proper methodological quality is required to reinforce the conclusive evidence.