Clinical evidence in the treatment of white spot lesions following fixed orthodontic therapy: a meta-analysis

Publications

Share / Export Citation / Email / Print / Text size:

Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine

GET ALERTS

ISSN: 2207-7472
eISSN: 2207-7480

DESCRIPTION

5
Reader(s)
5
Visit(s)
0
Comment(s)
0
Share(s)

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue / page

Archive
Volume 37 (2021)
Volume 36 (2020)
Volume 35 (2019)
Volume 34 (2018)
Volume 33 (2017)
Volume 32 (2016)
Volume 31 (2015)
Related articles

VOLUME 34 , ISSUE 1 (May 2018) > List of articles

Clinical evidence in the treatment of white spot lesions following fixed orthodontic therapy: a meta-analysis

Eng Seng Yeoh * / Tam Le / Joemer Maravilla / Vincent O’Rourke / Yan He / Qingsong Ye

Citation Information : Australasian Orthodontic Journal. Volume 34, Issue 1, Pages 45-60, DOI: https://doi.org/10.21307/aoj-2020-058

License : (CC BY 4.0)

Published Online: 20-July-2021

ARTICLE

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.

Content not available PDF Share

FIGURES & TABLES

REFERENCES

1. Julien KC, Buschang PH, Campbell PM. Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod 2013;83:641-7.

2. Øgaard B. White spot lesions during orthodontic treatment: mechanisms and fluoride preventive aspects. Semin Orthod 2008;14:183-93.

3. Heymann GC, Grauer D. A contemporary review of white spot lesions in orthodontics. J Esthet Restor Dent 2013;25:85-95.

4. Gomez J, Pretty IA, Santarpia RP 3rd, Cantore B, Rege A, Petrou I et al. Quantitative light-induced fluorescence to measure enamel remineralization in vitro. Caries Res 2014;48:223-7.

5. Wilson D, Xu C, Hong L, Wang Y. Effects of different preparation procedures during tooth whitening on enamel bonding. J Mater Sci Mater Med 2009;20:1001-7.

6. Boersma JG, van der Veen MH, Lagerweij MD, Bokhout B, PrahlAndersen B. Caries prevalence measured with qlf after treatment with fixed orthodontic appliances: influencing factors. Caries Res 2005;39:41-7.

7. Artun J, Brobakken BO. Prevalence of carious white spots after orthodontic treatment with multibonded appliances. Eur J Orthod 1986;8:229-34.

8. O’Reilly MM, Featherstone JD. Demineralization and remineralization around orthodontic appliances: an in vivo study. Am J Orthod Dentofacial Orthop 1987;92:33-40.

9. Yap J, Walsh L, Naser‐Ud Din S, Ngo H, Manton DJ. Evaluation of a novel approach in the prevention of white spot lesions around orthodontic brackets. Aust Dent J 2014;59:70-80.

10. Stecksén-Blicks C, Renfors G, Oscarson ND, Bergstrand F, Twetman S. Caries-preventive effectiveness of a fluoride varnish: a randomized controlled trial in adolescents with fixed orthodontic appliances. Caries Res 2007;41:455-9.

11. Reynolds EC. Calcium phosphate-based remineralization systems: scientific evidence? Aust Dent J 2008;53:268-73.

12. Bröchner A, Christensen C, Kristensen B, Tranæus S, Karlsson L, Sonnesen L et al. Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate. Clin Oral Investig 2011;15:369-73.

13. Iijima M, Ito S, Nakagaki S, Muguruma T, Kohda N, Saito T et al. Effects of the addition of fluoride to a 4-META/MMA-TBB-based resin adhesive on fluoride release, acid resistance of enamel and shear bond strength in vitro. Dent Mater J 2013;32:156-64.

14. Cochrane NJ, Reynolds EC. Calcium phosphopeptides -- mechanisms of action and evidence for clinical efficacy. Adv Dent Res 2012;24:41-7.

15. Chen H, Liu X, Dai J, Jiang Z, Guo T, Ding Y. Effect of remineralizing agents on white spot lesions after orthodontic treatment: a systematic review. Am J Orthod Dentofacial Orthop 2013;143:376-82.

16. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 2009;62:e1-34.

17. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.

18. Lipsey MW, Wilson DB. Practical meta-analysis. Thousand Oaks, Calif.: Sage Publications, 2001.

19. Doi SA, Barendregt JJ, Khan S, Thalib L, Williams GM. Advances in the meta-analysis of heterogeneous clinical trials II: The quality effects model. Contemp Clin Trials 2015;45:123-9.

20. Ballard RW, Hagan JL, Phaup AN, Sarkar N, Townsend JA, Armbruster PC. Evaluation of 3 commercially available materials for resolution of white spot lesions. Am J Orthod Dentofacial Orthop 2013;143:S78-84.

21. Behnan SM, Arruda AO, González-Cabezas C, Sohn W, Peters MC. In-vitro evaluation of various treatments to prevent demineralization next to orthodontic brackets. Am J Orthod Dentofacial Orthop 2010;138:712.e1-7; discussion 712-3.

22. Benson PE, Pender N, Higham SM. An in situ caries model to study demineralisation during fixed orthodontics. Clin Orthod Res 1999;2:143-53.

23. Bichu YM, Kamat N, Chandra PK, Kapoor A, Razmus T, Aravind NK. Prevention of enamel demineralization during orthodontic treatment: an in vitro comparative study. Orthodontics (Chic.) 2013;14:e22-9.

24. Pliska BT, Warner GA, Tantbirojn D, Larson BE. Treatment of white spot lesions with ACP paste and microabrasion. Angle Orthod 2012;82:765-9.

25. Restrepo M, Bussaneli DG, Jeremias F, Cordeiro RC, Magalhães AC, Palomari Spolidorio DM et al. Control of white spot lesion adjacent to orthodontic bracket with use of fluoride varnish or chlorhexidine gel. ScientificWorldJournal 2015;2015:218452.

26. Aljehani A, Yousif MA, Angmar-Månsson B, Shi XQ. Longitudinal quantification of incipient carious lesions in postorthodontic patients using a fluorescence method. Eur J Oral Sci 2006;114:430-4.

27. Kleber CJ, Milleman JL, Davidson KR, Putt MS, Triol CW, Winston AE. Treatment of orthodontic white spot lesions with a remineralizing dentifrice applied by toothbrushing or mouth trays. J Clin Dent 1999;10:44-9.

28. Krithikadatta J, Fredrick C, Abarajithan M, Kandaswamy D. Remineralisation of occlusal white spot lesion with a combination of 10% CPP-ACP and 0.2% sodium fluoride evaluated using Diagnodent: a pilot study. Oral Health Prev Dent 2013;11:191-6.

29. Agarwal A, Pandey H, Pandey L, Choudhary G. Effect of fluoridated toothpaste on white spot lesions in postorthodontic patients. Int J Clin Pediatr Dent 2013;6:85-8.

30. He WD, Liu YZ, Xu YY, Chen D. [Study on application of CPPACP on tooth mineralization during orthodontic treatment with fixed appliance]. Shanghai kou qiang yi xue (Shanghai journal of stomatology) 2010;19:140-3. Chinese.

31. Donly KJ, Sasa IS. Potential Remineralization of Postorthodontic Demineralized Enamel and the Use of Enamel Microabrasion and Bleaching for Esthetics. Semin Orthod 2008;14:220-5.

32. Kalha AS. Lack of reliable evidence of the effectiveness of remineralising agents for the treatment of post orthodontic white spot lesions. Evid Based Dent 2013;14:76-7.

33. Mahony D. Treatment of “white spot lesions” after removal of fixed orthodontic appliances. Int J Orthod Milwaukee 2012;23:59-60.

34. Willmot D. White spot lesions after orthodontic treatment. Semin Orthod 2008;14:209-19.

35. Akin M, Basciftci FA. Can white spot lesions be treated effectively? Angle Orthod 2012;82:770-5.

36. Andersson A, Sköld-Larsson K, Hallgren A, Petersson LG, Twetman S. Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence. Oral Health Prev Den 2007;5:229-33.

37. Baeshen HA, Lingström P, Birkhed D. Effect of fluoridated chewing sticks (Miswaks) on white spot lesions in postorthodontic patients. Am J Orthod Dentofacial Orthop 2011;140:291-7.

38. Bailey DL, Adams GG, Tsao CE, Hyslop A, Escobar K, Manton DJ et al. Regression of post-orthodontic lesions by a remineralizing cream. J Dent Res 2009;88:1148-53.

39. Beerens MW, van der Veen MH, van Beek H, ten Cate JM. Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: a 3-month follow-up. Eur J Oral Sci 2010;118:610-7.

40. Bröchner A, Christensen C, Kristensen B, Tranæus S, Karlsson L, Sonnesen L et al. Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate. Clin Oral Investig 2011;15:369-73.

41. Du M, Cheng N, Tai B, Jiang H, Li J, Bian Z. Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment. Clin Oral Investig 2012;16:463-8.

42. He T, Li X, Dong Y, Zhang N, Zhong Y, Yin W et al. Comparative assessment of fluoride varnish and fluoride film for remineralization of postorthodontic white spot lesions in adolescents and adults over a 6-month period: A single-center, randomized controlled clinical trial. Am J Orthod Dentofacial Orthop 2016;149:810-9.

43. Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM et al. Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Am J Orthod Dentofacial Orthop 2013;143:31-41.

44. Yetkiner E, Wegehaupt F, Wiegand A, Attin R, Attin T. Colour improvement and stability of white spot lesions following infiltration, micro-abrasion, or fluoride treatments in vitro. Eur J Orthod 2014;36:595-602.

45. Staudt CB, Lussi A, Jacquet J, Kiliaridis S. White spot lesions around brackets: in vitro detection by laser fluorescence. Eur J Oral Sci 2004;112:237-43.

46. Srivastava K, Tikku T, Khanna R, Sachan K. Risk factors and management of white spot lesions in orthodontics. J Orthod Sci 2013;2:43-9.

47. ten Cate JM, Buijs MJ, Miller CC, Exterkate RA. Elevated fluoride products enhance remineralization of advanced enamel lesions. J Dent Res 2008;87:943-7.

48. Buzalaf MA, Pessan JP, Honório HM, ten Cate JM. Mechanisms of action of fluoride for caries control. Monogr Oral Sci 2011;22:97-114.

49. Mettu S, Srinivas N, Reddy Sampath CH, Srinivas N. Effect of casein phosphopeptide-amorphous calcium phosphate (cpp-acp) on caries-like lesions in terms of time and nano-hardness: An in vitro study. J Indian Soc Pedod Prev Dent 2015;33:269-73.

50. Kumar VL, Itthagarun A, King NM. The effect of casein phosphopeptide-amorphous calcium phosphate on remineralization of artificial caries-like lesions: an in vitro study. Aust Dent J 2008;53:34-40.

51. Rahiotis C, Vougiouklakis G, Eliades G. Characterization of oral films formed in the presence of a CPP-ACP agent: an in situ study. J Dent 2008;36:272-80.

52. Reynolds EC, Cai F, Cochrane NJ, Shen P, Walker GD, Morgan MV et al. Fluoride and casein phosphopeptide-amorphous calcium phosphate. J Dent Res 2008;87:344-8.

53. Shen P, Cai F, Nowicki A, Vincent J, Reynolds EC. Remineralization of enamel subsurface lesions by sugar-free chewing gum containing casein phosphopeptide-amorphous calcium phosphate. J Dent Res 2001;80:2066-70.

54. Button KS, Ioannidis JP, Mokrysz C, Nosek BA, Flint J, Robinson ES et al. Power failure: why small sample size undermines the reliability of neuroscience. Nat Rev Neurosci 2013;14:365-76.

55. van der Veen MH, de Josselin de Jong E. Application of quantitative light-induced fluorescence for assessing early caries lesions. Monogr Oral Sci 2000;17:144-62.

56. Shi XQ, Tranaeus S, Angmar-Månsson B. Comparison of QLF and DIAGNOdent for quantification of smooth surface caries. Caries Res 2001;35:21-6.

57. Aljehani A, Tranaeus S, Forsberg CM, Angmar-Månsson B, Shi XQ. In vitro quantification of white spot enamel lesions adjacent to fixed orthodontic appliances using quantitative light-induced fluorescence and DIAGNOdent. Acta Odontol Scand 2004;62:313-8.

58. Pretty IA. Caries detection and diagnosis: novel technologies. J Dent 2006;34:727-39.

59. Lussi A, Hibst R, Paulus R. DIAGNOdent: an optical method for caries detection. J Dent Res 2004;83 Spec No C:C80-3.

60. Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions. Hoboken, NJ: Wiley-Blackwell, 2008;6-7.

61. Myers HM. Dose-response relationship between water fluoride levels and the category of questionable dental fluorosis. Community Dent Oral Epidemiol 1983;11:109-12.

62. Srinivasan N, Kavitha M, Loganathan SC. Comparison of the remineralization potential of CPP-ACP and CPP-ACP with 900 ppm fluoride on eroded human enamel: An in situ study. Arch Oral Biol 2010;55:541-4.

EXTRA FILES

COMMENTS