Dataset Information

Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review.

ABSTRACT:

Background

Fluoride varnish (FV) is an established technology for primary and secondary caries prevention.

Objective

The aim of this review was to evaluate the preventive effect of FV on development of white spot lesions (WSL) when regularly applied during orthodontic treatment with fixed appliances.

Search methods

We searched PubMed, Scopus and Google Scholar up to October 2022 using predetermined keywords.

Selection criteria

We included randomized controlled trials of a duration of minimum 12 months and at least quarterly FV applications.

Data collection and analysis

Based on abstracts, we retrieved full-text papers, extracted key outcome data, and assessed risk of bias. Primary outcome was prevalence of WSLs on subject level after debonding. We conducted a narrative synthesis and pooled comparable outcome data in a random effects model.

Results

We included seven studies covering 666 patients and assessed four publications with low or moderate risk of bias and three with high. The prevalence of WSLs at debonding varied between 12 and 55%. All studies presented results in favour for the FV intervention, one reached statistical significance on subject level. Five studies provided data for a meta-analysis. The pooled risk ratio was 0.64 [95% CI: 0.42, 0.98], indicating a statistically significant preventive effect. Certainty of evidence was graded as very low after reducing for risk of bias, inconsistency and imprecision.

Limitations

We pooled data on subject level and did not consider lesion severity on tooth level.

Conclusions and implications

Even if the certainty of evidence was very low, it was shown that FV can prevent development of WSL when regularly applied during orthodontic treatment. Larger investigations reporting a core outcome set are required to increase the certainty of evidence.

Registration

PROSPERO database (CRD42022370062).

SUBMITTER: Sonesson M

PROVIDER: S-EPMC10505687 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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Publications

Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review.

Sonesson Mikael M Sonesson Mikael M Twetman Svante S

European journal of orthodontics 20230901 5

<h4>Background</h4>Fluoride varnish (FV) is an established technology for primary and secondary caries prevention.<h4>Objective</h4>The aim of this review was to evaluate the preventive effect of FV on development of white spot lesions (WSL) when regularly applied during orthodontic treatment with fixed appliances.<h4>Search methods</h4>We searched PubMed, Scopus and Google Scholar up to October 2022 using predetermined keywords.<h4>Selection criteria</h4>We included randomized controlled trials ...[more]

PMID: 37032523

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Project description:This randomized, parallel, controlled trial assessed the effect of fluoride varnish, ozone and octenidine on white spot lesions (WSLs) and caries during orthodontic treatment. Patients were enrolled between 1st September 2017 and 31st August 2020 at initiation of orthodontic treatment in Department of Interdisciplinary Dentistry Pomeranian Medical University in Szczecin, Poland. All participants were randomly assigned to four study and one control groups using number random generator. However, investigators were not blinded due to the nature of the study. Groups I, II, III, IV had professional cleaning and varnishing (5% NaF) every 4 weeks. Groups II and IV had in-office ozone therapy before varnishing, groups III and IV received domestic octenidine mouthrinse. Group K had no professional hygienic or prophylactic procedures. WSLs were assessed at T0 and then every 4 weeks (T1-T4) and caries-at T0 and T4. The specific objective was to assess the influence of fluoride varnish, ozone and octenidine on the incidence of white spot lesions and caries during orthodontic treatment. The primary outcome of this report was the highest number of WSLs in group K and the lowest percentage of patients with WSLs in group IV. Each group comprised 30 randomized participants; they were all analyzed. No WSLs were found at T0, but they were stated in all groups at T4. The numbers of patients with WSLs significantly increased between T0-T4 in groups I and K. Group IV had the lowest percentage of patients with WSLs in T1-T4. WSLs in group IV were found no earlier than at T2. Group K had the highest percentage of WSLs at T4: 26%. At T0 all the groups had DMFs above 0 with a significant increase at T4. No side effects of the introduced prophylaxis were observed in any group. Caries is an important problem of fixed orthodontic treatment. Even an extremely intensive prophylaxis could not completely prevent WSLs and caries. Simultaneous application of fluoride varnish, ozone gas exposure and octenidine appears to have a beneficial effect in limiting the development of WSLs.Trial registration: NCT04992481.

Project description:White spot lesions (WSLs) are a formidable challenge during orthodontic treatment, affecting patients regardless of oral hygiene. Multifactorial in nature, amongst potential contributors to their development are the microbiome and salivary pH. The aim of our pilot study is to determine if pre-treatment differences in salivary Stephan curve kinetics and salivary microbiome features correlate with WSL development in orthodontic patients with fixed appliances. We hypothesize that non-oral hygiene determined differences in saliva could be predictive of WSL formation in this patient population through analysis of salivary Stephan curve kinetics, and that these differences would further manifest as changes in the oral microbiome. In this prospective cohort study, twenty patients with initial simplified oral hygiene index scores of "good" that were planning to undergo orthodontic treatment with self-ligating fixed appliances for at least 12 months were enrolled. At pre-treatment stage, saliva was collected for microbiome analysis, and at 15-minute intervals after a sucrose rinse over 45 min for Stephan curve kinetics. 50% of patients developed a mean 5.7 (SEM: 1.2) WSLs. There were no differences in saliva microbiome species richness, Shannon alpha diversity or beta diversity between the groups. Capnocytophaga sputigena exclusively and Prevotella melaninogenica predominantly were found in WSL patients, while Streptococcus australis was negatively correlated with WSL development. Streptococcus mitis and Streptococcus anginosus were primarily present in healthy patients. There was no evidence to support the primary hypothesis. While there were no differences in salivary pH or restitution kinetics following a sucrose challenge and no global microbial differences in WSL developers, our data showed change in salivary pH at 5 min associated with an abundance of acid-producing bacteria in saliva. The results suggest salivary pH modulation as a management strategy to inhibit the abundance of caries initiators. Our study may have uncovered the earliest predecessors to WSL/caries development.

Project description:AimThe aim of the study was to assess the remineralizing efficacy of fluoride and its combination varnishes on white spot lesion (WSL) in children with early childhood caries (ECC).Materials and methodsSixty children with active WSL on primary maxillary anterior teeth were randomly selected. At baseline, the WSL activity was evaluated using ICDAS II [lesion activity assessment (LAA)] and its dimensions through photographic method. They were allocated to group I (GI) (5% NaF), group II (GII) [5% NaF with amorphous calcium phosphate (ACP)], and group III (GIII) [5% NaF with casein phosphopeptides - amorphous calcium phosphate (CPP -ACP)]. First, oral hygiene instructions and diet counseling were given followed by application of fluoride varnishes in their respective groups. The same parameters were recorded at follow-up of 2, 4, 12, and 24 weeks intervals. Data were collected and subjected to statistical analysis using Friedman Chi-square and Mann-Whitney tests.ResultsOverall, the active WSL changed to inactive over a period of 24 weeks in GI was 90%, GII was 95%, and 100% in GIII. There was a significant reduction in dimension of WSL in GI from 4.119 to 2.525 (p = 0.0001). Likewise, there was a significant reduction in dimension of WSL in GII and GIII from 4.586 to 3.258 and 4.696 to 1.2155, respectively (p = 0.0001, p = 0.0001). Comparatively, group III (MI varnish) showed statistically significant reduction in the dimension of WSL from baseline to 24 weeks (p = 0.002). But the results were statistically insignificant with change of active lesions to its inactivity (p = 0.349).ConclusionFluoride varnish with CPP-ACP was found to be an effective preventive strategy in reversing WSL in children with ECC.Clinical relevanceThese combination varnishes could prove to be a promising preventive measure for pediatric dentists in reversing white spot lesions of ECC.Clinical trial registryNCT03360266.How to cite this articleRadha S, Kayalvizhi G, Adimoulame S, et al. Comparative Evaluation of the Remineralizing Efficacy of Fluoride Varnish and its Combination Varnishes on White Spot Lesions in Children with ECC: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2020;13(4):311-317.

Project description:Background: Despite the large number of studies that have been done in this area, there is still a gap in the literature when it comes to comparing the orthodontic tooth movement (OTM) efficacy of Invisalign and fixed orthodontic appliances. The primary objectives of this study were to evaluate and compare the efficacy of Invisalign and fixed orthodontic appliances in terms of the amount and rate of OTM. Specifically, the study aimed to determine if there was a statistically significant difference between these two treatment modalities in achieving OTM and to assess whether treatment duration differs significantly between Invisalign and traditional fixed appliances. This investigation seeks to address the existing gaps in the literature by providing a clear comparison based on recent empirical evidence, thereby contributing to more informed treatment decisions in orthodontic practices. Methodology: Relevant MeSH keywords and Boolean operators were selected by a team of reviewers to search several online databases for papers that were in accordance with the objectives of our review. Results: At the end of the search protocol, 10 studies were deemed to be eligible for inclusion in the review. The pooled analysis revealed a statistically significant reduction in treatment time for patients using Invisalign compared to those with fixed appliances, with a total OR of 0.61 [95% CI 0.43, 0.85]. No significant heterogeneity was detected (I2 = 0%), and the test for overall effect was significant (Z = 2.86, p=0.004). Furthermore, a nonsignificant trend favoring Invisalign was shown, with an odds ratio of 1.43 and a confidence interval that included 1 (0.97, 2.10). The p value was 0.07, and there was negligible heterogeneity among studies, as indicated by an I2 of 0%. Conclusion: Based on the findings from the selected studies, it can be concluded that Invisalign and fixed orthodontic appliances have similar overall efficacy in eliciting OTM. However, Invisalign treatment requires significantly less time to complete than fixed orthodontic appliances. Despite these observations, further studies are required to explore the long-term stability of OTM achieved with Invisalign and fixed orthodontic appliances. Registration and Protocol: Registration was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards (CRD42023405593). The research protocol was created to meet the goals and was properly filed with PROSPERO; however, it has not been prospectively registered.

Dataset Information

Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review.

Background

Objective

Search methods

Selection criteria

Data collection and analysis

Results

Limitations

Conclusions and implications

Registration

Publications

Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review.

Similar Datasets

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