Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review.
Journal
European journal of orthodontics
ISSN: 1460-2210
Titre abrégé: Eur J Orthod
Pays: England
ID NLM: 7909010
Informations de publication
Date de publication:
18 09 2023
18 09 2023
Historique:
medline:
19
9
2023
pubmed:
11
4
2023
entrez:
10
4
2023
Statut:
ppublish
Résumé
Fluoride varnish (FV) is an established technology for primary and secondary caries prevention. 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. We searched PubMed, Scopus and Google Scholar up to October 2022 using predetermined keywords. We included randomized controlled trials of a duration of minimum 12 months and at least quarterly FV applications. 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. 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. We pooled data on subject level and did not consider lesion severity on tooth level. 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. PROSPERO database (CRD42022370062).
Sections du résumé
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).
Identifiants
pubmed: 37032523
pii: 7111424
doi: 10.1093/ejo/cjad013
pmc: PMC10505687
doi:
Substances chimiques
Fluorides
Q80VPU408O
Fluorides, Topical
0
Cariostatic Agents
0
Types de publication
Systematic Review
Meta-Analysis
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
485-490Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society.
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