Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

126 questions · 147 findings · 16 reviews · Orthodontics

No studies found 14 · 9.5%GRADE not reported 76 · 51.7%Very low 34 · 23.1%Low 13 · 8.8%Moderate 10 · 6.8%High 0 · 0%

Resin infiltration vs Baseline before resin infiltration

Color change · Patients with post-orthodontic white spot lesions and permanent dentition

Eckstein (2015) reported a statistically significant color-change effect.

4 findings from 1 review
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Resin infiltration vs Pre-treatment baseline before infiltration (T0); pooled as a within-arm before/after change

Lightness/brightness change of white spot lesion (luminosity L*, T0 to T1) · Patients with post-orthodontic white spot lesions and permanent dentition

ICON resin infiltration showed no statistically significant change in lightness/brightness of post-orthodontic white spot lesions at 6 months (pooled Cohen's d/SMD -0.001, 95% CI -0.23 to 0.23; 3 studies, 330 teeth; I2=97%); not GRADE-rated.

1 finding from 1 review

Resin infiltration vs Pre-treatment baseline before infiltration (T0); pooled as a within-arm before/after change

Color change of white spot lesion (color difference, T0 to T1) · Patients with post-orthodontic white spot lesions and permanent dentition

ICON resin infiltration significantly improved the color of post-orthodontic white spot lesions at 6 months (pooled Cohen's d/SMD 1.36, 95% CI 1.14 to 1.59; 4 studies, 458 teeth), although heterogeneity was very high (I2=98%) with a heavy outlier (Kannan); not GRADE-rated.

1 finding from 1 review

Fluoride-releasing glass ionomer-based bonding agent vs Non-fluoride glass ionomer-based bonding agent

Initiation of white spot lesions (WSL), visual-tactile assessment · Patients of any age (11-40 years) receiving comprehensive/fixed orthodontic treatment with fixed appliances

For a glass-ionomer-based bonding agent (single study), fluoride release significantly reduced WSL initiation (RR 0.64); subgroup not separately GRADE-rated.

1 finding from 1 review

Sealant/coating agent WITH fluoride release applied to teeth with fixed appliances vs No sealant (control/no treatment)

Initiation of white spot lesions (WSL), visual-tactile assessment · Patients of any age (11-40 years) receiving comprehensive/fixed orthodontic treatment with fixed appliances

Among fluoride-releasing sealants, the reduction in WSL initiation versus no sealant was not statistically significant (RR 0.69); subgroup not separately GRADE-rated.

1 finding from 1 review

Resin infiltration vs Untreated control (natural remineralization)

Optical/esthetic improvement (visual-tactile assessment) · Patients with post-orthodontic white spot lesions (WSL)

Resin infiltration produced significantly greater optical improvement of white spot lesions than untreated (naturally remineralizing) controls (SMD 1.24, 95% CI 0.59 to 1.88; moderate certainty).

4 findings from 1 review
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Coating material (bonding material or sealant) WITH fluoride release vs Coating material WITHOUT fluoride release

Initiation of white spot lesions (WSL), visual-tactile assessment · People receiving orthodontic treatment with fixed appliances (upper and/or lower full arch)

Fluoride-releasing coating material did not show a statistically significant reduction in new white spot lesions versus non-fluoride coating (very low certainty).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Lactobacilli presence (CFU > 10^5) · Adults undergoing orthodontic treatment

Aligners probably lower the risk of high lactobacilli counts versus fixed appliances in adults at 3 months (RR 0.09, 95% CI 0.02 to 0.47; low certainty).

2 findings from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Average fluorescence loss (dF%) · Adults undergoing orthodontic treatment

A single study reported lower average fluorescence (mineral) loss with aligners versus fixed appliances in adults at 3 months (MD -1.40, 95% CI -2.15 to -0.65; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Plaque · Adolescents/teenagers undergoing orthodontic treatment

A single study reported a lower full-mouth plaque score with aligners versus fixed appliances in adolescents at 12 months (MD -43.48, 95% CI -47.65 to -39.31; ungraded).

3 findings from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Gingival index (GI) · Adolescents/teenagers undergoing orthodontic treatment

A single study reported lower gingival index with aligners versus fixed appliances in adolescents at 18 months (MD -0.57, 95% CI -0.93 to -0.21; ungraded).

1 finding from 1 review

Glass ionomer cement vs Resin adhesive

Initiation of white spot lesions (WSL), visual-tactile assessment · People receiving orthodontic treatment with fixed appliances (upper and/or lower full arch)

Glass ionomer cement did not show a statistically significant difference in new white spot lesions versus resin adhesive (very low certainty).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

S. mutans presence (CFU > 10^5) · Adults undergoing orthodontic treatment

Aligners probably lower the risk of high S. mutans counts versus fixed appliances in adults at 3 months (RR 0.07, 95% CI 0.01 to 0.49; low certainty).

2 findings from 1 review

Bleaching before resin infiltration (bleaching + infiltration) vs Resin infiltration alone

Patient/dentist satisfaction · Patients with dental fluorosis

Patient/dentist satisfaction did not differ between bleaching-then-infiltration and infiltration alone (SMD -1.53, 95% CI -4.75 to 1.70; ungraded).

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Gingival index (GI) · Adults undergoing orthodontic treatment

A single study found no significant difference in gingival index between aligners and fixed appliances in adults at 6-12 weeks (MD -0.10, 95% CI -0.35 to 0.15; ungraded).

1 finding from 1 review

Glass ionomer cement (for bracket bonding) vs Resin adhesive

Initiation of white spot lesions (WSL), visual-tactile assessment · Patients of any age (11-40 years) receiving comprehensive/fixed orthodontic treatment with fixed appliances

There is no clear difference in WSL initiation between glass ionomer cement and resin adhesive for bracket bonding (RR 0.72, not significant); certainty of evidence is very low.

1 finding from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

White spot lesions (WSLs), tooth level · Adults undergoing orthodontic treatment

A single study reported a lower risk of white spot lesions (tooth level) with aligners versus fixed appliances in adults at 3 months (RR 0.72, 95% CI 0.60 to 0.86; ungraded).

1 finding from 1 review

Resin infiltration vs Fluoride varnish

Optical/esthetic improvement (DIAGNOdent reading) · Patients (mainly children) with white spot lesions (WSL)

Resin infiltration produced significantly greater optical improvement than fluoride varnish (MD 4.76, 95% CI 0.74 to 8.78; moderate certainty).

3 findings from 1 review

Clear aligners (Invisalign / thermoformed aligners) vs Fixed appliances

Percentage of bleeding on probing (BOP) · Adults undergoing orthodontic treatment

No clear difference in bleeding on probing between aligners and fixed appliances in adults at 6-12 weeks (MD -0.26, 95% CI -0.77 to 0.26; very low certainty).

1 finding from 1 review