Non-Cochrane · intervention · PM29709015
Efficacy of fluorides and CPP-ACP vs fluorides monotherapy on early caries lesions: A systematic review and meta-analysis.
Tao Siying, Zhu Yan, Yuan He, et al. · PloS one · 2018 · PubMed · doi:10.1371/journal.pone.0196660
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
5
current version
GRADE rated
0
No studies
0
Included studies
11
linked below
No studies 0 · 0%Ungraded 5 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Subjects with early caries lesions in permanent teeth, living in a non-fluoridated water area; excluded systemic disease or proven/suspected milk protein allergy | 559 patients with early caries lesions in permanent teeth (10 RCTs) |
| Intervention | Fluorides combined with CPP-ACP (any fluoride product, e.g. toothpaste, mouth rinse or varnish, plus any CPP-ACP product, e.g. MI Paste or Tooth Mousse) | Fluorides + CPP-ACP (Tooth Mousse or MI Paste Plus with fluoride toothpaste/varnish/rinse) |
| Comparison | Fluorides alone (monotherapy) | Fluorides alone (toothpaste, varnish or mouth rinse) |
| Outcomes | Laser fluorescence (LF); quantitative light-induced fluorescence (QLF); total lesion area / total surface area; visual inspection scores | LF change (6 studies); QLF (2 studies); lesion area/surface area (2 studies); visual inspection scores (2 studies, narrative only) |
| Study designs | Randomised controlled trials (parallel-design human clinical trials) | 10 RCTs (1 high, 3 low, 6 unclear risk of bias) |
| Timing | Not specified | Follow-up 3-24 weeks |
Search date: August 2017 (databases searched from January 1990 to August 2017). Databases: Medline (via PubMed); EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL)
Questions and results
Fluorides combined with CPP-ACP vs Fluorides alone (monotherapy)
Population: Patients with early caries lesions in permanent teeth (non-fluoridated water area)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Quantitative light-induced fluorescence (QLF) change Post-treatment (4-12 weeks) · Location of lesions: smooth surfaces Adding CPP-ACP to fluorides did not significantly change QLF outcomes for smooth-surface early caries lesions versus fluorides alone; not GRADE-rated. Source: Fig 3; Results (Quantitative light-induced fluorescence) · same question in other reviews | MD 0.26 [-0.50, 1.01] | 2 studies | Ungraded |
Visual inspection scores Post-treatment (4-24 weeks) Two trials reported visual inspection scores but could not be pooled (different criteria, missing standard deviations) and gave inconsistent findings, so no quantitative conclusion could be drawn. Source: Results (Visual inspection scores) · same question in other reviews | Not pooled (2 trials, different scoring criteria, standard deviations not reported). Brochner 2011: no significant difference; Andersson 2007: more lesions became invisible with fluorides + CPP-ACP. | 2 studies | Ungraded |
Laser fluorescence (LF) change Post-treatment (3-12 weeks) · Location of lesions: occlusal surfaces For occlusal early caries lesions, adding CPP-ACP to fluorides produced significantly greater laser-fluorescence improvement than fluorides alone (favors the combination); not GRADE-rated. Source: Fig 2; Results (Laser fluorescence) · same question in other reviews | MD -21.02 [-27.94, -14.10] | 3 studies | Ungraded |
Laser fluorescence (LF) change Post-treatment (12-24 weeks) · Location of lesions: smooth surfaces For smooth-surface early caries lesions, adding CPP-ACP to fluorides did not significantly change laser-fluorescence outcomes versus fluorides alone; not GRADE-rated. Source: Fig 2; Results (Laser fluorescence) · same question in other reviews | MD -13.90 [-39.25, 11.46] | 4 studies | Ungraded |
Total lesion area divided by total surface area (visual) Post-treatment (8-24 weeks) · Location of lesions: smooth surfaces Adding CPP-ACP to fluorides did not significantly change the lesion-area outcome for smooth-surface early caries lesions versus fluorides alone; not GRADE-rated. Source: Fig 4; Results (Total lesion area divided by total surface area) · same question in other reviews | MD 4.37 [-0.51, 9.26] | 2 studies | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | No | no |
| 3Choice of study designs explained | No | Yes | no |
| 4Comprehensive literature searchcritical | Partial Yes | Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | Yes | Yes | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | N/A | no |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 11
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Altenburger 2010 matched by author and year (probable) | 1 other review | Laser fluorescence (LF) change | not extracted yet | not extracted yet |
| Brochner 2011 Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate DOI:10.1007/s00784-010-0401-2 | 1 other review | not stated | not extracted yet | not extracted yet |
| Guclu 2016 A 12-Week Assessment of the Treatment of White Spot Lesions with CPP-ACP Paste and/or Fluoride Varnish. PMID:27843950 | 1 other review | Laser fluorescence (LF) change; PM29709015-P2-O1 | not extracted yet | not extracted yet |
| Llena 2015 matched by author and year (probable) | 1 other review | Laser fluorescence (LF) change | not extracted yet | not extracted yet |
| Akin 2012 Can white spot lesions be treated effectively? PMID:22356705 | this review only | Total lesion area divided by total surface area (visual); PM29709015-P2-O3 | not extracted yet | not extracted yet |
| Andersson 2007 Microwave fixation of brain tissue as a neurochemical technique- a review. PMID:200753 | this review only | not stated | not extracted yet | not extracted yet |
| Aykut 2014 matched by author and year (probable) | this review only | Laser fluorescence (LF) change; PM29709015-P2-O1 | not extracted yet | not extracted yet |
| Beerens 2010 Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic… DOI:10.1111/j.1600-0722.2010.00780.x | this review only | Quantitative light-induced fluorescence (QLF) change; PM29709015-P2-O2 | not extracted yet | not extracted yet |
| Fredrick 2013 DOI:10.3290/j.ohpd.a29736 | this review only | Laser fluorescence (LF) change | not extracted yet | not extracted yet |
| Fredrick 2013 matched by author and year (probable) | this review only | Laser fluorescence (LF) change | not extracted yet | not extracted yet |
| Huang 2013 Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. PMID:23273358 | this review only | Total lesion area divided by total surface area (visual); PM29709015-P2-O3 | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).