Non-Cochrane · intervention · PM37032523
Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review.
Sonesson Mikael, Twetman Svante · European journal of orthodontics · 2023 · PubMed · doi:10.1093/ejo/cjad013
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
2
current version
GRADE rated
1
No studies
0
Included studies
12
linked below
No studies 0 · 0%Ungraded 1 · 50%Very low 1 · 50%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 | Healthy adolescents and adults undergoing orthodontic multi-bracket (fixed appliance) treatment | 666 patients across 7 RCTs (mostly adolescents and young adults, age range 12 to 50 years; Sweden, Poland, Iran, Hong Kong, USA) |
| Intervention | Periodic applications (at least quarterly) of fluoride varnish around the bracket bases | Fluoride varnish: 5% sodium fluoride (3 studies), 5% NaF with CPP-ACP (2), 0.1% difluorosilane (1), 1.5% ammonium fluoride (1); application frequency every 4 weeks to every 3 months |
| Comparison | Placebo varnish applications, other comparators, or standard care | Placebo varnish (3 studies), resin sealant (1), standard care with oral hygiene instructions (3) |
| Outcomes | Prevalence or incidence of white spot lesions at debonding by any clinically validated index (primary outcome: WSL prevalence on subject level after debonding) | WSL prevalence/incidence at debonding (subject and tooth level); prevalence at debonding 12 to 55%; pooled subject-level prevalence RR 0.64 (5 studies); pooled clinical-score SMD -0.44 (2 studies) |
| Study designs | Parallel-group randomized controlled trials, minimum 12 months duration, at least quarterly varnish applications; split-mouth designs, single/bi-annual applications, convenience samples, case series/reports, and grey literature excluded | 7 randomized controlled trials (n=7); 5 pooled in the prevalence meta-analysis |
| Timing | Minimum 12 months; outcome assessed at/after debonding | Study duration 12 to 26 months; outcome assessed at debonding |
Search date: 7 October 2022. Databases: PubMed; Scopus; Google Scholar (complementary grey-literature search)
Questions and results
Fluoride varnish applied periodically (at least quarterly) around the bracket bases during treatment vs Placebo varnish, resin sealant, or standard care (oral hygiene instructions)
Population: Healthy adolescents and adults undergoing orthodontic treatment with fixed multi-bracket appliances
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prevalence of white spot lesions (WSL) at debonding, subject level At debonding Fluoride varnish applied regularly during fixed orthodontic treatment may reduce the prevalence of white spot lesions at debonding (pooled RR 0.64, 95% CI 0.42 to 0.98), but the certainty of evidence is very low. Source: Abstract; Results (Synthesis of results); Certainty of evidence; Figure 3 (forest plot) · same question in other reviews | RR 0.64 [0.42, 0.98] | 5 studies · 558 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
White spot lesion clinical score (mean values), subject level At debonding In a pooled analysis of two placebo-controlled trials, fluoride varnish also reduced white spot lesion clinical scores (pooled SMD -0.44, 95% CI -0.64 to -0.24); this secondary outcome was not separately GRADE-rated. Source: Results (Synthesis of results) · same question in other reviews | SMD -0.44 [-0.64, -0.24] | 2 studies · 258 participants | 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 | Partial Yes | yes |
| 3Choice of study designs explained | Yes | Yes | yes |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | Yes | Yes | yes |
| 8Included studies described in detail | Yes | Yes | yes |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: N/A | NRSI: N/A · RCT: Partial 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 | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | No | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |
Included primary studies 12
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Rechmann 2018 MI Varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial. PMID:29299732 | 1 other review | not stated | not extracted yet | not extracted yet |
| Sonesson 2020 Fluoride varnish for the prevention of white spot lesions during orthodontic treatment with fixed appliances: a randomized controlled trial DOI:10.1093/ejo/cjz045 | 1 other review | not stated | not extracted yet | not extracted yet |
| Sonesson 2020 Fluoride varnish for the prevention of white spot lesions during orthodontic treatment with fixed appliances: a randomized controlled trial. PMID:31197364 | 1 other review | not stated | not extracted yet | not extracted yet |
| Stecksen-Blicks 2007 Caries-preventive effectiveness of a fluoride varnish: a randomized controlled trial in adolescents with fixed orthodontic appliances. PMID:17827963 | 1 other review | not stated | not extracted yet | not extracted yet |
| Stecksén-Blicks 2007 Caries-Preventive Effectiveness of a Fluoride Varnish: A Randomized Controlled Trial in Adolescents with Fixed Orthodontic Appliances DOI:10.1159/000107932 | 1 other review | not stated | not extracted yet | not extracted yet |
| Zarif Najafi 2021 Evaluation of the preventive effect of two concentrations of xylitol varnish versus fluoride varnish on enamel demineralization around… PMID:34379121 | 1 other review | not stated | not extracted yet | not extracted yet |
| Zarif Najafi 2022 Evaluation of the preventive effect of two concentrations of xylitol varnish versus fluoride varnish on enamel demineralization around… DOI:10.1093/ejo/cjab049 | 1 other review | not stated | not extracted yet | not extracted yet |
| Flynn 2022 The efficacy of fluoride varnish vs a filled resin sealant for preventing white spot lesions during orthodontic treatment. PMID:34679162 | this review only | not stated | not extracted yet | not extracted yet |
| Grocholewicz 2022 Fluoride varnish, ozone and octenidine reduce the incidence of white spot lesions and caries during orthodontic treatment: randomized… PMID:35978074 | this review only | not stated | not extracted yet | not extracted yet |
| Rechmann 2018 MI Varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial DOI:10.1007/s00784-017-2314-9 | this review only | not stated | not extracted yet | not extracted yet |
| Sardana 2022 Caries-preventive effectiveness of two different fluoride varnishes: A randomised clinical trial in patients with multi-bracketed fixed… PMID:35737872 | this review only | not stated | not extracted yet | not extracted yet |
| Sardana 2023 Caries‐preventive effectiveness of two different fluoride varnishes: A randomised clinical trial in patients with multi‐bracketed fixed… DOI:10.1111/ipd.13013 | this review only | not stated | 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).