Non-Cochrane · aetiology · PM38387465
Distribution of initial caries lesions in relation to fixed orthodontic therapy. A systematic review and meta-analysis.
Salerno Claudia, Grazia Cagetti Maria, Cirio Silvia, et al. · European journal of orthodontics · 2024 · PubMed · doi:10.1093/ejo/cjae008
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
9
current version
GRADE rated
6
No studies
0
Included studies
33
linked below
No studies 0 · 0%Ungraded 3 · 33.3%Very low 6 · 66.7%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 | Patients in permanent dentition during or after fixed orthodontic (multibracket) appliance treatment (RCT/NRSI placebo or untreated groups, cohort, and cross-sectional studies; English; published after 1990) | 21 studies (16 countries; published 2005-2022); pooled denominators: prevalence 1448 subjects / 484 subjects (mean) / 11583 teeth; incidence 533 subjects / 208 subjects (mean) / 1890 teeth |
| Intervention | Fixed orthodontic treatment with fixed (multibracket) appliances (exposure) | Fixed orthodontic multibracket appliances in all included studies |
| Comparison | None prespecified (single-group prevalence/incidence estimation) | None (single-group pooled proportions; untreated/placebo arms of RCTs and no-treatment groups contributed) |
| Outcomes | Primary: prevalence and/or incidence of ICLs at subject and/or tooth-surface level. Secondary: influence of demographic and treatment variables (age, sex, oral hygiene, treatment duration) on ICLs | Pooled prevalence 0.57 per subject (95% CI 0.48-0.65), mean 2.24 per subject (1.79-2.70), 0.22 per surface (0.14-0.33); pooled incidence 0.48 per subject (0.33-0.63), mean 2.29 per subject (1.12-3.46), 0.15 per surface (0.08-0.26); all with high heterogeneity (I2 88-99%) |
| Study designs | RCTs, non-randomized studies of intervention (NRSI), cohort, and cross-sectional studies | 11 RCTs, 7 NRSIs, 3 observational studies without control group (21 included; 19 meta-analyzed; Hammad 2016 and van der Kaaij 2015 excluded from meta-analysis for data type) |
| Timing | During or after fixed orthodontic treatment; studies published 1990 to May 2023 | Treatment durations ~3 to >=18 months; prevalence assessed during/at debonding, incidence during treatment |
Search date: 01 May 2023. Databases: PubMed, Embase, Scopus; reference-list cross-referencing; grey literature via OpenGrey (opengrey.eu)
Questions and results
Fixed orthodontic treatment with fixed (multibracket) appliances (exposure) vs None (single-group prevalence/incidence estimate)
Population: Patients (permanent dentition) during or after fixed orthodontic treatment with fixed (multibracket) appliances
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Prevalence of ICLs (mean number of lesions per subject) During or after fixed orthodontic treatment (cross-sectional/at debonding) · Overall (random-effects model) Patients had on average about 2.24 ICLs per subject during/after fixed orthodontic treatment (95% CI 1.79-2.70; very low certainty; very high heterogeneity). Source: Results 'Meta-analysis'; Fig. 4b (forest plot); Abstract · same question in other reviews | MEAN 2.24 [1.79, 2.70] | 6 studies · 484 participants | Very low Downgraded: inconsistency |
Association between orthodontic treatment duration and ICLs prevalence During or after fixed orthodontic treatment · By orthodontic treatment duration (subgroup meta-analysis; positive association, P=.01) ICLs prevalence increased with longer orthodontic treatment duration (meta-regression P=.01; ungraded). Source: Results 'Meta-analysis'; Discussion; Fig. 6a · same question in other reviews | Prevalence of ICLs positively associated with orthodontic treatment duration (meta-regression, P=.01); effect size/slope not available (Fig. 6a image not provided) | NR | Ungraded |
Association between patient age and number of ICLs During or after fixed orthodontic treatment · By patient age (subgroup meta-analysis; no significant association) Patient age was not significantly associated with the number of ICLs (ungraded). Source: Results 'Meta-analysis'; Discussion 'ICLs and subject-related factors' · same question in other reviews | No significant association found between patient age and the number of ICLs (meta-regression / subgroup analysis) | NR | Ungraded |
Prevalence of ICLs (proportion of tooth surfaces affected) During or after fixed orthodontic treatment (cross-sectional/at debonding) · Overall (random-effects model) About 22% of tooth surfaces showed ICLs during/after fixed orthodontic treatment (pooled 0.22, 95% CI 0.14-0.33; very low certainty; extreme heterogeneity). Source: Results 'Meta-analysis'; Fig. 4c (forest plot); Abstract · same question in other reviews | Proportion 0.22 [0.14, 0.33] | 6 studies · 11583 participants | Very low Downgraded: inconsistency |
Prevalence of ICLs (proportion of subjects affected) During or after fixed orthodontic treatment (cross-sectional/at debonding) · Overall (random-effects model) Around 57% of patients had ICLs during or after fixed orthodontic treatment (pooled prevalence 0.57, 95% CI 0.48-0.65; very low certainty; very high heterogeneity). Source: Results 'Meta-analysis'; Fig. 4a (forest plot); Abstract · same question in other reviews | Proportion 0.57 [0.48, 0.65] | 13 studies · 1448 participants | Very low Downgraded: inconsistency |
Fixed orthodontic treatment with fixed (multibracket) appliances (exposure) vs None (single-group prevalence/incidence estimate)
Population: Patients undergoing fixed orthodontic treatment with fixed (multibracket) appliances, followed for development of new ICLs
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of new ICLs (mean number of new lesions per subject) During fixed orthodontic treatment (development of new lesions) · Overall (random-effects model) Patients developed on average about 2.29 new ICLs during fixed orthodontic treatment (95% CI 1.12-3.46; very low certainty; very high heterogeneity). Source: Results 'Meta-analysis'; Fig. 5b (forest plot); Abstract · same question in other reviews | MEAN 2.29 [1.12, 3.46] | 5 studies · 208 participants | Very low Downgraded: inconsistency |
Incidence of new ICLs (proportion of tooth surfaces developing new lesions) During fixed orthodontic treatment (development of new lesions) · Overall (random-effects model) About 15% of tooth surfaces developed new ICLs during fixed orthodontic treatment (pooled 0.15, 95% CI 0.08-0.26; very low certainty; extreme heterogeneity). Source: Results 'Meta-analysis'; Fig. 5c (forest plot); Abstract · same question in other reviews | Proportion 0.15 [0.08, 0.26] | 4 studies · 1890 participants | Very low Downgraded: inconsistency |
Association between orthodontic treatment duration and ICLs incidence During or after fixed orthodontic treatment · By orthodontic treatment duration (subgroup meta-analysis; positive association, P<.01) ICLs incidence increased with longer orthodontic treatment duration (meta-regression P<.01; ungraded). Source: Results 'Meta-analysis'; Discussion; Fig. 6b · same question in other reviews | Incidence of new ICLs positively associated with orthodontic treatment duration (meta-regression, P<.01); effect size/slope not available (Fig. 6b image not provided) | NR | Ungraded |
Incidence of new ICLs (proportion of subjects developing new lesions) During fixed orthodontic treatment (development of new lesions) · Overall (random-effects model) About 48% of patients developed new ICLs during fixed orthodontic treatment (pooled incidence 0.48, 95% CI 0.33-0.63; very low certainty; very high heterogeneity). Source: Results 'Meta-analysis'; Fig. 5a (forest plot); Abstract · same question in other reviews | Proportion 0.48 [0.33, 0.63] | 7 studies · 533 participants | Very low Downgraded: inconsistency |
Included primary studies 33
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| van der Kaaij et al. 2015 A prospective, randomized placebo-controlled clinical trial on the effects of a fluoride rinse on white spot lesion development and… PMID:25913893 | 3 other reviews | not stated | not extracted yet | not extracted yet |
| Hammad and Knosel 2016 Efficacy of a new sealant to prevent white spot lesions during fixed orthodontic treatment DOI:10.1007/s00056-016-0052-2 | 1 other review | not stated | not extracted yet | not extracted yet |
| Mahmoudzadeh et al. 2019 Effect of CO2 Laser on the Prevention of White Spot Lesions During Fixed Orthodontic Treatment: A Randomized Clinical Trial. PMID:31565692 | 1 other review | not stated | not extracted yet | not extracted yet |
| Martignon et al. 2010 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Mohammed et al. 2021 matched by author and year (probable) | 1 other review | not stated | not extracted yet | not extracted yet |
| Najafi et al. 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 |
| Najafi et al. 2022 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 |
| Sonesson et al. 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 et al. 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 et al. 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 |
| Stecksén-Blicks et al. 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 |
| Almosa et al. 2014 Diagnosing the severity of buccal caries lesions in governmental and private orthodontic patients at debonding, using the ICDAS-II and the… PMID:24144384 | this review only | not stated | not extracted yet | not extracted yet |
| Boersma et al. 2005 Caries Prevalence Measured with QLF after Treatment with Fixed Orthodontic Appliances: Influencing Factors DOI:10.1159/000081655 | this review only | not stated | not extracted yet | not extracted yet |
| Boersma et al. 2005 Caries prevalence measured with QLF after treatment with fixed orthodontic appliances: influencing factors. PMID:15591733 | this review only | not stated | not extracted yet | not extracted yet |
| Esenlik et al. 2016 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Esenlik et al. 2016 Efficacy of a casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste in preventing white spot lesions in patients with fixed… PMID:28045314 | this review only | not stated | not extracted yet | not extracted yet |
| Gizani et al. 2016 Effect of the probiotic bacterium<i>Lactobacillus reuteri</i>on white spot lesion development in orthodontic patients DOI:10.1093/ejo/cjv015 | this review only | not stated | not extracted yet | not extracted yet |
| Gizani et al. 2016 Effect of the probiotic bacterium Lactobacillus reuteri on white spot lesion development in orthodontic patients. PMID:25840585 | this review only | not stated | not extracted yet | not extracted yet |
| Hammad and Knösel 2016 Efficacy of a new sealant to prevent white spot lesions during fixed orthodontic treatment : A 12-month, single-center, randomized… PMID:27734089 | this review only | not stated | not extracted yet | not extracted yet |
| Heinig and Hartmann 2008 Efficacy of a sealant : study on the efficacy of a sealant (Light Bond) in preventing decalcification during multibracket therapy. PMID:18506401 | this review only | not stated | not extracted yet | not extracted yet |
| Jiang et al. 2013 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Jiang et al. 2013 Effect of 1.23% acidulated phosphate fluoride foam on white spot lesions in orthodontic patients: a randomized trial. PMID:23756315 | this review only | not stated | not extracted yet | not extracted yet |
| Jiang et al. 2015 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Jiang et al. 2015 Patterns and Risk Factors for White Spot Lesions in Orthodontic Patients with Fixed Appliances. PMID:26485510 | this review only | not stated | not extracted yet | not extracted yet |
| Lucchese and Gherlone 2013 Prevalence of white-spot lesions before and during orthodontic treatment with fixed appliances DOI:10.1093/ejo/cjs070 | this review only | not stated | not extracted yet | not extracted yet |
| Martignon et al. 2010 Plaque, caries level and oral hygiene habits in young patients receiving orthodontic treatment. PMID:21046903 | this review only | not stated | not extracted yet | not extracted yet |
| Pinto et al. 2018 Does the Duration of Fixed Orthodontic Treatment Affect Caries Activity among Adolescents and Young Adults? DOI:10.1159/000488209 | this review only | not stated | not extracted yet | not extracted yet |
| Pinto et al. 2018 Does the Duration of Fixed Orthodontic Treatment Affect Caries Activity among Adolescents and Young Adults? PMID:29669345 | this review only | not stated | not extracted yet | not extracted yet |
| Ravikiran et al. 2021 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Sonesson et al. 2014 Effectiveness of high-fluoride toothpaste on enamel demineralization during orthodontic treatment--a multicenter randomized controlled trial DOI:10.1093/ejo/cjt096 | this review only | not stated | not extracted yet | not extracted yet |
| Sonesson et al. 2014 Effectiveness of high-fluoride toothpaste on enamel demineralization during orthodontic treatment-a multicenter randomized controlled trial. PMID:24375756 | this review only | not stated | not extracted yet | not extracted yet |
| Toti et al. 2022 White Spots Prevalence and Tooth Brush Habits during Orthodontic Treatment. PMID:35206934 | this review only | not stated | not extracted yet | not extracted yet |
| Tufekci et al. 2011 Prevalence of white spot lesions during orthodontic treatment with fixed appliances. PMID:21208070 | 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).