Non-Cochrane · intervention · PM39609782
Remineralization and anti-demineralization effect of orthodontic adhesives on enamel surrounding orthodontic brackets: a systematic review of in vitro studies.
Hamdi Kareem, Elsebaai Ahmed, Abdelshafi Mostafa A, et al. · BMC oral health · 2024 · PubMed · doi:10.1186/s12903-024-05237-y
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
12
current version
GRADE rated
0
No studies
0
Included studies
25
linked below
No studies 0 · 0%Ungraded 12 · 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 | Teeth (human enamel/teeth specimens); non-human/animal teeth excluded | Human enamel specimens around orthodontic brackets (24 in vitro studies; sample sizes about 18 to 96 specimens per study) |
| Intervention | Experimental, modified, or remineralizing orthodontic adhesives applied around orthodontic brackets/appliance (PECOS exposure) | Modified orthodontic adhesives: bioactive glass/BAG (n=13), n-ACP (n=2), n-HAP (n=1), n-CaF2 (n=1), n-AFCP (n=1), ammonium-based methacrylate (n=1); plus commercial fluoride/RMGIC/ACP adhesives (n=7) |
| Comparison | Comparison with (conventional) orthodontic adhesives | Conventional control orthodontic adhesive (most commonly Transbond XT); some used negative/saline control |
| Outcomes | Enamel surface/subsurface remineralization after application of orthodontic adhesive | Remineralization/anti-demineralization extent (primary; all 24 studies, mostly significant vs control); ion release (secondary; 8 studies) |
| Study designs | In vitro and in situ studies | In vitro studies (n=24); cariogenic challenge chemical (majority) or biological/biofilm (n=3: refs 15, 19, 37) |
| Timing | Not specified | pH cycling / cariogenic challenge 5 days to 6 months (most 14 to 30 days); ion release up to 6 months |
Search date: 2005 to 2024 (search coverage; exact search date not reported). Databases: PubMed (including Medline); Scopus; Web of Science
Questions and results
Orthodontic adhesives containing bioactive glass (BAG) particles/nanoparticles (including Ag-, Zn-, fluoride-, or Ga-doped BAG) vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control
Population: Human enamel specimens around orthodontic brackets (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel remineralization / anti-demineralization extent pH cycling 14 days to 6 months (majority 14 days) · Overall In vitro, most bioactive glass-containing orthodontic adhesives (9 of 13 studies) showed significant enamel remineralization/anti-demineralization versus control, but the evidence is weak (predominantly high risk of bias, methodological heterogeneity, no meta-analysis; ungraded). Source: Results (Remineralization results, primary outcome); Study characteristics; Table 1; Table 2 · same question in other reviews | Out of 13 studies that evaluated bioactive glass particles/nanoparticles, 9 reported definitive statistically significant remineralization potential compared to control orthodontic adhesives [17, 21-24, 26-28, 31]; one… | 13 studies | Ungraded |
Enamel remineralization or anti-demineralization 5 days to 6 months Population: Human teeth with early enamel lesions surrounding orthodontic brackets No meta-analysis was conducted; most included in vitro studies reported significant remineralization with remineralizing orthodontic adhesives versus controls. Source: Results, Remineralization results (primary outcome); Conclusion · same question in other reviews | no estimate extracted | 24 studies | Ungraded |
Ion release 14 days to 6 months Population: Human teeth with early enamel lesions surrounding orthodontic brackets No meta-analysis was conducted; most studies reported increased ion release over time, but few reported peak values. Source: Results, Ion-release results (secondary outcome) · same question in other reviews | no estimate extracted | 8 studies | Ungraded |
Ion release (fluoride, calcium, phosphate) 14 days [31] and 20 days [27,28] (per Discussion); ion-release durations for [23,24] not reported · Overall In vitro, among the 5 BAG ion-release studies only Ga-doped BAG (GaMBN, Song [31]) reported a significant increase (phosphate, up to 14 days); a general significant fluoride/calcium/phosphate increase across all 5 is not supported (ungraded). Source: Results (Ion-release results, secondary outcome); Discussion · same question in other reviews | Ion release from BAG-containing adhesives was assessed in 5 studies [23, 24, 27, 28, 31]; a significant increase of phosphate ion release with gallium-doped bioactive glass nanoparticles up to 14 days was reported… | 5 studies | Ungraded |
Orthodontic adhesives containing nano-amorphous calcium phosphate (n-ACP) particles/nanoparticles vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control
Population: Human enamel specimens around orthodontic brackets (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel remineralization extent pH cycling / biofilm challenge 14 to 28 days · Overall In vitro, n-ACP-containing orthodontic adhesives showed significant enamel remineralization versus control in both studies, but evidence is weak (only 2 studies; ungraded). Source: Results (Remineralization results); Study characteristics; Table 1 · same question in other reviews | Studies using orthodontic adhesives containing n-ACP showed statistically significant remineralization compared with control orthodontic adhesives [15, 33]. | 2 studies | Ungraded |
Calcium and phosphate ion release up to 42 days · Overall In vitro, an n-ACP-containing adhesive significantly increased calcium and phosphate ion release up to 42 days in a single study (ungraded). Source: Results (Ion-release results, secondary outcome) · same question in other reviews | One study using an experimental quaternary ammonium resin monomer + 40% n-ACP adhesive reported a significant increase of calcium and phosphate ion release up to 42 days compared with the control group [33]. | 1 study | Ungraded |
Experimental orthodontic composite containing nano-hydroxyapatite (n-HAP) vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control
Population: Human enamel specimens around orthodontic brackets (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Superficial surface (enamel) mineralization (surface microhardness) pH cycling 28 days · Overall In vitro, a nano-hydroxyapatite-containing orthodontic composite showed significant enamel remineralization versus control in a single study (ungraded). Source: Results (Remineralization results); Study characteristics; Table 1 · same question in other reviews | A study using an orthodontic composite containing nano-hydroxyapatite showed statistically significant remineralization compared with control orthodontic adhesives [34]. | 1 study | Ungraded |
Orthodontic adhesive/composite containing nano-calcium fluoride (n-CaF2), alone or with DMAHDM vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control
Population: Human enamel specimens around orthodontic brackets (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel remineralization extent pH cycling 30 days · Overall In vitro, a nano-CaF2-containing orthodontic cement showed significant enamel remineralization versus control in a single study (ungraded). Source: Results (Remineralization results); Study characteristics; Table 1 · same question in other reviews | A study using an orthodontic adhesive containing nano-calcium fluoride showed statistically significant remineralization compared with control orthodontic adhesives [35]. | 1 study | Ungraded |
Experimental orthodontic adhesive containing amorphous fluorinated calcium phosphate nanoparticles (n-AFCP) vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control
Population: Human enamel specimens around orthodontic brackets (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel remineralization extent and color change pH cycling 21 days · Overall In vitro, an n-AFCP-containing orthodontic primer showed significant enamel remineralization and less color change versus control in a single study (ungraded). Source: Results (Remineralization results); Study characteristics; Table 1 · same question in other reviews | A study using an orthodontic primer containing amorphous fluorinated calcium phosphate nanoparticles showed statistically significant remineralization and less enamel color change (delta-E) compared with the control… | 1 study | Ungraded |
Experimental adhesive containing ammonium-based methacrylate monomer (MADQUAT) vs Conventional/control orthodontic adhesive (e.g., Transbond XT) or negative control
Population: Human enamel specimens around orthodontic brackets (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Enamel remineralization / carious lesion development biofilm cariogenic challenge 5 days · Overall In vitro, an ammonium-based methacrylate-containing adhesive showed significant remineralization/anti-demineralization versus control in a single study (ungraded). Source: Results (Remineralization results); Study characteristics; Table 1 · same question in other reviews | A study using an orthodontic adhesive containing ammonium-based methacrylate showed significant remineralization power compared with control adhesives [37]. | 1 study | Ungraded |
Commercial fluoride-releasing RMGIC orthodontic adhesive (Fuji Ortho LC) vs Conventional non-fluoride control orthodontic adhesive (e.g., Transbond XT)
Population: Human enamel specimens around orthodontic brackets (in vitro)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Fluoride ion release up to 6 months · Overall In vitro, the commercial RMGIC Fuji Ortho LC showed significant fluoride release up to 6 months in a single study (ungraded). Source: Results (Ion-release results, secondary outcome) · same question in other reviews | One study reported significant fluoride release from the commercial RMGIC Fuji Ortho LC up to 6 months [14]. | 1 study | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Fluoride ion release nCaF2-containing orthodontic adhesive (Yi 2024 [35]); significant increase up to 56 days vs control | no estimate extracted | 1 study | 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 | No | No | yes |
| 8Included studies described in detail | Partial Yes | Yes | no |
| 9Risk of bias assessed satisfactorilycritical | NRSI: N/A · RCT: N/A | NRSI: N/A · RCT: N/A | yes |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: N/A · NRSI: N/A | NRSI: N/A · RCT: N/A | no |
| 12Impact of risk of bias on the pooled results | N/A | N/A | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | N/A | no |
| 15Publication bias investigatedcritical | N/A | N/A | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | Low | Low | yes |
Included primary studies 25
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Bhushan 2021 Assessment of the Effectiveness of Different Fluoride-releasing Bonding Agents on Prevention of Enamel Demineralization around Orthodontic… PMID:35197380 | this review only | PM39609782-P7-O1 | not extracted yet | not extracted yet |
| Choi 2021 Anti-Microbial and Remineralizing Properties of Self-Adhesive Orthodontic Resin Containing Mesoporous Bioactive Glass. PMID:34202013 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Choi 2022 Enhanced antimicrobial and remineralizing properties of self-adhesive orthodontic resin containing mesoporous bioactive glass and… PMID:35756757 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Chow 2011 In vitro properties of orthodontic adhesives with fluoride or amorphous calcium phosphate. PMID:21912546 | this review only | PM39609782-P7-O1 | not extracted yet | not extracted yet |
| Demircioglu 2023 matched by author and year (probable) | this review only | PM39609782-P7-O1 | not extracted yet | not extracted yet |
| Firoz 2019 matched by author and year (probable) | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Firzok 2019 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Iijima 2013 Effects of the addition of fluoride to a 4-META/MMA-TBB-based resin adhesive on fluoride release, acid resistance of enamel and shear bond… PMID:23370885 | this review only | PM39609782-P7-O1 | not extracted yet | not extracted yet |
| Kim 2018 Antibacterial and remineralization effects of orthodontic bonding agents containing bioactive glass. PMID:29732302 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Kohda 2015 Inhibition of enamel demineralization and bond-strength properties of bioactive glass containing 4-META/MMA-TBB-based resin adhesive. PMID:25903115 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Lee 2017 Remineralization Property of an Orthodontic Primer Containing a Bioactive Glass with Silver and Zinc. PMID:29088092 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Liu 2018 Antibacterial and remineralizing orthodontic adhesive containing quaternary ammonium resin monomer and amorphous calcium phosphate… PMID:29534887 | this review only | Enamel remineralization extent | not extracted yet | not extracted yet |
| Ma 2017 Novel multifunctional dental cement to prevent enamel demineralization near orthodontic brackets. PMID:28642057 | this review only | Enamel remineralization extent | not extracted yet | not extracted yet |
| Manfred 2013 A novel biomimetic orthodontic bonding agent helps prevent white spot lesions adjacent to brackets. PMID:22765388 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Nam 2019 Enamel Surface Remineralization Effect by Fluorinated Graphite and Bioactive Glass-Containing Orthodontic Bonding Resin. PMID:31013602 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Nam 2019 Fluorinated Bioactive Glass Nanoparticles: Enamel Demineralization Prevention and Antibacterial Effect of Orthodontic Bonding Resin. PMID:31167432 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Nascimento 2017 Addition of ammonium-based methacrylates to an experimental dental adhesive for bonding metal brackets: Carious lesion development and… PMID:28457273 | this review only | Enamel remineralization / carious lesion development | not extracted yet | not extracted yet |
| Parihar 2024 matched by author and year (probable) | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Paschos 2009 Effect of different bonding agents on prevention of enamel demineralization around orthodontic brackets. PMID:19409343 | this review only | PM39609782-P7-O1 | not extracted yet | not extracted yet |
| Rahmanpanah 2023 Evaluation of shear bond strength and enamel remineralizing effect of experimental orthodontic composite containing nano-hydroxyapatite:… PMID:36669460 | this review only | Superficial surface (enamel) mineralization (surface microhardness) | not extracted yet | not extracted yet |
| Seifi 2024 Investigation of mechanical properties, remineralization, antibacterial effect, and cellular toxicity of composite orthodontic adhesive… PMID:38824555 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Shirazi 2019 Effect of addition of bioactive glass to resin modified glass ionomer cement on enamel demineralization under orthodontic brackets. PMID:31346371 | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Song 2019 matched by author and year (probable) | this review only | Enamel remineralization or anti-demineralization | not extracted yet | not extracted yet |
| Xu 2023 Effects of an orthodontic primer containing amorphous fluorinated calcium phosphate nanoparticles on enamel white spot lesions. PMID:36379092 | this review only | Enamel remineralization extent and color change | not extracted yet | not extracted yet |
| Yi 2019 A nano-CaF2-containing orthodontic cement with antibacterial and remineralization capabilities to combat enamel white spot lesions. PMID:31326528 | this review only | Enamel remineralization extent | not extracted yet | not extracted yet |