Non-Cochrane · intervention · PM41723426
Efficacy of various interventions for the management of white spot lesions associated with fixed orthodontic treatment: a systematic review and network meta-analysis of randomized controlled trials.
Hussain Umar, Kunwar Sara Shahid, Khan Umair Wali, et al. · BMC oral health · 2026 · PubMed · doi:10.1186/s12903-026-07755-3
Findings
86 findings
| Population | ||||
|---|---|---|---|---|
| Orthodontic patients with fixed appliances | NovaMin | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | OR 0.96 [0.29, 3.20] Low Downgraded: imprecision 1 study |
| Orthodontic patients with fixed appliances | NovaMin | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -1.37 [-2.26, -0.48] Low Downgraded: risk of bias 2 studies |
| Orthodontic patients with fixed appliances | NovaMin | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -1.70 GRADE not reported 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Self-assembling peptide | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | SMD -1.38 [-2.30, -0.46] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Self-assembling peptide | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -1.38 [-2.41, -0.34] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | NovaMin | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.96 [0.30, 3.10] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | NovaMin | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -1.37 [-2.37, -0.38] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Nano-agent | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -1.16 [-1.79, -0.53] Moderate Downgraded: inconsistency 3 studies |
| Orthodontic patients with fixed appliances | Nano-agent | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | OR 0.46 [0.14, 1.56] Low Downgraded: imprecision, inconsistency 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Nano-agents | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -1.30 [-2.04, -0.56] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Nano-agents | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.45 [0.13, 1.49] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Nano-agent | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -1.23 GRADE not reported 3 studies |
| Orthodontic patients with fixed appliances | Nano-agent | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | OR 0.44 GRADE not reported 2 studies |
| Orthodontic patients with fixed appliances | Xylitol varnish | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.99 [-1.84, -0.15] High 1 study |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Xylitol varnish | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.81 [-2.03, 0.42] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | CPP-ACP | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | OR 0.32 [0.13, 0.82] Low 2 studies |
| Orthodontic patients with fixed appliances | CPP-ACP | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -1.09 GRADE not reported 7 studies |
| Orthodontic patients with fixed appliances | CPP-ACP | Control (placebo, no treatment or negative control) | WSL size End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.14 [-1.29, 1.00] Moderate Downgraded: imprecision 3 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | CPP-ACP | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -1.72 [-2.55, -0.90] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | CPP-ACP | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.94 [-1.38, -0.50] Low Downgraded: risk of bias, inconsistency, publication bias 7 studies |
| Orthodontic patients with fixed appliances | CPP-ACP | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | OR 0.39 GRADE not reported 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | CPP-ACP | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.39 [0.12, 1.22] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Probiotics | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.57 [0.27, 1.21] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Probiotics | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.92 [-1.88, 0.05] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Probiotic | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.90 [-1.76, -0.05] High 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Probiotics | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | OR 0.57 [0.26, 1.25] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Probiotic | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.95 GRADE not reported 2 studies |
| Orthodontic patients with fixed appliances | Fluoride in combination | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.45 GRADE not reported 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride in combination | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.31 [-1.55, 0.93] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Fluoride in combination | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | OR 0.31 [0.16, 0.59] Low Downgraded: inconsistency, publication bias 3 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride in combination | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.36 [0.13, 1.00] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Fluoride in combination | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | OR 0.27 GRADE not reported 3 studies |
| Orthodontic patients with fixed appliances | Fluoride in combination | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.79 [-1.43, -0.16] Moderate Downgraded: inconsistency 2 studies |
| Orthodontic patients with fixed appliances | Fluoride varnish | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.67 [-1.01, -0.34] Moderate Downgraded: risk of bias, inconsistency, publication bias 12 studies |
| Orthodontic patients with fixed appliances | Fluoride varnish | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | OR 0.27 GRADE not reported 4 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride varnish | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.51 [-1.03, 0.00] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Fluoride varnish | Control (placebo, no treatment or negative control) | WSL size End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.50 GRADE not reported 2 studies |
| Orthodontic patients with fixed appliances | Fluoride varnish | Control (placebo, no treatment or negative control) | WSL size End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.72 [-2.10, 0.66] Low Downgraded: imprecision 2 studies |
| Orthodontic patients with fixed appliances | Fluoride varnish | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.57 GRADE not reported 12 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride varnish | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.08 [0.02, 0.33] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Fluoride varnish | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | OR 0.25 [0.14, 0.45] Moderate Downgraded: publication bias 4 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Laser | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | OR 0.38 [0.13, 1.08] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Laser | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.74 [-2.19, 0.71] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Laser | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | SMD -0.74 [-2.03, 0.55] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Ozone | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | OR 0.35 [0.12, 1.07] High 2 studies |
| Orthodontic patients with fixed appliances | Ozone | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | OR 0.40 GRADE not reported 2 studies |
| Orthodontic patients with fixed appliances | Ozone | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.50 [-1.59, 0.59] Low Downgraded: imprecision 1 study |
| Orthodontic patients with fixed appliances | Resin infiltration | Control (placebo, no treatment or negative control) | WSL size End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.79 [-2.10, 0.52] Low Downgraded: risk of bias, imprecision, inconsistency 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Resin infiltration | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.46 [0.23, 0.91] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Resin infiltration | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.28 [-0.96, 0.40] High 2 studies |
| Orthodontic patients with fixed appliances | Resin infiltration | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | OR 0.49 [0.25, 0.93] Moderate Downgraded: publication bias 3 studies |
| Orthodontic patients with fixed appliances | Resin infiltration | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.25 GRADE not reported 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Resin infiltration | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.17 [-0.95, 0.62] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Resin infiltration | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | OR 0.46 GRADE not reported 3 studies |
| Orthodontic patients with fixed appliances | Resin infiltration | Control (placebo, no treatment or negative control) | WSL size End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -1.71 GRADE not reported 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride gel | Control (placebo, no treatment or other control) | WSL size (lesion size) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | SMD -0.48 [-2.60, 1.64] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride gel | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.07 [-1.09, 0.94] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Fluoride gel | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.45 GRADE not reported 2 studies |
| Orthodontic patients with fixed appliances | Fluoride gel | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.39 [-1.10, 0.32] Moderate Downgraded: imprecision 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride toothpaste | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.27 [-1.17, 0.64] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride toothpaste | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.59 [0.41, 0.85] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Fluoride toothpaste | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.17 GRADE not reported 2 studies |
| Orthodontic patients with fixed appliances | Fluoride toothpaste | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.24 [-1.02, 0.53] Moderate Downgraded: publication bias 2 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride toothpaste | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | OR 0.61 [0.40, 0.93] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoridated miswak | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | SMD -0.15 [-1.45, 1.15] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Chlorhexidine | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.12 [-1.57, 1.33] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Chlorhexidine | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | OR 0.64 GRADE not reported 3 studies |
| Orthodontic patients with fixed appliances | Chlorhexidine | Control (placebo, no treatment or negative control) | WSL prevalence End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | OR 0.72 [0.24, 2.18] Low Downgraded: imprecision, publication bias 3 studies |
| Orthodontic patients with fixed appliances | Chlorhexidine | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.07 [-0.96, 0.81] Low Downgraded: risk of bias, imprecision 1 study |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Chlorhexidine | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.51 [0.08, 3.19] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Fluoride mouthwash | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.21 GRADE not reported 4 studies |
| Orthodontic patients with fixed appliances | Fluoride mouthwash | Control (placebo, no treatment or negative control) | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.12 [-0.59, 0.35] Moderate Downgraded: risk of bias, imprecision 4 studies |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride mouthwash | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD -0.21 [-1.04, 0.62] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | RMGIC varnish | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | SMD 0.14 [-1.84, 2.11] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | RMGIC varnish | Control (placebo, no treatment or other control) | WSL score Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | SMD 0.02 [-1.79, 1.84] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Self-etch primer | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Low risk of bias trials only | OR 0.83 [0.22, 3.20] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Self-etch primer | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | OR 0.83 [0.21, 3.31] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Self-etch primer | Control (placebo, no treatment or other control) | WSL size (lesion size) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | SMD -0.03 [-2.13, 2.06] GRADE not reported Studies not reported |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | Fluoride-releasing resin | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | OR 0.78 [0.28, 2.18] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Microabrasion | Control (placebo, no treatment or negative control) | WSL size End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.85 [-2.89, 1.20] Low Downgraded: risk of bias, imprecision, publication bias 1 study |
| Orthodontic patients with labial fixed metallic brackets (prevention or reversal of WSL) | RMGIC resin | Control (placebo, no treatment or other control) | Prevalence of white spot lesions (WSL) Various follow-up (1 to 36 months) · Orthodontic clinics (fixed appliance treatment) · Overall | OR 0.71 [0.36, 1.41] GRADE not reported Studies not reported |
| Orthodontic patients with fixed appliances | Fluoride film | Control (placebo, no treatment or negative control) | WSL size End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances | SMD -0.20 [-2.10, 1.70] Low Downgraded: imprecision, inconsistency 1 study |
| Orthodontic patients with fixed appliances | Fluoride varnish | CPP-ACP | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.18 GRADE not reported 2 studies |
| Orthodontic patients with fixed appliances | Fluoride in combination | Fluoride mouthwash | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.84 GRADE not reported 2 studies |
| Orthodontic patients with fixed appliances | Xylitol varnish | Fluoride varnish | WSL score End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD -0.30 GRADE not reported 2 studies |
| Orthodontic patients with fixed appliances | Resin infiltration | CPP-ACP | WSL size End of follow-up (1 to 36 months across trials) · Orthodontic treatment with fixed appliances · Direct evidence only (node-splitting) | SMD 0.08 GRADE not reported 2 studies |
Included primary studies 134
Open in Studies| Study | Year | Also included by | Outcomes it informs here | Trial data |
|---|---|---|---|---|
| Kronenberg 2009 A prospective, randomized placebo-controlled clinical trial on the effects of a fluoride rinse on white spot lesion development and… PMID:25913893 | 2015 | 4 other reviews | not stated | not extracted yet |
| Badiee 2020 Effect of self-assembling peptide P11-4 on orthodontic treatment-induced carious lesions. PMID:32321955 | 2020 | 2 other reviews | not stated | not extracted yet |
| Bailey 2009 matched by author and year (probable) | NR | 2 other reviews | not stated | not extracted yet |
| Kashash 2024 Resin infiltration versus fluoride varnish for visual improvement of white spot lesions during multibracket treatment. A… PMID:38733458 | 2024 | 2 other reviews | not stated | not extracted yet |
| Øgaard 2005 Effect of CO2 Laser on the Prevention of White Spot Lesions During Fixed Orthodontic Treatment: A Randomized Clinical Trial. PMID:31565692 | 2019 | 2 other reviews | not stated | not extracted yet |
| Schlagenhauf 2022 Management of Post Orthodontic White Spot Lesions Using Resin Infiltration and CPP-ACP Materials- A Clinical Study. PMID:35311975 | 2022 | 2 other reviews | not stated | not extracted yet |
| Shan 2021 Masking-efficacy and caries arrestment after resin infiltration or fluoridation of initial caries lesions in adolescents during… PMID:37730095 | 2023 | 2 other reviews | not stated | not extracted yet |
| Singh 2016 matched by author and year (probable) | NR | 2 other reviews | not stated | 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 | 2020 | 2 other reviews | not stated | not extracted yet |
| Stecksén-Blicks 2007 Caries-preventive effectiveness of a fluoride varnish: a randomized controlled trial in adolescents with fixed orthodontic appliances. PMID:17827963 | 2007 | 2 other reviews | not stated | not extracted yet |
| Uysal a 2011 Evaluation of the preventive effect of two concentrations of xylitol varnish versus fluoride varnish on enamel demineralization around… PMID:34379121 | 2022 | 2 other reviews | not stated | not extracted yet |
| Ali 2021 Effect of nanosilver mouthwash on prevention of white spot lesions in patients undergoing fixed orthodontic treatment - a randomized… PMID:35028045 | 2022 | 1 other review | not stated | not extracted yet |
| Alshammari 219 A prospective randomized clinical trial into the capacity of a toothpaste containing NovaMin to prevent white spot lesions and gingivitis… PMID:26268772 | 2015 | 1 other review | not stated | not extracted yet |
| Baeshen 2011 Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic… PMID:21083623 | 2010 | 1 other review | not stated | not extracted yet |
| Beerens 2010 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Beerens 2018 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Benham 2009 One Year Clinical Evaluation of White Spot Lesions with Newly Introduced Resin Modified Glass-Ionomer in Comparison to Resin Infiltration… DOI:10.14295/bds.2021.v24i1.2063 | 2020 | 1 other review | not stated | not extracted yet |
| Benson 2019 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Elaut 2004 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Elaut 2004 Regression of post-orthodontic lesions by a remineralizing cream. PMID:19887683 | 2009 | 1 other review | not stated | not extracted yet |
| Enerbäck 2023 Resin-modified glass ionomer cement vs composite for orthodontic bonding: A multicenter, single-blind, randomized controlled trial. PMID:30591153 | 2019 | 1 other review | not stated | not extracted yet |
| Esenlik 2016 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Esenlik 2016 Efficacy of a casein phosphopeptide amorphous calcium phosphate (CPP-ACP) paste in preventing white spot lesions in patients with fixed… PMID:28045314 | 2016 | 1 other review | not stated | not extracted yet |
| Garry 2017 Treatment of post-orthodontic white spot lesions with CPP-ACP paste: A three year follow up study. PMID:28835597 | 2017 | 1 other review | not stated | not extracted yet |
| Gizani 2016 Efficacy of a new sealant to prevent white spot lesions during fixed orthodontic treatment : A 12-month, single-center, randomized… PMID:27734089 | 2016 | 1 other review | not stated | not extracted yet |
| Gohar 2022 Long-term remineralizing effect of MI Paste Plus on regression of early caries after orthodontic fixed appliance treatment: a 12-month… PMID:29161371 | 2018 | 1 other review | not stated | 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 | 2022 | 1 other review | not stated | not extracted yet |
| Horan 2023 Comparison of three orthodontic bonding systems in white spot lesion development: a randomized clinical trial. PMID:37017436 | 2023 | 1 other review | not stated | not extracted yet |
| Jiang 2013 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Jiang 2013 Impact of a non-fluoridated microcrystalline hydroxyapatite dentifrice on enamel caries progression in highly caries-susceptible… PMID:30701704 | 2019 | 1 other review | not stated | not extracted yet |
| Karabekiroğlu 2017 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Kau 2019 Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial. PMID:27480987 | 2016 | 1 other review | not stated | not extracted yet |
| Mehta 2015 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Mollabashi 2023 Effect of a mouth rinse and a high-fluoride toothpaste on caries incidence in orthodontic patients: A randomized controlled trial. PMID:35491328 | 2022 | 1 other review | not stated | not extracted yet |
| Rajendran 2022 The efficacy of fluoride varnish vs a filled resin sealant for preventing white spot lesions during orthodontic treatment. PMID:34679162 | 2022 | 1 other review | not stated | not extracted yet |
| Restrepo 2016 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Restrepo 2016 Evaluation of the remineralizing effect of biomimetic self-assembling peptides in post-orthodontic white spot lesions compared to… PMID:36287272 | 2023 | 1 other review | not stated | not extracted yet |
| Rohym 2021 Effect of 1.23% acidulated phosphate fluoride foam on white spot lesions in orthodontic patients: a randomized trial. PMID:23756315 | 2013 | 1 other review | not stated | 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 | 2023 | 1 other review | not stated | not extracted yet |
| Shah 2017 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Silva 2021 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Silva 2021 Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment. PMID:21331637 | 2012 | 1 other review | not stated | not extracted yet |
| Simon 2022 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Sonesson 2014 Effectiveness of high-fluoride toothpaste on enamel demineralization during orthodontic treatment-a multicenter randomized controlled trial. PMID:24375756 | 2014 | 1 other review | not stated | not extracted yet |
| Sonesson 2020 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Tomaževič 2022 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Trimpeneers 1996 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Uysal 2010 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Uysal 2011 Enamel resistance to demineralisation around orthodontic brackets after CO2 laser irradiation: a randomised clinical trial. PMID:30071781 | 2018 | 1 other review | not stated | not extracted yet |
| Welk 2020 matched by author and year (probable) | NR | 1 other review | not stated | not extracted yet |
| Welk 2020 Evaluation of fluoride varnish treatment of postorthodontic white spot lesions by visual inspection and laser fluorescence-A randomized… PMID:35510617 | 2022 | 1 other review | not stated | not extracted yet |
| Wierichs 2023 Comparison of the effects of toothpastes containing nanohydroxyapatite and fluoride on white spot lesions in orthodontic patients: A… PMID:33343843 | 2020 | 1 other review | not stated | not extracted yet |
| Al Tuma 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Al Tuma 2023 Effect of calcium fluoride nanoparticles in prevention of demineralization during orthodontic fixed appliance treatment: a randomized… PMID:36049047 | 2023 | this review only | not stated | not extracted yet |
| Badiee 2020 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Baeshen 2011 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Bailey 2009 Effectiveness of amine fluoride mouthwash in preventing white spot lesions during fixed orthodontic therapy - A randomized control trial. PMID:38197343 | 2023 | this review only | not stated | not extracted yet |
| Beerens 2010 Remineralization of early enamel caries lesions using self-assembling peptides P11-4: Systematic review and meta-analysis. PMID:35433245 | 2022 | this review only | not stated | not extracted yet |
| Beerens 2018 Efficacy of CPP-ACP and CPP-ACPF for Prevention and Remineralization of White Spot Lesions in Orthodontic Patients: a Systematic Review of… PMID:31762578 | 2019 | this review only | not stated | not extracted yet |
| Belasic 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Belasic 2024 Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized… PMID:27702807 | 2017 | this review only | not stated | not extracted yet |
| Benham 2009 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Benson 2019 Effectiveness of a sealant compared with no sealant in preventing enamel demineralization in patients with fixed orthodontic appliances: a… PMID:23726334 | 2013 | this review only | not stated | not extracted yet |
| Bock 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Bock 2016 Effect of antibacterial monomer-containing adhesive on enamel demineralization around orthodontic brackets: an in-vivo study. PMID:21536208 | 2011 | this review only | not stated | not extracted yet |
| Du 2012 Prevention of white spot lesions with fluoride varnish during orthodontic treatment with fixed appliances: a systematic review. PMID:37032523 | 2023 | this review only | not stated | not extracted yet |
| Enerbäck 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Flynn 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Flynn 2022 Effect of fluoridated chewing sticks (Miswaks) on white spot lesions in postorthodontic patients. PMID:21889073 | 2011 | this review only | not stated | not extracted yet |
| Garry 2017 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Gizani 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Gohar 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Grocholewicz 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Hammad 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Hammad 2016 Effect of fluoride dentifrices on white spot lesions during orthodontic treatment: A randomized trial. PMID:30719933 | 2019 | this review only | not stated | not extracted yet |
| He 2016 A prospective, randomized clinical study on the effects of an amine fluoride/stannous fluoride toothpaste/mouthrinse on plaque, gingivitis… PMID:16230329 | 2006 | this review only | not stated | not extracted yet |
| Horan 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Hosseinpour-Nader 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Hosseinpour-Nader 2022 Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a systematic review and… PMID:34106348 | 2021 | this review only | not stated | not extracted yet |
| Jahanbin 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Jahanbin 2016 An Extensive Comparison of the Clinical Efficiency of Acidulated Phosphate Fluoride (APF) and Neutral Sodium Fluoride (NaF) Oral Rinses in… PMID:35355827 | 2022 | this review only | not stated | not extracted yet |
| Jena 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Jena 2015 Evaluation of 3 commercially available materials for resolution of white spot lesions. PMID:23540640 | 2013 | this review only | not stated | not extracted yet |
| Kannan 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kannan 2023 A clinical evaluation of the effectiveness of a fluoride-releasing visible light-activated bonding system to reduce demineralization… PMID:8760850 | 1996 | this review only | not stated | not extracted yet |
| Karabekiroğlu 2017 Remineralization potential of strontium-doped nano-hydroxyapatite dentifrice and casein phosphopeptide-amorphous calcium phosphate cream… PMID:38162913 | 2024 | this review only | not stated | not extracted yet |
| Kashash 2024 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kaveh 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kaveh 2022 Control of White Spot Lesions with Use of Fluoride Varnish or Chlorhexidine Gel During Orthodontic Treatment A Randomized Clinical Trial. PMID:27471804 | 2016 | this review only | not stated | not extracted yet |
| Kiran 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kiran 2023 Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis. PMID:33849907 | 2022 | this review only | not stated | not extracted yet |
| Kirschneck 2016 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Kirschneck 2016 The effects of argon laser curing of a resin adhesive on bracket retention and enamel decalcification: a prospective clinical trial. PMID:15536845 | 2004 | this review only | not stated | not extracted yet |
| Kronenberg 2009 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mahmoudzadeh 2019 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mahmoudzadeh 2019 Prevention of non-cavitated lesions with fluoride and xylitol varnishes during orthodontic treatment: a randomized clinical trial. PMID:33835256 | 2021 | this review only | not stated | not extracted yet |
| Mehta 2015 Efficacy of Amorphous Calcium Phosphate (ACP) Containing Adhesive in Preventing Demineralization during Orthodontic Treatment, a Triple… PMID:31358717 | 2019 | this review only | not stated | not extracted yet |
| Mollabashi 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Mollabashi 2022 DIAGNOdent pen quantification of the synergy of NovaMin® in fluoride toothpaste to remineralize white spot lesions in patients with fixed… PMID:35428577 | 2022 | this review only | not stated | not extracted yet |
| Mollabashi 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Najafi 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Najafi 2022 Efficacy of fluoride varnish for preventing white spot lesions and gingivitis during orthodontic treatment with fixed appliances-a… PMID:26832780 | 2016 | this review only | not stated | not extracted yet |
| O’Reilly 2013 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| O’Reilly 2013 Effect of nanomicelle curcumin-based photodynamic therapy on the dynamics of white spot lesions and virulence of Streptococcus mutans in… PMID:36602066 | 2022 | this review only | not stated | not extracted yet |
| Øgaard 2005 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Pilli 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Pilli 2022 Does a chitosan-containing dentifrice prevent demineralization around orthodontic brackets? PMID:21208086 | 2011 | this review only | not stated | not extracted yet |
| Raghis 2018 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Raghis 2018 Antimicrobial efficacy and bonding properties of orthodontic bonding systems enhanced with silver nanoparticles: a systematic review with… PMID:39501230 | 2024 | this review only | not stated | not extracted yet |
| Rajendran 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Rohym 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Sardana 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Schlagenhauf 2022 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Shah 2017 Comparative assessment of conventional and light-curable fluoride varnish in the prevention of enamel demineralization during fixed… PMID:28505317 | 2018 | this review only | not stated | not extracted yet |
| Shan 2021 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Simon 2022 Probiotics for maintaining oral health during fixed orthodontic treatment: A systematic review and meta-analysis. PMID:38764155 | 2025 | this review only | not stated | not extracted yet |
| Singh 2016 Topographic Evaluation of the Remineralizing Potential of Biomimetic Scaffolds on Enamel White Spot Lesions: An In Vitro Study. PMID:39663737 | 2025 | this review only | not stated | not extracted yet |
| Sonesson 2014 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Stecksén-Blicks 2007 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Tiwari 2023 Comparative Evaluation of White Spot Lesion incidence between NovaMin, Probiotic, And Fluoride containing Dentifrices during Orthodontic… DOI:10.1080/27705781.2023.2190950 | 2023 | this review only | not stated | not extracted yet |
| Tiwari 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Tomaževič 2022 The effect of nano-hydroxyapatite on white spot lesions: A systematic review and meta-analysis. PMID:39395626 | 2024 | this review only | not stated | not extracted yet |
| Trimpeneers 1996 Effect of light-curable fluoride varnish on enamel demineralization adjacent to orthodontic brackets: an in-vivo study. PMID:26522042 | 2015 | this review only | not stated | not extracted yet |
| Uysal 2010 Efficacy of resin-modified glass ionomer cement varnish in the prevention of white spot lesions during comprehensive orthodontic… PMID:25843603 | 2015 | this review only | not stated | not extracted yet |
| Uysal 2011 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Uysal a 2011 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| van der Kaaij 2015 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| van der Kaaij 2015 In vivo effects of amorphous calcium phosphate-containing orthodontic composite on enamel demineralization around orthodontic brackets. PMID:20887516 | 2010 | this review only | not stated | not extracted yet |
| Vivaldi-Rodrigues 2006 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Vivaldi-Rodrigues 2006 Supragingival dental biofilm profile and biofilm control during orthodontic treatment with fixed orthodontic appliance: A randomized… PMID:38701663 | 2024 | this review only | not stated | not extracted yet |
| Wang 2023 RCT matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Wang 2023 RCT Comparative evaluation of four treatments for postorthodontic white spot lesions: a randomized controlled trial. PMID:37603170 | 2023 | this review only | not stated | not extracted yet |
| Wierichs 2023 matched by author and year (probable) | NR | this review only | not stated | not extracted yet |
| Willmot 2004 matched by author and year (probable) | NR | this review only | not stated | 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). Only the non-Cochrane dental reviews have study lists, so overlap with Cochrane reviews is not counted yet.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Orthodontic patients wearing fixed appliances for at least one month (or having completed fixed-appliance therapy), with WSLs at baseline or at risk of WSLs | Orthodontic patients with fixed appliances (n=4,634; age 12 to 50 years, mean 15.9; 21 countries) |
| Intervention | Agents for prevention, reduction or reversal of white spot lesions | Fluoride varnish (16 studies), CPP-ACP (12), resin infiltration (7), nano-agents (6), chlorhexidine (3), fluoride combinations (3), fluoride mouthwash (3), self-assembling peptide (3), NovaMin (2), probiotics (2), xylitol varnish (2) and others |
| Comparison | Placebo, negative control or another active agent | Control, placebo or no intervention, and active comparators |
| Outcomes | WSL prevalence/incidence and WSL score (primary); WSL size and fluorescence loss (secondary) | WSL score (n=55 studies), prevalence/incidence (n=29), lesion size (n=10); DMFT, microhardness, fluorescence loss and mineral content reported but not pooled |
| Study designs | RCTs on humans (split-mouth, parallel or crossover) | 70 RCTs (14 split-mouth, 1 crossover, rest parallel); networks of 44 (score), 23 (prevalence) and 9 (size) studies |
| Timing | Not specified | 1 to 36 months follow-up |
AMSTAR 2 items
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 | Partial Yes | Partial 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 | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | Yes | yes |
| Overall | High | High | yes |