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DOI

10.1007/s00784-020-03610-z

Effectiveness of remineralizing agents in the prevention and reversal of orthodontically induced white spot lesions: a systematic review and network meta-analysis

Huimin Hu ; Chong Feng ; Zhaowei Jiang ; Lufei Wang ; Sonu Shrestha ; Jiarong Yan ; Yu Shu ; Long Ge ; Wenli Lai ; Fang Hua ; Hu Long

作者地址

Department of Orthodontics, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, Sichuan University, No. 14, Section 3, Ren Min South Road, Chengdu, China

通讯作者

Fang Hua; Hu Long

来源期刊

Clinical oral investigations

ISSN

1432-6981

EISSN

1436-3771

出版日期

2020-10-15

卷号

期号

页码

4153-4167

摘要

Objectives: To compare the effectiveness of remineralizing agents in the prevention and reversal of white spot lesions (WSLs), which occur during fixed orthodontic treatment, through a systematic review and network meta-analysis. Materials and methods: We reviewed controlled randomized clinical trial (RCT) data querying nine databases combined with a manual search (last search date: March 10, 2020). Of 2273 identified studies, 36 RCTs were finally included. After study selection and data extraction, pair-wise and network meta-analyses were performed to analyze the effectiveness of remineralizing agents in the prevention and reversal of WSLs in the short term (≤ 3 months) and long term (> 3 months). The risk of bias was assessed based on the Cochrane guidelines. Statistical heterogeneity, inconsistencies, and cumulative ranking were also evaluated. Results: In terms of WSL prevention, sodium fluoride (NaF) varnish had the highest cumulative ranking for the short-term decalcification index (99.3%); acidulated phosphate fluoride (APF) foam ranked first for long-term incidence (96.9%), followed by difluorosilane (Dfs) varnish and high-concentration fluoride toothpaste (HFT) (79.4% and 77.4%, respectively). In the reversal of WSLs, no significant difference was found among different agents or their combinations for the two available outcomes (short-term integrated fluorescence loss and short-term percentage of fluorescence loss). Conclusions: In the prevention of WSLs, APF foam showed the best remineralizing effectiveness in the long term (after debonding), followed by Dfs varnish and HFT. It is unclear whether remineralizing agents can effectively reverse WSLs based on the existing evidence. Clinical relevance: APF foam may be recommended as a remineralizing agent for preventing orthodontically induced WSLs. Prospero registration number: CRD42019116852.

关键词

Enamel demineralization Enamel remineralization Frequentist model Network meta-analysis Orthodontics Randomized controlled trial

资助信息

National Natural Science Foundation of China (81571004, 81500884, 81901044 and 82071147); the Applied and Fundamental Research Program funded by the Department of Science and Technology of Sichuan Province (2018JY0558).

资助机构

国家自然科学基金委员会 ; 四川省科技厅

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