Fluoride-Releasing Materials to Prevent White Spot Lesions around Orthodontic Brackets: A Systematic Review

Abstract

The relation between orthodontic fixed appliances use and enamel demineralization is well established. Different preventive approaches have been suggested to this problem, but controversy remains about which is the best. The aim of this study was to perform a systematic review of clinical trials that investigated the effectiveness of materials containing fluorides to lute brackets or cover the bonding interface in order to inhibit the development and progression of white spot lesions. The null hypothesis was that fluoride materials do not affect the incidence of white spot lesions around brackets. A MEDLINE search was conducted for randomized clinical trials evaluating the development of white spot lesions in patients using fixed orthodontic appliances, followed by meta-analysis comparing the results for patients for whom dental materials containing fluorides were used (experimental group) to those for whom these materials were not used (control group). The pooled relative risk of developing white spot lesions for the experimental group was 0.42 (95% confidence interval: 0.25 to 0.72); hence, when fluoride-releasing materials are used, the patient has 58% less risk of white spot lesion development. Regarding white spot lesion extent, the pooled mean difference between the experimental and control groups was not statistically significant (-0.12; 95% confidence interval: -0.29 to 0.04).In conclusion, the results of the present systematic review suggest that fluoride-releasing materials can reduce the risk of white spot lesions around brackets. However, when white spot lesions had already occurred, there is no evidence that fluoride-releasing materials reduce the extent of these lesions.

Comparative evaluation of Icon® resin infiltration and Clinpro™ XT varnish on colour and fluorescence changes of white spot lesions: a randomized controlled trial

“…The management of WSLs can be divided into prevention (prior to the formation of WSLs), intervention (during the course of orthodontic treatment) and treatment (after the completion of orthodontic treatment). In the prevention and intervention categories, fluorides in the form of varnish, toothpaste, mouthwash, sealant and miswaks [2]; CPP-ACP, NovaMin®; laser therapy; silver nanoparticles; and ozone have been used extensively [3–7]. However, the clinicians often encounter WSLs post-debonding.…”

Fluoride Ion Release Characteristics of Fluoride-Containing Varnishes—An In Vitro Study

“…In contrast, Frazier et al demonstrated that tooth surfaces sealed with a fissure sealant developed 80% fewer occurrences of demineralization than the control group without sealant, and this difference was significant [20]. It has been reported that the use of fluoride-releasing materials around the bracket environment is beneficial to reducing white spot lesions in patients undergoing fixed appliance therapy [21,22]. To prevent white spot lesions, fluoride release should be prolonged [23].…”

Enamel demineralization around two different orthodontic bracket adhesive systems: An in vivo study

“…In an attempt to prevent enamel demineralization around fixed orthodontic brackets, several improvements and innovations have been developed over the past few years. Most of these attempts studied the effect of fluoride releasing agents around orthodontic brackets (Nascimento et al, 2016, Oz et al, 2017). However, the recent development in the APC Flash Free bracket adhesive system attempts to reduce the risk of WSL’s by eliminating the excess adhesive around the bracket that can remain after flash removal.…”