The effect of sealant on prevention of enamel demineralization in patients with fixed orthodontic appliances: A systematic review

Abstract

Introduction: One of the common problems of patients undergoing orthodontic treatment with fixed appliances is the development of enamel demineralization. The objective of this review is to evaluate the effectiveness of sealants in preventing the occurrence of enamel demineralization in patients with fixed orthodontic appliances during treatment.Methods: A complex search was performed in Medline (1969 to May 2013, and by hand in individual articles, in order to identify any relevant study based upon various combinations of key words. The included studies are Randomized Controlled Trials (RCTs), or otherwise prospective clinical trials, with patients (teeth) of any age undergoing fixed orthodontic treatment and with a control group or at least two intervention groups. In the absence of the above, any prospective cohort with more than ten patients was evaluated. To assess the internal validity of the eligible studies, the Cochrane Risk of Bias Tool for Randomized Clinical Trials was applied. Results:The searches originally identified 237 titles and abstracts, 6 fulfilled the inclusion criteria of the review. From these studies, 4 were randomized clinical trials and 2 prospective clinical trials. The results were contradictory, with half of the studies showing significant reductions in the incidence of enamel decalcification for the sealed teeth compared with the control group while the remaining half did not show any important differences.Discussion: Based on the findings from the present systematic review, it was impossible to make any reliable recommendations on the usage of sealants during orthodontic treatment for the prevention of WSL development. Nevertheless, their use in general seems to be beneficial for caries prevention, depending on the type of material, the method of its application and the caries risk status of the patient. Gizani, Sotiria* Department of Pediatric Dentistry, Dental School, University of Athens, Greece Submitted: November 11, 2013. ; Accepted: January 13, 2014. ; Published: April 25, 2014 Gizani S. The effect of sealant on prevention of enamel demineralization in patients with fixed orthodontic appliances: A systematic review.

Prevention of demineralization during multi‐bracketed fixed orthodontic treatment: An overview of systematic reviews

“…One author of the conference abstract was contacted by email to obtain complete information about the systematic review, but no information could be obtained. Finally, 29 reviews (equal to 30 published papers 11‐40 ; since two of the papers 12,13 were almost identical, they were considered only once) met the eligibility criteria and were included in the present overview. The value of Cohen’s kappa for final inclusion after full‐text reading of the 86 articles among two reviewers (SD and MS) was found to be 0.85, indicating substantial agreement.…”

“…Four of the reviews 35,36,37,39 had “ moderate” overall confidence in the review and another four reviews (5 published papers) were assessed to have “low” overall confidence in the review 11,12,13,29,34 . Majority of the reviews were, however, assessed to have “critically low” overall confidence in the review 16,17,18,19,20,21,22,23,24,25,26,27,28,30,31,32,33,38,40 . The detailed assessment of the risk of bias of included reviews using the AMSTAR‐2 tool is presented in Figure 3.…”

“…Only 5 reviews 11,13,14,38,39 included in this overview were assessed by the authors to be of low risk of overall bias, whereas 23 reviews (equal to 24 published papers) 12,15,16,17,18,19,20,21,22,23,25,26,27,28,29,30,31,32,33,34,35,36,37,40 were assessed to be of high risk of overall bias, and one review 24 was of unclear risk of bias. The most common domain assessed to be of high risk or unclear risk was domain 1 (study eligibility criteria; 86.2%), followed by domains 2 and 3 (identification and selection of studies and data collection and study appraisal, respectively) with 51.7% of the reviews having high or unclear risk.…”

“…11,12,13,29,34 Majority of the reviews were, however, assessed to have "critically low" overall confidence in the review. 16,17,18,19,20,21,22,23,24,25,26,27,28,30,31,32,33,38,40 The detailed assessment of the risk of bias of included reviews using the AMSTAR-2 tool is presented in Figure 3.…”

“…Qualitative synthesis (risk of bias assessment) together with quantitative synthesis (meta-analysis) was performed in 8 of the included systematic reviews 15,24,26,27,35,37,39,40 , whereas 12 others (equal to 13 published papers) performed only qualitative synthesis. 12,13,14,18,19,20,21,23,25,29,31,34,36 One review provided quantitative synthesis without any quality assessment. 28 All the reviews that performed quantitative synthesis assessed heterogeneity and mentioned the method of assessment except for the one review.…”