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Does orthodontic treatment have a permanent effect on tooth color?

A systematic review and meta-analysis

Hat eine kieferorthopädische Behandlung dauerhafte Auswirkungen auf die Zahnfarbe?

Systematisches Review und Metaanalyse

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objectives

Aim of this systematic review was to assess the effect of orthodontic treatment with fixed appliances on the tooth color of patients.

Methods

Nine databases were searched up to May 2017 for clinical cohort studies on the effect of fixed appliance treatment on tooth color. After elimination of duplicate studies, data extraction, and risk of bias assessment according to the Cochrane guidelines, random effects meta-analyses of mean differences (MD) or means and their 95% confidence intervals (CIs) were performed, followed by GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment of the quality of evidence.

Results

Three nonrandomized and one randomized study with a total of 138 patients (46% male, 54% female) with average age of 15.7 years were included. Tooth color of treated patients was significantly altered during or after orthodontic treatment (4 studies; average of 3.2 ∆E units; 95% CI = 2.0–4.4 ∆E units), which was more than the variation among controls (1 study; MD = 1.9 ∆E units; 95% CI = 1.7–2.2 ∆E units). However, the quality of evidence was very low, due to the inclusion of nonrandomized studies, bias, and imprecision. Re-analysis of raw study data indicated that significant differences in clinically discernable treatment-induced color changes were seen between chemically and light-cured adhesives and among the various tooth categories.

Conclusion

Existing evidence of very low quality indicates that orthodontic treatment might be associated with alterations of tooth color, which are however not consistently clinically discernible. Treatment-induced color alterations might be dependent on bonding material and tooth type, but evidence supporting this is weak.

Zusammenfassung

Zielsetzung

In diesem systematischen Review sollte der Effekt einer Behandlung mit festsitzenden Apparaturen auf die Zahnfarbe von Patienten ermittelt werden.

Methoden

In 9 Datenbanken wurde bis Mai 2017 nach klinischen Kohortenstudien zum Thema „Effekt einer Behandlung mit festsitzenden Apparaturen auf die Zahnfarbe“ gesucht. Doppelt erfasste Studien wurden ausgeschlossen. Nach Datenextraktion und der Ermittlung des Bias-Risikos gemäß der Cochrane-Leitlinien wurden Random-Effects-Metaanalysen zu Mittleren Differenzen (MD) bzw. Durchschnitten mit 95 %-Konfidenzintervallen (KI) durchgeführt. Anschließend wurde die Qualität der Evidenz mit dem GRADE-Assessment (Grading of Recommendations Assessment, Development and Evaluation) bestimmt.

Ergebnisse

Eingeschlossen wurden 3 nichtrandomisierte und eine randomisierte Studie mit insgesamt 138 Patienten (46 % männlich, 54 % weiblich; Durchschnittsalter: 15,7 Jahre). Die Zahnfarbe der kieferorthopädisch behandelten Patienten hatte sich während oder nach der Behandlung signifikant verändert (4 Studien; 3,2 ∆E-Einheiten im Durchschnitt; 95 %-KI 2,0–4,4 ∆E-Einheiten) damit war die Abweichung größer als bei den Kontrollen (eine Studie; MD = 1,9 ∆E-Einheiten; 95 %-KI 1,7–2,2 ∆E-Einheiten). Aufgrund der Berücksichtigung nichtrandomisierter Studien sowie durch Bias und Ungenauigkeiten war die Evidenzqualität jedoch sehr gering. Die erneute Analyse der Rohdaten ergab, dass sich signifikante Unterschiede zwischen chemischen und lichthärtenden Adhäsiven sowie zwischen unterschiedlichen Zahnarten feststellen ließen.

Schlussfolgerung

Der geringe Evidenzgrad weist darauf hin, dass eine kieferorthopädische Behandlung mit Veränderungen der Zahnfarbe assoziiert sein könnte. Klinisch sind diese Veränderungen jedoch nicht konsistent nachweisbar. Behandlungsbedingte Farbveränderungen könnten abhängig sein vom für das Bonding verwendete Material und vom Zahntyp, die Evidenz ist jedoch schwach.

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Acknowledgements

We thank Dr. A. Karamouzos (private practice, Chios, Greece) for graciously providing the full dataset of their included study.

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Authors and Affiliations

  1. Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstr. 11, 8032, Zurich, Switzerland

    Rita Kamber, Spyridon N. Papageorgiou & Theodore Eliades

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  1. Rita Kamber
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  2. Spyridon N. Papageorgiou
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  3. Theodore Eliades
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Correspondence to Spyridon N. Papageorgiou.

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R. Kamber, S.N. Papageorgiou and T. Eliades declare that they have no competing interests.

Caption Electronic Supplementary Material

Appendix1: Search strategy for each database with the corresponding hits (last search 16.5.2017)

Appendix 2: Authors contacted for individual patient data

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Kamber, R., Papageorgiou, S.N. & Eliades, T. Does orthodontic treatment have a permanent effect on tooth color?. J Orofac Orthop 79, 73–82 (2018). https://doi.org/10.1007/s00056-018-0123-7

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