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

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Abstract

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.

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References

  1. Bishara SE, Ostby AW (2008) White spot lesions: formation, prevention, and treatment. Semin Orthod 14(3):174–182. https://doi.org/10.1053/j.sodo.2008.03.002

    Article  Google Scholar 

  2. Mizrahi E (1983) Surface distribution of enamel opacities following orthodontic treatment. Am J Orthod 84(4):323–331. https://doi.org/10.1016/S0002-9416(83)90348-2

    Article  PubMed  Google Scholar 

  3. Machiulskiene V, Campus G, Carvalho JC et al (2019) Terminology of dental caries and dental caries management: consensus report of a workshop organized by ORCA and Cariology Research Group of IADR. Caries Res 54(1):1–8. https://doi.org/10.1159/000503309

    Article  Google Scholar 

  4. Nyvad B, Machiulskiene V, Baelum V (2003) Construct and predictive validity of clinical caries diagnostic criteria assessing lesion activity. J Dent Res 82(2):117–122. https://doi.org/10.1177/154405910308200208

    Article  PubMed  Google Scholar 

  5. Ogaard B (1989) Prevalence of white spot lesions in 19-year-olds: a study on untreated and orthodontically treated persons 5 years after treatment. Am J Orthod Dentofac Orthop 96(5):423–427. https://doi.org/10.1016/0889-5406(89)90327-2

    Article  Google Scholar 

  6. Julien KC, Buschang PH, Campbell PM (2013) Prevalence of white spot lesion formation during orthodontic treatment. Angle Orthod 83(4):641–647. https://doi.org/10.2319/071712-584.1

    Article  PubMed  Google Scholar 

  7. Huang GJ, Roloff-Chiang B, Mills BE, Shalchi S, Spiekerman C, Korpak AM, Starrett JL, Greenlee GM, Drangsholt RJ, Matunas JC (2013) Effectiveness of MI Paste Plus and PreviDent fluoride varnish for treatment of white spot lesions: a randomized controlled trial. Am J Orthod Dentofac Orthop 143(1):31–41. https://doi.org/10.1016/j.ajodo.2012.09.007

    Article  Google Scholar 

  8. Geiger AM, Gorelick L, Gwinnett AJ, Benson BJ (1992) Reducing white spot lesions in orthodontic populations with fluoride rinsing. Am J Orthod Dentofac Orthop 101(5):403–407. https://doi.org/10.1016/0889-5406(92)70112-N

    Article  Google Scholar 

  9. Geiger AM, Gorelick L, Gwinnett AJ, Griswold PG (1988) The effect of a fluoride program on white spot formation during orthodontic treatment. Am J Orthod Dentofac Orthop 93(1):29–37. https://doi.org/10.1016/0889-5406(88)90190-4

    Article  Google Scholar 

  10. Benson PE, Parkin N, Dyer F, Millett DT, Furness S, Germain P (2013) Fluorides for the prevention of early tooth decay (demineralised white lesions) during fixed brace treatment. Cochrane Database Syst Rev 12:CD003809. https://doi.org/10.1002/14651858.CD003809.pub3

    Article  Google Scholar 

  11. Bailey DL, Adams GG, Tsao CE, Hyslop A, Escobar K, Manton DJ, Reynolds EC, Morgan MV (2009) Regression of post-orthodontic lesions by a remineralizing cream. J Dent Res 88(12):1148–1153. https://doi.org/10.1177/0022034509347168

    Article  PubMed  Google Scholar 

  12. Milly H, Festy F, Watson TF, Thompson I, Banerjee A (2014) Enamel white spot lesions can remineralise using bio-active glass and polyacrylic acid-modified bio-active glass powders. J Dent 42(2):158–166. https://doi.org/10.1016/j.jdent.2013.11.012

    Article  PubMed  Google Scholar 

  13. Chen H, Liu X, Dai J, Jiang Z, Guo T, Ding Y (2013) Effect of remineralizing agents on white spot lesions after orthodontic treatment: a systematic review. Am J Orthod Dentofac Orthop 143(3):376–382 e3. https://doi.org/10.1016/j.ajodo.2012.10.013

    Article  Google Scholar 

  14. Lopatiene K, Borisovaite M, Lapenaite E (2016) Prevention and treatment of white spot lesions during and after treatment with fixed orthodontic appliances: a systematic literature review. J Oral Maxillofac Res 7(2):e1. https://doi.org/10.5037/jomr.2016.7201

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hochli D, Hersberger-Zurfluh M, Papageorgiou SN, Eliades T (2017) Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis. Eur J Orthod 39(2):122–133. https://doi.org/10.1093/ejo/cjw065

    Article  PubMed  Google Scholar 

  16. Sonesson M, Bergstrand F, Gizani S, Twetman S (2017) Management of post-orthodontic white spot lesions: an updated systematic review. Eur J Orthod 39(2):116–121. https://doi.org/10.1093/ejo/cjw023

    Article  PubMed  Google Scholar 

  17. Fernandez-Ferrer L, Vicente-Ruiz M, Garcia-Sanz V, Montiel-Company JM, Paredes-Gallardo V, Almerich-Silla JM, Bellot-Arcis C (2018) Enamel remineralization therapies for treating postorthodontic white-spot lesions: a systematic review. J Am Dent Assoc 149(9):778–786 e2. https://doi.org/10.1016/j.adaj.2018.05.010

    Article  PubMed  Google Scholar 

  18. Sardana D, Zhang J, Ekambaram M, Yang Y, McGrath CP, Yiu CKY (2019) Effectiveness of professional fluorides against enamel white spot lesions during fixed orthodontic treatment: a systematic review and meta-analysis. J Dent 82:1–10. https://doi.org/10.1016/j.jdent.2018.12.006

    Article  PubMed  Google Scholar 

  19. Al Wattar BH, Zamora J, Khan KS (2017) Informing treatment decisions through meta-analysis: to network or not? Evid Based Med 22(1):12–15. https://doi.org/10.1136/ebmed-2016-110599

    Article  PubMed  Google Scholar 

  20. Hoaglin DC, Hawkins N, Jansen JP, Scott DA, Itzler R, Cappelleri JC et al (2011) Conducting indirect-treatment-comparison and network-meta-analysis studies: report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: part 2. Value Health 14(4):429–437. https://doi.org/10.1016/j.jval.2011.01.011

    Article  PubMed  Google Scholar 

  21. Jansen JP, Trikalinos T, Cappelleri JC, Daw J, Andes S, Eldessouki R, Salanti G (2014) Indirect treatment comparison/network meta-analysis study questionnaire to assess relevance and credibility to inform health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report. Value Health 17(2):157–173. https://doi.org/10.1016/j.jval.2014.01.004

    Article  PubMed  Google Scholar 

  22. Caldwell DM, Ades AE, Higgins JP (2005) Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ 331(7521):897–900. https://doi.org/10.1136/bmj.331.7521.897

    Article  PubMed  PubMed Central  Google Scholar 

  23. Salanti G, Higgins JP, Ades AE, Ioannidis JP (2008) Evaluation of networks of randomized trials. Stat Methods Med Res 17(3):279–301. https://doi.org/10.1177/0962280207080643

    Article  PubMed  Google Scholar 

  24. Tu YK, Woolston A, Faggion CM (2010) Do bone grafts or barrier membranes provide additional treatment effects for infrabony lesions treated with enamel matrix derivatives? A network meta-analysis of randomized-controlled trials. J Clin Periodontol 37(1):59–79. https://doi.org/10.1111/j.1600-051X.2009.01499.x

    Article  PubMed  Google Scholar 

  25. Chaimani A, Higgins JP, Mavridis D, Spyridonos P, Salanti G (2013) Graphical tools for network meta-analysis in STATA. PLoS One 8(10):e76654. https://doi.org/10.1371/journal.pone.0076654

    Article  PubMed  PubMed Central  Google Scholar 

  26. Moher D, Liberati A, Tetzlaff J, Altman DG, P. Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1136/bmj.b2535

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hutton B, Catala-Lopez F, Moher D (2016) The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Med Clin (Barc) 147(6):262–266. https://doi.org/10.1016/j.medcle.2016.10.003

    Article  Google Scholar 

  28. Hu H, Feng C, Jiang Z, Wang L, Shrestha S, Su X, Shu Y, Ge L, Lai W, Hua F, Long H (2019) Effectiveness of remineralising agents in prevention and treatment of orthodontically induced white spot lesions: a protocol for a systematic review incorporating network meta-analysis. Syst Rev 8(1):339. https://doi.org/10.1186/s13643-019-1253-8

    Article  PubMed  PubMed Central  Google Scholar 

  29. Stegenga B, Dijkstra PU (2007) Principles of evidence-based medicine applied to dentistry. Ned Tijdschr Tandheelkd 114(4):155–160. https://doi.org/10.1002/sim.1186

    Article  PubMed  Google Scholar 

  30. Higgins J, Green S (2009) Cochrane handbook for systematic reviews of interventions. http://handbook-5-1.cochrane.org/. Accessed Dec 2019

  31. Song F, Eastwood AJ, Gilbody S, Duley L, Sutton AJ (2000) Publication and related biases. Health Technol Assess 4(10):1–115. https://doi.org/10.3310/hta4100

    Article  PubMed  Google Scholar 

  32. White IR (2015) Network meta-analysis. Stata J 15(4):951–985

    Article  Google Scholar 

  33. White I (2018) NETWORK: Stata module to perform network meta-analysis. https://econpapers.repec.org/software/bocbocode/s458319.htm. Accessed Dec 2019

  34. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11):1539–1558. https://doi.org/10.1002/sim.1186

    Article  PubMed  Google Scholar 

  35. Shim S, Yoon BH, Shin IS, Bae JM (2017) Network meta-analysis: application and practice using Stata. Epidemiol Health 39:e2017047. https://doi.org/10.4178/epih.e2017047

    Article  PubMed  PubMed Central  Google Scholar 

  36. Higgins JP, Jackson D, Barrett JK, Lu G, Ades AE, White IR (2012) Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods 3(2):98–110. https://doi.org/10.1002/jrsm.1044

    Article  PubMed  PubMed Central  Google Scholar 

  37. Greco T, Edefonti V, Biondi-Zoccai G, Decarli A, Gasparini M, Zangrillo A, Landoni G (2015) A multilevel approach to network meta-analysis within a frequentist framework. Contemp Clin Trials 42:51–59. https://doi.org/10.1016/j.cct.2015.03.005

    Article  PubMed  Google Scholar 

  38. Salanti G (2012) Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool. Res Synth Methods 3(2):80–97. https://doi.org/10.1002/jrsm.1037

    Article  PubMed  Google Scholar 

  39. Alavi S, Yaraghi N (2018) The effect of fluoride varnish and chlorhexidine gel on white spots and gingival and plaque indices in fixed orthodontic patients: a placebo-controlled study. Dent Res J (Isfahan) 15(4):276–282

    Google Scholar 

  40. Cheng HC, Hu HT, Chang YC (2019) Effectiveness of enzyme dentifrices on oral health in orthodontic patients: a randomized controlled trial. Int J Environ Res Public Health 16(12):2243. https://doi.org/10.3390/ijerph16122243

    Article  PubMed Central  Google Scholar 

  41. He WD, Liu YZ, Xu YY, Chen D (2010) Study on application of CPP-ACP on tooth mineralization during orthodontic treatment with fixed appliance. Shanghai Kou Qiang Yi Xue 19(2):140–143. https://doi.org/10.1097/CAD.0b013e32833db1bb

    Article  PubMed  Google Scholar 

  42. Hoffman DA, Clark AE, Rody WJ Jr, McGorray SP, Wheeler TT (2015) A prospective randomized clinical trial into the capacity of a toothpaste containing NovaMin to prevent white spot lesions and gingivitis during orthodontic treatment. Prog Orthod 16:25. https://doi.org/10.1186/s40510-015-0095-8

    Article  PubMed  PubMed Central  Google Scholar 

  43. Jiang H, Hua F, Yao L, Tai B, Du M (2013) Effect of 1.23% acidulated phosphate fluoride foam on white spot lesions in orthodontic patients: a randomized trial. Pediatr Dent 35(3):275–278

    PubMed  Google Scholar 

  44. Hua Y, Chen J, Jean G (2006) The preventive effectiveness in reducing tooth decay and decalcification of different concentration of fluoride toothpaste for orthodontic patients. Hua Xi Kou Qiang Yi Xue Za Zhi 24(2):146–147. https://doi.org/10.3321/j.issn:1000-1182.2006.02.014

    Article  PubMed  Google Scholar 

  45. Kau CH, Wang J, Palombini A, Abou-Kheir N, Christou T (2019) Effect of fluoride dentifrices on white spot lesions during orthodontic treatment: a randomized trial. Angle Orthod 89(3):365–371. https://doi.org/10.2319/051818-371.1

    Article  PubMed  Google Scholar 

  46. Kirschneck C, Christl JJ, Reicheneder C, Proff P (2016) Efficacy of fluoride varnish for preventing white spot lesions and gingivitis during orthodontic treatment with fixed appliances-a prospective randomized controlled trial. Clin Oral Investig 20(9):2371–2378. https://doi.org/10.1007/s00784-016-1730-6

    Article  PubMed  Google Scholar 

  47. Ogaard B, Alm AA, Larsson E, Adolfsson U (2006) A prospective, randomized clinical study on the effects of an amine fluoride/stannous fluoride toothpaste/mouthrinse on plaque, gingivitis and initial caries lesion development in orthodontic patients. Eur J Orthod 28(1):8–12. https://doi.org/10.1093/ejo/cji075

    Article  PubMed  Google Scholar 

  48. Rechmann P, Bekmezian S, Rechmann BMT, Chaffee BW, Featherstone JDB (2018) MI varnish and MI Paste Plus in a caries prevention and remineralization study: a randomized controlled trial. Clin Oral Investig 22(6):2229–2239. https://doi.org/10.1007/s00784-017-2314-9

    Article  PubMed  Google Scholar 

  49. Robertson MA, Kau CH, English JD, Lee RP, Powers J, Nguyen JT (2011) MI Paste Plus to prevent demineralization in orthodontic patients: a prospective randomized controlled trial. Am J Orthod Dentofac Orthop 140(5):660–668. https://doi.org/10.1016/j.ajodo.2010.10.025

    Article  Google Scholar 

  50. Schlagenhauf U, Kunzelmann KH, Hannig C, May TW, Hösl H, Gratza M et al (2019) Impact of a non-fluoridated microcrystalline hydroxyapatite dentifrice on enamel caries progression in highly caries-susceptible orthodontic patients: a randomized, controlled 6-month trial. J Investig Clin Dent 10(2):e12399. https://doi.org/10.1111/jicd.12399

    Article  PubMed  PubMed Central  Google Scholar 

  51. Skold-Larsson K, Sollenius O, Karlsson L, Petersson LG, Twetman S (2013) Effect of fluoridated milk on enamel demineralization adjacent to fixed orthodontic appliances. Acta Odontol Scand 71(3–4):464–468. https://doi.org/10.3109/00016357.2012.696687

    Article  PubMed  Google Scholar 

  52. Sonesson M, Twetman S, Bondemark L (2014) Effectiveness of high-fluoride toothpaste on enamel demineralization during orthodontic treatment-a multicenter randomized controlled trial. Eur J Orthod 36(6):678–682. https://doi.org/10.1093/ejo/cjt096

    Article  PubMed  Google Scholar 

  53. Sonesson M, Brechter A, Abdulraheem S, Lindman R, Twetman S (2019) Fluoride varnish for the prevention of white spot lesions during orthodontic treatment with fixed appliances: a randomized controlled trial. Eur J Orthod:1–5. https://doi.org/10.1093/ejo/cjz045

  54. Stecksen-Blicks C, Renfors G, Oscarson ND, Bergstrand F, Twetman S (2007) Caries-preventive effectiveness of a fluoride varnish: a randomized controlled trial in adolescents with fixed orthodontic appliances. Caries Res 41(6):455–459. https://doi.org/10.1159/000107932

    Article  PubMed  Google Scholar 

  55. van der Kaaij NC, van der Veen MH, van der Kaaij MA, ten Cate JM (2015) A prospective, randomized placebo-controlled clinical trial on the effects of a fluoride rinse on white spot lesion development and bleeding in orthodontic patients. Eur J Oral Sci 123(3):186–193. https://doi.org/10.1111/eos.12186

    Article  PubMed  PubMed Central  Google Scholar 

  56. Yao H, Wen S (2017) Clinical evaluation of the preventing effect of 4 anti-caries preparations on enamel decalcification in orthodontic treatment with fixed appliance. J Pract Stomatol 33(4):526–530. https://doi.org/10.3969/j.issn.1001-3733.2017.04.021

    Article  Google Scholar 

  57. Li-ping Y, Jing L, Han J, Bao-jun T, Min-quan D (2011) The effects of 1.23% fluoride foam on the prevention of enamel demineralization during orthodontic treatment. J Pract Stomatol 27(05):717–719. https://doi.org/10.3724/SP.J.1077.2011.00049

    Article  Google Scholar 

  58. Andersson A, Skold-Larsson K, Hallgren A, Petersson LG, Twetman S (2007) Effect of a dental cream containing amorphous cream phosphate complexes on white spot lesion regression assessed by laser fluorescence. Oral Health Prev Dent 5(3):229–233

    PubMed  Google Scholar 

  59. Baeshen HA, Lingstrom P, Birkhed D (2011) Effect of fluoridated chewing sticks (Miswaks) on white spot lesions in postorthodontic patients. Am J Orthod Dentofac Orthop 140(3):291–297. https://doi.org/10.1016/j.ajodo.2010.04.034

    Article  Google Scholar 

  60. Beerens MW, Ten Cate JM, Buijs MJ, van der Veen MH (2018) Long-term remineralizing effect of MI Paste Plus on regression of early caries after orthodontic fixed appliance treatment: a 12-month follow-up randomized controlled trial. Eur J Orthod 40(5):457–464. https://doi.org/10.1093/ejo/cjx085

    Article  PubMed  Google Scholar 

  61. Beerens MW, van der Veen MH, van Beek H, ten Cate JM (2010) Effects of casein phosphopeptide amorphous calcium fluoride phosphate paste on white spot lesions and dental plaque after orthodontic treatment: a 3-month follow-up. Eur J Oral Sci 118(6):610–617. https://doi.org/10.1111/j.1600-0722.2010.00780.x

    Article  PubMed  Google Scholar 

  62. Bock NC, Seibold L, Heumann C, Gnandt E, Roder M, Ruf S (2017) Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part I: photographic data evaluation. Eur J Orthod 39(2):134–143. https://doi.org/10.1093/ejo/cjw06

    Article  PubMed  Google Scholar 

  63. Bock NC, Seibold L, Heumann C, Gnandt E, Roder M, Ruf S (2017) Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part II: clinical data evaluation. Eur J Orthod 39(2):144–152. https://doi.org/10.1093/ejo/cjw061

    Article  PubMed  Google Scholar 

  64. Brochner A, Christensen C, Kristensen B, Tranaeus S, Karlsson L, Sonnesen L, Twetman S (2011) Treatment of post-orthodontic white spot lesions with casein phosphopeptide-stabilised amorphous calcium phosphate. Clin Oral Investig 15(3):369–373. https://doi.org/10.1007/s00784-010-0401-2

    Article  PubMed  Google Scholar 

  65. Du M, Cheng N, Tai B, Jiang H, Li J, Bian Z (2012) Randomized controlled trial on fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment. Clin Oral Investig 16(2):463–468. https://doi.org/10.1007/s00784-011-0520-4

    Article  PubMed  Google Scholar 

  66. Ebrahimi M, Mehrabkhani M, Ahrari F, Parisay I, Jahantigh M (2017) The effects of three remineralizing agents on regression of white spot lesions in children: a two-week, single-blind, randomized clinical trial. J Clin Exp Dent 9(5):e641–e648. https://doi.org/10.4317/jced.53582

    Article  PubMed  PubMed Central  Google Scholar 

  67. He T, Li X, Dong Y, Zhang N, Zhong Y, Yin W, Hu D (2016) Comparative assessment of fluoride varnish and fluoride film for remineralization of postorthodontic white spot lesions in adolescents and adults over a 6-month period: a single-center, randomized controlled clinical trial. Am J Orthod Dentofac Orthop 149(6):810–819. https://doi.org/10.1016/j.ajodo.2015.12.010

    Article  Google Scholar 

  68. Heravi F, Ahrari F, Tanbakuchi B (2018) Effectiveness of MI Paste Plus and Remin Pro on remineralization and color improvement of postorthodontic white spot lesions. Dent Res J (Isfahan) 15(2):95–103. https://doi.org/10.4103/1735-3327.226532

    Article  Google Scholar 

  69. Jumanca D, Galuscan A, Podariu AC, Ardelean L, Rusu LC (2012) Infiltration therapy - an alternative to fluoride varnish application for treatment of white spot lesion after fixed orthodontic treatment. Rev Chim 63(8):783–786

    Google Scholar 

  70. Karabekiroglu S, Unlu N, Kucukyilmaz E, Sener S, Botsali MS, Malkoc S (2017) Treatment of post-orthodontic white spot lesions with CPP-ACP paste: a three year follow up study. Dent Mater J 36(6):791–797. https://doi.org/10.4012/dmj.2016-228

    Article  PubMed  Google Scholar 

  71. Restrepo M, Bussaneli DG, Jeremias F, Cordeiro RC, Raveli DB, Magalhaes AC, Candolo C, Santos-Pinto L (2016) Control of white spot lesions with use of fluoride varnish or chlorhexidine gel during orthodontic treatment a randomized clinical trial. J Clin Pediatr Dent 40(4):274–280. https://doi.org/10.17796/1053-4628-40.4.274

    Article  PubMed  Google Scholar 

  72. Singh S, Singh SP, Goyal A, Utreja AK, Jena AK (2016) Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial. Prog Orthod 17(1):25. https://doi.org/10.1186/s40510-016-0138-9

    Article  PubMed  PubMed Central  Google Scholar 

  73. Willmot DR (2004) White lesions after orthodontic treatment: does low fluoride make a difference? J Orthod 31(3):235–242; discussion 202. https://doi.org/10.1179/146531204225022443

    Article  PubMed  Google Scholar 

  74. Benson PE, Parkin N, Dyer F, Millett DT, Germain P (2019) Fluorides for preventing early tooth decay (demineralised lesions) during fixed brace treatment. Cochrane Database Syst Rev 4:CD003809. https://doi.org/10.1002/14651858.CD003809.pub4

    Article  Google Scholar 

  75. Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A (2019) Fluoride toothpastes of different concentrations for preventing dental caries. Cochrane Database Syst Rev 3:CD007868. https://doi.org/10.1002/14651858.CD007868.pub3

    Article  PubMed  Google Scholar 

  76. Marinho VC, Higgins JP, Logan S, Sheiham A (2003) Fluoride mouthrinses for preventing dental caries in children and adolescents. Cochrane Database Syst Rev 3:CD002284. https://doi.org/10.1002/14651858.CD002284

    Article  Google Scholar 

  77. Lucchese A, Gherlone E (2013) Prevalence of white-spot lesions before and during orthodontic treatment with fixed appliances. Eur J Orthod 35(5):664–668. https://doi.org/10.1093/ejo/cjs070

    Article  PubMed  Google Scholar 

  78. Sudjalim TR, Woods MG, Manton DJ (2006) Prevention of white spot lesions in orthodontic practice: a contemporary review. Aust Dent J 51(4):284–289; quiz 347. https://doi.org/10.1111/j.1834-7819.2006.tb00445.x

    Article  PubMed  Google Scholar 

  79. Raphael S, Blinkhorn A (2015) Is there a place for Tooth Mousse in the prevention and treatment of early dental caries? A systematic review. BMC Oral Health 15(1):113. https://doi.org/10.1186/s12903-015-0095-6

    Article  PubMed  PubMed Central  Google Scholar 

  80. Harrison JE, Burnside G (2012) Why does clustering matter in orthodontic trials? Eur J Orthod 34(3):293–295. https://doi.org/10.1093/ejo/cjs026

    Article  PubMed  Google Scholar 

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Funding

This work was supported by the National Natural Science Foundation of China (Nos. 81571004, 81500884, 81901044 and 82071147) and the Applied and Fundamental Research Program funded by the Department of Science and Technology of Sichuan Province (No. 2018JY0558).

Author information

Authors and Affiliations

  1. 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

    Huimin Hu, Sonu Shrestha, Wenli Lai & Hu Long

  2. Department of Pediatric Dentistry, School and Hospital of Stomatology, Tianjin Medical University, Tianjin, China

    Chong Feng

  3. School of Medicine, University of Nankai, Tianjin, China

    Chong Feng & Zhaowei Jiang

  4. Department of Oral and Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, Chapel Hill, USA

    Lufei Wang

  5. Department of Orthodontics & Centre for Evidence-Based Stomatology, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China

    Jiarong Yan & Fang Hua

  6. Sichuan University Library, Chengdu, China

    Yu Shu

  7. Evidence-based Social Science Research Center & Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China

    Long Ge

  8. Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK

    Fang Hua

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  1. Huimin Hu
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  2. Chong Feng
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  3. Zhaowei Jiang
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  8. Long Ge
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  10. Fang Hua
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  11. Hu Long
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Contributions

HH and CF contributed equally to this study. HH, CF, WL, FH, and HL conceived the study. HH, CF, and YS developed the search strategies. HH and CF wrote the first draft. ZJ, LG, SS, YR, LW, FH, and HL revised the draft critically. HH and CF independently screened the studies and extracted the data from the included studies. HF, CF, ZJ, FH, and HL assessed the risk of bias and summarized the evidence. HH, CF, and LG performed the statistical analysis. FH and HL arbitrated in the cases of disagreement. All authors gave their final approval and agree to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Fang Hua or Hu Long.

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Hu, H., Feng, C., Jiang, Z. et al. Effectiveness of remineralizing agents in the prevention and reversal of orthodontically induced white spot lesions: a systematic review and network meta-analysis. Clin Oral Invest 24, 4153–4167 (2020). https://doi.org/10.1007/s00784-020-03610-z

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