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Prevention of non-cavitated lesions with fluoride and xylitol varnishes during orthodontic treatment: a randomized clinical trial

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Abstract

Objective

Fixed orthodontic appliances impair oral hygiene increasing the risk of non-cavitated lesions (NCLs) and tooth decay. The aim of this study was to compare the outcomes of fluoride and xylitol varnishes in preventing NCLs during comprehensive orthodontic treatment.

Materials and methods

The sample comprised 55 volunteers from 15 to 20 years of age under orthodontic treatment that were randomly divided into three groups: Fluoride Group (FG; n=17), Xylitol Group (XG; n=19), and Placebo Group (PG; n=19). The patients in each group received two applications of the following varnishes: DuraphatTM (5% NaF), 20% xylitol, and placebo (no F/Xylitol) in the three groups, respectively. The varnishes were applied in the first appointment (T0) and 3 months later (T1). Clinical examinations were carried out at T0 and 6 months after (T2) using the ICDAS index and the QLF system (fluorescence difference). The intergroup comparisons were performed by ANOVA/Tukey’s or Kruskal-Wallis/Dunn’s tests (P<0.05).

Results

There was no significant intergroup difference regarding ICDAS index changes from T0 to T2. Fluoride varnish produced significantly greater increase in fluorescence of NCLs (mean change of −0.65 +0.78 and −0.56 +0.83, for maxilla and mandible, respectively) in comparison to the other groups. The majority of non-cavitated lesions improved in the fluoride and xylitol varnish groups.

Conclusions

Fluoride varnish produced significantly greater increase in enamel fluorescence compared to xylitol and placebo varnishes. In short term, both fluoride and xylitol varnishes produced remineralization of NCLs in orthodontic patients.

Clinical relevance

Non-cavitated lesions can be effectively controlled in high-risk orthodontic patients by means of fluoride varnishes.

Clinical trial registration

ReBEC Identifier: RBR-6mdxfq; Date of Register: March 19th, 2020. Retrospectively Registered

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Acknowledgements

The authors would like to thank the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Funding

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES) - Finance Code 001. This study was funded by FAPESP (grant number 2016/19761-0).

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Authors and Affiliations

  1. Bauru Dental School, Department of Orthodontics, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil

    Vinicius Merino Silva, Camila Massaro & Guilherme Janson

  2. Bauru Dental School, Department of Biochemistry, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil

    Marilia Afonso Rabelo Buzalaf

  3. Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Alameda Octávio Pinheiro Brisolla 9-75, Bauru, SP, 17012-901, Brazil

    Daniela Garib

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  1. Vinicius Merino Silva
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Vinicius Merino da Silva, Camila Massaro, Guilherme Janson, and Daniela Garib. Varnish selection and ICDAS and QLF analyses were performed by Vinicius Merino da Silva, Camila Massaro, Marilia Afonso Rabelo Buzalaf, and Daniela Garib. The first draft of the manuscript was written by Vinicius Merino da Silva, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Vinicius Merino Silva.

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Silva, V.M., Massaro, C., Buzalaf, M.A.R. et al. Prevention of non-cavitated lesions with fluoride and xylitol varnishes during orthodontic treatment: a randomized clinical trial. Clin Oral Invest 25, 3421–3430 (2021). https://doi.org/10.1007/s00784-021-03930-8

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