Little evidence exists about optimal caries-prevention strategies during orthodontic treatment

Abstract

Data sources: Medline, PubMed and hand searches were used to source studies., Study selection: Publications were screened independently by two observers. Only randomised controlled trials (RCT) of orthodontic fixed appliance treatment with bonded brackets that addressed prevention of white spot lesions which were published in English were included. Studies also had to provide enough data to calculate the preventive fraction (PF)., Data extraction and synthesis: The studies were divided into four groups based on comparable preventive measures (fluoride, chlorhexidine, sealants and bonding materials) and then the PF was calculated., Results: The overall PF of the fluoride-releasing bonding materials was 20% (standard error, 0.09). This effect, however, was not statistically significant. It was impossible to calculate an overall PF for the other preventive measures, but the tendency of their caries-inhibiting effect was described. The use of toothpaste and gel with a high fluoride concentration of 1500-5000 ppm or of complementary chlorhexidine during orthodontic treatment showed a demineralisation-inhibiting tendency. The use of a polymeric tooth coating on the tooth surface around the brackets showed almost no demineralisation-inhibiting effect., Conclusions: Many publications had to be excluded from this systematic review because of inadequate research designs. Future clinical trials are needed to give evidence-based advice on the optimal caries-prevention strategy., Copyright (C) 2004 Nature Publishing Group