Höchli Damian, Hersberger-Zurfluh Monika, Papageorgiou Spyridon N, Eliades Theodore
Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, Faculty of Medicine, University of Zurich, Switzerland.
Department of Oral Technology, School of Dentistry, University of Bonn, Germany.
Eur J Orthod. 2017 Apr 1;39(2):122-133. doi: 10.1093/ejo/cjw065.
Although orthodontic white spot lesions (WSLs) are one of the most often and most evident adverse effects of comprehensive fixed appliance treatment, the efficacy of interventions for WSLs has not yet been adequately assessed in an evidence-based manner.
Aim of this systematic review was to assess the therapeutic and adverse effects of interventions to treat post-orthodontic WSLs from randomized trials in human patients.
An unrestricted electronic search of eight databases from inception to May 2016.
Randomized controlled trials assessing any interventions for post-orthodontic WSLs on human patients.
After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs), including their 95% confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses.
A total of 20 unique studies and a total of 942 (42 per cent male and 58% per cent female) patients were included, with an average age of 16.2 years and a mean number of 8.2 WSLs (range 2.2 to 45.4) per patient. These were allocated to adjunct treatment with casein phosphopeptide-stabilized amorphous calcium phosphate creams, external tooth bleaching, low- or high-concentration fluoride films, gels, mouthrinses or varnishes, resin infiltration, miswak chewing sticks, bioactive glass toothpastse, or to no adjunct treatment (i.e. conventional oral hygiene). The monthly use of fluoride varnish was the best supplement to improve WSLs in terms of lesion area (1 trial; MD = -0.80 mm2; 95% CI = -1.10, -0.50 mm2; P < 0.05; high quality) and enamel fluorescence (3 trials; SMD = -0.92; 95% CI = -1.32, -0.52; P < 0.05; high quality), followed by the use of fluoride film. WSL treatment did not provide a considerable improvement in their clinical evaluation (3 trials; OR = 0.97; 95% CI = 0.60, 1.56; P > 0.05; moderate quality), with imprecision due to small sample size being the main limitation of existing evidence.
Based on the existing trials, interventions for post-orthodontic WSLs, mainly fluoride varnish, seem to be effective, but further research is needed to elucidate their clinical relevance.
PROSPERO (CRD42016037538).
尽管正畸性白斑病变（WSLs）是全面固定矫治器治疗中最常见且最明显的不良反应之一，但尚未以循证医学的方式充分评估针对WSLs干预措施的疗效。
本系统评价的目的是评估针对人类患者正畸后WSLs进行干预的治疗效果和不良反应。
对8个数据库进行从建库至2016年5月的无限制电子检索。
评估针对人类患者正畸后WSLs的任何干预措施的随机对照试验。
根据Cochrane指南进行重复研究筛选、数据提取和偏倚风险评估后，对平均差（MDs）、标准化平均差（SMDs）和比值比（ORs）进行随机效应荟萃分析，包括其95%置信区间（CIs），随后进行亚组分析和敏感性分析。
共纳入20项独特研究，总计942例患者（男性42%，女性58%），平均年龄16.2岁，每位患者平均有8.2个WSLs（范围2.2至45.4）。这些患者被分配接受酪蛋白磷酸肽稳定的无定形磷酸钙乳膏辅助治疗、外源性牙齿漂白、低浓度或高浓度氟化物贴膜、凝胶、漱口水或 varnishes、树脂渗透、咀嚼棒、生物活性玻璃牙膏，或不接受辅助治疗（即常规口腔卫生）。就病变面积而言，每月使用氟化物 varnish是改善WSLs的最佳补充（1项试验；MD = -0.80 mm2；95% CI = -1.10，-0.50 mm2；P < 0.05；高质量）以及牙釉质荧光（3项试验；SMD = -0.92；95% CI = -1.32，-0.52；P < 0.05；高质量），其次是使用氟化物贴膜。WSLs治疗在临床评估中未提供显著改善（3项试验；OR = 0.97；95% CI = 0.60，1.56；P > 0.05；中等质量），现有证据的主要局限性是由于样本量小导致的不精确性。
基于现有试验，针对正畸后WSLs的干预措施，主要是氟化物 varnish，似乎是有效的，但需要进一步研究以阐明其临床相关性。
PROSPERO（CRD42016037538）。
