Department of Orthodontics, Faculty of Dentistry, University of Damascus, Syria.
Dent Med Probl. 2020 Jul-Sep;57(3):305-325. doi: 10.17219/dmp/118330.
The purposes of this review were to appraise the current evidence on the management of orthodontically induced white spot lesions (OIWSLs) and to choose the best evidence from among conflicting systematic reviews. The published literature was searched from inception through November 2019 in 5 databases. Only systematic reviews and/or meta-analyses were eligible for inclusion. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2). The Jadad decision algorithm was applied to choose the best available evidence from among discordant reviews. Thirteen publications were included. The interventions reported in the management of OIWSLs were topical fluorides, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-containing products, fluoridecontaining bonding materials, laser therapy, resin infiltration, and micro-abrasion. The methodological quality of the reviews ranged between moderate and critically low according to the AMSTAR-2 tool. Based on the Jadad decision algorithm criteria, topical fluorides yielded a 25-30% prevention of OIWSLs; however, their effect on reversing OIWSLs was unclear. The CPP-ACP products were effective in both preventing and reversing OIWSLs. No differences were noted between fluoride-releasing adhesives and conventional adhesives. Laser irradiation was effective in preventing OIWSLs, with some concerns about the argon laser at a certain setting. Finally, there is a lack of reliable evidence supporting the efficacy of resin infiltration or micro-abrasion due to the limited number of available studies. Based on the currently available information, topical fluorides and laser irradiation are effective in preventing OIWSLs. The CPP-ACP products are effective in preventing and reversing OIWSLs. Fluoride-releasing adhesives have no effect on OIWSL prevention.
本次综述的目的是评估正畸诱导的白色斑点病变（OIWSL）管理的现有证据，并从相互冲突的系统评价中选择最佳证据。从创建到 2019 年 11 月，在 5 个数据库中搜索了已发表的文献。只有系统评价和/或荟萃分析才有资格入选。使用评估系统评价的测量工具-2（AMSTAR-2）评估方法学质量。应用贾达德决策算法从意见不一致的综述中选择最佳可用证据。共纳入 13 篇文献。报道的 OIWSL 管理干预措施包括局部氟化物、含酪蛋白磷酸肽-无定形磷酸钙（CPP-ACP）的产品、含氟黏结材料、激光治疗、树脂渗透和微研磨。根据 AMSTAR-2 工具，这些综述的方法学质量介于中度和极低之间。根据贾达德决策算法标准，局部氟化物可预防 25-30%的 OIWSL；然而，其逆转 OIWSL 的效果尚不清楚。CPP-ACP 产品在预防和逆转 OIWSL 方面均有效。释放氟化物的黏结剂与常规黏结剂之间无差异。激光辐射可有效预防 OIWSL，但在特定设置下对氩激光存在一些担忧。最后，由于可用研究数量有限，缺乏支持树脂渗透或微研磨疗效的可靠证据。基于目前的信息，局部氟化物和激光辐射可有效预防 OIWSL。CPP-ACP 产品可有效预防和逆转 OIWSL。释放氟化物的黏结剂对 OIWSL 预防无影响。
