Department of Orthodontics, Faculty of Dentistry, Alexandria University, Champollion St, Azarita, P. O. Box: 21521, Alexandria, Egypt.
Department of Orthodontics, College of Dentistry El Alamein, Arab Academy for Science, Technology and Maritime Transport (AASTMT), El Alamein, Egypt.
BMC Oral Health. 2023 Jul 1;23(1):440. doi: 10.1186/s12903-023-03103-x.
Development of white spot lesions (WSLs) is common among orthodontic patients. Several measures have been introduced to prevent and remineralize the lesions. Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is used for both prevention and remineralization. The effect of its application before bonding is controversial. This systematic review was conducted to investigate the most up to date available literature regarding the effect of CPP-ACP enamel pre-treatment on shear bond strength (SBS) of metallic orthodontic brackets.
A search was conducted in electronic databases (MEDLINE (via PubMed), Scopus, Cochrane Library, Web of Science and Google scholar (grey literature)) up to March 29, 2023. The inclusion criteria included in vitro studies comparing the SBS of metal orthodontic brackets following pre-treatment of enamel using CPP-ACP versus control. The exclusion criteria included study types other than in vitro studies, studies conducted on non-human enamel, or studies using CPP-ACP in combination with another intervention. The included studies were analysed by two reviewers, independently. The risk of bias assessment was done using a modified risk of bias tool. A Meta-analysis was performed. I values and Q-test were used for assessment of heterogeneity. Results were displayed in forest plots with a random-effects model. Standardized mean difference, standard error (SE) and 95% confidence intervals were calculated for all studies.
The search resulted in 76 articles. After duplicate removal and assessment for eligibility, 15 studies were included in the review. High statistical heterogeneity was found among the included studies using I values and Q-Test (I = 95.147%; Q = 288.456; df = 14; P < 0.001). The overall effect of CPP-ACP pre-treatment on the SBS of metal orthodontic brackets was not significant (Mean difference = 1.163 MPa, SE = 0.757, 95% CI = -0.321, 2.648, p value = 0.125). The use of CPP-ACP for prevention of WSLs did not significantly affect the SBS of brackets (Standardized mean difference = 1.009, SE = 0.884, 95% CI = -0.723, 2.740, p value = 0.254). No significant change was found when CPP-ACP was used for remineralization of WSLs (Standardized mean difference = 1.501, SE = 1.087, 95% CI = -0.630, 3.632, p value = 0.167).
Within the limitations of the study, the evidence suggests that the use of CPP-ACP for either prevention or remineralization of WSLs before bonding does not affect the SBS of metal orthodontic brackets.
正畸患者中常见的是白色斑点病变（WSL）的发展。已经引入了几种措施来预防和再矿化病变。酪蛋白磷酸肽-无定形磷酸钙（CPP-ACP）用于预防和再矿化。其在粘结前应用的效果存在争议。本系统评价旨在调查有关 CPP-ACP 釉质预处理对金属正畸托槽剪切粘结强度（SBS）的最新可用文献。
对电子数据库（MEDLINE（通过 PubMed）、Scopus、Cochrane 图书馆、Web of Science 和 Google Scholar（灰色文献））进行了检索，截至 2023 年 3 月 29 日。纳入标准包括比较使用 CPP-ACP 预处理釉质后金属正畸托槽 SBS 的体外研究与对照组。排除标准包括除体外研究以外的研究类型、在非人类釉质上进行的研究或使用 CPP-ACP 与另一种干预措施结合进行的研究。由两名独立的审稿人分析纳入的研究。使用改良的偏倚风险工具进行偏倚风险评估。进行了荟萃分析。I 值和 Q 检验用于评估异质性。结果以森林图显示，使用随机效应模型。对所有研究均计算了标准化均数差、标准误差（SE）和 95%置信区间。
搜索结果产生了 76 篇文章。重复删除和资格评估后，有 15 项研究纳入了综述。纳入的研究使用 I 值和 Q 检验显示出高度统计学异质性（I 值=95.147%；Q 值=288.456；df=14；P<0.001）。CPP-ACP 预处理对金属正畸托槽 SBS 的总体影响不显著（平均差值=1.163 MPa，SE=0.757，95%CI=-0.321，2.648，p 值=0.125）。CPP-ACP 用于预防 WSL 并不显著影响托槽的 SBS（标准化均数差=1.009，SE=0.884，95%CI=-0.723，2.740，p 值=0.254）。CPP-ACP 用于 WSL 再矿化时未发现显著变化（标准化均数差=1.501，SE=1.087，95%CI=-0.630，3.632，p 值=0.167）。
在研究的限制范围内，证据表明，在粘结前使用 CPP-ACP 预防或再矿化 WSL 并不影响金属正畸托槽的 SBS。
