Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012 Bern, Switzerland.
Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Beldiletto 1, 20142 Milan, Italy.
Eur J Orthod. 2024 Apr 1;46(2). doi: 10.1093/ejo/cjae008.
Initial caries lesion (ICLs) adjacent to orthodontic brackets are the most common side effect of orthodontic treatment with fixed appliances. The reported prevalence is uncertain and varies considerably across studies, from 27% to 97%.
This paper was designed to evaluate and synthesize the available evidence on the prevalence and incidence rates of ICLs in relation to orthodontic treatment. Selection criteria: The review (Prospero protocol CRD42023412952) included randomized and non-randomized clinical trials of interventions, cohort studies, and cross-sectional studies, published after 1990 on the prevalence or incidence of ICLs during or after orthodontic treatment with fixed appliances. Search methods: Pubmed, Scopus, and Embase databases were searched from 1990 until 01 May 2023. The risk of bias assessment was performed with RoB 2 and ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Data collection and analysis: The proportion of individuals with ICLs, reported as the number/percentage of individuals/teeth with ICLs or mean number of ICLs per subject, were used to synthesize results.
The search yielded a total of 468 papers; 21 studies were included in the systematic review, 2 of which were not included in the meta-analysis. The prevalence rate [95%CI] of ICLs was 0.57% [0.48; 0.65] in 1448 patients, 0.22% [0.14; 0.33] in 11583 teeth, with a mean number of lesions equal to 2.24 [1.79; 2.70] in 484 patients evaluated. The incidence rate of new carious lesions developed during orthodontic treatment was 0.48% [0.33; 0.63] in 533 patients, 0.15% [0.08; 0.26] in 1890 teeth with a mean number of ICLs equal to 2.29 [1.12; 3.46] in 208 patients evaluated.
Although the high number of included studies and the overall good quality, there was a significant heterogeneity in the collected data.
The prevalence and incidence rates of ICLs in subjects undergoing orthodontic treatment are quite high and raise some concerns in terms of risk assessment of orthodontic treatment. ICLs represent an alarming challenge for both patients and professionals. Effective caries prevention strategies during treatment need to be considered and implemented where appropriate.
正畸治疗中，托槽周围的初始龋损（ICLs）是最常见的副作用。其报道的患病率不确定，且在不同研究中差异很大，从 27%到 97%不等。
本研究旨在评估和综合与正畸治疗相关的 ICLs 患病率和发生率的现有证据。
本综述（Prospéro 方案 CRD42023412952）纳入了 1990 年后发表的关于固定矫治器正畸治疗期间或之后 ICLs 患病率或发生率的干预措施随机和非随机临床试验、队列研究和横断面研究。
1990 年至 2023 年 5 月 1 日，检索 Pubmed、Scopus 和 Embase 数据库。使用 RoB 2 和 ROBINS-I 工具以及 Joanna Briggs 研究所的批判性评估清单进行偏倚风险评估。
使用 ICLs 个体的比例（报告为 ICLs 个体/牙齿的数量/百分比或每位受试者的平均 ICLs 数量）来综合结果。
检索共得到 468 篇论文；21 项研究纳入系统评价，其中 2 项未纳入荟萃分析。1448 名患者的 ICLs 患病率[95%CI]为 0.57%[0.48；0.65]，11583 颗牙齿的 ICLs 患病率为 0.22%[0.14；0.33]，484 名接受评估的患者的平均病变数为 2.24[1.79；2.70]。533 名患者在正畸治疗过程中新发生龋病的发生率为 0.48%[0.33；0.63]，1890 颗牙齿的发生率为 0.15%[0.08；0.26]，208 名接受评估的患者的平均 ICLs 数为 2.29[1.12；3.46]。
尽管纳入的研究数量很多，且整体质量较好，但收集的数据存在显著异质性。
接受正畸治疗的患者的 ICLs 患病率和发生率相当高，这对正畸治疗的风险评估提出了一些关注。ICLs 对患者和专业人员都是一个令人警惕的挑战。需要考虑并在适当情况下实施治疗期间的有效龋齿预防策略。
