Hussain Umar, Wahab Abdul, Kamran Muhammad Abdullah, Alnazeh Abdullah Ali, Almoammar Salem, Alshahrani Shaya Saud Mohammed, Niazi Fayez Hussain, Alam Shamsul, Arif Nauman, Campobasso Alessandra, Pandis Nikoloas
Orthodontics, Saidu College of Dentistry, Swat, Pakistan.
Sardar Begum Dental College & Hospital, Peshawar, Pakistan.
Orthod Craniofac Res. 2025 Apr;28(2):379-399. doi: 10.1111/ocr.12888. Epub 2024 Dec 24.
The primary objective was to systematically assess the prevalence, incidence and risk factors of WSLs with orthodontic treatment. The secondary objective was to compare the prevalence of WSLs between conventional fixed appliances (CFA) and other appliances, as well as with no treatment. PubMed, Scopus, Web of Science, LILACs, Virtual Health Library and Cochrane CENTRAL were searched. Risk of bias was assessed using RoB-2, ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Random-effects meta-analyses of pooled proportions and odds ratios (OR) with 95% confidence intervals (CIs) were conducted, followed by meta-regressions, sensitivity analyses, and an assessment of the quality of evidence using GRADE. Trial Sequential Analysis (TSA) was performed to determine the conclusiveness of the evidence. Fifty-seven studies involving 9101 patients (mean age of 16.4 years, 33.5% male) were included. Among orthodontic patients, the pooled prevalence of WSLs was 55.06% (95% CI: 47.7%, 63.6%: 42 studies), incidence was 34.2% (95% CI: 27.6%, 40.6%: 44 studies) and surface prevalence was 26.9% (6 studies; 95% CI: 13.8%, 39.8%). Among non-treated patients, the pooled prevalence of WSLs was 29.1% (95% CI: 17.2%, 41.1%; 21 studies). The odds of WSLs were significantly higher, with CFA being 4.73 times greater compared to other appliances (OR = 4.7, 95% CI: 1, 19.2, p = 0.05) and seven times higher compared to no treatment (OR = 7, 95% CI: 2.6, 18.5, p = 0.001). Prevalence of WSLs increased with longer treatment duration (p < 0.001), varied with ethnicity, being highest in Africans and lowest in Americans (p < 0.05), and method of detection (p < 00.1). TSA confirmed that CFA leads to more WSLs than other appliances or no treatment, with future studies unlikely to alter the direction of the outcomes. Orthodontic treatment increases WSL prevalence, influenced by various factors. Clinicians should carefully consider the development of WSLs during orthodontic treatment and adjust treatment plans accordingly, choose appliances wisely and monitor with effective detection tools. Since one-third of untreated cases already have WSLs, proper documentation at treatment start is essential. Trail Registration: CRD42023478065.
主要目的是系统评估正畸治疗中牙釉质脱矿（WSLs）的患病率、发病率及风险因素。次要目的是比较传统固定矫治器（CFA）与其他矫治器以及未治疗情况之间的牙釉质脱矿患病率。检索了PubMed、Scopus、Web of Science、LILACs、虚拟健康图书馆和Cochrane CENTRAL。使用RoB - 2、ROBINS - I工具和乔安娜·布里格斯研究所批判性评价清单评估偏倚风险。进行了合并比例和比值比（OR）的随机效应荟萃分析，并给出95%置信区间（CIs），随后进行了荟萃回归、敏感性分析以及使用GRADE评估证据质量。进行了试验序贯分析（TSA）以确定证据的确定性。纳入了57项研究，涉及9101名患者（平均年龄16.4岁，男性占33.5%）。在正畸患者中，牙釉质脱矿的合并患病率为55.06%（95% CI：47.7%，63.6%：42项研究），发病率为34.2%（95% CI：27.6%，40.6%：44项研究），表面患病率为26.9%（6项研究；95% CI：13.8%，39.8%）。在未治疗患者中，牙釉质脱矿的合并患病率为29.1%（95% CI：17.2%，41.1%；21项研究）。牙釉质脱矿的几率显著更高，与其他矫治器相比，CFA导致牙釉质脱矿的几率高4.73倍（OR = 4.7，95% CI：1，19.2，p = 0.05），与未治疗相比高7倍（OR = 7，95% CI：2.6，18.5，p = 0.001）。牙釉质脱矿的患病率随治疗时间延长而增加（p < 0.001），因种族而异，在非洲人中最高，在美国人中最低（p < 0.05），并且与检测方法有关（p < 0.01）。TSA证实，与其他矫治器或未治疗相比，CFA导致更多的牙釉质脱矿，未来研究不太可能改变结果方向。正畸治疗会增加牙釉质脱矿患病率，受多种因素影响。临床医生在正畸治疗期间应仔细考虑牙釉质脱矿的发生情况并相应调整治疗计划，明智地选择矫治器并使用有效的检测工具进行监测。由于三分之一的未治疗病例已经存在牙釉质脱矿，治疗开始时进行适当记录至关重要。试验注册号：CRD42023478065。
