Can Orthodontic Adhesive Systems Inhibit the Formation and Development of White Spot Lesions During Fixed Orthodontic Treatment? A Systematic Review

Overview

Journal J Adhes Dent

Specialty Dentistry

Date 2024 Oct 14

PMID 39397759

Authors

Marwan El Helou

Sandra Chakar

Emmanuel Nicolas

Elias Estephan

Frederic Cuisinier

Stephane Barthelemi

Affiliations

Soon will be listed here.

Abstract

Purpose: This study aims to assess whether orthodontic bonding systems prevent orthodontic-induced white spot lesions (OIWSLs), exploring efficacy and identifying associated factors through a comprehensive systematic review of existing evidence.

Materials And Methods: The study complied to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two evaluators screened records, and data were extracted on orthodontic bonding systems, outcomes, and participant characteristics from PubMed/MEDLINE, Cochrane Library, and EM Premium. The search equation focused on white spot lesions and orthodontic bonding. Only in-vivo studies and clinical trials on humans were included, while in-vitro studies were excluded. The risk of bias was assessed using Cochrane's RoB2 tool for RCTs and ROBINS-I tool for non-randomized studies, evaluating key domains related to bias.

Results: The systematic review, including 12 articles with 550 participants and 2,000 teeth, revealed that bonding with nanoparticles of nCaF2-primer and amorphous calcium phosphate-containing adhesives effectively reduced WSLs. In contrast, one-step adhesive without primer (GC Ortho Connect™) was associated with higher and more severe WSLs. Fluoride-releasing primers (Opal Seal™ and Clearfil™) did not exhibit an advantage in demineralization reduction. The inclusion of TiO2 nanoparticles in two studies yielded conflicting results on antibacterial effects.

Discussion: Various nanoparticles incorporated into adhesives or primers exhibit promise in preventing white spot lesions in fixed orthodontic treatment. However, the used evaluation methods, such as clinical examinations or advanced imaging, significantly impact result interpretation. The effectiveness of orthodontic adhesives in preventing WSLs should balance between biocompatibility, bond strength and demineralization control tailored to patient-specific needs.

References

Oz A, Oz A, Yazicioglu S, Sancaktar O . Effectiveness of an antibacterial primer used with adhesive-coated brackets on enamel demineralization around brackets: an in vivo study. Prog Orthod. 2019; 20(1):15. PMC: 6462439. DOI: 10.1186/s40510-019-0271-3. View

Li Y, Mei L, Wei J, Yan X, Zhang X, Zheng W . Effectiveness, efficiency and adverse effects of using direct or indirect bonding technique in orthodontic patients: a systematic review and meta-analysis. BMC Oral Health. 2019; 19(1):137. PMC: 6615229. DOI: 10.1186/s12903-019-0831-4. View

Al Tuma R, Yassir Y . Effect of calcium fluoride nanoparticles in prevention of demineralization during orthodontic fixed appliance treatment: a randomized clinical trial. Eur J Orthod. 2022; 45(2):122-132. DOI: 10.1093/ejo/cjac055. View

Al Maaitah E, Adeyemi A, Higham S, Pender N, Harrison J . Factors affecting demineralization during orthodontic treatment: a post-hoc analysis of RCT recruits. Am J Orthod Dentofacial Orthop. 2011; 139(2):181-91. DOI: 10.1016/j.ajodo.2009.08.028. View

Horan O, Al-Khateeb S . Comparison of three orthodontic bonding systems in white spot lesion development: a randomized clinical trial. Angle Orthod. 2023; 93(5):531-537. PMC: 10575644. DOI: 10.2319/111422-781.1. View

Foersch M, Schuster C, Rahimi R, Wehrbein H, Jacobs C . A new flash-free orthodontic adhesive system: A first clinical and stereomicroscopic study. Angle Orthod. 2015; 86(2):260-4. PMC: 8603604. DOI: 10.2319/050415-302.1. View

Tan A, Cokakoglu S . Effects of adhesive flash-free brackets on enamel demineralization and periodontal status. Angle Orthod. 2020; 90(3):339-346. PMC: 8032304. DOI: 10.2319/80819-518.1. View

Mollabashi V, Soleymani M, Arabestani M, Farhadian M, Abbasalipourkabir R, Salehzadeh M . Evaluation of Nano TiO Modified Orthodontic Composite Effects on S. mutans Population and Enamel Demineralization in Fixed Orthodontic Patients; a Split Mouth Randomized Controlled Clinical Trial. Biol Trace Elem Res. 2023; 201(10):4657-4666. DOI: 10.1007/s12011-023-03559-6. View

Yetkiner E, Gurlek O, Isik A, Lappin D, Buduneli N . Do Adhesive Flash-free Brackets Affect Bacterial Plaque in Patients with Adequate Oral Hygiene? A Randomised Controlled Clinical and Microbiological Assessment. Oral Health Prev Dent. 2019; 17(6):533-539. DOI: 10.3290/j.ohpd.a43753. View

10.

Sodagar A, Bahador A, Pourhajibagher M, Ahmadi B, Baghaeian P . Effect of Addition of Curcumin Nanoparticles on Antimicrobial Property and Shear Bond Strength of Orthodontic Composite to Bovine Enamel. J Dent (Tehran). 2017; 13(5):373-382. PMC: 5250636. View

11.

Marinelli G, Inchingolo A, Inchingolo A, Malcangi G, Limongelli L, Montenegro V . White spot lesions in orthodontics: prevention and treatment. A descriptive review. J Biol Regul Homeost Agents. 2021; 35(2 Suppl. 1):227-240. DOI: 10.23812/21-2supp1-24. View

12.

Shakeel M, Jabeen F, Shabbir S, Asghar M, Khan M, Chaudhry A . Toxicity of Nano-Titanium Dioxide (TiO2-NP) Through Various Routes of Exposure: a Review. Biol Trace Elem Res. 2015; 172(1):1-36. DOI: 10.1007/s12011-015-0550-x. View

13.

Tufekci E, Dixon J, Gunsolley J, Lindauer S . Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod. 2011; 81(2):206-10. PMC: 8925248. DOI: 10.2319/051710-262.1. View

14.

Lopatiene K, Borisovaite M, Lapenaite E . Prevention and Treatment of White Spot Lesions During and After Treatment with Fixed Orthodontic Appliances: a Systematic Literature Review. J Oral Maxillofac Res. 2016; 7(2):e1. PMC: 4970501. DOI: 10.5037/jomr.2016.7201. View

15.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

16.

Choi A, Yoo K, Yoon S, Park S, Choi Y, Kim Y . Enhanced antimicrobial and remineralizing properties of self-adhesive orthodontic resin containing mesoporous bioactive glass and zwitterionic material. J Dent Sci. 2022; 17(2):848-855. PMC: 9201928. DOI: 10.1016/j.jds.2021.09.029. View

17.

Grunheid T, Larson B . Comparative assessment of bonding time and 1-year bracket survival using flash-free and conventional adhesives for orthodontic bracket bonding: A split-mouth randomized controlled clinical trial. Am J Orthod Dentofacial Orthop. 2018; 154(5):621-628. DOI: 10.1016/j.ajodo.2018.05.012. View

18.

Comert S, Oz A . Clinical effect of a fluoride-releasing and rechargeable primer in reducing white spot lesions during orthodontic treatment. Am J Orthod Dentofacial Orthop. 2020; 157(1):67-72. DOI: 10.1016/j.ajodo.2019.06.013. View

19.

Toodehzaeim M, Zandi H, Meshkani H, Hosseinzadeh Firouzabadi A . The Effect of CuO Nanoparticles on Antimicrobial Effects and Shear Bond Strength of Orthodontic Adhesives. J Dent (Shiraz). 2018; 19(1):1-5. PMC: 5817337. View

20.

Cross K, Huq N, Stanton D, Sum M, Reynolds E . NMR studies of a novel calcium, phosphate and fluoride delivery vehicle-alpha(S1)-casein(59-79) by stabilized amorphous calcium fluoride phosphate nanocomplexes. Biomaterials. 2004; 25(20):5061-9. DOI: 10.1016/j.biomaterials.2004.01.045. View