ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Lingual Orthodontic Treatment with Lingual Brackets Results in Fewer White Spot Lesions (WSLs) than Conventional Orthodontic Treatment with Buccal Brackets
Clinical Question In adolescent orthodontic patients, does lingual orthodontic treatment result in fewer white spot lesions compared to conventional orthodontic treatment?
Clinical Bottom Line Lingual orthodontic treatment results in fewer white spot lesions (WSLs) than conventional orthodontic treatment. This is supported by a randomized controlled trial (RCT) and a case-control study. The RCT reported that WSL progression or development was higher from conventional orthodontic treatment using buccal brackets and may correlate more with the presence of carious lesions prior to bracketing. The case-control study reported that treatment duration had the largest impact on WSL development. After combining the evidence, it is reasonable to conclude that lingual orthodontic treatment may not contribute to WSL development as compared to conventional orthodontic treatment.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 20572865van der Veen/201028 orthodontic patients aged 12 to 18 yearsRandomized Controlled Trial
Key resultsAfter orthodontic treatment, WSL formation or progression was 4.8 times more prevalent on bracketed buccal surfaces than bracketed lingual surfaces (paired t-test, P = .01). Carious lesion extension was also higher for buccal surfaces than for lingual surfaces (paired t-test, P = 0.03).
#2) 26321339Wiechmann/2015174 orthodontic patients < 18 years Case Control Study
Key resultsAbout 42% of the patients reviewed developed at least one WSL as a result of lingual orthodontic treatment, which translates to about 3% of all teeth considered. Treatment duration had the largest impact on the development of WSLs (P = .01).
Evidence Search (("tongue"[MeSH Terms] OR "tongue"[All Fields] OR "lingual"[All Fields]) AND orthodontic[All Fields]) AND (Randomized Controlled Trial[ptyp] OR systematic[sb] OR Meta-Analysis[ptyp] OR Comparative Study[ptyp])
Comments on
The Evidence
Validity: The first article suffers from a low sample size and oral hygiene was not considered a cofounder. Although, the split-mouth design of this study did help to control for differences in oral hygiene between each patient. The second article is only a case control study and bias/human error may be present for three reasons: oral hygiene and pre-existing carious lesions were not considered; only one individual assessed the occurrence of lingual WSLs; the data was compared with published research that used different methodologies to report WSL incidence from buccal orthodontic treatment. Perspective: While lingual orthodontics provides an “invisible” treatment option for patients and may result in fewer white spot lesions, these benefits may not outweigh the fact that lingual braces are much more costly for the patient, more challenging for the orthodontist, and will likely result in pain, discomfort and speech difficulties early on.
Applicability All participants in these studies were representative of an average orthodontic patient as they were all less than 18 years of age and healthy. The first article included 28 subjects with an average age of 15.3 ± 1.2 years and required no existing cavitated lesions or smooth-surface WSLs. The second article included 174 subjects (47% female, 53% male) with an average age of 14.36 ± 1.23 years who had completed lingual orthodontic treatment with high-quality initial and final photos of their dentition. Some disadvantages include higher cost as well as the potential for discomfort or pain around the tongue. Patients should be thoroughly informed of these potential side effects and should consult with the provider about the various advantages and disadvantages of each treatment option before proceeding.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords Lingual orthodontic treatment, Conventional orthodontic treatment, White spot lesions (WSLs)
ID# 3018
Date of submission: 04/26/2016spacer
E-mail leikerb@livemail.uthscsa.edu
Author Bradley Leiker, II
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Clarence C. Bryk, DDS, MS
Faculty mentor/Co-author e-mail BRYKC@uthscsa.edu
Basic Science Rationale
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