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Title Sealant Therapy, Along with Good Oral Hygiene Practices, Can Prevent the Formation of White Spot Lesions in Fixed Orthodontic Patients
Clinical Question In patients receiving fixed orthodontic treatment, would placement of sealants prior to bonding traditional fixed orthodontic brackets, compared to not using any sealant prior to bonding, reduce the risk of white spot lesion formation throughout treatment?
Clinical Bottom Line For fixed orthodontic patients, sealant therapy, along with good oral hygiene practices, can be preventive in the formation of white spot lesions. This is supported by a systematic review, a randomized control trial and a prospective clinical trial, in which sealant placement resulted in less frequent white spot lesion formation after treatment compared to patients who did not have sealants placed with their fixed orthodontic appliances. Placing sealants under fixed orthodontic brackets is a simple, time-efficient technique, does not rely on patient compliance, and can provide protection from the occurrence of white spot lesions.
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) 27734089Hammad/201550 subjects with mean age 14.5 from the orthodontic department in EgyptRandomized Controlled Trial
Key resultsThis randomized control trial compared two groups over a 12 month period; one that had SeLECT Defense sealant therapy placed on all teeth under their fixed orthodontic braces, and a control group with no sealant therapy, to decipher if the addition of sealants would decrease the formation of white spot lesions found after treatment. The sealant therapy used was SeLECT Defense sealant therapy, which is an organoselenium compound that is marketed to prevent the formation of biofilm on teeth by inhibiting bacterial attachment to teeth. Oral hygiene compliance was also judged in both groups by an Approximate Plaque Index (API) throughout treatment. Although the control group had a higher number of white spot formation (71.4%) than the sealant group (33.3%), only patients classified as having “bad-fair” oral hygiene practices showed independent adverse risk for the development of WSLs (Odds ratio of 0.073,p=0.035). There was no significant effect from the SeLECT Defense therapy alone on the development of caries (Odds ratio of 0.212 and p=0.215). However, while this study proves that maintaining good oral hygiene practices are a more efficacious method in preventing WSLs and that “SeLECT Defense does not suffice as a stand-alone solution to prevent WSLs”, it also states that using SeLECT Defense works well as a concomitant prevention strategy with fixed orthodontic appliances.
#2) 23726334O’ Reilly/ 2013 62 male and female patients aged 12-26 yrs in 5 different orthodontic practices Prospective Cohort Study
Key resultsThis study’s aim was to test if the placement of Biscover LV Sealant prevented the formation of white spot lesions in patients wearing fixed orthodontic appliances. The study used an alternating split-mouth design and placed sealants on the six anterior maxillary teeth and compared the results to a control group, not using sealant therapy. The Biscover LV Sealant used is a light cured, low viscosity sealant that eliminates the formation of the oxygen-inhibited layer on teeth. The study also measured the oral hygiene of the subjects in the study throughout the treatment. After treatment was completed, slightly lower incidence of WSLs was found in the sealant group (13.5%; 95% confidence interval [CI] 8.6-18.4) than in the control teeth (17.7%; 95% CI 12.4-23.7), which was a statistically significant finding (p=0.024). Additionally, the subjects with poor oral hygiene had a significantly higher risk of developing white spot lesions compared with subjects with good oral hygiene (p= 0.009, Odds ratio: 2.492)
#3) 31081584Tasios/2019 23 studies/1473 patients Systematic review of randomized trials
Key resultsCommon prevention methods against the formation of white spot lesions in fixed orthodontic patients were assessed through this systematic review. The efficacy of flat surface sealants was measured in 5 trials and 2784 teeth. There was a reduced white spot lesion incidence on sealed teeth compared to the control group (RR:0.8, 95% CI: 0.63-0.95).
Evidence Search “Sealants and white spot lesions fixed and orthodontic brackets”
Comments on
The Evidence
Validity: All of the studies were in vivo clinical trials or a systematic review; however, there are a few important points to be made on the validity of certain aspects of these studies. First, the classification of the WSLs in the clinical trials was subjective, and the number of participants enrolled was significantly fewer than the power value in the O'Reilly study. While the PRISMA guidelines were followed in the systematic review, the article itself mentions a low quality of evidence due to high risk of bias among included studies. Perspective: While the most important and predictable prevention strategy in the formation of white spot lesions is good oral hygiene, this evidence proves that there is a benefit of sealant placement along with good oral hygiene practices. Placing sealants does not depend on patient compliance and is a simple yet effective method to provide extra protection to the formation of white spot lesions.
Applicability The frequency in which orthodontists see white spot lesions on patients wearing fixed orthodontic appliances necessitates an intervention to prevent WSLs from occurring. Sealants placed on teeth prior to fixed orthodontic brackets eliminates compliance by the patient and can prove beneficial in WSL formation, but cannot be used as a sole treatment modality. Patients must practice good oral hygiene throughout treatment in order for the sealants to provide any protection against the formation of WSLs.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords “sealants and white spot lesions fixed orthodontic brackets”
ID# 3451
Date of submission: 12/03/2020spacer
E-mail Mathurs1@livemail.uthscsa.edu
Author Simi Mathur, DDS
Co-author(s) Addison Walker, DMD
Co-author(s) e-mail walkera2@livemail.uthscsa.edu
Faculty mentor/Co-author Dr. Ravi Anthony, DMD MDS MS
Faculty mentor/Co-author e-mail anthonyr@uthscsa.edu
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