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Title There is No Difference in Caries Risk Between Patients with Fixed Lingual Orthodontic Appliances and Those with Fixed Labial Appliances
Clinical Question In a patient interested in orthodontic care, do lingual fixed orthodontic appliances increase the patient’s caries risk opposed to labial fixed orthodontic appliances?
Clinical Bottom Line In orthodontic patients, lingual orthodontic appliances do not cause an increase in caries risk compared to those patients wearing bonded fixed labial orthodontic appliances. This is based on a systematic review and meta-analysis of the limited available evidence.
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) 27241992Ata-Ali / 2016131 patients in 8 trialsSystematic review and meta-analysis
Key resultsAlthough it was shown that lingual braces cause an increase in pain, speech difficulties and oral hygiene, they do not cause an increase in caries risk compared to patients in buccal orthodontic appliances. The odds ratio (OR) for caries based on S. mutans counts was OR = 1.15 (95% CI, 0.17-7.69; P = 0.814); based on Lactobacillus counts, OR = 0.67 (95% CI, 0.20-2.23; P = 0.515). It was concluded by the authors that more studies with a larger sample size are necessary to confirm these results.
Evidence Search PUBMED: “bleaching”, “orthodontics”, “brackets”, “bond strength”, “shear bond strength”, “SBS”
Comments on
The Evidence
The systematic search process yielded 8 articles, assessed independently by the two authors with a third author settling disagreements. Risk of bias was assessed by using the Cochrane Collaboration tool and Newcastle-Ottawa Scale. Eight studies with a total of 131 patients were included in the qualitative analysis. Six studies were included in the meta-analysis, two of which were randomized controlled trials (RCTs) that evaluated caries risk in 48 patients. One of these RCTs was considered to have low risk of bias and the other had high risk of bias. While oral hygiene was found to be poorer in those patients wearing fixed lingual orthodontic brackets, their caries risk was not increased compared to those wearing fixed labial orthodontic brackets. The authors of this meta-analysis excluded two articles due to inadequate follow-up duration, which was not stated as one of their inclusion criteria. One of these excluded articles met the recommended 30-day adaptation time and should not have been excluded based on follow-up duration.
Applicability Uncontrolled caries caused by orthodontic brackets could be a reason to halt treatment and get the patient’s decay under control before proceeding. These studies have shown that lingual fixed appliances do not cause any greater risk for caries than labial fixed appliances. Esthetics is an advantage with lingual appliances, but they may contribute to more tongue pain and difficulty speaking. Further studies with larger sample sizes are needed in order to either confirm or deny that no change in caries risk is evident between lingual and labial fixed orthodontic appliances.
Specialty/Discipline (Orthodontics)
Keywords Brackets, lingual, labial, fixed appliances, caries risk, orthodontics
ID# 3464
Date of submission: 05/19/2021spacer
E-mail shortp@livemail.uthscsa.edu
Author Paxton Short
Co-author(s) e-mail
Faculty mentor/Co-author Brent Callegari
Faculty mentor/Co-author e-mail callegari@uthscsa.edu
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