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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) 27241992 | Ata-Ali / 2016 | 131 patients in 8 trials | Systematic review and meta-analysis | | Key results | Although 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: |
05/19/2021 |
| E-mail |
shortp@livemail.uthscsa.edu |
| Author |
Paxton Short |
| Co-author(s) |
|
| Co-author(s) e-mail |
|
| Faculty mentor/Co-author |
Brent Callegari |
| Faculty mentor/Co-author e-mail |
callegari@uthscsa.edu |
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) |
post a rationale |
| None available | |
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Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) |
post a comment |
| None available | |
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