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Title Fluoride-Releasing Primers Do Not Reduce Risk of White Spot Lesions Compared to Conventional Primers During Orthodontic Treatment
Clinical Question In a patient undergoing orthodontic care, do fluoride releasing primers reduce risk of white spot lesions compared to conventional primers?
Clinical Bottom Line In patients that have fixed orthodontic appliances, fluoride-releasing primers do not reduce significantly the rate of white spot lesions compared to conventional primers. This is based on a clinical study 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) 31901283Comert / 202060 patients divided in 2 groupsClinical study
Key resultsAlthough fluoride decreases tooth demineralization, the study has shown that when incorporated into a primer for orthodontic treatment, there was no significant difference between fluoride-releasing primers compared to conventional primers to reduce white spot lesion rate. The WSL rate 26.9% for fluoride-releasing primers groups and 29% for conventional primers. It was concluded by the authors that the fluoride-releasing primer had no significant advantage in reducing demineralization over conventional primer during orthodontic treatment.
Evidence Search PUBMED: ("demineralization"[All Fields] OR "white spot lesion"[All Fields] OR “WSL”[All fields] OR “decalcification”) AND ("primer"[All Fields] OR "adhesives"[All Fields]) AND ("orthodontic"[All Fields]) AND (“fluoride”[All fields])
Comments on
The Evidence
This was a clinical study (prospective) comparing the rate of white spot lesions in patients who were treated with fluoride-releasing primers with that of conventional primers during orthodontic treatment. The study was comprised of an experimental group (30 patients) and a control group (30 patients), and special care was taken to include in both groups patients with similar characteristics (age, sex distribution, duration of treatment, crowding amount, buffer capacity, salivary flow, number of patients who needed extractions for the treatment). The two subject groups were selected according to several criteria: no visible enamel demineralization or restoration on the labial surfaces of the teeth, no morphologic crown anomalies, full permanent dentition and no physical disability that could prevent an adequate tooth brushing. Both groups were treated the same, except for the choice of primer, and had adequate follow up (patients were recalled every 4 weeks). After the orthodontic treatment, digital images of each tooth were taken in order to score and measure the WSLs with software. The DIAGNOdent pen was used as well to assess the WSLs. Two patients in each group did not attend regularly their appointments and were excluded from the final data analysis. There was no statement provided regarding competing interests.
Applicability White spot lesions have always been a concern for Orthodontists, as fixed orthodontic appliances make it harder to have good plaque control and thus increase the risk of enamel demineralization. White spot lesions are, in the majority of cases, irreversible and they carry an esthetic impact. Knowing that there is no clinically significance difference in the rate of white spot lesions whether using a fluoride-releasing primer compared to a conventional one, it would be more judicious for the clinician to pick a primer based on other factors, such as bonding strength.
Specialty/Discipline (General Dentistry) (Orthodontics)
Keywords White spot lesion, WSL, demineralization, fluoride, primer, orthodontics
ID# 3469
Date of submission: 11/22/2021spacer
E-mail foucher@livemail.uthscsa.edu
Author Anne-Isabelle Foucher
Co-author(s) Timothy Glesener
Co-author(s) e-mail Glesener@livemail.uthscsa.edu
Faculty mentor/Co-author Ravikumar Anthony, BDS, MDS, MS
Faculty mentor/Co-author e-mail Anthonyr@uthscsa.edu
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