Management of post-orthodontic white spot lesions: an updated systematic review

Background/objectives: The management of post-orthodontic white spot lesions is based on remineralization strategies or a minimal-invasive camouflage of the lesions. Aim: The aim of this systematic review was to identify and assess the quality of evidence for the various clinical technologies. Search methods: Four databases were searched for relevant literature published in English between 2011 and 31 October 2015 according to a pre-determined PICO. Only controlled clinical studies were considered. Abstract lists and the selected full-text papers were independently examined by two reviewers and any differences were solved in consensus. The Cochrane handbook and the AMSTAR tool were used for grading the risk of bias. The quality of evidence was rated according to GRADE. Results: Out of 280 identified publications, seven studies on remineralization, micro-abrasion and resin infiltration met the inclusion criteria. Two of them were assessed with low risk of bias. No pooling of results was possible due to study heterogeneity. The quality of evidence for all technologies was graded as very low. Limitations: Only papers published in English with more than 20 adolescents or young adults were considered. Furthermore, a follow-up period of at least 8 weeks was required. The publication bias could not be assessed due to the paucity of included trials. Conclusions/clinical implications: There is a lack of reliable scientific evidence to support remineralizing or camouflaging strategies to manage post-orthodontic white spot lesions. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.