Effectiveness of different adjunctive interventions in the management of orthodontically induced white spot lesions: A systematic review of systematic reviews and meta-analyses.

The purposes of this review were to appraise the current evidence on the management of orthodontically induced white spot lesions (OIWSLs) and to choose the best evidence from among conflicting systematic reviews. The published literature was searched from inception through November 2019 in 5 databases. Only systematic reviews and/or meta-analyses were eligible for inclusion. Methodological quality was assessed using A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2). The Jadad decision algorithm was applied to choose the best available evidence from among discordant reviews. Thirteen publications were included. The interventions reported in the management of OIWSLs were topical fluorides, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP)-containing products, fluoridecontaining bonding materials, laser therapy, resin infiltration, and micro-abrasion. The methodological quality of the reviews ranged between moderate and critically low according to the AMSTAR-2 tool. Based on the Jadad decision algorithm criteria, topical fluorides yielded a 25-30% prevention of OIWSLs; however, their effect on reversing OIWSLs was unclear. The CPP-ACP products were effective in both preventing and reversing OIWSLs. No differences were noted between fluoride-releasing adhesives and conventional adhesives. Laser irradiation was effective in preventing OIWSLs, with some concerns about the argon laser at a certain setting. Finally, there is a lack of reliable evidence supporting the efficacy of resin infiltration or micro-abrasion due to the limited number of available studies. Based on the currently available information, topical fluorides and laser irradiation are effective in preventing OIWSLs. The CPP-ACP products are effective in preventing and reversing OIWSLs. Fluoride-releasing adhesives have no effect on OIWSL prevention.