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The Clinical Evidence-Base Of Oral Health Care Products And The Current “Rinshotrial” App As Possible Dissemination Tool (Preprint)

Authors:
  • Review Center For Health Science Research / Untersuchungszentrum für Gesundheitsforschung (RCHSR)
Preprints and early-stage research may not have been peer reviewed yet.

Abstract

SUMMARY Prospective, controlled clinical trials avoid the pitfalls of uncontrolled and/or retrospective clinical study designs. Hence, the identification of such trials provides an important first step when questioning the evidence-base of any dental product. Dissemination of such information to dental academia or oral health care providers with interest in questioning current products on the market, may be assisted through the RinshoTrial app. The app generates easy usable, product specific, reference lists that can be directly emailed from the app and geographic overviews in form of maps, concerning the location of research centers in the world that included any particular product in their clinical trials. In addition, the reference list and maps can be easily shared from the app on social media for peer-to-peer or group discussions. The app’s main limitation is that it gives no indication for the quality or the results of the included trials and thus can only be a supportive tool prior actual trial appraisal.
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The Clinical Evidence-Base Of Oral Health Care Products And The
Current “Rinshotrial” App As Possible Dissemination Tool (Preprint)
S Mickenautsch
Author affiliations:
 Review Center For Health Science Research (RCHSR), 84 Concorde Road East, Bedfordview/Johannesburg, 2008, South Africa, ORCID
Number: 0000-0002-4994-2328.
 Department of Community Dentistry, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, 7 York
Rd., Parktown/Johannesburg 2193, South Africa.
Correspondence:
Steffen Mickenautsch, BDS, PhD
Review Center For Health Science Research (RCHSR), 84 Concorde Road East, Bedfordview/Johannesburg, 2008,
South Africa, Email: neem@global.co.za
2
ABSTRACT
Introduction
Prospective, controlled clinical trials avoid the pitfalls of uncontrolled and/or retrospective studies.
Aims and objectives
To conduct systematic literature searches for prospective, controlled clinical trials concerning oral
health care products on the market and dissemination of the results through a smart phone app.
Methods
Database search and reference lists check. Trial selection criteria: prospective, controlled clinical
trial design; report published 1990 or later; product names reported in trial. From the accepted trials
data points are extracted per product and include: full publication reference, city of first author’s
affiliation. Data is made accessible as app for Android 5.0 and iOS smart phones.
Results
Until 2019, a total of 1685 data points for 446 products were found for caries preventive /
remineralization products, dental filling materials and fissure sealant materials, combined. The
results were presented through the RinshoTrial app, available on Google’s Play Store and Apple’s
App Store.
Discussion
The RinshoTrial app may assist in the dissemination of commercial product-specific prospective,
controlled clinical trial references. It generates easy usable reference lists of conducted trials per
product, as well as maps concerning the location of the trial research centers, worldwide. Reference
list and maps can be emailed and shared on social media from the app, directly. However, the
RinshoTrial app gives no indication for trial quality and can only be a supportive, preliminary tool
for trial appraisal.
Keywords:
Prospective, controlled clinical trials, oral health care products, RinshoTrial.
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INTRODUCTION
Belief about the effectiveness of oral health care products may be supported by many sources: research trials
of any type or design, expert opinion or own anecdotal experiences. Whether such belief reflects reality is a
matter of whether such sources are valid. The validity of (and thus the ability to generalise from) expert
opinion or own anecdotal experiences has been questioned 1,2 and the validity of laboratory-based studies has
been shown not to reflect clinical reality.3 Hence, the need for clinical trials as evidence-base for therapeutic
oral health care products has been emphasized.4
However, the validity of clinical trials depends largely on the characteristics of their applied study
method, such as whether trials include a comparison against a control intervention and whether they measure
therapeutic effects in time (prospectively) or in the past (retrospectively). Retrospective, controlled clinical
trials may provide valuable estimates about rare risk factors where prospective trials are not feasible5 but
unlike prospective, controlled clinical trials they can only be observational and thus carry a high risk of
systematic error (bias).6 Uncontrolled clinical trials, even when prospective, simply lack a benchmark or
standard against which test-treatment results can be compared. For that reason, the causal relationship between
the characteristics and outcome of the test-treatment is uncertain.7 Therefore, any judgement based on
uncontrolled trials about treatment effectiveness is arbitrary, since it is not clear whether any other
intervention, may it be a placebo or a gold standard treatment, would have yielded the same result in the
selected patient cohort. Against such background, it is concluded that any belief about the effectiveness of
commercial oral health care products should at minimum be based on results from prospective, controlled
clinical trials. Of course, results of such trials may still be misleading for many other reasons that are subject
to trial appraisal in systematic reviews, such as effectiveness of randomisation; statistical power, due to
sample size, etc.8
Nonetheless, prospective, controlled clinical trials do at least avoid the pitfalls of laboratory and
clinical non-controlled or retrospective studies. Hence, the identification of such trials provides an important
first step when questioning the evidence-base of an oral health care product. Dissemination of such
information to dental academia with e.g. interest in potential therapeutic gold-standards for future clinical
trials, or to oral health care providers with interest in questioning current products on the market, may be
assisted through simple online tools such as smart phone apps. One of such app is “RinshoTrial” (Figure 1),
available on Google’s Play Store and Apple’s App Store (Figure 2).
4
MATERIALS AND METHODS
The RinshoTrial app was conceptionalized in 2019. The app has a free 3-day try-out period and is available
thereafter on a 12-month subscription basis for a low annual fee. The app is not sponsored or supported by any
product manufacturer or related interest group and, in order to retain its editorial independence, is financed
solely through its subscription-user base.
App functions
The app provides a search function for oral health care products. Products can be searched by name and yield
per product a map of geographical locations where prospective, controlled clinical trials were conducted in the
world, as well as a full reference list of the published trials reports (Figure 1). In addition, the app allows
email forwarding and social media sharing of both maps and lists. The app also provides a function for users
to request further information about any product’s evidence-base. The app data for oral health care products is
regularly updated (at least once per year) and can be extended. Data updates can be followed by use of a
dedicated online blog.9
Systematic literature search
Systematic literature searches are conducted in PubMed, DOAJ, LILACS, IndMed, CNKI and GoogleScholar
for published clinical trials and systematic review reports that are relevant to selected product categories,
without limitations regarding the publication language. Publications in non-English language are translated
preliminary with the GoogleTranslate online tool10 and further in depth with the help of translators. The
identified systematic review reports are traced in full copy and from these references of included/excluded
trials extracted. The cut-off dates, trial selection criteria, searched databases and strings of search terms per
systematic review report are recorded in MS Excel. The reference lists of all identified trials are further
checked for possible relevant studies.
Trial selection criteria are prospective, controlled clinical trial design; trial report published 1990 or
later; product names reported in study. From the accepted trial reports data points are extracted, per product
name and product category. Each data point comprises of author names, report title, journal name, publication
year, journal volume, first page number; city of first author’s academic affiliation. All data points are entered
5
in Unicode Text-format into the app’s backend portal and made accessible through the app on Android 5.0 or
iOS based smart phones.
RESULTS
By 2019, the systematic literature search identified a total of 1685 data points for 446 products in the product
categories: Caries preventive products/ remineralization products; Dental filling materials and Fissure sealant
materials (Table 1).
Caries preventive and tooth remineralization products
PubMed was searched on the 10 November 2018 using the string of search terms: (remineralization OR
remineralization) OR "Tooth Remineralization"[Mesh] AND ("Dental Enamel"[Mesh] OR enamel) and the
following set search limits: Article types: Clinical study, clinical trial, pragmatic clinical trial, randomised
controlled trial, systematic reviews, meta-analysis. In total, 218 trial reports and 35 systematic reviews (Table
2) of clinical trials were found. Of the identified systematic reviews, 20 were further updated in 2019. From
the original database search, reference checks of the systematic review reports and their updates, a total of 425
trial reports could be included for review. Of these, 182 trial reports were found in line with the selection
criteria and accepted for data extraction (Figure 3). A total of 225 data points, were extracted from the
accepted trial reports concerning 67 caries preventive and tooth remineralizing products.
Fissure sealant materials
PubMed was searched on the 26 July 2019 for systematic review reports using the search term: ‘fissure
sealant’. A total of 58 citations were found. Of these, 15 systematic reviews of clinical trials were included
(Table 3). Two of the systematic reviews were further updated in 2019. From the reference check of the
systematic reviews a total of 205 trial reports were included for review. Of these, 143 trial reports were found
in line with the selection criteria and accepted for data extraction (Figure 3). A total of 267 data points were
extracted from the accepted trial reports concerning 77 fissure sealant materials.
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Dental filling materials
The databases PubMed, DOAJ, LILACS, IndMed, GoogleScholar were searched up to 26 April 2018 using
several strings of search terms (Table 4). In addition, journal hand search was conducted. CNKI database was
searched up to 25 July 2018. These two searches were updated on the 27 June 2019 and 14 July 2019,
respectively. A total of 739 trial reports were found in line with the selection criteria and accepted for data
extraction (Figure 3). A total of 1193 data points were extracted from the accepted trial reports concerning 302
dental filling materials.
DISCUSSION
Limitations of the applied systematic search strategy
The aim of the applied systematic literature search is to identify as many prospective, clinical controlled trials
for caries preventive products/ remineralization products, dental filling materials and fissure sealant materials,
as possible. The most important limitations of the search results, so far, were the inability to trace 124 trial
reports in full copy to date with potential relevance for caries preventive products/ remineralization products
and the fact that, so far, 20 out of 35 and 2 out of 15 systematic reviews were updated, only, for caries
preventive products/ remineralization products and fissure sealant materials, respectively. However, the
RhinshoTrial app, like any systematic review of clinical trials, relies on consistent, regular updating, in order
to remain relevant. Hence, continued updates are ongoing, including the tracing of remaining trial reports,
which will be added in time to the app’s database. App users can inform themselves about these updates via
the app’s online blog.9
App strengths
While many systematic reviews provide their information per product types (Table 2 and 3), such as ‘fluoride
varnishes’ or ‘fissure sealants’, the RinshoTrial app provides a unique reference source directly related to
specific commercial dental products, based on systematic literature searches exclusively concerning
prospective, controlled clinical trials. Reason for the commercial product focus was the considerations that in
the ‘real world’ oral health care providers apply specific products during patient treatment and trialists include
specific products into their clinical trials and not random samples of a particular product type. This is
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important, since many products of the same product type may differ substantially from each other in their
(often undisclosed by manufactures) chemical composition and clinical merits.
The RinshoTrial app generates easy usable, product specific, reference lists that can be directly
emailed from the app to e.g. a collaborating librarian for article tracing. It also provides a geographic overview
in form of maps, concerning the location of research centers in the world that included any particular products
in their clinical trials (Figure 1). In addition, both reference lists and maps can be easily shared from the app
on social media for peer-to-peer or group discussions about a specific product’s clinical evidence-base.
The app provides further opportunities for dental academics, interested in conducting a systematic
review to a particular product or product range, in form of a first bibliographic basis as evidence overview.
Oral health care provider, who are interested in existing products on the market, have the opportunity to easily
access reference lists of clinical trial reports, relevant for reading up on clinical product efficacy. Furthermore,
the app provides interested users the opportunity to compare the volume of current clinical evidence between
different, perhaps even competing, products.
App limitations
Besides its strengths, RinshoTrial’s most important limitation is its lack of trial quality measure, i.e. the lack
of indication regarding trial validity and precision. In this context, app users need to be aware that a large
volume of listed trials for a particular product may lead to the false impression that such product has a strong
evidence-base or perhaps at least stronger than a product with fewer listed trials. It is important to note that
prospective, controlled clinical trials, albeit being of higher quality than retrospective, uncontrolled or
laboratory studies, may still suffer from severe shortcomings, such as a too low sample size or lack of
effective randomisation. Therefore, further appraisal of trial quality remains warranted before any quality
judgment about the evidence-base of a specific product can be made. In addition, the app does not provide any
information about actual trial results. Instead, the app provides a function to request further information per
product.
Another important limitation of the RinshoTrial app is the ambiguity of non-included products, since
such products may either not been included, due to lack of prospective, controlled clinical trials for them or
due to any existing trials not been captured into the app’s database, yet. Hence, the app gives no indication for
the evidence-base of not included products.
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A further limitation is that the app includes only a few dental product categories, so far. However, the utility
of the app will increase with its extension to further relevant clinical topics, such as implantology, endodontics
or orthodontics. App users are able to receive notification about the inclusion of further added product
categories, via the app’s dedicated online notifier.9
SUMMARY
Prospective, controlled clinical trials avoid the pitfalls of uncontrolled and/or retrospective clinical study
designs. Hence, the identification of such trials provides an important first step when questioning the
evidence-base of any dental product. Dissemination of such information to dental academia or oral health care
providers with interest in questioning current products on the market, may be assisted through the RinshoTrial
app. The app generates easy usable, product specific, reference lists that can be directly emailed from the app
and geographic overviews in form of maps, concerning the location of research centers in the world that
included any particular product in their clinical trials. In addition, the reference list and maps can be easily
shared from the app on social media for peer-to-peer or group discussions. The app’s main limitation is that it
gives no indication for the quality or the results of the included trials and thus can only be a supportive tool
prior actual trial appraisal.
9
References
1. Sackett DL, Rosenberg WM. The need for evidence-based medicine. J R Soc Med 1995; 88: 620-4.
2. Irwig L, Irwig J, Trevena L, Sweet M. Smart health choices: Making sense of health advice. London:
Hammersmith Press; 2008: 103 –111. Chapter 8, The weakness of one.
3. Mickenautsch S, Yengopal V. Do laboratory results concerning high-viscosity glass-ionomers versus
amalgam for tooth restorations indicate similar effect direction and magnitude than that of controlled
clinical trials? - A Meta-Epidemiological Study. PLoS One 2015; 10: e0132246.
4. Hill AB. The clinical trial. N Engl J Med 1952; 247: 113-9.
5. Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease.
J Natl Cancer Inst 1959; 22: 719-48.
6. Sutherland SE. Evidence-based dentistry: Part IV. Research design and levels of evidence. J Can Dent
Assoc 2001; 67: 375-8.
7. Mickenautsch S, Yengopal V. Reports of uncontrolled clinical trials for directly placed restorations in
vital teeth. Braz Oral Res 2017; 31: e48.
8. Berger VW. Selection bias and covariate imbalances in randomized clinical trials. New York: John
Wiley & Sons; 2005: 1-84. Part I, Is there a problem with reliability in medical studies?
9. RinshoTrial Update Notifier. Website: https://rinshotrial.blogspot.com (Accessed: October 21,2019).
10. Google Translate. Website: https://translate.google.com (Accessed: October 21,2019).
10
Table 1. Identified data points per products and oral health care topics
Product categories Caries preventive & tooth remineralization products Fissure sealant materials Dental filling materials
Number of products 67 77 302
Data points 225 267 1193
Table 2. Caries preventive and tooth remineralization products: Included published systematic reviews
Systematic review reports Date of most
recent update
1 Marinho VC, Higgins JP, Logan S, Sheiham A. Topical fluoride (toothpastes, mouthrinses, gels or varnishes) for preventing
dental caries in children and adolescents. Cochrane Database Syst Rev. 2003;(4):CD002782. 16.06.2019
2 Tubert-Jeannin S, Auclair C, Amsallem E, Tramini P, Gerbaud L, Ruffieux C, Schulte AG, Koch MJ, Rège-Walther M,
Ismail A. Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children. Cochrane
Database Syst Rev. 2011 Dec 7;(12):CD007592.
12.10.2011*
3 Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and
adolescents. Cochrane Database Syst Rev. 2013 Jul 11;(7):CD002279. 13.05.2013*
4 Benson PE, Parkin N, Dyer F, Millett DT, Furness S, Germain P. Fluorides for the prevention of early tooth decay
(demineralised white lesions) during fixed brace treatment. Cochrane Database Syst Rev. 2013 Dec 12;(12):CD003809. 31.01.2013*
5 Marinho VC, Worthington HV, Walsh T, Chong LY. Fluoride gels for preventing dental caries in children and adolescents.
Cochrane Database Syst Rev. 2015 Jun 15;(6):CD002280. 22.04.2016*
6 Walsh T, Oliveira-Neto JM, Moore D. Chlorhexidine treatment for the prevention of dental caries in children and
adolescents. Cochrane Database Syst Rev. 2015 Apr 13;(4):CD008457. 25.02.2015*
7 Riley P, Moore D, Ahmed F, Sharif MO, Worthington HV. Xylitol-containing products for preventing dental caries in
children and adults. Cochrane Database Syst Rev. 2015 Mar 26;(3):CD010743. 14.08.2014*
8 Ahovuo-Saloranta A, Forss H, Hiiri A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for
preventing dental decay in the permanent teeth of children and adolescents. Cochrane Database Syst Rev. 2016 Jan
18;(1):CD003067.
18.12.2015*
9 Takahashi R, Ota E, Hoshi K, Naito T, Toyoshima Y, Yuasa H, Mori R, Nango E. Fluoride supplementation (with tablets,
drops, lozenges or chewing gum) in pregnant women for preventing dental caries in the primary teeth of their children.
Cochrane Database Syst Rev. 2017 Oct 23;10:CD011850.
25.01.2017*
10 Duangthip D, Jiang M, Chu CH, Lo EC. Non-surgical treatment of dentin caries in preschool children--systematic review.
BMC Oral Health. 2015 Apr 3;15:44. 09.07.2019
11 Okada EM, Ribeiro LN, Stuani MB, Borsatto MC, Fidalgo TK, Paula-Silva FW, Küchler EC. Effects of chlorhexidine
varnish on caries during orthodontic treatment: a systematic review and meta-analysis. Braz Oral Res. 2016 Nov
28;30(1):e115.
11.07.2019
12 Derks A, Katsaros C, Frencken JE, van't Hof MA, Kuijpers-Jagtman AM. Caries-inhibiting effect of preventive measures
during orthodontic treatment with fixed appliances. A systematic review. Caries Res. 2004 Sep-Oct;38(5):413-20. 19.06.2019
13 James P, Parnell C, Whelton H. The caries-preventive effect of chlorhexidine varnish in children and adolescents: a
systematic review. Caries Res. 2010;44(4):333-40. 24.06.2019
14 Slot DE, Vaandrager NC, Van Loveren C, Van Palenstein Helderman WH, Van der Weijden GA. The effect of chlorhexidine
varnish on root caries: a systematic review. Caries Res. 2011;45(2):162-73. 24.06.2019
15 Zhang Q, van Palenstein Helderman WH, van't Hof MA, Truin GJ. Chlorhexidine varnish for preventing dental caries in
children, adolescents and young adults: a systematic review. Eur J Oral Sci. 2006 Dec;114(6):449-55. 20.06.2019
16 Mickenautsch S, Yengopal V. Anticariogenic effect of xylitol versus fluoride -a quantitative systematic review of clinical
trials. Int Dent J. 2012 Feb;62(1):6-20. 03.07.2019
17 Mickenautsch S, Yengopal V. Effect of xylitol versus sorbitol: a quantitative systematic review of clinical trials. Int Dent J.
2012 Aug;62(4):175-88. 05.07.2019
18 Tang X, Sensat ML, Stoltenberg JL. The antimicrobial effect of chlorhexidine varnish on mutans streptococci in patients with
fixed orthodontic appliances: a systematic review of clinical efficacy. Int J Dent Hyg. 2016 Feb;14(1):53-61. 10.07.2019
19 Wierichs RJ, Meyer-Lueckel H. Systematic review on noninvasive treatment of root caries lesions. J Dent Res. 2015
Feb;94(2):261-71. 01.05.2014*
20 Janakiram C, Deepan Kumar CV, Joseph J. Xylitol in preventing dental caries: A systematic review and meta-analyses. J Nat
Sci Biol Med. 2017 Jan-Jun;8(1):16-21. 10.07.2019
21 Freires IA, Denny C, Benso B, de Alencar SM, Rosalen PL. Antibacterial Activity of Essential Oils and Their Isolated
Constituents against Cariogenic Bacteria: A Systematic Review. Molecules. 2015 Apr 22;20(4):7329-58. 10.07.2019
22 Abdullah Z, John J. Minimally Invasive Treatment of White Spot Lesions—A Systematic Review. Oral Health Prev Dent.
2016;14(3):197-205. 01.06.2014*
23 Azarpazhooh A, Main PA. Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic
review. J Can Dent Assoc. 2008 Feb;74(1):73-9. 01.01.2007*
24 Indrapriyadharshini K, Madan Kumar PD, Sharma K, Iyer K. Remineralizing potential of CPP-ACP in white spot lesions - A
systematic review. Indian J Dent Res. 2018 Jul-Aug;29(4):487-496. 11.07.2019
25 Xiaotong W, Nanquan R, Jing X, Yuming Z, Lihong G. [Remineralization effect of casein phosphopeptide-amorphous
calcium phosphate for enamel demineralization: a system review]. Hua Xi Kou Qiang Yi Xue Za Zhi. 2017 Dec 1;35(6):629-
635.
12.07.2019
26 Höchli D, Hersberger-Zurfluh M, Papageorgiou SN, Eliades T. Interventions for orthodontically induced white spot lesions: a
systematic review and meta-analysis. Eur J Orthod. 2017 Apr 1;39(2):122-133. 11.07.2019
27 Elhennawy K, Schwendicke F. Managing molar-incisor hypomineralization: A systematic review. J Dent. 2016 Dec;55:16-
24. 11.07.2019
28 Gao SS, Zhang S, Mei ML, Lo EC, Chu CH. Caries remineralisation and arresting effect in children by professionally applied
fluoride treatment - a systematic review. BMC Oral Health. 2016 Feb 1;16:12. 08.07.2019
29 Lenzi TL, Montagner AF, Soares FZ, de Oliveira Rocha R. Are topical fluorides effective for treating incipient carious
lesions?: A systematic review and meta-analysis. J Am Dent Assoc. 2016 Feb;147(2):84-91. 11.07.2019
11
30 Urquhart O, Tampi MP, Pilcher L, Slayton RL, Araujo MWB, Fontana M, Guzmán-Armstrong S, Nascimento MM, Nový
BB, Tinanoff N, Weyant RJ, Wolff MS, Young DA, Zero DT, Brignardello-Petersen R, Banfield L, Parikh A, Joshi G,
Carrasco-Labra A. Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. J Dent Res. 2019
Jan;98(1):14-26.
01.06.2017*
31 Yengopal V, Mickenautsch S. Caries preventive effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP):
a meta-analysis. Acta Odontol Scand. 2009;67(6):321-32. 23.06.2019
32 Chen H, Liu X, Dai J, Jiang Z, Guo T, Ding Y. Effect of remineralizing agents on white spot lesions after orthodontic
treatment: a systematic review. Am J Orthod Dentofacial Orthop. 2013 Mar;143(3):376-382. 04.11.2011*
33 Lopatiene K, Borisovaite M, Lapenaite E. Prevention and Treatment of White Spot Lesions During and After Treatment with
Fixed Orthodontic Appliances: a Systematic Literature Review. J Oral Maxillofac Res. 2016 Jun 30;7(2):e1. 11.07.2019
34 Wang Y, Li J, Sun W, Li H, Cannon RD, Mei L. Effect of non-fluoride agents on the prevention of dental caries in primary
dentition: A systematic review. PloS One. 2017 Aug 7;12(8):e0182221. 16.12.2016*
35 Tao S, Zhu Y, Yuan H, Tao S, Cheng Y, Li J, He L. Efficacy of fluorides and CPP-ACP vs fluorides monotherapy on early
caries lesions: A systematic review and meta-analysis. PLoS One. 2018 Apr 30;13(4):e0196660. 01.08.2017*
* Systematic review not updated to date.
Table 3. Fissure sealant materials: Included published systematic reviews
Systematic review reports Date of most
recent update
1 Alirezaei M, Bagherian A, Sarraf Shirazi A. Glass ionomer cements as fissure sealing materials: yes or no?: A systematic
review and meta-analysis. J Am Dent Assoc. 2018 Jul;149(7):640-649.e9. 20.09.2017*
2 Papageorgiou SN, Dimitraki D, Kotsanos N, Bekes K, van Waes H. Performance of pit and fissure sealants according to
tooth characteristics: A systematic review and meta-analysis. J Dent. 2017 Nov;66:8-17. 23.02.2017*
3 Ahovuo-Saloranta A, Forss H, Walsh T, Nordblad A, Mäkelä M, Worthington HV. Pit and fissure sealants for preventing
dental decay in permanent teeth. Cochrane Database Syst Rev. 2017 Jul 31;7:CD001830. 03.08.2016*
4 Wright JT, Tampi MP, Graham L, Estrich C, Crall JJ, Fontana M, Gillette EJ, Nový BB, Dhar V, Donly K, Hewlett ER,
Quinonez RB, Chaffin J, Crespin M, Iafolla T, Siegal MD, Carrasco-Labra A. Sealants for preventing and arresting pit-and-
fissure occlusal caries in primary and permanent molars: A systematic review of randomized controlled trials-a report of the
American Dental Association and the American Academy of Pediatric Dentistry. J Am Dent Assoc. 2016 Aug;147(8):631-
645.e18.
01.05.2013*
5 Mickenautsch S, Yengopal V. Caries-Preventive Effect of High-Viscosity Glass Ionomer and Resin-Based Fissure Sealants
on Permanent Teeth: A Systematic Review of Clinical Trials. PLoS One. 2016 Jan 22;11(1):e0146512. 16.01.2015*
6 Hiiri A, Ahovuo-Saloranta A, Nordblad A, Mäkelä M. Pit and fissure sealants versus fluoride varnishes for preventing dental
decay in children and adolescents. Cochrane Database Syst Rev. 2010 Mar 17;(3):CD003067. 01.11.2009*
7 Mickenautsch S, Yengopal V. Validity of sealant retention as surrogate for caries prevention--a systematic review. PLoS
One. 2013 Oct 23;8(10):e77103. 21.10.2012*
8 Mickenautsch S, Yengopal V. The modified Ottawa method to establish the update need of a systematic review: glass-
ionomer versus resin sealants for caries prevention. J Appl Oral Sci. 2013 Sep-Oct;21(5):482-9. 01.05.2012*
9 Kühnisch J, Mansmann U, Heinrich-Weltzien R, Hickel R. Longevity of materials for pit and fissure sealing--results from a
meta-analysis. Dent Mater. 2012 Mar;28(3):298-303. 30.09.2011*
10 Yengopal V, Mickenautsch S. Resin-modified glass-ionomer cements versus resin-based materials as fissure sealants: a
meta-analysis of clinical trials. Eur Arch Paediatr Dent. 2010 Feb;11(1):18-25. 15.04.2009*
11 Yengopal V, Mickenautsch S, Bezerra AC, Leal SC. Caries-preventive effect of glass ionomer and resin-based fissure
sealants on permanent teeth: a meta analysis. J Oral Sci. 2009 Sep;51(3):373-82. 15.01.2008*
12 Azarpazhooh A, Main PA. Pit and fissure sealants in the prevention of dental caries in children and adolescents: a systematic
review. J Can Dent Assoc. 2008 Mar;74(2):171-7. 01.01.2007*
13 16: Beiruti N, Frencken JE, van 't Hof MA, van Palenstein Helderman WH. Caries-preventive effect of resin-based and glass
ionomer sealants over time: a systematic review. Community Dent Oral Epidemiol. 2006 Dec;34(6):403-9. 01.12.2004*
14 18: Muller-Bolla M, Lupi-Pégurier L, Tardieu C, Velly AM, Antomarchi C. Retention of resin-based pit and fissure sealants:
A systematic review. Community Dent Oral Epidemiol. 2006 Oct;34(5):321-36. 09.09.2019
15 20: Mejàre I, Lingström P, Petersson LG, Holm AK, Twetman S, Källestål C, Nordenram G, Lagerlöf F, Söder B, Norlund
A, Axelsson S, Dahlgren H. Caries-preventive effect of fissure sealants: a systematic review. Acta Odontol Scand. 2003
Dec;61(6):321-30.
19.08.2019
* Systematic review not updated to date.
Table 4. Dental filling materials: Strings of search terms
Database searched: PubMed / Online: http://www.ncbi.nlm.nih.gov/pubmed
Search terms:
[1] (((tooth restoration) OR tooth filling) OR dental filling) OR "Dental Restoration, Permanent"[Mesh] Sort by: PublicationDate Filters: Clinical
Trial; Abstract; Humans
[2] (amalgam OR composite OR glass-ionomer OR compomer) AND restoration Sort by: PublicationDate Filters: Clinical Trial; Abstract; Humans
[3] atraumatic restorative treatment (no filters)
[4] composite restorations (Filters activated: Clinical Trial, Abstract.)
[5] compomer restoration (Filters activated: Clinical Trial, Abstract.)
[6] amalgam restoration (Filters activated: Clinical Trial, Abstract.)
[7] glass ionomer restoration (Filters activated: Clinical Trial, Abstract.)
Database searched: DOAJ / Online: http://www.doaj.org
12
[1] Dental Restoration
[2] composite restoration
[3] compomer restoration
[4] amalgam restoration
[5] glass ionomer restoration
[6] atraumatic restorative treatment
Database searched: LILACS / Online: http://pesquisa.bvsalud.org/portal/
[1] Dental Restoration
[2] composite restoration
[3] compomer restoration
[4] amalgam restoration
[5] glass ionomer restoration
[6] atraumatic restorative treatment
Database searched: IndMed / Online: http://indmed.nic.in/indmed.html
Limit: Controlled Clinical Trial
[1] Dental AND Restoration
[2] composite AND restoration
[3] compomer AND restoration
[4] amalgam AND restoration
[5] glass ionomer AND restoration
[6] atraumatic AND restorative AND treatment
Database searched: GoogleScholar/ Online: http://indmed.nic.in/indmed.html
[1] "tooth Restoration"+"clinical trial"
[2] "composite restoration"+"clinical trial"
[3] "compomer restoration"+"clinical trial"
[4] "atraumatic restorative treatment"+"clinical trial"
[5] "glass ionomer restoration"+"clinical trial"
[6] "amalgam restoration"+"clinical trial"
Database searched CNKI / Online: http://cnki.net
Limit: Clinical study
[1] tooth Restoration
[2] composite restoration
[3] compomer restoration
[4] atraumatic restorative treatment
[5] glass ionomer restoration
[6] amalgam restoration
[7] 玻璃离子水门汀
[8] 光固化复合树脂 AND 修复牙
[9] 银汞合金 AND 修复牙
13
Figure 1. Screenshots of RinshoTrial’s main functions
14
Figure 2. QR (Quick response) – codes for RinshoTrial app access
To scan a QR – code use smart phone with a camera and QR-scanner function enabled.
15
Figure 3. Flow diagram of trial selection
ResearchGate has not been able to resolve any citations for this publication.
Article
Full-text available
The goal of nonrestorative or non- and microinvasive caries treatment (fluoride- and nonfluoride-based interventions) is to manage the caries disease process at a lesion level and minimize the loss of sound tooth structure. The purpose of this systematic review and network meta-analysis was to summarize the available evidence on nonrestorative treatments for the outcomes of 1) arrest or reversal of noncavitated and cavitated carious lesions on primary and permanent teeth and 2) adverse events. We included parallel and split-mouth randomized controlled trials where patients were followed for any length of time. Studies were identified with MEDLINE and Embase via Ovid, Cochrane CENTRAL, and Cochrane Database of Systematic Reviews. Pairs of reviewers independently conducted the selection of studies, data extraction, risk-of-bias assessments, and assessment of the certainty in the evidence with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Data were synthesized with a random effects model and a frequentist approach. Forty-four trials (48 reports) were eligible, which included 7,378 participants and assessed the effect of 22 interventions in arresting or reversing noncavitated or cavitated carious lesions. Four network meta-analyses suggested that sealants + 5% sodium fluoride (NaF) varnish, resin infiltration + 5% NaF varnish, and 5,000-ppm F (1.1% NaF) toothpaste or gel were the most effective for arresting or reversing noncavitated occlusal, approximal, and noncavitated and cavitated root carious lesions on primary and/or permanent teeth, respectively (low- to moderate-certainty evidence). Study-level data indicated that 5% NaF varnish was the most effective for arresting or reversing noncavitated facial/lingual carious lesions (low certainty) and that 38% silver diamine fluoride solution applied biannually was the most effective for arresting advanced cavitated carious lesions on any coronal surface (moderate to high certainty). Preventing the onset of caries is the ultimate goal of a caries management plan. However, if the disease is present, there is a variety of effective interventions to treat carious lesions nonrestoratively.
Article
Full-text available
Objective: The aim of this systematic review was to assess the long term remineralizing potential of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) only in paste form compared with fluoride varnish, and or placebo in both naturally occurring and post-orthodontic white spot lesions in vivo. Data sources: The literature search covered the electronic databases: PubMed and Google scholar from 2005-2016. Only articles published in English were included. Randomized control trials in which CPP-ACP delivered by paste form were included. All studies which met inclusion criteria underwent two independent reviews. Study selection: Two ninety five articles were identified from the search after excluding duplications. Abstracts of forty one articles were reviewed independently. Twenty nine articles were excluded after reading abstract. Full text articles were retrieved for fifteen relevant studies. After reviewing articles independently, three articles were excluded after full text reading. Finally twelve studies were selected based on the eligibility criteria. The remineralizing effect of CPP-ACP were compared with placebo and fluoridated toothpaste and fluoride varnish in randomized control trial. Conclusion: A high level evidence of remineralizing potential of CPP-ACP on naturally occurring white spot lesion and WSL post orthodontic treatment was found in comparison with placebo/fluoridated toothpaste and fluoride varnish without any statistically significant difference. Well-designed RCTs are, therefore, required to improve the level of evidence in this area.
Article
Full-text available
Objective To assess the effect of non-fluoride agents on the prevention of dental caries in primary dentition. Materials and methods Medline, Web of Science, Embase, Cochrane Library, CBM and CNKI databases were searched to identify all the relevant articles published prior to 16 December 2016. Grey literature was also searched. Randomized controlled human clinical trials in which non-fluoride agents were delivered by any method were considered. Results Of the 1,236 studies screened, 39 full articles were scrutinized and 14 selected for inclusion in the final sample. Five chemical agents, namely arginine, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), chlorhexidine, triclosan and xylitol were investigated in these included studies. The cariostatic effects of non-fluoride agents in vivo were evaluated in comparison with fluoride or placebos in randomized controlled trials. There is evidence that the use of certain doses of xylitol may be effective in arresting dental caries in primary dentition. However, quantitative synthesis could not be carried out because of the clinical and methodological heterogeneity of the included studies. Conclusions A study at low risk of bias indicated that daily use of xylitol wipes is a useful adjunct for caries control in young children, however, this conclusion should be interpreted with caution as this study had a very limited sample size. Chlorhexidine and CPP-ACP may be more effective than a placebo in managing caries in primary dentition, but their effectiveness is borderline when compared with fluoride. Arginine-containing mint confection and 0.3% triclosan varnish were found to reduce caries development in primary teeth but the evidence was at high risk of bias. High quality randomized controlled trials are needed in order to make a conclusive recommendation.
Article
Full-text available
This study aimed to perform a systematic review and meta-analysis to evaluate the effectiveness of chlorhexidine varnish on the reduction of caries incidence during fixed orthodontic treatment. The literature searches involved The Cochrane Library, Medline, Scopus, OpenSigle databases and manual searches. The search on OpenSigle did not produce any additional articles. Clinical studies conducted in patients with orthodontic fixed appliances that used professional application of chlorhexidine varnish were included. The effect-size was calculated and a meta-analysis was performed. From 182 abstracts, a total of six articles fulfilled the inclusion criteria. After reading the full articles, one was excluded because of lack of a control group. Three articles were used for continuous data analysis, and two articles were used for the dichotomous data analysis. The pooled meta-analysis with continuous data demonstrated chlorhexidine varnish effectiveness on caries reduction (p = 0.003), with a mean difference and confidence interval of -1.49 [-2.47, -0.51]. On the basis of the pooled meta-analysis of continuous data, we were able to conclude that professional application of chlorhexidine varnish is effective in caries incidence reduction during fixed orthodontic treatment.
Article
Full-text available
Introduction: Xylitol is a sugar alcohol having the properties that reduce levels of mutans streptococci (MS) in the plaque and saliva. Objective: To assess the role of xylitol in preventing dental caries. Methods: Systematic review and meta‑analysis developed by Cochrane cooperation were adapted. Electronic search was carried out in PubMed through the period up to 2014. Included clinical studies were done on (1) humans (2) participants include both individuals and as pairs (mother‑child) (3) participants using orthodontic appliances (4) xylitol dispensed in any form (5) compare the effect of xylitol on dental caries and on other phenotype that determines the preventive effect on dental caries, such as decayed, missing, and filled (DMF/dmf) and salivary or plaque MS level. Twenty articles of the 477 articles initially identified. Among 20 studies indexed, 16 articles were accessed, systematically reviewed, and the meta‑analysis was carried out. The evaluation of quality of the studies was done using risk of bias assessment tool. Results: The quality of the studies was high risk and unclear risk for six and five trials. The meta‑analysis shows a reduction in DMF/dmf with the standard mean (SM) of −1.09 (95% confidence interval [95% CI], −1.34, −0.83) comparing xylitol to all controls. The effect of DMF/dmf reduction by xylitol to fluoride varnish was with the SM of −1.87 (95% CI, −2.89, −0.84). The subgroup analysis, there was a reduction in MS count with SM of 0.30 (95% CI, 0.05, 0.56) when compared with all other caries preventive strategies; however, it was insignificant. Conclusion: Xylitol was found to be an effective strategy as self‑applied caries preventive agent.
Article
Objective: This study aims to assess the remineralization effect of casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) on enamel demineralization by performing system review of randomized controlled trials (RCT) involving the treatment of enamel demineralization with CPP-ACP. Methods: The study was developed based on the Cochrane handbook for systematic reviews of interventions (Version 5.1.0) and included the following: search strategy, selection criteria, data extraction, and risk of bias assessment. We searched electronic databases such as PubMed, Embase, Cochrane Library, CNKI, Wanfang and VIP up to September 2016. RCT of treating enamel demineralization with CPP-ACP were included. Data extraction and domain-based risk of bias assessment were independently performed by two reviewers. Results: Twelve RCTs were included. Because of the difference of experimental design and evaluation standards, the quantitative analysis can not be carried out. Conclusions: There is no strong evidence that CPP-ACP is superior to conventional fluoride formulations in enamel remineralization. However, due to the limitations of sample size, follow-up time and study design, more high quality and large-sample RCT are needed to further verify the evidence.
Article
Background: Dental caries (tooth decay) is one of the most common chronic childhood diseases. Caries prevalence in most industrialised countries has declined among children over the past few decades. The probable reasons for the decline are the widespread use of fluoride toothpaste, followed by artificial water fluoridation, oral health education and a slight decrease in sugar consumption overall. However, in regions without water fluoridation, fluoride supplementation for pregnant women may be an effective way to increase fluoride intake during pregnancy. If fluoride supplements taken by pregnant women improve neonatal outcomes, pregnant women with no access to a fluoridated drinking water supply can obtain the benefits of systemic fluoridation. Objectives: To evaluate the effects of women taking fluoride supplements (tablets, drops, lozenges or chewing gum) compared with no fluoride supplementation during pregnancy to prevent caries in the primary teeth of their children. Search methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 25 January 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 11) in the Cochrane Library (searched 25 January 2017); MEDLINE Ovid (1946 to 25 January 2017); Embase Ovid (1980 to 25 January 2017); LILACS BIREME Virtual Health Library (Latin American and Caribbean Health Science Information database; 1982 to 25 January 2017); and CINAHL EBSCO (Cumulative Index to Nursing and Allied Health Literature; 1937 to 25 January 2017). We searched the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 25 January 2017. No restrictions were placed on the language or date of publication when searching the electronic databases. Selection criteria: Randomised controlled trials (RCTs) of fluoride supplements (tablets, drops, lozenges or chewing gum) administered to women during pregnancy with the aim of preventing caries in the primary teeth of their children. Data collection and analysis: Two review authors independently screened the titles and abstracts (when available) of all reports identified through electronic searches. Two review authors independently extracted data and assessed risk of bias, as well as evaluating overall quality of the evidence utilising the GRADE approach. We could not conduct data synthesis as only one study was included in the analysis. Main results: Only one RCT met the inclusion criteria for this review. This RCT showed no statistical difference on decayed or filled primary tooth surfaces (dfs) and the percentage of children with caries at 3 years (risk ratio (RR) 1.46, 95% confidence interval (CI) 0.75 to 2.85; participants = 938, very low quality of evidence) and 5 years old (RR 0.84, 95% CI 0.53 to 1.33; participants = 798, very low quality of evidence). The incidence of fluorosis at 5 years was similar between the group taking fluoride supplements (tablets) during the last 6 months of pregnancy and the placebo group. Authors' conclusions: There is no evidence that fluoride supplements taken by women during pregnancy are effective in preventing dental caries in their offspring.
Article
Objective: Aim: of this systematic review was to assess the clinical performance of sealants on various teeth in an evidence-based manner. Sources: Five databases were searched from inception to February 2017. Data: Randomized clinical studies on humans. Methods: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, Paule-Mandel random-effects meta-analyses of Relative Risks (RRs) and their 95% confidence intervals (CIs) were calculated. Results: A total of 16 randomized clinical trials with 2778 patients (male/female 49.1%/50.9%) and an average age of 8.4 years were included. No significant difference in either caries incidence of sealed teeth or sealant retention could be found according to (i) mouth side (right versus left), (ii) jaw (upper versus lower), (iii) and tooth type (1st permanent molar versus 2nd permanent molar/1st permanent molar versus 2nd deciduous molar/1st deciduous molar versus 2nd deciduous molar), based on evidence of very low to low quality. On the other side, compared to 1st permanent molars, sealed premolars were significantly less likely to develop caries (3 trials; RR=0.12; 95% CI=0.03 to 0.44; P=0.001) and less likely to experience loss of the sealant (5 trials; RR=0.33; 95% CI=0.20 to 0.54; P=0.001), both based on low to moderate quality evidence. Conclusions: The performance of pit and fissure sealants does not seem to be negatively affected by mouth side, jaw, and tooth type, apart from the exception of a favorable retention on premolars. Clinical significance: Based on existing evidence, pit and fissure sealants can be effectively applied on any deciduous or permanent posterior teeth without adverse effects on their clinical performance.
Article
Background: Dental sealants were introduced in the 1960s to help prevent dental caries, mainly in the pits and fissures of occlusal tooth surfaces. Sealants act to prevent bacteria growth that can lead to dental decay. Evidence suggests that fissure sealants are effective in preventing caries in children and adolescents compared to no sealants. Effectiveness may, however, be related to caries incidence level of the population. This is an update of a review published in 2004, 2008 and 2013. Objectives: To compare the effects of different types of fissure sealants in preventing caries in occlusal surfaces of permanent teeth in children and adolescents. Search methods: Cochrane Oral Health's Information Specialist searched: Cochrane Oral Health's Trials Register (to 3 August 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 7), MEDLINE Ovid (1946 to 3 August 2016), and Embase Ovid (1980 to 3 August 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 3 August 2016. No restrictions were placed on language or date of publication. Selection criteria: Randomised controlled trials (RCTs) comparing sealants with no sealant or a different type of sealant material for preventing caries of occlusal surfaces of premolar or molar teeth in children and adolescents aged up to 20 years. Studies required at least 12 months follow-up. We excluded studies that compared compomers to resins/composites. Data collection and analysis: Two review authors independently screened search results, extracted data and assessed risk of bias of included studies. We presented outcomes for caries or no caries on occlusal surfaces of permanent molar teeth as odds ratio (OR) or risk ratio (RR). We used mean difference (MD) for mean caries increment. All measures were presented with 95% confidence intervals (CI). We conducted meta-analyses using a random-effects model for comparisons where there were more than three trials; otherwise we used the fixed-effect model. We used GRADE methods to assess evidence quality. Main results: We included 38 trials that involved a total of 7924 children; seven trials were new for this update (1693 participants). Fifteen trials evaluated the effects of resin-based sealant versus no sealant (3620 participants in 14 studies plus 575 tooth pairs in one study); three trials with evaluated glass ionomer sealant versus no sealant (905 participants); and 24 trials evaluated one type of sealant versus another (4146 participants). Children were aged from 5 to 16 years. Trials rarely reported background exposure to fluoride of trial participants or baseline caries prevalence. Resin-based sealant versus no sealant: second-, third- and fourth-generation resin-based sealants prevented caries in first permanent molars in children aged 5 to 10 years (at 24 months follow-up: OR 0.12, 95% CI 0.08 to 0.19, 7 trials (5 published in the 1970s; 2 in the 2010s), 1548 children randomised, 1322 children evaluated; moderate-quality evidence). If we were to assume that 16% of the control tooth surfaces were decayed during 24 months of follow-up (160 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 5.2% (95% CI 3.13% to 7.37%). Similarly, assuming that 40% of control tooth surfaces were decayed (400 carious teeth per 1000), then applying a resin-based sealant would reduce the proportion of carious surfaces to 6.25% (95% CI 3.84% to 9.63%). If 70% of control tooth surfaces were decayed, there would be 19% decayed surfaces in the sealant group (95% CI 12.3% to 27.2%). This caries-preventive effect was maintained at longer follow-up but evidence quality and quantity was reduced (e.g. at 48 to 54 months of follow-up: OR 0.21, 95% CI 0.16 to 0.28, 4 trials, 482 children evaluated; RR 0.24, 95% CI 0.12 to 0.45, 203 children evaluated). Although studies were generally well conducted, we assessed blinding of outcome assessment for caries at high risk of bias for all trials (blinding of outcome assessment is not possible in sealant studies because outcome assessors can see and identify sealant). Glass ionomer sealant versus no sealant: was evaluated by three studies. Results at 24 months were inconclusive (very low-quality evidence). One sealant versus another sealant: the relative effectiveness of different types of sealants is unknown (very low-quality evidence). We included 24 trials that directly compared two different sealant materials. Comparisons varied in terms of types of sealant assessed, outcome measures chosen and duration of follow-up. Adverse events: only four trials assessed adverse events. No adverse events were reported. Authors' conclusions: Resin-based sealants applied on occlusal surfaces of permanent molars are effective for preventing caries in children and adolescents. Our review found moderate-quality evidence that resin-based sealants reduced caries by between 11% and 51% compared to no sealant, when measured at 24 months. Similar benefit was seen at timepoints up to 48 months; after longer follow-up, the quantity and quality of evidence was reduced. There was insufficient evidence to judge the effectiveness of glass ionomer sealant or the relative effectiveness of different types of sealants. Information on adverse effects was limited but none occurred where this was reported. Further research with long follow-up is needed.
Article
Background: Although orthodontic white spot lesions (WSLs) are one of the most often and most evident adverse effects of comprehensive fixed appliance treatment, the efficacy of interventions for WSLs has not yet been adequately assessed in an evidence-based manner. Objective: Aim of this systematic review was to assess the therapeutic and adverse effects of interventions to treat post-orthodontic WSLs from randomized trials in human patients. Search methods: An unrestricted electronic search of eight databases from inception to May 2016. Selection criteria: Randomized controlled trials assessing any interventions for post-orthodontic WSLs on human patients. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs), including their 95% confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. Results: A total of 20 unique studies and a total of 942 (42 per cent male and 58% per cent female) patients were included, with an average age of 16.2 years and a mean number of 8.2 WSLs (range 2.2 to 45.4) per patient. These were allocated to adjunct treatment with casein phosphopeptide-stabilized amorphous calcium phosphate creams, external tooth bleaching, low- or high-concentration fluoride films, gels, mouthrinses or varnishes, resin infiltration, miswak chewing sticks, bioactive glass toothpastse, or to no adjunct treatment (i.e. conventional oral hygiene). The monthly use of fluoride varnish was the best supplement to improve WSLs in terms of lesion area (1 trial; MD = -0.80 mm(2); 95% CI = -1.10, -0.50 mm(2); P < 0.05; high quality) and enamel fluorescence (3 trials; SMD = -0.92; 95% CI = -1.32, -0.52; P < 0.05; high quality), followed by the use of fluoride film. WSL treatment did not provide a considerable improvement in their clinical evaluation (3 trials; OR = 0.97; 95% CI = 0.60, 1.56; P > 0.05; moderate quality), with imprecision due to small sample size being the main limitation of existing evidence. Conclusions: Based on the existing trials, interventions for post-orthodontic WSLs, mainly fluoride varnish, seem to be effective, but further research is needed to elucidate their clinical relevance. Registration: PROSPERO (CRD42016037538).