The effect of sealant on prevention of enamel demineralization in patients with fixed orthodontic appliances: A systematic review

One of the commonest problems of patients undergoing orthodontic treatment with fixed appliances is the development of enamel demineralization. In the study of Gorelick et al. (1982) 1 50% of the patients undergoing orthodontic treatment with fixed appliances developed white spot lesions compared to 25% of the non-orthodontic patients. These initial lesions can be visible as soon as the fourth week after the placement of the fixed orthodontic appliances, 2-4 and may be detectible even 5 years after treatment. 5 Studies have shown that their incidence can be present in 25% of patients under orthodontic treatment despite the application of preventive measures for this group. 6,7 Brackets and bands create areas on the tooth surfaces, which favor the increase of plaque and food accumulation due to the restrictive access for self-cleaning. 8 Their placement causes significant quantitative and qualitative changes in the oral biofilm such as decrease in pH and increase of Streptococcus mutans and Lactobacilli. 9 Consequently, patients being in treatment with fixed appliances and bands are at an increased risk for developing dental caries. The earliest sign of the caries process is enamel demineralization with an opaque white surface. These initial lesions (White Spot Lesion-WSL) are most often seen at the facial surfaces of the maxillary incisors, mandibular canines and first premolars at the cervical and middle third of the tooth surface. 1,10 They often have a “U” shape since they develop around the borders of the brackets where the remaining cement favors the accumulation of plaque. ABSTRACT