Prognostic factors and prognostic models for white spot lesions: A systematic review and meta-analysis

To summarize the existing evidence on prognostic factors (PFs) and prognostic models (PMs) for white spot lesions (WSLs) in orthodontic patients.

Electronic searches were conducted across PubMed, Embase, Cochrane Library, Web of Science, and Scopus (last search date: December 19th, 2024), supplemented by grey sources (Google Scholar and ProQuest). Manual searches were performed by checking the reference lists of key relevant publications.

Cohort and case-control studies reporting PFs and PMs for WSLs in orthodontic patients were included. The risk of bias was assessed with QUIPS and PROBAST tools for PF and PM studies, respectively. Prognostic estimates were pooled with risk ratio (RR) using the random effects model. The certainty of the evidence was assessed with an adapted GRADE system.

Thirty-two PF and one PM studies were included, involving 5101 participants and investigating 31 PFs and 1 PM. Pretreatment lesions [RR=3.87 (95 % CI, 2.06 to 7.27)] and pretreatment oral hygiene condition [RR=1.86 (95 % CI 1.20 to 2.88)] were significant PFs for WSL incidence, whereas there is insufficient evidence for gender and treatment duration. Only 1 PM was identified, which was developed via Fisher's discriminatory analysis without adjustment and validation. The certainty of evidence was rated as very low or low.

Based on low and very low certainty evidence, the existing lesions and oral hygiene condition before the commencement of orthodontic treatment are significant PFs for WSL incidence. Comprehensive pretreatment assessments are vital for preventing WSLs in orthodontic patients. The development of a novel, validated PM for WSL risk assessment is warranted.