Comparison Between Detection of Orthodontic-Related Carious Lesions With Fluorescence or Visual Method: A Systematic...

To pare the detection of carious lesions involving orthodontic appliances (O) with the fluorescent method (I) and visual clinical examination (R) in patients treated with fixed orthodontics (P).

Five databases and grey literature were searched until January 2023. Clinical studies, comparing at least one digital fluorescent method (DFM) with visual clinical examination (VCE), in patients who completed treatment with fixed orthodontic appliances, were eligible. After extracting the data, the risk of bias and the certainty of the evidence were evaluated through the QUADAS-2 and the GRADE approaches, respectively.

Five cross-sectional studies were included in the final synthesis. The number of teeth evaluated ranged from 137 to 1653. Quantification of lesion severity by determining fluorescence loss was a great benefit compared to the qualitative data obtained by VCE. The average loss of fluorescence, measured by quantitative light-induced fluorescence (QLF) method, in the lesions visually detected was 12.6%, in some areas greater than 15%. The correlation between DIAGNODent and VCE scores ranged from 0.40 to 0.71. The studies were judged at risk of bias with very low certainty of evidence on the comparison between DFMs and VCE.

The detection of non-cavitated carious lesions by DFMs showed a similar pattern to the VCE, although the former detected more lesions than the latter, which encourages the use of these technologies for early detection in patients submitted to fixed orthodontic treatment.

The clinical advantage of using the DFMs include the more objective diagnosis, and that measurements can be displayed to the patients and may, therefore, have a pedagogical value. In contrast, they are more time consuming clinically and pose an extra cost; however, it is believed that rapid technology innovation may reduce these costs.