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Comparative Study
. 2025 Apr;53(4):3000605251328608.
doi: 10.1177/03000605251328608. Epub 2025 Apr 11.

White spot lesion in self-ligating versus conventional ligating bracket systems: A systematic review

Mohammad I Idris  1 , Ahmad S Burhan  1 , Mohammad Y Hajeer  1   2 , Ahmad M Alhamwi  1 , Fehmie R Nawaya  3
Affiliations
Comparative Study

White spot lesion in self-ligating versus conventional ligating bracket systems: A systematic review

Mohammad I Idris et al. J Int Med Res. 2025 Apr.

Abstract

BackgroundWhite spot lesion formation around orthodontic brackets is a major complication associated with fixed orthodontic treatment.ObjectiveThis review aimed to evaluate the current evidence regarding the differences in white spot lesion formation between self-ligating and conventional ligating brackets.MethodsEleven bibliographic databases were searched until January 2025. This review covered parallel-group and split-mouth randomized controlled trials, controlled clinical trials, and cross-sectional studies that investigated the differences in white spot lesion formation between self-ligating and conventional ligating brackets.ResultsThree randomized controlled trials, one controlled clinical trial, and one cross-sectional study were included in this systematic review. Among these, three studies were classified as having a low risk of bias. Four of the five included studies showed no statistically significant difference in white spot lesion formation between the two types of bracket systems (p < 0.05).ConclusionThere are no potential differences in white spot lesion formation between self-ligating and conventional ligating bracket systems. However, orthodontists must be aware of the other factors affecting white spot lesion formation, with oral hygiene being the most critical factor.Registration: The protocol was registered in the PROSPERO database (CRD42022353478) on 25 August 2022.

Keywords: Ligation; orthodontic bracket; systematic review; white spot lesion.

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Figures

Figure 1.
Figure 1.
PRISMA flow chart of the included studies. PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2.
Figure 2.
Risk of bias of the included RCTs using the RoB-2 tool. RCTs: randomized controlled trials.
Figure 3.
Figure 3.
The overall risk of bias of the included RCTs using the RoB-2 tool. RCTs: randomized controlled trials.
Figure 4.
Figure 4.
Risk of bias of the included non-RCTs using the ROBINS-I tool. RCTs: randomized controlled trials.
Figure 5.
Figure 5.
The overall risk of bias of the included non-RCTs using the ROBINS-I tool. RCTs: randomized controlled trials.
See this image and copyright information in PMC

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References

    1. Ren Y, Jongsma MA, Mei L, et al.. Orthodontic treatment with fixed appliances and biofilm formation–a potential public health threat? Clin Oral Investig 2014; 18: 1711–1718. - PubMed
    1. Al-Blaihed D, El Meligy O, Baghlaf K, et al.. White spot lesions in fixed orthodontics: a literature review on etiology, prevention, and treatment. Cureus 2024; 16: e65679. - PMC - PubMed
    1. Kidd EAM, Fejerskov O. Essentials of dental caries. 4th ed. New York: Oxford University Press, 2016.
    1. Tufekci E, Dixon JS, Gunsolley JC, et al.. Prevalence of white spot lesions during orthodontic treatment with fixed appliances. Angle Orthod 2011; 81: 206–210. - PMC - PubMed
    1. Munjal D, Garg S, Dhindsa A, et al.. Assessment of white spot lesions and in-vivo evaluation of the effect of CPP-ACP on white spot lesions in permanent molars of children. J Clin Diagn Res 2016; 10: Zc149–154. - PMC - PubMed

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