title: Management of post-orthodontic white spot lesions: an updated systematic review.
abstract: The management of post-orthodontic white spot lesions is based on remineralization strategies or a minimal-invasive camouflage of the lesions.
  
  
  
  The aim of this systematic review was to identify and assess the quality of evidence for the various clinical technologies.
  
  
  
  Four databases were searched for relevant literature published in English between 2011 and 31 October 2015 according to a pre-determined PICO. Only controlled clinical studies were considered. Abstract lists and the selected full-text papers were independently examined by two reviewers and any differences were solved in consensus. The Cochrane handbook and the AMSTAR tool were used for grading the risk of bias. The quality of evidence was rated according to GRADE.
  
  
  
  Out of 280 identified publications, seven studies on remineralization, micro-abrasion and resin infiltration met the inclusion criteria. Two of them were assessed with low risk of bias. No pooling of results was possible due to study heterogeneity. The quality of evidence for all technologies was graded as very low.
  
  
  
  Only papers published in English with more than 20 adolescents or young adults were considered. Furthermore, a follow-up period of at least 8 weeks was required. The publication bias could not be assessed due to the paucity of included trials.
  
  
  
  There is a lack of reliable scientific evidence to support re-mineralizing or camouflaging strategies to manage post-orthodontic white spot lesions. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.
authors.affiliation: Department of Orthodontics, Faculty of Odontology, Malmö University, Sweden.
authors.forename: Mikael
authors.initials: M
authors.lastname: Sonesson
authors.affiliation: Private Orthodontic Practice, Stockholm, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Bergstrand
authors.affiliation: Department of Paediatric Dentistry, Dental School, National and Kapodistrian University of Athens, Greece.
authors.forename: Sotiria
authors.initials: S
authors.lastname: Gizani
authors.affiliation: Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
authors.forename: Svante
authors.initials: S
authors.lastname: Twetman
mesh_terms: D000293:Adolescent; D000328:Adult; D003731:Dental Caries / Q000209:etiology / Q000628:therapy*; D020878:Device Removal; D019243:Enamel Microabrasion / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods; D005260:Female; D006801:Humans; D016910:Orthodontic Brackets / Q000009:adverse effects*; D017594:Publication Bias; D012117:Resins, Synthetic / Q000627:therapeutic use; D014089:Tooth Remineralization / Q000379:methods*; D055815:Young Adult
chemical_list: D012117:Resins, Synthetic