Effect of bioactive glass toothpaste on the white spots around orthodontic brackets: A systematic review and meta-analysis.

Background: White spot lesions (WSLs), early indicators of tooth decay, are common in patients with fixed orthodontic appliances and can disrupt esthetic outcomes. Various methods have been proposed to prevent and treat WSLs, with bioactive glass products being one of the latest approaches. This study aims to evaluate the effect of bioactive glass toothpastes on WSLs around orthodontic brackets.

Methods: Relevant articles were identified using databases such as PubMed, EMBASE, Cochrane's CENTRAL, Scopus, and Web of Science up to November 2023. The full texts of selected studies were retrieved, and their quality was assessed. The study included clinical and in vitro research. Four clinical studies (2015‒2023) were reviewed, with meta-analysis performed on three. A random-effects inverse variance meta-analysis was performed, and the quality of the evidence was graded using GRADE.

Results: No significant difference was found between bioactive glass and fluoride toothpaste in remineralizing WSLs (P=0.10, SMD=-0.29). Nine in vitro studies (2013‒2022) were reviewed, with a meta-analysis on three showing significant lesion depth reduction with bioactive glass compared to no treatment (P<0.00001, MD=-63.98).

Conclusion: Bioactive glass toothpaste may be effective in remineralizing WSLs, though its efficacy is not significantly different from conventional fluoride toothpaste.