Objective. This study examines the effect of fluoride varnish in early preventing enamel demineralization that occurs around the brackets in patients with fixed orthodontic treatment. It tries to shed light on three issues: the extent of varnish usefulness in preventing White Spot Lesions, under what conditions varnish is effective in its preventive role, and what are the factors contributing to the protection degree that fluoride varnish offers against White Spot Lesions.
Material and methods. The preventive role of fluoride varnish in the fixed orthodontic treatment is deeply investigated in this systematic scientific literature analysis. The search was conducted to identify all the studies that analyzed and reported results on varnish role. Medline via PubMed and ScienceDirect were the search engines used. Only controlled in vivo clinical studies, published in English language between 2006 and 2019 were considered in the research. From 149 identified articles, according to the inclusion criteria, only 7 clinical papers were deemed appropriate.
Results. Five of the seven selected articles examined the conventional fluoride varnish while only two evalueted the lightcured fluoride ones. In all these studies contradicting findings were reported. In particular, a study demonstrated that varnish utilization dued the 90-100% reduction of WSLs. A moderate contribution in the decrease of White Spot Lesions, approximately 40%, derived by varnish avail, was instead asserted in three otherwise articles. Finally, three papers reported a degree of varnish protection against White Spot Lesions not statistically significant when the patient is able to maintain a good standard of oral hygiene.
Conclusions. Fluoride varnishes could be a reasonable alternative to reduce the percentage of White Spot Lesions on the tooth surface around the orthodontic bracket, especially in noncompliant or patients considered to be high risk of enamel demineralization. However, Literature is agreeing to affirm that varnish exclusive use is not able to totally prevent the development of White Spot Lesions. In addition, the fews data available in literature does not allow to recommend which of the clinical protocols at present described (every 6 weeks, every 3 or 6 months, 1 single application) really help and empower fluoride varnishs in providing the greatest effect as possible.