{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T14:12:55Z","timestamp":1785852775545,"version":"3.56.0"},"reference-count":55,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T00:00:00Z","timestamp":1708560000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Initial caries lesion (ICLs) adjacent to orthodontic brackets are the most common side effect of orthodontic treatment with fixed appliances. The reported prevalence is uncertain and varies considerably across studies, from 27% to 97%.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>This paper was designed to evaluate and synthesize the available evidence on the prevalence and incidence rates of ICLs in relation to orthodontic treatment. Selection criteria: The review (Prospero protocol CRD42023412952) included randomized and non-randomized clinical trials of interventions, cohort studies, and cross-sectional studies, published after 1990 on the prevalence or incidence of ICLs during or after orthodontic treatment with fixed appliances. Search methods: Pubmed, Scopus, and Embase databases were searched from 1990 until 01 May 2023. The risk of bias assessment was performed with RoB 2 and ROBINS-I tool and the Joanna Briggs Institute Critical Appraisal Checklist. Data collection and analysis: The proportion of individuals with ICLs, reported as the number\/percentage of individuals\/teeth with ICLs or mean number of ICLs per subject, were used to synthesize results.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The search yielded a total of 468 papers; 21 studies were included in the systematic review, 2 of which were not included in the meta-analysis. The prevalence rate [95%CI] of ICLs was 0.57% [0.48; 0.65] in 1448 patients, 0.22% [0.14; 0.33] in 11583 teeth, with a mean number of lesions equal to 2.24 [1.79; 2.70] in 484 patients evaluated. The incidence rate of new carious lesions developed during orthodontic treatment was 0.48% [0.33; 0.63] in 533 patients, 0.15% [0.08; 0.26] in 1890 teeth with a mean number of ICLs equal to 2.29 [1.12; 3.46] in 208 patients evaluated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Limitations<\/jats:title>\n                  <jats:p>Although the high number of included studies and the overall good quality, there was a significant heterogeneity in the collected data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The prevalence and incidence rates of ICLs in subjects undergoing orthodontic treatment are quite high and raise some concerns in terms of risk assessment of orthodontic treatment. ICLs represent an alarming challenge for both patients and professionals. Effective caries prevention strategies during treatment need to be considered and implemented where appropriate.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejo\/cjae008","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T22:08:10Z","timestamp":1708639690000},"source":"Crossref","is-referenced-by-count":26,"title":["Distribution of initial caries lesions in relation to fixed orthodontic therapy. A systematic review and meta-analysis"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7799-5451","authenticated-orcid":false,"given":"Claudia","family":"Salerno","sequence":"first","affiliation":[{"name":"Department of Restorative, Preventive and Pediatric Dentistry, University of Bern , Freiburgstrasse 7, 3012 Bern , Switzerland"},{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan , Via Beldiletto 1, 20142 Milan , Italy"},{"name":"Graduate School for Health Sciences, University of Bern , Bern , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Grazia Cagetti","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan , Via Beldiletto 1, 20142 Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Cirio","sequence":"additional","affiliation":[{"name":"Department of Biomedical, Surgical and Dental Sciences, University of Milan , Via Beldiletto 1, 20142 Milan , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcella","family":"Esteves-Oliveira","sequence":"additional","affiliation":[{"name":"Department of Restorative, Preventive and Pediatric Dentistry, University of Bern , Freiburgstrasse 7, 3012 Bern , Switzerland"},{"name":"Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern , Bern , Switzerland"},{"name":"Department of Restorative Dentistry and Endodontology, Justus-Liebig-University Giessen , Giessen , Germany"},{"name":"Department of Conservative Dentistry, Periodontology and Endodontology, University Centre of Dentistry, Oral Medicine and Maxillofacial Surgery (UZMK), University of T\u00fcbingen , T\u00fcbingen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J","family":"Wierichs","sequence":"additional","affiliation":[{"name":"Department of Restorative, Preventive and Pediatric Dentistry, University of Bern , Freiburgstrasse 7, 3012 Bern , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Kloukos","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopedics, School of Dental Medicine, University of Bern , Bern , Switzerland"},{"name":"Department of Orthodontics and Dentofacial Orthopedics , 251 Hellenic Air Force Hospital, Athens , Greece"},{"name":"Department of Periodontology, Faculty of Odontology, Malm\u00f6 University , Malm\u00f6 , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guglielmo","family":"Campus","sequence":"additional","affiliation":[{"name":"Department of Restorative, Preventive and Pediatric Dentistry, University of Bern , Freiburgstrasse 7, 3012 Bern , Switzerland"},{"name":"Department of Medicine, Surgery and Pharmacy, University of Sassari , 07100 Sassari , Italy"},{"name":"Department of Cariology, Saveetha Dental College and Hospitals , Chennai 600077 , India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,2,22]]},"reference":[{"key":"2024022222073037400_CIT0001","first-page":"230","article-title":"Factors influencing treatment time in orthodontic patients","volume-title":"American Journal of Orthodontics and Dentofacial Orthopedics","author":"Skidmore","year":"2006"},{"key":"2024022222073037400_CIT0002","first-page":"59","article-title":"Caries experience in orthodontically treated individuals","volume-title":"The Angle Orthodontist","author":"Wisth","year":"1977"},{"key":"2024022222073037400_CIT0003","first-page":"35","article-title":"Salivary Streptococcus mutans levels in patients before, during, and after orthodontic treatment","volume-title":"American Journal of Orthodontics and Dentofacial Orthopedics","author":"Rosenbloom","year":"1991"},{"key":"2024022222073037400_CIT0004","first-page":"93","article-title":"Incidence of white spot formation after bonding and banding","volume-title":"American Journal of Orthodontics","author":"Gorelick","year":"1982"},{"key":"2024022222073037400_CIT0005","first-page":"62","article-title":"Enamel demineralization following orthodontic treatment","volume-title":"American Journal of Orthodontics","author":"Mizrahi","year":"1982"},{"key":"2024022222073037400_CIT0006","first-page":"17030","article-title":"Dental caries","volume-title":"Nature Reviews Disease Primers","author":"Pitts","year":"2017"},{"key":"2024022222073037400_CIT0007","first-page":"7","article-title":"Terminology of dental caries and dental caries management: consensus report of a workshop organized by ORCA and Cariology Research Group of IADR","volume-title":"Caries Research","author":"MacHiulskiene","year":"2020"},{"key":"2024022222073037400_CIT0008","first-page":"35","article-title":"What constitutes dental caries? 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