Table 2.

Studies on WSLs in the scientific literature

Authors and year		Nature of study		Methodology		Conclusion
Sonesson et al. in 2023[72]		Systematic review		Evaluation of the effect of continuous application of fluoride varnish during fixed orthodontic treatment in the prevention of WSLs.		WSL adjacent to brackets was shown to be prevented on professional application of fluoride varnish regularly during fixed orthodontic treatment.[72]
Höchli et al. in 2017[73]		Systematic review and meta-analysis		The therapeutic and adverse effects of casein phosphopeptide stabilized amorphous calcium phosphate creams, external tooth bleaching, low- or high-concentration fluoride films, gels, mouth rinses or varnishes, resin infiltration, miswak chewing sticks, bioactive glass toothpaste, or to no adjunct treatment (i.e., conventional oral hygiene) in the management of WSL were evaluated.		The regular use of fluoride varnish followed by the use of fluoride film was shown to be effective in the management of WSL compared to other agents.[73]
Aref et al. in 2022[74]		In vitro study		Evaluation of the effectiveness of casein phosphopeptide amorphous calcium phosphate (CPP-ACP) coupled with universal adhesive resin in the treatment of WSLs.		Treatment of WSL using CPP-ACP and consequently coated with universal adhesive resin is shown to be promising in the management of WSL efficiently through increasing surface microhardness and restoring esthetics while yielding a smoother surface.[74]
Horan et al. in 2023[75]		Randomized clinical trial		To evaluate the development of WSLs during fixed orthodontic therapy and compare between the conventional three-step bonding system, a self-etching primer bonding system, and a one-step adhesive bonding system.		WSL was significantly greater in the group in which the one-step adhesive system was used compared with the groups that used self-etch primer and the conventional bonding system.[75]
Gu et al. in 2019[76]		A split-mouth, randomized clinical trial		To compare the effectiveness of resin infiltration and microabrasion in the treatment of WSL for 12 months		Resin infiltration showed superior results in the management of WSL compared to microabrasion at 12 months[76]
Mahmoudzadeh et al. in 2019[77]		Randomized clinical trial		Assessment of the effectiveness of carbon dioxide (CO2) laser in the prevention of WSLs.		The CO2 laser irradiation seemed to be effective in the prevention of the incidence of WSLs.[77]
Sardana et al. in 2019[78]		Systematic review		To appraise the current literature systematically for evaluating the effectiveness of self-applied topical fluorides in the management of WSLs.		This study did not confirm the effectiveness of self-applied fluorides in the management of WSLs developed during fixed orthodontic treatment.[78]
Hu et al. in 2020[79]		Systematic review and meta-analysis		Comparing the effectiveness of remineralizing agents [sodium fluoride (NaF), acidulated phosphate fluoride (APF) foam, dichlorosilane (Dfs) varnish, and high-concentration fluoride toothpaste (HFT)] in management of WSLs.		APF foam showed the highest remineralization efficiency, followed by Dfs varnish and HFT.[79]
Albhaisi et al. in 2020[80]		Randomized clinical trial		To compare WSL development between clear aligner (CA) therapy and orthodontic fixed appliance (FA)		The CA group showed large but shallow WSL development, but the FA group developed more new severe lesions that were smaller in area. More plaque accumulation was found in the FA group compared with the CA group.[80]
Adel et al. in 2020		An in vitro study		Comparison of the effect of the use of laser, casein phosphopeptide–amorphous calcium phosphate (CPP–ACP), and their combination on the management of WSL using polarized light microscopy to check lesion depth.		The combined use of laser and CPP–ACP showed the best result in the management of WSL development. The use of CPP–ACP or laser alone also resulted in a good reduction in WSL but was less than their combined use, with no significant difference between them.[81]