Sealing of Smooth Surfaces

Enamel Sealing with Fixed Braces: What Studies Show About the Benefits

Multibracket or multiband orthodontic treatment increases the risk of so-called white spot lesions. These are early stages of enamel demineralization that can appear as white, dull spots around the brackets. The main cause is that fixed appliances make cleaning more difficult, causing plaque to remain on the tooth surface for longer. (Nature)

What is a smooth-surface sealant?

In smooth-surface sealing, a protective coating or sealant is applied to the tooth surface around the brackets. The goal is to provide additional protection for the enamel against acid erosion and demineralization. In orthodontics, this is a complementary preventive measure, especially for patients at increased risk of white spots. (Nature)

What do the studies say?

The best available evidence suggests a benefit. A systematic review with a meta-analysis published inScientific Reportsshowed that the additional use of sealants during fixed orthodontic treatment can significantly reduce the incidence of white spot lesions. At the same time, the authors rated the certainty of the evidence as very low because the studies varied widely in terms of materials, methodology, and quality. (Nature)

A recent umbrella review from 2025 confirms this trend: sealants, topical fluoride, and oral hygiene reminders are among the preventive measures that have been shown to be beneficial compared to a control or placebo. However, the review also emphasizes that high-quality studies are still lacking. (ScienceDirect)

What does this mean in practice?

To put it in scientific terms: Sealing smooth tooth surfaces can reduce the risk of white spot lesions associated with fixed braces. It is therefore a sensible additional protective measure—especially in cases of prolonged treatment, difficult oral hygiene, or an already elevated risk of demineralization. (Nature)

Where are the limits?

Sealants are not a substitute for good dental care. Thorough oral hygiene, fluoride treatment, and regular preventive care remain essential. The effectiveness of sealants also depends on how well the material adheres to the tooth surface. (Nature)

Conclusion

Current evidence suggests that sealing smooth surfaces during multibracket and multiband treatments may be beneficial for preventing white spot lesions. This recommendation is strongest when considered as an additional preventive measure—not as the sole protective strategy. From a scientific perspective, this is a plausible and clinically relevant component of modern orthodontic prophylaxis. (Nature)