Effect of Fluorescent Adhesives on Visibility and Tooth Enamel Surface Properties After Debonding: A Systematic Review and Meta-Analysis

Objectives: To systematically review and meta-analyze the impact of fluorescent versus conventional orthodontic adhesives on debonding efficiency, bond strength, and enamel integrity.

Methods: This systematic review and meta-analysis, following the PRISMA guidelines, searched PubMed, Scopus, Embase, Web of Science, and Cochrane Central (inception to November 2024) for studies comparing fluorescent versus conventional adhesives. Included were 19 studies (17 in vitro and 2 in vivo), with 11 meta-analyses for shear bond strength (SBS), adhesive remnant index (ARI), residual adhesive surface area, enamel damage index (EDI), and removal time using a random-effects model. The risk of bias was assessed with CRIS, RoB 2, and ROBINS-I.

Results: Of 798 records, 19 were included. Fluorescent adhesives reduced residual adhesive area (MD -0.57 mm², 95% CI: -1.13, -0.02, p = 0.04) and removal time (MD -24.89 s, 95% CI: -50.29, 0.51, p = 0.05), but showed no significant differences in SBS (MD 1.07 MPa, 95% CI: -3.05, 5.19, p = 0.61), ARI (MD 0.18, 95% CI: -0.10, 0.46, p = 0.20), or EDI (MD -0.04, 95% CI: -0.28, 0.20, p = 0.73). Heterogeneity was high (e.g., I² = 99.77% for removal time), and most studies had a moderate bias. Narratively, fluorescence improved remnant detection (e.g., 50 µm via QLF).

Conclusion: Fluorescent adhesives enhance debonding efficiency by reducing residual adhesive area and removal time in laboratory settings, without affecting bond strength. Enamel protection is operator-dependent. Due to the predominance of in vitro studies (17/19) and limited clinical data (only 2 in vivo studies, one with a single patient), firm clinical recommendations cannot be made. High heterogeneity and moderate risk of bias further limit the strength of the findings. Further standardized clinical trials are needed.