The authors of the recent systematic review of adhesives are to be congratulated on a thorough review of the literature. I know from experience how much work this involves (Rogers S, Chadwick B, Treasure E. Fluoride-containing orthodontic adhesives and decalcification in patients with fixed appliances: a systematic review. Am J Orthod Dentofacial Orthop 2010;138:390.e1-8).

Systematic reviews have a bad reputation because they so often conclude that there is no satisfactory scientific evidence for our clinical practice. I agree with the authors that much of the research carried out in this area (and many other areas of orthodontic research) is disappointing due to poor study design, inadequate reporting, or inappropriate statistical analyses. I hope that future researchers will take note of the authors’ recommendations, and we will start to find definitive answers to the important clinical questions soon.

I would like to question one of the authors’ conclusions. They stated that “because of the limitations of successful bonding with a glass ionomer adhesive, it cannot be recommended.” Some studies they cited in the discussion as evidence for this did not actually investigate the use of glass ionomer cements. It is true that Marcusson et al did report a disappointing bond failure rate ; however, this was with a conventional glass ionomer cement. The newer resin-modified glass ionomers are much stronger.

I have been using resin-modified glass ionomer for cementing both bands and bonds for several years and in a recent audit found that 4% of my brackets failed during use. I believe this is acceptable, particularly if it reduces the incidence and severity of unsightly demineralization during treatment, but I eagerly await the results of an RCT to confirm this.

One other thing. Please can we stop upsetting the cariologists by continually referring to “decalcification”? The correct term is “demineralization,” because calcium is not the only mineral lost during the process.