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Wittich FK, Cebula M, Effenberger S, Schoppmeier CM, Schwendicke F, Barbe AG, Wicht MJ. Masking efficacy of bleaching and/ or resin infiltration of fluorotic spots on anterior teeth - a systematic review and meta-analysis. J Dent 2024; 149:105276. [PMID: 39103078 DOI: 10.1016/j.jdent.2024.105276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to evaluate the masking success of bleaching and/or resin infiltration treatment of fluorotic lesions in anterior teeth of adults and adolescents. DATA SOURCES PubMed, Cochrane Library, and Embase were systematically searched from the beginning of documentation to December 31, 2023. PRIMARY OUTCOME WAS THE NUMBER OF MASKED TEETH A tooth was considered masked when the color difference (ΔE CIE76) between fluorotic areas and the surrounding sound enamel was ≤3.7 and unmasked if ΔE > 3.7. Secondary outcomes were mean ΔE values between fluorotic and sound enamel reported for a treatment group at baseline and after any intervention as well as patient satisfaction. STUDY SELECTION Of 1575 search results 4 publications met the inclusion criteria, comprising 230 treated anterior teeth with fluorosis in 47 patients. Meta-analyses were performed comparing the result after treatment (bleaching, resin infiltration, or bleaching followed by resin infiltration) to baseline. RESULTS Bleaching and resin infiltration were suitable intervention strategies to improve the esthetics of fluorosis affected anterior teeth, with a combination of both treatment approaches being particularly effective in reducing the color difference between fluorotic defects and the surrounding sound enamel below the acceptability thresholds of 3.7 (success rate [95 %CI]: 0.75 [0.44, 1.06]). Patient satisfaction increased after treatments, indicating a beneficial impact on their mental health. The overall bias of the included studies was 2.5 (ROBINS-I analysis tool). CONCLUSION There is evidence that resin infiltration with preceding bleaching therapy is more effective in masking fluorotic lesions in anterior teeth than bleaching alone. The combination therapy also showed a tendency towards higher success rates compared to infiltration alone. However, this difference was statistically not significant, and more studies are needed to further assess the efficacy of specific treatments and their combinations as well as the certainty in the evidence. The methodologic heterogeneity of study designs regarding estimation of color difference before and after treatment and bleaching protocols calls for unification in future studies. CLINICAL SIGNIFICANCE Results of this systematic review and meta-analysis revealed the combination of bleaching followed by resin infiltration as efficacious approach for masking fluorotic lesions in young adults. While resin infiltration alone improves the aesthetic appearance of fluorotic lesions, dentists should consider a combined bleaching-infiltration regimen to achieve more favorable clinical outcome for their patients.
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Affiliation(s)
- Florian K Wittich
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Kerpener Straße 32, 50931 Cologne, Germany.
| | - Marcus Cebula
- Clinical Research Department, DMG Dental Material Gesellschaft mbH, Elbgaustraße 248, 22547 Hamburg, Germany.
| | - Susanne Effenberger
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-University (LMU), Goethestr. 70, 80336 Munich, Germany.
| | - Christoph M Schoppmeier
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Kerpener Straße 32, 50931 Cologne, Germany.
| | - Falk Schwendicke
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians-University (LMU), Goethestr. 70, 80336 Munich, Germany.
| | - Anna Greta Barbe
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Kerpener Straße 32, 50931 Cologne, Germany.
| | - Michael J Wicht
- Department of Operative Dentistry and Periodontology, Centre of Dental Medicine, University of Cologne, Kerpener Straße 32, 50931 Cologne, Germany.
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Sinanovic AL, Messer-Hannemann P, Samadi M, Schwendicke F, Effenberger S. Effect of Bleaching on Resin-Infiltration-Masked Artificial White Spots In Vitro. J Funct Biomater 2024; 15:125. [PMID: 38786636 PMCID: PMC11122313 DOI: 10.3390/jfb15050125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 04/30/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024] Open
Abstract
Resin infiltration is an effective method to mask vestibular white spots. If needed, external bleaching is usually recommended before infiltration, whilst in clinical practice, this sequence may not always be feasible. This in vitro study evaluated the effect of bleaching after resin infiltration regarding surface roughness and color using bovine incisors. Unlike for the untreated specimens (control, n = 25), artificial caries lesions were created within the test group (n = 25) using a demineralization solution at 37 °C for five days (pH = 4.95). The lesions were subsequently infiltrated using a resin infiltrant (Icon, DMG, Hamburg, Germany), followed by polishing. Afterwards, all specimens were bleached with a 10% carbamide peroxide gel (Opalescence, Ultradent, South Jordan, UT, USA) for 8 h/day over a ten-day period. Between bleaching treatments, specimens were stored in an opaque container with moistened paper tissues at 37 °C. Surface roughness was measured using a profilometer, and color in the L*a*b* space was assessed spectrophotometrically before and after bleaching. Bleaching increased the L*-values of both infiltrated (mean ± SD; ΔL* = 3.52 ± 1.98) and untreated (control) specimens (ΔL* = 3.53 ± 2.30) without any significant difference between the groups (p = 0.983). Bleaching also induced a significant increase in the mean surface roughness of both infiltrated (p < 0.001) and untreated (p = 0.0134) teeth. In terms of clinical relevance; it can be concluded that bleaching resin-infiltrated enamel is as effective as bleaching sound enamel.
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Affiliation(s)
- Alan Leon Sinanovic
- Clinical Research, DMG Dental-Material Gesellschaft mbH, 22547 Hamburg, Germany
- Department Biotechnology, University of Applied Sciences Hamburg, 21033 Hamburg, Germany
| | | | - Mariam Samadi
- Clinical Research, DMG Dental-Material Gesellschaft mbH, 22547 Hamburg, Germany
| | - Falk Schwendicke
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians University Munich, 80336 Munich, Germany
| | - Susanne Effenberger
- Clinical Research, DMG Dental-Material Gesellschaft mbH, 22547 Hamburg, Germany
- Department of Conservative Dentistry and Periodontology, Ludwig-Maximilians University Munich, 80336 Munich, Germany
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Chandak M, Agrawal P, Dass A, Bhopatkar J. In-Office Power Bleaching for the Aesthetic Management of Dental Fluorosis. Cureus 2024; 16:e59806. [PMID: 38846193 PMCID: PMC11154080 DOI: 10.7759/cureus.59806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Fluorosis is a widespread condition that is endemic and found in approximately 25 nations worldwide. It manifests as dental fluorosis, an inherited enamel imperfection resulting from excessive fluoride exposure during tooth development. This condition can lead to varying degrees of tooth discoloration, often requiring aesthetic correction. Bleaching represents one of the treatment approaches for such instances, with in-office power bleaching being a technique that comprises the clinical implementation and triggering of bleaching agents using light to expedite the procedure. This case report outlines the successful aesthetic revision of moderate dental fluorosis through power bleaching, obviating the demand for intrusive procedures. It underscores the efficacy and conservative nature of in-office power bleaching to address tooth discoloration associated with extensive fluorosis.
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Affiliation(s)
- Manoj Chandak
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Paridhi Agrawal
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Abhilasha Dass
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jay Bhopatkar
- Conservative Dentistry and Endodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Shu J, Huang Y, Ma X, Duan Z, Wu P, Chu S, Wu Y, Wang Y. Aesthetic impact of resin infiltration and its mechanical effect on ceramic bonding for white spot lesions. BMC Oral Health 2024; 24:365. [PMID: 38515110 PMCID: PMC10958835 DOI: 10.1186/s12903-024-04011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/11/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Treating white spot lesions (WSLs) with resin infiltration alone may not be sufficient, raising questions about its compatibility with other treatments amid controversial or incomplete data. Therefore, this study aimed to assess the aesthetic feasibility of resin infiltration combined with bleaching, as well as its potential mechanical effect on ceramic bonding to WSLs. METHODS One hundred and fifty flat enamel surfaces of bovine incisors were prepared. Ninety specimens were deminerailized and randomly assigned to three groups(n = 30): post-bleaching resin infiltration (Bl-R), pre-bleaching resin infiltration (R-Bl), and only resin infiltration (R). Color, surface roughness and microhardness were assessed in immediate, thermocycling and pigmentation tests. The remaining sixty samples were randomly assigned to three groups (n = 20): control (Ctrl), bonding (Bo), pre-bonding resin infiltration (R-Bo). Shear bonding strength, failure mode, micro-leakage depth and interface morphology were evaluated after ceramic bonding. The Tukey test and analysis of variance (ANOVA) were used for statistical analysis. RESULTS For the effect of resin infiltration and bleaching on WSLs, the R-Bl group showed the worst chromic masking ability, with the highest |ΔL|, |Δa|, |Δb|, and ΔE values after treatment. Compared with those in the Bl-R group, the R-Bl and R groups showed significant time-dependent staining, which is possibly attributed to their surface roughness. For the effect of resin infiltration on the adhesive properties of WSLs, resin infiltration reduced the staining penetration depth of WSLs from 2393.54 ± 1118.86 μm to 188.46 ± 89.96 μm (P < 0.05) while reducing WSLs porosity in SEM observation. CONCLUSIONS Post-bleaching resin infiltration proved to be advantageous in the aesthetic treatment of WSLs. Resin infiltration did not compromise bonding strength but it did reduce microleakage and enhance marginal sealing. Overall, resin infiltration can effectively enhance the chromatic results of treated WSLs and prevent long-term bonding failure between ceramics and enamel. Based on these findings, the use of post-bleaching resin infiltration is recommended, and resin infiltration before ceramic bonding is deemed viable in clinical practice.
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Affiliation(s)
- Jiaen Shu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yijia Huang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xueying Ma
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhonghua Duan
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Pei Wu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Sijing Chu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yuqiong Wu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China.
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.
- National Center for Stomatology, Shanghai, China.
- National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Shanghai Research Institute of Stomatology, Shanghai, China.
| | - Yuhua Wang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 200011, Shanghai, China.
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China.
- National Center for Stomatology, Shanghai, China.
- National Clinical Research Center for Oral Diseases, Shanghai, China.
- Shanghai Key Laboratory of Stomatology, Shanghai, China.
- Shanghai Research Institute of Stomatology, Shanghai, China.
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Resin Infiltration of Non-Cavitated Enamel Lesions in Paediatric Dentistry: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121893. [PMID: 36553336 PMCID: PMC9776437 DOI: 10.3390/children9121893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
The resin infiltration (RI) technique was introduced as one of the minimal intervention dentistry strategies in addressing dental caries among the paediatric population. This technique used the low-viscosity resin monomer to infiltrate the non-cavitated carious lesion and other developmental enamel porosities, thus allowing the conservation of the tooth structure. This narrative review aims to explore the value of RI in Paediatric Dentistry. Through our search of the literature, the development of the material, their clinical applications and shortcomings, as well as the innovation that has been carried out to improve the current RI, were discussed. There are number of high-level evidence supporting the use of RI in arresting non-cavitated proximal caries lesions in primary and permanent teeth, but its efficacy in managing anterior white spot lesions is still unclear. Limited penetration depth, not radiopaque and questionable long-term colour and material stability were among the limitation of the material. Various laboratory-based studies have been conducted to improve the current properties of RI. Nevertheless, RI has emerged as one of the important micro-invasive techniques in addressing non-cavitated and anterior white-spot enamel lesions in children and adolescents with great success.
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da Freiria ACB, Ortiz MIG, de Sobral DFS, Aguiar FHB, Lima DANL. Nano-hydroxyapatite-induced remineralization of artificial white spot lesions after bleaching treatment with 10% carbamide peroxide. J ESTHET RESTOR DENT 2022; 34:1290-1299. [PMID: 36205242 DOI: 10.1111/jerd.12969] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/08/2022] [Accepted: 09/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assessed in vitro the effect of nanohydroxyapatite (n-HA) to improve the aesthetic appearance and microhardness of white spot lesions (WSL) when associated with a low-concentration bleaching agent (carbamide peroxide-CP10%). MATERIAL AND METHODS Enamel/dentin specimens (n = 60) of 5 × 5 × 2.2 mm were prepared, of these, 48 were submitted to pH-cycling to create artificial WSL. Subsequently, these were allocated into five groups (n = 12): n-HA; n-HA + CP10%; CP10%; WSL control (WSLC ); sound control (Sound). The color was assessed at baseline, pre-treatment, and post-treatment using a spectrophotometer, and the color (ΔE/ΔE00 ) and whiteness index (ΔWID) alterations were determined. The enamel cross-sectional microhardness (CSMH) was evaluated (post-treatment) with a Knoop indenter, 25gf/5 s, 20-200 μm. The data was analyzed through generalized linear models (α = 5%). RESULTS ΔE and ΔE00 were significantly higher for the bleached groups (n-HA + CP10% and CP10%), and the n-HA was higher than the WSLC group (p < 0.05). ΔWID was significantly higher for the bleached groups (p < 0.05). The CSMH values were significantly higher in the sound group than in the n-HA, CP10%, and WSLC groups (p < 0.05). The WSLC had lower microhardness than the n-HA + CP10% and sound groups (p < 0.05). CONCLUSION n-HA is suitable to remineralize and recover the color of the WSL. However, its association with CP10% maintains the esthetical outcome while increasing its in-depth remineralizing effect. CLINICAL SIGNIFICANCE Considering the aesthetic and functional repercussions of the WSL persistence, treatments that tend to improve its physical appearance and reinforce its weakened substructure in a non-invasive way are ideal. For this associating low-concentration, bleaching agents to the remineralizing treatments is promising to treat this type of lesions.
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Affiliation(s)
| | | | | | - Flavio Henrique Baggio Aguiar
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Débora Alves Nunes Leite Lima
- Department of Restorative Dentistry, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Yeslam HE, AlZahrani SJ. Time-dependent effect of intense capsule-coffee and bleaching on the color of resin-infiltrated enamel white spot lesions: an in vitro study. PeerJ 2022; 10:e14135. [PMID: 36221260 PMCID: PMC9548318 DOI: 10.7717/peerj.14135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 09/06/2022] [Indexed: 01/21/2023] Open
Abstract
Background and Objectives White spot lesions (WSLs) are a common problem that can be conservatively managed by resin infiltration. Consumption of dark beverages such as coffee causes staining of dental hard tissues, which can deteriorate the esthetic qualities of treated WSLs. The aims of this study were to investigate the effect of dark coffee heavy consumption on ICON® resin infiltrated WSLs and the influence of bleaching on them after staining. Methods Twenty surfaces from sound human extracted third molars were used in the study. Two square-shaped buccal and lingual window areas had artificially created WSLs (received buccal resin infiltration afterward). Using VITA Easyshade, the baseline ΔE was recorded. Espresso coffee was used to immerse all surfaces for 8 days. The color coordinates according to CIE LAB were recorded for all surfaces at 2, 4, 6, and 8 days of immersion, and ΔE was calculated at each timepoint. After 8 days, in-office bleaching was applied to all surfaces according to the manufacturer's instructions and the color. Coordinates and ΔE were recorded. For statistical analysis, an independent sample t-test was used to compare each group. A general linear mixed model (GLMM) repeated measure ANOVA was applied for statistical analysis of L*and changes due to staining over time. Results Analysis of time as a main effect on the L values of surfaces was statistically highly significant (p < 0.01). The interaction of time with surfaces under investigation and type of surface (test vs. control) as a main effect were non-significant (p = 0.47 and p = 0.35, respectively). Bleaching showed a significant difference in color lightness in both test and control surfaces compared to the mean L value at 8 days of staining (p < 0.01). Conclusion Capsule-coffee consumption gradually influences the esthetic of resin infiltration on treated teeth. However, bleaching materials might restore an esthetic shade.
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Affiliation(s)
- Hanin E. Yeslam
- Department of Restorative Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saeed J. AlZahrani
- Department of Restorative Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
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Zhang Z, Shi Y, Zheng H, Zhou Z, Wu Z, Shen D, Wang Y, Zhang Y, Wang Z, Fu B. A Hydroxypropyl Methylcellulose Film Loaded with AFCP Nanoparticles for Inhibiting Formation of Enamel White Spot Lesions. Int J Nanomedicine 2021; 16:7623-7637. [PMID: 34815669 PMCID: PMC8605885 DOI: 10.2147/ijn.s335549] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/01/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study investigated the effects of mineralizing film consisting of hydroxypropyl methylcellulose (HPMC) and amorphous fluorinated calcium phosphate (AFCP) nanoparticles on enamel white spot lesions (WSLs). Material and Methods The AFCP nanoparticles and mineralizing film were prepared via nanoprecipitation and solvent evaporation, respectively. They were characterized with Fourier transform infrared spectroscopy (FTIR), X-ray powder diffraction (XRD), transmission electron microscopy (TEM), selected area electron diffraction (SAED), scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), inductively coupled plasma atomic emission spectrometry (ICP-AES), and fluoride ion selective electrode. Thirty-two human enamel slices (4 mm × 4 mm × 1.5 mm) were highly polished and randomly assigned to four groups: negative control (no treatment); pure HPMC film; mineralizing film; GC Tooth Mousse Plus® (contains 10% CPP-ACP and 0.2% NaF). Subsequently, samples were challenged by a modified pH-cycling and characterized by color measurement, Micro-CT, SEM/EDX, and nanoindentation. Results The mineralizing film could sustain release of Ca, P and F ions over 24 h and maintain AFCP nanoparticles in metastable state over 8~12 h. During 4 weeks of pH cycling, the mineralizing film group exhibited least color change (∆E), mineral loss and lesion depth (120 ± 10 µm) among four groups (p < 0.05). SEM findings revealed that the porosities among enamel crystals increased in negative control and pure HPMC film groups after pH cycling, whereas in mineralizing film group, the original microstructure of enamel was well conserved and mineral deposits were detected between enamel prisms. Mineralizing film group demonstrated a least reduction of nanomechanical properties such as elastic modulus of 77.02 ± 6.84 GPa and hardness of 3.62 ± 0.57 GPa (p < 0.05). Conclusion The mineralizing film might be a promising strategy for prevention and management of WSLs via inhibiting enamel demineralization and promoting enamel remineralization.
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Affiliation(s)
- Zhixin Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Ying Shi
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Haiyan Zheng
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Zihuai Zhou
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Zhifang Wu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Dongni Shen
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Yiru Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Yizhou Zhang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Zhe Wang
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
| | - Baiping Fu
- Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University, Hangzhou, 310006, People's Republic of China
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Bourouni S, Dritsas K, Kloukos D, Wierichs RJ. Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a systematic review and meta-analysis. Clin Oral Investig 2021; 25:4711-4719. [PMID: 34106348 PMCID: PMC8342329 DOI: 10.1007/s00784-021-03931-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/30/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The present review systematically analyzed clinical studies investigating the efficacy of resin infiltration on post-orthodontic or non-post-orthodontic, white spot lesions (WSL), or fluorosis. MATERIALS Five electronic databases (Central, PubMed, Ovid MEDLINE, Ovid EMBASE, LILACS) were screened. Article selection and data abstraction were done in duplicate. No language or time restrictions were applied. Outcomes were visual-tactile or DIAGNOdent measurements. RESULTS Eleven studies with 1834 teeth being affected in 413 patients were included. Nine studies were randomized control trials, one a prospective cohort study, and one had an unclear study design. Meta-analysis could be performed for "resin infiltration vs. untreated control," "resin infiltration vs. fluoride varnish," and "resin infiltration without bleaching vs. resin infiltration with bleaching." WSL being treated with resin infiltration showed a significantly higher optical improvement than WSL without any treatment (standard mean difference (SMD) [95% CI] = 1.24 [0.59, 1.88], moderate level of evidence [visual-tactile assessment]) and with fluoride varnish application (mean difference (MD) [95% CI] = 4.76 [0.74, 8.78], moderate level of evidence [DIAGNOdent reading]). In patients with fluorosis, bleaching prior to resin infiltration showed no difference in the masking effect compared to infiltration alone (MD [95% CI] = - 0.30 [- 0.98, 0.39], moderate level of evidence). CONCLUSION Resin infiltration has a significantly higher masking effect than natural remineralization or regular application of fluoride varnishes. However, although the evidence was graded as moderate, this conclusion is based on only very few well-conducted RCTs. CLINICAL RELEVANCE Resin infiltration seems to be a viable option to esthetically mask enamel white spot lesions and fluorosis.
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Affiliation(s)
- S Bourouni
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland.
| | - K Dritsas
- Department of Orthodontics and Dentofacial Orthopedics, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - D Kloukos
- Department of Orthodontics and Dentofacial Orthopedics, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
| | - R J Wierichs
- Department of Restorative, Preventive and Pediatric Dentistry, zmk bern, University of Bern, Freiburgstrasse 7, 3010, Bern, Switzerland
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Singhania S, Nandlal B, Shanbhog R, Veeramani R. Resin infiltration and remineralization interventions in management of moderate dental fluorosis: A quantitative light-induced fluorescence-based randomized controlled trial. Indian J Dent Res 2021; 32:362-371. [PMID: 35229777 DOI: 10.4103/ijdr.ijdr_998_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Context Aesthetic concerns due to dental fluorosis (DF) considerably impact pyschosocial health in young children and requires aesthetic microinvasive treatment. Aims The aim of this study was to use quantitative light-induced fluorescence to evaluate two intervention protocols: microabrasion with resin infiltration and microabrasion with remineralization and assess which brings about more fluorescence gain; better colour masking and greater patient satisfaction among subjects with dental fluorosis. Methods and Material 120 maxillary central incisors with Grade 3 DF (Dean's Fluorosis Index) were randomly distributed into four groups: I-microabrasion + resin infiltration (fluorosis with stains); II microabrasion + remineralization (fluorosis with stains); III-microabrasion + resin infiltration (fluorosis without stains); IV microabrasion + remineralization (fluorosis without stains). At baseline, post-microabrasion and post-intervention Quantitative light-induced fluorescent images were captured. Fluorescence gain (ΔF) was analysed from the blue light images. The white light images were used to evaluate post intervention colour difference (ΔE = [(ΔL*) 2+(Δa*) 2+(Δb*) 2]1/2) and child satisfaction was evaluated. Statistical Analysis Used Collected data was analysed using repeated measures ANOVA and Independent t-test. Results Intra-group comparison of ΔF values showed statistically significant improvement in ΔF value in all the four groups (P < 0.001, 0.002). Inter-group comparison of ΔF values based on intervention showed statistically significant fluorescence gain (P < 0.004) indicating resin infiltration intervention being better than remineralization in unstained grade III fluorosis. The colour difference was statistically significantly better with resin infiltration in both stained and unstained Grade III DF (P < 0.001). Conclusions Resin infiltration intervention showed better fluorescence gain and colour masking compared to remineralization intervention.
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Affiliation(s)
- Shreepriya Singhania
- Department of Pediatric and Preventive Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education, Mysuru, Karnataka, India
| | - B Nandlal
- Department of Pediatric and Preventive Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education, Mysuru, Karnataka, India
| | - Raghavendra Shanbhog
- Department of Pediatric and Preventive Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education, Mysuru, Karnataka, India
| | - Ragavee Veeramani
- Department of Pediatric and Preventive Dentistry, JSS Dental College and Hospital, JSS Academy of Higher Education, Mysuru, Karnataka, India
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Divyameena B, Sherwood A, Rathna Piriyanga S, Deepika G. Clinical Performance of Enamel Microabrasion for Esthetic Management of Stained Dental Fluorosis Teeth. Oper Dent 2021; 46:15-24. [PMID: 32926733 DOI: 10.2341/19-248-c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2020] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE Enamel microabrasion is an effective first-line esthetic treatment for the removal of tooth stains due to fluorosis, with an improvement in the appearance of teeth that is associated with a high level of patient acceptance. SUMMARY
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Athayde GS, Jorge RC, Americano G, Barja-Fidalgo F, Soviero VM. Esthetic Management of Incisors with Diffuse and Demarcated Opacities: 24 Month Follow-up Case Report. Oper Dent 2020; 45:569b-574. [PMID: 32516394 DOI: 10.2341/19-206-s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2019] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE A minimally invasive esthetic treatment can provide longevity and color stability. SUMMARY This clinical case report describes a minimally invasive approach to mask diffuse and demarcated opacities in permanent anterior teeth in an eight-year-old child who was upset with the appearance of her incisors. Clinical examination showed diffuse opacities in teeth 7, 8, 9, and 10, diagnosed as dental fluorosis associated with yellow demarcated opacity in tooth 9 related to molar-incisor hypomineralization. The treatment was based on conservative dentistry using the low-viscosity resin infiltration technique and resin composite restoration in an attempt to mask the lesions. The follow-up time was 24 months.
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Raut AW, Mantri V, Gedam PV, Phabyani PP. Conservative esthetic management of severe dental fluorosis with in-office power bleaching. Ann Afr Med 2020; 19:211-214. [PMID: 32820736 PMCID: PMC7694703 DOI: 10.4103/aam.aam_52_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Fluorosis is an endemic disease, prevailing in about 25 countries globally. Dental fluorosis is an acquired defect of enamel due to the exposure of an individual to excessive fluoride levels during tooth development. It could result in mild-to-severe discoloration of teeth, which might necessitate esthetic correction. Bleaching is one of the common treatment modalities used in the esthetic correction of such cases. In-office power bleaching is one of the techniques of tooth bleaching that involves clinical application and activation of the bleaching agent with light to accelerate the bleaching process. This case report describes the esthetic correction of severe dental fluorosis by power bleaching, without any need for invasive treatment. This report suggests that in-office power bleaching is an effective and conservative method for esthetic correction of tooth discoloration in severe dental fluorosis.
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Affiliation(s)
- Ambar W Raut
- Department of Conservative Dentistry and Endodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Vijay Mantri
- Modern Dental College and Research Centre, Indore, Madhya Pradesh, India
| | - Priyanka V Gedam
- Department of Conservative Dentistry and Endodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
| | - Pooja P Phabyani
- Department of Conservative Dentistry and Endodontics, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India
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Knowledge and Management of First Permanent Molars with Enamel Hypomineralization among Dentists and Orthodontists. J Clin Pediatr Dent 2020; 44:20-27. [PMID: 31995422 DOI: 10.17796/1053-4625-44.1.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: Molar Incisor Hypomineralization (MIH) is a developmental enamel anomaly of systemic origin affecting the first permanent molars and often the permanent incisors. Despite MIH being a prevalent anomaly, its diagnosis and management are challenging for practitioners; including poor anesthesia, failure of restorations, rapid enamel breakdown, poor resin adhesion, and related child anxiety. This study aimed to evaluate knowledge regarding and management of MIH amongst orthodontists and dentists. Study design: The study was performed from March to September 2017 and included 336 dentists and 32 orthodontists. Questionnaires comprised questions on MIH diagnosis, socio-demographic characteristics of the subjects, and photographs of a case of MIH with related questions regarding management. Results: Our results showed that 48% of dentists and 25% of orthodontists misdiagnosed MIH; with misdiagnosis associated with graduation prior to 1986 (p < 0.001). Amongst dentists, 59% applied a fluoridated product and 34% applied fissure sealants in the case of moderate MIH. The application of fluoride was associated with graduation after 1986 (p < 0.0001).Conclusion: Large disparities about knowledge and management of MIH exist between dental practitioners in France. Education regarding diagnosis and management of MIH is necessary.
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Pan Z, Que K, Liu J, Sun G, Chen Y, Wang L, Liu Y, Wu J, Lou Y, Zhao M. Effects of at-home bleaching and resin infiltration treatments on the aesthetic and psychological status of patients with dental fluorosis: A prospective study. J Dent 2019; 91:103228. [PMID: 31704387 DOI: 10.1016/j.jdent.2019.103228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE This study aims to evaluate the effect of the combination approach of at-home bleaching (HB) and resin infiltration (RI) techniques on different severity degrees of dental fluorosis (DF) and further analyze the psychological changes caused by HB and RI in patients. METHOD Twenty-two patients (4 males, 18 females, 27.8 ± 1.6 yrs) with 186 fluorotic teeth were included in this study and classified into mild (N = 56), moderate (N = 100) and severe (N = 30) DF groups according to the Dean's index. The treatment effects on patients with DF were assessed by questionnaires including the changes in patients' subjective evaluation of their teeth and psychological status before and after treatments. Standardized digital photographs were taken at each time point of the treatment process, including baseline (T1), after bleaching (T2), immediately after RI treatment (T3) and more than six months after RI treatment (T4). The color alterations (ΔE) between the fluorotic (F2) and the surrounding relatively sound areas (F1) were analyzed. RESULTS Bad tooth appearance caused 13.64% of patients often depressed, frustrated, or disappointed, whereas 72.72% occasionally had these feelings. After treatment, the satisfaction of DF patients regarding tooth appearance increased from 0% (satisfied) to 58.82% (satisfied) and 23.53% (very satisfied). Moreover, these treatments improved all patients' confidence in smiling, laughing and showing their teeth. The percentage of fluorotic teeth with ΔE values more than 3.0 and 3.7 units decreased gradually from T1 stage to T3 stage in mild and moderate DF groups (p < 0.05), whereas the ΔE value in T3 stage was significantly lower than that of T2 stage in severe DF group (p < 0.05). In T4 stage, no significant difference was observed in the ΔE values between T4 and T3 stages (p > 0.05). CONCLUSION This study shows the obvious positive aesthetic effect of HB and RI treatment on different severity degrees of DF and the great improvements in psychological discomforts. CLINICAL SIGNIFICANCE The combination treatment of RI and low concentration HB gel improves the aesthetics of DF and may have a stable effect after 6-months follow-up, suggesting that this approach is a valuable clinical choice for dentists to treat DF.
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Affiliation(s)
- Zhouyan Pan
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Kehua Que
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China.
| | - Jie Liu
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Guangxu Sun
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Yi Chen
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Lisha Wang
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Yangqiu Liu
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Jiaxin Wu
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Yaxin Lou
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China
| | - Mengming Zhao
- Department of Endodontics, College of Stomatology, Tianjin Medical University, Tianjin, China
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