An new concept for removal of dental fluorosis stains

Dental hypomineralization treatment: A systematic review

INTRODUCTION

Defects in the maturation stage of amelogenesis result in a normal volume of enamel but insufficient mineralization, called hypomineralization. Molar-incisor hypomineralization (MIH), amelogenesis imperfecta and dental fluorosis (DF) are examples of such defects.

OBJECTIVE

To evaluate the effectiveness of the treatments applied to the different forms of dental hypomineralization.

MATERIALS AND METHODS

PubMed, Scopus, Cochrane Library, Web of Science, and Embase were screened. The research was limited to studies published in English, Spanish, and Portuguese, until May 30, 2018. The research question was formulated following the Population, Intervention, Comparison, Outcome strategy. The quality of the methodology of each article was evaluated employing the Cochrane Handbook for Systematic Reviews.

RESULTS

From the initial research, 7895 references were obtained, of which 33 were included in the systematic review. The following treatments were reported: desensitizing and remineralizing products, resin infiltration, restorations, fissure sealants, tooth bleaching, enamel microabrasion and calcium, and vitamins supplements.

CONCLUSIONS

Although the results are suggestive, there is a clear need for a greater uniformity of the methodologies, thus allowing for the development of clinical guidelines. Nevertheless, it was possible to identify several effective treatments for teeth with MIH (arginine pastes or fluoride varnishes) and DF (tooth bleaching and/or enamel microabrasion).

CLINICAL SIGNIFICANCE

Because MIH, amelogenesis imperfecta, and DF are commonly seen in dental daily practice, it is extremely important to analyze the literature regarding its treatment.

Bleaching of fluorosis stains using sodium hypochlorite

Fluorosis staining is commonly considered an esthetic problem because of the psychological impact of unesthetic maxillary anterior teeth. Numerous treatment approaches have been proposed, ranging from bleaching to enamel reduction to restorative techniques. Bleaching of hypomineralized enamel lesions, using 5% sodium hypochlorite, has been useful clinically. The technique described, in this case, appears to have advantages over other methods for improving the appearance of fluorotic lesions. It is simple, low cost, noninvasive, so the enamel keeps its structure, relatively rapid, and safe; it requires no special materials, and it can be used with safety on young permanent teeth.

White spots on enamel: treatment protocol by superficial or deep infiltration (part 2)

In this 2nd part, the current treatment of white spot lesions by erosion/infiltration is presented, beginning with a reminder of the principle of superficial infiltration, which enables most early carious lesions, fluorosis and post-traumatic lesions to be treated. However, this technique has met with frequent failures in cases of MIH or deep lesions of traumatic origin or those associated with fluorosis. For this reason a new deep infiltration technique is proposed: thanks to its global treatment concept, this enables all white spots to be treated. The place of whitening in these treatment options is discussed, with explanations of the main reasons for its failures.

Use of clinical bleaching with 35% hydrogen peroxide in esthetic improvement of fluorotic human incisors in vivo

AIM

The aim of the study was to evaluate esthetic improvement with the use of 35% hydrogen peroxide clinical bleaching as related to the different grades of enamel fluorosis in vivo and to study adverse effect of clinical bleaching with 35% hydrogen peroxide on teeth and gingiva.

MATERIALS AND METHODS

A total of 60 children of different grades of fluorosis were included in the study. With 35% hydrogen peroxide-based dual activated bleaching system, in-office vital teeth bleaching was carried out for each subject. Clinical evaluation for improvement in esthetics, effect on teeth and gingiva were performed for each child during preoperative, immediate postoperative and later 6 months postoperative period. For evaluation and comparison, all the collected data were subjected to statistical analysis.

RESULTS

Although in all the subjects, partial shade relapse was seen over a period of time, good homogeneous and esthetic results were seen in very mild and mild cases. A total of 35% hydrogen peroxide in-office bleaching has no adverse effect on teeth and gingiva.

CONCLUSION

Comparing all the three groups who participated in the study, 35% hydrogen peroxide in-office bleaching seems to be very effective in very mild and mild forms of fluorosis.

CLINICAL SIGNIFICANCE

In very mild and mild forms of fluorosis, in-office vital tooth bleaching with 35% hydrogen peroxide is the most conservative and effective approach in esthetic improvement.

Nonvital tooth bleaching: a review of the literature and clinical procedures

Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3-7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3-4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques.

Quantification of dental fluorosis using fluorescence imaging

Fluorescence imaging hardware and software have been recently employed to assess demineralization due to early dental caries. Dental fluorosis also presents as diffuse surface hypomineralization of enamel and in principle similar measurement methods might be applicable to both. The caries analysis system requires the user to select an area of sound enamel around the lesion so that the affected surface can be reconstructed and the lesion subtracted. Whereas early caries presents as discrete isolated lesions fluorosis is characterized by diffuse opacities covering most of the tooth. Consequently it is difficult to use commercial QLF software for the assessment of fluorosis, as there is typically no sound area of enamel to use for reconstruction. This study describes a fluorescent imaging device capable of recording digital images of the anterior teeth and also software that is able to objectively measure fluorosis area and severity. A convenience sample of 26 subjects with a range of fluorosis from TF scores 0-3 took part in the study. The upper left central incisor of these subjects was scored for fluorosis using the TF index, photographed using a conventional digital camera and imaged using the fluorescence imaging device. The TF index was then used to visually score the digital photographs and the fluorescence images. The data from the fluorescence method demonstrated a strong correlation with TF scores from fluorescence images (Kendall's tau = 0.862). The fluorescence imaging method shows promise as an objective, potentially blinded system for the longitudinal assessment of enamel fluorosis in vivo.