Alternative esthetic management of fluorosis and hypoplasia stains: blending effect obtained with resin infiltration techniques

The Effect of Resin Infiltration Technique on the Calculated Color Change of Demineralized Lesions of Different Severities

OBJECTIVE

To assess the color change of demineralized enamel lesions of different severities after resin infiltration using both clinical spectrophotometry and digital photography.

METHODS AND MATERIALS

Sixty sound human premolars were randomly divided into 3 groups according to the demineralization level. All the teeth were immersed in a demineralizing solution of a pH adjusted to 4.4 at 37°C. Three levels of demineralization were obtained (D1 shallow, D2 moderate, D3 deep) according to the demineralization time. The demineralized area was then infiltrated by low-viscosity resin (ICON, DMG, Germany). Two instrumental methods were utilized to assess the color difference, a clinical spectrophotometer and digital photography at three time points (sound, demineralized, and infiltrated enamel) to calculate the color difference between sound and demineralized enamel (ΔE1) and between sound and infiltrated enamel (ΔE2). Statistical analysis was performed by ANOVA, followed by Tukey's post hoc test. The correlation was analyzed using linear regression.

RESULTS

Two-way ANOVA showed statistically significant differences for both levels of the study (p≤0.05). The color change (ΔE1) and (ΔE2) for different demineralization levels showed statistically significant differences between all groups. For both clinical spectrophotometry and digital photography, D3 showed the highest difference followed by D2 and then D1. As for (ΔE1) calculations, digital photography had a significantly higher difference than spectrophotometry for the D1 group (5.47±0.93 vs 2.78±0.58). As for (ΔE2) digital photography had a statistically significantly lower difference than spectrophotometry (5.55±1.05 vs 6.48±0.76) for the D3 group.

CONCLUSIONS

Color correction after resin infiltration is affected by the demineralization level of enamel. Clinical spectrophotometry and digital photography can detect similarly the color change of demineralized enamel after resin infiltration in shallow and moderate demineralization. However, in deep demineralization clinical spectrophotometry tends to exaggerate the color change compared to digital photography.

Conservative esthetic management of brown enamel fluorosis using combination therapy: A clinical report

Dental fluorosis is caused by ingestion of excessive fluoride during tooth development resulting in hypomineralization of the enamel and can present as white or brown intrinsic lesions. This case report describes a combination of minimally invasive techniques: microabrasion, bleaching, and resin infiltration to address brown enamel fluorosis present on the maxillary anterior teeth of a young patient. Before resin infiltration, air microabrasion was targeted at subsurface lesions located on the maxillary central and lateral incisors, and chairside bleaching was done with 37% hydrogen peroxide (Opalescence). After which, hypoplastic lesions on the buccal surfaces were etched before being treated with two sessions of resin infiltration (ICON and DMG). Following treatment, satisfactory esthetic outcomes were achieved. Accurate diagnosis, depth of lesions, and understanding the effectiveness and limitations of each technique are essential to select the appropriate type of treatment to obtain the best esthetic outcome. In conclusion, the conservative management of varying severity of dental fluorosis may require the appropriate use of combination treatment modalities, such as microabrasion, bleaching and resin infiltration, when clinically indicated, to address the treatment needs and achieve a desired outcome.

Management of Hypoplastic or Hypomineralized Defects with Resin Infiltration at Pediatric Ages: Systematic Review

Hypoplastic or hypomineralized enamel defects represent a recurrent reason for consultation within the pediatric population, causing great discomfort due to their aesthetic appearance, as well as their functional limitations. Current conservative dentistry requires minimally invasive treatments in order to treat such defects and provide successful, definitive solutions. A systematic review of the literature has been carried out in accordance with the PRISMA recommendations. A search was carried out in the PubMed, Scopus, SciELO and Web of Science databases, completed with a manual search. The following variables were extracted from the selected studies: author, year, publication journal, type of study, sample, age of the participants and the materials used for its development. From the initial electronic search of the four databases, 282 articles were identified: 34 from PubMed, 240 from Scopus, 0 from SciELO and 8 from Web of Science. After eliminating duplicate articles, a total of 225 remained. After reading the title and abstract, 158 articles were eliminated, leaving 68. Upon reading the full text, the remaining studies were eliminated for not answering the research question or the inclusion criteria, leaving a total of 13 articles. Finally, 12 articles were used to carry out the systematic review. Treatments performed to date with the ICON™ system in pediatric patients have shown good results after their application. Since the variability of diagnostic methods has been observed, new diagnostic and assessment protocols should be created after treatment to objectify their effect on hypoplastic or hypomineralized enamel defects. In the same way, it has been described that treatment provides better results if combined with other opalustre-type or remineralizing materials. This review is registered in PROSPERO with the number CRD42021288738.

Management of Enamel Defects with Resin Infiltration Techniques: Two Years Follow Up Retrospective Study

Background: Developmental Defects of Enamel (DDE) represent an aesthetic, functional, and often psychological problem, especially in young patients. Infiltrative treatment with resin (Icon-DMG, Hamburg, Germany) is a minimally invasive technique based on the infiltration of high viscosity resin inside the hypomineralized enamel, modifying its optical properties. The aim of this paper is to evaluate the clinical efficacy of superficial infiltration in the treatment of white enamel defects of the anterior sector with pre-eruptive etiology and its stability over time. Methods: Thirty-three patients affected by DDE associated with mild and moderate Molar Incisor Hypomineralization (MIH), mild and moderate fluorosis, and post-traumatic hypomineralization treated with resin infiltration were retrospectively retrieved. Results: In all cases an improvement in aesthetic appearance was achieved, and the 24-month follow-up confirmed the stability of the results. However, in the cases of traumatic hypomineralization the results were not completely satisfactory. Conclusions: The superficial infiltration technique can be considered a valid minimally invasive alternative to traditional treatment of mild or moderate fluorosis and mild MIH.

Effect of different surface treatments on the microhardness and colour change of artificial enamel lesions

BACKGROUND

To investigate the effect of three different surface treatments on the microhardness and colour change of artificial enamel lesions.

MATERIALS AND METHODS

One hundred bovine teeth were randomly assigned into four groups. Artificial enamel lesions were created using demineralizing solution for all groups except the sound enamel group. Different surface treatments were then performed G1: resin-infiltrant; G2: Casein phosphopeptide-amorphous calcium phosphate (CPP-ACP); G3: artificial saliva; G4: Sound Enamel. Each group was subdivided into three subgroups, where each subgroup was subjected to a different testing method. Subgroup 1: surface microhardness; subgroup 2: cross-sectional microhardness; subgroup 3: colour measurement. Statistical analysis was performed by ANOVA, followed by Tukey's post hoc test.

RESULTS

Sound enamel group recorded the highest surface and cross-sectional microhardness results. No significant difference was found between the resin-infiltrant group and CPP-ACP regarding surface and cross-sectional microhardness at different lesion depths. Resin-infiltrant group showed the least colour change (∆E) results compared to the other groups.

CONCLUSION

Resin-infiltrant can effectively enhance surface microhardness and enamel resistance to demineralization, additionally, reduces the staining susceptibility of white spot lesions (WSLs) after treatment. CPP-ACP application for 4 weeks seems to improve surface microhardness; however, has a limited effect in resisting staining of WSLs after treatment. © 2022 Australian Dental Association.

Enamel Developmental Defect Masking on Central Incisor with Infiltrant Resin

The aim of this paper is to present a case of masking of a hypoplastic lesion using the infiltrating resin technique, without use of drilling or any loss of tooth structure. A 22-year-old female patient complained of a noncarious white spot on the buccal surface of the upper right central incisor which affected the esthetics of her smile. Despite the tooth discoloration, the tooth structure was intact, with no depressions, cracks, or grooves. During the anamnesis, she reported that the white spot had been present since childhood. On the basis of the information provided by the patient and collected during intraoral clinical examination, it was determined that the stain was suggestive of enamel hypoplasia. The treatment proposed to the patient was the application of infiltrating resin to mask the hypoplasia on the surface of the tooth enamel without any loss of tooth structure. In this case, Icon infiltrating resin proved to be efficient in masking the hypoplastic lesion. The final appearance of the treated tooth was satisfactory, with homogeneity and gloss on the surface, which minimized the characteristics of an unpleasant smile.

Application of computer-assisted dynamic navigation in complex root canal treatments: Report of two cases of calcified canals

Root canal treatment and non-vital bleaching of teeth with pulp canal obliteration may represent a complex challenge to the clinician. This report describes the usefulness of the computer-assisted dynamic navigation system for the root canal treatment of two cases of teeth with a history of traumatic injury, extensively obliterated root canals and crown discoloration. Clinical and cone-beam computed tomographic evaluations were completed prior to procedures and 12 months after treatment. Both cases were treated using a computer-assisted dynamic navigation system coupled to a high-speed handpiece in order to establish the location and orientation of the partially obliterated canal and endodontic access route planning. The system allowed an accurate localisation of the root canal with a conservative access cavity. At the 12-month recall examination, the patients continue to be symptom-free, with a normal appearance of the mucogingival complex, adequate restoration of the tooth colour and intact periapical structures.

Esthetic and Functional Rehabilitation of an Adolescent Patient with Severe Dental Fluorosis: A Clinical Report

Dental fluorosis is a developmental defect affecting amelogenesis. It presents clinically in different forms depending on the concentration, duration, and time of exposure to fluoride. Several therapeutic modalities have been described to manage mild and moderate forms of dental fluorosis; however, limited literature is available on the restorative management of severe forms of dental fluorosis, specifically in young individuals. This clinical report describes a complete prosthodontic rehabilitation of an adolescent patient with severe dental fluorosis affecting his permanent dentition. The patient was treated with a combination of monolithic, minimally-veneered zirconia crowns and direct composite resins. At the 1-year follow-up appointment, there were no complications, and both the patient's oral health and the integrity of the restorations remained stable.

Resin infiltration in white spot lesions caused by orthodontic hypomineralisation: a minimally invasive therapy

Objective White spot lesions are characterised by the presence of clinically detectable opaque lesions due to enamel demineralisation. These frequently present in patients following fixed orthodontic treatment, mostly due to the prolonged accumulation of bacterial plaque on the dental surface. When remineralisation is not achieved through good oral hygiene and prophylaxis with fluoride products, the infiltration of lesions with low-viscosity photopolymerised resin has proved to be a valid micro-invasive alternative compared to traditional conservative therapy.Clinical considerations A case series will be presented, where the chosen approach was resin infiltration, a micro-invasive and aesthetic technique.Clinical significance Infiltrative resin therapies are single-session procedures that reduce the need for more invasive therapies such as the use of rotary instruments for greater patient comfort. The need for periodic fluoride applications is also avoided. This approach increases the durability of the infiltrated lesion without compromising its mechanical properties and impedes the development of recurrent or secondary caries.Conclusions Resin infiltration might be considered as a routine procedure in the treatment of post-eruptive hypomineralised lesions. This follows the line of thought of minimally invasive dentistry, is an excellent treatment option and prevents the lesion's progression.

Oral care product formulations, properties and challenges

This review explores the physical, chemical and structural properties of key components of oral care products, whilst looking at the challenges which need to be overcome to continue to improve the efficacy of oral care, and improve dental health. Oral care has been an essential part of all populations and cultures around the world for thousands of years. To maintain good oral health, dental plaque causing bacteria and malodour must be controlled whilst also strengthening and protecting the teeth to prevent dental caries. Advanced modern formulations need to provide controlled and extended release of ingredients vital for dental health. With modern day products such as toothpastes and mouthwashes, it has never been easier to maintain good oral hygiene and health, yet the incidence of dental caries is still on the rise. The complex formulations of modern toothpastes and mouthwashes makes them one of the most sophisticated pharmaceutical products on the market today. The demands of the consumer coupled with the complexity of the oral cavity make it one of the most challenging development processes.

Resin Infiltration in Dental Fluorosis Treatment-1-Year Follow-Up

Background and objective: Dental fluorosis is a disease affecting dental hard tissues featured with white or yellowish lesions. Several treatments are proposed in the literature, some even invasive. This clinical study aimed to evaluate the effectiveness of resin infiltration in terms of lesions resolution, trend of sensitive teeth and satisfaction of patients over time. Methods and material: 200 fluorosis lesions were treated using ICON infiltrating resin (DMG, Hamburg, Germany). Parameters related to patients were collected by a questionnaire and analyzed aesthetic dissatisfaction about lesions, Shiff Air Index Sensitive Scale, sensitive teeth after treatment, the satisfaction of duration of treatment. The same operator measured dimensions of lesions Tooth Surface Index of Fluorosis (TSIF) and numbers of etching cycles needed for treating lesions. Statistical analysis was performed. The follow-up was of 1-year a measurement were performed at baseline (t0), immediately after the treatment (t1) and every three months during the observation period. Results: All lesions disappeared after one treatment. Pain or sensitive teeth were reported inside the 72 h and they disappeared after. Statistical analysis showed highly statistically correlation between etching cycles and the dimension of lesions and TSIF at the time-points evaluated as well as for pain during treatment, whereas a statistical significance was not noticed where etching cycles were correlated to sensitive teeth after 72 h. Overall, the treatment was found to be statistically significantly associated with differences in answers of aesthetic dissatisfaction between t0 and t1 and those collected between t1 and t2. Between t2 and t3 and between t3 and t4 no statistical differences were found in answers of patients about dissatisfaction, indicating the stability of the results. Conclusions: The ICON resin infiltration technique was found to be effective in lesions resolution with steady results.

Esthetic management of white spot lesions by using minimal intervention techniques of bleaching and resin infiltration: A clinical report

Dental fluorosis and hypocalcification manifest as white spot lesions and/or brown discolorations. With dental fluorosis, mottled layers in enamel can also be present depending on severity. Treatment options have varied in such situations, depending on severity, and can range from conservative to more invasive. This clinical report focuses on a combination of bleaching and resin infiltration as one of the more conservative treatment options.

Diagnosis and treatment options for anterior white spot lesions

White spot lesions on teeth present as white opacities due to enamel surface and/or subsurface demineralisation. Unfortunately, dentistry has seen a marked jump in prevalence and severity of white spot lesions over the past decade. In response to the rise in white spot lesions, the dental industry has been pushed to create less invasive alternatives for the removal of these lesions, particularly when located anteriorly. There are numerous different causes of white spot lesions that influence how the enamel substructure is affected and which treatment option is selected. Once, the only treatment option for white spot lesions was drilling the defects away, but with a better understanding of the science and the aetiology, we have now been able to create minimally invasive, preventive alternatives. It is vital that the cause, size and depth of the white spot lesions are ascertained before providing treatment options to a patient, as treatment results will vary depending on the enamel substructure available. This paper will explore the main causes of white spot lesions and the recommended treatments for them.

Spectrophotometric Evaluation of Color Change in Tooth Enamel Defects Using Resin Infiltrate: An In Vivo Study

Aim

To analyze the comparative change in pretreatment and posttreatment La*b* values of color in initial nonpitted white spot lesions of fluorosed teeth after resin infiltration with DMG-Icon spectrophotometrically with VITA easy shade.

Materials and methods

A total of 30 maxillary and mandibular permanent anterior teeth with mild, nonpitted white spot lesions (atleast one) of fluorosis [till grade IV of Thylstrup and Fejerskov (TF) index] in patients between 6 years and 14 years of age were included in the present study. Shade of selected tooth and its white spot lesion area was recorded using VITA 3D shade guide, both pre and postoperatively, i.e., after application of DMG Icon. This was followed by recording the change in corresponding La*b* values of tooth shade and white spot lesion spectrophotometrically using VITA Easy Shade. Results obtained were analyzed statistically.

Results

ΔE value of color change was found to be less than 3.7 in most of samples after resin infiltration and esthetically color change to naked eye was statistically significant (p value < 0.00001) postoperatively.

Conclusion

Resin infiltration with DMG Icon can improve the color of non-cavitated white spot lesions. The esthetic effect of this treatment was evident immediately after treatment. Moreover, no cavitation occurred after etching, even when the surface layer had been eroded completely.

Clinical significance

Achievement of esthetic results without loss of tooth structure and postoperative sensitivity.

How to cite this article

Dogra S, Goyal V, Gupta A, et al. Spectrophotometric Evaluation of Color Change in Tooth Enamel Defects Using Resin Infiltrate: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(2):150–154.

Influence of the mode of application of universal adhesive systems on adhesive properties to fluorotic enamel

The objective of this study is to compare the resin-enamel bond strength (mμSBS), in-situ degree of conversion (DC), and the enamel-etching pattern (SEM/EDX) of universal adhesive systems when applied to sound and fluorotic enamel. Ninety-eight human molars were sectioned into 4 parts and divided into 24 groups according to 1) enamel surface (sound or fluorotic enamel), 2) adhesive system (Clearfil Universal Bond [CUB], Futurabond U [FBU], iBond Universal [IBU], and Scotchbond Universal [SBU]), and 3) application mode (etch-and-rinse [ER], active self-etch [Active-SE], and passive self-etch [Passive-SE]). Specimens were stored at 37 °C, for 24 hours and tested at 1.0 mm/min (μSBS). Enamel-resin interfaces were evaluated for in-situ DC. The enamel-etching pattern was evaluated under a SEM/EDX. Data from mμSBS and in-situ DC was analyzed using a three-way ANOVA and Tukey's test at 5 % level of significance. For all adhesives, the ER resulted in a statistically significant higher mean mμSBS than the passive-SE in both substrates (p < 0.001). For all adhesives, active-SE resulted in mean mμSBS (p > 0.31) and in-situ DC (p > 0.45) that were statistically similar to those obtained with the ERs in both substrates. A statistically significant, higher mean mμSBS and in-situ DC were obtained in sound enamel (p < 0.001) than in fluorotic enamel. In general, SBU showed higher mean values for mμSBS and in-situ DC compared to those of CUB and IBU (p < 0.001). ER and active-SE showed the deepest enamel-etching pattern in both substrates. A higher amount of fluor was observed in fluorotic enamel. The active application of universal adhesives in the SE-mode may be a viable alternative to increase the adhesive properties in sound and fluorotic enamel.

Color Masking White Fluorotic Spots by Resin Infiltration and Its Quantitation by Computerized Photographic Analysis: A 12-month Follow-up Study

OBJECTIVE

To manage three cases of mild to moderate fluorosis by resin infiltration technique and to quantify the tooth color changes by measuring CIE L*a*b* values of digital photographs and calculating ΔE₀₀ based on the CIEDE2000 formula using Adobe Photoshop software.

METHODS AND MATERIALS

Three cases of mild to moderate fluorosis were treated with a combination of bleaching and a resin infiltration technique. CIE L*a*b* values of 18 fluorosed spots were measured from digital photographs of these cases at four different stages-preoperative, postbleaching, postinfiltration and at 12-month follow-up-using Adobe Photoshop software, and ΔE₀₀ was calculated based on the CIEDE2000 formula. The ΔE₀₀ values of all 18 points obtained at different stages were submitted to statistical analysis (α=0.05).

RESULTS

In all the cases reported, clinically as well as by the photographic color analysis, it was found that the technique masked the lesions, improving the patients' esthetics, which was maintained even at 12-month recall. Statistically significant difference in ΔE₀₀ values was present between comparison of all stages (p<0.001) except between postinfiltration and the 12-month follow-up stage (p=0.642).

CONCLUSION

A resin infiltration technique helped in the satisfactory management of white spot lesions of fluorosis, which were stable even at 12-month follow up. Quantitation of the changes was achieved using Adobe Photoshop software.

A comparison of the effectiveness of resin infiltration and microabrasion treatments applied to developmental enamel defects in color masking

This study aimed to evaluate color masking effect from treatments with resin infiltrant and two different remineralization agents applied with microabrasion to anterior teeth with developmental enamel defects. The incisors of patients aged 8-17 were evaluated. The study involved two groups including fluorosis (Group 1) and hypomineralization (Group 2) cases. These two groups were further divided based on the treatment received: Group A: Icon^®, Group B: Opalustre^®+Clinpro White Varnish^®, and Group C: Opalustre^®+Tooth Mousse^®. The spectrophotometric values were recorded. Furthermore, the L* and ΔE values were evaluated by repeated measures of ANOVA. The largest increase in L* values over time after treatment was in Group 1A, followed by Group 1C and Group 1B. The largest increase in ΔE values over time after treatment was in Group 1A. Clinically observable difference was achieved as a result of all treatment groups. Especially resin infiltration treatment has been found to be more effective in teeth with fluorosis.

Aesthetic treatment of dental fluorosis in a 9-year-old girl: Case report

Background/Aim: Dental fluorosis is a specific disturbance of tooth formation caused by excessive intake of fluoride. The discoloration of teeth is the most common reason for parents to seek treatment. The purpose of this paper is to describe the therapeutic management performed in a 9-year-old girl with fluorosis. Case report: A clinical case of a 9-year-old girl diagnosed with fluorosis is reported. The treatment of this clinical case was achieved using microabrasion, which is a minimally invasive method. This technique improves the aesthetics of the teeth without causing significant loss of dental tissue; a characteristic making microabrasion applicable to children as well. Its implementation involved the combined use of 18% hydrochloric acid and pumice on the enamel surface of upper incisors. The improved appearance of the teeth was aesthetically pleasing and, consequently, the patient gained in self-confidence. Conclusions: In the literature, several treatment choices are proposed, depending on the severity of the fluorosis. In our case, microabrasion was applied and the aesthetic outcome satisfied both the patient and the dentist.

Is Resin Infiltration a Microinvasive Approach to White Lesions of Calcified Tooth Structures?: A Systemic Review

Aim

The treatment of white lesions should aim at arresting the lesion progression of carious lesions and improving the esthetics by diminishing the opacity of the developmental disturbances of a tooth. The objective of this review was to present the scientific basis, the principles of resin infiltration and to discuss its inherent clinical applications.

Data sources

Data were identified by PubMed searches. Papers published in English between 2010 and 2015 were selected and most up-to-date or relevant references were chosen.

Conclusion

The resin infiltration technique, while promising, needed more clinical evidence for conclusive findings. However, based on available laboratory and clinical studies, it seems convincing that resin infiltration of enamel lesions should aim at arresting the progression of white spot lesions. Combining this microinvasive approach with a substantial caries remineralization program may provide therapeutic benefits and significantly reduce both long term restorative needs and costs, thus complementing the concept of minimum intervention dentistry.

How to cite this article

Manoharan V, Kumar AS, et al. Is Resin Infiltration a Micro invasive Approach to White Lesions of Calcified Tooth Structures?: A Systemic Review. Int J Clin Pediatr Dent 2019;12(1):53-58.

Testing the Clinical Applicability of Resin Infiltration of Developmental Enamel Hypomineralization Lesions Using an In Vitro Model

Aim

The aim of this study is to investigate the penetration abilities of a commercially available low-viscosity resin infiltrant into developmentally hypomineralized teeth in vitro.

Materials and methods

Four extracted third molars of a 17-year-old patient with signs of developmental enamel hypomineralization (discoloration, increased opacity, and surface roughness) were infiltrated with a low-viscosity resin mixed with a fluorescent dye, according to the manufacturer's standard protocol. Four extracted molars with sound enamel or showing only initial fissure caries were used as a control group. Specimens were embedded in polymethylmethacrylate, and grindings were prepared. High-resolution projectional radiography of the grindings was performed, and, for one specimen, quantitative micro-computed tomography was used to measure hydroxyapatite density in enamel and dentin lesions. After decalcification, the grindings were examined by reflected bright-field microscopy, wide-field fluorescence microscopy, and confocal laser scanning microscopy. Fluorescence micrographs were superimposed on the radiographs and analyzed correlatively.

Results

The pattern of hypo-/demineralization in enamel and dentin in developmentally hypomineralized teeth showed a good congruence with the pattern of resin infiltration. Cavitations and dentin tubules up to a depth of 2 mm beyond cavitations were filled by the infiltrant. In control teeth, the penetration of the infiltrant was limited to decalcified enamel areas (initial fissure caries).

Conclusions

In vitro infiltration of developmentally hypomineralized enamel was successful.

Clinical significance

Resin infiltration might be considered as a routine procedure in the treatment of developmentally hypomineralized teeth. Further investigations with higher sample sizes, different degrees of severity, different stages of lesion extension, and modified treatment protocols are necessary.

How to cite this article

Schnabl D, Dudasne-Orosz V, et al. Testing the Clinical Applicability of Resin Infiltration of Developmental Enamel Hypomineralization Lesions Using an In Vitro Model. Int J Clin Pediatr Dent 2019;12(2):126-132.

Power bleaching enhances resin infiltration masking effect of dental fluorosis. A randomized clinical trial

OBJECTIVES

Patients with moderate dental fluorosis often feel esthetically compromised. Aim of this RCT was to evaluate the objectively and self-assessed masking effect of resin infiltration alone or in combination with in-office bleaching on dental fluorosis in adults.

METHODS

Twenty-seven patients (9 male, 18 female, 24.81 ± 3.7 yrs) with 410 fluorotic teeth (TF 1-4) were randomly assigned to a treatment (BLI) or control group (NBLI). Patients underwent in-office bleaching (25% H₂O₂) in the BLI or a placebo bleaching (ACP gel) in the NBLI group followed by resin infiltration after two weeks. Standardized digital photographs were obtained at baseline; after bleaching; before and after resin infiltration and after 1, 3, and 6 months. Color differences (ΔE) between sound and fluorotic areas were calculated and patient satisfaction was evaluated using a VAS (1-10).

RESULTS

Statistical analysis revealed significant differences in the mean ΔE values 6 months after resin infiltration between the BLI (ΔE = 1.41) and the NBLI group (ΔE = 4.33) (p = 0.024). VAS values increased after resin infiltration (p < 0.05) in both groups. After 3 months patients in the BLI group had higher VAS values than in the NBLI group (p = 0.029).

CONCLUSIONS

Findings of this study suggest that resin infiltration alone can effectively mask mild to moderate dental fluorosis in young adults. In-office bleaching with 25% H₂O₂ before resin infiltration provides significantly better masking effects.

CLINICAL SIGNIFICANCE

Resin infiltration is a safe and efficient treatment option for masking fluorotic opacities. A priori in-office bleaching with 25% H₂O₂ enhances the masking effect. This controlled clinical trial is registered in the German Clinical Trials Register #DRKS00010465.

Minimally Invasive Approach for Improving Anterior Dental Aesthetics: Case Report with 1-Year Follow-Up

Dental aesthetics have become highly important in recent years. Treating aesthetic demands with noninvasive or minimally invasive techniques can preserve the natural tissues. A 20-year-old female patient presented to the clinic with aesthetic concerns. After the clinical and radiographic examinations, hypomineralization was identified in the maxillary anterior teeth except the maxillary right canine. An external discoloration was also identified in the maxillary left canine tooth. Moreover, the right canine tooth was identified as a Turner's tooth according to the patient's anamnesis. The resin infiltration technique was applied to the maxillary anterior teeth except the maxillary right canine. The bleaching treatment was applied to the maxillary left canine tooth. Then, a laminate veneer restoration was applied to the upper right canine tooth with Turner's hypoplasia. Following the treatment, a satisfactory aesthetic restoration was achieved. After 1-year examination, no clinical failures were observed.

A Combined Approach for the Aesthetic Management of Stained Enamel Opacities: External Bleaching Followed by Resin Infiltration

Stained enamel opacities are frequently encountered in dental practice. However, due to the risk of unaesthetic outcome, managing such lesions by resin infiltration techniques alone is not advised. Therefore, performing external bleaching before resin infiltration procedure is mandatory to eliminate stains from the hypomineralized lesions in order to aesthetically infiltrate them. In this work, we describe clinical cases in which external bleaching and resin infiltration techniques were used for managing stained enamel hypomineralized lesions related to traumatic dental injuries and molar incisor hypomineralization. Despite the fact that this approach has some limitations, it could be concluded that external bleaching associated with the resin infiltration technique shows promising results to aesthetically manage stained enamel opacities when the stain is totally removed after bleaching.

Different applicabilities of the etch-bleach-seal technique for treating opacities on permanent incisor damage by molar incisor hypomineralisation in three young patients

Enamel opacity on anterior teeth can be prejudicial for the aesthetic appearance of affected patients. Patients with molar incisor hypomineralisation, for example, present opacities that can range from discrete white mottling to extensive yellow-brown discolourations. They can request a treatment to improve their aesthetic conditions. Many techniques have been considered to manage this condition. Wright developed a technique called etch-bleach-seal, which showed promising results for the management of anterior enamel opacities. The aims of this report are to present this technique and to analyse its benefits and inconveniences.

Amelogenesis Imperfecta: A Non-Invasive Approach to Improve Esthetics in Young Patients. Report of Two Cases

Objective-Evaluate esthetic and functional efficacy of infiltrant resin (Icon, DMG, Hamburg, Germany) in Amelogenesis Imperfecta's treatment.

STUDY DESIGN

Two adolescent patients, G.S. (13 years old) and C.M. (15 years old), affected by the hypomaturation type of Amelogenesis Imperfecta, were treated with Icon resin and were followed for twelve months.

RESULTS

Treated teeth show an excellent aesthetical result immediately after the resin application, effect that lasts in the long-term (six and twelve months follow-up examinations); the dental wear's progression seems to be clinically arrested.

CONCLUSIONS

Resin infiltration has proven to be a minimal invasive treatment for dental discoloration, less aggressive than conventional procedures. This approach might be recommended for a stable esthetical improvement in moderate AI's lesions especially in children and adolescents.

Comparative evaluation of esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in-office bleaching, and combination therapies

OBJECTIVES

Dental fluorosis leads to esthetic deviation and varies from nonpitted white opacities, dark brown stains to pitting or structural breakdown of enamel surface. Treatment for fluorosis depends on the severity of condition and includes both noninvasive methods and invasive methods. Recently resin infiltration has been proposed as an alternative treatment for nonpitted fluorosis. This study was done to evaluate the esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in-office bleaching and combination therapies.

MATERIALS AND METHODS

The present study is a randomized, single blinded controlled trial with four parallel arms with 1:1 allocation ratio. The intervention arms included bleaching with 35% hydrogen peroxide, resin infiltration, resin infiltration with increased infiltration time and a combination approach of bleaching and infiltration. Immediate esthetic changes were evaluated for two parameters including, 'Change in esthetics' and 'Improvement in opacities/stains' using a VAS scale by two independent observers. Kruskal-Wallis test and Mann-Whitney U-test were done for intergroup comparisons.

RESULTS

Best results for both the parameters were observed among patients treated with resin infiltration with increased infiltration time. Mann-Whitney U test revealed significantly better results for resin infiltration groups (alone or combination with bleaching) as compared to bleaching alone (P < .001).

CONCLUSIONS

Resin infiltration procedure with tailored etching times and increased infiltration time exhibited best results in terms of change in esthetics and improvement in stains.

CLINICAL SIGNIFICANCE

White and brown opacities due to fluorosis have always been a concern for esthetics. In our study, resin infiltration technique with tailored etching times and increased infiltration time exhibited best immediate esthetic improvement for nonpitted fluorotic opacities and stains. These esthetic outcomes reaffirm the applicability of RI technique for nonpitted fluorosis, which was originally advocated only for white spot lesions due to early caries. This will in turn help the dentists to plan the esthetic management of nonpitted fluorosis in a micro-invasive manner.

Treatment of Fluorosis Spots Using a Resin Infiltration Technique: 14-month Follow-up

The aim of this study was to report a clinical case of moderate fluorosis spots treated with infiltration of low-viscosity resin. A commercial resin was applied to the facial surfaces on the anterior teeth in both the maxillary and mandibular arches. The white spots of fluorosis lost their whitish appearance and appeared similar to sound enamel. This technique, which might constitute an alternative to white-masking of fluorosis spots, showed optimal esthetic results.

Hydrolytic and Color Stability of Resin Infiltration: A Preliminary in vitro Trial

AIMS

Resin infiltration is an emerging technique for management of noncavitated lesions. This study evaluated the in vitro hydrolytic and color stability of the ICON® resin infiltration system (IC) in 42 extracted human teeth.

MATERIALS AND METHODS

ICON® resin infiltration system was compared with dental adhesive (DA) and dental sealant (DS). The products were applied according to manufacturer's instructions. The baseline weight and color of the samples were recorded. Color was recorded by spectoral colorimeter. The samples were subjected to four experimental conditions: (1) group 1: Stored in lactic acid solution (pH 4.9) for 24 hours; (2) group 2: Thermocycled for 100 cycles (temperatures: 5°C, 55°C, and dwell time of 15 seconds); (3) group 3: Stored in 0.1 N sodium hydroxide solution (pH 12.48) for 14 days at 60°C; (4) group 4: Stored in phosphate-buffered saline solution (pH 7.2) at 37°C for 4 months. The weight and color were recorded again after removal of the samples from the experimental conditions. Two-factor analysis of variance models and Tukey's Honestly Significant Difference were performed to assess statistical differences among the groups. Scanning electron microscopy imaging was performed for samples from groups 1, 3, and 4.

RESULTS

All the samples showed loss of material and change in color. In the demineralizing solution, IC showed significantly greater weight loss (p = 0.032) and color change (p = 0.038) compared with DA. Dental Sealant showed significantly greater weight loss than IC (p = 0.027) after thermocycling. Teeth in group 3 exhibited the greatest weight loss (p < 0.001). Teeth in group 2 exhibited the greatest color change (p < 0.001).

CONCLUSION

All tested materials showed loss of retention and color change in the experimental conditions. Infiltration system exhibited greatest weight loss and color change in demineralizing solution. Dental sealant exhibited greatest weight loss upon thermocycling.

CLINICAL SIGNIFICANCE

Clinicians should be cautious about the limitations of retention and color stability when considering resin infiltration for incipient lesions.

Camouflage effects following resin infiltration of postorthodontic white-spot lesions in vivo: One-year follow-up

OBJECTIVE

To assess camouflage effects by concealment of postorthodontic white-spot lesions (WSLs) to sound adjacent enamel (SAE) achieved over 12 months with resin infiltration (Icon, DMG, Hamburg, Germany).

METHODS

Twenty subjects (trial teeth nteeth = 111) who had received resin infiltration treatment of noncavitated postorthodontic WSLs were contacted for a 1-year follow-up assessment of CIE-L*a*b* colors (T12). Color and lightness (CIE-L*a*b*) data for WSLs and SAE were compared to baseline data assessed before infiltration (T0) and those assessed after 6 months (T6), using a spectrophotometer. The target parameter was the difference between the summarized color and lightness values (ΔEWSL/SAE). Intergroup (WSL, SAE) and intertime comparisons (T0 vs T6, T12) were performed using paired t-tests at a significance level of α = 5%.

RESULTS

Nine subjects (trial teeth nteeth = 49; male/female ratio 5/4; age range 13-19 years) were available at T12. After the highly significant reduction of ΔEWSL/SAE discrepancies between T0 and T6, analysis of 12-month records revealed color and lightness discrepancy of WSL vs SAE that was significantly decreased compared with baseline, indicating an assimilation of WSL color to SAE appearance after infiltration, while an additional reduction of discrepancies between T6 and T12 was not significant.

CONCLUSION

As color and lightness characteristics of the Icon infiltrant as well as the esthetic camouflage effects achieved by WSL infiltration were not altered significantly or clinically relevant after 12 months, the method of resin infiltration can be recommended for an enduring esthetic improvement of postorthodontic WSL.

Enamel microabrasion: An overview of clinical and scientific considerations

Superficial stains and irregularities of the enamel are generally what prompt patients to seek dental intervention to improve their smile. These stains or defects may be due to hypoplasia, amelogenesis imperfecta, mineralized white spots, or fluorosis, for which enamel microabrasion is primarily indicated. Enamel microabrasion involves the use of acidic and abrasive agents, such as with 37% phosphoric acid and pumice or 6% hydrochloric acid and silica, applied to the altered enamel surface with mechanical pressure from a rubber cup coupled to a rotatory mandrel of a low-rotation micromotor. If necessary, this treatment can be safely combined with bleaching for better esthetic results. Recent studies show that microabrasion is a conservative treatment when the enamel wear is minimal and clinically imperceptible. The most important factor contributing to the success of enamel microabrasion is the depth of the defect, as deeper, opaque stains, such as those resulting from hypoplasia, cannot be resolved with microabrasion, and require a restorative approach. Surface enamel alterations that result from microabrasion, such as roughness and microhardness, are easily restored by saliva. Clinical studies support the efficacy and longevity of this safe and minimally invasive treatment. The present article presents the clinical and scientific aspects concerning the microabrasion technique, and discusses the indications for and effects of the treatment, including recent works describing microscopic and clinical evaluations.

Resin infiltration of non-cavitated caries lesions: a systematic review

OBJECTIVE

The aim of this systematic review was to evaluate the in vivo scientific evidence of the ability of resin infiltration (RI) to arrest non-cavitated caries lesions.

MATERIALS AND METHODS

The PubMed database was searched for randomized controlled trials that evaluated the in vivo effect of RI versus placebo or other preventive treatment on the progression of caries lesions. The keywords used were 'resin infiltration, dental caries', 'resin infiltration, carious lesions', 'resin infiltration, caries lesions', 'caries infiltration' and 'Icon DMG' with the 'clinical trial' filter activated. Among the 14 articles originally identified with these keywords, only 4 (related to 3 different in vivo studies) were included for this review.

RESULTS

All 4 articles reported on proximal caries lesions. One study had been conducted on 48 high-caries-risk children while the other 3 (n = 22, 22 and 39, respectively) concerned moderate- and low-caries-risk adolescents and adults. The quality of the studies was assessed to be high with respect to randomization, split-mouth design and blinding. All the included studies showed significant differences in caries progression between test and control/placebo groups, indicating that RI may inhibit the carious process.

CONCLUSION

This systematic review revealed that RI appeared to be an effective method to arrest the progression of non-cavitated caries lesions. Additional, long-term studies are required.

Color masking of developmental enamel defects: a case series

Developmental defects involving color alteration of enamel frequently compromise the esthetic appearance of the tooth. The resin infiltration technique represents an alternative treatment for color masking of these lesions and uniformization of tooth color. This technique is considered relatively simple and microinvasive, since only a minimal portion of enamel is removed. This article illustrates the color-masking effect with resin infiltration of fluorosis and traumatic hypomineralization lesions with a case series. The final esthetic outcomes demonstrated the ability of the resin infiltrant to mask the color of white developmental defect lesions, resulting in satisfactory clinical esthetic improvements. However, in more severe cases, the color-masking effect was not complete.

Color stability of carious incipient lesions located in enamel and treated with resin infiltration or remineralization

OBJECTIVE

In this in vitro study, the color change of artificial caries lesions in enamel was evaluated after resin infiltration (Icon(®), DMG, Hamburg, Germany) or remineralization.

METHODS

Bovine enamel specimens (n = 72) were randomly divided into four groups: G1 - exposure to demineralizing solution (32 h) and resin infiltration; G2 - immersion in demineralizing solution and remineralization cycles (8 days); G3 - demineralizing solution (negative control); G4 - healthy/non-treated enamel (positive control). The groups were subdivided and immersed in: A (saliva), B (coffee), and C (wine). The baseline color was evaluated by spectrophotometer and repeated after 4 and 8 weeks, and after polishing, at the end of 8 weeks. The variation in color (∆E) and lightness (∆L) was analyzed by anova (two-way) and Tukey tests, and Friedman and Kruskal-Wallis tests, respectively.

RESULTS

All specimens underwent color and lightness change, irrespective of immersion medium. In coffee, G2 presented the lowest mean ∆E (P < 0.05), compared with the other groups. In saliva, G3 presented the highest mean ∆E, and G2 and G4 lower ∆E means.

CONCLUSION

Lesions infiltrated with Icon(®) underwent greater color change when compared with remineralized lesions, which may represent an esthetic disadvantage for the first-mentioned treatment.

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.