Transillumination‐aided infiltration: A diagnostic concept for treating enamel opacities

Masking efficacy of bleaching and/ or resin infiltration of fluorotic spots on anterior teeth - a systematic review and meta-analysis

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.

White spot lesions: diagnosis and treatment - a systematic review

BACKGROUND

White spot lesions represent the first stage of caries and their prevalence has been increasing in recent years, particularly in patients undergoing orthodontic treatment. DIferential diagnosis and lesion activity are essential to decide on the clinical approaches to treatment. The aim of this study is to understand if the new diagnostic tools such as fluorescence, microradiography and computed microtomography have the potential to change the conventional treatment of white spots".

METHODS

A systematic search of available studies in the literature was carried out, using PRISMA guidelines, in Pubmed and Scopus electronic databases and manually to identify relevant articles to answer the PICO question: "Do the new diagnostic tools have the potential to change the conventional treatment of white spots?". This systematic review included randomized controlled trials (RCT), cross-sectional and longitudinal studies complying with the following inclusion criteria: (i) studies in humans, (ii) studies about white spot lesions, (iii) studies published between 2012 and 2023, (iv) studies having both diagnosis and treatment and (v) studies with full text available. In this review we excluded other systematic reviews of clinical trials and in vitro studies. The RoB tool was used to assess the risk of bias.

RESULTS

The systematic literature search identified 143 potentially relevant references, which after applying the exclusion criteria, resulted in 20 articles. Regarding diagnostic methods, most articles found were based on conventional methods of visual examination (n:10) or fluorescence (n:7). The least referenced diagnostic techniques were based on the use of clinical photographs (n:2), cross-sectional microradiography (n:1) and computed microtomography (n:1). The use of DIAGNOdent was reported by 3 in vitro studies. With regard to therapies, most studies reported the use of infiltrating resin (n:7) and fluoride-based products (n:5). Other studies have reported the use of self-assembling peptide P11-4 (n:1), home care (n:1), casein phosphopeptide-amorphous calcium phosphate (n:2) and hydrochloric acid (n:1). Combination therapies were also considered.

CONCLUSION

Diagnostic tool does not have the potential to change the form of treatment, whether it is a conventional method or a more differentiated one.

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.

Management of Teeth Affected by Molar Incisor Hypomineralization Using a Resin Infiltration Technique—A Systematic Review

In recent years, an increase in children diagnosed with molar incisor hypomineralization (MIH) has been observed. Children with MIH show a high failure rate with conservative treatment. The ICON® system (DMG, Hamburg, Germany), which is an infiltration of decalcified lesions with resin, may strengthen the tooth structure, improve its aesthetics, and cure hypersensitivity. The following article is a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. Scientific articles in the PubMed and Google Scholar databases describing the use of the ICON system in the treatment of MIH published in the years 2012–2022 were analyzed. Two independent study authors selected publications that show that the ICON system can be used during the treatment of children with MIH. So far, in the literature, there are no standardized protocols for the dental treatment of patients with hypomineralization of the incisors using the ICON system. Therefore, clinicians rarely use this method of treatment. The ICON system may be successfully used to infiltrate tooth decalcification in children with MIH. However, the depth of infiltration and the achievement of enamel hardness after such therapy are not precisely defined.

Impact of masking hypomineralization opacities in anterior teeth on the esthetic perception of children and parents: A randomized controlled clinical trial

OBJECTIVES

The aim of this study was to evaluate the impact of treating demarcated opacities in anterior teeth on the esthetic perception of children and their parents. Additionally, the masking effect was evaluated quantitively and qualitatively.

METHODS

Thirty-nine patients, 8-18 years-old, presenting white-creamy opacity in permanent incisors were randomly allocated to test or control group. Test received resin infiltration and control received a placebo. The questionnaire Child's and Parent's Questionnaire about Teeth Appearance was used. The masking effect was quantitatively analyzed using the Lab System to calculate the color difference (ΔE) between the opacity and the surrounding enamel in Photoshop. Fisher's, Chi-square, Wilcoxon, Mann-Whitney tests and Spearman's correlation were applied to data analysis.

RESULTS

In the test group, a significant impact on physical and psychological domains in parents' and in social domain in parents' and children's perception was observed (p<0.05). Significant difference in ΔE between test and control groups was seen from 15 min of application onwards (p<0.05). After treatment, the mean ΔE was 4.07 (SD=3.07) in the test and 7.35 (SD=3.54) in the control group (p<0.01). One month later, the mean ΔE was 4.22 (SD=2.96) in the test and 6.06 (SD=2.52) in the control group (p<0.01). Total masking was seen only in the test group (p<0.01).

CONCLUSION

Aesthetic treatment of hypomineralization opacities in anterior teeth with resin infiltration impacted positively on parents and children. Resin infiltration reduced the color difference between opacities and sound enamel significantly after an application time of at least fifteen minutes.

CLINICAL SIGNIFICANCE

Opacities in anterior teeth impact the self-image of children and parents negatively. This study demonstrated that 15 min resin infiltration can mask opacities in permanent incisors and recover social wellbeing. This minimally invasive approach can be offered to MIH children who report dissatisfaction with their incisors.

The use of transillumination in mapping demarcated enamel opacities in anterior teeth: A cross-sectional study

BACKGROUND

Despite intensive efforts for categorizing demarcated enamel opacities, often related to molar incisor hypomineralization (MIH), there is a lack of descriptive criteria aiming to describe them physically outside the scope of color and size. This is most likely due to the indices focusing on molar, not anterior, teeth.

AIM

To map and classify demarcated lesions on permanent anterior teeth using reflected and transilluminated light. The association between classification and related lesion characteristics was also examined.

DESIGN

Permanent anterior teeth with demarcated opacities related to MIH were selected. For each tooth, standardized photographs were taken using transmitted and reflected light. Each lesion was mapped and classified according to its color, lesion size, surface integrity, and type. The data were analyzed using the chi-square and Fisher's exact tests. A logistic regression analysis was performed to identify the risk of PEB.

RESULTS

There were significant relationships between lesion size, color, and type with surface integrity. Lesion type and size were more important than lesion color for assessing the risk of PEB. There was also a significant relationship between lesion size and lesion color.

CONCLUSIONS

Lesion size and type are significant clinical parameters for assessing the risk of PEB on enamel opacities related to MIH.

The influence of lesion characteristics on application time of an infiltrate applied to MIH lesions on anterior teeth: An exploratory in vivo pilot study

OBJECTIVES

To evaluate the factors that influences the kinetics of resin infiltration of molar incisor hypomineralisation (MIH) lesions on permanent anterior teeth.

METHODS

Demarcated MIH lesions with homogeneous and heterogeneous lesion body appearance, Types 1 (n = 14) and 2 (n = 18), respectively, were selected. After removal of the lesion surface layer using a tapered diamond finishing bur, the lesions were etched and ethanol was applied to the lesions and it was determined if the lesion was still visible or not. Images were taken just prior infiltrant (Icon; DMG) application (T₀), during the infiltration process (T_x) and when infiltration had ceased progressing or opacity disappearance was clinically apparent (T_max). Surface-area measurements of the opacity and infiltrated area were calculated and the infiltration proportion (IP_x) was calculated over the infiltration time.

RESULTS

Type 1 and positive ethanol test lesions showed significantly lower mean T_max (3.4 min) in comparison with Type 2 and negative ethanol test lesions (9.9 min) [Student t-test/Fisher's exact test; p < .01]. A non-linear correlation was observed (R² = 0.88) indicating that the IP_x was rapid at the beginning of resin application, decreasing over time.

CONCLUSION

In comparison with Type 1 and positive ethanol test lesions, Type 2 and negative ethanol test lesions require longer application time to infiltrate.

CLINICAL SIGNIFICANCE

MIH-lesion type and the 'ethanol test' were reliable predictive factors for the application time required for infiltrating MIH lesions on permanent anterior teeth.

Molar incisor hypomineralization: A review and prevalence in Japan

Molar incisor hypomineralization (MIH) is defined as hypomineralization of systemic origin of one to four first permanent molars, and incisors are also frequently affected. This disorder is a serious concern in pediatric dentistry. Teeth affected by MIH have many dental problems, such as hypersensitivity, poor aesthetics, and rapid progression of dental caries. The prevalence of MIH ranges from 2.8% to 21% among studies with more than 1000 subjects in different countries and age groups. The etiology of MIH is unclear, but genetic and environmental factors have been proposed. This review describes the prevalence, etiology, and clinical management of MIH. A detailed description of MIH prevalence in Japan is also provided.