Restoration of Fluorosis Stained Teeth: A Case Study

Treatment of Cases with Different Grades of Fluorosis by Lithium Disilicate Glass-Ceramic CAD/CAM Materials: A Case Report of Two Cases

Over exposure to high amount of fluoride during the development of enamel leads to fluorosis. Dental fluorosis is considered to be the most common color disorders of the enamel. It presents with different clinical signs on the enamel of the patients. The diagnosis of dental fluorosis is very challenging in the clinical practice since the enamel defects could be confusing. This case report presented two cases and their treatment for different grades of dental fluorosis to improve the esthetic appearance of the teeth. Keywords: Dental fluorosis, Fluorosis index, Lithium disilicate glass-ceramic, Microabrasion, Resin infiltration.

Resin infiltration and remineralization interventions in management of moderate dental fluorosis: A quantitative light-induced fluorescence-based randomized controlled trial

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.

Esthetic Management of Incisors with Diffuse and Demarcated Opacities: 24 Month Follow-up Case Report

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.

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.