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

Multi-modal management of dental fluorosis in a family: A case series

RATIONALE

This case series addresses the management of dental fluorosis, a condition caused by excessive fluoride intake during tooth development. The 3 patients in this report, all from the same family, exhibited varying degrees of dental fluorosis, impacting both aesthetics and function. Treatments ranged from conservative approaches like bleaching and macro-abrasion to more extensive restorative options like veneers and crowns, aiming to improve dental appearance and oral health.

PATIENT CONCERNS

All 3 patients were concerned with the discoloration and aesthetic issues caused by dental fluorosis. Each expressed a desire to improve their smile and address any functional impacts on their teeth.

DIAGNOSES

The patients were diagnosed with dental fluorosis of varying severity. Diagnosis was made based on clinical examination, history of fluoride intake, and radiographs. The condition was classified using the Thylstrup and Fejerskov index, which assesses the extent of fluorosis based on enamel opacity, pitting, and discoloration.

INTERVENTIONS

Case 1 (moderate fluorosis): The patient underwent home bleaching, composite restorations, and the application of laminate veneers after gingivectomy. Case 2 (moderate-to-severe fluorosis): The patient had several teeth extracted due to failed endodontic treatment, followed by the placement of lithium disilicate crowns and a zirconia bridge. Case 3 (mild fluorosis): This patient received in-office and at-home bleaching, followed by macro-abrasion and resin infiltration to improve the appearance of white spots.

OUTCOMES

Each treatment successfully addressed the functional and aesthetic concerns of the patients. The use of bleaching, veneers, crowns, and resin infiltration significantly improved their smiles. All patients reported satisfaction with the results, achieving a more natural tooth appearance and improved confidence in their dental health.

LESSONS

This case series highlights the importance of a multi-modal, individualized approach to managing dental fluorosis. By tailoring treatment to the severity of the condition, aesthetic and functional improvements were consistently achieved across different fluorosis severities. Dental fluorosis management should prioritize minimally invasive options while maintaining a focus on long-term aesthetic and functional restoration.

Color Change and Color Stability of White Spot Lesions Treated with Resin Infiltration, Microabrasion, or Nano-Hydroxyapatite Remineralization: An In Vitro Study

Background: We compared the camouflage effect of three white spot lesion (WSL) treatments (infiltration, nano-hydroxyapatite (nHAP) remineralization, and microabrasion) and color stability of the treated surfaces. Methods: Fifty sound extracted teeth were used in the study. WSLs were created on 40 buccal dento-enamel specimens through the use of acidic methylcellulose gel. These specimens were randomly assigned to treatment groups (n = 10 per group): negative controls, nano-hydroxyapatite (nHAP), resin infiltration, and microabrasion. After the treatment, all 50 specimens were immersed in coffee for 7 days. Color measurements were performed four times: at baseline (T0), after the demineralization procedure (T1), after the treatments (T2), and after immersion in coffee (T3). Results: No restoration of the initial enamel color was observed in any of the groups. The ICON and MA groups exhibited the highest masking effect, with the mean ΔET0-T2 = 7.46, although the differences among the study groups were insignificant. All three treatments increased the resistance of WSLs to discoloration in coffee compared to the negative control group; however, infiltration (∆ET2-T3 = 4.13) and microabrasion (∆ET2-T3 = 3.49) showed a better color stability tendency than nHAP remineralization (∆ET2-T3 = 7.26). Conclusions: Despite its well-known remineralizing and desensitizing effects, nHAP showed the least masking effect for WSLs and lower color stability compared to resin infiltration and microabrasion. However, none of the methods allowed for complete restoration of the original color. After the discoloration procedure, the color changes in the white spots treated with microabrasion and infiltration were comparable to those of the sound enamel.

Does the Transillumination Technique Using a Diagnostic White Tip Influence the Degree of Conversion of the Infiltrant Resin? A Case Report With In Vitro Insights: A New Technique to Improve the Predictability During the Application of Resin Infiltration: Transillumination Using a Diagnostic White Tip

OBJECTIVE

This study aimed to evaluate, through a case report combined with in vitro study, whether a new diagnostic white tip for the transillumination technique during resin infiltration influences the procedure and degree of conversion (DC).

MATERIALS AND METHODS

A clinical case report demonstrated resin infiltration using the transillumination technique with a new white diagnostic tip (Radii Xpert LED diagnostic tip, SDI, Bayswater, VIC, AU) along with a light-curing device to enhance aesthetic results. An in vitro study assessed the DC of two diagnostic white tips (Radii Xpert LED diagnostic tip [SDI, Bayswater, VIC, AU] and Valo Grand White Light Lens [Ultradent Prod., South Jordan, UT, USA]) compared to that achieved using conventional tips of both light-curing devices. Statistical analysis was performed using two-way ANOVA and Tukey's test (α = 0.05).

RESULTS

The clinical case achieved complete masking of the white spot lesion. In vitro, the diagnostic white tips exhibited significantly lower DC values compared to conventional tips (p = 0.001), regardless of the light-curing unit.

CONCLUSIONS

The diagnostic white tip used in the transillumination technique improves resin infiltration visibility without compromising the degree of conversion.

CLINICAL SIGNIFICANCE

The transillumination technique with the diagnostic white tip enables monitoring of resin infiltration while maintaining effective polymerization.

Resin Infiltration for the Esthetic Improvement of Dental Fluorosis and White Spots: A Case Report

White spot lesions, characterized by opaque enamel discolorations from early carious lesions, fluorosis, or developmental issues, can be effectively managed through various treatments. Resin infiltration is a unique therapy that bridges the gap between non-invasive and invasive alternatives, potentially delaying the need for restorations by applying a low-viscosity resin that penetrates and seals the lesion, enhancing both appearance and function. This study evaluates the clinical and esthetic outcomes of resin infiltration in a 33-year-old female patient with mild dental fluorosis, who presented with white and brown discolorations on her anterior teeth and a high caries index. Following a comprehensive treatment plan that included scaling, root planning, and resin infiltration, several diagnostic tests - such as Endo-Ice, Electric pulp testing, DIAGNOdent, and Spectrophotometer - were utilized to assess treatment success, showing reduced pulp sensory response times, improved caries detection values, and noticeable esthetic enhancements. However, one-month post-treatment, the patient reported yellow staining on the treated surfaces due to turmeric consumption, necessitating additional finishing and polishing. This case underscores the effectiveness of resin infiltration in improving both esthetic and clinical outcomes for fluorosis and incipient carious lesions, emphasizing the importance of patient education regarding dietary habits and oral hygiene to prevent staining and ensure long-term success, while further research is warranted to explore the long-term efficacy of resin infiltration and develop strategies to mitigate post-treatment discoloration.

A Bibliometric Study of Trends, Indicators, and Characteristics in the Global Scientific Production on Fluorosis

AIM

To perform an analysis of the trends, indicators, and characteristics of the world scientific production on fluorosis, and to evaluate its impact on scientific research in this field.

MATERIALS AND METHODS

A descriptive, cross-sectional study was conducted with a bibliometric approach of the worldwide scientific production on fluorosis published during the years 2018-2023. All metadata were extracted from the Scopus database. The articles were exported in .csv format to SciVal (Elsevier). Of the collected articles, 69 were original, 17 were reviews, 2 were conference papers, 6 were book chapters, among others.

RESULTS

It was found that among the journals with the highest number of articles were Biological Trace Element, Caries Research, Children, Fluoride, and Indian Journal of Forensics. In addition, the highest percentage of authors have published between 1 and 2 articles, with a smaller proportion having 3-4 publications. Among the journals with the highest number of articles are Biological Trace Element, Caries Research, Children, Fluoride, and Indian Journal of Forensics. The Universidade de São Paulo has the most publications, although it is also one of those with the lowest citation-weighted impact in relation to the global average (FWCI: 0.9).

CONCLUSION

The collaboration map shows a wide international cooperation network, with an active participation of Brazil among Latin American countries. Scientific production in fluorosis has a negative trend from 2018 to 2023 and is mainly concentrated in high-impact scientific journals.

CLINICAL SIGNIFICANCE

The study shows a wide network of international cooperation on fluorosis, so the results provide important information to guide future clinically focused research on fluorosis and its impact on public health.

Aesthetic management of discoloured incisors in children

Children can often present with discolouration of their teeth, commonly affecting their permanent maxillary central incisors. These opacities can often cause children to suffer with psychosocial and confidence related issues. With long waiting lists in secondary care, many children may face increased waiting times to receive aesthetic dental treatment. It is important that the dental professional is aware of the different causes of discolouration, the possible treatment options and when to consider a referral to secondary care.

Resin Infiltration of Non-Cavitated Enamel Lesions in Paediatric Dentistry: A Narrative Review

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.

Patient Satisfaction with Resin Infiltration Treatment for Masking Noncavitated White Spot Lesions on Anterior Maxillary Teeth: Two Case Reports

Aim

We assessed patient satisfaction with resin infiltration treatment outcomes for masking postorthodontic treatment noncavitated white spot lesions on anterior maxillary teeth.

Background

White spot lesions (WSLs) are opaque white areas of demineralization. The lesion may remineralize over time, but the opaque color usually remains, retaining the undesirable tooth color. Case Description: Resin infiltration (RI) was administered to two patients with a total of 10 anterior maxillary teeth diagnosed with noncavitated WSLs. Immediately after treatment, patients were asked about their comfort during the RI treatment and their level of satisfaction with treatment outcomes. Two weeks post-treatment, the two patients were asked again about their level of treatment outcome satisfaction and if they thought they needed a second treatment. Both reported that they were comfortable during the treatment and were extremely satisfied with the achieved treatment outcomes immediately and two weeks after the treatment and did not feel that they would need to seek further treatment to reach the desired outcome.

Conclusion

Resin infiltration is a comfortable, conservative treatment option providing satisfactory outcomes in masking noncavitated WSLs on anterior maxillary teeth after orthodontic treatment. Clinical Significance. Resin infiltration is a conservative treatment option to mask noncavitated WSLs after orthodontic treatment.

Assessment of Enamel Color Stability of Resins Infiltration Treatment in Human Teeth: A Systematic Review

(1) The evolution of techniques and materials used in dentistry has led to the introduction of a technique known as micro-infiltration, using ICON infiltrating resin. The purpose of this study was to evaluate whether the resin infiltrant can remain stable in the enamel color of human teeth over time or if it causes discoloration and review current knowledge on color stability based on the literature selected solely on studies performed on human teeth and to provide a perspective on the methods proposed by clinicians in the infiltration procedure; (2) Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement; (3) Results: Twelve studies were selected for this review. The study results suggest that the device content is sufficiently comprehensive. The reviewers expressed strong support for the device's content for assessing the quality of reviews. The paper summarizes current reports regarding the color stability assessment of enamel treated by in- filtration resin confirmed in in vitro and in vivo studies; (4) Conclusions: Based on these considerations, the resin infiltration method can be recommended to improve the appearance of enamel lesions. The infiltrated lesions remained chromatically stable, showing no significant color changes in the long term.

Effects of hybrid inorganic-organic nanofibers on the properties of enamel resin infiltrants - An in vitro study

This in vitro study aimed to evaluate the overall mechanical properties of resin infiltrants doped with bioactive nanofibers and their ability in inhibiting enamel demineralization or achieving remineralization of the adjacent enamel to white spots. A commercial resin infiltrant (ICON, DMG) was doped with hybrid inorganic-organic nanofibers and analyzed for degree of conversion (DC, n = 3) and surface hardness (SH, n = 6). Subsequently, enamel specimens (6 × 4 × 2 mm³) were prepared and submitted to a demineralizing/remineralizing process to produce a subsurface caries-like lesion. The specimens were treated with one of the following materials: ICON infiltrant, DMG (control); ICON + nanofibers of poly-lactic acid (PLA)-filled with silica (PLA-SiO₂); ICON + nanofibers of (PLA)-filled with calcium incorporated into a silica network (SiO₂-CaP). Then, the specimens were subjected to a pH-cycling demineralizing/remineralizing model for 7 days at 37 °C. The %ΔSH change (after treatment), %SH loss and %SH recovery (after pH-cycling regimen) were calculated after SH evaluation (n = 9/group). The Ca/P weight ratio before and after pH-cycling regimen was evaluated through SEM/EDX. The results of DC were analyzed through the T-test (p < 0.05). ANOVA followed by Tukey's test (p < 0.05) was performed for hardness and EDX. A significant SH increase was observed in the ICON/SiO₂CaP group (p < 0.05). The ICON/PLA-SiO₂ presented higher DC values than the control group (p = 0.043). All groups presented significant difference in %ΔSH (p < 0.05), although the specimens treated with ICON/SiO₂CaP presented greater values. Regarding the %SHL and %SHR, the ICON/SiO₂CaP and ICON/PLA-SiO₂ were significantly different compared to the control group (p < 0.001). However, no difference was observed between the ICON/SiO₂CaP and ICON/PLA-SiO_2. The Ca/P ratio showed that the ICON/SiO₂CaP and ICON/PLA-SiO₂ after the pH-cycling regimen differed from sound enamel and modified infiltrants before pH-cycling. In conclusion, tailored hybrid nanofibers may be incorporated into enamel resin infiltrants without compromise the mechanical properties of such experimental materials. These latter can inhibit the demineralization of enamel and increase its hardness during pH-clycling challange.

A Qualitative and Comprehensive Analysis of Caries Susceptibility for Dental Fluorosis Patients

Dental fluorosis (DF) is an endemic disease caused by excessive fluoride exposure during childhood. Previous studies mainly focused on the acid resistance of fluorotic enamel and failed to reach a consensus on the topic of the caries susceptibility of DF patients. In this review, we discuss the role of DF classification in assessing this susceptibility and follow the “four factors theory” in weighing the pros and cons of DF classification in terms of host factor (dental enamel and saliva), food factor, bacteria factor, and DF treatment factor. From our analysis, we find that susceptibility is possibly determined by various factors such as the extent of structural and chemical changes in fluorotic enamel, eating habits, fluoride levels in diets and in the oral cavity, changes in quantity and quality of saliva, and/or oral hygiene. Thus, a universal conclusion regarding caries susceptibility might not exist, instead depending on each individual’s situation.