Masking Dental Fluorosis in Adolescents: Literature Review, RCT and Case Series

Background: Patients exhibiting dental fluorosis frequently feel compromised regarding their esthetical appearance. Resin infiltration has been proposed as a micro-invasive treatment alternative aiming at masking fluorotic enamel. Aim of this study was to identify parameters influencing the esthetic outcome after resin infiltrating permanent teeth with mild to moderate fluorosis.

Methods: Electronic databases were screened for all studies on resin infiltration of dental fluorosis. Cross-referencing was used to identify further articles. Additionally, 26 adolescents and young adult patients exhibiting at least one fluorotic permanent front tooth were enrolled in a single blinded RCT. In the test group (n=13) patients were bleached in office with light-activated 25% H₂O₂ prior to resin infiltration (6 mins HCL etching, 10 mins resin infiltration). In the control group (n=13) a placebo bleaching was performed using ACP before infiltration. Delta-E values and patients’ satisfaction (VAS) were recorded at baseline, after treatment and at 1, 3 and 6 months recall.

Results: Most studies on masking dental fluorosis using resin infiltration are either in vitro studies or case reports with moderate risk of bias. To date two clinical trials have been published. There are indications that resin infiltration yields better esthetic results than no treatment or preventive care. Results of our RCT proofed that in office bleaching performed two weeks prior to resin infiltration significantly reduced Delta-E values and increased patients’ satisfaction (p<0.001, mixed model analysis) over the 6 months observation period compared to resin infiltration alone.

Conclusions: There is evidence that white spot lesions due to fluorosis can effectively be masked with resin infiltration in adolescents. Time of HCL etching and time of the infiltration process per se are associated with the esthetic outcome. In-office bleaching as a pre-treatment further enhances the masking effect as well as patients’ satisfaction.