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ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 301-305  

Clinical efficacy of resin infiltration technique alone or in combination with micro abrasion and in-office bleaching in adults with mild-to-moderate fluorosis stains


1 Department of Conservative Dentistry and Endodontics, Geetanjali Dental and Research Institute, Udaipur, Rajasthan, India
2 Department of Conservative Dentistry and Endodontics, SGT Dental College Hospital and Research Institute, Gurugram, Haryana, India
3 Department of Conservative Dentistry and Endodontics, PDM Dental College and Research Institute, Bahadurgarh, Haryana, India

Date of Submission02-Dec-2020
Date of Decision05-Dec-2020
Date of Acceptance06-Dec-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Poorvi Saxena
Department of Conservative Dentistry and Endodontics, Senior Lecturer, Geetanjali Dental and Research Institute, Udaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_795_20

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   Abstract 


Background: The present study was conducted to evaluate the clinical efficacy of resin infiltration technique alone or in combination with microabrasion and in-office bleaching in adults with mild-to-moderate fluorosis stains on permanent maxillary anterior teeth at the end of 1 month. Materials and Methods: A total of 30 patients with nonpitted fluorosis stains on maxillary anterior were classified as mild (n = 15) and moderate (n = 15). Each grade is subdivided into three groups as Group A, Group B, and Group C. Group 1: Mild (score 2), Subgroup A: Resin infiltration (n = 5 patients), Subgroup B: Microabrasion followed by resin infiltration (n = 5 patients), Subgroup C: Microabrasion and bleaching followed by resin infiltration after 2 weeks (n = 5 patients). Group 2: Moderate (score 3), Subgroup A: Resin infiltration (n = 5 patients), Subgroup B: Microabrasion followed by resin infiltration (n = 5 patients), and Subgroup C: Microabrasion and bleaching followed by resin infiltration after 2 weeks (n = 5 patients). Microabrasion was performed with the opalustre kit from Ultradent according to the manufacturer's instructions. Pola office bleaching from SDI and Icon infiltrant was performed. Stain score, improvement in appearance score, need for further treatment, patient satisfaction score, tooth sensitivity immediately after treatment, 24 h and 72 h were recorded. Results: The mean appearance score in Group 1A was 73.60, in Group 1B was 72.87, in Group 1C was 65.27, in Group 2A was 68.00, in Group 2B was 72.93 and in Group 2C was 84.73. The mean need for further treatment score in Group 1A was 72.80, in Group 1B was 78.40, in Group 1C was 68.73, in Group 2A was 71.20, in Group 2B was 79.53 and in Group 2C was 88.73. The mean patient satisfaction score in Group 1A was 91.40, in Group 1B was 95.20, in Group 1C was 98.00, in Group 2A was 90.20, in Group 2B was 99.40 and in Group 2C was 100.00. There was a significant difference in mean tooth sensitivity immediately after treatment between Groups 1A, 1B, 1C, 2A, 2B, and 2C. There was a significant difference in mean tooth sensitivity after 24 h between Groups 1A, 1B, 1C, 2A, 2B, and 2C. Conclusion: Resin infiltration technique in combination with bleaching and microabrasion technique found to be effective in the management of dental fluorosis.

Keywords: Bleaching, fluorosis, resin infiltration technique


How to cite this article:
Saxena P, Grewal MS, Agarwal P, Kaur G, Verma J, Chhikara V. Clinical efficacy of resin infiltration technique alone or in combination with micro abrasion and in-office bleaching in adults with mild-to-moderate fluorosis stains. J Pharm Bioall Sci 2021;13, Suppl S1:301-5

How to cite this URL:
Saxena P, Grewal MS, Agarwal P, Kaur G, Verma J, Chhikara V. Clinical efficacy of resin infiltration technique alone or in combination with micro abrasion and in-office bleaching in adults with mild-to-moderate fluorosis stains. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jun 20];13, Suppl S1:301-5. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/301/317693




   Introduction Top


Tooth color is of esthetic importance to many individuals, especially if the discolorations are visible.[1] Dental fluorosis is a developmental disturbance of enamel caused by excessive fluoride on ameloblasts during enamel formation. Dental fluorosis is the result of chronic endogenic intake of fluorides in amounts exceeding the optimal daily dose of 1 ppm.[2]

Fluoride is an effective agent in preventing caries by inhibiting demineralization and stimulating remineralization of enamel.[3] A linear relationship exists between the amount and duration of fluoride ingested and the development and severity of dental fluorosis.[4] Long-term exposure and high doses of systemic fluorides can cause the enamel as well as dentin and cementum to become hypomineralized and more porous. Hypomineralized tissue frequently alternates with hypermineralized bands of enamel. Deeper layers of enamel can become severely hypomineralized, making the affected teeth increasingly fragile.[5]

Several treatment options, ranging from bleaching (less invasive) to full crowns (more invasive) have been used to treat dental fluorosis depending on the extent of enamel destruction.[6] Micro-and macro-abrasion have also been moderately successful, but this has the potential to remove greater amounts of tooth structure than needed or desired.[7] Treatment of moderate levels of fluorosis has been shown to be successful with veneers. More severe levels of fluorosis require more highly invasive procedures such as veneers and crowns, especially if there are mottling and loss of occlusal vertical dimension.[8] The micro-invasive resin infiltration procedure is a new technique developed as a preventive treatment to inhibit the progression of incipient white-spot carious lesions. Following the three-step process of etching, drying, and infiltrating the affected area with a resin, the end result has a positive outcome of improving the carious lesion by masking it.[9] The present study was conducted to evaluate the clinical efficacy of resin infiltration technique alone or in combination with micro abrasion and in-office bleaching in adults with mild-to-moderate fluorosis stains on permanent maxillary anterior teeth at the end of 1 month.


   Materials and Methods Top


This study was conducted in the department of Conservative Dentistry and Endodontics, SGT Dental College, Gurugram, Haryana. A total of 30 patients of age >18 years with nonpitted fluorosis stains, recruited from the hospital, were included in the study.

Inclusion criteria

Only the nonpitted fluorosis opacities were included for this purpose, opacities in anterior teeth shall be classified according to Russell's criteria for differentiating fluoride and nonfluoride opacities. Subjects classified/Teeth classified with Dental fluorosis score 2 and 3 according to Dean's classification of dental fluorosis 1942.

Exclusion criteria

History of allergy toward any dental material, teeth classified as nonfluoride opacities, subjects with fractured teeth maxillary central or lateral incisors, subjects with Class V carious lesions, smoking habit, pregnant, or lactating woman.

The consent form was taken from the patients after a detailed explanation of the procedure. A total of 30 patients with nonpitted fluorosis stains on the maxillary anterior were included and classified as mild (n = 15) and moderate (n = 15). Each grade is subdivided into three groups as Group A, Group B, and Group C. Group 1: Mild (score 2), Subgroup A: Resin infiltration (n = 5 patients), Subgroup B: Microabrasion followed by resin infiltration (n = 5 patients), Subgroup C: Microabrasion and bleaching followed by resin infiltration after 2 weeks (n = 5 patients). Group 2: moderate (score 3), Subgroup A: Resin infiltration (n = 5 patients), Subgroup B: Microabrasion followed by resin infiltration (n = 5 patients) and Subgroup C: Microabrasion and bleaching followed by resin infiltration after 2 weeks (n = 5 patients). All three treatment procedures were performed under rubber dam isolation. Enamel microabrasion will be performed with the opalustre kit from Ultradent according to the manufacturer's instructions. Similarly, pola office bleaching from SDI and Icon infiltrant from DMG Germany were used according to the manufacturer's instructions [Figure 1], [Figure 2], [Figure 3]. In cases of sensitivity, at the end of the procedure, topical desensitizing agents were prescribed to the patients.
Figure 1: Preoperative photograph showing moderate score 3 fluorosis

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Figure 2: (a). Intraoperative photograph showing application of Icon Etchant. (b) Intraoperative photograph showing application of Icon Dry. (c): Intraoperative photograph showing Application of Icon resin

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Figure 3: Postoperative photograph showing micro abrasion and bleaching followed by resin infiltration after 2 weeks

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Stain score, improvement in appearance score, need for further treatment, patient satisfaction score, tooth sensitivity immediately after treatment, 24 h, 72 h, and 1 week were recorded. Results were tabulated and subjected to statistical analysis. Value of P < 0.05 was considered significant.


   Results Top


The mean change in stains was compared between Groups 1A, 1B, 1C, 2A, 2B, and 2C using the one-way ANOVA test. There was a significant difference in mean change in stains between Groups 1A, 1B, 1C, 2A, 2B, and 2C [Table 1].
Table 1: Change in stain score

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[Table 2] shows that the mean improvement in appearance was compared between Groups 1A, 1B, 1C, 2A, 2B and 2C. There was a significant difference in mean improvement in appearance between Groups 1A, 1B, 1C, 2A, 2B, and 2C.
Table 2: Improvement in appearance

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The mean appearance score in Group 1A was 73.60, in Group 1B was 72.87, in Group 1C was 65.27, in Group 2A was 68.00, in Group 2B was 72.93 and in Group 2C was 84.73.

The mean need for further treatment score was compared between Groups 1A, 1B, 1C, 2A, 2B, and 2C [Table 3]. There was a significant difference in mean need for further treatment between Groups 1A, 1B, 1C, 2A, 2B, and 2C.
Table 3: Need for further treatment

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The mean need for further treatment score in Group 1A was 72.80, in Group 1B was 78.40, in Group 1C was 68.73, in Group 2A was 71.20, in Group 2B was 79.53 and in Group 2C was 88.73.

The mean patient satisfaction score was compared between Groups 1A, 1B, 1C, 2A, 2B, and 2C. There was a significant difference in mean patient satisfaction score between Groups 1A, 1B, 1C, 2A, 2B, and 2C. The mean patient satisfaction score in Group 1A was 91.40, in Group 1B was 95.20, in Group 1C was 98.00, in Group 2A was 90.20, in Group 2B was 99.40, and in Group 2C was 100.00 [Table 4] and [Table 5].
Table 4: Tooth sensitivity

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Table 5: Patient satisfaction score

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The mean tooth sensitivity immediately after treatment was compared between Groups 1A, 1B, 1C, 2A, 2B, and 2C [Table 6]. There was a significant difference in mean tooth sensitivity immediately after treatment between Groups 1A, 1B, 1C, 2A, 2B, and 2C. The mean tooth sensitivity immediately after treatment in Group 1A was 0.00, in Group 1B was 23.40, in Group 1C was 55.80, in Group 2A was 14.20, in Group 2B was 15.40, and in Group 2C was 52.40.
Table 6: Tooth sensitivity immediately after treatment

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The mean tooth sensitivity after 24 h, 72 h was compared between Groups 1A, 1B, 1C, 2A, 2B and 2C. The mean tooth sensitivity after 24 h in Group 1A was 0.00, in Group 1B was 11.40, in group 1C was 30.20, in Group 2A was 5.20, in Group 2B was 19.60, and in Group 2C was 31.40. There was a significant difference in mean tooth sensitivity after 24 h between groups 1A, 1B, 1C, 2A, 2B, and 2C.


   Discussion Top


Fluorosis Index, developed by H. T. Dean in 1942, is the gold standard in classifying the varying degrees of severity of dental fluorosis.[10] The six scores according to their clinical signs are 0 for normal or unaffected teeth that have a smooth, uniform, creamy white surface, 0.5 for teeth that are questionable and have some white flecks or spots, 1 for very mild where <25% of the tooth is covered with small white opaque areas, 2 for mild where no more than 50% of the tooth is covered with white opaque areas, 3 for moderate where more than 50% of the entire tooth surface is affected and may have brown staining, and 4 for teeth that are severely corroded or pitted and often have brown staining affecting 100% of the enamel surface. A single source of fluoride or usually a combination of different factors can cause different degrees of severity of dental fluorosis.[11] The present study was conducted to assess the clinical efficacy of resin infiltration technique alone or in combination with micro abrasion and in-office bleaching in adults with mild to moderate fluorosis stains on permanent maxillary anterior teeth.

In the present study, the mean stain score in Group 1A was 74.13, in Group 1B was 77.27, in Group 1C was 70.33, in Group 2A was 70.27, in Group 2B was 77.07 and in Group 2C was 86.93. Treatment of moderate levels of fluorosis has been shown to be successful with veneers. More severe levels of fluorosis require more highly invasive procedures such as veneers and crowns, especially if there is mottling and loss of occlusal vertical dimension.[12]

We found that the mean appearance score in Group 1A was 73.60, in Group 1B was 72.87, in Group 1C was 65.27, in Group 2A was 68.00, in Group 2B was 72.93 and in Group 2C was 84.73. The mean need for further treatment score in Group 1A was 72.80, in Group 1B was 78.40, in Group 1C was 68.73, in Group 2A was 71.20, in Group 2B was 79.53 and in Group 2C was 88.73.

The mean patient satisfaction score in Group 1A was 91.40, in Group 1B was 95.20, in Group 1C was 98.00, in Group 2A was 90.20, in Group 2B was 99.40 and in Group 2C was 100.00. Various studies have revealed that low-viscosity resins decreased visibility of white-spot lesions as a supplementary positive influence due to a similar refractive index to that of enamel. Few studies have also demonstrated the usefulness of this technique in monitoring incipient caries advancement and on proximal lesions and it could constrain further demineralization of white-spot lesions that developed at the time of orthodontic treatment. However, little is known about the action of the technique on the white spots of fluorosis, and the effect of this treatment is considered with other treatment modalities such as micro-abrasion and bleaching.[13],[14]

The mean tooth sensitivity after 24 h, 72 h was compared between Groups 1A, 1B, 1C, 2A, 2B and 2C. The mean tooth sensitivity after 24 h in Group 1A was 0.00, in Group 1B was 11.40, in Group 1C was 30.20, in Group 2A was 5.20, in Group 2B was 19.60 and in Group 2C was 31.40. Bharath et al.[15] conducted an in vitro study and compared two techniques of enamel stain removal on fluorosed teeth and concluded that both immediate and long term (6 months) esthetic enhancement attained by McInnes bleaching were greater to enamel microabrasion. There is decrease in the esthetics of dentition in both the techniques after 6 months, which was marginal with McInnes technique and substantial in enamel microabrasion. Postoperative sensitivity in both techniques was minimal. The sensitivity perceived were transitory and receded within a month postoperatively. Sensitivity was not reported by any subjects at 1, 3, and 6 months intervals.

The limitation of the study is the small sample size.


   Conclusion Top


Authors found that resin infiltration technique in combination with bleaching and microabrasion technique found to be effective in the management of dental fluorosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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El-Murr J, Ruel D, St-Georges AJ. Effects of external bleaching on restorative materials: A review. J Can Dent Assoc 2011;77:b59.  Back to cited text no. 1
    
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Shenoi P, Kandhari A, Gunwal M. Esthetic enhancement of discolored teeth by macroabrasion microabrasion and its psychological impact on patients – A case series. Ind J Multidiscip Dent 2012;2:388-92.  Back to cited text no. 2
    
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Watts A, Addy M. Tooth discolouration and staining: A review of the literature. Br Dent J 2001;190:309-16.  Back to cited text no. 3
    
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Abanto Alvarez J, Rezende KM, Marocho SM, Alves FB, Celiberti P, Ciamponi AL, et al. Dental fluorosis: Exposure, prevention and management. Med Oral Patol Oral Cir Bucal 2009;14:E103-7.  Back to cited text no. 4
    
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Robinson PG, Nalweyiso N, Busingye J, Whitworth J. Subjective impacts of dental caries and fluorosis in rural ugandan children. Community Dent Health 2005;22:231-6.  Back to cited text no. 5
    
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Sherwood IA. Fluorosis varied treatment options. J Conserv Dent 2010;13:47-53.  Back to cited text no. 6
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Beltran-Aguilar ED, Barker L, Dye BA. Prevalence and severity of dental fluorosis in the United States, 1999–2004. NCHS Data Brief 2010;53:1-8.  Back to cited text no. 8
    
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DenBesten P, Li W. Chronic fluoride toxicity: Dental fluorosis. Monogr Oral Sci 2011;22:81-96.  Back to cited text no. 9
    
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McCloskey R. A technique for removal of fluorosis stains. J Am Dent Assoc 1984;109:63-4.  Back to cited text no. 10
    
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Bailey RW, Christen AG. Effects of a bleaching technique on the labial enamel of human teeth stained with endemic dental fluorosis. J Dent Res 1970;49:168-70.  Back to cited text no. 11
    
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Castro SK, Ferreira AC, Duarte RM, Sampaioc FC, Meireles SS. Acceptability, efficacy and safety of two treatment protocols for dental fluorosis: A randomized clinical trial. J Dent 2014;42:938-44.  Back to cited text no. 12
    
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Auschill TM, Schmidt KE, Arweiler NB. Resin infiltration for aesthetic improvement of mild to moderate fluorosis: A Six-month follow-up case report. Oral Health Prev Dent 2015;13:317-22.  Back to cited text no. 13
    
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Cocco AR, Lund RG, Torre E, Martos J. Treatment of fluorosis spots using a resin infiltration technique: 14-month follow-up. Oral Health Prev Dent 2015;13:317-22.  Back to cited text no. 14
    
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Bharath KP, Subba Reddy VV, Poornima P, Revathy V, Kambalimath HV, Karthik B, et al. Comparison of relative efficacy of two techniques of enamel stain removal on fluorosed teeth. An in vivo study. J Clin Pediatr Dent 2014;38:207-13.  Back to cited text no. 15
    


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