Journal of Operative Dentistry & Endodontics

Register      Login

VOLUME 8 , ISSUE 1 ( January-June, 2023 ) > List of Articles

Original Article

Clinical Performance of Combined Microabrasion, Home Bleaching and Resin Infiltration for the Esthetic Management of Stained Fluorotic Teeth

Anand Sherwood, Rahul Baskar, Divyameena Bommiah, Melvin G Edwin, Sathvika Kanesalingavelan, Suresh K Boominathan

Keywords : Esthetic management, Fluorosis, Home bleaching, Microabrasion, Original research, Resin infiltration

Citation Information : Sherwood A, Baskar R, Bommiah D, Edwin MG, Kanesalingavelan S, Boominathan SK. Clinical Performance of Combined Microabrasion, Home Bleaching and Resin Infiltration for the Esthetic Management of Stained Fluorotic Teeth. J Oper Dent Endod 2023; 8 (1):5-10.

DOI: 10.5005/jp-journals-10047-0130

License: CC BY-NC 4.0

Published Online: 30-04-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: India is among one of the most affected countries in the world with over 62 million people suffering from dental fluorosis. The development of economic and conservative treatments for the management of these otherwise disease-free teeth is crucial to the dental health temperament of India. In the present study, we have analyzed the combined clinical performance of microabrasion, home bleaching, and resin infiltration to mask stained fluorotic teeth. Materials and methods: A clinical trial was conducted in Madurai where 101 fluorosis-stained anterior teeth were assessed for CIE L*a*b* values using standardized treatment photographs. Statistical analysis was done using SPSS software. Results: Through the results of our study, we observed a statistically significant (p ≤ 0.05) difference in the pre- and post-treatment b* values of the stained areas. The mean ΔE value also significantly (p ≤ 0.05) reduced from 7 to 4.5 following bleaching and then further reduced to 3.008 following resin infiltration. No significant difference was seen in the b* values for the unstained points even after bleaching and resin infiltration. Conclusion: The current study presents the concept that fluorosis can be successfully managed using the minimally invasive combination of microabrasion, home bleaching, and resin infiltration. Microabrasion aids in the absorption of the bleaching agent which subsequently reduces yellowish-brown stains, while the resin in filtrant masks the white opacities on the enamel surface. This novel three-step combination thus eliminates the need for more time-consuming and invasive techniques such as veneers and crowns.


PDF Share
  1. Qiao L, Liu X, He Y, et al. Progress of signaling pathways, stress pathways and epigenetics in the pathogenesis of skeletal fluorosis. Int J Mol Sci 2021;22(21):11932. DOI: 10.3390/ijms222111932.
  2. Maheshwari RC. Fluoride in drinking water and its removal. J Hazard Mater 2006;137(1):456–463. DOI: 10.1016/j.jhazmat.2006.02.024.
  3. Wei W, Pang S, Sun D. The pathogenesis of endemic fluorosis: Research progress in the last 5 years. J Cell Mol Med 2019;23(4): 2333–2342. DOI: 10.1111/jcmm.14185.
  4. Saini A, Agrawal PR. Fluoride contamination in water resources and its health risk assessment. In Contamination of Water. Academic Press 2021;173–185. DOI: 10.1016/b978-0-12-824058-8.00040-2.
  5. Molina-Frechero N, Nevarez-Rascón M, Nevarez-Rascón A, et al. Impact of dental fluorosis, socioeconomic status and self-perception in adolescents exposed to a high level of fluoride in water. Int J Environ Res Public Health 2017;14(1):73. DOI: 10.3390/ijerph 14010073.
  6. de Castilho LS, e Ferreira EF, Perini E. Perceptions of adolescents and young people regarding endemic dental fluorosis in a rural area of Brazil: Psychosocial suffering. Health Soc Care Community 2009;17(6):557–563. DOI: 10.1111/j.1365-2524.2009.00859.x.
  7. Divyameena B, Sherwood A, Rathna Piriyanga S, et al. Clinical performance of enamel microabrasion for esthetic management of stained dental fluorosis teeth. Oper Dent 2021;46(1):15–24. DOI: 10.2341/19-248-C.
  8. Bassir MM, Bagheri G. Comparison between phosphoric acid and hydrochloric acid in microabrasion technique for the treatment of dental fluorosis. J Conserv Dent 2013;16(1):41–44. DOI: 10.4103/0972-0707.105297.
  9. Nanjundasetty JK, Ashrafulla M. Efficacy of desensitizing agents on postoperative sensitivity following an in-office vital tooth bleaching: A randomized controlled clinical trial. J Conserv Dent 2016;19(3): 207–211. DOI: 10.4103/0972-0707.181927.
  10. Sundfeld D, Pavani CC, Pavesi Pini NI, et al. Esthetic recovery of teeth presenting fluorotic enamel stains using enamel microabrasion and home-monitored dental bleaching. J Conserv Dent 2019;22(4): 401–405. DOI: 10.4103/JCD.JCD_77_19.
  11. Sekundo C, Frese C. Underlying resin infiltration and direct composite veneers for the treatment of severe white color alterations of the enamel: Case report and 13-month follow-up. Oper Dent 2020;45(1):10–18. DOI: 10.2341/18-242-L.
  12. Sundfeld RH, Franco LM, Gonçalves RS, et al. Accomplishing esthetics using enamel microabrasion and bleaching—A case report. Oper Dent 2014;39(3):223–227. DOI: 10.2341/13-002-S.
  13. Sherwood IA. Fluorosis varied treatment options. J Conserv Dent 2010;13(1):47–53. DOI: 10.4103/0972-0707.62631.
  14. Mahendran K, Padmini G, Murugesan R, et al. Acute allergic angioedema of upper lip. J Conserv Dent 2016;19(3):285–288. DOI: 10.4103/0972-0707.181949.
  15. Faul F, Erdfelder E, Lang AG, et al. G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39(2):175–191. DOI: 10.3758/bf03193146.
  16. Bengel WM. Digital photography and the assessment of therapeutic results after bleaching procedures. J Esthet Restor Dent 2003;15 Suppl 1:S21–S32. DOI: 10.1111/j.1708-8240.2003.tb00315.x.
  17. Garg SA, Chavda SM. Color masking white fluorotic spots by resin infiltration and its quantitation by computerized photographic analysis: A 12-month follow-up study. Oper Dent 2020;45(1):1–9. DOI: 10.2341/17-260-T.
  18. Kim S, Kim EY, Jeong TS, et al. The evaluation of resin infiltration for masking labial enamel white spot lesions. Int J Paediatr Dent 2011;21(4):241–248. DOI: 10.1111/j.1365-263X.2011.01126.x.
  19. Paul S, Peter A, Pietrobon N, et al. Visual and spectrophotometric shade analysis of human teeth. J Dent Res 2002;81(8):578–582. DOI: 10.1177/154405910208100815.
  20. Paul SJ, Peter A, Rodoni L, et al. Conventional visual vs spectrophotometric shade taking for porcelain-fused-to-metal crowns: A clinical comparison. Journal of Prosthetic Dentistry 2004;92(6):577. DOI: https://doi.org/10.1016/j.prosdent.2004.07.004.
  21. Celik EU, Yildiz G, Yazkan B. Clinical evaluation of enamel microabrasion for the aesthetic management of mild-to-severe dental fluorosis. J Esthet Restor Dent 2013;25(6):422–430. DOI: 10.1111/jerd.12052.
  22. Pini NI, Sundfeld-Neto D, Aguiar FH, et al. Enamel microabrasion: An overview of clinical and scientific considerations. World J Clin Cases 2015;3(1):34–41. DOI: 10.12998/wjcc.v3.i1.34.
  23. Croll TP. Enamel microabrasion. Chicago: Quintessence. J Dent 1991;13–21.
  24. Donly KJ, O'Neill M, Croll TP. Enamel microabrasion: A microscopic evaluation of the “abrosion effect”. Quintessence Int 1992;23(3): 175–179. PMID: 1641458.
  25. Ramalho KM, Eduardo Cde P, Rocha RG, et al. A minimally invasive procedure for esthetic achievement: Enamel microabrasion of fluorosis stains. Gen Dent 2010;58(6):e225–e229. PMID: 21062704.
  26. Allen K, Agosta C, Estafan D. Using microabrasive material to remove fluorosis stains. J Am Dent Assoc 2004;135(3):319–323. DOI: 10.14219/jada.archive.2004.0180.
  27. Lynch CD, McConnell RJ. The use of microabrasion to remove discolored enamel: A clinical report. J Prosthet Dent 2003;90(5): 417–419. DOI: 10.1016/s0022-3913(03)00503-1.
  28. Pontes DG, Correa KM, Cohen-Carneiro F. Re-establishing esthetics of fluorosis-stained teeth using enamel microabrasion and dental bleaching techniques. Eur J Esthet Dent 2012;7(2):130–137. PMID: 22645728.
  29. Kendell RL. Hydrochloric acid removal of brown fluorosis stains: Clinical and scanning electron micrographic observations. Quintessence Int 1989;20(11):837–839. PMID: 2639397.
  30. Wang Y, Sa Y, Liang S, et al. Minimally invasive treatment for esthetic management of severe dental fluorosis: A case report. Oper Dent 2013;38(4):358–362. DOI: 10.2341/12-238-S.
  31. Sundfeld RH, Croll TP, Briso AL, et al. Considerations about enamel microabrasion after 18 years. Am J Dent 2007;20(2):67–72. PMID: 17542197.
  32. Balamurali N, Mohamed Thowbieck NS, Amreen SS, et al. Prevalence and perception of dental fluorosis among the school-going children and its impact on academic performance. Indian J Dent Sci 2020;12: 1–6. DOI: 10.4103/IJDS.IJDS_108_19.
  33. Patel C, Patel, Patil D, Veeresh Tegginmani DZ, et al. Post bleaching re-pigmentation susceptibility of teeth–An in vitro study. Turkish Journal of Physiotherapy and Rehabilitation 2021;32(3)10451–10456. ISSN: 2651–4451.
  34. Turkun M, Sevgican F, Pehlivan Y, et al. Effects of 10% carbamide peroxide on the enamel surface morphology: A scanning electron microscopy study. J Esthet Restor Dent 2002;14(4):238–244. DOI: 10.1111/j.1708-8240.2002.tb00169.x.
  35. Llena C, Villanueva A, Mejias E, et al. Bleaching efficacy of at home 16% carbamide peroxide. A long-term clinical follow-up study. J Esthet Restor Dent 2020;32(1):12–18. DOI: 10.1111/jerd.12560.
  36. Sherwood IA, Llena C, Bennett T Amaechi, et al. Management of stained fluorotic teeth by combined minimal invasive esthetic procedure–Case series Journal of Dentistry Open Access 2020;2(1): 1–6. DOI: 10.31487/j.JDOA.2020.01.03.
  37. Paris S, Meyer-Lueckel H, Cölfen H, et al. Penetration coefficients of commercially available and experimental composites intended to infiltrate enamel carious lesions. Dent Mater 2007;23(6):742–748. DOI: 10.1016/j.dental.2006.06.029.
  38. Paris S, Meyer-Lueckel H. Masking of labial enamel white spot lesions by resin infiltration–A clinical report. Quintessence Int 2009;40(9): 713–718. PMID: 19862396.
  39. Zotti F, Albertini L, Tomizioli N, et al. Resin infiltration in dental fluorosis treatment—1-year follow-up. Medicina 2020;57(1):22. DOI: 10.3390/medicina57010022.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.