Clinical Application Of Home Bleaching Combined With Resin Infiltration In The Treatment Of Dental Fluorosis

ObjectiveDental fluorosis(DF)is a disease of enamel hypoplasia caused by excessive fluoride intake during the tooth development.The clinical features include opaque white lines,plaques,discolorations ranging from light yellow to black and even the pits or defects on enamel in more serious cases.DF is epidemic in China,India,Mexico,the United States,Brazil and many other countries,which may affect the quality of life and interpersonal communication of many patients.In clinic,bleaching technology is mainly applied to remove extrinsic and intrinsic stains of teeth,which can greatly improve the aesthetic effect,while resin infiltration(RI),a new material with good aesthetics,permeability and anti-caries properties,has achieved great success in the treatment of white spots lesions(WLS)and incipient caries.Most previous clinical studies mainly focused on the aesthetic improvement effect of the single technique on treatment of DF instead of the combined effect of different techniques,and no study systematically assesses the psychological influences of DF on patients.Therefore,this study aims to evaluate the aesthetic effect of home bleaching(HB)combined with RI on different severity degrees of DF,and to analyze the effect of the combined therapy on the improvement of patients’psychological status.Method and MaterialsDuring a four-year period from 2015 to 2019,every patient who was diagnosed with mild to severe DF seeking aesthetic treatment at the Department of Endodontics,Hospital of Stomatology,Tianjin Medical University,was included in this study following the inclusion and exclusion criteria(anterior teeth and premolars).Informed consents were obtained from participants before treatment and DF were divided into three groups according to the Dean’s index:mild,moderate and severe.All fluorotic teeth were subjected to HB and RI treatments.Before and after treatment,patients were assisted to fill in questionnaires about psychological status and subjective evaluation of DF.The patients were treated with RI at an interval of 14days after the completion of HB with 10%carbamide perioxide(CP),and all materials were carried out following the manufacturer’s instructions.Standardized digital photographs were taken at baseline(T1),after bleaching(T2),immediately after RI treatment(T3),and more than six months after RI treatment(T4).Then the image analysis software Adobe Photoshop CS6 was used to analyze the changes of brightness value(L~*),red value(a~*),yellow value(b~*)and color alterations(ΔE)between the fluorotic area(F2)and the surrounding relatively sound areas(F1),which were then assessed by paired t-test.Image-pro plus 6.0 was used to evaluate the changes of WLS before and after RI treatment,and then these changes were analyzed by Wilcoxon’s signed rank test.ResultsA total of 22 participants with 186 fluorotic teeth were enrolled:mild(N=56),moderate(N=100),and severe(N=30).The ratio of male to female was 0.22,and the average age was 27.8±1.6 years old.The questionnaire survey showed that 13.64%of the patients were often depressed,frustrated or disappointed due to bad tooth appearance caused by DF,while 72.72%of the patients felt sad occasionally.The satisfaction of patients with DF regarding tooth appearance increased from 0%(satisfied)before treatment to 23.53%(very satisfied)and 58.82%(satisfied)after treatment.In addition,all patients who were unwilling to laugh,smile and show their teeth due to DF were able to express themselves confidently after treatment.The clinical evaluation results showed that the percentage of fluorotic teeth withΔE values more than 3.0 and 3.7 units decreased gradually from T1 stage to T3 stage in mild and moderate DF groups(P<0.05),whereas the percentage of teeth withΔE>3.7in T3 stage was significantly lower than that of T2 stage in the severe DF group(P<0.05).After treatment,only the value of b~*in mild DF group decreased significantly,while the values of L~*,a~*and b~*in moderate and severe DF groups changed significantly(P<0.05),and the percentage of the WSL area on the whole labial or buccal surface decreased from 42.0%to 3.7%(P<0.01).Eighteen patients(82%)in T4 stage were followed up for more than half a year,with an average follow-up of 16±11.8 months.In addition,there was no significant difference inΔE between T4 and T3 stage(P>0.05).ConclusionThis study showed that the treatment with HB and RI had a great aesthetic effect on the different severity degrees of DF and could significantly improve the psychological problems caused by DF,with a relatively stable long-term effect,suggesting that the combined technique has a great application prospect in the clinical treatment of DF.