Is resin infiltration an effective esthetic treatment for enamel development defects and white spot lesions? A systematic review

Objectives: To determine if resin infiltration is an effective treatment for improving the esthetic appearance of tooth discoloration resulting from development defects of enamel (EDD) and white spot lesions (WSL) by means of a systematic review. Data sources: A comprehensive search was performed in PubMed, Scopus, Web of Science, LILACS, BBO Library, Cochrane Library, and SIGLE, as well as in the abstracts of IADR conference, and in the clinical trials registry. Study selection: Clinical studies in patients with whitish tooth discoloration, in which the resin infiltration technique was applied, were included. Color masking was the primary outcome. The methodological quality and risk of biases of included papers was assessed using MINORS criteria for non-randomized (NRS) comparative studies and Cochrane Collaboration for randomized clinical trials (RCT). Results: From a total of 2930 articles, 17 were assessed for eligibility and 11 remained in the qualitative synthesis. Four NRS and seven RCT studies were selected, the latter consisting of four full-text studies and three conference abstracts. Two studies were excluded from the quality assessment, due to overlapping results. The number of participants (treated teeth) ranged from 18 to 21(38-74) in the NRS, and 20-83 (20-231) in the RCT studies. Post-orthodontic WSL were the most frequent treated lesions. Initial condition was used as control in the NR studies. In the RCT, resin infiltration was compared to non treatment, remineralization, or bleaching. Overall, partial or complete color masking of affected teeth was reported immediately after resin infiltration. Only two studies followed original outcomes up to one year and reported maintenance of original color masking. Two NR studies were assessed as "moderate" and one as "high" quality. Two RCT were classified as "low" risk of bias in the chosen key domains. The remaining four studies were considered "unclear" or "high" risk of bias. Conclusion: Although the partial or total masking effect of enamel whitish discoloration has been shown with resin infiltration, there is no strong evidence to support this technique based on the present clinical studies. Clinical significance: Enamel whitish discolorations in esthetically, compromised areas are clinically undesirable. Minimally invasive approaches used as attempts to minimize the discoloration include the resin infiltration technique. The evidence for clinical recommendation of this technique is not strong, thus, further RCT studies with long-term follow-ups should be conducted. (C) 2016 Elsevier Ltd. All rights reserved.