Non-Cochrane · intervention · PM34106348
Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis - a systematic review and meta-analysis.
Bourouni S, Dritsas K, Kloukos D, et al. · Clinical oral investigations · 2021 · PubMed · doi:10.1007/s00784-021-03931-7
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
11
current version
GRADE rated
3
No studies
0
Included studies
11
linked below
No studies 0 · 0%Ungraded 8 · 72.7%Very low 0 · 0%Low 0 · 0%Moderate 3 · 27.3%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Patients of any age with white spot lesions (WSL) or fluorosis | Patients 8-30 years of age with post-orthodontic or non-post-orthodontic WSL or fluorosis (413 patients, 1834 teeth; n=11 studies) |
| Intervention | Resin infiltration | Resin infiltration (Icon) (n=11) |
| Comparison | Any other (placebo) treatment or untreated control | Untreated control / natural remineralization (n=4); fluoride varnish (n=4); microabrasion (n=2); bleaching (n=2) |
| Outcomes | Primary: any esthetic outcome; secondary: patient-related outcome measures (PROMs) such as pain, satisfaction, discomfort, quality-of-life indicators, and economic factors | Optical/esthetic improvement via DIAGNOdent, spectroscopy, colorimetric values, ICDAS II/LAA-ICDAS, modified enamel decalcification score, and VAS; patient satisfaction / oral health-related quality of life |
| Study designs | Randomized controlled clinical trials (RCTs), prospective controlled clinical trials (CCTs), prospective and retrospective cohort studies, and split-mouth and parallel-arm designs | 9 RCTs, 1 prospective cohort study, 1 study of unclear design (n=11) |
| Timing | Not specified (maximum follow-up over all groups used) | Follow-up 1 day to 12 months (median 6 months) |
Search date: Not specified. Databases: Central; PubMed; Ovid MEDLINE; Ovid EMBASE; LILACS; grey literature via ClinicalTrials.gov, OpenGrey, the National Research Register, and ProQuest Dissertation Abstracts and Thesis databases
Questions and results
Resin infiltration vs Untreated control (natural remineralization)
Population: Patients with post-orthodontic white spot lesions (WSL)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Optical/esthetic improvement (visual-tactile assessment) 4 weeks to 6 months Resin infiltration produced significantly greater optical improvement of white spot lesions than untreated (naturally remineralizing) controls (SMD 1.24, 95% CI 0.59 to 1.88; moderate certainty). Source: Abstract; Results (Fig. 2); Fig. 2 (forest plot, overall); Quality assessment (Supplementary material Table 4, GRADE) · same question in other reviews | SMD 1.24 [0.59, 1.88] | 3 studies · 949 participants | Moderate Downgraded: risk of bias |
Optical/esthetic improvement (visual-tactile assessment) 4 weeks to 6 months · Visual analog scale (Senestraro et al. 2013) In the visual analog scale subgroup, resin infiltration improved optical appearance versus untreated control (SMD 2.34, 95% CI 1.68 to 3.01; ungraded subgroup). Source: Fig. 2 (forest plot, subgroup) · same question in other reviews | SMD 2.34 [1.68, 3.01] | 1 study · 66 participants | Ungraded |
Optical/esthetic improvement (visual-tactile assessment) 4 weeks to 6 months · Spectroscopy delta-E (Knosel et al. 2013) In the spectroscopy delta-e subgroup, resin infiltration improved optical appearance versus untreated control (SMD 0.63, 95% CI 0.26 to 1.01; ungraded subgroup). Source: Fig. 2 (forest plot, subgroup) · same question in other reviews | SMD 0.63 [0.26, 1.01] | 1 study · 115 participants | Ungraded |
Optical/esthetic improvement (visual-tactile assessment) 4 weeks to 6 months · Modified enamel decalcification index (Cronan 2012) In the modified enamel decalcification index subgroup, resin infiltration improved optical appearance versus untreated control (SMD 0.98, 95% CI 0.83 to 1.13; ungraded subgroup). Source: Fig. 2 (forest plot, subgroup) · same question in other reviews | SMD 0.98 [0.83, 1.13] | 1 study · 768 participants | Ungraded |
Resin infiltration vs Fluoride varnish
Population: Patients (mainly children) with white spot lesions (WSL)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Optical/esthetic improvement (DIAGNOdent reading) 3 to 6 months Resin infiltration produced significantly greater optical improvement than fluoride varnish (MD 4.76, 95% CI 0.74 to 8.78; moderate certainty). Source: Abstract; Results (Fig. 3); Fig. 3 (forest plot, overall); Quality assessment (Supplementary material Table 4, GRADE) · same question in other reviews | MD 4.76 [0.74, 8.78] | 3 studies · 212 participants | Moderate Downgraded: risk of bias |
Optical/esthetic improvement (DIAGNOdent reading) 3 to 6 months · Mild lesions, DIAGNOdent score <=14 (Ciftci et al. 2018; Giray et al. 2018) In the mild lesions subgroup, resin infiltration gave greater optical improvement than fluoride varnish (MD 3.65, 95% CI 0.82 to 6.48; ungraded subgroup). Source: Fig. 3 (forest plot, subgroup) · same question in other reviews | MD 3.65 [0.82, 6.48] | 2 studies · 172 participants | Ungraded |
Optical/esthetic improvement (DIAGNOdent reading) 3 to 6 months · Severe lesions, DIAGNOdent score >14 (Gozetici et al. 2019) In the severe lesions subgroup, resin infiltration gave greater optical improvement than fluoride varnish (MD 13.15, 95% CI 3.98 to 22.32; ungraded subgroup). Source: Fig. 3 (forest plot, subgroup) · same question in other reviews | MD 13.15 [3.98, 22.32] | 1 study · 40 participants | Ungraded |
Bleaching before resin infiltration (bleaching + infiltration) vs Resin infiltration alone
Population: Patients with dental fluorosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Patient/dentist satisfaction Patient/dentist satisfaction did not differ between bleaching-then-infiltration and infiltration alone (SMD -1.53, 95% CI -4.75 to 1.70; ungraded). Source: Results para 4; Supplementary material Figure 1 · same question in other reviews | SMD -1.53 [-4.75, 1.70] | 2 studies | Ungraded |
Masking effect (esthetic improvement) Bleaching before resin infiltration did not improve masking of fluorosis compared with infiltration alone (MD -0.30, 95% CI -0.98 to 0.39; moderate certainty). Source: Abstract; Quality assessment (Supplementary material Table 4, GRADE) · same question in other reviews | MD -0.30 [-0.98, 0.39] | 2 studies | Moderate Downgraded: risk of bias |
Resin infiltration alone vs In-office bleaching alone
Population: Patients with dental fluorosis
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dentist satisfaction (masking effect) Resin infiltration alone produced greater dentist-rated masking than in-office bleaching alone in one study (MD 3.97, 95% CI 3.33 to 4.61; ungraded). Source: Results para 4 · same question in other reviews | MD 3.97 [3.33, 4.61] | 1 study | Ungraded |
Resin infiltration vs Microabrasion
Population: Patients with white spot lesions or developmental enamel defects
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Masking effect / color improvement Two studies compared resin infiltration with microabrasion, but no pooled or comparative effect estimate was reported (ungraded). Source: Results para 1 (comparisons); Discussion · same question in other reviews | no estimate extracted | 2 studies | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | No | no |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Yes | Partial Yes | no |
| 5Study selection in duplicate | Yes | Yes | yes |
| 6Data extraction in duplicate | Yes | Yes | yes |
| 7List of excluded studies with reasonscritical | No | No | yes |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: Yes · NRSI: Yes | NRSI: Yes · RCT: Yes | no |
| 10Funding of included studies reported | No | No | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: Yes · RCT: Yes | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | Yes | Yes | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | No | N/A | no |
| 16Conflicts of interest reported | Yes | No | no |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 11
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Kannan et al. 2019 Comparative evaluation of Icon® resin infiltration and Clinpro™ XT varnish on colour and fluorescence changes of white spot lesions: a… PMID:31204437 | 2 other reviews | not stated | not extracted yet | not extracted yet |
| Gu et al. 2019 Esthetic improvements of postorthodontic white-spot lesions treated with resin infiltration and microabrasion: A split-mouth, randomized… PMID:30719932 | 1 other review | Masking effect / color improvement | not extracted yet | not extracted yet |
| Knosel et al. 2019 Long-term follow-up of camouflage effects following resin infiltration of post orthodontic white-spot lesions in vivo. PMID:30324799 | 1 other review | Optical/esthetic improvement (visual-tactile assessment) | not extracted yet | not extracted yet |
| Ciftci et al. 2018 The efficacy of resin infiltrate on the treatment of white spot lesions and developmental opacities DOI:10.4103/njcp.njcp_235_18 | this review only | Optical/esthetic improvement (DIAGNOdent reading) | not extracted yet | not extracted yet |
| Cronan 2012 matched by author and year (probable) | this review only | Optical/esthetic improvement (visual-tactile assessment) | not extracted yet | not extracted yet |
| Gencer et al. 2019 A comparison of the effectiveness of resin infiltration and microabrasion treatments applied to developmental enamel defects in color… DOI:10.4012/dmj.2018-074 | this review only | Masking effect / color improvement | not extracted yet | not extracted yet |
| Giray et al. 2018 Resin infiltration technique and fluoride varnish on white spot lesions in children: Preliminary findings of a randomized clinical trial DOI:10.4103/njcp.njcp_209_18 | this review only | Optical/esthetic improvement (DIAGNOdent reading) | not extracted yet | not extracted yet |
| Gozetici et al. 2019 DOI:10.3290/j.ohpd.a42203 | this review only | Optical/esthetic improvement (DIAGNOdent reading) | not extracted yet | not extracted yet |
| Gugnani et al. 2017 Comparative evaluation of esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in‐office bleaching, and… DOI:10.1111/jerd.12312 | this review only | Masking effect (esthetic improvement) | not extracted yet | not extracted yet |
| Schoppmeier et al. 2018 Power bleaching enhances resin infiltration masking effect of dental fluorosis. A randomized clinical trial DOI:10.1016/j.jdent.2018.10.005 | this review only | Masking effect (esthetic improvement) | not extracted yet | not extracted yet |
| Senestraro et al. 2013 Minimally invasive resin infiltration of arrested white-spot lesions DOI:10.14219/jada.archive.2013.0225 | this review only | Optical/esthetic improvement (visual-tactile assessment) | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).