Resin infiltration versus other minimally invasive treatments for demarcated opacities in molar-incisor hypomineralization: a systematic review

INTRODUCTION

Molar-incisor hypomineralization (MIH) is a qualitative enamel defect of systemic origin that affects one to four first permanent molars and is frequently accompanied by involvement of the permanent incisors.(1) Its pooled prevalence has been estimated around 14% in the general child population, with substantial variation across regions and diagnostic criteria.(2,3) Diagnosis is based on the European Academy of Paediatric Dentistry criteria, which define the condition by the presence of demarcated opacities, posteruptive enamel breakdown, atypical restorations or the extraction of affected first molars, and a standardized scoring method has been proposed to make epidemiological records comparable.(4) On the labial surfaces of anterior teeth the defect appears as well-demarcated opacities whose color ranges from creamy white to yellow-brown, and these opacities are among the most common reasons why children and their parents seek aesthetic treatment.(5,6) The clinical burden extends beyond appearance, because affected teeth are also hypersensitive, prone to rapid caries progression and difficult to restore, which together make MIH one of the more demanding conditions in paediatric practice.(7,8) The visual impact is likewise not merely cosmetic: visible opacities have been associated with reduced oral health-related quality of life and with negative self-perception during a developmental period in which self-image is being consolidated.(5,6)

The condition is graded by the extension and color of the lesions and by the presence of posteruptive breakdown, and the treatment decision follows that severity: mild opacities can be monitored, whereas visible incisor opacities and broken molars require progressively more invasive management.(9) For anterior opacities in particular the treatment aim shifts from protection to appearance, and the clinician must balance the benefit of concealment against the amount of enamel that each technique sacrifices.(10) This tension, between a predictable appearance and the preservation of tooth structure, is the practical context in which resin infiltration is proposed.

Clinical management of MIH opacities spans a wide spectrum. Mild lesions can be observed or treated with remineralizing agents, whereas more visible defects are managed with enamel microabrasion, tooth bleaching, resin infiltration or direct composite veneers, and severe lesions may require full-coverage restorations.(9,10) Resin infiltration occupies an intermediate position because it removes only a thin hypermineralized surface layer with hydrochloric acid, replaces water in the porous lesion body with ethanol and then fills the intercrystalline spaces with a low-viscosity resin whose refractive index approaches that of sound enamel.(11,12) The marketed Icon system standardizes this sequence with a 15% hydrochloric acid gel applied for two minutes, ethanol dehydration for thirty seconds and two consecutive applications of the infiltrant, each followed by light polymerization.(13) The procedure is completed in a single visit, requires no anaesthesia in most cases and preserves enamel tissue, which makes it attractive for children.(10) Its optical effect, however, depends on the depth and the organic content of the lesion, and MIH enamel is protein-rich and more resistant to penetration than the demineralized enamel of white spot lesions, so the aesthetic response may be less predictable.(11) In children, the choice among these options is further shaped by behavior management, by the wish to defer irreversible restorative procedures while the enamel is still maturing, and by the principle that the least destructive treatment should be attempted before more invasive ones, all of which favor microabrasion, bleaching and infiltration over direct veneering in mild to moderate defects.(9,10)

Previous syntheses have examined resin infiltration either in enamel defects in general or within broader overviews of MIH treatment.(14-17) Reviews restricted to resin infiltration in MIH concluded that the technique improves the appearance of demarcated opacities, but they relied on small uncontrolled series and did not isolate the comparative question of how infiltration performs against other minimally invasive options.(14,18) An overview of systematic reviews on MIH treatment judged the overall quality of the available evidence as low, and a meta-analysis restricted to white spot lesions and fluorosis cannot be transferred directly to MIH because the two substrates differ histologically.(19,20) The reviews closest to the present topic assembled mostly case reports and short series, and the broader treatment reviews were organized by clinical presentation rather than by the comparative aesthetic question, so none of them quantified how infiltration performs against the alternative minimally invasive options.(14,15,17) It therefore remains unclear whether resin infiltration should be preferred over microabrasion, bleaching or fluoride varnish when the clinical objective is to conceal a demarcated MIH opacity.

Although the optical principle of infiltration is the same regardless of etiology, the response of MIH opacities is not interchangeable with that of caries-related white spot lesions or fluorosis. MIH enamel retains a higher protein content and a porous structure that differs in depth and distribution from demineralized enamel, and yellow-brown opacities in particular tend to be deeper and less permeable to the infiltrant.(11) Evidence from fluorosis and white spot lesions therefore cannot be extrapolated directly to MIH, and the question of whether infiltration conceals MIH opacities as effectively as it conceals other enamel defects, or as effectively as microabrasion does, has to be answered with studies conducted in the MIH population itself.(20)

The aim of this systematic review was to compare the aesthetic effectiveness of resin infiltration versus other minimally invasive approaches for masking demarcated enamel opacities in patients with molar-incisor hypomineralization. The review addressed the question: in patients with molar-incisor hypomineralization, how effective is resin infiltration in masking demarcated opacities compared with other minimally invasive approaches?

METHODS

RESULTS

Study selection

The searches identified 237 records, of which 47 were duplicates, leaving 190 records for title and abstract screening (Figure 1). Of these, 176 were excluded. The exclusions at this stage consisted mainly of narrative and systematic reviews, prevalence and etiology surveys, case reports and case series, laboratory studies on extracted teeth, and studies whose population was fluorosis, caries-associated white spot lesions or post-orthodontic demineralization rather than molar-incisor hypomineralization. The remaining 14 reports were assessed for eligibility, and 4 were excluded: one because the outcome was structural integrity rather than masking, one because the outcome was surface roughness and hypersensitivity, and two because their bibliographic records could not be verified against a resolvable identifier. Finally, 10 studies were included in the review.

DISCUSSION

The evidence assembled here indicates that resin infiltration reduces the visibility of demarcated MIH opacities, but that it rarely produces complete concealment. Across the included studies the color difference between the opacity and sound enamel decreased after infiltration, the affected area shrank and the brightness of the lesion fell, and the effect remained stable for up to six months.(13,27,29) The proportion of teeth that achieved total masking was small, and the largest series reported only partial masking in the vast majority of treated incisors.(30) This partial rather than complete response is the central finding of the review and should temper the expectations communicated to patients. Because the partial response was consistent across designs and outcome metrics, it is unlikely to be an artifact of measurement error alone, and it should be reflected explicitly in the information given to patients before treatment.(30)

The direction of the comparative results was consistent. Where resin infiltration was tested against placebo, the color difference after treatment was almost half that of the control condition, and complete masking occurred only in the infiltration group.(26) Against fluoride varnish, infiltration produced a lower color difference and a higher grey level at every time point, which the authors interpreted as a clearly superior masking effect.(31) These findings align with the broader resin-infiltration literature on white spot lesions and fluorosis, in which infiltration consistently improves color and outperforms non-invasive controls in the short term.(20,33) They also agree with previous reviews of MIH treatment that placed infiltration among the recommended first-line aesthetic options, while acknowledging that the underlying evidence was weak.(14,15,17)

The comparison with microabrasion is less settled. The one study that directly compared the two approaches reported the largest color gain with infiltration, but the result was restricted to the fluorosis subgroup and the hypomineralization subgroup was not described.(25) In fluorotic lesions, a randomized study likewise found resin infiltration and microabrasion to be effective, with infiltration producing comparable or greater color change, and a four-arm trial in fluorosis favored infiltration over microabrasion and bleaching.(34,35) For MIH specifically, the image-based study of Warner et al. showed that microabrasion and infiltration, used alone or in combination, reduced both the size and the brightness of incisor opacities, but its design did not allow the two procedures to be separated.(27) A systematic review of microabrasion in paediatric dentistry concluded that microabrasion improves pre- and post-eruptive discolorations, so both techniques appear clinically useful, yet no randomized trial has yet isolated resin infiltration against microabrasion in MIH.(36) Systematic reviews of resin infiltration in enamel more broadly, which pooled predominantly white spot lesions and fluorosis, reported consistent color improvement and, where quantified, effects in favor of infiltration over no treatment, but they did not address the MIH substrate specifically.(37,38)

The conclusions reached here are consistent with, but more cautious than, earlier reviews. Bulanda et al. reported that resin infiltration improves the appearance of MIH opacities and recommended it as a valid option, and the reviews by Somani et al. and Inchingolo et al. reached similar recommendations while emphasizing the absence of standardized protocols.(14,15,17) What this review adds is the observation that the improvement is partial rather than complete in the majority of treated teeth and that the comparative evidence against microabrasion is thinner than the narrative reviews imply.(25,30) The overview by Gevert et al. is relevant here because it found the methodological quality of MIH treatment reviews to be low, which argues for restraint when translating these recommendations into practice.(19) A systematic review of resin infiltration for hypoplastic and hypomineralized defects in paediatric patients likewise reported favorable results while noting the scarcity of randomized evidence, mirroring the present observations.(18)

In practice, the decision between infiltration and microabrasion can be framed around what each procedure offers. Microabrasion removes a thin layer of enamel together with the superficial discoloration, which suits uniform opacities but is less effective for deep or mottled defects, whereas infiltration targets the porosity within the lesion and preserves the surface.(9,12) The two techniques are not mutually exclusive, and combined protocols are common in fluorosis.(35) For MIH, the choice should currently be based on lesion depth and color, patient age and the expected degree of concealment, with the understanding that neither technique reliably produces complete disappearance of the opacity.(30) A reasonable working rule is to begin with infiltration for shallow white opacities, to consider microabrasion or a combined protocol for superficial uniform discolorations, and to reserve direct composite veneering for deep yellow-brown defects in which the minimally invasive techniques have little chance of achieving an acceptable appearance.(9,30)

Several mechanisms may explain why infiltration masks MIH opacities only partially. The infiltrant fills the intercrystalline spaces and raises the refractive index of the lesion toward that of sound enamel, which removes much of the optical contrast.(11,12) MIH enamel, however, contains more protein and a thicker, more irregular porous structure than demineralized white spot lesions, which limits the depth and homogeneity of resin penetration.(1,11) This substrate difference is consistent with the observation that yellow and brown opacities, which are deeper and more protein-rich, responded less well than white opacities.(30) It also explains why the same infiltration protocol produces more complete concealment in fluorosis and caries-like lesions than in MIH.(20,25) The clinical corollary is that lesion depth and color should guide case selection, and that double infiltration or an initial microabrasion step may be required for resistant opacities.(12)

A further dimension that the included studies captured only partially is the patient perspective. Masking treatment with resin infiltration has been associated with improvements in the oral health-related quality of life of children with MIH, and the determinants of that improvement extend beyond the objective color change to the child's self-concept and the parent's perception.(6,39) In the randomized trial of Athayde et al., the objective reduction in color difference was accompanied by positive changes in the physical, psychological and social domains reported by children and parents.(26) Objective masking and perceived benefit may therefore diverge, and the subjective outcome should be measured alongside the spectrophotometric result in future trials.

Several sources of heterogeneity complicate the comparison across these studies. The outcome was expressed as a color difference, a lightness change, an opacity area or a categorical concealment score, and these metrics are not directly convertible, which prevents quantitative pooling. Follow-up ranged from one month to two years, and the severity and color of the lesions, which influence the response, were reported inconsistently.(30) The comparator also varied: placebo, fluoride varnish, microabrasion with or without a remineralizing agent, and untreated healthy enamel are not equivalent benchmarks. These differences, together with the small number of studies per comparison, explain why the review can describe the direction of the effect but not a single summary estimate. The small number of studies also prevented subgroup analyses by opacity color or severity, which would otherwise be the natural way to explain the between-study variation in the proportion of teeth that achieved a satisfactory result.(30)

The review has strengths. The search spanned three bibliographic sources with a predefined window, the selection and extraction were recorded in a structured form with source locations, and the arithmetic of the screening flow was checked against the included reference set rather than assembled by hand. By restricting the analysis to studies that enrolled MIH patients, or that reported the MIH subgroup separately, the synthesis avoided the common error of importing fluorosis results into an MIH conclusion.

The present review has limitations that must be weighed against its conclusions. First, most included studies were small, uncontrolled and followed patients for six months or less, so the durability of the masking effect beyond two years rests on very few observations.(24) Second, only one full text was openly accessible, so eligibility and extraction for the remaining records relied on database abstracts, which prevented a complete risk-of-bias assessment and may have introduced information bias. Third, screening was performed by a single reviewer with artificial-intelligence assistance rather than by two independent reviewers, and the protocol was not registered, both of which raise the risk of selective inclusion. Fourth, the absence of a common outcome metric prevented quantitative pooling, and the small number of direct comparisons means the relative ranking of infiltration, microabrasion and bleaching remains uncertain. Each of these limitations could be reduced in future work by registering the protocol, publishing structured per-lesion color data, reporting randomization procedures in full, and running head-to-head trials that compare infiltration with microabrasion using a shared spectrophotometric outcome and at least a 12-month follow-up.

The certainty of the evidence supporting these conclusions is low. Each randomized comparison rests on a single trial, the non-randomized and uncontrolled studies carry a serious risk of bias, and the estimates come from small samples with short follow-up. The review therefore establishes a consistent direction of effect rather than a precise magnitude, and the relative ranking of infiltration and microabrasion remains genuinely uncertain.(19,25)

The findings also need to be read in the light of their external validity. The included patients were mostly children and adolescents recruited in university clinics in Europe, South Asia and South America, and the severity of the treated opacities ranged from grade I to moderate. Whether the results extend to adults with mature enamel, to severe yellow-brown defects with posteruptive breakdown, or to settings in which operator experience with the infiltration technique is limited is unknown.(30) The predominance of the Icon system in the included studies also means that the estimates may not transfer to other infiltrants without verification. Operator experience likewise influences the quality of the infiltration, because the etching and drying steps control the depth and homogeneity of resin penetration.

From a practical standpoint, the findings support offering resin infiltration as a first-line, minimally invasive option for demarcated MIH opacities when the objective is improvement rather than complete disappearance of the lesion. The evidence also justifies caution: patients and parents should be told that partial improvement is the expected result and that yellow-brown lesions respond less predictably.(30) For teeth in which the priority is structural protection rather than appearance, resin infiltration has the additional advantage of reducing post-eruptive enamel breakdown relative to fluoride varnish, which strengthens the case for choosing it over purely remineralizing approaches.(40) Longer-term color stability data from resin-infiltrated hypomineralized enamel are reassuring but derive from cohorts outside the MIH-specific comparative literature.(41,42)

For research, the priorities follow directly from the gaps identified. A randomized trial that compares resin infiltration with microabrasion, or with a combined microabrasion plus infiltration protocol, using the same spectrophotometric endpoint and a follow-up of at least 12 months would provide the missing head-to-head evidence. Such a trial should stratify randomization by opacity color and severity, report the complete randomization and blinding procedures, and include a patient-reported outcome, since the perceptual benefit does not always mirror the objective color change.(39) Reporting of individual lesion data, rather than group means alone, would also allow future syntheses to examine whether the partial response observed here is concentrated in yellow-brown or deep lesions.(30)

CONCLUSIONS

Resin infiltration reduces the color difference, size and brightness of demarcated opacities in molar-incisor hypomineralization, with a short-term masking effect that was consistently superior to placebo and fluoride varnish at the time points evaluated. Complete concealment was rare, and most treated teeth showed only partial improvement, which should be stated explicitly when the procedure is offered. Direct randomized comparisons between resin infiltration and microabrasion in molar-incisor hypomineralization are lacking, and the available evidence does not establish the superiority of one minimally invasive protocol over another. The certainty of these conclusions is limited by small samples, short follow-up and the serious risk of bias of most included studies. Until head-to-head randomized trials are available, treatment selection should be individualized and the expected partial outcome discussed with the patient before the procedure.

References

1. 1 Weerheijm KL, Jälevik B, Alaluusua S. Molar–Incisor Hypomineralisation. Caries Res. 2001;35(5):390-391. doi: 10.1159/000047479
2. 2 Lopes LB, Machado V, Mascarenhas P, Mendes JJ, Botelho J. The prevalence of molar-incisor hypomineralization: a systematic review and meta-analysis. Sci Rep. 2021;11(1):22405. doi: 10.1038/s41598-021-01541-7
3. 3 Zhao D, Dong B, Yu D, Ren Q, Sun Y. The prevalence of molar incisor hypomineralization: evidence from 70 studies. Int J Paed Dentistry. 2018;28(2):170-179. doi: 10.1111/ipd.12323
4. 4 Ghanim A, Elfrink M, Weerheijm K, Mariño R, Manton D. A practical method for use in epidemiological studies on enamel hypomineralisation. Eur Arch Paediatr Dent. 2015;16(3):235-246. doi: 10.1007/s40368-015-0178-8
5. 5 Da Silva FMF, Vasconcelos Cruz C, Leal L, De Castro Costa M. Aesthetic Perception and psychological impact of molar-incisor hypomineralisation among patients and parents. d3000. 2019;7(1):13-20. doi: 10.5195/d3000.2019.90
6. 6 Hasmun N, Lawson J, Vettore MV, Elcock C, Zaitoun H, Rodd H. Change in Oral Health-Related Quality of Life Following Minimally Invasive Aesthetic Treatment for Children with Molar Incisor Hypomineralisation: A Prospective Study. Dentistry Journal. 2018;6(4):61. doi: 10.3390/dj6040061
7. 7 Almulhim B. Molar and Incisor Hypomineralization. J Nepal Med Assoc. 2021;59(235):295-302. doi: 10.31729/jnma.6343
8. 8 Saitoh M, Shintani S. Molar incisor hypomineralization: A review and prevalence in Japan. Japanese Dental Science Review. 2021;57:71-77. doi: 10.1016/j.jdsr.2021.05.001
9. 9 Lygidakis NA, Garot E, Somani C, Taylor GD, Rouas P, Wong FSL. Best clinical practice guidance for clinicians dealing with children presenting with molar-incisor-hypomineralisation (MIH): an updated European Academy of Paediatric Dentistry policy document. Eur Arch Paediatr Dent. 2022;23(1):3-21. doi: 10.1007/s40368-021-00668-5
10. 10 Almuallem Z, Busuttil-Naudi A. Molar incisor hypomineralisation (MIH) – an overview. Br Dent J. 2018;225(7):601-609. doi: 10.1038/sj.bdj.2018.814
11. 11 Perdigão J. Resin infiltration of enamel white spot lesions: An ultramorphological analysis. J Esthet Restor Dent. 2020;32(3):317-324. doi: 10.1111/jerd.12550
12. 12 Knösel M, Vogel R, Sandoval P. Infiltration of White-Spot-Lesions and developmental enamel defects. Rev Clin Periodoncia Implantol Rehabil Oral. 2017;10(2):101-106. doi: 10.4067/s0719-01072017000200101
13. 13 Altan H, Yilmaz RE. Clinical evaluation of resin infiltration treatment masking effect on hypomineralised enamel surfaces. BMC Oral Health. 2023;23(1):444. doi: 10.1186/s12903-023-03140-6
14. 14 Bulanda S, Ilczuk-Rypuła D, Dybek A, Pietraszewska D, Skucha-Nowak M, Postek-Stefańska L. Management of Teeth Affected by Molar Incisor Hypomineralization Using a Resin Infiltration Technique—A Systematic Review. Coatings. 2022;12(7):964. doi: 10.3390/coatings12070964
15. 15 Somani C, Taylor GD, Garot E, Rouas P, Lygidakis NA, Wong FSL. An update of treatment modalities in children and adolescents with teeth affected by molar incisor hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent. 2022;23(1):39-64. doi: 10.1007/s40368-021-00635-0
16. 16 da Cunha Coelho ASE, Mata PCM, Lino CA, Macho VMP, Areias CMFGP, Norton APMAP, et al. Dental hypomineralization treatment: A systematic review. J Esthet Restor Dent. 2019;31(1):26-39. doi: 10.1111/jerd.12420
17. 17 Inchingolo AM, Inchingolo AD, Viapiano F, Ciocia AM, Ferrara I, Netti A, et al. Treatment Approaches to Molar Incisor Hypomineralization: A Systematic Review. JCM. 2023;12(22):7194. doi: 10.3390/jcm12227194
18. 18 Casaña-Ruiz MD, Marqués Martínez L, García Miralles E. Management of Hypoplastic or Hypomineralized Defects with Resin Infiltration at Pediatric Ages: Systematic Review. IJERPH. 2023;20(6):5201. doi: 10.3390/ijerph20065201
19. 19 Gevert MV, Soares R, Wambier LM, Ribeiro AE, Avais LS, de Souza JF, et al. How is the quality of the available evidence on molar-incisor hypomineralization treatment? An overview of systematic reviews. Clin Oral Invest. 2022;26(10):5989-6002. doi: 10.1007/s00784-022-04612-9
20. 20 Bourouni S, Dritsas K, Kloukos D, Wierichs RJ. Efficacy of resin infiltration to mask post-orthodontic or non-post-orthodontic white spot lesions or fluorosis — a systematic review and meta-analysis. Clin Oral Invest. 2021;25(8):4711-4719. doi: 10.1007/s00784-021-03931-7
21. 21 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021:n71. doi: 10.1136/bmj.n71
22. 22 Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019:l4898. doi: 10.1136/bmj.l4898
23. 23 Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016:i4919. doi: 10.1136/bmj.i4919
24. 24 Brescia AV, Montesani L, Fusaroli D, Docimo R, Di Gennaro G. Management of Enamel Defects with Resin Infiltration Techniques: Two Years Follow Up Retrospective Study. Children. 2022;9(9):1365. doi: 10.3390/children9091365
25. 25 GENÇER MDG, KIRZIOĞLU Z. A comparison of the effectiveness of resin infiltration and microabrasion treatments applied to developmental enamel defects in color masking. Dent Mater J. 2019;38(2):295-302. doi: 10.4012/dmj.2018-074
26. 26 Athayde GDS, Reis PPGD, Jorge RC, Americano GCA, Fidalgo TKDS, Soviero VM. Impact of masking hypomineralization opacities in anterior teeth on the esthetic perception of children and parents: A randomized controlled clinical trial. Journal of Dentistry. 2022;123:104168. doi: 10.1016/j.jdent.2022.104168
27. 27 Warner C, Hasmun NN, Elcock C, Lawson JA, Vettore MV, Rodd HD. Making white spots disappear! Do minimally invasive treatments improve incisor opacities in children with molar‐incisor hypomineralisation?. Int J Paed Dentistry. 2022;32(4):617-625. doi: 10.1111/ipd.12940
28. 28 Bhandari R, Thakur S, Singhal P, Chauhan D, Jayam C, Jain T. Concealment effect of resin infiltration on incisor of Grade I molar incisor hypomineralization patients: An in vivo study. J Conserv Dent. 2018;21(4):450. doi: 10.4103/jcd.jcd_61_18
29. 29 Ozgur B, Unverdi GE, Ertan A, Cehreli Z. Effectiveness and Color Stability of Resin Infiltration on Demineralized and Hypomineralized (MIH) Enamel in Children: Six-month Results of a Prospective Trial. Oper Dent. 2023;48(3):258-267. doi: 10.2341/22-041-c
30. 30 Ćwiklińska A, Szczepańska J, Majewska-Beśka S, Bruzda-Zwiech A. Clinical assessment of the effectiveness of Icon resin infiltration treatment for masking enamel opacities on permanent anterior teeth affected by molar-incisor hypomineralisation (MIH). NS. 2023;28(2):39-51. doi: 10.25121/ns.2023.28.2.39
31. 31 ElBaz G, Mahfouz S. EFFICACY OF TWO DIFFERENT TREATMENT MODALITIES ON MASKING WHITE SPOT LESIONS IN CHILDREN WITH MOLAR INCISOR HYPO-MINERALIZATION. Egyptian Dental Journal. 2017;63(3):2147-2154. doi: 10.21608/edj.2017.75657
32. 32 Bhandari R, Thakur S, Singhal P, Chauhan D, Jayam C, Jain T. In vivo comparative evaluation of esthetics after microabrasion and microabrasion followed by casein phosphopeptide–amorphous calcium fluoride phosphate on molar incisor hypomineralization-affected incisors. Contemp Clin Dent. 2019;10(1):9. doi: 10.4103/ccd.ccd_852_17
33. 33 Borges AB, Caneppele TMF, Masterson D, Maia LC. Is resin infiltration an effective esthetic treatment for enamel development defects and white spot lesions? A systematic review. Journal of Dentistry. 2017;56:11-18. doi: 10.1016/j.jdent.2016.10.010
34. 34 Asthana G, Patel K, Parmar R. Efficacy of microabrasion and resin infiltration techniques for masking of fluorotic white spot lesions: A randomized clinical study. Journal of Conservative Dentistry and Endodontics. 2023;26(6):677-681. doi: 10.4103/jcde.jcde_95_23
35. 35 Garg I, Kumar A, Kumar A. Comparative Evaluation of Esthetic Improvement of Resin Infiltration (RI), In-office Bleaching (B), Enamel Microabrasion (M) and Resin Infiltration with Double Application of Infiltrant (2RI) on Non-pitted Fluorosis Stains: A Randomized Six-month Interventional Study. International Journal of Clinical Pediatric Dentistry. 2022;15(1):20-34. doi: 10.5005/jp-journals-10005-2140
36. 36 Blanchet I, Camoin A, Tardieu C, Jacquot BM. Microabrasion in the management of enamel discolorations in paediatric dentistry: a systematic review. Journal of Clinical Pediatric Dentistry. 2022;47(1):17-26. doi: 10.22514/jocpd.2022.015
37. 37 Soveral M, Machado V, Botelho J, Mendes JJ, Manso C. Effect of Resin Infiltration on Enamel: A Systematic Review and Meta-Analysis. JFB. 2021;12(3):48. doi: 10.3390/jfb12030048
38. 38 Abang Ibrahim DF, Venkiteswaran A, Hasmun NN. Esthetic effects and color stability of resin infiltration on demineralized enamel lesions: A systematic review. JISPCD. 2023;13(4):273-286. doi: 10.4103/jispcd.jispcd_29_23
39. 39 Hasmun N, Vettore MV, Lawson JA, Elcock C, Zaitoun H, Rodd HD. Determinants of children’s oral health-related quality of life following aesthetic treatment of enamel opacities. Journal of Dentistry. 2020;98:103372. doi: 10.1016/j.jdent.2020.103372
40. 40 Nogueira VKC, Mendes Soares IP, Fragelli CMB, Boldieri T, Manton DJ, Bussaneli DG, et al. Structural integrity of MIH-affected teeth after treatment with fluoride varnish or resin infiltration: An 18-Month randomized clinical trial. Journal of Dentistry. 2021;105:103570. doi: 10.1016/j.jdent.2020.103570
41. 41 Mazur M, Westland S, Ndokaj A, Nardi GM, Guerra F, Ottolenghi L. In-vivo colour stability of enamel after ICON® treatment at 6 years of follow-up: A prospective single center study. Journal of Dentistry. 2022;122:103943. doi: 10.1016/j.jdent.2021.103943
42. 42 Mazur M, Westland S, Guerra F, Corridore D, Vichi M, Maruotti A, et al. Objective and subjective aesthetic performance of icon® treatment for enamel hypomineralization lesions in young adolescents: A retrospective single center study. Journal of Dentistry. 2018;68:104-108. doi: 10.1016/j.jdent.2017.11.001