Minimally Invasive Treatments for Dental Fluorosis: A Network Meta-Analysis of Esthetic Masking Efficacy.

BACKGROUND

Dental fluorosis produces enamel opacities and discolorations that compromise esthetics and often require minimally invasive treatments. Although several modalities are available including microabrasion, bleaching, resin infiltration, and remineralization, their comparative performance remains unclear.

OBJECTIVE

To evaluate and rank the esthetic masking efficacy of minimally invasive treatments for dental fluorosis using a network meta-analysis.

METHODS

A systematic review and network meta-analysis were conducted in accordance with PRISMA-NMA. Seven controlled clinical studies (13 interventions; 555 participants) met eligibility criteria. Random-effects network models were performed in R and independently replicated in MetaInsight. Treatment rankings were generated with SUCRA/P-scores, and certainty of evidence was assessed using CINeMA.

RESULTS

Multimodal protocols combining microabrasion with in-office bleaching achieved the highest esthetic performance across immediate, three-month, and 6-month evaluations. Microabrasion + in-office bleaching (MAB + IOB) ranked first (highest SUCRA probability) and produced the largest ΔE improvements, followed by MAB + IOB + CPP-ACP and MAB + RI. Resin infiltration alone showed consistent, clinically meaningful effects and emerged as the most effective standalone technique. In contrast, microabrasion alone, CPP-ACP, and sodium hypochlorite demonstrated modest or unstable changes. Cross-platform triangulation between R and MetaInsight produced fully concordant effect estimates and identical treatment hierarchies. CINeMA indicated no major incoherence and moderate confidence for most comparisons.

CONCLUSION

Combined minimally invasive strategies, particularly MAB + IOB, with or without CPP-ACP, provide the greatest and most durable esthetic masking of fluorosis-related discoloration. Resin infiltration remains the strongest single-modality option. Remineralization and oxidizing agents alone show limited effectiveness. These findings establish a clinically relevant hierarchy to guide conservative management of dental fluorosis.

CLINICAL SIGNIFICANCE: Sequential multimodal protocols integrating surface modification, bleaching, and resin-based refractive adjustment maximize esthetic outcomes while preserving enamel, supporting their use as first-line approaches for mild-to-moderate fluorosis.

TRIAL REGISTRATION: PROSPERO; registration number CRD420251234096.