Is the current evidence sufficient to establish the most effective treatment for dental fluorosis?

Abstract

A commentary on: Chaple Gil AM, Pereda Vázquez L, Santiesteban Velázquez M, Menéndez JJ. Minimally invasive treatments for dental fluorosis: a network meta-analysis of aesthetic masking efficacy. J Esthet Restor Dent. 2026;38(7):1323-1337.

Design: A systematic review and network meta-analysis evaluated the comparative aesthetic masking efficacy of minimally invasive treatments for dental fluorosis, including microabrasion, bleaching, resin infiltration, and remineralization strategies. The authors searched PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library. It is stated that the review was conducted according to PRISMA-NMA guidelines.

Study selection: Randomized clinical trials with at least two parallel-group or split-mouth treatment arms were included. Eligible studies enroled patients with dental fluorosis diagnosed clinically using Dean's Index, the Thylstrup-Fejerskov Index (TFI), or the Tooth Surface Index of Fluorosis (TSIF), and reported aesthetic outcomes using continuous colorimetric measures, such as ΔE or CIE Lab* values, at short- or mid-term follow-up. Studies were excluded if they reported only subjective or ordinal aesthetic outcomes (e.g., TSIF categories, shade-guide scores, or visual analogue scale ratings) or evaluated restorative or prosthodontic treatments.

Data analysis: Mean differences (MDs) in change scores with corresponding standard errors were pooled using a random-effects model. Network geometry, consistency, heterogeneity, and influence diagnostics were assessed to evaluate model fit and robustness. Results were presented using network forest plots, league tables, and treatment ranking plots (SUCRA/P-scores). Separate network meta-analyses were conducted for immediate post-treatment, 3-month, and 6-month follow-up periods. Risk of bias and certainty of evidence were assessed using the RoB 2 tool and CINeMA.

Results: Across the seven included trials, the greatest improvement in aesthetic outcomes was observed with the combination of microabrasion and in-office bleaching. Among the standalone interventions, resin infiltration demonstrated the most consistent and clinically meaningful benefit. The overall risk of bias assessment indicated that most studies were judged as having some concerns. Assessment of incoherence using the CINeMA framework indicated a generally coherent evidence network.

Conclusions: The highest aesthetic masking efficacy was observed with sequential multimodal approaches that combined surface modification, bleaching, and resin-based refractive adjustment in fluorosis lesions after 3- and 6-month follow-up.