Resin infiltration or bioactive adhesive: which treatment provides better esthetic satisfaction for post-orthodontic white spot lesions?

A COMMENTARY ON: Albashaireh ZS, Altallaq MK. Assessment of patient satisfaction and esthetic outcomes following treatment of post-orthodontic white spot lesions using a bioactive adhesive and resin infiltrant: a randomized split-mouth clinical trial. Journal of Dentistry. 2026;167:106565. DESIGN: Split-mouth randomized clinical trial of 20 orthodontically treated patients (13 female, 7 male) involving 120 teeth with anterior white spot lesions (WSLs). Each participant received ICON resin infiltration or Hi-Bond Universal in contralateral quadrants. Esthetic changes were assessed by the patients and by two independent clinicians using a 100-point visual analogue scale (VAS) at one-month recall. CASE SELECTION: Participants aged 16-30 years and who had completed fixed orthodontic treatment at least one month before enrollment were included. Eligible participants presented with at least one visible WSL on the labial surfaces of the anterior teeth or premolars on contralateral quadrants. All participants were required to have good oral hygiene, clinically healthy gingival tissues, and no evidence of active periodontal disease. DATA ANALYSIS: Categorical outcome data were presented using descriptive summary measures including frequencies and percentages. The proportion of satisfactory vs. unsatisfactory outcomes (paired binary data) was compared between the Hi-Bond Universal and ICON treatments using the McNemar test. RESULTS: Overall patient satisfaction was equally high (80%) for both treatments, and there were no significant differences between patient or clinician ratings. Inter-assessor agreement was deemed "fair" for both groups (Cohen's kappa 0.318-0.340). Thus, both ICON and Hi-Bond Universal effectively masked WSLs, as deemed by subjective esthetic evaluation. CONCLUSION: Both bioactive adhesives and resin infiltration achieve satisfactory esthetic outcomes in masking demineralized enamel, at least in the short-term. Further longitudinal studies comparing the outcomes of these materials would be beneficial to determine whether these effects are sustained over time.