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Giulio Pavolucci

Removing white spots combining resin infiltration with direct composite

34974 Views - Apr 2017

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As dentists we must focus on biological and functional problems of our patients, but nowadays we have to pay a lot of attention to aesthetica, which is one of the more common reasons why patients come to our offices. Correcting unaesthetic problems may require sound tissue removal because of tooth preparation; sometimes this is mandatory, but we must try and avoid it whenever it's possible.

Last year Styleitaliano members had the opportunity to use ICON, a low density resin used to infiltrate and eliminate white and brown stains and to stop incipient caries. Most of our members introduced the resin infiltration technique to their daily practice as it is an easy, feasible technique; It's a well accepted option for patients as it is more conservative than other available options, avoiding the turbine. 

In many articles on styleitaliano.org we have seen how easy can be to remove white and brown spots from tooth surfaces using the Icon infiltration technique; in the past we presented some clinical cases with Icon used in different clinical situations:

- To stop cervical caries and eliminate the aesthetic defects

- To eliminate white spots After orthodontics

- To eliminate fluorosis stains

- To stop proximal posterior caries lesions

In this clinical case we present the resin infiltration technique with Icon used in another clinical situation: white and brown spots caused by an old trauma.

Trauma in decidous teeth can affect enamel formation on the permanent ones; in anterior lesions caused by an old trauma we can frequently find deep lesions. We cannot detect in advance the lesion depth, but sometimes the origin of the spots and their size make us think that probably we will need to combine icon with composite, because the only resin can't go deeply enough. In these cases a thin composite layer can help us to achieve a better aesthetic outcome, and we use Icon layer like a enamel adhesive.



Img. 1 - This 17 years old female patient came to our attention complaining about big white and orange spots on both upper central incisors and asking for two ceramic veneers (she read about this kind of solution on the internet). Covering this kind of spots with ceramic would have requested quite a thickness, and consequently a preparation of the teeth; considering the young age of the patient, we decided to propose her a resin infiltration in combination with a direct composite restoration. This kind of solution is for sure less invasive and considerably less expensive.

Img. 2 - A closer view of the central incisors

Img. 3 - Rubber dam was placed to properly isolate the teeth, no anesthesia was necessary.

Img. 4 - Enamel surfaces were slightly sandblasted.

Img. 5 - Icon Etch (15% hydrochloric acid) was applied for 2 minutes and gently rubbed using the application tip.

Img. 6 - The etchant was rinsed, teeth were air dried and the Icon etch was applied for a second time (2 minutes)

Img. 7 - The etchant was rinsed once again for 30 seconds.

Img. 8 - Ethanol (icon dry) was applied and then air blown. Ethanol has a refractive index close to that of resin, so it can be really helpful to pre-visualize the final result.

Img. 9 - Tegdma resin (Icon infiltrant) is applied for 3 minutes, gently rubbing the application tip. Excesses are removed with a gentle air blow and floss, then a light curing procedure is performed for 40 seconds.

Img. 10 - The resin is applied a second time.

Img. 11 - Then is cured again.

Img. 12 - The result is quite good, but some spots are still visible, so the application of a composite layer was necessary.

Img. 13 - A layer of resin composite is applied using a brush and light cured.

Img. 14 - Finishing and polishing procedures are very fast and easy, just a silicone tip and an abrasive stripe.

Img. 15 - Immediate post-op, just after rubber dam removal.

Img. 16 - One month post-op control: the patient is really happy, she had no problems at all and she feel much more confident when smiling without the white and brown spots.

Conclusions

The infiltration technique is an easy, conservative, non invasive and reliable source for the dentist, especially with young patients; it can be the perfect solution to achieve aesthetic results without removing sound tissue in this kind of lesions caused by an old trauma. If needed, it can be easily combined with a normal resin composite to improve the aesthetic outcome.
 

Bibliography

  1. Attal JP, Atlan A, Denis M, Vennat E, Tirlet G. White spots on enamel: treatment protocol by superficial or deep infiltration (part 2). Int Orthod. 2014 Mar;12(1):1-31
  2. Salat Anna. http://www.styleitaliano.org/post-orthodontic-white-spots
  3. Clement Marie. http://www.styleitaliano.org/infiltrate-and-restore.
  4. Manauta J, Salat A. Layers: an atlas of composite resin stratification. Quintessence 2012.
  5. Devoto W, Saracinelli M, Manauta J. Composites in every day practice: How to choose the right material and simplify application techniques in the anterior teeth JEAD, Jan. 2010.

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