Removing white spots by resin infiltration and direct composite

13 Apr 2017 - 79691

Correcting aesthetic problems, such as white spots, may require sound tissue removal because of tooth preparation; sometimes this is mandatory, but we must try and avoid it if possible. As dentists nowadays we have to pay a lot of attention to aesthetics, which is one of the more common reasons why patients come to our practices, but we still must focus on biological and functional problems of our patients. 

Last year the Style Italiano members had the opportunity to use ICON, a low density resin for infiltration and elimination of white and brown stains, which also turns out useful in stopping incipient caries. Most of our members introduced the resin infiltration technique in 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 Style Italiano 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 deciduous teeth can affect enamel development on the permanent ones; in anterior lesions caused by an old trauma, we can frequently find deep lesions. There’s no way we can detect the lesion depth in advance, but sometimes the origin of the spots and their size make us think that we will probably need to combine the Icon treatment with composite, because the resin alone can’t go deep enough. In these cases a thin composite layer can help us achieve a better aesthetic outcome, and we use Icon layer like an enamel adhesive.

Fig. 1

This 17 year 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 required quite thick veneers, and consequently the preparing of the teeth; given the young age of the patient, we decided to propose a resin infiltration in combination with a direct composite restoration. This kind of solution is, for sure, less invasive and considerably less expensive.

Fig. 2

A closer view of the central incisors.

Fig. 3

The rubber dam was placed to properly isolate the teeth, no anesthesia was necessary.

Fig. 4

Enamel surfaces were slightly sandblasted.

Fig. 5

Icon Etch (15% hydrochloric acid) was applied for 2 minutes and gently rubbed using the dedicated application tool.

Fig. 6

The etchant was then rinsed, teeth were air dried and the Icon etch was applied once again for 2 minutes.

Fig. 7

The etchant was again rinsed for 30 seconds.

Fig. 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.

Fig. 9

A TEGDMA resin (Icon infiltrant) was applied for 3 minutes, gently rubbing the application tip. Excess material was removed with a gentle air blow and floss, and the resin was light cured for 40 seconds.

Fig. 10

The resin is applied a second time.

Fig. 11

Then is cured again.

Fig. 12

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

Fig. 13

A layer of resin composite was applied using a brush and light cured.

Fig. 14

Finishing and polishing procedures are very fast and easy, just a silicone tip and an abrasive strip.

Fig. 15

Immediate post-operative picture, just after rubber dam removal.

Fig. 16

One month post-operative control: the patient is very 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 dental practitioner, 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

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.
Manauta J, Salat A. Layers: an atlas of composite resin stratification. Quintessence 2012.
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.