Removing white spots with deep infiltration technique

10 Oct 2016 - 87396

One of the first concern of the patient is the shade of their teeth, especially when white spots cover a big part of their front teeth. Practitioners are today facing the increasing aesthetic demand from the patients and must respond by using simple repeatable and conservative protocols. There are several treatment options described to correct this kind of discoloration, and one of the most conservative and efficient ones is the erosion/infiltration protocol using the Icon system. This technique was first developed to process initial carious lesions of the posterior teeth. This procedure had the effect of removing the whitish discoloration of demineralized areas and was therefore proposed and improved to treat the anterior region.

Fig. 1

A young female patient came to the office to correct the big white spots on her front teeth. She asked us for veneers and we told her that there is probably a better and more conservative approach to solve her case. We proposed to treat her by using an erosion/infiltration protocol.

Fig. 2

Clinical examination and pictures are done.

Fig. 3

Cross polarized picture shows the extension of the spots.

Fig. 4

The first step of the treatment was to whiten her teeth using White Dental Beauty 16% CP for 10 days.

Fig. 5

When performing an erosion infiltration treatment, rubber dam isolation is mandatory.

Fig. 6

Sandblasting (50um aluminum oxyde) allows us to access depth of the lesion.

Fig. 7

Icon Etch (15% hydrochloric acid) is brushed for 2 minutes and then rinsed and dried for 30 seconds.

Fig. 8

Icon dry is applied and sit for 30 seconds.

Fig. 9

White spots are still visible, we have to start the procedure again.

Fig. 10

Second application of Icon etchant.

Fig. 11

Second application of Icon dry. 

Fig. 12

After 4 cycles of this procedure, we can see that white spots are nearly invisible, we can now apply Icon infiltrant for 3 minutes and light cure for for 1 minute.

Fig. 13

Sandblasting removed about 100 to 200 microns of enamel, that is why we need to use enamel composite to restore this loss.

Fig. 14

Outcome after composite application.

Fig. 15

The same procedure was used for the canines and the cusps were rebuilt with a direct composite restoration.

Fig. 16

After restoration.

Fig. 17

Before restoration.

Fig. 18

after restoration

Fig. 19

Final result before dam removal.

Fig. 20

Direct post operative outcome, after dam removal, teeth were thoroughly polished.

Fig. 21

Direct post operative outcome (without flash bouncers )

Fig. 22

Post operative smile

Fig. 23

Before/after result.

Fig. 24

Before/after result, cross polarized picture.

Fig. 25

1 week later teeth are rehydrated, final outcome is correct and the patient is satisfied.

 

Conclusions

The erosion/infiltration protocol is a conservative and reliable option to restore a smile with white spots. This technique used with Icon allows us to guarantee to the patient a great aesthetic outcome with minimal loss of sound structure.

Bibliography

1. Attal JP, Atlan A, Denis M, Vennat E, Tirlet G. L’infiltration en profondeur : un nouveau concept pour le masquage des tâches de l’émail (partie 1). L’information dentaire n°19- 15 mai 2013 : 74-79.

2. 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.Feb 3. English, French.

3. Tassery H. Lésions amélaires: quand et comment agir? Clinic 2009;30:72–74.

4.Salat Anna. Post orthodontic white spots. www.styleitaliano.org

5. Clement Marie. Infiltrate and restore www.styleitaliano.org

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

7. Gauthier Weisrock, Jean-Louis Brouillet. Le champ opératoire évidemment. L’INFORMATION DENTAIRE n° 42 – 3 décembre 2008.

8. 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.