Solving White Spots with Composite

Shadeguides - Cases - Tips and tricks - Products - Direct anteriors
2016-12-12

There are some imperfections on enamel that cause esthetic issues to our patients. Some of them can be treated with infiltration or non invasive procedures but others needs the help of the composite resins. This article tries to give a step by step protocol for this type of procedures for all of us to obtain a predictable result in this kind of treatment.

Fig. 1

Img. 1 – 25 years male patient presents a white and brown spot that produces him an esthetic problem in his smile. Previous treatments of infiltration and whitening were made and the final result wasn't satisfactory to him. So he asks for another solution and composite restoration for eliminating the defect was proposed to obtain a result that integrates in the mouth.

 

Fig. 2

Img. 2 – During this workflow we take photos with the twin flash (img. 1), ring flash (img. 2)

Fig. 3

Img. 3 – And polarized photos

Fig. 4

Img. 4 – To select the color we use the smile lite lamp and the smartphone photographs with the MDP protocols

Fig. 5

Img. 5 – Previous to the isolation we use floss to ensure that the interdental spaces are permeable to place the rubber dam

Fig. 6

Img. 6 – Dental floos can also be used to make slipknots to adapt the rubber dam to the cervical part of the teeth and avoid the fluids to interfere with the adhesion

Fig. 7

Img. 7 – We check from the palatal side

Fig. 8

Img. 8 – A thin spatula can help holding the slipknot and introducing the rubber dam in the sulcus

Fig. 9

Img. 9 – Once the field is adequately clean and clear we can proceed to the restorative phase

Fig. 10

Img. 10 – With the macro photos we can see the details of the defect

Fig. 11

Img. 11 – The  8801-314-014 bur of the Direct Style bur kit is used to eliminate the spot in a conservative way

Fig. 12

Img. 12 -Try to eliminate the lesion as much as possible but at the same time being so conservative with the enamel, without anesthesia 

Fig. 13

Img. 13 – After the cavity is prepared, adjacent teeth are protected with teflon tape

Fig. 14

Img. 14 – Etch the lesion with 37% orthophosporic acid (BM4) for 15 seconds

Fig. 15

Img. 15

Fig. 16

Img. 16 – Wash and dry in a proper way

Fig. 17

Img. 17 – Magnification allows us to see where are the parts that needs to be covered

Fig. 18

Img. 18 – Universal adhesive is applied in several layers and air-sprayed in order not to get a  thick layer

Fig. 19

Img. 19 – Polymerization with high intensity for 20 seconds

Fig. 20

Img. 20

Fig. 21

Img. 21 – We can use an opaque composite or an opaquer in the white areas to obtain a better color and a natural result within a minimal space; in this case we decide to use a Masking Liner

Fig. 22

Img. 22 – A small quantity of medium dentin is applied brushing in the transition area and smoothing the composite, if we like to wet the brush we will use a dental bonding agent (multipurpose system 3M)

Fig. 23

Img. 23 – Smoothing the composite allows us to integrate it with the natural teeth

Fig. 24

Img. 24 – After polymerization, a layer of light enamel is applied in a 0,5 mm controlled by the use of Misura instrument after applying the dentin mass to leave the adequate space for the enamel layer

Fig. 25

Img. 25 – Brushing every increment

Fig. 26

Img. 26 – Finishing and polishing procedures with the soflex system

Fig. 27

Img. 27 – The speed of the disc can be controlled, 20.000 rpm for the first and second one

Fig. 28

Img. 28 – Polishing with the burs of the Finishing Style bur kit in a 1:5 handpiece

Fig. 29

Img. 29 – Magnification allows us to check if the anatomy is integrated in the tooth

Fig. 30

Img. 30 – Immediately after finishing, we need to wait to rehydratation

 

The first option in this type of discoloration lesions must be the infiltration process or abrasion to eliminate them, but when this procedure is not enough, composite becomes the most suitable one. Shade selection and control enamel thickness are mandatory to obtain really natural results without eliminating so much dental structure and maintain as much enamel as possible