White Spots, Bleaching and Micro-abrasion
Since its introduction in the late 80’s, dental bleaching has become one of the most commonly performed procedures by practitioners. The popularity of dental bleaching has increased due to the influence of the media. In fact, its newly gained popularity has brought to light a whole new set of challenges. White spots caused by alterations on the enamel formation (Dental hypoplasia) or by extrinsic substances (Dental Fluorosis) are widely prevalent in many countries around the globe . In these cases, dental bleaching has become a big concern for dentists as they do not want to make white spots even more evident. In these situations patients may require combined techniques for optimal results. Micro-abrasion is a technique that combines two strategies (erosion and abrasion) to obtain minimally invasive wear of enamel white spots. These products usually contain an erosive substance (6.6% hydrochloric acid) and abrasive particles (silica) to allow 25 to 200 μm enamel wear per application. In this clinical case we present a simplified step by step treatment of white spots using a simplified bleaching system and micro-abrasion.
Minimally invasive combined procedure for patients with enamel white spots using a simplified bleaching material and micro-abrasives.
Pre-operative. Female, 27 years old. Initial aspect. White spot caused by Dental Fluorosis.
Color reference selection with a Vita Classic Scale (right side).
Color reference with a Vita Classic Scale (left side).
Bleaching procedure using Opalescence Go. This bleaching system requires no previous mould. The pre-contoured trays allow immediate adjustment.
Adjusting the lower pre-contoured tray in the mouth.
Aspect after adjusting the upper and lower pre-contoured trays. It can be observed a transparent thin tray containing 10% Hydrogen Peroxide (Opalescence GO, Ultradent). The manufacturer recommends 45 minutes to 1 hour exposure to the bleaching system per session.
Clinical Aspect after 7 days of at-home bleaching using Opalescence GO (Ultradent).
Bleaching control after one week, using Opalescence GO (Right side).
Bleaching control after one week, using Opalescence GO (Left side).
Thickness and depth determination of the white spot using a contrast light. A curing light can be used for this purpose.
After isolated the tooth was conditioned with Opalustre (6.6% Hydrochloric acid containing silica particles) Ultradent.
After 2 minutes conditioning the paste must be removed using a rubber cup (Opalcup, Ultradent).
Aspect after two applications in one session of Opalustre, Ultradent.
Polishing with composite polishing cups in decreasing order. Jiffy,Ultradent.
The use of diamond paste is also an option while polishing tooth surface.
Final polished with diamond paste and polishing cup.
Final Aspect of the tooth after bleaching and micro-abrasive procedures.
The combination of bleaching and micro-abrasion can result in an even more conservative procedure since we can mimic the spots with a clearer enamel substrate that may result in a lower tissue loss.