This is case number 3 of a series of cases that have as their main goal to explain a technique to eliminate the enamel white spots. As Style Italiano members and friends we want to share our experience with the Resin Infiltration Technique using ICON. Icon is the name of the resin infiltrant produced by DMG. We present a series of cases where white spots lesions are present for different reasons. With increasing esthetic requirements, patients need options for the most effective therapies. Today, fluorosis stains constitute a frequent reason for consultation for esthetic dentistry. These stains, which are white or brown in the most severe cases, may originate from a physical problem. We will see the treatment of definite white fluorosis stains, using a current conservative technique : erosion-infiltration and in the same time composite resin restauration for restore coronal fracture and proximal caries.
The objective is to describe a simple and predictable clinical sequence, to ensure the patient expectations with erosion infiltration and direct composite resins in the same anterior teeth.
Img. 1 - Initial situation. A patient came to my clinic to improve the aesthetics of her smile. Img. 2 - Initial situation. The patient complained mainly about the white spots and the coronal fractures of teeth 1.1 and 2.1. We explained the advantages of direct composite resin with erosion infiltration because of her age (14 years). Img. 3 - Initial situation Img. 4 - Initial situation, surface texture. Img. 5 - Initial situation, palatal caries. Img. 6 - Initial situation, polarized picture for internal stratification analysis. The white spots are the main challenge, but we have to imagine stratification under white spots opalescence and incisor line. Img. 7 - Choice of composites in order to mimic the dental tissues. UD2 / UD3 / UE2 / OBN shades were chosen from Enamel HRi. Img. 8 - After rubber dam placement, the first step is erosion infiltration to treat the white spots. The following step consists of accessing the hypomineralized fluorosis lesions. This requires the elimination of the hypermineralized enamel on the surfaces of the lesions. Therefore, the erosion is performed using a gel of 15% hydrochloric acid (Icon-Etch DMG) for 120 seconds. In order to avoid uneven erosion, which could be caused, for example, by bubbles forming in the gel, the surface is mechanically rubbed using a microbrush. (3 steps of erosion to access to the lesion) Img. 9 - Dehydration with ICON DRY. Once the enamel has been eroded, the water contained in the micro-pores of the fluorosis lesions must be eliminated before the resin infiltration is carried out. In fact, the infiltrating resin (Icon-Infiltrant) is a matrix based on hydrophobic methacrylate resin (TEGDMA): for this reason, the lesions must be desiccated beforehand. This dehydration is accomplished through the application of a solution of 99% ethanol (Icon-Dry), for 30 seconds, on the surface of the lesions using a flat-end needle. Img. 10 - Resin infiltration (ICON INFILTRATE). At this point, infiltration can be performed. The application of TEGDMA-based resin (Icon-Infiltrant) with a refractive index of 1.52, which is close to that of enamel (1.62), is performed using the sponge applicator tip. This resin, which has very low viscosity, uses capillary action to infiltrate the porosities of the lesions for 3 minutes. Since the resin can be photo-polymerized, this should be done away from light. The application of acid agent provides significant surface tension, which also facilitates the infiltration. The resin penetrates more deeply into the enamel than conventional adhesives do. Solvents are evaporated using the air blower and any excess is eliminated using dental floss on the vestibular surface. A polymerization step is performed for 40 seconds before a second, similar infiltration step is carried out. This minimizes the surface porosity. Img. 11 - Caries removal on palatal side. Img. 12 - Composite resin stratification with a palatal silicone index made on waxed-up model. Img. 13 - Enamel stratification after dentin and opalescent masses. Img. 14 - Final result just after polishing and rubber dam removal. Img. 15 - Final result with polarized picture. There is a lot of imperfection in this stratification as we can see with this polarized picture. Img. 16 - Macro aspect of superficial texture. Img. 17 -15 days follow-up.
Conclusions
The combination of resin-infiltration treatment with composite restorations represents, especially on young patients, a very conservative therapy and good aesthetic result.
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