A conservative approach to treating brown and white lesions with Icon and composite

Globally, groundwater provides potable water to millions of people. It is the only source of water for over 400 million people in Africa alone. Fluoride, a common groundwater contaminant, poses a significant health risk to humans. It has been found that fluoride in small amounts (0.5-1.0 mg/L) aids in the development of bones and teeth, but concentrations exceeding 1.5 mg/L have been linked to fluorosis and other health problems. As a result of excessive fluoride exposure, dental fluorosis and skeletal fluorosis are among the most common diseases. Drinking contaminated water remains the main source of fluoride ingestion, despite other pathways such as tea consumption and vegetable consumption. A high level of fluoride has been documented in groundwater in sub-Saharan Africa, particularly in East African nations, Sudan, and South Africa.

style italiano styletaliano intraoral picture showing brown and white lesions

Fig.1
This young patient wanted to remove the white and brown lesions on her front teeth. She had tried whitening in the past with little or no improvement. After discussion with the patient we agreed to use Icon by DMG to treat these lesions.

style italiano styletaliano rubber dam isolation before icon infiltration treatment

Fig.2
Rubber dam placed to provide adequate isolation and improved visibility. Icon is an adhesive procedure and therefore rubber dam should be used as standard practice to improve predictability and outcome of final results.

style italiano styletaliano aquacare for thorough surface cleaning prior to infiltration

Fig.3
Aquacare used to clean the teeth and also to remove the superficial discolouration.

style italiano styleitaliano application of icon etchant

Fig.4
Icon Etch used and applied to the teeth for 2 minutes.

dmg banner style italiano styleitaliano
dmg banner style italiano styleitaliano
style italiano styletaliano icon etch sitting for two minutes

Fig.5
Application of Icon-etch.

style italiano styletaliano teeth after one cycle etching and drying

Fig.6
Teeth are air dried after washing.

style italiano styletaliano icon dry solution showing remaining brown halo

Fig.7
Icon Dry is used to confirm whether or not the first round of etching has managed to remove the white and brown lesions. If the white/brown lesions disappear then we can move onto the next step. If not, we repeat the Icon Etch step again. The ethanol solution allows you to previsualise the result as Icon Dry and Icon resin Infiltrant have a similar refraction index.

style italiano styletaliano second etching cycle

Fig.8
As seen from figure 7. the white/brown lesions remained after the first round of etching so the teeth are etched once again for 2mins. They are washed copiously and dried. In this case the brown lesions did not disappear after 3x cycles of etch. Aquacare is once again used to air abrade the lesion followed by use of a coarse or medium soflex disc to minimally remove the brown lesions.

style italiano styletaliano previsualization of spot removal

Fig.9
The Icon Dry is reapplied until we can see the white/brown lesions disappear. This is the moment we can move onto the next step; the Icon resin application.

style italiano styletaliano dried teeth before infiltration with resin

Fig.10
Before applying the Icon Infiltrant we place some metal strips to separate the teeth and stop them from sticking to one another and make the finishing processes easier. Note the presence of small superficial enamel defects on the central incisors. This is where weak enamel was removed during the air abrasion process with the aquacare and a coarse soflex disc.

style italiano styletaliano infiltration resin being applied with metal strips in between teeth

Fig.11
Icon Infiltrant applied and left for 3 minutes to infiltrate.

style italiano styletaliano light curing of infiltrant resin

Fig.12
The teeth are light cured for 60 seconds each (Eighteeth CuringPen).

style italiano styletaliano after light curing of infiltration resin

Fig.13
Re-apply Icon Infiltrant to the teeth for a further 1 minute and light cure again to reduce porosity.

dmg banner style italiano styleitaliano
dmg banner style italiano styleitaliano
style italiano styletaliano application of buccal composite to biggest lesions on central incisors

Fig.14
A small amount of 3M filtek universal composite was used to fill the small enamel defects created by air abrasion. LM anterior Solo instrument used to apply and shape the composite.

style italiano styletaliano after infiltration and composite restoration

Fig.15
We can now remove the metal separators.

style italiano styletaliano removal of metal matrices before polishing

Fig.16
Once we remove the separators we can begin the finishing and polishing. Metal separators can be removed using the Bella instrument.

style italiano styletaliano finishing and polishing by soflex discs

Fig.17
Soflex disc used to remove any excess composite labially from the UR1 and UL1.

style italiano styletaliano flossing to ensure proximal accessibility for strips

Fig.18
Floss is used to remove excess composite and simplify the interproximal finishing with the strips.

style italiano styletaliano proximal strip polishing after resin infiltration

Fig.19
Interproximal finishing strips used to remove excess resin.

style italiano styletaliano polishing wheel

Fig.20
ASAP polishing wheel used to polish the teeth.

style italiano styletaliano polished teeth after resin infiltration

Fig.21
Completion of treatment.

style italiano styletaliano infiltrated teeth after composite removal

Fig.22
Immediate post operative retracted view.

style italiano styletaliano smile after brown and white spot removal

Fig.23
The final immediate post operative results reveal a beautiful outcome. Icon is a fantastic treatment option for patients whereby we can address the patient’s concern in a conservative and pain free way.

style italiano styletaliano one month after resin infiltration

Fig.24
1 month recall retracted view.

style italiano styletaliano smile at one month follow up

Fig.25
1 month recall smile view.

style italiano styletaliano before and after brown and white spot infiltration

Fig.26
Pre and 1 month Post operative retracted view side by side.

Conclusions

Icon is a fantastic conservative treatment modality. In most cases where Icon is used there is no need for anaesthetic, drilling, or tooth damage. It is important to follow the instructions and utilise the icon-dry solution to preview the results before placing the resin infiltrate. In most cases Icon can be used as an alternative to cavity preparation, prolonging the need or even eliminating all together thinned for more invasive or aggressive removal of tooth tissue.

Bibliography

  1. Shaalan O. Bleaching, microabrasion and composite restoration. 2019 – styleitaliano.org
  2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 5. Quintessence Books, 2012.
  3. Attal J P, Atlan A, Denis M, Vennat E, Tirlet G . White spots on enamel: treatment protocol by superficial or deep infiltration (part 2). Int Orthod 2014; 12: 1–31.
  4. Paris S, Schwendicke F, Keltsch J, Dorfer C, Meyer-Lueckel H . Masking of white spot lesions by resin infiltration in vitro. J Dent 2013; 41: 28–34.

RELATED CASES

style italiano styleitaliano composite veneers restoration

Canine to canine direct composite veneers

Composite veneers are typically chosen as a conservative treatment for anterior teeth. With the right materials and products a durable and good looking result is achievable.