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.
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.
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.
Fig.3
Aquacare used to clean the teeth and also to remove the superficial discolouration.
Fig.4
Icon Etch used and applied to the teeth for 2 minutes.
Fig.5
Application of Icon-etch.
Fig.6
Teeth are air dried after washing.
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.
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.
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.
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.
Fig.11
Icon Infiltrant applied and left for 3 minutes to infiltrate.
Fig.12
The teeth are light cured for 60 seconds each (Eighteeth CuringPen).
Fig.13
Re-apply Icon Infiltrant to the teeth for a further 1 minute and light cure again to reduce porosity.
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.
Fig.15
We can now remove the metal separators.
Fig.16
Once we remove the separators we can begin the finishing and polishing. Metal separators can be removed using the Bella instrument.
Fig.17
Soflex disc used to remove any excess composite labially from the UR1 and UL1.
Fig.18
Floss is used to remove excess composite and simplify the interproximal finishing with the strips.
Fig.19
Interproximal finishing strips used to remove excess resin.
Fig.20
ASAP polishing wheel used to polish the teeth.
Fig.21
Completion of treatment.
Fig.22
Immediate post operative retracted view.
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.
Fig.24
1 month recall retracted view.
Fig.25
1 month recall smile view.
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
- Shaalan O. Bleaching, microabrasion and composite restoration. 2019 – styleitaliano.org
- Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 5. Quintessence Books, 2012.
- 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.
- 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.
