Brown and White Spots on Teeth: Micro-invasive Treatment
As tooth discolorations, brown and white spots have, among ultraconservative methods of dental therapy, chemical treatments as one of the most biomimetic options due to the total conservation of remaining intact tooth substance. Knowledge of these techniques, combined with a well-defined selection of indications, often allows more invasive treatment options (composite or ceramic veneers) to be avoided.
In previous articles of the Style Italiano community, external and internal bleaching techniques have been well described. In certain cases of idiopathic spots and stains of the vital teeth, chemical treatment was proposed as the definitive therapy. Whitish and brownish stains can occasionally be eliminated by combining bleaching with mechanical abrasion treatment.
Recently, practitioners received another option to consider while treating brown/white spots: the erosion-infiltration technique.
The method, initially developed for the treatment of early caries lesions in the enamel, has the secondary effect of masking white stains because it modifies the optical properties of the tooth (ICON by DMG). After erosion conducted using a gel of 15% hydrochloric acid, the infiltration of a very low-viscosity resin (with a refraction index close to the healthy enamel) into the porosities of the body of the lesion produces a translucent enamel one again. This therapy preserves the structures of the patient’s tooth and does not cause any pain.
The infiltration technique has been widely proven to eliminate unaesthetic enamel spots, as long as the depth is correctly evaluated and the indications followed correctly; in other words, in deep lesions infiltration alone can appear to be insufficient.
Before stain treatment as a routine procedure, bleaching should be proposed for several reasons described by Jordi Manauta.
In previous published SI case studies it has been shown that, through effective bleaching, the amber spots turn into white spots which are more subject to the acid treatment of the infiltration therapy.
Concerning the white spots: bleaching reduces their opacity and the contrast between the white spots and surrounding newly bleached tissues.
At the second appointment, the lesion on tooth 11 was eroded with 15% hydrochloric acid for 120 seconds (ICON etch, DMG, Germany)
1. The dental practitioner should be aware of the minimal invasive possibilities that are available in contemporary dentistry.
2. Bleaching should be the first choice when thinking about discolouration or restorative treatment
3. Infiltration therapy should be a considered together with bleaching for the treatment of brownish/whitish spot problems.
1. Meyer-Lueckel H, Chatzidakis A, Naumann M, Dörfer CE, Paris S. Influence of application time on penetration of an infiltrant into natural enamel caries. J Dent 2011; 39 (7): 465-469.
2. Manauta J. Bleach, infiltrate and restore; http://styleitaliano.hime.host/bleach-infiltrate-and-restore/
3. Clement M. Minimally invasive treatment of enamel fluorosis white spot lesions; http://styleitaliano.hime.host/minimally-invasive-treatment-of-enamel-fluorosis-white-spot-lesions/
4.Zarow M. Nonvital Tooth Bleaching: A Case Discussion for the Clinical Practice. Compend Contin Educ Dent. 2016 Apr;37(4):268-76.
5. Zarow M, D’Arcangelo C, D’Amario M, Marzo G. Conservative approach for the management of congenital bilateral agenesis of permanent mandibular incisors: case report and literature review. Eur J Paediatr Dent. 2015 Jun;16(2):154-8.
6. Tirlet G, Chabouis HF, Attal JP. Infiltration, a new therapy for masking enamel white spots: a 19-month follow-up case series. Eur J Esthet Dent. 2013 Summer;8(2):180-90.Kim S, Kim EY, Jeong
7. TS, Kim JW. The evaluation of resin infiltration for masking labial enamel white spot lesions. International Journal Paediatric Dentistry 2011;21:2418.
8. Magne P, Belser U : Bonded Porcelain Restorations in Anterior Dentition : A Biomimetic Approach; Quintessence Publishing 2002