Although resin infiltration techniques are not the first choice in treating most MIH lesions, many patients refuse to have their teeth drilled, while they come seeking for a solution to this esthetic issue.
Fig.1
A patient aged 46 came to my clinic asking me to solve her aesthetic problem. As I usually do, whenever I have to treat white spots on dark teeth, or basically when I approach treatments with a high aesthetic impact, I recommend a bleaching to improve the base we work on.
Fig.2
A 16% carbamide peroxide-based home whitening gel (White Dental Beauty) with custom trays without reservoirs was selected for bleaching.
Fig.3
After 3 weeks whitening for 4 hours a day, and after an additional 20 days wait, teeth were ready for treatment of the discolorations.
Fig.4
The white portion of the spots had faded but the orange portion was still evident.
Fig.5
The K-lite allows me to understand the actual depth of the stain due to MIH (K-Lite – SmileLine)
Fig.6
Although MIH is not the ideal condition to apply resin infiltration, I tried to apply this minimally invasive approach, but the position of the spot in the thickness of the enamel forced me to sandblast before letting the etching work (AquaCare).
Fig.7
Because of the depth of the lesions, I knew from the beginning that I would have to repeat the cycle several times.
Fig.8
Using ICON dry after each erosion I simulated the action of the infiltrant resin. The dyschromia was still evident after the first cycle.
Fig.9
I repeated the etching step.
Fig.10
Third cycle.
Fig.11
Since the patient had two shallow white spots on the lateral incisors as well, I decided to extend the treatment involving them, as two erosion cycles should be enough to make them disappear.
Fig.12
I repeated the etching step for the fifth and last time.
Fig.13
The action of Icon Dry revealed that the stains were ready to be infiltrated.
Fig.14
After infiltrating dyschromias and curing, I needed to restore the involved teeth.
Fig.15
A thin layer of white enamel was applied on 11 and 21 to increase the value on the incisal third and to thicken it.
Fig.16
A greyish halo still remained, but for final evaluation we needed to wait for rehydration.
Fig.17
Final outcome after removing the rubber dam.
Fig.18
Smile after finishing and polishing procedures 2 weeks later.
Fig.19
6 months after professional oral hygiene recall.
Fig.20
15 months later.
Conclusions
An approach with a bur would have been faster and more performing, but certainly more destructive. If the patient does not consent to such kind of treatment, whitening and infiltration can be used to reduce the difference between the refractive index of the stain and healthy enamel, providing a basis for a minimal restoration. Either way, bleaching can help to even out the color and simplify the choice of the restorative material.
Bibliography
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- Colella A. When should I really stop etching a white spot? 2020 Styleitaliano.org
- Subramaniam P, Girish Babu KL. Evaluation of penetrating depth of a Commercially available resin infiltrate into artificially created enamel lesions: An in vitro study. J Conserv Dent. 2014;17(2):146-148.
- Arnold WH, Haddad B, Schaper K, Hagemann K, Lippold C, Danesh G. Enamel surface alterations after repeated conditioning with HCl. Head Face Med. 2015;11:32.
- Fejerskov O, Nyvad B, Kidd E. (eds) (2015) Dental Caries: The Disease and Its Clinical Management. 3rd Edn. Oxford, Wiley Blackwell.
