Conservative treatment of Fluorosis and post-orthodontic white spots
After the enthusiastic adoption of resin infiltration as a conservative treatment for conditions such as fluorosis and white spots, many dentists from around the world were disappointed by it only working “sometimes”. The indications for infiltration procedures and the clinical protocols are extremely important. Sometimes combining infiltration with bleaching can dramatically improve the outcome of the infiltration procedure, making it easier to complete the treatment successfully.
Bleaching should not be considered a vanity procedure anymore, but a conservative treatment, as it has clear actions in making white and amber spots disappear, among many other benefits.
White spots are common lesions of different etiology that haven’t been treated for ages, as, before the adhesive era, treatment of these lesions was extremely destructive (i.e. crowns). After a while, more conservative treatments came to the rescue, as mechanical macro-abrasion with burs, abrasive and acid micro-abrasion and composite resin restorations.
Recently, the ultraconservative treatment with chemical erosion, bleaching and resin infiltration has opened a window on the full, conservative treatment of these spots.
TIP: The best strategy features a first, mandatory home bleaching stage with 10% Carbamide Peroxide (White Dental Beauty) for 15 days. This might sound as a paradox, but many of the spots change, the color of the substrate whitens and the contrast between spot and tooth becomes is reduced. Spots are easier to infiltrate after bleaching and the reason is not clear yet.
The resin infiltration technique is an effective treatment option in a large number of cases of post-orthodontic white spots and mild fluorosis.
A first clinical study demonstrated successful masking of post-orthodontic lesions (61% completely and 33% incompletely masked lesions) with infiltration treatment (Kim S. et al). In our experience even in the incompletely masked lesion the patients are satisfied with the results. After the success of the resin infiltration technique masking post-orthodontic white spots we decided to propose the technique to different origin white spots. So in our series of clinical cases it is seen that the resin infiltration makes it possible to treat the superficial enamel lesions effectively, whatever their etiology.
The role of whitening is very important since it helps vanishing effectively white spots and amber spots, making them more attackable by the resin infiltration technique.
First case performed by Dr. Elisa Oneto. Second case by Dr. Elisa Oneto and Dr. Anna Salat. Thanks to Dr. Elisa Oneto with whom it is always a pleasure to collaborate for an interdisciplinary approach.
Tirlet G, Attal JP. L erosion/infiltration: une nouvelle therapeutique pour masquer les taches blanches. Inf Dent 2011;2-7.
Salat A, Devoto W, Manauta J: Achieving a precise color chart with common computer software for excellence in anterior composite restorations. Eur J Esthet Dent; 2011;6(3):280-96
Manauta J, Salat A. Layers, An atlas of composite resin stratification. Chapter 5. Quintessence Books, 2012.
Denis M, Atlan A, Vennat E, Tirlet G, Attal JP. White defects on enamel: diagnosis and anatomopathology: two essential factors for proper treatment (part 1). Int Orthod 2013;11 ?(2):13965.
Kim S, Kim EY, Jeong TS, Kim JW. The evaluation of resin infiltration for masking labial enamel white spot lesions. International Journal Paediatric Dentistry 2011;21:2418.