Minimally invasive approach in treating white spot lesion using icon

A clinical case by our Community member Dr Ali Ashraf

This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.

White enamel lesions, commonly referred to as white spot lesions, are a relevant dental condition characterized by demineralization of the tooth enamel, leading to chalky white opaque areas on the tooth surface. These lesions can arise due to several reasons, including prolonged exposure to acidic conditions, poor oral hygiene, and the accumulation of dental plaque. It used to be treated invasively with heavy tooth reduction followed by indirect restoration, but now, with minimally invasive approaches, more conservative treatments can be provided to achieve the best results with minimal intervention.
In the case presented, a 10-year-old female patient was unhappy with the white-brownish lesion covering her anterior tooth.

styleitaliano style italiano close up of tooth with brown spot DMG Icon resin infliltration white spot lesions

Fig.1
Upon diagnosis, there was a history of trauma to tooth 11, which likely led to the formation of the lesion. The treatment plan involved using microabrasion followed by Icon infiltration.

styleitaliano style italiano rubber dam isolation DMG Icon resin infliltration white spot lesions

Fig.2
First, multiple isolation was performed using the rubber dam to prevent any harm to the gingival tissue during the use of the acidic slurry during microabrasion or the Icon etchant.

styleitaliano style italiano abrasive paste before infiltration DMG Icon resin infliltration white spot lesions

Fig.3
Microabrasion was performed using Ultradent Opalustre. The paste was applied over the affected tooth and gentle mechanical abrasion was conducted using cups at approximately 500 rpm. This process lasted for 60 seconds, followed by rinsing with water.

styleitaliano style italiano result after mechanical microabrasion DMG Icon resin infliltration white spot lesions

Fig.4
As observed, microabrasion successfully removed the brown stains affecting the tooth, which would facilitate the penetration of resin during infiltration, resulting in better and more predictable outcomes.

styleitaliano style italiano icon etch applied on white spot DMG Icon resin infliltration white spot lesions

Fig.5
Icon etch was applied for 2 minutes with continuous gentle rubbing.

styleitaliano style italiano ethanol solution applied on brown spot DMG Icon resin infliltration white spot lesions

Fig.6
Icon Dry, which consists of ethanol, was applied for 30 seconds to check if the refractive index of the porosities created by the etching process had become similar to sound enamel. If the discolored lesion persists, the etching step should be repeated (up to 3 times).

styleitaliano style italiano light curing of infiltrant resin DMG Icon resin infliltration white spot lesions

Fig.7
Finally, after 3 cycles of Icon etch, the tooth was ready for Icon infiltration, which consists of methacrylate-based resin. It was applied for 3 minutes, then cured for 40 seconds. A second infiltration is recommended to compensate for polymerization shrinkage, applied for 1 minute.

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styleitaliano style italiano result after resin infiltration DMG Icon resin infliltration white spot lesions

Fig.8
After the infiltration, only some polishing and finishing were required to enhance the results, making it look perfectly natural.

styleitaliano style italiano teeth after infiltration of brown spot DMG Icon resin infliltration white spot lesions

Fig.9

Conclusions

While minimally invasive approaches may seem straightforward, achieving optimal and predictable results necessitates thorough diagnosis, planning, and communication. The use of microabrasion prior to Icon infiltration has shown its effectiveness in enhancing outcomes.

Bibliography

Sure, here are the references in a uniform format:

  1. Gugnani N, Pandit IK, Gupta M, Josan R. Caries infiltration of noncavitated white spot lesions: A novel approach for immediate esthetic improvement. Contemp Clin Dent. 2012 Sep;3(Suppl 2):S199-202. doi: 10.4103/0976-237X.101092. PMID: 23230363; PMCID: PMC3514922.
  2. Paris S, Meyer-Lueckel H, et al. Resin infiltration of artificial enamel caries lesions with experimental light curing resins. Dent Mater J. 2007 Jul;26(4):582–588. doi: 10.4012/dmj.26.582.
  3. Domejean S, Ducamp R, et al. Resin infiltration of non-cavitated caries lesions: a systematic review. Med Princ Pract. 2015 Feb;24:216–221. doi: 10.1159/000371709.
  4. Akpata ES. Occurrence and management of dental fluorosis. Int Dent J 2001; 51: 325– 33.
  5. Manoharan V, Arun Kumar S, Arumugam SB, Anand V, Krishnamoorthy S, Methippara JJ. Is Resin Infiltration a Microinvasive Approach to White Lesions of Calcified Tooth Structures?: A Systemic Review. Int J Clin Pediatr Dent. 2019 Jan-Feb;12(1):53-58. doi: 10.5005/jp-journals-10005-1579. PMID: 31496574; PMCID: PMC6710943.

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