This is case number 2 of a series of cases that have as their main goal to explain a technique to eliminate the enamel white spots. As Style Italiano members and friends we want to share our experience with the Resin Infiltration Technique using ICON. Icon is the name of the resin infiltrant produced by DMG. We present a series of cases where white spots lesions are present for different reasons.
In this clinical case the reason for the appearance of white spots (initial demineralization) is the presence of dental plaque around the orthodontic appliances.
In general, in dental practices, white spots are treated for aesthetic reasons (typically after an orthodontic treatment) with remineralization products (but did not solve the esthetic impairment in most cases because fluoride remineralizes only the surface) or with microabrasion and/or turbine (not well accepted for patients neither for dentists because is an aggressive approach, due to the lesions depth and extension much dental structure should be removed)
Between these two techniques we have now another option that is called resin infiltration. Until now, there has never really been a satisfactory solution for treating the white spots which often occur after removing dental braces. Resin infiltration with Icon leads to a caries arrest at an early stage and disappearance of white spots. This means aesthetic results with minimum intervention in the tooth structure are achieved. At the beginning, the technique of resin infiltration was invented to arrest the caries progression. It was unexpected that the initial lesions (typical white spots) optically disappear.
In this clinical case it is possible to appreciate some white spots that disappeared thanks to the resin infiltration technique and some deeper lesions, that were treated with the conventional turbine and composite method.
Salivary test was done and showed both a low buffering capacity and a low flow rate.
Despite appearing to be a high caries risk patient, she showed a tooth crowding such that orthodontic interceptive treatment was to be carried out.
During the orthodontic treatment.
Close up of frontal teeth after braces removal. We can appreciate several white spots.
Initial situation, lateral view. Tooth number 12 distal, we can appreciate a cavity. In cavitated lesions resin infiltration is contraindicated. Unfortunately, the patient has terrible oral hygiene habits in spite of the recommendations and frequent check-ups before, during and after orthodontic treatment. The braces were removed because of the inability of the patient to maintain clean teeth.
Lateral close-up view. Even brown spots, which have developed over a longer period of time, can be treated aesthetically, as long as the surface is not cavitated.
Initial situation. The patient, and especially her mother, were very interested in the conservative approach of the resin infiltration technique.
After cleaning the affected teeth, isolation with dental dam is performed.
Icon etch (15% HCl) applied onto the lesions directly from the syringe from the system and letting set for 2 minutes.
After removing the etchant with abundant water, alcohol is applied to dry the tooth, with its refractive index (how the light travels through) simulates the final result. At this crucial moment if the lesion have visibly disappeared, resin infiltration can be performed. On the contrary the etching step has to be repeated. If after rinsing and drying with alcohol masking of the lesion seems favorable, infiltration of the resin can be performed and proper masking is obtained. Optical appearance of the teeth after application of Icon resin.
Resin infiltration is applied onto the etched surface and let infiltrate for 3 minutes before light curing.
In deep cavities, where resin infiltration is unsuccessful, the conventional technique is performed. So we prepared a cavity for 2.1 distal and 1.2 distal. In tooth 1.2 distal we already knew that the conventional technique should be used.
Round diamond bur used to remove the lesion.
During the procedure of cavity cleaning.
Etching agent application (phosphoric acid) for 20 seconds and adhesive agent.
Composite application. A single mass Body (BA3 Asteria, Tokuyama) was applied in a single layer.
Composite already cured.
Masking of white spot lesions by resin infiltration with Icon after orthodontic treatment seems to be a very good option, even in severe white lesions like the ones we have seen in this clinical case. Most of the lesions disappeared with Icon leading to a minimal use of micro- or macroabrasion with turbine and therefore to a negligible undermining of sound enamel. Resin infiltration technique with Icon provides aesthetic result with minimal intervention on the tooth structure.
Thanks to Dr. Elisa Oneto, the orthodontist of this clinical case, with whom it is always a pleasure to collaborate for an interdisciplinary approach.
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