Removing white spots in a conservative way

Shadeguides - Direct anteriors
19 Jan 2017

Aesthetic demand from our patients is getting higher everyday; it’s our duty to educate them and to focus on biological and functional problems at first, but we also must pay a lot of attention to aesthetics.

Sometimes for aesthetic reasons we have to remove sound dental structure, always thinking about the correct balance between costs and benefits. On the other hand, we must be as conservative as we can, trying to avoid any healthy tissue removal.

A lot of patients have some white or brown blur on the buccal surface of their teeth; covering and masking them with composite resin might be difficult, and require healthy structure sacrifice to obtain enough space for the restorative material. Ceramic veneers are an highly aesthetic solution, but they are invasive and often require tooth preparation.

As you already saw on our website (http://www.styleitaliano.org/removing-white-spots-with-deep-infiltration-technique) we can remove this kind of spot without using burs, thanks to the infiltration technique (Icon – DMG).

In this case report we want to show how easy and efficient this technique is.

Fig. 1

Img. 1 – The patient is a 17 years old girl, complaining about a white blur on the upper right lateral incisor. The blur is really well visible and is obviously unaesthetic.

Fig. 2

Img. 2 – We decide to use the infiltration technique, so without any kind of anesthesia (no drilling is required) we place the rubber dam; we have to remember that this material is just a particular kind of enamel adhesive, so it’s really important to control humidity using the rubber dam.

Fig. 3

Img. 3 – Following the product instructions we apply the etching gel, gently moving the tip over the blur.

Fig. 4

Img. 4 – Then we carefully rinse the etchant gel.

Fig. 5

Img. 5 – The second syringe contains alcohol, and we can use it to perfectly remove all the water.

Fig. 6

Img. 6 – Now we can easily dry with an air blow.

Fig. 7

Img. 7 – With the third syringe we can apply the resin, gently moving the tip to facilitate the resin penetration.

Fig. 8

Img. 8 – Then we carefully light cure the resin.

Fig. 9

Img. 9 – The resin application can be immediately repeated followed by another light curing step.

Fig. 10

Img. 10 – The surface can be gently polished with a silicone tip.

Fig. 11

Img. 11 – The surface just after rubber dam removal. You can easily see the difference in color caused by dehydration.

Fig. 12

Img. 12 – 2 weeks control: the white spot has been reduced, the aesthetic outcome is satisfactory and the patient is really happy. She reached her purpose without losing tooth structure and with a non invasive treatment.

 

Conclusions

Infiltration technique is an easy, conservative, non invasive and reliable source for the dentist, especially with young patients. Sometimes it can be combined with sandblasting to improve its efficacy.

Bibliography

Attal JP, Atlan A, Denis M, Vennat E, Tirlet G. White spots on enamel: treatment protocol by superficial or deep infiltration (part 2). Int Orthod. 2014 Mar;12(1):1-31
Salat Anna. http://www.styleitaliano.org/post-orthodontic-white-spots
Clement Marie. http://www.styleitaliano.org/infiltrate-and-restore.
Manauta J, Salat A. Layers: an atlas of composite resin stratification. Quintessence 2012.
Devoto W, Saracinelli M, Manauta J. Composites in every day practice: How to choose the right material and simplify application techniques in the anterior teeth JEAD, Jan. 2010.