Removing white spots with deep infiltration technique

Bleaching - Direct anteriors
10 Oct 2016

Practitioners are faced today with increasing aesthetic demand from the patients and must respond by using simple reproducible and if possible conservative protocols.One of the first concern of the patient is the shade of their teeth, especially when white spots cover a big part of their front teeth.There are several treatment options described to correct this affection and one of the most conservative and efficient is the erosion/infiltration protocol by using Icon system.This technique was first developed to process initial carious lesions of the posterior sectors. This procedure had the effect of removing the whitish coloration of demineralized areas and has therefore been proposed and improved to treat the anterior region.

Fig. 1

Img. 1 – A young female patient comes to the office to correct big white spots on her front teeth. She asks us for veneers and we tell her that there is probably a better and more conservative approach to solve her case. We propose her to treat her concern by using erosion/infiltration protocol.

Fig. 2

Img. 2 – Clinical examination and pictures are done.

Fig. 3

Img. 3 – Cross polarized picture shows how important the spots are.

Fig. 4

Img. 4 – First step of the treatment is whitening protocol by using White Dental Beauty 16% CP for 10 days.

Fig. 5

Img. 5 – When doing erosion infiltration treatment, rubber dam is mandatory.

Fig. 6

Img. 6 – Sandblasting (50um aluminium oxyde) allows us to access deeply in the lesion.

Fig. 7

Img. 7 – Icon Etch (15% hydrochloric acid) is brushed for 2 minutes and then rinsed and dried for 30 seconds.

Fig. 8

Img. 8 – Icon dry is applied and sit for 30 seconds.

Fig. 9

Img. 9 – White spots are still visible, we have to start the procedure again.

Fig. 10

Img. 10 – Second application of Icon etch.

Fig. 11

Img. 11 – Second application of Icon dry. 

Fig. 12

Img. 12 – After 4 cycles of this procedure, we can see that white spots are nearly not visible, we can now apply Icon infiltrant for 3 minutes and light cure for for 1 minute.

Fig. 13

Img. 13 – Sandblasting has removed about 100 to 200um of enamel, that is why we need to use enamel composite to restore this loss.

Fig. 14

Img. 14 – Outcome after composite application.

Fig. 15

Img. 15 – The same procedure has been used for the canines and the cusps have been rebuild with direct composite.

Fig. 16

Img. 16 – The same procedure has been used for the canines and the cusps have been rebuild with direct composite.

Fig. 17

Img. 17 – The same procedure has been used for the canines and the cusps have been rebuild with direct composite.

Fig. 18

Img. 18 – The same procedure has been used for the canines and the cusps have been rebuild with direct composite.

Fig. 19

Img. 19 – Final result before dam removal.

Fig. 20

Img. 20 – Direct post op outcome, after dam removal, teeth have been polished.

Fig. 21

Img. 21 – Direct post op outcome (without bouncers on the flashes)

Fig. 22

Img. 22 – Direct post operative smile

Fig. 23

Img. 23 – Before/after result

Fig. 24

Img. 24 – Before/after result with cross polarized picture

Fig. 25

Img. 25 – 1 week later teeth are rehydrated, final outcome is correct and the patient is satisfied.

 

Conclusions

Conclusions

Erosion/infiltration protocol is a conservative and reliable option to restore a smile compromised with white spots. This technique used with Icon allows us to guarantee to the patient, he will have a great aesthetic outcome with minimal loss of sound structure.

Bibliography

References

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