Clinical
Fig 5 Icon-etch is aspirated and rinsed
Fig 6 Dehydration process is carried out
Fig 7 A second erosion procedure is carried out
Fig 8 Lesion are becoming much less bright
Fig 9 Infiltration is performed
Fig 10 Surfaces are given a protective polish
Fig 11 Final results show a big improvement Continued »
ı0 per cent carbamide peroxide for three weeks, followed by one session of caries- infiltrationı0, ı3. This caries-infiltration technique, which was initially developed for the treatment of early carious lesions in the enamel, has the secondary effect of masking white stains because it modifies the optical properties of the tooth. In fact, hypomineralisation due to fluorosis has a refraction index that is different from that of healthy enamel7, 8. The lesion does not absorb any wavelength and therefore appears to be white in colour. The infiltration of a very low-viscosity resin, with a refraction index that is close to that of healthy enamel, into the porosities of the body of the lesion, produces a translucent enamel once againı. Maximum tissue preservation is achieved with this treatment. The only product currently on the market for treatment by caries- infiltration is Icon, by DMG.
Clinical case one A young woman attended (Fig ı) complaining of the presence of “white
Fig 12 Patient hid white stains with bottom lip
stains”. A prophylactic dose of fluoride appears to have been exceeded over a number of years, since no record of her prior fluoride treatment was available. Clinical exam did not reveal any dental caries and the diagnosis of fluorosis was confirmed. According to the Hattab classification4, we were looking at a class II fluorosis, corresponding to symmetrical opaque stains. External outpatient whitening was carried out using thermoformed trays and ı0 per cent carbamide peroxide gel. Treatment consisting of night-time use of the trays lasted 2ı days with a weekly inspection in the Dentist’s chair. Whitening, by increasing the overall brightness of the teeth, acts as masking of small white defects in the enamel. The results of the whitening process (Fig 2) was satisfactory, but not sufficient. In fact, the opaque fluorosis stains were not sufficiently attenuated by whitening the rest of the tooth. Therefore, a caries- infiltration session was scheduled for one month after the whitening treatment had been completed.
Fig 13 Teeth displayed very slight porosity The erosion-infiltration session began
with prophylactic polishing using an interdental brush and prophylactic paste (Fig 3), in order to eliminate any biofilm and therefore salivary proteins. A rubber dam was applied. This step was essential for protecting the surrounding tissues, while the hydrochloric acid was being applied, and in order to keep everything away from any moisture during the resin infiltration process. The next step consisted of accessing
the hypomineralised fluorosis lesions (Fig 4). This requires the elimination of the hypermineralised enamel on the surfaces of the lesions. Therefore, the erosion was treated using a gel of ı5 per cent hydrochloric acid (Icon-Etch DMG) for ı20 seconds9. The acid was applied using the applicator tip provided. In order to avoid uneven erosion, which could be caused, for example, by bubbles forming in the gel, the surface was mechanically agitated using a microbrush. The Icon-etch was then aspirated and
Continued » Scottish Dental magazine 55
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