Management of Multifactorial Stained Enamel Defects on Anterior Dentition Using a Combination Treatment of Whitening, Microabrasion, Resin Infiltration and Resin-based Composite Restoration
This case report describes a combination treatment composed of tooth whitening, microabrasion, resin infiltration, and resin-based composite restoration to manage multifactorial stained enamel lesions on anterior teeth. The patient’s primary concern was to improve the esthetics of their smile after about a decade of extensive orthodontic and orthognathic procedures. After clinical evaluation and history taking, the authors determined that the enamel defects were the result of carious and developmental factors. In-office tooth whitening took place in one visit, followed by micro abrasion and resin infiltration in another visit. Thirteen months later, a follow-up visit showed that the results were stable and that the patient was satisfied with the overall outcome. A small resin composite restoration was added at the follow up visit to repair a previous restoration and to reestablish the facial contours of the central incisor. A combination treatment protocol composed of tooth whitening, microabrasion, and resin infiltration can improve patient satisfaction and avoid unnecessary invasive treatment.SUMMARY
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Clinical presentation of the anterior teeth before (A) and after (B–D) orthodontic treatment. Notice the multiple discolored enamel defects consistent with a history of excessive fluoride ingestion, primary teeth infection, and post-orthodontic carious lesions.
In-office bleaching protocol using 25% hydrogen peroxide. A. Teeth isolation per manufacturer’s instructions. B. Bleaching material application. C. Light activation. D Immediately after with gingival tissue barrier in place. E. Immediately after gingival tissue barrier was removed.
Microabrasion procedure. A. Maxillary anterior teeth isolated. B. and C. Transillumination demonstrating a mix of diffused and sharp margins consistent with shallow and deep enamel defects, respectively. D. HCl-silica slurry (Opalustr 6.6%) application. E. Immediately after rinsing following one application of Opalustr on both central incisors. F. Immediately after a repeated selective application of Opalustr on both central incisors.
Resin infiltration procedure using Icon. A. Icon Etch (15% HCl) application. B. Icon Dry (99% ethanol) application. C. Icon infiltrant application. D. Light cutting. E–G Finishing and polishing of the resin-infiltrated enamel surface. H. Immediately after.
A. Immediately after resin infiltration process. B. 13-months follow up.
Repairing of the chipped resin composite on #9 at the 13-month follow up visit. Resin composite was added to the defective hypoplastic enamel on the facial of #9 to restore the correct contour and to enhance esthetics. A. Pre-operative situation. B. Air abrasion. C–F Etching, rinsing, adhesive application, and light curing steps. G. After resin composite was added. H. Immediately after rubber dam isolation removal.
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