Article Presented by: Jeanette MacLean, DDS, Affiliated Children’s Dental Specialist
CASE OVERVIEW
A 17-year-old male presented with a chief complaint of white spots on his front teeth. The patient had recently completed orthodontic treatment and wanted to improve the look of his teeth. While they were nice and straight, he didn’t like the bright white spots on his maxillary central incisors.
DIAGNOSIS
Maxillary central incisors have congenital enamel hypomineralization near the incisal edges.
INFORMED CONSENT AND TREATMENT PLAN
I reviewed with the patient and his mother that we could treat his teeth with Icon resin infiltration to try and help make his teeth look more uniform in color. I reviewed that due to the depth of the lesion bodies and their location within the thinner incisal third of the tooth, I could not promise the spots would disappear entirely. I reviewed the worst-case scenario would be that there would be no visual improvement, however, because Icon is a minimally invasive procedure, no harm would be done to the tooth. Icon (DMG) will strengthen the hypomineralized enamel and make it more caries resistant. If he was not satisfied with the outcome, he could then go on to do more conventional cosmetic treatment such as a bonding or a veneer, but at least he would have tried the least minvasive treatment first. The patient and his mom understood and expressed their desire to try Icon resin infiltration. The patient also wanted whiter teeth overall, so I encouraged him to bleach his teeth first with over-the-counter Crest White Strips.
INITIAL THOUGHTS & STRATEGY
- Wait at least 2 weeks after the patient has completed their at-home tooth whitening system prior to attempting Icon treatment to avoid residual peroxide in the tubules interfering with the procedure. Patients can also whiten after Icon treatment, although the tooth surface will become slightly rougher. (Youssef AS et al JADA 2022)
- Use caution to not over-etch the enamel with the Icon Etch (DMG)-comprised of 15% hydrochloric acid-so as not to over-thin the incisal edge
TREATMENT STEPS
- The teeth were cleaned with plain pumice
- Fine grit polishing disc was used to remove some residual orthodontic cement
- 5 rounds of Icon etch
- Resin infiltration time was increased from 3 minutes to 10 minutes to allow deeper penetration of the Icon Infiltrant (DMG) into the lesion body
- Excess Icon Infiltrant (DMG) was wiped off, contacts flossed
- Light cured for 40 seconds from the palatal (lingual) aspect first to draw the resin even deeper into the tooth. Light cured a second time from the facial aspect.
- Icon Infiltrant (DMG) applied again for one minute to accommodate for polymerization shrinkage. Excess removed, cured 40 seconds
- Polished with a fine polishing disk
- Rinsed thoroughly
THE PATIENT’S REACTION
The patient was very happy with the outcome, he looked in the mirror and said, “Wow!” His father, who brought him to the treatment visit, was also really impressed and grateful for how it turned out.
FINAL THOUGHTS
Increasing infiltration time and curing first from the palatal (lingual) aspect are simple tricks to help improve your results for areas of hypomineralization with deep lesion bodies. Always be sure to set realistic expectations, under promise and hopefully over deliver. Over time, these spots may look even better as the teeth rehydrate.
