Resin infiltration and direct resin reconstruction in a post-traumatic enamel defect: a case report

BACKGROUND: Resin infiltration proved to be effective on enamel hypomineralized lesion of various etiologies, as described by Paris et al. White spot post orthodontic lesions, early enamel carious lesion, developmental defects of enamel and mild fluorosis can be treated with good prognosis by Iconâ. On the other hand, when a deeper configuration of the lesion is found, as in severe fluorosis and post-traumatic lesions, an experimental approach has been described by Attal et al. The aim of this study was to present the clinical report of deep infiltrative technique with a mixed approach of liquid and solid resin in a patient presenting with a post traumatic lesion. METHODS: The study was performed at Sapienza University, Rome, Italy. The patient, a 12 years old female, who was found with a hypomineralized lesion of traumatic origin on the upper right central incisor. Photographic images (Nikon D7100, 105 mm Macro lens, R1C1 Macro flash) were taken before and after treatment, in order to document the colourimetric outcome after treatment. Icon Etch (15% HCl) is applied up to three times (2 minutes X 3) and after each rinsing and drying the lesion is still visible. Also, the final drying with Icon Dry (Ethanol) does not reveal masking of the spot. The application of Icon Etch is not recommended moreover, after three repetitions. After the three cycles of erosion-rising-drying, milling is performed. Application of Icon Etch is repeated up to three times again. When the enamel translucency is reached, the infiltration can be performed. Icon Infiltrant is applied on the pre-treated surface and left in place for 3 minutes. The excess is removed then from the interproximal areas by dental floss and with air spray and light cured for 40 seconds. The infiltration is repeated another time with a penetration time of 60 seconds and the light curing for additional 40 seconds. After the first step of the procedure the result is of an optimal enamel translucency recovery and of a substance loss visible in the lateral view intra-oral photographs. The subsequent step of the procedure is direct restoration of the volume lost by the erosion and milling, with bonding of a small and sufficient resin quantity. In this case, we have used the Admira Fusion (Voco) A2 shade. RESULTS: The photographic images show the pleasant aesthetic outcome of the treated lesion, observed on the central and incisal tooth section of the right upper incisor. 15% HCl eliminates 0.2 to 0.3 mm of the outer enamel layer and when the lesion has a deeper configuration, clinically appears to be markedly opaque. In traditional dentistry, it would be impossible to hide the opacity at this stage using composite in such a thin layer. Milling is necessary to reach the ceiling of the lesion and to recover the enamel translucency by subsequent repeated infiltration. CONCLUSIONS: Icon procedure combined with direct resin restoration and milling can be performed when clinical indication for lesions presenting a deeper configuration are ceramic veneers. This clinical case reports on the efficacy of deep resin infiltration performed on enamel hypomineralized lesion of traumatic origin.