At home bleaching and resin infiltration: a severe fluorosis case report

BACKGROUND: Iconâ proved to be effective on enamel hypomineralized lesion with white demarcated and diffuse clourimetric alteration, such as White Spot Lesion (WSL), Developmental Defects of Enamel (DDE) and mild cases of Fluorosis (1) (2) (3) (4)on the buccal side of aesthetic tooth. Resin infiltration treatment increases the Refractive Index (RI) of demineralized enamel. Paris et al. described the rising of RI on infiltrated lesions, that took on the appearance of the sound surrounding enamel (5). On the other hand, lesions with brown demarcated and diffuse enamel defects such as severe cases of Fluorosis did not seem to have the same response to Iconâ treatment. The aim of this study was to present the clinical procedure of pre-treatment with two weeks of home bleaching with 16% carbamide peroxide take-home whitening gel and then resin infiltration (1). Methods: The study was performed at Sapienza University, Rome, Italy. The patient, a 14 years old male, who was found with a severe fluorosis on both the upper and lower dental arches. Upper incisors presented with brown demarcated defects on central and incisal tooth sections and whitish diffuse and demarcated enamel alterations on the other teeth. Custom fitted trays were done in our Lab and a two weeks home bleaching treatment was performed (3 hours per day). Before and after two weeks’ photographic images documented the beaching outcome. After a wash-out period of two weeks, Icon infiltration clinical procedure was performed according to manufacturer instructions. Results: The photographic images show the aesthetic outcome of the treated lesions. The treatments proved to be effective both on brown and white lesions. Conclusions: Icon clinical procedure proved to be effective on hypomineralized lesions with superficial configuration in the enamel layer. On the other hand, the clinical indication for lesions presenting a deeper configuration were ceramic veneers. This clinical case reports on the efficacy of deep resin infiltration performed on enamel hypomineralized lesion of traumatic origin.