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Fluorosis is characterized by hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel formation. Characterized by relatively well mineralized outer surface layer, beneath which a diffused hypomineralization or porosity in subsurface enamel is seen while clinically it leads to esthetic deviations depending on the severity of fluorosis.
The severity of the condition is dependent on:
1. dose
2. duration
3. age of the individual during the exposure.
The “very mild” (and most common) form of fluorosis, is characterized by small, opaque white irregular areas over the tooth, covering less than 25% of the tooth surface. In the mild form of the disease, these mottled patches can involve up to half of the surface area of the teeth. When fluorosis is moderate, all of the surfaces of the teeth are involved and brown stains frequently “disfigure” the teeth. Severe fluorosis is characterized by brown discoloration and discrete or confluent pitting; brown stains are widespread and teeth often present a corroded-looking appearance.
1. dose
2. duration
3. age of the individual during the exposure.
The “very mild” (and most common) form of fluorosis, is characterized by small, opaque white irregular areas over the tooth, covering less than 25% of the tooth surface. In the mild form of the disease, these mottled patches can involve up to half of the surface area of the teeth. When fluorosis is moderate, all of the surfaces of the teeth are involved and brown stains frequently “disfigure” the teeth. Severe fluorosis is characterized by brown discoloration and discrete or confluent pitting; brown stains are widespread and teeth often present a corroded-looking appearance.
Icon, from DMG, is already well established for the treatment of decay at its earliest 'white spot' stage on vestibular surfaces without the need for injections or drilling. It restores the optical properties of the tooth structure thereby returning the tooth’s natural shade. After desiccating the lesion, capillary forces draw the resin. The treatment I had was DMG Icon for prominent white fluorosis spots on my front teeth. The lesions are 95% removed after a. Foziam1; Dental Implants. Before and after whitening pictures B3 to shade B1 Teeth Whitening Dec 2017 Before and after pictures of a whitening case.
This is a case of mild fluorosis in a woman of 50 years: I treat this mild case with bleaching 40% H2O2 and after two weeks I masked the white spots with ICON DMG. Moreover The patient has restored old fillings as we can the in the before and after photos.
AND you can download the protocol by clicking here:
This second case is a case of moderate-severe fluorosis in a young man of 30 years old. We can see also yellow and brown spot
For a severe case of Fluorosis I recommend to see this pdf: amazing result with combined technique.
Minimally Invasive Treatment for Esthetic Management of Severe Dental Fluorosis: A Case Report
Y Wang • Y Sa • S Liang • T Jiang
CLICK HERE: http://www.jopdentonline.org/doi/pdf/10.2341/12-238-S
Minimally Invasive Treatment for Esthetic Management of Severe Dental Fluorosis: A Case Report
Y Wang • Y Sa • S Liang • T Jiang
CLICK HERE: http://www.jopdentonline.org/doi/pdf/10.2341/12-238-S
People with fluorosis are relatively resistant to dental caries although they may be of cosmetic concern. In moderate to severe fluorosis, teeth are physically damaged. With increasing severity, the subsurface enamel, all along the tooth becomes more porous. Enamel may appear yellow/ brown discolouration and/ or many and pitted white-brown lesions that look like cavities. They are often described as “mottled teeth”. Fluorosis does not cause discolouration to the enamel directly, as upon eruption into the mouth, affected permanent teeth are not discoloured yet. In dental enamel, fluorosis causes subsurface porosity or hypomineralizations, which extend toward the dentinal-enamel junction as severity increases. Hence, affected teeth are more susceptible to staining. Due to diffusion of exogenous ions (ex, iron and copper), the stains would develop into the abnormally porous enamel. The spots and stains left by fluorosis are permanent. They may darken over time.
DIFFERENTIAL DIAGNOSIS :
• Turner’s hypoplasia (although this is usually more localized)
• Enamel defects caused by an undiagnosed and untreated celiac disease.
• Some mild forms of amelogenesis imperfecta
• Enamel defects caused by infection of a primary tooth predecessor
• Dental caries: Fluorosis-resembling enamel defects are often misdiagnosed as dental caries.
• Dental Trauma: Mechanical trauma to the primary tooth may cause disturbance to the maturation phase of enamel formation, which may result in enamel opacities on the permanent successors.
• Turner’s hypoplasia (although this is usually more localized)
• Enamel defects caused by an undiagnosed and untreated celiac disease.
• Some mild forms of amelogenesis imperfecta
• Enamel defects caused by infection of a primary tooth predecessor
• Dental caries: Fluorosis-resembling enamel defects are often misdiagnosed as dental caries.
• Dental Trauma: Mechanical trauma to the primary tooth may cause disturbance to the maturation phase of enamel formation, which may result in enamel opacities on the permanent successors.
MANAGEMENT OPTIONS:
Dental fluorosis may or may not be of cosmetic concern. In some cases, there may be varying degrees of negative psychosocial effects.
Dental fluorosis may or may not be of cosmetic concern. In some cases, there may be varying degrees of negative psychosocial effects.
The treatment options are:
• Tooth bleaching
• Micro-abrasion
• Composite fillings
• Veneers
• Crowns
Generally, more conservative options such as bleaching are sufficient for mild cases.
To this list you can add the icon technique!
• Tooth bleaching
• Micro-abrasion
• Composite fillings
• Veneers
• Crowns
Generally, more conservative options such as bleaching are sufficient for mild cases.
To this list you can add the icon technique!
Bleaching and microabrasion techniques can consider as an interesting alternatives to conventional operative treatment options.
There are some of new articles about ICON DMG technique and these are the link to pubmed:
There are some of new articles about ICON DMG technique and these are the link to pubmed:
1. Resin Infiltration for Aesthetic Improvement of Mild to Moderate Fluorosis: A Six-month Follow-up Case Report
This case report demonstrates that resin infiltration is an agreeable option for this type of tooth discolouration, rather than choosing more invasive, conventional procedures. More studies need to be completed to determine longer-term outcomes of the technique
2. White spots on enamel: treatment protocol by superficial or deep infiltration (part 2).
In this 2nd part, the current treatment of white spot lesions by erosion/infiltration is presented, beginning with a reminder of the principle of superficial infiltration, which enables most early carious lesions, fluorosis and post-traumatic lesions to be treated. However, this technique has met with frequent failures in cases of MIH or deep lesions of traumatic origin or those associated with fluorosis. For this reason a new deep infiltration technique is proposed: thanks to its global treatment concept, this enables all white spots to be treated. The place of whitening in these treatment options is discussed, with explanations of the main reasons for its failures.
This case report demonstrates that resin infiltration is an agreeable option for this type of tooth discolouration, rather than choosing more invasive, conventional procedures. More studies need to be completed to determine longer-term outcomes of the technique
2. White spots on enamel: treatment protocol by superficial or deep infiltration (part 2).
In this 2nd part, the current treatment of white spot lesions by erosion/infiltration is presented, beginning with a reminder of the principle of superficial infiltration, which enables most early carious lesions, fluorosis and post-traumatic lesions to be treated. However, this technique has met with frequent failures in cases of MIH or deep lesions of traumatic origin or those associated with fluorosis. For this reason a new deep infiltration technique is proposed: thanks to its global treatment concept, this enables all white spots to be treated. The place of whitening in these treatment options is discussed, with explanations of the main reasons for its failures.
3. Infiltration, a new therapy for masking enamel white spots: a 19-month follow-up case series (https://www.ncbi.nlm.nih.gov/pubmed/23712339)
Tirlet G1, Chabouis HF, Attal JP.
Abstract
Enamel white spot lesions are frequent and can impact patients’ quality of life. The most conservative treatment in such cases is microabrasion, a technique that presents some drawbacks. The proposed strategy is not based on the elimination of dysplastic enamel, but on masking the lesion by infiltrating the porous subsurface enamel with a hydrophobic resin that has a refraction index closer to that of sound enamel, after permeating the non-porous surface enamel through hydrochloric acid erosion. Erosion-infiltration approaches have been proposed to treat initial caries, but this report suggests extending it to two novel indications: fluorosis and traumatic hypo-mineralization lesions. Four cases were treated by erosion infiltration following the original protocol. They were followed up clinically at several intervals during a period of 19 months of clinical service. The clinical results, although not perfect, satisfied the patients entirely. Erosion infiltration could be a promising alternative for minimally invasive treatment in similar situations.
4. Alternative Esthetic Management of Fluorosis and Hypoplasia Stains: Blending Effect Obtained with Resin Infiltration Techniques
Tirlet G1, Chabouis HF, Attal JP.
Abstract
Enamel white spot lesions are frequent and can impact patients’ quality of life. The most conservative treatment in such cases is microabrasion, a technique that presents some drawbacks. The proposed strategy is not based on the elimination of dysplastic enamel, but on masking the lesion by infiltrating the porous subsurface enamel with a hydrophobic resin that has a refraction index closer to that of sound enamel, after permeating the non-porous surface enamel through hydrochloric acid erosion. Erosion-infiltration approaches have been proposed to treat initial caries, but this report suggests extending it to two novel indications: fluorosis and traumatic hypo-mineralization lesions. Four cases were treated by erosion infiltration following the original protocol. They were followed up clinically at several intervals during a period of 19 months of clinical service. The clinical results, although not perfect, satisfied the patients entirely. Erosion infiltration could be a promising alternative for minimally invasive treatment in similar situations.
4. Alternative Esthetic Management of Fluorosis and Hypoplasia Stains: Blending Effect Obtained with Resin Infiltration Techniques
5. Amelogenesis Imperfecta: A Non-Invasive Approach to Improve Esthetics in Young Patients. Report of Two Cases (http://jocpd.org/doi/abs/10.17796/1053-4628-41.5.332)
Maria Grazia Cagetti*/ Stefano Cattaneo**/ Ye Qing Hu***/ Guglielmo Campus****
*Maria Grazia Cagetti, DDS, PhD, Associate Professor, Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy.
**Stefano Cattaneo, DDS, Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy.
***Ye Qing Hu, DDS, Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy.
****Guglielmo Campus, DDS, PhD, Associate Professor, Department of Surgery, Microsurgery and Medical Sciences – School of Dentistry, University of Sassari, Sassari, Italy.
Send all correspondence to: Maria Grazia Cagetti, Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy. Via Beldiletto 1/3, 20142 Milan, Italy, Phone: +39-02-50319008, E-mail: [email protected]
Objective–Evaluate esthetic and functional efficacy of infiltrant resin (Icon, DMG, Hamburg, Germany) in Amelogenesis Imperfecta’s treatment. Study design: Two adolescent patients, G.S. (13 years old) and C.M. (15 years old), affected by the hypomaturation type of Amelogenesis Imperfecta, were treated with Icon resin and were followed for twelve months. Results: Treated teeth show an excellent aesthetical result immediately after the resin application, effect that lasts in the long-term (six and twelve months follow-up examinations); the dental wear’s progression seems to be clinically arrested. Conclusions: Resin infiltration has proven to be a minimal invasive treatment for dental discoloration, less aggressive than conventional procedures. This approach might be recommended for a stable esthetical improvement in moderate AI’s lesions especially in children and adolescents.
Maria Grazia Cagetti*/ Stefano Cattaneo**/ Ye Qing Hu***/ Guglielmo Campus****
*Maria Grazia Cagetti, DDS, PhD, Associate Professor, Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy.
**Stefano Cattaneo, DDS, Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy.
***Ye Qing Hu, DDS, Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy.
****Guglielmo Campus, DDS, PhD, Associate Professor, Department of Surgery, Microsurgery and Medical Sciences – School of Dentistry, University of Sassari, Sassari, Italy.
Send all correspondence to: Maria Grazia Cagetti, Department of Biomedical, Surgical and Dental Science, University of Milan, Milan, Italy. Via Beldiletto 1/3, 20142 Milan, Italy, Phone: +39-02-50319008, E-mail: [email protected]
Objective–Evaluate esthetic and functional efficacy of infiltrant resin (Icon, DMG, Hamburg, Germany) in Amelogenesis Imperfecta’s treatment. Study design: Two adolescent patients, G.S. (13 years old) and C.M. (15 years old), affected by the hypomaturation type of Amelogenesis Imperfecta, were treated with Icon resin and were followed for twelve months. Results: Treated teeth show an excellent aesthetical result immediately after the resin application, effect that lasts in the long-term (six and twelve months follow-up examinations); the dental wear’s progression seems to be clinically arrested. Conclusions: Resin infiltration has proven to be a minimal invasive treatment for dental discoloration, less aggressive than conventional procedures. This approach might be recommended for a stable esthetical improvement in moderate AI’s lesions especially in children and adolescents.
6. An investigation into the effect of a resin infiltrant on the micromechanical properties of hypomineralised enamel (http://onlinelibrary.wiley.com/doi/10.1111/ipd.12272/pdf)
7. Comparative evaluation of esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in-office bleaching, and combination therapies
http://onlinelibrary.wiley.com/doi/10.1111/jerd.12312/pdf
Dental fluorosis leads to esthetic deviation and varies from nonpitted white opacities, dark brown stains to pitting or structural breakdown of enamel surface. Treatment for fluorosis depends on the severity of condition and includes both noninvasive methods and invasive methods. Recently resin infiltration has been proposed as an alternative treatment for nonpitted fluorosis. This study was done to evaluate the esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in-office bleaching and combination therapies.
Materials and methods
The present study is a randomized, single blinded controlled trial with four parallel arms with 1:1 allocation ratio. The intervention arms included bleaching with 35% hydrogen peroxide, resin infiltration, resin infiltration with increased infiltration time and a combination approach of bleaching and infiltration. Immediate esthetic changes were evaluated for two parameters including, ‘Change in esthetics’ and ‘Improvement in opacities/stains’ using a VAS scale by two independent observers. Kruskal-Wallis test and Mann-Whitney U-test were done for intergroup comparisons.
Results
Best results for both the parameters were observed among patients treated with resin infiltration with increased infiltration time. Mann-Whitney U test revealed significantly better results for resin infiltration groups (alone or combination with bleaching) as compared to bleaching alone (P < .001).
Conclusions
Resin infiltration procedure with tailored etching times and increased infiltration time exhibited best results in terms of change in esthetics and improvement in stains.
Clinical significance
White and brown opacities due to fluorosis have always been a concern for esthetics. In our study, resin infiltration technique with tailored etching times and increased infiltration time exhibited best immediate esthetic improvement for nonpitted fluorotic opacities and stains. These esthetic outcomes reaffirm the applicability of RI technique for nonpitted fluorosis, which was originally advocated only for white spot lesions due to early caries. This will in turn help the dentists to plan the esthetic management of nonpitted fluorosis in a micro-invasive manner
.
http://onlinelibrary.wiley.com/doi/10.1111/jerd.12312/pdf
Dental fluorosis leads to esthetic deviation and varies from nonpitted white opacities, dark brown stains to pitting or structural breakdown of enamel surface. Treatment for fluorosis depends on the severity of condition and includes both noninvasive methods and invasive methods. Recently resin infiltration has been proposed as an alternative treatment for nonpitted fluorosis. This study was done to evaluate the esthetic changes in nonpitted fluorosis stains when treated with resin infiltration, in-office bleaching and combination therapies.
Materials and methods
The present study is a randomized, single blinded controlled trial with four parallel arms with 1:1 allocation ratio. The intervention arms included bleaching with 35% hydrogen peroxide, resin infiltration, resin infiltration with increased infiltration time and a combination approach of bleaching and infiltration. Immediate esthetic changes were evaluated for two parameters including, ‘Change in esthetics’ and ‘Improvement in opacities/stains’ using a VAS scale by two independent observers. Kruskal-Wallis test and Mann-Whitney U-test were done for intergroup comparisons.
Results
Best results for both the parameters were observed among patients treated with resin infiltration with increased infiltration time. Mann-Whitney U test revealed significantly better results for resin infiltration groups (alone or combination with bleaching) as compared to bleaching alone (P < .001).
Conclusions
Resin infiltration procedure with tailored etching times and increased infiltration time exhibited best results in terms of change in esthetics and improvement in stains.
Clinical significance
White and brown opacities due to fluorosis have always been a concern for esthetics. In our study, resin infiltration technique with tailored etching times and increased infiltration time exhibited best immediate esthetic improvement for nonpitted fluorotic opacities and stains. These esthetic outcomes reaffirm the applicability of RI technique for nonpitted fluorosis, which was originally advocated only for white spot lesions due to early caries. This will in turn help the dentists to plan the esthetic management of nonpitted fluorosis in a micro-invasive manner
.
Thank you
Dr. Sofia Drivas