Ricerc@Sapienza

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.