Minimally Invasive Management for Esthetic Treatment of Dental Fluorosis: A Microabrasion and Resin Infiltration Approach Clinical Case Report Ghazaleh Ahmadi Zenouz, DDS, MSD, Assistant Professor, Ghazaleh Daryakenari, 3rd year resident, Corresponding Author ghazaldarya@gmail.com

Introduction Excessive fluoride ingestion during enamel development → a range of changes, called enamel fluorosis Invasive treatments → composite/ceramic veneers or even crowns A conservative method to achieve desirable esthetics, preserving the original dental tissue would be the better solution. AIM: to present a step by step minimally invasive esthetic treatment for a case of dental fluorosis(DF), including a final preventive procedure of resin infiltration.

Clinical Case A 27-year-old man visited the esthetics and restorative department of Babol Dental School, to seek a solution for his discolored anterior teeth. He has not accepted treatments like laminates, veneers, etc… White spots on most teeth, while almost the incisal two thirds of upper centrals were yellow to brown; the DF was categorized moderated as stated by H.T. Dean in 1942

Materials & methods 1. Microabrasion(Opalustre, Ultradent), 40’ on all teeth+ additional 120’ for two centrals 2. Same session 38% hydrogen peroxide (Opalescence Boost)+ 20% carbamide peroxide (whiter image, four syringes)

resin infiltration therapy (Icon, DMG ) Acid etching for resin infiltration Immediately after resin infiltration

Result

BEFORE AFTER

Discussion White opaque areas chronic exposure to fluoride during the maturation stage of enamel+ interferense with the degradation of enamel matrix proteins resulting in a whitish-brown look Available evidence best approach for DF treatment is microabrasion +/-bleaching Resin infiltration to compensate the hypomineralized and porous enamel, and the removed 22-27 micron of the surface enamel exposing the subsurface porosities, making teeth sensitive and resulting in the opaque areas mentioned by the patient, after tooth brushing. Resin infiltrant: 1-a very low viscosity, 2-low contact angle to enamel, and 3-high surface tension, enabling it to penetrate porosities and rapidly occlude any pathways 4-light refraction index similar to that of healthy enamel

To Treat Discolored Teeth Affected By Dental Fluorosis, A Minimally Invasive And Inexpensive Approach Would Be Microabrasion Followed By Tooth Whitening And Resin Infiltration Application Conclusion

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