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

BACKGROUND: Iconâ proved to be effective on enamelhypomineralized lesion with white demarcated and diffuseclourimetric alteration, such as White Spot Lesion (WSL),Developmental Defects of Enamel (DDE) and mild cases ofFluorosis (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 ofRI on infiltrated lesions, that took on the appearance of thesound surrounding enamel (5). On the other hand, lesions withbrown demarcated and diffuse enamel defects such as severecases of Fluorosis did not seem to have the same responseto Iconâ treatment. The aim of this study was to present theclinical procedure of pre-treatment with two weeks of homebleaching with 16% carbamide peroxide take-home whiteninggel and then resin infiltration (1).Methods: The study was performed at Sapienza University,Rome, Italy. The patient, a 14 years old male, who was foundwith a severe fluorosis on both the upper and lower dentalarches. Upper incisors presented with brown demarcateddefects on central and incisal tooth sections and whitish diffuseand demarcated enamel alterations on the other teeth.Custom fitted trays were done in our Lab and a two weekshome bleaching treatment was performed (3 hours per day).Before and after two weeks’ photographic images documentedthe beaching outcome. After a wash-out period of two weeks,Icon infiltration clinical procedure was performed accordingto manufacturer instructions. Results: The photographic images show the aestheticoutcome of the treated lesions. The treatments proved to beeffective both on brown and white lesions.Conclusions: Icon clinical procedure proved to be effectiveon hypomineralized lesions with superficial configurationin the enamel layer. On the other hand, the clinical indicationfor lesions presenting a deeper configuration were ceramicveneers. This clinical case reports on the efficacy of deepresin infiltration performed on enamel hypomineralized lesionof traumatic origin.