The human body absorbs too much fluorine and causes the coloring or the defect tooth to be called the fluorine spot tooth. The main manifestations of dental fluorosis are chalky, brown or black changes on the enamel surface, and even some dents and defects. Serious dental fluorosis enamel surface will appear large and small dents and defects. The color and shape of the bad enamel is just like the birthmark for teenagers, which makes them uneasy and anxious, and has an important influence on the healthy growth of teenagers. The traditional method of restoration is veneer, all ceramic crown restoration, which more or less will cause damage to the tooth tissue, which is not conducive to the healthy development of young teeth, and the price is high, clinical operation, long time for follow-up. Penetrating resin combined with home bleaching is a more conservative and minimally invasive method for the treatment of dental fluorosis, and the price of patients is also relatively easy to accept, and the operation time is shorter and easier.
In this issue, we share with you a case of severe dental fluorosis treated by penetrating resin combined with family bleaching. This case won the first prize of "the first season of ICON penetrating resin good case appreciation competition".
Operator: Li Ren
Case reporter: Li Xiao
01 patient information
Basic information: female patient, 23 years old. Main complaint: the color of anterior teeth is serious and there is pit like defect, which seriously affects the appearance, hoping to improve the appearance of teeth. Diagnosis: severe dental fluorosis. Treatment plan: patients do not want to pass veneer, all ceramic crown repair. Therefore, we have developed a treatment plan for the patients with osmotic resin combined with home bleaching. After weighing the advantages and disadvantages, the patients agree to this treatment method.
02 treatment process
The preoperative photos of the patients showed that the staining of the whole dentition was even, the staining and the defect were serious. Because the vital pulp teeth had a good response to the bleaching treatment, family bleaching had the advantages of simple operation and low tooth sensitivity, so the patients chose family bleaching for treatment.
After a comprehensive clinical examination of the patients, the teeth were colorimetric, the impression was made, the plaster model was put in, the storage space for bleach was set aside on the plaster model, the individual bleaching tray was made, and the bleaching tray was used to guide the bleaching gel placement and dosage, and oral hygiene guidance for the patients was conducted. Three weeks after the use of eight opalescence pf 10% ultradent products, the staining on the tooth surface was significantly reduced. In order to prevent postoperative rebound, bleaching reached a more white color than the patient was satisfied with, and then lcon DMG products Hamburg Germany was used for penetration resin.
Clean the affected teeth, put the rubber barrier on top, turn the edge of the rubber barrier around the gum, use the sealer on the lower edge, and use the floss to tie the neck of the teeth, isolate the saliva, and prevent the overflow of the acid etchant.
Enamel (about 1mm) grinding paste (mechanical and chemical grinding paste containing 6.6% hydrochloric acid and carborundum particles) is coated on the tooth surface, and a low-speed rubber cup, 500 rpm, is used for micro invasive grinding under medium and high pressure for 60 seconds.
Rinse the surface paste with clear water and evaluate the affected teeth. Repeat if necessary.
Coating lcon etch, etching for 2 minutes, thoroughly washing with water for more than 30 seconds, and drying with oil-free air.
After coating lcon dry for 30s, the etching effect of teeth can be seen, but the local effect is not good, and the second etching washing and drying can be carried out.
The second acid etching, washing and drying were carried out to achieve satisfactory results.
Lcon lnfiltrant was applied under the safe light source for 3 minutes to keep the tooth surface moist and use floss to remove redundant materials.
The tooth defect was repaired with enamel resin, which solidified on the lingual side and then on the lip.
Replace the lcon resin head, apply for another 1min, blow dry and clean up the excess materials.
Coating oxygen inhibitor, first palatal side curing, then labial side curing.
Rinse teeth with water
Felt wheel wool brush with ENA shine polishing paste, Polish according to ABC sequence.
Significant effect after operation
The same procedure was used for the lower anterior teeth to achieve satisfactory results.
Photos of the whole mouth after operation
Patients smile with confidence
03 discussion
The clinical features of dental fluorosis are chalky to brown plaque on the surface of enamel erupted at the same time, and serious enamel defect. Severe dental fluorosis can be accompanied by colouring and defect at the same time.
Coloring can be treated with tooth bleaching. Tooth bleaching is to use hydrogen peroxide or urea peroxide to diffuse into the tooth tissue, forming free radicals, which can oxidize or reduce other molecules. As a result, the organic matter is slowly degraded into small molecules, making the color lighter, destroying the molecular structure of the pigment that makes the tooth discolor, and forming colorless substances. It is generally believed that vital pulp bleaching is safe and effective, and its side effects may cause temporary dentin sensitivity and no long-term damage to pulp.
Micro grinding is to coat the surface of enamel with a paste containing silica urea particles and 6.6% hydrochloric acid. It can produce the chemical corrosion of hydrochloric acid and the mechanical grinding of grinding materials at the same time in the damaged parts, not only remove the dented enamel surface, improve the appearance of teeth, but also make the enamel form a smooth and shiny surface, so as to achieve the purpose of inhibiting pigmentation and making the bleaching effect more stable. In addition, more natural tooth tissue can be preserved than veneer, full crown and other traumatic treatment methods.
Through capillary siphonage, the resin with low viscosity infiltrates into the multi void structure of demineralised enamel, sealing off the invasion of acid substances and further loss of minerals. Because the refractive index of the penetrating resin entering the space is closer to the normal enamel, it makes up for the lower refractive index of the chalky demineralization area, so as to better restore the color and color of the teeth.
04 conclusion
Micro grinding, permeating resin and home bleaching can effectively treat the dental fluorosis, change the chalky or brown color on the enamel surface, and achieve the effect of aesthetic restoration. Its minimally invasive, simple, time-saving, low cost, is the first choice for patients with minimally invasive treatment.
About the author:
Li Ren, attending physician, lecturer, master. Graduated from China Medical University. He is good at diagnosis and treatment of stomatological diseases and flexible use of various new technologies, such as preparation of root canal with large taper machine nickel titanium instrument, filling treatment with hot gum root canal, use of root canal microscope and restoration of anterior teeth cosmetic resin, etc.
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