Case Author: Zhang can, instructor: Chen Lei, Qiu Xiaoling, Stomatological Hospital of Southern Medical University (Guangdong stomatological hospital)
Basic information: patient fan XX, male, engineer.
Main complaint: conscious that the bilateral upper anterior teeth are not beautiful, and require filling.
Present medical history: bilateral upper anterior teeth have brown patches for many years, which are not beautiful and require aesthetic restoration.
Preoperative photos of the front outside the mouth
Previous history: the ancestral home of Hunan, said that the same generation of people have different degrees of white plaque teeth, but the patient himself is relatively serious. Physical fitness, denial of systemic history, denial of history of food and drug allergy.
speciality check-up
#12 - ා22: 1 / 3 brown plaque in the lip and 1 / 3 brown plaque in the neck, basically complete teeth, percussion -, loose -, slightly swollen gums, exploration and subgingival calculus. The chalky demineralization was observed in different degrees on the labiobuccal side of the whole tooth.
Intraoral photograph before operation
Preoperative intraoral incision versus incision
Preoperative local magnification of anterior teeth
Diagnosis: dental fluorosis
Communicate with the patients about the expected repair effect, discuss the scope of treatment, and inform them of the possible problems, costs and prognosis during and after the operation.
The treatment plan is as follows:
(1) Basic periodontal treatment
(2) Slightly polish the surface and repair the front teeth with penetrating resin
Treatment steps
(1) Periodontal basic treatment: subgingival ultrasonic curettage
(2) Penetrating resin combined with enamel surface micro grinding repair: upper rubber barrier, step by step according to the following steps.
Surface grinding of yellow stained area of teeth: slow machine + green sand
Micro grinding of tooth surface without yellow dye: using slow machine + polishing disc
After micro grinding, remove the surface coloring and part of chalk demineralised enamel
After micro grinding of tooth surface
Icon etch etching for 2min
Wash with water for 30s and dry with icon dry for 30s
Preliminary inspection effect after drying
Local re etching according to the effect to strengthen the clinical effect
After washing, icon dry is used again for drying, and the effect of penetrating resin can be evaluated at the same time in the state of alcohol infiltration
Under the dark condition, the penetrating resin shall be evenly applied to the lip surface for 3 minutes to maintain the wet state. The adjacent parts shall be cleaned with dental floss. The light shall be cured for 40 s, and the cut end shall be illuminated first, and then the neck. After penetrating resin again for 1min, clean up excess resin, light cure for 40s, polish as appropriate, as shown in the figure after penetrating resin.
Immediate local post-operative light
Immediate post-operative biting photos
Immediately after operation
Local intraoral radiograph 10 days after operation
Intraoral occlusal photos 10 days after operation
10 days after operation
Comparison of preoperative, postoperative immediate and postoperative 10 days
Experience and discussion
Dental fluorosis is a special disease that affects the appearance. Its mechanism is: the fluoride concentration is too high in the process of enamel development, the calcium ion concentration is reduced, which indirectly interferes with the activity of alkaline phosphatase, thus delaying or even inhibiting the degradation of enamel matrix protein, which is manifested as enamel dysplasia and incomplete mineralization [1]. The pathological features of the enamel are poor intercellular mineralization of the surface and deep enamel and over mineralization of the enamel column. Therefore, the enamel, especially the surface enamel, is porous, transparent and easy to absorb exogenous pigments and produce fluoride spots. Clinical manifestations: symmetrical occurrence, scattered white opaque plaques and stripes, may have coloring. According to the degree of lesion, it can be divided into three types: chalky (mild), pigmented (moderate) and defective (severe). In this case, the stained teeth with chalky demineralization and no obvious enamel defect were found.
There are many interventions for different degrees of dental fluorosis, including external bleaching, micro abrasion, veneering, full crown or combined treatment. Among them, the treatment options for mild to moderate dental fluorosis [3] are bleaching, enamel micro abrasion combined with penetrating resin, and bleaching combined with penetrating resin. Permeable resin is a kind of material with low viscosity and high permeability. It has few inorganic fillers and high fluidity. The refractive index of penetrating resin is 1.52, which is similar to that of enamel. It is a treatment method between non-invasive and invasive. By sacrificing the enamel with a thickness of several microns, the penetrating resin can penetrate into the pores of deep enamel to achieve the effect of internal sealing and surface barrier [4]. In addition, combined bleaching can enhance the concealment effect of penetrating resin [5].
There are several precautions in the operation of penetrating resin.
1. Because of the aesthetic problems involved, it is necessary to communicate with the patients many times before, during and after the operation: understand the aesthetic expectations of the patients before the operation, discuss the possible problems of the contrast between the treated teeth and the rest of the teeth after the treatment, because the color of the dentin is displayed after the use of the penetrating resin, you can refer to the more healthy tooth color, such as the color of the lower incisors in this case After treatment, the color of the upper and lower incisors is basically consistent, and the scope of treatment is discussed on the basis of the color contrast. In this case, the aesthetic requirements of the patients are not high, so only ා 12 - ා 22 is treated. After the tooth surface is slightly polished, the effect after treatment can be expected, usually the surface will be more uniform after treatment, at this time, the patients can be communicated to see if the satisfactory effect is achieved. During the operation, the adjacent teeth will fall off Water may increase the contrast between the treatment teeth and the adjacent teeth after operation, and timely communication and follow-up should be done.
2. it is suggested that rubber barrier be used in operation. Because the etching agent is 15%HCl gel, using rubber barrier can better protect the soft tissue. It is better to turn the rubber barrier into the gingival groove and then fix it, so as to fully expose the lip surface. 3. The permeation resin needs to penetrate for enough time and fully. In the process of permeation, keep wet state, and the effect of twice permeation is better.
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