A Combined Approach for the Aesthetic Management of Stained Enamel Opacities: External Bleaching Followed by Resin Infiltration

Abstract

Stained enamel opacities are frequently encountered in dental practice. However, due to the risk of unaesthetic outcome, managing such lesions by resin infiltration techniques alone is not advised. Therefore, performing external bleaching before resin infiltration procedure is mandatory to eliminate stains from the hypomineralized lesions in order to aesthetically infiltrate them. In this work, we describe clinical cases in which external bleaching and resin infiltration techniques were used for managing stained enamel hypomineralized lesions related to traumatic dental injuries and molar incisor hypomineralization. Despite the fact that this approach has some limitations, it could be concluded that external bleaching associated with the resin infiltration technique shows promising results to aesthetically manage stained enamel opacities when the stain is totally removed after bleaching.

Figure 1

Stained enamel opacity related to traumatic dental injuries (a). The underestimation of the presence of stain into the lesion have led to unaesthetic outcomes after performing resin infiltration (c). Note the presence of enamel cracks (white arrow), observed under transillumination, which could constitute a possible pathway for chromatogenic substances (b). This case is considered a failure.

Figure 2

Yellowish lesion related to molar incisor hypomineralization (a). The combination of in-office bleaching (38% H₂O₂) (b) applied on a single visit for 15 min (c) and resin infiltration procedure were sufficient to end up with an esthetically satisfying result. By the end of the infiltration step, the incisal part of the lesion was not completely infiltrated probably due to excessive depth of the lesion at this area (d).

Figure 3

Brownish lesion related to molar incisor hypomineralization (a). After one week of at-home whitening using 10% carbamide peroxide gel (b), the stain was partially removed and has disappeared completely by the end of the bleaching treatment (c). Immediate result after performing resin infiltration (d). 3 months after treatment (e). Significant improvement in the aesthetic appearance of this patient's teeth was achieved, and the case was thus considered to be a success.