Conservative esthetic management of brown enamel fluorosis using combination therapy: A clinical report

Abstract

Dental fluorosis is caused by ingestion of excessive fluoride during tooth development resulting in hypomineralization of the enamel and can present as white or brown intrinsic lesions. This case report describes a combination of minimally invasive techniques: microabrasion, bleaching, and resin infiltration to address brown enamel fluorosis present on the maxillary anterior teeth of a young patient. Before resin infiltration, air microabrasion was targeted at subsurface lesions located on the maxillary central and lateral incisors, and chairside bleaching was done with 37% hydrogen peroxide (Opalescence). After which, hypoplastic lesions on the buccal surfaces were etched before being treated with two sessions of resin infiltration (ICON and DMG). Following treatment, satisfactory esthetic outcomes were achieved. Accurate diagnosis, depth of lesions, and understanding the effectiveness and limitations of each technique are essential to select the appropriate type of treatment to obtain the best esthetic outcome. In conclusion, the conservative management of varying severity of dental fluorosis may require the appropriate use of combination treatment modalities, such as microabrasion, bleaching and resin infiltration, when clinically indicated, to address the treatment needs and achieve a desired outcome.

Keywords: Bleaching; color science; dental materials; microabrasion; operative dentistry; restorative dentistry.

Figure 1

Pretreatment smile

Figure 2

Pretreatment frontal view of upper anterior teeth

Figure 3

Application of rubber dam isolation and initial application of ICON etchant

Figure 4

Microabrasion targeting the brown lesions

Figure 5

Chairside bleaching with Opalescent for 45 mins

Figure 6

Final round of ICON etchant applied

Figure 7

Posttreatment frontal view of upper anterior teeth

Figure 8

1-week post operative smile

Figure 9

1-year post operative smile