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April's Tip: Treatment of "White Spot Lesions" After Removal of Fixed Orthodontic Appliances

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By: Dr. Derek Mahony

Demineralized white spot lesions occur frequently after orthodontic treatment.  Some teeth are more prone to demineralization (typically the maxillary lateral incisors and the mandibular canine teeth).  The disto-gingival area of the labial enamel surface is the area most commonly affected (Figure 1).  In the First few weeks after removal of the fixed appliances, there is a reduction in white spot lesion size and appearance, possibly due to the action of saliva (Figure 2).

Various treatments have been proposed to assist remineralization.  It is important to note that fluoride should not be used, in high concentration, as it tends to prevent remineralization and can lead to further unsightly staining.  Low concentration of fluoride may assist remineralization, such as those amounts found in casein calcium phosphate materials.  Stimulation of salivary flow, by chewing sugar-free gum, is also helpful.

This article will describe a revolutionary new approach to the cosmetic treatment of white spot lesions (Figure 3).  Icon resin represents a rapid approach to the treatment of these carious lesions.  The breakthrough, micro invasive technology fills and reinforces demineralized enamel, without drilling or anesthesia (Figures 4 and 5).

The reason previous approaches have fallen short, is because fluoride therapy is not always effective in the advanced stages of decay, and the use of restorative fillings almost always sacrifices significant amounts of healthy tooth structure. 

Instead of adopting a “wait and see” approach, Icon resin can arrest the progress of early enamel lesions, up to the first third of dentine (Figure 6).  This is done in one simple procedure, without the unnecessary loss of healthy tooth structure. 

The Procedure, when using Icon, is as follows: the surface areas of the white spot lesion is eroded with a 15% HC1 gel.  This opens the pore system of the lesion.  The pore system is then dried with ethanol.  Icon resin is then applied to the lesion, with the application aid.  The extremely high penetration coefficient of the Icon resin enables it to penetrate into the pores of the carious lesion.  Excess material is then removed, and the material is light cured.  The total treatment time is about 15 minutes (Figure 7).

The Cosmetic treatment of the cariogenic white spots, in one patient visit, is very appealing to patients, and their parents (Figures 8a, b).  There is no drilling or anesthesia required, so there is greater patient comfort.  Furthermore, patients who have already demonstrated poor compliance with their brushing can be treated earlier.  This is not just minimally invasive dentistry; it is micro-invasive dentistry. 

I would recommend that all clinicians try the Icon product when attempting to remineralize white spot lesions, post orthodontic treatment.