Enamel and dentine defects diagnosis and tx pt 2

Question 1

Tx options for developmental enamel defects of anterior teeth

Answer 1

None/tooth mousse/bleaching/microabrasion/resin infiltration/direct or indirect composite veneers

Question 2

Tooth mousse

Answer 2

Re-mineralisation of hypoplastic molars and WSL
Casein phosphoro-peptides amorphous calcium phosphate product

Question 3

Bleaching

Answer 3

Products containing or released hydrogen peroxide should not be used in those <18yrs
GDC: except where such use is intended wholly for the purpose of treating or preventing disease

ADV: non-destructive to tooth/non-irritation to gingival health/ no change in tooth contour
Disad: not suitable when large composite resin restorations are present

Non-vital: “walking bleaching” technique/inside outside bleaching indicated in non-vital endodontically treated teeth
Vital bleaching: nightguard (10% carbamide peroxide) indicated in cases of mild tetracycline staining/mild to moderate fluorosis/hypoplastic/hypomineralisation defects/sclerosed pulp chambers/ AI

Question 4

Microabrasion

Answer 4

Involves the removal of surface enamel by abrasion and erosion.
Indicated for: fluorosis/ post ortho demineralisation/ localised hypoplasia/ idiopathic hypoplasia where the defect is limited to the outer layer of enamel
Analysis of effectiveness should be delayed for 1 month as appearance of teeth will improve over this period of time
Prior to procedure: vitality tests/radiographs/photographs

Question 5

Resin infiltration

Answer 5

Introduced as a method of arresting non-cavitated interproximal and smooth surface enamel lesion (occludes the pores in the body of the enamel lesions with a low viscosity resin and blocks the diffusion of cariogenic acids and hence reduces or arrest lesion progression).

Fully infiltrated lesions will lose their white appearance then micropores are filled. WSL appear white due to the difference in the refractive index of sound hydroxyapatite crystals and the medium in the lesion pores.

Infiltrating the lesion with resin makes refractive index closer to that of enamel, hence reducing the appearance of WSL.

Limited research on developmental defects of enamel. Appear to show better results in post orthodontic WSL. May be due to difficulty in lesion penetration. Further research is required to determine which defects are suitable for long term.

Has been indicated for: smooth surface white decalcification on the tooth such as after stasis of plaque after orthodontic.

Question 6

Composite

Answer 6

Porcelain veneers contraindicated in the growing patient due to large size of pulp chamber and immature gingival contour.
Composite can be used as: Localised/Composite Veneers
Indicated for: localised hypoplasia not responsive to microabrasion or bleaching/to augment tx with microabrasion/tetracycline staining/ discolouration due to loss of vitality
When deciding whether to remove enamel or not consider: increased labio-palatal bulk can make OH difficult to maintain, composite resin has a higher bond strength to subsurface enamel, may remove discolouration)

Question 7

Stainless Steel Crowns

Answer 7

ADV: prevent further TSL/control sensitivity/ est interprox and occlusal contacts
Disadv: aesthetics

Question 8

Metal onlays

Answer 8

Adv: minimal tooth destruction for preparation/more conservative/supragingival margins
Disadv: Requires impression and laboratory/ more technique sensitive and time consuming