Minimally Invasive Treatment for Esthetic Enhancement of Enamel Hypoplasia in Upper Central Incisors: Clinical Case Reports

Abstract White enamel discolorations are frequent and can impact patients' quality of life. Enamel hypoplasia is a condition that affects the quality of enamel, resulting in a change in its translucency and color. Minimally invasive procedures of the slightly altered enamel are an effective treatment for improving the esthetic appearance of tooth discoloration. They contribute to a greater longevity of teeth and prevent them from relapsing into the repetitive restorative cycle. Two case reports aimed to show a sequential technique of minimally invasive procedures for treating enamel hypoplasia in anterior teeth. The sequential technique consisted of three steps: anterior teeth were firstly bleached in office with 40% hydrogen peroxide (Opalescence™ Boost™, Ultradent Products Inc, South Jordan, UT, USA), then hypoplastic spots on the buccal incisal thirds of the maxillary central incisors were treated with two sessions of microabrasion using phosphoric acid (Ultra-Etch, Ultradent Produtos Inc, USA) and pumice stone and finally resin infiltrant (Icon, DMG, Germany) was applied on the buccal incisal thirds of teeth in one session. The proposed strategy was based on masking the lesion by infiltrating the porous subsurface enamel with a hydrophobic resin that has a refraction index closer to that of sound enamel, after permeating the non-porous surface enamel through hydrochloric acid erosion. The masking of hypoplastic spots was done with this sequence of treatments and reestablishing color harmony. However, the clinical success can vary depending on the depth of white spots, patient's oral hygiene habit and compliance with post-treatment care instructions.