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3 Enamel Idiopathic Hypomineralization Treated with Direct Resin-based Composite

3 Enamel Idiopathic Hypomineralization Treated with Direct Resin-based Composite

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264



E. Araújo and J. Perdigão



Fig. 15.12 Transillumination

confirmed that the center of the

hypomineralized area had a

thinner area of tooth structure

compared to the periphery



a



b



c



Fig. 15.13  The porous enamel was removed with a diamond bur



ESPE) (Fig. 15.14a) followed by characterization of the secondary anatomy

(Fig. 15.14b) with a composite finishing bur. A felt disk (Diamond Flex, FGM) and

a fine diamond paste (Diamond Excel, FGM) and used for the final polishing step

(Fig. 15.14c). Figure 15.15 is a close-up photograph of the final aspect of restored

tooth #10 (FDI 2.2) showing an optimal esthetic integration with the other anterior

teeth. Figure 15.16 portrays the patient’s new smile.



15  Restorative Options for Discolored Teeth



a



b



265



c



Fig. 15.14  After etching with 35% phosphoric acid for 15 s, a two-step etch-and-rinse adhesive

was applied, gently air dried and light cured, followed by a nanofilled resin-based composite;

(a) Finishing with aluminum oxide disks; (b) Placing secondary anatomy with a fine diamond

finishing bur; (c) The final polishing step was carried out with a felt disk impregnated with a fine

diamond paste

Fig. 15.15 Close-up

photograph of the restored

tooth



Fig. 15.16  The patient’s

new smile



266



E. Araújo and J. Perdigão



15.4 R

 estorative Solution for a Case of Unsuccessful Intra-­

coronal Whitening

As described in Chap. 8, intra-coronal whitening of endodontically treated teeth has

a fairly good prognosis for discolorations caused by necrotic pulp tissue or blood

components, with a short-term success rate of 50–90 %. However, the long-term

success rate is considerably lower as some color regression may occur after the

initial bleaching effect.

This 35-year-old female patient was concerned about the discoloration of her

right maxillary central incisor (Figs. 15.17, 15.18, 15.19, 15.20, 15.21, and 15.22).

According to the patient this tooth had been endodontically treated 6 years ago and

immediately became darker. Her dentist performed three intra-coronal whitening

treatments three years later, followed by two sessions of external in-office whitening. In spite of a slight improvement in the tooth color patient never felt that the

tooth was esthetically acceptable.

Medical history was not contributory. Radiographically tooth #8 (FDI 1.1) had

no evidence of root resorption or periapical pathology. The radiographic aspect of

the root canal treatment was considered excellent. The clinical exam revealed a few

areas of incipient caries lesions on the posterior area, besides defective resin-based



Fig. 15.17 Preoperative

view showing the

discoloration of tooth #8

(FDI 1.1)



Fig. 15.18 After

replacement of resin-based

composite restorations and

preparation of tooth # 8

(FDI 1.1) for a porcelain

crown



15  Restorative Options for Discolored Teeth

Fig. 15.19  Shade matching



Fig. 15.20  High-opacity lithium

disilicate coping try-in (IPS

e.max Press HO, Ivoclar

Vivadent)



Fig. 15.21  Characterization of

the opaque ceramic coping



Fig. 15.22  Final aspect after

adhesive cementation of the

lithium disilicate ceramic crown



267



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