Esthetic Impact of Different Minimally Invasive Approaches on Hypomineralized Permanent Anterior Teeth

Resin infiltration treatment (Icon®) for Hypomineralized anterior permanent teeth in children

• Applying a 15% hydrochloric acid gel (ICON-Etch; DMG; Hamburg, Germany®) for 120 s using the Icon® etch syringe included in the set,
• followed by a thorough washing of the etchant for 30 s. and Dring the tooth using an air spray,
• Once the enamel surface appeared chalky, Ethanol lesion desiccation (ICON-Dry; DMG®) will be performed for 30 s,
• followed by drying using an air spray.
• Using the Icon® infiltrant syringe Infiltration with a sufficient amount resin (ICON-Infiltrate; DMG®) of the lesion surface by massaging the tip of the syringe on the lesion in circular movements for 3 min.
• Before drying, clean the remaining material and excess removal by Gauze or cotton swab and dental floss.
• Light curing for 40 s with a light-cure device,
• Then another round of infiltration will take place
• One minute was provided for the material to infiltrate the pores, after which it was polymerized for 40 s.

Opalustre® Enamel Microabrasion Slurry

• Isolation is extremely important because of the hydrochloric acid. Patients and clinician should both wear protective eyewear.
• Isolate teeth to be treated and one tooth posterior on each side using rubber dam.
• For additional protection, apply a bead of rubber dam sealer or light-cured resin barrier at the gingival margin beneath the dam.

NOTE: For hypo-mineralization greater than 0.1-0.3mm use a fine-grit water-cooled tapered diamond bur, lightly sweep over the stained area for 5-10 seconds prior to applying Opalustre.

• Apply approximately 1.0mm thick layer over the discolored area from Opalustre syringe with the White Mac tip.
• Using a rubber prophy cup at a slow RPM (approximately 500 RPM), apply medium to heavy pressure for 60 seconds at a time.
• Suction the paste from the teeth first, then rinse, evaluate and repeat as necessary.
• Aesthetic improvement should be visualized on the wet surfaces.
• After final rinse, remove rubber dam, and sealer from the teeth. Rinse

Antivet® enamel micro-abrasion

• The Antivet® abrasive solution (MDC DENTAL, Zapopan Jalisco, México) containing 21% hydrofluoric acid will be placed on the buccal surface with a cotton swab.
• When the swab became pigmented, it will change to another clean swab with the abrasive solution.
• The procedure would be repeated for 10 min.
• When the process is finished, the excess solution will be cleaned using cotton, and calcium hydroxide as a neutralizing solution would be placed for 1 min with a micro brush.
• In the end, rinsing with water for 30 s.
• Apply MI varnish to the enamel.

Clinical photographs will be taken with a digital camera macro lens, and flash. With the patient and digital camera at the same vertical plane and dental clinic illuminated evenly.

The photographs will be taken in baseline, during the application time of the test or control.

For standardizing the photographic conditions, the camera will be placed at the equidistance from the tooth. To prevent the change of refractive index by moisture, 30 s of drying of the lesion will be done.

The patient is asked to draw a line perpendicular to the VAS at their perceived pain-intensity level, no discomfort (score 0), mild discomfort (score 1-3), moderate (score 4-6) and very severe (7-9) or worst discomfort (score 10).

It is a behavioral scale because it is based on observed behavior in response to a stimulus beyond a certain threshold.

The dentist (or another assessor present) rates the response of the patient to the stimulus as 0 for no response to air stimulus,

1. for response to air stimulus but no request for discontinuation of the stimulus,
2. for response to air stimulus and requests discontinuation or moves from the stimulus&
3. for response to air stimulus, considers stimulus to be painful, and requests discontinuation'