CARIOLOGY

WHITE SPOT LESIONS OR

INCIPIENT (REVERSIBLE)
CARIES

GROUP 1
White spot lesions Fluorosis
caused by dental caries caused by excessive intake of fluoride during
usually appear as white, opaque spots on the development of teeth
the tooth's surface typically presents as white, chalky, or opaque
often surrounded by a yellowish or areas on the tooth enamel
brownish border generally smooth and flat
may feel slightly rougher than the
surrounding enamel
CLINICAL
MANIFESTATIONS
Classification of WSL (Gorelick)
CASE NO. 1
WSL CLASS: CLASS 2

LOCATION: INCISAL THIRD OF TOOTH

CROWN

BORDER: WELL-DEFINED

A PATIENT WHO EXPERIENCED TRAUMA ON PRIMARY

INCISORS AT AGE OF 4 PRESENTED WITH LARGE WHITE
SPOTS ON THE INCISAL HALF OF 11 AND 22
CASE NO. 2
WSL CLASS: CLASS 2

LOCATION: CERVICAL 1/3 OF MX AND

MD ANTERIOR TEETH

BORDER: WELL-DEFINED (C-SHAPED)

A PATIENT PRESENTING WHITE SPOT LESIONS AFTER

ORTHODONTIC TREATMENT WITH FIXED APPLIANCES
DIAGNOSTIC
TOOLS
 Visual / Tactile Trans-illuminator
Examination Tools

Dental mirror
Light source
Explorer
Probe
Loupes
 Quantitative light- Laser
induced fluorescence (DIAGNOdent)
(QLF)
DIAGNOSING WSL
 CASE NO. 1
A 19-year-old young patient consulted our department the university hospital of Sahloul,
Sousse, Tunisia, to correct the white opacity on her Maxillary anterior tooth (Tooth # 11).

NORMAL TEETH WHITE SPOT LESION UNDER

TRANSILLUMINATION

Appearance: Appearance:
Clinically - no signs of white spot lesion Clinically - a vivid white opaque spot
Under Transillumination- translucent Under Transillumination- black and homogenous
limits with neat and rumble appearance
 CASE NO. 2
A 30 year old patient had previous orthodontic treatment presenting
white spot lesions on tooth 12, 13

WHITE SPOT LESION UNDER

NORMAL TEETH QUANTITATIVE LIGHT-INDUCED
FLUORESCENCE (QLF)

Appearance: Appearance:
Clinically - no signs of white spot lesion Clinically - chalky and rough
Under QLF - full color Under QLF - wsl shows darker contrast
PREVENTATIVE
TREATMENTS
Good Oral Usage of Agents Usage of
Hygiene with Fluoride Xylitol
 Usage of agents
Usage of with casein Orthodontic
antimicrobial phosphopeptide- materials
agents Amorphous containing
calcium phosphate fluoride
(CPP-ACP)
CORRECTIVE
TREATMENTS
CORRECTIVE:
Microabrasion

Microabrasion works by removing a thin

layer of enamel where the white spot
lesions are located. This is a conservative
approach as it only removes a minimal
amount of enamel. This helps improve the
appearance of the tooth and minimize the
visibility of white spots.
MICROABRASION
TECHNIQUE
1.
Patient Assessment:

Evaluate the white spot lesions to

determine their extent and suitability
for microabrasion.
MICROABRASION
TECHNIQUE
2.
Isolation:

Isolate the affected teeth using a

rubber dam or cotton rolls to keep
the area dry.
MICROABRASION
TECHNIQUE
3.
Pumice Application:

Apply a pumice slurry to the white

spot lesion with a rubber cup or
prophy brush to remove superficial
stains and debris.
MICROABRASION
TECHNIQUE
4.
Etchant Application:

Apply a 15-37% phosphoric acid

etchant to the lesion for 15-30
seconds to prepare the enamel
surface.
MICROABRASION
TECHNIQUE
5. Microabrasion:

Use a microabrasion paste (37%

H3PO4 and 18% HCL) with a rubber
cup or brush attached to a slow-
speed handpiece. Gently abrade the
lesion for 5-10 seconds in a circular
motion. Rinse and repeat as
necessary.
MICROABRASION
TECHNIQUE
6.
Fluoride Application:

Apply fluoride varnish or gel to the

treated area to promote
remineralization.
MICROABRASION
TECHNIQUE
7.
Follow-Up:

Schedule follow-up appointments to

monitor the treated area's progress.
Tooth whitening can often be done after white spot lesion microabrasion. In fact,
some patients choose to combine these treatments to achieve a more uniform and
brighter smile.
CORRECTIVE:
Resin Infiltration (RI) Technique

This treatment aims to occlude the

microporosities within the lesion body by
infiltration with low-viscosity light-curing
resins that have been optimized for rapid
penetration into the porous enamel. The
resin penetrates into the lesion body,
driven by capillary forces.

This technique aims to create a diffusion

barrier inside the lesion, not on the lesion
surface
 STEPS OF RI TECHNIQUE

CASE DESCRIPTION

1 Britt, a 22-year old patient was

looking for minimal invasive
treatment to remove the white
spots on her front teeth (11 and 21).

WSL on incisal third of crown

INITIAL STATUS
 STEPS OF RI TECHNIQUE

Rubberdam is placed to get a

2 clear and dry work field.

Use a micro-abrasive paste
(Opalustre, Ultradent) to clean
the surface and start opening
the porosities.
Duration: 3 times for 60
seconds each
Alternative: 15%
Hydrochloride acid (Icon-
Etch, DMG) can also be
mixed with some pumice and
rubbed with a special rubber
cup using gentle forces
MICROABRASION
 STEPS OF RI TECHNIQUE

3
Neighboring teeth are isolated
with Teflon tape.
Use hydrochloric acid (Icon-
Etch, DMG) in a rubbing motion
with a special smooth surface
(sponge) tip.
Duration: 2 minutes
A check can be performed with
the absorpton of ethanol (Icon-
Dry, DMG)
Condition: If white spots
disappear, proceed to
infiltration; If not, repeat
ETCHING etching procedure
 STEPS OF RI TECHNIQUE

4
Capillary forces suck the
methacrylate (Icon-Infiltrant.
DMG) into the enamel, filling up
the porosities.
Duration: at least 3 minutes
Polymerisation can be
performed for 40 seconds
removing the excess with air.
Should be repeated for 1 to 2
minutes and light cured as well.
After, apply glycerine gel and
polymerise again for 40
seconds
INFILTRATION
 STEPS OF RI TECHNIQUE

5
Remove excess
scalers
cotton roll
dental floss
Polish with rubbers
Brownie (Brownie, Shofu)
Greenie (Greenie, Shofu)
Felt disc (Flexibuff,
Cosmedent) with aluminum
oxide paste (Enamelize,
Cosmedent)

POLISHING
pre-treatment after completion of RI
MICROABRASION & RESIN INFILTRATION

CASE DESCRIPTION

A 26-year-old female came to correct

the white lesions on mandibular
anterior teeth and premolars.

PATIENT HISTORY

Patient had undergone orthodontic

treatment 10 years ago and the white
spot lesions had existed since
brackets were removed.
Microabrasion with Opalustre

Resin Infiltration with Icon

pre-treatment after completion of microabrasion
pre-treatment after completion of RI technique
Thank you for
listening!