Non-destructive management of white spot lesions by using tooth jewelry
A 23-year-old female patient with a non-contributory medical history, presented to Wonkwang University Dental Hospital, Department of Conservative Dentistry for the removal of white spot lesions on the labial surface of the maxillary incisors (). Intraoral examination showed that the white spot lesions were present on maxillary central incisors and maxillary left canine. No specific feature was found on diagnostic radiographs. After clinical and radiographic examination, the white spots on maxillary central incisors and left canine were diagnosed as enamel hypomineralization.\nBased on the moderate degree of hypomineralization, the treatment options including resin restoration or laminate veneer were explained to the patient. However, the patient showed a considerable fear of dental procedure and rejected tooth preparation. After discussing with the patient, tooth jewelry was considered as a treatment option. The lesion located on the distal part of the labial surface of the maxillary right central incisor was most notable, thus we decided as an appropriate position for tooth jewelry.\nAfter discussing the final location of the tooth jewelry with the patient, phosphoric acid etching (Scotchbond Etchant, 3M ESPE, St. Paul, MN, USA) and adhesive system application (Adper Scotchbond Multi-Purpose Adhesive, 3M ESPE) were performed. One drop of flowable composite resin (Filtek Supreme Ultra Flowable Restorative, A1, 3M ESPE) was placed on the bottom surface of tooth jewelry (Twinkles) which was stuck to the tip of the resin instrument using petroleum jelly and transferred on the white spot lesion (). Then, the location of jewelry was adjusted by the operator and confirmed by the patient with a hand mirror at the same time. After removal of redundant resin, light polymerization was performed for 60 seconds. The patient was informed that there could be a feeling of irritation during the first 1 or 2 days and the discomfort would disappear with time. Oral hygiene instructions were given as well. The patient has been satisfied with the result after 6 months ().