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12 Oral Pathology

White Spot Lesions (Part I): A New Topographic Classification (WSTC) Dr. Fadwa Chtioui DDS and Postgraduate Student Department of restorative Dentistry and Endodontics University Hospital of Sahloul Sousse, Tunisia

Abstract Enamel demineralization is frequently encountered in dental practice. Histologically, hypomineralization is the common feature and several etiologies stand behind their clinical appearance.


Dr. Omar Marouane Assistant Doctor Department of restorative Dentistry and Endodontics University Hospital of Sahloul Sousse, Tunisia

Dr. Nabiha Douki Head of the department of Odontology, Professor in Restorative Dentistry and Endodontics University Hospital of Sahloul Sousse, Tunisia

Recently, resin infiltration technique was introduced to mask these enamel lesions. Over time, the indication evolved and was extended to all etiologies responsible for enamel white lesions. However, from a topographic point of view, the location of hypomineralized lesion differs based on the corresponding etiology and the appropriate choice of a specific treatment for each location is necessary. To date, the etiology of the lesion is solely considered when identifying their topographic location within the enamel. Conversely, the correlation between etiology and topography remains theoretical and is, however, regarded to be quite weak especially in cases where only a partial improvement of the esthetic appearance was seen. Therefore, the results remain unpredictable in most cases of such lesions regardless of their plausible etiologies. As this idea kept grabbing our attention during our study, it was compelling to figure out the missing link between etiology and the topography of hypomineralized enamel areas. Likewise, a clinical evaluation of the enamel white lesion’s depth must be adopted as, technically, the latter seems to exclusively influence the treatment outcome. This work proposes a new topographic classification along with a new set or classification criteria of enamel white lesions for a more proper management of hypomineralized teeth

Dental News, Volume XXIV, Number IV, 2017

comprising a major breakthrough in their treatment. The means of Visual examination and transillumination have served as references to develop this new topographic classification. Key words: Cosmetic dentistry, Demineralization, Esthetic dentistry, Minimally invasive dentistry, Restorative dentistry, Enamel

Introduction Hypomineralization is the presence of that visible white area on the tooth surface is due solely to a defect in the enamel. These opacities are developmental defects of enamel (DDE) resulting from enamel organ dysfunction due to a variety of agents and defined as a qualitative defect resulting histologically in hypomineralization [Mastroberardino et al., 2012; Pini et al., 2015; Senestraro et al., 2013]. Recently, resin infiltration technique has been introduced to optically mask these enamel hypomineralized lesions and improve their mechanical properties [Kielbassa et al., 2010; Paris et al., 2013]. In order to successfully infiltrate these lesions, having the necessary knowledge of their topographic location seems crucial. Right up to the present day, this topographic knowledge has been based on the etiology of these lesions despite the fact that new studies have emerged to provide data on the little-known subsections of white-spot lesions [Denis et al., 2013]. And while there is a good correlation between such lesions, their etiologies seem to present an unpredictable location of hypomineralized enamel surfaces. And it should be mentioned that several studies have shown only partial improvement of esthetic appearance of enamel white lesions while the

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