The patient presented complaining of aesthetic and functional discomfort. We were asked for a quick fix for aesthetic improvement of the upper central incisor group.
Clinical examination revealed the presence of deep and secondary carious lesions, non-sustained enamel prisms, broken teeth and cuneiform lesions.
Following X-ray examination we decided to restore root canal treatments.
Prosthetics were then performed using zirconia root canal reconstruction and Eco Line zirconia was used for the veneering crowns.
Two weeks were required for the patient to wear a temporary dental PMMA while the prosthetic work was performed. Ivoclar ceramics and Ketac Cem Plus cement were used.
The same way we are concerned when we discover certain changes in the skin or in any other organ, we should also pay attention to our teeth and their health.
Under certain circumstances stained teeth can occur. These discolorations can have many causes. Therefore, regular check-ups and reporting changes to the dentist should be part of everyone’s medical education.
Stains can appear spontaneously or, on the contrary, over time, the color changing gradually. These signs indicate different diagnoses and, therefore, treatment plans.
Classification
We will classify the factors that cause dental stains into extrinsic and intrinsic depending on the mechanism of their appearance and their depth.
Extrinsic factors:
For example, brown stains may be due to frequent consumption of coffee, tea or smoking. These stains are extrinsic; they only affect the outer surface of the tooth enamel and can be removed by a professional cleaning session in the dental surgery.
The yellowish color of the teeth is a shade that most patients find dissatisfying. It should be noted that this can be the natural color of the teeth, and often cannot be changed by simple dental hygiene.
The dentin layer (yellow-brown) lies just below the superficial enamel layer (white and translucent). The thinner the enamel thickness, the more the yellowish-brown color of the dentine shows through the enamel.
Black-stained teeth in the vicinity of old dental amalgam fillings. Dental amalgam is a mixture used in the past to make dental fillings. Among the drawbacks of this material is that it “tattoos” healthy, nearby dental tissue by impregnating it with mercury.
Moreover, tooth darkening occurs as a natural effect of aging.
Intrinsic factors:
Brown stains are not always due to food or smoking. Sometimes they hide carious lesions which, if treated as soon as possible, reduce the risk of spreading and damaging deeper dental structures.
Excessive intake of fluoride leads to acute intoxication, also known as fluorosis. In the first phase, at low doses, it manifests itself as unevenly dispersed white spots, and in the advanced stages of fluorosis it turns yellow or even brown. Fluoride is found in drinking water mainly in certain geographical regions. External intake, via tablets, is a fluoridation treatment that prevents the appearance of caries, but can lead to the formation of fluorosis stains, a process that is irreversible once the tablets are stopped.
Sometimes, these white spots can be colored by the food consumed such as coffee, red wine, tea, berries, in the corresponding shades.
Tetracyclines cross the placenta, enter fetal circulation, accumulate in fetal bones, and, if used during the 2nd or 3rd trimester, may cause permanent discoloration of the fetus’s teeth. In children exposed to tetracycline in utero the teeth may be yellow and susceptible to caries, enamel hypoplasia and retardation of bone growth may occur. Tetracycline should therefore be avoided after the first trimester of pregnancy and in children less than 8 years of age.
White, chalky spots may occur in the early stages of dental caries, when the enamel is demineralized. Acids formed as a consequence of dental plaque dissolve the tooth enamel, leaving its matt, whitish surface. At this stage, through the remineralisation carried out in the dental surgery, the caries process is stopped and the tooth regains its natural shine.
Treatment
Professional hygiene in the dental office consists of scaling, professional brushing and air-flow as needed. Air-flow uses a mixture of baking soda powder and water which, applied to the teeth with pressure via a device, effectively removes extrinsic stains, even interdental stains, a more difficult area to tackle in general.
To achieve the whiteness of teeth that everyone wants, in the case of deep stains, we must turn to teeth whitening. Spectacular results in terms of dental aesthetics, fast and long-lasting, are obtained in professional whitening carried out under the close supervision of the dentist.
In complex cases, such as the one shown in the picture, veneer crowns are the optimal solution. Dental check-ups every 6 months, together with professional hygiene, can detect stains early, determine their cause and, by removing the responsible agent and treating it appropriately, restore the health and natural appearance of the teeth.
For appointments we are happy to be at your disposal from Monday to Saturday from 8.00 to 20.00 on the following numbers:
