ISSN 0975-8437 INTERNATIONAL JOURNAL OF DENTAL CLINICS 20 11:3(2):80-81

CASE REPORT

Esthetic management of Dental Fluorosis

Nitin Habbu, Nikhil Joshi, Murali Ramamoorthi, Vijay Mabrukar
Abstract
The demand for tooth colored restoration has grown considerably during the last decade. Porcelain
veneers are a useful adjunct to the armamentariu m of dentist to help in the management of esthetic problems in
patients both young and old. This case report discusses about the esthetic management of moderate to severe
fluorosis patient with porcelain laminate veneer.
Key Words: Laminates; Veneers; Dental Fluorosis
Received on: 10/12/2010 Accepted on: 14/01/2011

Introduction
Dental fluorosis is an irreversible condition
caused by excessive ingestion of fluoride during
the tooth forming years.(1) The first documented
effect of fluoride on dentition was dated back in
1916 published by McKay and GV Black.(1, 2) It
was Trendly Dean 1934, who developed a
classification fo r fluorosis which is still widely
used. Dean and McKay suggested that optimu m
level of water fluoride should be between 0.9 to 1.0
ppm.(1, 3) The fluorosis in India was first
identified by short et al in 1937 in Nellore. (1, 4)
This case report is about successful esthetic
management of a moderately fluorosed male
patient.
Case Report
A 23 year old male patient reported to our
clin ic with a chief comp laint of comp ro mised
esthetics due to discoloration of teeth. On clin ical
examination patient had generalized enamel
fluorosis affecting all of the permanent teeth.
Confluent pitting was present on most of the
surfaces of the teeth with wide spread of yellow
brown stains (Figure 1a).
Occlusion was in a class 1 relationship.
Oral hygiene was good and the gingival tissue was
in a healthy condition. Rad iographic examination
showed no caries or alveolar bone loss. Diagnosis
of moderate dental fluorosis was made, based on
history, clin ical findings and deans index. Given
the age of patient and severity of fluorosis
porcelain laminates were given as treatment option
and was accepted by the patient. The initial phase
of treatment started with smile analysis,
preliminary shade selection, photographs, study
models to evaluate the occlusion and diagnostic
wax up was done.
Next clin ical appointment tooth
preparation was performed, followed by final shade
selection with chro mascopic shade guide and final
impression. The teeth were desensitized.
Temporization was not done since 0.5 to 0.8mm
tooth reduction was performed. Porcelain laminate
veneers were fabricated using pressable ceramic
system IPS Empress II (Figure 1b). The correct fits
of veneers were verified both individually and
collectively on the model then on the teeth. The
patient was satisfied with the form, shape, and
shade of veneers. Final cementation was done. The
contacts and occlusion were checked. Final
fin ishing and polishing was done after 24 hours of
cementation. Post-operative photographs and
instructions concerning oral hygiene and avoidance
of habits causing trauma to veneered teeth were
given. One year post-operative evaluation shows
no caries involvement, breakage or discoloration of
veneers (Figure 1c).
Discussion
Dental fluorosis is a disturbance affecting the
enamel formation during the time of mineralizat ion
stage. The clin ical appearance reflects a spectrum
of change. Lusterless white lines or diffuse
opacities are present in its mild form, wh ile in the
more severe fo rms generalized opaque and chalky
appearance with confluent pitting and staining of
hypo mineralized tissue may be seen.(5)

Figure 1a. Preoperative View, 1b. Veneering on Cast, 1c. Postoperative view

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Fluorosis disturbs enamel significantly
and affects esthetics quite adversely which can
cause psychological distress to the affected person.
The etiology of intrinsic discoloration of enamel is
commonly associated with fluorosis. The treatment
of enamel fluorosis usually ranges fro m ceramic
veneer to free hand bonding restorations.(6)
Although vital bleaching does imp rove the
esthetics to certain extent it has only met with
partial success in regard to moderate to severe
fluorosis.(1)
The concept of veneering was first described
in dental literature sometimes ago, although it is
only with the advent of efficient bonding of resins
to enamel and dentine and the use of etched,
coupled porcelain surfaces that esthetically
pleasing, durable and successful restorations can be
made.(7) Porcelain veneers have traditionally been
made fro m alu minous or reinforced feldspathic
porcelains, wh ich have relatively poor strength in
themselves but produce a strong structure when
bonded to enamel.
A key element in success with porcelain
veneer is carefully controlled but appropriate tooth
tissue reduction(8). Veneers are generally
prescribed for the buccal aspect of maxillary
anterior teeth, but there are nu mbers of
nonstandard applications, like the palatal/ lingual
aspect of teeth which have been worn or fracture,
diastema elimination using slips restricted to the
proximal aspects of teeth, lower incisors, and
posterior occlusal onlays. Incisal coverage of
porcelain has to be s ufficiently thick to be durable
under continuing rubbing contact with the opposite
tooth.(8) In this case porcelain laminates were
chosen for its esthetic performance,
biocompatibility, durability and the translucency
provided by the restoration which allows light
transmission through to the underlying tooth which
minimizes gingival shadowing and yields an
appearance of vitality.
Source of Support: Nil, Conflict of Interest: None Declared
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INTERNATIONAL JOURNAL OF DENTAL CLINICS 20 11:3(2):80-81
Conclusion
Fluorosis is a major health problem in India
with over 6 million people at risk. Veneering the
fluorosed teeth with laminates is one of the best
possible management options esthetically.
Authors Affiliations: 1. Dr. Nitin Habbu, MDS, Reader,
2. Dr. Nikhil Joshi, M DS, Reader, 3. Dr. R. M urali,
MDS, Reader, 4. Dr. Vijay M abrukar, M DS, Reader,
Dept. of Prosthodontics, Sinhgad Dental College, Pune,
India.
References
1. Sherwood IA. Fluorosis varied treatment options.
Journal of Conservative Dentistry. 2010;13(1):47-53.
2. M cKay F, Black G. Investigation of mottled teeth:
An endemic imperfection of the enamel of teeth
heretofore unknown in literature of dentistry. Dent
Cosmos. 1916;58:129-56.
3. Dean H, M cKay F. Production of mottled enamel
halted by a change in common water supply. Am J
Public Health 1939;29:590-6.
4. Shortt W. Endemic fluorosis in Nellore District,
South India. Indian M ed Gazette. 1937;72:396.
5. Fejerskov O, Johnson N, Silverstone L. The
ultrastructure of fluorosed human dental enamel.
European Journal of Oral Sciences. 1974;82(5):357-
72.
6. Nazirkar G, M eshram S. An Evaluation of Two
M odern All-Ceramic Crowns and their comparison
with M etal Ceramic Crowns in terms of the
Translucency and Fracture Strength. International
Journal of Dental Clinics. 2011;3(1):5-7.
7. Akapata E. Occurrence and management of dental
fluorosis. Int Dent J. 2001;51:325-33.
8. Christensen GJ, Christensen RP. Clinical
Observations of Porcelain Veneers: A ThreeYear
Report. Journal of Esthetic and Restorative Dentistry.
1991;3(5):174-9.
Address for correspondence
Dr. R. M urali, M DS,
Reader,
Dept. of Prosthodontics,
Sinhgad dental college,
Pune, India.
Email: muralee.dr@gmail.com
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