This case epitomizes how many options we have as restorative dentists to repair, restore, and in this case remineralized root surfaces. The outcome may look similar to the naked eye, but, the long-term impact of our approach to treatment really matters. Let me explain it simply, the remineralized teeth did not require any cutting with a drill or any other cutting tool. The remineralized teeth were treated with topical applications, (which I will describe in technical details below.) The teeth that are eligible to be remineralized in the photo above meet the following criteria: 1. They have discolored and demineralized tooth structure (limited mostly to enamel,) **2. They have an intact outer surface without physical cavitation. **This second criteria is important, because if it is not met, the tooth is not a good candidate for this form of remineralization.
- Let’s answer the 3 questions:
- 1. Cost Per Visit%: ($100 for 1-3 teeth per arch,) ($150 for 4+more teeth per arch) [%See Note to Patient below]
- 2. Time in the chair: 20-30 minutes 1-3 teeth, 40 minutes for 4+ teeth.
- 3. Does it hurt? My patients reported only mild (1-2 on a scale of 1-10) discomfort following up on the therapy 4-days later.
When we look to restore a mouth, we are often choosing which methodology to follow. Patients like a non-invasive option that reduces: 1. Cost. 2. Injections. 3. Time in the chair. Remineralization therapy delivers on all 3 counts.
Here is the protocol I have employed for getting these results on these teeth. The teeth receive topical application of HF acid etch. Then, I mix a thick slurry (in a dappen dish) of: 1. dry lab pumice^ (medium grit,) 2. 1-2 drops of water to wet 1/2 of the pumice, leaving half of the pumice still dry. 3. a liberal squirt of HF acid (the same used for etching our all-ceramic porcelain crowns) to wet the remaining pumice. The consistency should be paste-like and almost dry. When I tried it more wet, it did not work as well. Apply the paste to the areas of interest. Then, using a prophy cup, polish the area. Then, apply MI Paste Plus^. Repeat the process a total of 2-3 times per treatment. Each time – polish with the slurry, then, apply MI Paste Plus. [^See Notes to Dentist below]
This treatment can be used to get rid of bracket scars and other stains on roots. I even applied this treatment to eliminate discoloration on the roots of teeth with #veneers and recession with exposed and discolored roots. I will put up pictures of this case another day. [#See Note to Dentist Below]
%Note to patients: It is realistic that root remineralization may take multiple visits to get complete stain removal. The before and after shown here is what we were able to achieve in 1 sitting. The veneer case I will put up later is what we achieved in 2 visits. I expect for more significant cases of demineralization you could expect that it might require up to 5 visits to a more complete removal of the staining and demineralization.
#Note to Dentists: HF acid will etch the edge of the porcelain at the root x porcelain junction. The only reason we employed this technique was to help the patient extend the life of their veneers a little longer. We will still likely plan to replace them in the future, but, for now it buys her time and helps her love her smile and build her confidence. Also, a tiny bit of etching Vs. cutting them off and redoing them is no loss to the patient as she was completely prepared that she might not see any meaningful improvement because she was prepared to replace them.
^Notes to Dentists: ^1. It MUST be lab pumice, because you need it to be dry to take on the HF acid. You will not get the same result from using the prepackaged toothpaste pumice from your hygiene department. 2. I like MI Paste Plus, it works well on my patients. If you want to use MI Paste, with no Plus, that’s fine too. Either one is fine.
This service is available for any patients who have: bracket scars, stained roots, and may have tried other teeth whitening options that failed to deliver.
If you want to set up an appointment, call us at 512-947-0596
Sincerely,
J. Russell McFarlane