International Dentistry - Vol. 12, No. 2 - 10

CLINICAL

A minimally invasive approach to brown
and white lesion removal
Luke Hutchings1

Luke Hutchings presents his winning tooth whitening case from the Aesthetic Dentistry
Awards 2016.
The patient presented at the practice, unhappy that her teeth didn't match as they
were all different colours - she had obvious white and brown marks, which she disliked.
She had seen two previous dentists for an opinion, so attended my surgery to discuss
veneers, as she felt this was the only option for cosmetic improvement.

Clinical presentation
The patient presented with a moderately restored dentition; she had no carious teeth
and no periodontal concerns. Radiographic examination showed endodontic treatment
evident in the UL3; this was well condensed and of good length and no apical pathology
was noted.
Aesthetic evaluation showed mild anterior segment crowding and an acceptable smile
line, with a reasonable midline and good incisor display. There were uneven gingival
levels, especially associated with the UL3, which exhibited recession. A black triangle
was present between UR1 and UL1, and UL3 and UL1 were both darker - UL3 as it
was non-vital; UL1 proved to be vital on testing with an electric pulp test. Finally, mild
fluorosis was evident with white patches UR1/UL1, and a brown spot, likely post-eruptive
from extrinsic staining UL1 (Watts and Addy, 2001).

Treatment discussion
The patient's complaint was about the colour of her teeth, so I discussed the option of
trying to improve this in a minimally invasive way through the means of tooth whitening.
Discussion followed that if she still wasn't happy with the improvement after whitening
then we could consider a number of different options to remove the white or brown
lesions if they were still present: micro/macro abrasion, resin infiltration (Icon, DMG),
composite bonding or veneers. The patient felt happy to proceed with the whitening
using a progressive smile design methodology.

1

Dr Luke Hutchings BDS
Private Practice, Alresford and
Twyford Dental Care, UK

Figure 1: Pre-treatment anterior smile view.

10 INTERNATIONAL DENTISTRY - AUSTRALASIAN EDITION VOL. 12, NO. 2

Figure 2: Pre-treatment close-up anterior view.



Table of Contents for the Digital Edition of International Dentistry - Vol. 12, No. 2

Contents
International Dentistry - Vol. 12, No. 2 - Cover1
International Dentistry - Vol. 12, No. 2 - Cover2
International Dentistry - Vol. 12, No. 2 - Contents
International Dentistry - Vol. 12, No. 2 - 2
International Dentistry - Vol. 12, No. 2 - 3
International Dentistry - Vol. 12, No. 2 - 4
International Dentistry - Vol. 12, No. 2 - 5
International Dentistry - Vol. 12, No. 2 - 6
International Dentistry - Vol. 12, No. 2 - 7
International Dentistry - Vol. 12, No. 2 - 8
International Dentistry - Vol. 12, No. 2 - 9
International Dentistry - Vol. 12, No. 2 - 10
International Dentistry - Vol. 12, No. 2 - 11
International Dentistry - Vol. 12, No. 2 - 12
International Dentistry - Vol. 12, No. 2 - 13
International Dentistry - Vol. 12, No. 2 - 14
International Dentistry - Vol. 12, No. 2 - 15
International Dentistry - Vol. 12, No. 2 - 16
International Dentistry - Vol. 12, No. 2 - 17
International Dentistry - Vol. 12, No. 2 - 18
International Dentistry - Vol. 12, No. 2 - 19
International Dentistry - Vol. 12, No. 2 - 20
International Dentistry - Vol. 12, No. 2 - 21
International Dentistry - Vol. 12, No. 2 - 22
International Dentistry - Vol. 12, No. 2 - 23
International Dentistry - Vol. 12, No. 2 - 24
International Dentistry - Vol. 12, No. 2 - 25
International Dentistry - Vol. 12, No. 2 - 26
International Dentistry - Vol. 12, No. 2 - 27
International Dentistry - Vol. 12, No. 2 - 28
International Dentistry - Vol. 12, No. 2 - 29
International Dentistry - Vol. 12, No. 2 - 30
International Dentistry - Vol. 12, No. 2 - 31
International Dentistry - Vol. 12, No. 2 - 32
International Dentistry - Vol. 12, No. 2 - 33
International Dentistry - Vol. 12, No. 2 - 34
International Dentistry - Vol. 12, No. 2 - 35
International Dentistry - Vol. 12, No. 2 - 36
International Dentistry - Vol. 12, No. 2 - 37
International Dentistry - Vol. 12, No. 2 - 38
International Dentistry - Vol. 12, No. 2 - 39
International Dentistry - Vol. 12, No. 2 - 40
International Dentistry - Vol. 12, No. 2 - 41
International Dentistry - Vol. 12, No. 2 - 42
International Dentistry - Vol. 12, No. 2 - 43
International Dentistry - Vol. 12, No. 2 - 44
International Dentistry - Vol. 12, No. 2 - 45
International Dentistry - Vol. 12, No. 2 - 46
International Dentistry - Vol. 12, No. 2 - 47
International Dentistry - Vol. 12, No. 2 - 48
International Dentistry - Vol. 12, No. 2 - 49
International Dentistry - Vol. 12, No. 2 - 50
International Dentistry - Vol. 12, No. 2 - 51
International Dentistry - Vol. 12, No. 2 - 52
International Dentistry - Vol. 12, No. 2 - 53
International Dentistry - Vol. 12, No. 2 - 54
International Dentistry - Vol. 12, No. 2 - 55
International Dentistry - Vol. 12, No. 2 - 56
International Dentistry - Vol. 12, No. 2 - 57
International Dentistry - Vol. 12, No. 2 - 58
International Dentistry - Vol. 12, No. 2 - 59
International Dentistry - Vol. 12, No. 2 - 60
International Dentistry - Vol. 12, No. 2 - 61
International Dentistry - Vol. 12, No. 2 - 62
International Dentistry - Vol. 12, No. 2 - 63
International Dentistry - Vol. 12, No. 2 - 64
International Dentistry - Vol. 12, No. 2 - Cover3
International Dentistry - Vol. 12, No. 2 - Cover4
https://www.nxtbook.com/nxtbooks/henryscheinhalas/dentalsolutions_201903
https://www.nxtbook.com/nxtbooks/henryscheinhalas/dentalsolutions_201902
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_surgicalsolutions_201902
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20181112
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20180910
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20180708
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201806
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201805
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20180304
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20180102
https://www.nxtbook.com/nxtbooks/henryscheinhalas/shopnow_20171112
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20171112
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_surgicalsolutions_20171012
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201710
https://www.nxtbook.com/nxtbooks/henryscheinhalas/shopnow_201710
https://www.nxtbook.com/nxtbooks/henryscheinhalas/cpd_3ed_2017
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201709
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20170708
https://www.nxtbook.com/nxtbooks/henryscheinhalas/shopnow_20170708
https://www.nxtbook.com/nxtbooks/henryscheinhalas/internationaldentistry_vol12no2
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201705
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_surgicalsolutions_20170305
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20170304
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20170102
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201610
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201609
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201607
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201606
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_201605
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20160304
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20160102
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20151112
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20150910
https://www.nxtbook.com/nxtbooks/henryscheinhalas/relyonus_20150708
https://www.nxtbook.com/nxtbooks/henryscheinhalas/ed_201506
https://www.nxtbook.com/nxtbooks/henryscheinhalas/ed_201505
https://www.nxtbook.com/nxtbooks/henryscheinhalas/catalogue_20150304
https://www.nxtbook.com/nxtbooks/henryscheinglobal/ed_20150304
https://www.nxtbookmedia.com