Treatment of enamel defects with a combined use of casein derivatives and carbamide peroxide

Introduction. Enamel defects on anterior teeth produce a significant aesthetic problem for patients. Enamel defects in form of white stains are frequently detected on incisors. Casein derivate, as Casein Phosphopeptide-Amorphoum Calcium Phosphate (CPP-ACP)* has been recently proposed to remineralize these enamel lesions. The use of carbamide peroxide is not recommended, because the whitening agent produces a visual increment of the defects. The aim of the present study is to suggest a new bleaching procedure for teeth presenting enamel defects. Materials and Methods. Two adult patients presenting enamel defects were enrolled: one with Molar Incisors Hypomineralization ant the other with Amelogenesis Imperfecta. Pictures were taken before the beginning of the treatment, and every dental visit, monthly performed. Alginate impressions were taken to realize customs trays. The patients were instructed to use two hours/day the trays with CPP-ACP inside for two months, in order to remineralize the enamel defects. After this period, a combined use of CPP-ACP and carbamide peroxide** was applied. The patients used for two day/week the bleaching agent and, in the remaining five days, the remineralizing agent, repeating this protocol for two months. Results. A visible reduction of the enamel defects was noted in one patient after the use of CPP-ACP for the first two months; no changes were noted in the second patient. At the end of the treatment, an almost complete reduction of the defects was noted. Discussion. The combined use of CPP-ACP and carbamide peroxide has shown to be effective in bleaching teeth with enamel defects, minimizing the risk of a visual increment of the defect