Microabrasion in tooth enamel discoloration defects: three
               cases with long-term follow-ups

Superficial irregularities and certain intrinsic stains on the dental enamel surfaces can be resolved by enamel microabrasion, however, treatment for such defects need to be confined to the outermost regions of the enamel surface. Dental bleaching and resin-based composite repair are also often useful for certain situations for tooth color corrections. This article presented and discussed the indications and limitations of enamel microabrasion treatment. Three case reports treated by enamel microabrasion were also presented after 11, 20 and 23 years of follow-ups.

Enamel microabrasion; Dental enamel; Clinical diagnosis; Tooth bleaching

Authorship

Renato Herman SUNDFELD Corresponding address: Renato Herman Sundfeld - Departamento de Odontologia Restauradora, Faculdade de Odontologia de Araçatuba - UNESP - R. José Bonifácio, 1193 - Araçatuba - SP - Brazil - 16015-050 - Phone: 55 18 3636 3346 - Fax: 55 18 36363349 - e-mail: sundfeld@foa.unesp.br

Department of Restorative Dentistry, Araçatuba Dental School, UNESP - Univ. Estadual Paulista, Araçatuba, São Paulo, BrazilUniv. Estadual PaulistaBrazilAraçatuba, São Paulo, BrazilDepartment of Restorative Dentistry, Araçatuba Dental School, UNESP - Univ. Estadual Paulista, Araçatuba, São Paulo, Brazil

Daniel SUNDFELD-NETO

Department of Restorative Dentistry, Piracicaba Dental School, UNICAMP - University of Campinas, Piracicaba, São Paulo, BrazilUniversity of CampinasBrazilPiracicaba, São Paulo, BrazilDepartment of Restorative Dentistry, Piracicaba Dental School, UNICAMP - University of Campinas, Piracicaba, São Paulo, Brazil

Lucas Silveira MACHADO

Laura Molinar FRANCO

Ticiane Cestari FAGUNDES

André Luiz Fraga BRISO

Corresponding address: Renato Herman Sundfeld - Departamento de Odontologia Restauradora, Faculdade de Odontologia de Araçatuba - UNESP - R. José Bonifácio, 1193 - Araçatuba - SP - Brazil - 16015-050 - Phone: 55 18 3636 3346 - Fax: 55 18 36363349 - e-mail: sundfeld@foa.unesp.br

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (9)

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Figure 1
A: A teenage girl had idiopathic white enamel demineralization of her maxillary central incisors; B: After dental prophylaxis with pumice and water, a fine-tapered diamond bur was used with water cooling to remove the superficial layer of the stained enamel; C: Before treatment, the patient received eyeglasses for protection and the teeth were isolated with a rubber dam; D and E: Opalustre microabrasive product was applied and compressed upon the enamel surfaces, using a rubber cup manufactured with enclosed brush bristles specifically developed for this purpose. The microabrasion “slurry” was applied with high torque, but very slow speed, to prevent splattering. The compound was applied three times on each of the three teeth for intervals of 60 seconds. The teeth were rinsed with water/air spray after each application; F: The teeth were then dried with an air syringe and polished with fluoridated prophylaxis paste. A 2% neutral-Ph sodium fluoride gel was applied to the treated enamel surfaces and left in place for 4 minutes; G: The treated incisors are shown immediately after enamel microabrasion

Thumbnail

Figure 2
A: A 12-year-old girl had idiopathic white enamel demineralization of both the maxillary and mandibular teeth; B: The teeth are shown eleven years after the enamel microabrasion. The worn mesial and incisal surfaces of the maxillary central incisors were reconstructed with composite resin, shades A1 and A2

Thumbnail

Figure 3
A: A 9-year-old boy with white enamel demineralization staining of six incisors; B: Twenty years after removal of the white stains on the maxillary central incisors by application of 18% hydrochloric acid and pumice; and after removal of white stains located on the mandibular teeth by application of the PREMA compound. The right mandibular lateral incisor presented a deep white stain; it was restored with resin-based composite

Thumbnail

Figure 4
A: Post-orthodontic white enamel stain of hard texture seen in a young patient; B: 23 years after the removal of stains using 18% hydrochloric acid/pumice and dental bleaching with 15% carbamide peroxide

Thumbnail

Figure 5
A: A teenage boy had deep white enamel stains on the maxillary central incisors; B: Removal of the remainder of the abnormal white enamel with a fine-tapered diamond bur; C: Tooth preparation for composite resin; D: Etching for 30 seconds with 35% phosphoric acid; E: After water rinsing and air drying, a two-step bonding agent was applied. Resin-based composite restoration was performed; F: Complete photo-polymerization was accomplished using a light beam of 1000 mW/cm²; G: Finishing and polishing were completed using high speed diamond burs and low speed points

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Figure 6
A: Patient with white spots; B: A method that can be used to try to see how deep the white spot in the enamel is to apply a LED source on the palatal surface and turn it on

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Figure 7
A: Teenage girl, presented with white enamel stain on the maxillary and mandibular teeth; B: After tooth bleaching with 15% carbamide peroxide Opalescence. In some cases, when white stains are small and not prominent, dental bleaching alone using carbamide peroxide or hydrogen peroxide in custom trays may lighten the underlying dentin and enamel sufficiently to camouflage the stain, with no need for microabrasion

Thumbnail

Figure 8
A: Ground tooth section presenting 25 µm enamel loss after 3 applications, of 15 seconds each, of a mixture of 18% hydrochloric acid and pumice (25X); B: 23 µm after 4 applications, of a mixture of Prema Compound enamel microabrasive; C: 42 µm after 4 applications , of 1 minute each, of a mixture of 37% phosphoric acid and pumice; D: 80 µm after, after 4 applications, of 1 minute each, of Opalustre enamel microabrasive. The depression in the enamel convexity (W) designates where the microabrasion was performed. Analyzed by polarized light microscope; E: enamel; D: dentin; W: wear

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Figure 9
Ground section of an upper incisor tooth - Enamel/dentin interface. A: Incisal third analyzed by polarized light microscope (25X); B. Digital image Nikon D 300 C. Cervical third analyzed by polarized light microscope (25X)

Figure 1 A: A teenage girl had idiopathic white enamel demineralization of her maxillary central incisors; B: After dental prophylaxis with pumice and water, a fine-tapered diamond bur was used with water cooling to remove the superficial layer of the stained enamel; C: Before treatment, the patient received eyeglasses for protection and the teeth were isolated with a rubber dam; D and E: Opalustre microabrasive product was applied and compressed upon the enamel surfaces, using a rubber cup manufactured with enclosed brush bristles specifically developed for this purpose. The microabrasion “slurry” was applied with high torque, but very slow speed, to prevent splattering. The compound was applied three times on each of the three teeth for intervals of 60 seconds. The teeth were rinsed with water/air spray after each application; F: The teeth were then dried with an air syringe and polished with fluoridated prophylaxis paste. A 2% neutral-Ph sodium fluoride gel was applied to the treated enamel surfaces and left in place for 4 minutes; G: The treated incisors are shown immediately after enamel microabrasion

Figure 2 A: A 12-year-old girl had idiopathic white enamel demineralization of both the maxillary and mandibular teeth; B: The teeth are shown eleven years after the enamel microabrasion. The worn mesial and incisal surfaces of the maxillary central incisors were reconstructed with composite resin, shades A1 and A2

Figure 3 A: A 9-year-old boy with white enamel demineralization staining of six incisors; B: Twenty years after removal of the white stains on the maxillary central incisors by application of 18% hydrochloric acid and pumice; and after removal of white stains located on the mandibular teeth by application of the PREMA compound. The right mandibular lateral incisor presented a deep white stain; it was restored with resin-based composite

Figure 4 A: Post-orthodontic white enamel stain of hard texture seen in a young patient; B: 23 years after the removal of stains using 18% hydrochloric acid/pumice and dental bleaching with 15% carbamide peroxide

Figure 5 A: A teenage boy had deep white enamel stains on the maxillary central incisors; B: Removal of the remainder of the abnormal white enamel with a fine-tapered diamond bur; C: Tooth preparation for composite resin; D: Etching for 30 seconds with 35% phosphoric acid; E: After water rinsing and air drying, a two-step bonding agent was applied. Resin-based composite restoration was performed; F: Complete photo-polymerization was accomplished using a light beam of 1000 mW/cm²; G: Finishing and polishing were completed using high speed diamond burs and low speed points

Figure 6 A: Patient with white spots; B: A method that can be used to try to see how deep the white spot in the enamel is to apply a LED source on the palatal surface and turn it on

Figure 7 A: Teenage girl, presented with white enamel stain on the maxillary and mandibular teeth; B: After tooth bleaching with 15% carbamide peroxide Opalescence. In some cases, when white stains are small and not prominent, dental bleaching alone using carbamide peroxide or hydrogen peroxide in custom trays may lighten the underlying dentin and enamel sufficiently to camouflage the stain, with no need for microabrasion

Figure 8 A: Ground tooth section presenting 25 µm enamel loss after 3 applications, of 15 seconds each, of a mixture of 18% hydrochloric acid and pumice (25X); B: 23 µm after 4 applications, of a mixture of Prema Compound enamel microabrasive; C: 42 µm after 4 applications , of 1 minute each, of a mixture of 37% phosphoric acid and pumice; D: 80 µm after, after 4 applications, of 1 minute each, of Opalustre enamel microabrasive. The depression in the enamel convexity (W) designates where the microabrasion was performed. Analyzed by polarized light microscope; E: enamel; D: dentin; W: wear

Figure 9 Ground section of an upper incisor tooth - Enamel/dentin interface. A: Incisal third analyzed by polarized light microscope (25X); B. Digital image Nikon D 300 C. Cervical third analyzed by polarized light microscope (25X)

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Microabrasion in tooth enamel discoloration defects: three cases with long-term follow-ups

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[1] Corresponding address: Renato Herman Sundfeld - Departamento de Odontologia Restauradora, Faculdade de Odontologia de Araçatuba - UNESP - R. José Bonifácio, 1193 - Araçatuba - SP - Brazil - 16015-050 - Phone: 55 18 3636 3346 - Fax: 55 18 36363349 - e-mail: sundfeld@foa.unesp.br