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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2017  |  Volume : 35  |  Issue : 4  |  Page : 384-387
 

Microabrasion-remineralization (MAb-Re): An innovative approach for dental fluorosis


Department of Paedodontics and Preventive Dentistry, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat, India

Date of Web Publication15-Sep-2017

Correspondence Address:
Anshula Neeraj Deshpande
Department of Paedodontics and Preventive Dentistry, K M Shah Dental College and Hospital, Sumandeep Vidyapeeth, Vadodara, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPPD.JISPPD_216_16

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   Abstract 


Enamel microabrasion is a noninvasive method that removes intrinsic and superficial defects from teeth aimed to improve dental esthetic with minimal loss of dental tissue. This case presentation describes the attempt for teeth color correction utilizing that conservative technique in a young girl whose maxillary anterior teeth presented an opaque white/brown stain. Along with microabrasion, an innovative approach of application of casein phosphopeptide-amorphous calcium phosphate crème on the tooth, and remineralization was carried out thereby reducing postoperative sensitivity of the treated tooth. Based on the results of this case report, it can be concluded that this technique is efficient and can be considered a minimally invasive procedure.


Keywords: Anterior teeth, brown stains, casein phosphopeptide-amorphous calcium phosphate, microabrasion, young permanent teeth


How to cite this article:
Deshpande AN, Joshi NH, Pradhan NR, Raol RY. Microabrasion-remineralization (MAb-Re): An innovative approach for dental fluorosis. J Indian Soc Pedod Prev Dent 2017;35:384-7

How to cite this URL:
Deshpande AN, Joshi NH, Pradhan NR, Raol RY. Microabrasion-remineralization (MAb-Re): An innovative approach for dental fluorosis. J Indian Soc Pedod Prev Dent [serial online] 2017 [cited 2019 Oct 18];35:384-7. Available from: http://www.jisppd.com/text.asp?2017/35/4/384/214919





   Introduction Top


Esthetic dentistry is an emerging branch and posing a challenge for pediatric dentist to cater the needs of young patients. There is an increased reporting of discolored teeth in child population.[1] These young attractive smiles are getting affected due to discolorations or stains. These discolorations are often seen as an isolated or generalized condition which needs to be dealt with, based on the extent of lesion.

The present time of improved materials and newer techniques has opened up the options for dealing with such unesthetic conditions. Utilizing minimal invasive technique, the strengthening of the enamel structure can also be achieved.[2]

The role of fluoride has been well documented for both of its benefits and detrimental effects on the dentition since long.[3] The detrimental effect caused by fluoride on teeth is usually in form of dental fluorosis which is commonly seen as discoloration of teeth. Enamel discoloration in maxillary anterior teeth often raises the esthetic concerns in patients. Conservative nonrestorative methods such as casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) have been mentioned in the literature in treating such discolorations and hypomineralized enamel structure.[4],[5],[6]

Microabrasion involves mild acid etching in combination with rotary application of an abrasive medium which was first described by Dr. Walter Kane (Colorado Springs, 1916). In this method, the teeth were treated with hydrochloric acid under the alcohol flame which gave favorable outcome to treat enamel fluorosis.[7],[8] Although the technique is old, it was never accepted by the clinicians for the reason of damaging or destroying the enamel by such invasive way of using strong acid (HCl) and alcohol flame.[9],[10] The new modified microabrasion method was introduced by Mc Closkey in 1984 where acid was combined with pumice, hence avoiding the flame. This technique was named as microabrasion by Croll in 1986.[11]

The concept behind this less invasive method is based on the stains being present due to the affected outer layers of enamel. These layers if removed or treated can result in a more smooth and glassy enamel surface which is caries resistant than the original enamel.

The recently available remineralizing agent CPP-ACP stabilizes high concentration of calcium and phosphate ions that bind themselves to the available plaque and pellicle.[3] Under the acid challenge, the reservoir thus created maintains a supersaturated mineral environment, thereby reducing demineralization and enhances remineralization of enamel.[12] CPP-ACP supplementation has proved to have beneficial effects by remineralizing the enamel affected by molar incisor hypoplasia, resulting in an esthetic improvement too. This technique requires longtime treatment that could last months or years, requiring patient's cooperation.[11] Based on this property, CPP-ACP with acid etching (37% phosphoric acid) and fluoridated prophylaxis paste was combined in a sequential manner in the present case report.[13]


   Case Report Top


A 12-year-old female patient reported to the department of pedodontics and preventive dentistry with noticeable brown-yellow stains on her teeth which resulted in unaesthetic appearance [Figure 1]. She was hesitant in talking or smiling due to the presence of brown-yellow stains on her teeth. The parents were emotionally upset and wanted a definitive long-term treatment for their child. Considering the age of the child, opting for veneers or laminates would have resulted in the removal of tooth structure. Hence, the noninvasive procedure resulting in better structural stability was planned and proposed to the parents.
Figure 1: Preoperative image

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The diagnosis of moderate fluorosis was made for the patient as per Dean's fluorosis index.[10] The treatment plan suggested to the parents was well accepted, and the sequence of the treatment with the required number of visits was informed in advance to the parents.

The initial preparation of the teeth was carried out with the pumice slurry and rubber cup with a slow-speed handpiece. In the second step, acid etching of the stained enamel surface was carried out for 30 s followed by rubbing with a hybrid bristled cup for another 30 s. The third step involved prophylaxis with fluoridated prophylactic paste followed by rinsing and drying [Figure 2]. The last step was the application of CPP-ACP crème (GC tooth mousse) treated tooth surface, which was left there for 4 min [Figure 3]. Same steps were carried out for all the incisors. Home application of GC tooth mousse thrice daily for 2 weeks was advised to the patient. Same procedure (as mentioned earlier) was performed after every 2 weeks for consecutive five sittings. In each follow-up, the patients feedback for any postoperative sensitivity was taken. The patient and her parents were happy and did not have any complaints/complications during the treatment [Figure 4], after 10 weeks of treatment].
Figure 2: Mid-treatment image

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Figure 3: Application of GC tooth mousse

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Figure 4: End of treatment procedure

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   Discussion Top


There are different forms of enamel defects seen in the young population, namely, enamel fluorosis, molar incisor hypomineralization, etc., which pose a great challenge to the clinicians.[14]

In the present case, it was a moderate type of fluorosis which was confirmed by the child coming from a fluoride-rich area. The teeth gave yellow-brown stains which gave a very unpleasant appearance in an esthetic zone. The present technique of enamel microabrasion along with using CPP-ACP crème is a promising method to repair the intrinsic enamel stains and correcting the irregularities without removing or sacrificing sound tooth structure. The use of CPP-ACP crème guarantees more long-term results and improved the crystalline structure of enamel.[12] As it is very difficult to determine the real depth of intrinsic brown stains, the number of applications of this technique may vary from patient to patient. The most possible complication which can be countered in the microabrasion method is sensitivity due to acid etching which was also taken care by the use of CPP-ACP crème giving a more stable oral environment and patient compliance.[15] Thus, microabrasion-remineralization (MAb-Re) method can be a very promising way of dealing with such stains, irregularities, developmental defects, and postorthodontic treatment lesions.

The present “MAb-Re” technique gave excellent results in few sittings which even increased the confidence and boosted the psychological will of the child for social acceptance. The parents too, with every visit, became more confident and followed every advice and the follow-up visit regularly without fail.


   Conclusion Top


The literature demonstrates that mostly enamel hypoplasia or similar conditions of enamel defects usually appear in mild-to-moderate forms. The treatment of such teeth in esthetic zone can be achieved by “MAb-Re” method in a very effective manner. The present method provides a more conservative and long-lasting futuristic approach for dealing such enamel defects.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Sheoran N, Garg S, Damle SG, Dhindsa A, Opal S, Gupta S, et al. Esthetic management of developmental enamel opacities in young permanent maxillary incisors with two microabrasion techniques – A split mouth study. J Esthet Restor Dent 2014;26:345-52.  Back to cited text no. 1
    
2.
Sundfeld RH, Rahal V, Croll TP, De Aalexandre RS, Briso AL. Enamel microabrasion followed by dental bleaching for patients after orthodontic treatment – Case reports. J Esthet Restor Dent 2007;19:71-7.  Back to cited text no. 2
    
3.
Bailey RW, Christen AG. Effects of a bleaching technic on the labial enamel of human teeth stained with endemic dental fluorosis. J Dent Res 1970;49:168-70.  Back to cited text no. 3
    
4.
Croll TP, Cavanaugh RR. Enamel color modification by controlled hydrochloric acid-pumice abrasion. I. Technique and examples. Quintessence Int 1986;17:81-7.  Back to cited text no. 4
    
5.
Sundfeld RH, Croll TP, Briso AL, de Alexandre RS, Sundfeld Neto D. Considerations about enamel microabrasion after 18 years. Am J Dent 2007;20:67-72.  Back to cited text no. 5
    
6.
McKay FS, Black GV. An investigation of mottled teeth: An endemic developmental imperfection of the enamel of the teeth, heretofore unknown in the literature of dentistry. Dent Cosm 1916;58:477-84.  Back to cited text no. 6
    
7.
Lynch CD, McConnell RJ. The use of microabrasion to remove discolored enamel: A clinical report. J Prosthet Dent 2003;90:417-9.  Back to cited text no. 7
    
8.
Croll TP. A case of enamel color modification: 60-year results. Quintessence Int 1987;18:493-5.  Back to cited text no. 8
    
9.
Balan B, Uthaiah CM, Narayanan S, and Monnappa PM. Microabrasion: An Effective Method for Improvement of Esthetics in Dentistry. Case Reports in Dentistry 2013. p4. Article ID 951589.  Back to cited text no. 9
    
10.
McCloskey RJ. A technique for removal of fluorosis stains. J Am Dent Assoc 1984;109:63-4.  Back to cited text no. 10
    
11.
Croll TP. Enamel microabrasion: The technique. Quintessence Int 1989;20:395-400.  Back to cited text no. 11
    
12.
de Vasconcelos AA, Cunha AG, Borges BC, Vitoriano Jde O, Alves-Júnior C, Machado CT, et al. Enamel properties after tooth bleaching with hydrogen/carbamide peroxides in association with a CPP-ACP paste. Acta Odontol Scand 2012;70:337-43.  Back to cited text no. 12
    
13.
Baroni C, Marchionni S. MIH supplementation strategies: Prospective clinical and laboratory trial. J Dent Res 2011;90:371-6.  Back to cited text no. 13
    
14.
Dalzell DP, Howes RI, Hubler PM. Microabrasion: Effect of time, number of applications, and pressure on enamel loss. Pediatr Dent 1995;17:207-11.  Back to cited text no. 14
    
15.
Pourghadiri M, Longhurst P, Watson TF. A new technique for the controlled removal of mottled enamel: Measurement of enamel loss. Br Dent J 1998;184:239-41.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
   Introduction
   Case Report
   Discussion
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    References
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