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Enamel Microabrasion in Pediatric Dentistry: Case Report

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DOI: 10.5585/conssaude.v8i1.1497

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Enamel Microabrasion in Pediatric

Dentistry: Case Report
Adriana Yuri Tashima1; Janaina Merli Aldrigui2; Sandra Kalil Bussadori3; Marcia Turolla Wanderley4
1
Postgraduated in Orthodontics and Pediatric Dentistry, Faculdade de Odontologia – USP.
2
Student of Postgraduation of Orthodontics and Pediatric Dentistry, Faculdade de Odontologia – USP.
3
PhD of the Rehabilitation Sciences Postgraduation Program – Uninove.
4
PhD of the Discipline of Pediatric Dentistry of Department of Orthodontics and Pediatric Dentistry, Faculdade de Odontologia – USP.

Postal address
Marcia Turolla Wanderley
Av. Professor Lineu Prestes, 2227, Cidade Universitária
05508-900 São Paulo – SP [Brasil]
[email protected]

Editorial
Artigos
para os autores
Instruções

Abstract
Enamel microabrasion technique is a conservative method that improves the appe-
arance of the tooth by restoring bright and superficial smoothness, without causing
significant structural loss. It is a safe method that may be used even in the treat-
ment of young children. This paper describes the microabrasion technique using
Opalustre® (Ultradent Products, Inc) applied over incipient carious lesions which
were remineralized but pigmented, aesthetically compromising deciduous teeth.
Key words: Deciduous tooth; Enamel microabrasion; Pediatric dentistry.

ConScientiae Saúde, 2009;8(1):133-137. 133

 Enamel Microabrasion in Pediatric Dentistry: Case Report

Introduction nal destruction of the upper deciduous incisors,

occlusal cavities on the molars, inactive white
The first report about hydrochloric acid spot lesions with brown stains added to superfi-
application used to improve the aesthetics of cial cavities on the buccal and proximal surfaces
teeth with fluorosis was done by Dr. Kane1, in of the deciduous canines and molars.
1916. Since the results obtained were favorable, The first step of the treatment involved the
researches were developed in order to verify removal of the infected areas and the modifica-
the effectiveness of the microabrasion tech- tion of dietary and oral hygiene habits. After
nique using different concentrations of hydro- accomplishing this first step, the microabra-
chloric acid (6.6% to 18%) and phosphoric acid sion technique using Opalustre ® (Ultradent
(30% to 40%) in association with abrasives. The Products, Inc) was chosen to aesthetically im-
objective of these researches was to obtain a prove the teeth that presented pigmentation.
long-lasting result that was safe, even for de- This material contains hydrochloric acid at 6.6%
ciduous teeth1-9. and silicon carbide microparticles, it is purple
Literature shows that this technique and it comes in syringes.
should be considered as the first treatment op- The sequence of the enamel microabrasion
tion when trying to improve the aesthetics of technique with Opalustre ® (Ultradent Products,
teeth that present intrinsic stains (fluorosis) or Inc) used in this clinical case was: topical anes-
extrinsic superficial enamel stains. The clinical thesia; infiltrative anesthesia; isolation by rub-
result obtained is directly related to the depth ber dam of the upper left quadrant (primary
of the stains/defects and, thus, the differential canine and first and second molars) (Figure 1);
diagnosis of such alterations is essential 2, 8, 10-12. dental prophylaxis; application of 1 mm of the
Microabrasion is effective, safe and may product (Figure 2); abrasion using a rubber cup
be used in order to improve the aesthetics of in slow speed and under slight compression
children and adolescents, as long as the patient during 10 seconds (Figure 3); abundant rinsing
is cooperative. This technique causes reduced after each application, followed by visual ob-
wear of tooth surface and minimum discomfort servation of the removal of the spots and of the
to the patient1-3, 7-8, 10, 13-14. smoothness of the wet surface. After 4 applica-
The purpose of this paper is to illustrate tion of Opalustre ®, done in a single session, it is
the microabrasion technique using Opalustre ® possible to visualize the removal of stains and
(Ultradent Products, Inc) applied over inactive the aesthetic improvement on the wet surface,
white spot lesions which had been pigmented
and were present on deciduous teeth.

Case Report
A five-year-old male patient sought treat-
ment at the Specialization in Pediatric Dentistry
clinic of the São Paulo State Dentists’ Syndicate.
No relevant systemic alteration was observed
Figure 1: Initial clinical aspect of the upper
during anamnesis, except for the use of a medi-
left quadrant after isolation by rubber
cation containing ferrous sulfate. The mother dam. Notice the presence of inactive white
signed an informed consent, allowing the treat- spots that were remineralized and present
ment of her child. During clinical examination, different degrees of brown pigmentation
it was noted that the child presented great coro- added to small cavities

134 ConScientiae Saúde, 2009;8(1):133-137.

 Tashima AY et al.

Figure 2: Application of 1mm of the Figure 5: Application of neutral topical

Opalustre® (Ultradent Products, Inc) paste fluoride gel at 2% during 1 minute
over the stains on the affected teeth in the
vestibular face

Editorial
Figure 6: Aspect at the one-month
maintenance appointment: observe that the
Figure 3: Mechanical removal of stains using

Artigos
characteristics obtained were maintained
a rubber cup at slow speed during 10 seconds
absence of pain or sensitivity on teeth that had
been treated with microabrasion.

Discussion

para os autores
The aesthetic treatment has not exclusive-

Instruções
ly concerned adults. Children and their parents
are becoming more and more appreciative of a
beautiful smile during childhood, seeking and
demanding resolutions to aesthetic problems.
Figure 4: Polishing of the teeth using felt According to Welbury and Shaw (1990)15, aesthet-
discs and paste at slow speed
ic problems may psychologically affect patients,
without need for aesthetic reconstruction. After especially teenagers, and may interfere in their
polishing the region with felt discs and paste social life.
at slow speed (Figure 4), a neutral fluoride gel Literature shows that enamel microabrasion
at 2% was applied during 1 minute (Figure 5). should be the first option of treatment because
Removal of the stains required 4 applications, it is a procedure that is less invasive and more
done in a single session, and a vitreous aspect conservative. It only requires a small amount of
of the surface was observed, with immediate structure removal, it doesn’t cause post-operative
aesthetic improvement. At the maintenance ap- pain or sensitivity, and, in the majority of cases,
pointment, after 1 month (Figure 6), it was ob- it can be done in a single session causing mini-
served that the shiny aspect and the surface mum discomfort to the patient1,7,10,16-18. Other ad-
smoothness were maintained and that there was vantages of this technique include: immediate,

ConScientiae Saúde, 2009;8(1):133-137. 135

 Enamel Microabrasion in Pediatric Dentistry: Case Report

permanent and lasting results due to the fact that inactive carious lesions because the technique
microabrasion involves the removal of the stain only causes a small amount of structure re-
instead of just covering up the stain or altering moval and it also forms a regular surface, thus
the enamel2,4,6,10-12,19; shorter time required for the decreasing the need for conventional restor-
procedure which is easy to execute2,6; elimination ative treatments 6,11,12,18. Because of the presence
of the need for dental cavity preparation or re- of superficial cavities on the buccal surfaces of
storative materials6,11-12,18; it does not cause injuries the deciduous canines and molars was chosen
either to the pulp or to the periodontal tissue2, 10. a more abrasive technique. Paic et al (2008)20
The association of an acid and an abrasive shows that Opalustre ® caused the highest tooth
agent may be used in the treatment of teenagers9, substance loss compared with other products,
11-12
and children who are at least 2 years old7,13 and Zuanon et al (2008)21 shows that mechanical
as long as protective measures are taken to keep technique (rubber cup attached to a low-speed
save the eyes and the soft tissue. Such measures handpiece) removed more enamel than manual
must be followed even when using a less concen- microabrasion using a plastic spatula. The com-
trated acid2,4,12. Therefore, rubber dam isolation bination of Opalustre ® and mechanical tech-
is mandatory during the procedure for not only nique resulted in a surface without roughness
does it protect soft tissues but it is also comfort- and discarded the need for restoration with
able, it stops material debris from falling into composite resin even in surfaces that presented
the mouth, it reduces contact with saliva, and it small cavities.
is a helpful tool for the behavior management of
young patients7.
In the clinical case reported, 4 applications Conclusion
of Opalustre ®, done in one session, were neces-
sary in order to remove the brown pigmentation The microabrasion technique using
found on the inactive carious lesions of primary Opalustre® (Ultradent Products, Inc) was effec-
maxillary teeth. After using the microabrasion tive in the removal of inactive carious white spot
technique, the coloration was improved and lesions that had been pigmented after remineral-
a shiny surface was obtained because, during ization and to produce a regular surface even in
the procedure, the demineralized layer is al- surfaces that presented small cavities.
most completely removed by the method18. Mild This technique presents a favorable and
surface abrasion of enamel demineralizes with lasting aesthetic result, without causing signifi-
simultaneous acid erosion leads to the forma-
cant enamel structural loss and without need for
tion of a compacted mineralized tissue within
cavity preparations. Microabrasion may be done
the organic areas, replacing the outer layer of
in a single session and it is safe to use even in
prism-rich enamel with a densely compacted
young children.
prism-free region. When light is reflected off
In order to obtain a favorable and lasting
this surface and refracted through it, it does so
aesthetic result, it is important to make an ade-
in a different manner than it would on an un-
quate diagnosis of the alterations found and the
treated surface, and these optical properties of
patient must be included in a preventive program
the newly micro-abraded surface camouflage
to reduce caries risk and activity.
the remaining subsurface stains 5,8. This vitreous
characteristic was observed in the clinical case
presented and is known as the “abrosion effect”5
or “enamel glaze”9.
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para os autores
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Instruções
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