|Year : 2013 | Volume
| Issue : 1 | Page : 36-39
Enamel microabrasion associated with dental bleaching to treat sequelae of amelogenesis imperfect
Josué Martos1, Daiani W. W. da Silveira1, Luiz F. M. Silveira1, Oscar L. V. Ramos2
1 Department of Semiology and Clinics, Faculty of Dentistry, University Federal of Pelotas, Pelotas, Brazil
2 Department of Restorative Dentistry, Faculty of Dentistry, University Federal of Pelotas, Pelotas, Brazil
|Date of Web Publication||29-Apr-2013|
Department of Semiology and Clinics, Faculty of Dentistry, Gonçalves Chaves street. 457, Pelotas
Source of Support: None, Conflict of Interest: None
The aim of this paper is to describe the treatment of a patient with amelogenesis imperfect in the maxillary teeth, employing the enamel microabrasion associated with tooth bleaching. It was used a microabrasive agent consisting of 6% hydrochloric acid and silicon carbide (Whiteness RM) and later, a hydrogen peroxide 35% bleaching product with the use of Twist pen system (Mix One Supreme). It can be concluded that, since being taken clinical care and also in diagnosis/planning, the association of microabrasion and bleaching techniques is an excellent option for esthetic and conservative treatment of teeth chromatically altered by enamel defects and its sequels.
Keywords: Amelogenesis imperfect, microabrasion, tooth bleaching, tooth discoloration
|How to cite this article:|
Martos J, da Silveira DW, Silveira LF, Ramos OL. Enamel microabrasion associated with dental bleaching to treat sequelae of amelogenesis imperfect. J Res Dent 2013;1:36-9
|How to cite this URL:|
Martos J, da Silveira DW, Silveira LF, Ramos OL. Enamel microabrasion associated with dental bleaching to treat sequelae of amelogenesis imperfect. J Res Dent [serial online] 2013 [cited 2018 Mar 20];1:36-9. Available from: http://www.jresdent.org/text.asp?2013/1/1/36/111232
| Introduction|| |
Despite the enamel microabrasion and tooth whitening are considered conservative options compared to more radical procedures such as veneers or prosthetic crown, this only have the desired effect if we consider all the causal factors involved, understand them and correct when necessary. ,, The amelogenesis imperfecta is a typical example of intrinsic alteration, affecting the enamel of deciduous and permanent dentition, and being generally accepted as a hereditary defect. In amelogenesis imperfecta caused by hypocalcification, the enamel presents normal thickness, but is soft, the crowns appear a dark opaque white to a dark brown, and usually is rough. 
The enamel microabrasion is a conservative technique that removes only a small layer of enamel surface by the action of abrasive agents, without using rotary instruments, such as diamond or multilaminated burs. ,,, This technique is well suited for the correction of irregularities present on the enamel surface, either by amelogenesis imperfecta, fluorosis, or even after removal of orthodontic brackets. The enamel microabrasion technique associated with carbamide peroxide whitening has also been shown to be an excellent choice for treating stained teeth.  The aim of this paper is to describe a clinical case with amelogenesis imperfecta in the upper anterior teeth treated by enamel microabrasion technique associated with tooth whitening.
| Case Report|| |
A 32-year-old male patient was referred to the dental clinic. The patient reported with concerns regarding esthetic presentation of irregularities and discoloration in the maxillary teeth. Dental history and clinical examination revealed that he had a slight form of amelogenesis imperfecta characterized by enamel hypoplasia. Clinical examination also evidenced an slight enamel defect in the maxillary lateral and central incisors, with rough surfaces and irregular limits that principally involve the middle third of the crown associated with brown and yellow stain of teeth [Figure 1].
The pattern of the enamel irregularities, the stain and a tooth remnant with a large substrate suggested that an association of enamel microabrasion techniques and tooth whitening would be a reliable option for this clinical case. The patient was systemically healthy, presented an overall plaque index and gingival index of below 10%, and the affected area was free from visible plaque.
After careful prophylaxis with oil-free paste (Villevie, Dentalville, Joinville, Brazil) the operative field was isolated (OptiView, KerrHawe, Switzerland) as well as eye protection of the patient. The color was recorded using the Vitapan Classical scale (Vita Zahnfabrik, Bad Sδckingen, Germany), and the shade 2 M was considered as the initial color [Figure 2]. It was mapped the areas with higher stains and irregularities in the enamel with the aid of a graphite tip [Figure 3]. A slight microabrasion, using a microabrasive paste (Whiteness RM, FGM, Joinville, SC, Brazil) [Figure 4] was fricctioned on the enamel with a spatula, on both the irregularities and the limits of the tooth defect for 10 seconds on each tooth. This procedure was repeated five times in each tooth on a single clinical session.
|Figure 4: Application of the microabrasive agent for smoothing out defects|
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After removed the rubber dam, and the teeth still wet it was examined the result obtained [Figure 5]. One week after enamel microabrasion the patient came back for clinical verification of the removal of stains deeper and continuity of bleaching treatment. The regularization of the defects and elimination of the brown discoloration created a good substrate that was favorable for whitening procedures.
Before starting the bleaching procedure the operative field was isolated with a lip retractor (OptiView, KerrHawe, Switzerland) and applied a light cured gingival barrier (Gingi Dam, Villevie, Dentalville, Joinville, Brazil). The bleaching treatment was performed with hydrogen peroxide to 35% with a pen applicator Twist Pen (Mix One Supreme, Villevie, Dentalville, Joinville, Brazil). The application of the bleaching agent in the pen is made by the bristles of the applicator tip to performed when a rotation at the rear of the pen [Figure 6]. Bleaching material was applied by brushing with the pen over the enamel surface of the teeth to be whitened, by following the instructions of the manufacturer and does not require any source of activating light or heat [Figure 7]. Three applications of 15 minutes, totaling 45 minutes from contact of the gel with the enamel, were performed at each clinical session. There were realized two clinical sessions with a week interval between them.
|Figure 6: Details of Twist Pen performing the application of bleaching gel through the bristles of your applicator tip in model|
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|Figure 7: Bleaching treatment with hydrogen peroxide (35%) one-week after enamel microabrsion was completed|
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At the end, with the conclusion of the bleaching procedure, the soft tissues were evaluated and it was verified a favorable change of the chromatic color of teeth, using as parameter the scale Vitapan 3D-Master. The teeth bleached were subjected to a polishing felt and polishing slurry and then an application of desensitizing composed by sodium fluoride and potassium nitrate (Sensis 2% Villevie, Dentalville Joinville, Brazil) on enamel for a period of 10 minutes. The patient presented no sensitivity during and even after the use of stain remover and bleaching product. Following completion of the bleaching protocol, the patient was instructed about their hygiene and also with regard to personal habits that could minimize pigmentation, increasing the longevity of the result of bleaching therapy. Four months after the procedures, a good final aspect was observed [Figure 8].
| Discussion|| |
The demand for aesthetic treatments such as tooth whitening has increased considerably, however, that they be successful in bleaching treatment a correct diagnosis is fundamental as the nature of tooth darkening, as well as the technique to be used. ,,, Microabrasion should be considered a minimally invasive method, since the opacities and surface irregularities of the enamel are removed, with minimum wear of tooth enamel. ,,,
The technique of enamel microabrasion has been suggested as a controlled and non-invasive method that has many advantages over other conventional techniques used to remove stains and surface irregularities from the enamel.  It was observed that the enamel microabrasion is a safe procedure when it is applied following the correct diagnosis and recommended criteria. Besides, the authors found that the amount of enamel removed is not significant when it's compared with the remaining enamel. Thus, microabrasion should be considered as the first treatment choice in patients with enamel coloration defects. 
The microabrasion technique not just removes the enamel surface stained but also contributes to the dental color correction. , The improvement of color occurs due to the creation of a highly mineralized layer, polished, densely compacted becoming an intrinsic part of the external layer of enamel. The surface, which suffered microabrasion, reflects and refracts the light from the tooth surface in a way that the imperfections are camouflaged. 
The performance of the procedure with microabrasive stain remover was suitable. We found that those surfaces associated with the enamel irregular staining have become more regular and smoother, probably due to the microabrasive composition, based on 6% hydrochloric acid and silicon carbide. Nevertheless, the association of this technique in conjunction with supervised home bleaching is presented as an excellent therapeutic option. , The combination of techniques is efficient and can be recommended as a suitable alternative to the conservative treatment of teeth affected by severe staining.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]