| Abstract|| |
The enamel hypoplasia, the demineralization, and the dental fluorosis are the result of general or local lesions at the dental enamel, which causes esthetic damage, since they are in disharmony within the natural aspect of the teeth. The search for a perfect esthetic has become one of the main goals of the patient and the dental surgeon as well. Microabrasion is an efficient method for intrinsic and superficial spots removal from the enamel, restoring the esthetics with minimal tissue waste. This study presents a clinical case in which the patient who presented enamel hypoplasia heredity type (imperfect amelogenesis) distinguished by brownish spots, mainly in the upper medial incisor teeth, underwent the micro abrasion technique.
Keywords: Enamel hypoplasia, esthetics, micro abrasion
|How to cite this article:|
HANNA LO, GOMES DE ARAUJO RJ, GOMES LO, AZEVEDO AA, NOGUEIRA AJ. Microabrasion of the enamel to soften the hypoplasia. Ann Trop Med Public Health 2009;2:53-6
|How to cite this URL:|
HANNA LO, GOMES DE ARAUJO RJ, GOMES LO, AZEVEDO AA, NOGUEIRA AJ. Microabrasion of the enamel to soften the hypoplasia. Ann Trop Med Public Health [serial online] 2009 [cited 2018 Aug 15];2:53-6. Available from: http://www.atmph.org/text.asp?2009/2/2/53/64270
| Introduction|| |
The dental enamel is the hardest substance in the body; it is only found at the dental crown which overlays and protects the dentine from external exposure. The enamel is 96% organic material, and the remaining 4% are a compound of organic matrix and water. 
Although it has highly mineralized characteristics, the dental enamel, suffers from genetic disorders which affect the structure. Many development disturbances, oral structure, and dental growth have been identified and may be displayed as abnormalities of the shape, number, eruption, and shedding or of the structure.
The enamel hypoplasia is the insufficient incomplete formation of the organic matrix of the teeth enamel, resulting in the lesion of the ameloblasts, which are the enamel former cells responsible for several functions during different stages of teeth formation.  It can be heredity type or caused by environmental factors. In the first instance, the injury appears at the two human dentitions, usually affecting the enamel itself. The second instance occurs in one of the two dentitions and most of the time affects only one tooth, reaching either the enamel or the dentine.  The imperfect amelogenesis is related to a group of hereditary disease of the teeth formation with similar manifestation in both dentitions.  The hypoplasic imperfect amelogenesis is defined by thin enamel, but properly mineralized. The spots and injuries on the enamel can happen due to many other factors, for instance flourosis, pigmentation by medication, or other agents, and demineralization by dental decay (SHAFER et al. 1987 apud RIBAS) 
In attempt to recovering esthetics, some procedures are suggested to remove those alterations. To eliminate generalized spots such as color modification by tetracycline or local causes in both vital and non-vital teeth, the dental whitening technique, either unitary or multiple, has been suggested. , Nonetheless, tiny spots on the enamel surface disregarding its etiology can be taken off most of the times, with local action of acid materials and/or abrasives. To incipient lesions of dental decay, the enamel remineralization technique associated with substances like calcium and fluorite can also be used. Although the remineralization recovers the enamel structure, authors report that the color hardly becomes genuine; therefore, the esthetics reconstruction is achieved, which is the goal of the treatment.  All the techniques, either dental whitening (associated to acid substances), microabrasion, or remineralization, are extremely conservative and in accordance with current dentistry expectations. The microabrasion with pumice stones and acid is one of the assessment used to correct enamel injuries and improve the patient's esthetic.
The goal of this work was to report a patient case who presented enamel hypoplasia, compromising the esthetics, as well as the recovering through the microabrasion technique.
| Case Report|| |
The patient M.V.S, male, 10 years-old, came to the Pediatric Dentistry Clinic at Universidade Federal do Pará, with dental decay in the molar region, early loss of some dental elements, and complaints concerning his two frontal teeth, which were getting yellowish, as reported. [Figure 1] At the clinical examination, it was observed that the patient presented enamel hypoplasia associated with white spots in the upper medial incisor teeth, and also extrinsic brownish spots with no cavities. The child had caries with cavitations at the 55, 16, and 26 teeth.
After being informed about the possible etiology of the white spots with extrinsic pigmentation, his mother was oriented on how to care about her child's teeth enhancing the oral hygiene, because the teeth presented fragile dental enamel.
After elaborating the child treatment scheme, his mother was also informed about it and inquired about the authorization for the procedure, besides signing a term of agreement regarding the images, demanded by Federal University of Pará, to be used in scientific works.
A preventive and therapeutic treatment plan was elaborated, with application of invasive sealant resin at the first permanent molars once they presented a slight hypoplasia and incipient caries at the furrow and fissures. For the tooth 55, a class II light-curing restoration with compound resin, brand "Fill Magic, was elaborated."
For the incisors, it was suggested that enamel microabrasion with pumice stone and phosphoric acid at 37%, since this treatment is more conservative and less aggressive, taking into account the patients' age. The other teeth were not under treatment, since they did not interfere the patients esthetics. In order to make microabrasion technique on the enamel at teeth , at first, the soft tissue was protected with vaseline in order to preserve the patient mucosa against injuries from phosphoric acid. Afterwards, the total isolation of the teeth was performed to prevent the patient from swallowing acid during the microabrasion process. Subsequently, the prophylaxis with pumice stone and water was conducted for vaseline leftovers and bacterial plaques removal. To conduct the technique, a homogeneous mixture was performed with pumicestone and phosphoric acid at 37% application. The application was performed using a rubber bowl and a low rotation micromotor. The technique consists of application with intermittent movements of the rubber bowl with the mixture, 15 times for each tooth, repeating 5 times in each session, and washing for 30 seconds after each period [Figure 2]. At the end of each session, a topical neutral fluorite application was performed for 5 minutes, before removing from total isolation. In the first session, it was observed a significant spot decrease [Figure 3]. After finishing the first session, the patient's mother was informed about a possible dental fragility of the child's teeth; in such case, she was instructed to spread some toothpaste over the uncomfortable teeth and then notify the fact on the following appointment. The child was not supposed to ingest any food-containing pigment such as soft drinks with sweet carbonate, artificial juices, coffee, teas, chocolate, ketchup, and aςaí. One week after the first session, the patient returned to a new clinical examination, and it was observed that some spots still remained, mainly at the teeth 11 and 21. It was decided to carry out the abrasion technique all over again. All operative steps from the first session were done, including the microabrasion technique performance, with profuse washing and neutral gel fluorite application. Similar procedure was accomplished for one more session. At the end of the sessions, it was observed a slight spot improvement, mainly at 11 and 21 teeth [Figure 4].
| Discussion|| |
Nowadays, there are several enamel abnormalities, it is quite important for professionals to know how to recognize and diagnose those anomalies in order to establish a suitable treatment, as well as a satisfactory prognostic. According to Peariasamy,  depending on the type and severity of the enamel defect, there are several options of treatment, from a simple selective polish, whitening techniques, and microabrasion to porcelain crown execution. In this case, the microabrasion was chosen due to patient's age, even though the hypoplasia severity, mainly in the upper medial incisor teeth. Although microabrasion takes the professional into significant results, many problems can be observed with this type of treatment, especially concerning sensibility, due to an excessive enamel waste. According to Mendes, Mondeli; Freitas,  the teeth waste after 5 microabrasion sessions with pumice stone and phosphoric acid at 37% is about 106.9 μm. Another dentifrice formed from pumice stone and hydrochloric acid at 18% can be used in microabrasion. This type of dentifrice, according to Mendes, Mondeli; Freitas  causes a larger dental waste if compared to the technique using phosphoric acid at 37%; however, in the cases of patients with flourosis, the microabrasion with pumice stone and hydrochloric acid at 18% is the best choice, because it leads to a great prognosis. The enamel treatment wounded by fluorosis is performed for esthetics purposes, removing the superficial layer up to normal enamel. The dentistry market offers several materials to perform a microabrasive treatment such as dental enamel acid/abradant product Opalustre (Ultradent Products, Inc.) compounded by low concentration hydrochloric acid (6.6%) associated with microparticles of silicon carbide, which offers, among the advantages, a high safety degree during its application either for the patient or the operator. For the treatment of inactive and stagnant white spots, a microabrasive treatment can performed with pumice stone and watery solution or phosphoric acid gel from inactive caries removal, presented by Kamp in 1989. By this technique, it can be used a wood spreader or rubber bowl in low rotation for the application of the mixture of pumice stone and phosphoric acid.  Although the literature reports on possible injuries at the circumoral and gingival tissues, through the patient's eyes the microabrasion technique was sustained due to patient protection against those injuries from the use of vaseline, complete isolation, and protection glasses. Even though several reports ,,, demonstrate excellent esthetic results, our clinical case obtained more satisfactory results, once the patient presented high-degree roughness spots due to enamel hypoplasia; however, this "roughness esthetics" in our opinion was considered by the patient and his mother being an excellent, because his smile was completely recovered, once lost, due the child embarrassment to show the teeth with spots.
| Conclusion|| |
The results obtained from this clinical case did not convey the patient a perfect esthetics, but softened previous problems, leading to a satisfactory esthetics. Due to the hypoplasia degree of the upper medial and the patient age, the decision for a more conservative treatment was taken.
Through the patient and his mother eyes, the final results were the best ones, since the child could smile again with no embarrassment. As a consequence, it can be observed that, inside a clinic, daily we should take into account not only the best technique but also the context as a whole available in a certain situation, what is possible to be done at a particular time, whereas we are dealing with a human being, who raises expectations and craves something in return.
| References|| |
|1.||Bhascar SN. Histologia e Embriologia Oral de Orban, 8. Ed., Sao Paulo: Artes Medicas. 1978. |
|2.||Pinheiro IVA. Lesoes Brancas no Esmalte Dentario: Como Diferencia-las e Trata-las. Revista Brasileira de Patologia 2003;2:1. |
|3.||Mondelli R F L. et al. Etiologia das alteracoes do esmalte dental. In: Mondelli, Odontologia Estetica: Fundamentos e Aplicacoes Clinicas. Sao Paulo: Santos; 2001. p.13-47. |
|4.||Ribas AO, Czlusniak GD. Anomalias do Esmalte Dental: Etiologia, Diagnostico e Tratamento. Publ. Uepg Ci. Biol. Saude, Ponta Grossa 2004;10:23-36. |
|5.||Paixao RF. Comparacao entre Duas Tecnicas para Remocao de Manchas Provocadas pela Fluorose Dentaria. Dissertacao (Mestrado em Odontopediatria). Universidade Federal de Santa Catarina, Florianopolis. 1991. |
|6.||Naylor AR, Robertson IJ, Edwards CR, Merrick MV, Sellar RJ, O'Shaughnessy D, et al. Cerebral vasospasm following subarachnoid hemorrhage: effect of calcitonin gene-related peptide on middle cerebral artery velocities using transcranial Doppler sonography. Surg Neurol 1991;36:278-80. [PUBMED] |
|7.||Sundfeld RH, et al. Remocao de Manchas no Esmalte Dental. Estudo Clinico e Microscopico. Rev Bras Odontol, Rio de Janeiro 1990;47:29-34. |
|8.||Peariasamy K, Anderson P, Brook AH. A quantitative study of the effect of pumicing and etching on the remineralisation of enamel opacities. Int J Pediatric Dent 2001;11:193-200. |
|9.||Mendes Regina Ferraz, Mondelli Jose, Freitas Cesar Antunes de. Avaliacao da Quantidade de Desgaste do Esmalte Dentario Submetido a Microabrasao 1999;7:35-40. |
|10.||Ramires-Romiro ACD, et al. Soluco Estetica para Dentes Anteriores Acometidos por Ameligenese Imperfeita e seu Aspecto Psicologico. In:. Odontopediatria: resolucoes clinicas. Curitiba: Mayo; 2000. p. 39-46. |
|11.||Peruchi C M S, Barreto Bezerra AC, Azevedo TDPL, Barbosa E. Silva, Uso EO. Microabrasao do Esmalte para Remocao de Manchas Brancas Sugestivas de Fluorose Dentaria: Caso Clinico. Revista Odontologica de Aracatuba 2004;25:72-7. |
|12.||Segura A, Donly KJ, Wefel JS, Drake D. Effect of enamel microabrasion on bacterial colonization. Amer J Dent 1997;10:272-4. |
Rodolfo Jose GOMES DE ARAUJO
TV. Rui Barbosa 1533 / 302 Nazare-Belem-Para- 66035-220
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3], [Figure 4]