Stains and defects on the tooth enamel may occur due to several factors, such as hypoplasia, fluorosis, pigmentation due to medication, and demineralization caused by caries. When these stains are superficial, microabrasion of the enamel is the treatment of choice.
The microabrasion technique began being used by Chandra and Chawla (1975), who advocated the use of abrasive rubber disks to help with the action of chemical whitening agents. In 1986, Croll and Cavanaugh proposed the removal of stains on the enamel by using a mixture of 18% hydrochloric acid and pumice, which was applied to the affected area with the aid of a wooden spatula. Thus, through the combined chemical action of the acid solution with the abrasive effect of the pumice, the most superficial layer of the enamel could be removed, reestablishing its color. Currently, both phosphoric acid gel with pumice and hydrochloric acid with silicon carbide have been indicated for the microabrasion technique.
The purpose of the microabrasion techniques is the recovery of aesthetics through minimum wear to the surface of the enamel. Despite actually involving wear, Sundfeld et al (1990) affirm that it is minimal when compared to the total thickness of the enamel on the tooth. According to Croll et al (1993), in addition to being polished, the enamel is less prone to demineralization and colonization by S. mutans when fluoride is applied after microabrasion.
Considering the above aspects, the purpose of this study is to present a clinical case using the microabrasion technique for removing hypoplastic white spots from the enamel.
CLINICAL CASE STUDY REPORT
Female patient, 20 years old, who sought the Integrated Clinic of the Universidade Federal Fluminense (UFF) with small hypoplastic stains throughout the anterior region of the upper arch (Figs. 1 to 4). In order to check the depth of the stain, a curing light was used for transillumination, which showed well-defined, superficial stains (Figs. 5 and 6).
Initially, prophylaxis was carried out, followed by absolute isolation of the operative field (Fig. 7). To perform the microabrasion, the 6% hydrochloric acid and silicon carbide based product (Whiteness RM, FGM) was applied according to the manufacturer’s instructions (Figs. 8 to 16). The acid present in the paste acts as a demineralization agent, while the rubber cup and the microbrush at low speed wear down a few micrometers of the structure due to friction against the grains. Two sessions were conducted with six applications in each one, and between applications the teeth were washed thoroughly for full removal of the paste.
The enamel was polished with a Diamond Flex (FGM) felt disk and Diamond Excel (FGM) polishing paste (Figs. 17 and 18). Still under absolute isolation, Flúor Care (FGM) sodium fluoride was applied (Figs. 19 and 20). The immediate final appearance can be seen in Figure 21.