Enamel microabrasion

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Enamel microabrasion is a procedure in cosmetic dentistry used to improve the appearance of the teeth. Like tooth whitening it is used to remove discolorations of the tooth surface but microabrasion is both a mechanical and chemical procedure.

Contents

History

In the past, teeth with stains or other color changes were made to look better through the use of restorative materials, such as dental porcelain. These materials would create a thin veneer over the outer surface of the tooth. Although veneers looked better, these materials did not match the structure or characteristics of the tooth enamel and replacement was frequently needed. As far back as 1916, some researchers were advocating instead removing a thin layer of the outermost enamel to expose the (presumably) undamaged layer underneath. [1] The first practical application of enamel microabrasion was developed by Theodore Croll and Richard Cavanaugh in 1986, who used a combination of weak hydrochloric acid and pumice to remove a few tenths of millimeters of the enamel. [2] [3]

Description

Contemporary enamel microabrasion uses a combination of mechanical and chemical means to remove of a small amount of tooth enamel (not more than a few tenths of a millimeter) to eliminate superficial discoloration. [4] These discolorations can result from either from extrinsic factors (such as tobacco, dental plaque, certain foods, etc.) or intrinsic ones (most commonly dental fluorosis).

Indications

Dental fluorosis is the most common indication where it ranges in severity from mild to severe, microabrasion should be considered the first option in treating mild and moderate cases of fluorosis. [5]

Removal of intrinsic enamel stains, correction of surface irregularities and defects in enamel caused either after removal of orthodontic appliances or during tooth formation. [6] [7]

Contraindications

The patients' age is not a limiting factor for the enamel microabrasion technique but in cases of not fully erupted teeth, it may be difficult to place rubber dam for the microabrasion process [8]

Microabrasion is not indicated when discoloration is located in dentin such as in dentigenous imperfecta or tetracycline discoloration.

Should be delayed or not used in patients with deficient labial seal because enamel surfaces are extremely dry which makes stains more obvious.so, Sundfeld, et al in 2007, found that orthodontic lip repositioning should be done first to make removal of these stains more effective. [9]

Consequences

Patients can benefit from combined microabrasion and bleaching techniques as microabrasion causes reduction in the enamel surface and sometimes the tooth surface appear yellowish or darker due to exposure of dentin surface and thinning of enamel layer over it. In this condition, correction of this yellow color can be achieved by using tooth whitening technique to mask the color. [8]

Fragoso, et al. (2011) found that applying fluoride paste on enamel surface after microabrasion process provides higher hardness & more enamel smoothness. [10] in addition, Segura et al found that the treated enamel surface become more resistant to demineralisation than untreated enamel and less colonisation of bacteria occur. [11]

Related Research Articles

<span class="mw-page-title-main">Human tooth</span> Calcified whitish structure in humans mouths used to break down food

Human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. As such, they are considered part of the human digestive system. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

<span class="mw-page-title-main">Toothpaste</span> Substance to clean and maintain teeth

Toothpaste is a paste or gel dentifrice used with a toothbrush to clean and maintain the aesthetics and health of teeth. Toothpaste is used to promote oral hygiene: it is an abrasive that aids in removing dental plaque and food from the teeth, assists in suppressing halitosis, and delivers active ingredients to help prevent tooth decay and gum disease (gingivitis). Owing to differences in composition and fluoride content, not all toothpastes are equally effective in maintaining oral health. The decline of tooth decay during the 20th century has been attributed to the introduction and regular use of fluoride-containing toothpastes worldwide. Large amounts of swallowed toothpaste can be poisonous. Common colors for toothpaste include white and blue.

<span class="mw-page-title-main">Tooth enamel</span> Major tissue that makes up part of the tooth in humans and many animals

Tooth enamel is one of the four major tissues that make up the tooth in humans and many animals, including some species of fish. It makes up the normally visible part of the tooth, covering the crown. The other major tissues are dentin, cementum, and dental pulp. It is a very hard, white to off-white, highly mineralised substance that acts as a barrier to protect the tooth but can become susceptible to degradation, especially by acids from food and drink. In rare circumstances enamel fails to form, leaving the underlying dentin exposed on the surface.

<span class="mw-page-title-main">Tooth decay</span> Deformation of teeth due to acids produced by bacteria

Tooth decay, also known as cavities or caries, is the breakdown of teeth due to acids produced by bacteria. The cavities may be a number of different colors, from yellow to black. Symptoms may include pain and difficulty eating. Complications may include inflammation of the tissue around the tooth, tooth loss and infection or abscess formation. Tooth regeneration is an ongoing stem cell–based field of study that aims to find methods to reverse the effects of decay; current methods are based on easing symptoms.

<span class="mw-page-title-main">Dentin</span> Calcified tissue of the body; one of the four major components of teeth

Dentin or dentine is a calcified tissue of the body and, along with enamel, cementum, and pulp, is one of the four major components of teeth. It is usually covered by enamel on the crown and cementum on the root and surrounds the entire pulp. By volume, 45% of dentin consists of the mineral hydroxyapatite, 33% is organic material, and 22% is water. Yellow in appearance, it greatly affects the color of a tooth due to the translucency of enamel. Dentin, which is less mineralized and less brittle than enamel, is necessary for the support of enamel. Dentin rates approximately 3 on the Mohs scale of mineral hardness. There are two main characteristics which distinguish dentin from enamel: firstly, dentin forms throughout life; secondly, dentin is sensitive and can become hypersensitive to changes in temperature due to the sensory function of odontoblasts, especially when enamel recedes and dentin channels become exposed.

Cosmetic dentistry is generally used to refer to any dental work that improves the appearance of teeth, gums and/or bite. It primarily focuses on improvement in dental aesthetics in color, position, shape, size, alignment and overall smile appearance. Many dentists refer to themselves as "cosmetic dentists" regardless of their specific education, specialty, training, and experience in this field. This has been considered unethical with a predominant objective of marketing to patients. The American Dental Association does not recognize cosmetic dentistry as a formal specialty area of dentistry. However, there are still dentists that promote themselves as cosmetic dentists.

Tooth whitening or tooth bleaching is the process of lightening the color of human teeth. Whitening is often desirable when teeth become yellowed over time for a number of reasons, and can be achieved by changing the intrinsic or extrinsic color of the tooth enamel. The chemical degradation of the chromogens within or on the tooth is termed as bleaching.

<span class="mw-page-title-main">Crown (dental restoration)</span> Dental prosthetic that recreates the visible portion of a tooth

In dentistry, a crown or a dental cap is a type of dental restoration that completely caps or encircles a tooth or dental implant. A crown may be needed when a large dental cavity threatens the health of a tooth. Some dentists will also finish root canal treatment by covering the exposed tooth with a crown. A crown is typically bonded to the tooth by dental cement. They can be made from various materials, which are usually fabricated using indirect methods. Crowns are used to improve the strength or appearance of teeth and to halt deterioration. While beneficial to dental health, the procedure and materials can be costly.

<span class="mw-page-title-main">Dental abrasion</span> Medical condition

Abrasion is the non-carious, mechanical wear of tooth from interaction with objects other than tooth-tooth contact. It most commonly affects the premolars and canines, usually along the cervical margins. Based on clinical surveys, studies have shown that abrasion is the most common but not the sole aetiological factor for development of non-carious cervical lesions (NCCL) and is most frequently caused by incorrect toothbrushing technique.

<span class="mw-page-title-main">Dental fluorosis</span> Tooth enamel discoloration due to excessive fluoride ingestion

Dental fluorosis is a common disorder, characterized by hypomineralization of tooth enamel caused by ingestion of excessive fluoride during enamel formation.

<span class="mw-page-title-main">Human tooth development</span> Process by which teeth form

Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. For human teeth to have a healthy oral environment, all parts of the tooth must develop during appropriate stages of fetal development. Primary (baby) teeth start to form between the sixth and eighth week of prenatal development, and permanent teeth begin to form in the twentieth week. If teeth do not start to develop at or near these times, they will not develop at all, resulting in hypodontia or anodontia.

<span class="mw-page-title-main">Veneer (dentistry)</span> Layer of material placed over a tooth

In dentistry, a veneer is a layer of material placed over a tooth. Veneers can improve the aesthetics and function of a smile and protect the tooth's surface from damage.

<span class="mw-page-title-main">Dental attrition</span>

Dental attrition is a type of tooth wear caused by tooth-to-tooth contact, resulting in loss of tooth tissue, usually starting at the incisal or occlusal surfaces. Tooth wear is a physiological process and is commonly seen as a normal part of aging. Advanced and excessive wear and tooth surface loss can be defined as pathological in nature, requiring intervention by a dental practitioner. The pathological wear of the tooth surface can be caused by bruxism, which is clenching and grinding of the teeth. If the attrition is severe, the enamel can be completely worn away leaving underlying dentin exposed, resulting in an increased risk of dental caries and dentin hypersensitivity. It is best to identify pathological attrition at an early stage to prevent unnecessary loss of tooth structure as enamel does not regenerate.

Adhesive dentistry is a branch of dentistry which deals with adhesion or bonding to the natural substance of teeth, enamel and dentin. It studies the nature and strength of adhesion to dental hard tissues, properties of adhesive materials, causes and mechanisms of failure of the bonds, clinical techniques for bonding and newer applications for bonding such as bonding to the soft tissue. There is also direct composite bonding which uses tooth-colored direct dental composites to repair various tooth damages such as cracks or gaps.

<span class="mw-page-title-main">Tooth polishing</span>

Tooth polishing procedures are done to smooth the surfaces of teeth and restorations. The purpose of polishing is to remove extrinsic stains, remove dental plaque accumulation, increase aesthetics and to reduce corrosion of metallic restorations. Tooth polishing has little therapeutic value and is usually done as a cosmetic procedure after debridement and before fluoride application. Common practice is to use a prophy cup—a small motorized rubber cup—along with an abrasive polishing compound.

<span class="mw-page-title-main">Fluoride varnish</span> Highly concentrated form of fluoride

Fluoride varnish is a highly concentrated form of fluoride that is applied to the tooth's surface by a dentist, dental hygienist or other dental professional, as a type of topical fluoride therapy. It is not a permanent varnish but due to its adherent nature it is able to stay in contact with the tooth surface for several hours. It may be applied to the enamel, dentine or cementum of the tooth and can be used to help prevent decay, remineralise the tooth surface and to treat dentine hypersensitivity. There are more than 30 fluoride-containing varnish products on the market today, and they have varying compositions and delivery systems. These compositional differences lead to widely variable pharmacokinetics, the effects of which remain largely untested clinically.

<span class="mw-page-title-main">Tooth resorption</span> Breakdown of the tooth root to be absorbed by the blood

Resorption of the root of the tooth, or root resorption, is the progressive loss of dentin and cementum by the action of odontoclasts. Root resorption is a normal physiological process that occurs in the exfoliation of the primary dentition. However, pathological root resorption occurs in the permanent or secondary dentition and sometimes in the primary dentition.

<span class="mw-page-title-main">Tooth discoloration</span> Medical condition

Tooth discoloration is abnormal tooth color, hue or translucency. External discoloration is accumulation of stains on the tooth surface. Internal discoloration is due to absorption of pigment particles into tooth structure. Sometimes there are several different co-existent factors responsible for discoloration.

<span class="mw-page-title-main">Molar incisor hypomineralisation</span> Medical condition

Molar incisor hypomineralisation (MIH) is a type of enamel defect affecting, as the name suggests, the first molars and incisors in the permanent dentition. MIH is considered a worldwide problem with a global prevalence of 12.9% and is usually identified in children under 10 years old. This developmental condition is caused by the lack of mineralisation of enamel during its maturation phase, due to interruption to the function of ameloblasts. Peri- and post-natal factors including premature birth, certain medical conditions, fever and antibiotic use have been found to be associated with development of MIH. Recent studies have suggested the role of genetics and/or epigenetic changes to be contributors of MIH development. However, further studies on the aetiology of MIH are required because it is believed to be multifactorial.

Anterior teeth are some of the most scrutinized teeth, as the size, shape and color of the anterior upper teeth plays an important role in dental aesthetics and smile aesthetics. A few aesthetic anterior problems, such as dental caries, tooth fracture, enamel defects and diastemas, can be solved with composite restorations. Composite restorations can also improve dental aesthetics by changing the shape, color, length and alignment of teeth.

References

  1. McCloskey RJ (1984). "A technique for removal of fluorosis stains". J Am Dent Assoc. 109:63-64.
  2. Croll, TP; Cavanaugh, RR (Feb 1986). "Enamel color modification by controlled hydrochloric acid-pumice abrasion. I. technique and examples". Quintessence Int. 17 (2): 81–7. PMID   3457401.
  3. Croll, TP; Cavanaugh, RR (Mar 1986). "Enamel color modification by controlled hydrochloric acid-pumice abrasion. II. Further examples". Quintessence Int. 17 (3): 157–64. PMID   3458266.
  4. "PRĒMA Enamel Microabrasion Compound". Premier Dental. Retrieved 15 June 2017.
  5. Celik EU, Yildiz G, Yazkan B (2013). "Clinical evaluation of enamel microabrasion for the aesthetic management of mild-to-severe dental fluorosis". Journal of Esthetic and Restorative Dentistry. 25 (6): 422–30. doi:10.1111/jerd.12052. PMID   24320061.
  6. Killian CM, Croll TP (1990). "Enamel microabrasion to improve enamel surface texture". J Esthet Dent. 2:125-128.
  7. Croll TP (1990). "Enamel microabrasion for removal of superficial dysmineralization and decalcification defects". J Am Dent Assoc. 120 (4): 411–415. doi: 10.14219/jada.archive.1990.0127 . PMID   2181011.
  8. 1 2 Sundfeld RH, Rahal V, de Alexandre RS, Briso AL, Sundfeld Neto D (2011). "Smile restoration through use of enamel microabrasion associated with tooth bleaching". Compend Contin Educ Dent. 32 (3): e53-7. PMID   23738859.
  9. Sundfeld RH, Croll TP, Briso AL, Alexandre RS, Sundfeld D (2007). "Considerations about enamel microabrasion after 18 years". Am J Dent. 20 (2): 67–72. PMID   17542197.
  10. Fragoso LS, Lima DA, Alexandre RS, Bertoldo CE, Aguiar FH, Lovadino JR (2011). "Evaluation of physical properties of enamel after microabrasion, polishing, and storage in artificial saliva". Biomed Mater. 6 (3): 035001. Bibcode:2011BioMa...6c5001F. doi:10.1088/1748-6041/6/3/035001. PMID   21487176.
  11. Segura A, Donly KJ, Wefel JS, Drake D (1997). "Effect of enamel microabrasion on bacterial colonization". Am J Dent. 10 (6): 272–4. PMID   9590914.