DIFFERENT TECHNIQUES OF

ENAMEL MICROABRASION
PRESENTED BY
DR SALMAN SALEEM
 CONTENTS

• Definition.
• History
• Advantage
• Disadvantage
• Indication
• Contraindication
• Different Techniques of enamel Microabrasion.
• DEFINITION
• Enamel microabrasion is a procedure in which a
microscopic layer of enamel is simultaneously eroded
and abraded with special compound, leaving a
perfectly intact enamel surface behind.
• It is used to treat enamel discoloration, which may be
the result of hypomineralization, hypermineralization
or staining.
 HISTORY

• The technique by which fluorosis stains (“The

Colorado Brown Stain”), was removed by an acid
was first developed in 1916 by Walter Kane, a dentist
from Colorado Springs, USA.
• He used 36% hydrochloric acid (HCl) and heat to
force the acid into the enamel.
• In 1960s, McInnes used a mixture of five parts of
36% HCl; five parts of 30% hydrogen peroxide; and
one part ether as a topical treatment.
 • In the 1980s, Myers and Lyon advocated etching of
teeth for two to three minutes with 37% phosphoric
acid, followed by a pumice abrasion with rotary
instrumentation of the surface.
In 2001, the United Kingdom National Clinical
Guidelines in Paediatric Dentistry recommended the use
of microabrasion to treat fluorosis, post orthodontic
demineralization, localized hypoplasia and idiopathic
hypoplasia where the discoloration is limited to the outer
enamel layer.
• The latest material used in enamel
microabrasion OPALUSTURE, (an abrasive
paste containing 6.6% HCl, 6.6% silicon
carbide particles, particle size 20-160 μm;
Ultradent products, Inc) water-cooled fine
diamond polishing bur at high speed.
 BLEACHING AND MICROABRASION

• In few cases, bleaching is done after microabrasion as

process of microabrasion causes the removal of the
superficial layer of enamel and more visibility of the
dentin layer below due to which the teeth appear
more yellow.
• Hence, bleaching if done after microabrasion helps
in restoring uniform natural colour of the tooth and
also high patient satisfaction.
 INDICATIONS OF MICROABRASION

• Developmental intrinsic stains and discoloration.

• Superficial surface enamel stains and opacities.
• Multicolored stains( grey, brown, yellow)
• Superficial hypoplastic enamel
• Areas of enamel fluorosis
• white spots, White patches
• Decalcification lesions from stasis of plaque and
orthodontic bands
• Irregular surface texture
 CONTRAINDICATIONS OF
MICROABRASION

• Age related staining

•Tetracycline staining
•Deep enamel hypoplasia
•Some concentric areas of hypocalcification that
extended to the dentine
•Amelogenesis imperfecta
•Dentinogenesis carious lesion underlying the regions
of decalcification
•Areas of deep enamel and dentine stain
• Teeth not fully erupted
• Patient with deficient lip seal as the enamel surface are
abnormally dry as teeth are always exposed to air and
dehydrate more easily
 ADVANTAGES OF MICROABRASION

• It is often different to determine actual depth of enamel

intrinsic stains.
• Irrespective of this enamel micro-abrasion should be the first
treatment option because it is less invasive and more
conservative procedure.
• It is easily performed
• It is a conservative treatment
• Teeth required minimal subsequent manintenance.
• It does not cause tooth sensitivity and may lead to
complete and final removal of stains
• The procedure are simple but require knowledge of
the cause and staining and mastering of technique,
thus minimizing excessive tooth preparation
• It is an approach that can be safely and effectively performed
in a single session yielding good esthetic result
• It removes the dysplastic superficial enamel layer
• It requires subsequent maintainence.
• It improves tooth structure and tooth coloration
• It is fast acting
• It requires subsequent maintainence.
• It improves tooth structure and tooth coloration.
• It is fast acting.
• It removes yellow-brown, white and multicolored stains.
• Advantages of this technique include small structure
removal, lack of post operative pain, no need for the
dental cavity preparation or restorative material and
shorter time required for the procedure which is easy to
execute.
DISADVANTAGE OF MICROABRASION

• It removes enamel.
• Hydrochloric acid compound are caustic.
• It requires a visit to the dental office.
• It cannot be delegate and must be carried out by a dentist.
 DIFFERENT TECHNIQUES OF
MICROABRASION

• The enamel stain or defect is removed by a

combination of the erosive and abrasive effects of the
recommended mixture containing low acid
concentrations and an abrasive agent, applied
mechanically using a low rotation micromotor. It
should be the first option for the management of teeth
with intrinsic stains because it removes opaque,
brown stains and smoothens surface irregularities by
providing a more regular and lustrous surface.
• As the technique is considered safe and minimally
invasive, it can also be combined with tooth
bleaching when necessary. An ideal microabrasion
technique should produce insignificant enamel loss,
no damage to pulp or periodontal tissues, and
satisfactory and permanent results in a short clinical
time without discomfort to the patient.
• McCloskey introduced the use of acid combined with
pumice which was named 'microabrasion' by Croll
two years later. Phosphoric acid (H 3 PO 4 ) that is
commonly used for etching in dental clinics.
• One technique of microabrasion mixes hydrochloric acid and
an abrasive powder to remove the surface layer of the enamel.
Donly et al. showed that a dense prismless layer is formed on
the abraded enamel surface giving the tooth a glass-like lustre
appearance.
• This acid-microabrasion technique has been used as an initial
treatment option to improve the disfigured enamel.
 Abrasive gel composed of 6% hydrochloric acid
and silicon carbide
• Prophylaxis was performed initially using a Robinson
toothbrush and prophylaxis paste, and subsequently
rubber dam isolation and protection with a gingival
barrier. The microabrasive paste was rubbed on the
tooth structure with a wooden toothpick. A total of six
10-second applications were performed on each
tooth.
• Between applications, the teeth were washed with
water and air dried. At the end of the procedure, the
teeth were polished with Sof-Lex finishing discs (3M
ESPE), and 5% fluoride varnish was applied for four
minutes to assist in enamel remineralization.
• The number of applications per session was estimated
according to protocols previously described.
• In a second session, six new applications were
performed, with repetition of the protocol used at the
first appointment.
MICROABRASION USING PRÈMA ABRASIVES WITH 18% HCL

• After the teeth were isolated with a rubber dam,

PrèmaTM abrasive paste mixed with 18%
hydrochloric acid was rubbed on the surface of the
disfigured enamel using a hand applicator for 5—10
minutes with intermittent washing.
• At the end of the treatment, after thorough washing
with copious water, the teeth were dried and 0.2 %
sodium fluoride liquid was applied in order to
enhance remineralisation. The patients were
instructed not to rinse for one hour. This procedure
was repeated after two weeks.
• The patients were then reviewed at six-monthly intervals. The
result showed, approximately two-thirds of the patients
(65.6%) were satisfied with their appearance immediately
after microabrasion.
 OPALUSTRE UTILIZING 6.6%
HYDROCHLORIC ACID

• The application technique used was, 10 applications per 10 sec

of microabrasive product. After each application of
microabrasive product, samples were washed with flow water
and were later placed into an ultrasonic tub.
 ACTIVE APPLICATION OF 35% H3 PO4

• The active application and the microabrasion was performed

with specific rubber cups. For this microabrasive system
composed of H3 PO4 and pumice, equal parts of each
component were measured with a dosage spoon (0.240 g) and
mixed.
• All of the components were placed on the enamel
surface with a syringe until the sample was covered and
microabrasion was performed with a specific rubber
cup coupled with a low-rotation electric micromotor.
• The treatments were performed with 10 applications of
10 s each.
• After each application, the enamel surface was rinsed
and dried for 10 s with a dental sprayer and compressed
air, respectively.
 PASSIVE APPLICATION OF 35% H3 PO4

• Passive application of 35% H3 PO4 involves non use of

rubber cups with the same technique as mentioned.
• Passive application of 6.6% HCl
• Passive application of 6.6% HCl (Drogal, Piracicaba, SP,
Brazil).
• Microabrasion with 35% H3 PO4
• Microabrasion with 35% H3 PO4 (Ultra EtchTM – Ultradent
Products Inc, Utah, USA) associated with pumice (SS White
Ltda; Rio de Janeiro, RJ, Brazil), performed with specific
rubber cup coupled with a low-rotation electric micromotor.
 MICROABRASION AND BLEACHING

• The method of bleaching mottled enamel by the use of

different approaches has also been investigated. It has been
argued that the use of acids to remove stains cause
decalcification of enamel, making the teeth more susceptible
to caries. Therefore, an alternative method where a bleaching
solution consisting of
• 30% hydrogen peroxide (H2O2) and ether applied
with a heated instrument was recommended (7).
Another suggested method was a combination of 30%
H2O2, 36% HCl and diethyl ether applied with a
cotton tip applicator , followed by neutralization with
a paste of sodium bicarbonate (NaHCO3) and water.
• the teeth need to be cleaned with pumice and water to remove
extrinsic stain . 18% hydrochloric acid is mixed with pumice
to form a slurry. The paste is applied to the buccal surface of
each teeth manually with a spatula, the acid is allowed to act
for 1 minute to allow a small demineralization of the enamel
layer, After that lightly rub using a contraangle handpiece in
slow rotation with acrylic bur.
• Then washed with sodium bicarbonate water to neutralize the
acid for 30 seconds. The number of applications depend of the
severity of the enamel defect.
• CLINICAL SUCCESS OF MICROABRASIVE TECHNIQUES
• Several case reports demonstrate the lasting and stable esthetic
results of the microabrasion technique. According to clinical results,
enamel microabrasion produced permanent color modification of
superficial enamel coloration defects because the discolored enamel
was removed, rather than altered or masked. Microabraded enamel
surfaces achieved a brilliant luster over time. Loguercio et al
compared two commercially available products for microabrasion
for removal of fluorosis stains, and found that treatment with
Opalustre was more effective than Prema Compound. This effect
was possibly due to the larger size of the silica granules in the
Opalustre.
• Microabraded enamel surfaces achieved a brilliant luster over
time.
• Loguercio et al compared two commercially available
products for microabrasion for removal of fluorosis stains, and
found that treatment with Opalustre was more effective than
Prema Compound.
• This effect was possibly due to the larger size of the silica
granules in the Opalustre
• Enamel microabrasion is one such procedure which is
a conservative, nonrestorative technique used for
elimination of superficial stains or defects of dental
enamel. It makes use of the wear provided by the
mechanical action of abrasive agents, such as pumice,
associated with the chemical action of phosphoric
acid or hydrochloric acid on the enamel's organic
portion.
 BIBLIOGRAPHY

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Microabrasion in tooth enamel discoloration defects: three cases with long-term follow-
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