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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 9  |  Issue : 3  |  Page : 145-147

A combination technique of microabrasion and remineralizing agent for treatment of dental fluorosis stains


1 Department of Pedodontics and Preventive Dentistry, Index Institutes of Dental Sciences, Indore, Madhya Pradesh, India
2 Department of Prosthodontics and Crown and Bridge, Bapuji Dental College and Hospital, Davangere, Karnataka, India

Date of Web Publication27-Sep-2018

Correspondence Address:
Divya Doneria
Room No. 6, Department of Pedodontics, Index Institutes of Dental Sciences, Indore, Madhya Pradesh
India
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DOI: 10.4103/srmjrds.srmjrds_23_18

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  Abstract 

Dental fluorosis leads to staining of the teeth which ranges from mild to moderate to severe grade. Mild-to-moderate fluorosis stains present over the anterior teeth gives an unaesthetic and unpleasant smile. In such conditions, enamel microabrasion could be a conservative approach which helps in rehabilitation of the esthetics with minimal enamel loss. Topical application of remineralizing agents after microabrasion enhances remineralization and reduces postoperative effects. The present case report of an 11-year-old boy describes the treatment of fluorosis stains with microabrasion in combination with topical application of casein phosphopeptide–amorphous calcium phosphate cream. The results show the benefit of the combination of microabrasion with remineralizing agent.

Keywords: Dental fluorosis, microabrasion, remineralizing agent


How to cite this article:
Doneria D, Keshav K, Singh Chauhan SP. A combination technique of microabrasion and remineralizing agent for treatment of dental fluorosis stains. SRM J Res Dent Sci 2018;9:145-7

How to cite this URL:
Doneria D, Keshav K, Singh Chauhan SP. A combination technique of microabrasion and remineralizing agent for treatment of dental fluorosis stains. SRM J Res Dent Sci [serial online] 2018 [cited 2018 Dec 18];9:145-7. Available from: http://www.srmjrds.in/text.asp?2018/9/3/145/242450


  Introduction Top


The modern-day dentistry is focused on esthetics, which is one of the prime concerns in pediatric patients. Discoloration of the anterior teeth in young permanent dentition is common due to many developmental defects. Dental fluorosis can be observed as white opacities, brown spots, or streaks, with superficial enamel defects, pitting, or mottling depending on the severity. It can affect the anterior teeth and sometimes complete dentition. For esthetic management of mild-to-moderate fluorosis stains, enamel microabrasion is preferred which is a minimally invasive procedure.[1],[2],[3] Microabrasion involves mild acid etching and application of an abrasive medium.[4],[5] The use of 18% hydrochloric acid (Croll) and 35% phosphoric acid (Kamp)[6] is recommended with pumice slurry. In young patients, an important aspect of enamel microabrasion is that it eliminates the need for enamel reduction with burs (which is mandatory for veneering or laminates).

It was also suggested that topical application of remineralizing agent or fluoridated toothpaste could have beneficial effects. The remineralizing agent casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) provides high concentration of calcium and phosphate ions which maintains a supersaturated mineral environment. This environment helps in reducing demineralization and aids in remineralization of enamel. The combination of enamel microabrasion with CPP-ACP is helpful in maintaining the stability of the results achieved.[7] Hence, in the present case, microabrasion with CPP-ACP cream (GC Mousse) is used to treat discolored anterior teeth.


  Case Report Top


A 12-year-old male patient reported to the department of pedodontics and preventive dentistry with a complaint of noticeable yellowish-brown stains on his front teeth. His history revealed that he was resident of the area having endemic fluorosis. He was hesitant in talking or smiling due to unesthetic appearance of his teeth [Figure 1]. The parents were also concerned for the same. According to Dean's fluorosis index, the stains were diagnosed as moderate fluorosis.[4] As the patient was younger, so minimal invasive treatment had to be chosen to prevent any tooth structure loss, so enamel microabrasion followed by remineralizing agent was preferred over veneers and laminates. The treatment plan, sequence of the treatment with the required number of visits, and possible outcomes were explained to the parents, and a written consent was obtained for the same. In the first step, scaling was done, and the teeth were prepared with the pumice slurry and rubber cup with a slow-speed handpiece. This was followed by isolation with rubber dam. In the second step, stained enamel surface was acid etched for 30 s followed by rubbing with a mixture of pumice and 37% phosphoric acid using rubber cup for another 30 s. The third step involved polishing with fluoridated prophylactic paste followed by rinsing and drying [Figure 2]. Then, CPP-ACP cream (GC Tooth Mousse) was applied to the treated tooth surface for 4 min. The patient was advised for home application of GC Tooth Mousse thrice daily for 2 weeks. In the consecutive sittings scheduled after 2 weeks, the same procedure was performed [Figure 3]. The patient did not report any postoperative sensitivity in subsequent visits. The patient and his parents were happy, and the patient did not have any complaints/complications during or after the treatment [Figure 4], after 10 weeks of treatment].
Figure 1: Preoperative photograph showing fluorosis stains with respect to 11, 12, 21, and 22

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Figure 2: After the first sitting

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Figure 3: After the second sitting

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Figure 4: After 10 weeks of treatment

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  Discussion Top


Dental fluorosis stains are characterized by surface demineralization accompanied by extrinsic staining agents. Mild-to-moderate fluorosis is presented as yellow or brown discolorations which can be treated conservatively with enamel microabrasion. In the present case report, the young patient was having esthetics concern for his yellowish-brown discolored anterior teeth. Enamel microabrasion followed by GC Mousse cream (CPP-ACP) application was the treatment of choice as microabrasion efficiently removes superficial stains, and remineralizing agent helps in improving the crystalline structure of enamel and hence reduces the chances of postoperative sensitivity and stabilizes the results.[8] Results showed that this combination technique proved a better treatment option for fluorosis stains.[7] Considerations regarding enamel microabrasion for fluorosis stains can be summarized as follows:

  1. Age is not a limiting factor as the procedure is simple, conservative, and noninvasive[9]
  2. Number of applications is according to the extent of lesion, i.e., severe stains require more number of applications[10]
  3. Postoperative sensitivity can be observed, so the combination with remineralizing agent is preferred[7]
  4. Not indicated in incompetent lip seal as continuous dehydration of enamel can appear as a failure of microabrasion[11]
  5. For better results, microabrasion can be used with bleaching technique in severe cases.[12]



  Conclusion Top


Microabrasion technique (with proper considerations, adjuncted with remineralizing agents or bleaching, or the use of composite resin) results in improved esthetics and color uniformity of the teeth, restoring the patient's esthetics and self-esteem. It can be concluded that microabrasion along with remineralizing agents is an effective, noninvasive treatment for fluorosis stains.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images, and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Sundfeld RH, Franco LM, Gonçalves RS, de Alexandre RS, Machado LS, Neto DS, et al. Accomplishing esthetics using enamel microabrasion and bleaching-a case report. Oper Dent 2014;39:223-7.  Back to cited text no. 1
    
2.
Schmidlin PR, Göhring TN, Schug J, Lutz F. Histological, morphological, profilometric and optical changes of human tooth enamel after microabrasion. Am J Dent 2003;16:4A-8A.  Back to cited text no. 2
    
3.
Croll TP. Enamel microabrasion: The technique. Quintessence Int 1989;20:395-400.  Back to cited text no. 3
    
4.
McCloskey RJ. A technique for removal of fluorosis stains. J Am Dent Assoc 1984;109:63-4.  Back to cited text no. 4
    
5.
Croll TP. Enamel microabrasion: Observations after 10 years. J Am Dent Assoc 1997;128 Suppl:45S-50S.  Back to cited text no. 5
    
6.
Kamp AA. Removal of white spot lesions by controlled acid-pumice abrasion. J Clin Orthod 1989;23:690-3.  Back to cited text no. 6
    
7.
Deshpande AN, Joshi NH, Pradhan NR, Raol RY. Microabrasion-remineralization (MAb-re): An innovative approach for dental fluorosis. J Indian Soc Pedod Prev Dent 2017;35:384-7.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
de Vasconcelos AA, Cunha AG, Borges BC, Vitoriano Jde O, Alves-Júnior C, Machado CT, et al. Enamel properties after tooth bleaching with hydrogen/carbamide peroxides in association with a CPP-ACP paste. Acta Odontol Scand 2012;70:337-43.  Back to cited text no. 8
    
9.
Sundfeld RH, Sundfeld-Neto D, Machado LS, Franco LM, Fagundes TC, Briso AL, et al. Microabrasion in tooth enamel discoloration defects: Three cases with long-term follow-ups. J Appl Oral Sci 2014;22:347-54.  Back to cited text no. 9
    
10.
Celik EU, Yildiz G, Yazkan B. Clinical evaluation of enamel microabrasion for the aesthetic management of mild-to-severe dental fluorosis. J Esthet Restor Dent 2013;25:422-30.  Back to cited text no. 10
    
11.
Sundfeld RH, Croll TP, Briso AL, de Alexandre RS, Sundfeld Neto D. Considerations about enamel microabrasion after 18 years. Am J Dent 2007;20:67-72.  Back to cited text no. 11
    
12.
Castro KS, Ferreira AC, Duarte RM, Sampaio FC, Meireles SS. Acceptability, efficacy and safety of two treatment protocols for dental fluorosis: A randomized clinical trial. J Dent 2014;42:938-44.  Back to cited text no. 12
    


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  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Discussion
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