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Original Article
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Introduction
In the past, teeth presenting color anomalies were restored
with direct or indirect restorative materials.1 Even though
satisfactory esthetics were obtained with those procedures,
replacement of restorative materials was frequent, since a
material with identical properties and characteristics to the
dental structure was not available in the dental market.
The literature shows that some, such as Kane, in 1916
(cited by McCloskey in 19842), Bailey & Christen5 in 1970,
Croll & Cavanaugh3 in 1986, and Croll4 in 1991, suggested
removing spotted dental enamel with acids.
Croll & Cavanaugh,3 in 1986, proposed the application of
a mixture of 18% hydrochloric acid combined with laboratory
pumice in order to solve the esthetic alterations present on the
enamel surface, as well as to obtain permanent results and
insignificant loss of enamel. The treatment would be
performed with a rubber dam in place, and the patient would
wear protective glasses. The mixture was applied with the aid
of a wooden stick and firm finger pressure for 5 seconds, not
surpassing a total of 15 applications. Between each
application, the enamel submitted to this technique should be
washed and dried (Fig. 1A-D). This technique, called enamel
microabrasion, allowed for a more conservative treatment,
and has been commonly indicated for the removal of intrinsic
enamel stains of any etiology and coloration, as well as for
correction of surface irregularities on the dental enamel3,6-12
caused either by imperfect enamel formation or acquired after
the removal of orthodontic appliances.7,13,14 Croll & Bullock,13
in 1994, reported that despite the best efforts of orthodontists
and their referring dentists to educate patients in proper oral
hygiene, some patients still developed dental caries or white
spot decalcification of the enamel adjacent to bands or
brackets. Such lesions can also occur in patients with poor
oral hygiene who are not in active orthodontic treatment.
Those alterations, however, should present hard texture and
be located in the superficial layers of the dental enamel.
68 Sundfeld et al
Fig. 1. A. Post-orthodontic white enamel stain of hard texture seen in a young patient (Sundfeld et al7). B. Application
of 18% hydrochloric acid/pumice mixture onto tooth enamel with wooden stick. C. Three-year postoperative view. D.
After removal of stains using 18% hydrochloric acid/pumice and dental bleaching with 15% carbamide peroxide
Opalescenceb 18 years later. (Photos reprinted with permission, Revista Brasileira de Odontologia.)
Enamel microabrasion 69
Fig. 3. A. 12-year-old girl with white enamel stain of hard texture and some erosion areas, located only
on dental enamel in maxillary and mandibular teeth (Sundfeld et al9). B. Application of fine-tapered bur
3195 FF on the buccal surfaces of the maxillary and mandibular incisors and premolars. C. Application
of the Opalustre microabrasive product, for 1 minute, in each application of compound. D. After enamel
microabrasion and reconstruction of the maxillary central incisor with resin composite (TPHd), shades
A1 and A2. E. Six years after enamel microabrasion on the left maxillary and mandibular teeth. F. Six
years after enamel microabrasion on the right maxillary and mandibular teeth. (Photos reprinted with
permission, Jornal Brasileiro de Dentistica e Esttica.)
70 Sundfeld et al
Fig. 4. A. A 9-year-old boy with white enamel stain of hard texture and with some erosion areas, located only
on dental enamel in the maxillary and mandibular teeth (Sundfeld et al7). B. Three and a half years after removal
of white stains on the maxillary teeth, by application of 18% hydrochloric acid and pumice on the maxillary
central incisor; and after removal of white stains on the mandibular teeth, by application of the Prema
Compound microabrasive product. However, as the right mandibular lateral incisor presented deep white stain,
it was restored with composite resin (Prisma Fild). C. Six and a half years after removal of white stains on the
maxillary central incisors by application of 18% hydrochloric acid and pumice; and after removal of white stains
located on the other maxillary and mandibular teeth by application of the Prema Compound microabrasive
product. D. 15 years after removal of white stains on the maxillary and mandibular teeth. (Photos reprinted with
permission, Revista Brasileira de Odontologia.)
Enamel microabrasion 71
Fig. 6. A. Brown and white enamel stains of hard texture and unknown etiology (Sundfeld et al9). B. Five years after
macroabrasion with application of fine tapered diamond bur (3195 FF KG) on the buccal surface, microabrasion with
the Opalustre microabrasive product and dental bleaching with 15% Opalescence (Sundfeld et al9). (Photos reprinted
with permission, Jornal Brasileiro de Dentistica e Esttica.)
Disclosure: Dr. Croll has financial interest in Prema Compound and Opalustre
by virtue of patent licensing agreements with Premier Dental Products
Company and Ultradent Products, Inc.
Dr. Sundfeld is Associate Professor, Dr. Briso is Assistant Professor, Department
of Restorative Dentistry, Araatuba Dental School UNESP, Brazil. Dr. Croll is
in private practice, Pediatric Dentistry, Doylestown, Pennsylvania, USA, and is
Adjunct Clinical Professor, Department of Pediatric Dentistry, University of Texas
Health Science Center at San Antonio (Dental School) and Affiliate Professor,
Department of Pediatric Dentistry, University of Washington School of Dentistry,
Seattle, WA, USA. Dr. de Alexandre is a graduate student, and Mr. Neto is an
undergraduate student, Department of Restorative Dentistry, Piracicaba School of
Dentistry, Unicamp, Piracicaba, Brazil.
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72 Sundfeld et al
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