Micro and Macro

abrasion
Outline:
Introduction
Definition
Review
Indication and contraindication
Advantages and disadvantages
Comparison
Technique
Instruction to patient
Conclusion
References
 Introduction
• Microabrasion and macroabrasion represent conservative
alternatives for the reduction or elimination of superficial
discoloration.
• As terms imply, the stained areas or defects are abraded away.
• These techniques do result in the physical removal of tooth
structure indicated only for stains or enamel defects that do not
extend beyond a few tenths of a millimeter in depth.

• If the defect or discoloration still remains after treatment with microabrasion or

macroabrasion, a restorative alternative treatment is indicated.
Review of micro-macroabrasion
Chapman in 1877 was the first to bleach the teeth affected
with fluorosis using oxalic acid.

The first recorded use of hydrochloric acid was done by

Kane and Spring in 1916

McCloskey continued the work by taken up by Kane but

he used 18% of HCl with pumice solution.
• Conservative method for removing enamel to improve
discolorations limited to the outer enamel layer.
• The technique results in a loss of enamel of around 25 to 200
μm, depending on the number of applications and acids
concentration.
• It is a technique where abrasive grit in mild acid solution
placed in rubber cup, the strains are polished away. If
strains are a bit deep, then macro abrasion is done.
It involves using of dental drill and
finishing bur to remove the strains.
In most of the cases a combination
of micro and macro abrasion is
done to remove the strains
completely.
 Indication
Developmental discolored spot
Surface discoloration due to fluorosis
Post-orthodontics demineralization
Localized hypoplasia due to infection or trauma
Idiopathic hypoplasia where the discoloration is limited to
enamel layer
Contraindication
Extrinsic stain
Dentinal stain
In cases that where application of the rubber
dam is difficult
Technique using
HCL acid
Step 1: Cleaning of tooth
surface from debris and
plaque to get rid of
superficial staining.
Step 2: Macroabrasion was
done by 12-fluted carbide or
a fine grit finishing diamond
bur, by moving it along the
anatomy of the tooth with
reduction of 0.5 mm.
Step 3: Isolate the teeth to be treated with rubber dam and
either apply vaseline to the gingiva prior to rubber dam
application or apply a layer of solid petroleum jelly or copal
vanish to the margins of the rubber dam/enamel

Step 4: Polishing of tooth with graded Soflex discs or

polishing pastes

Step 5: Casein phosphopeptides-amorphous calcium

phosphate (CCP-ACP) application Precaution - Protective
shield or eyewear should be used both by dentist and patient to
avoid splatter.
 Technique using the phosphoric acid

• (i) Clean the teeth to be treated with

pumice and water, wash and dry.
• (ii) Apply phosphoric acid 35% to
enamel surface for 30 secs, wash and
dry.
• (iii) Remove frosted enamel with
tungsten carbide composite finishing
bur, running dry in an air turbine using
minimal pressure, until a shiny enamel
surface reappears
• (iv) Clean teeth with a further pumice and water slurry in a slowly
rotating rubber prophylaxis cup, and then wash again.

(vi) Remove the rubber dam.

(vii) Polish the teeth with graded Soflex discs or proprietary polishing
pastes.

(viii) Polish the teeth with fluoridated toothpaste for one minute.

(ix) Review in one month for sensibility testing and photographs.

(x) Review in six months to check pulpal status.

 This technique can be readily carried out at the dental office,
since the treatment has a "nondestructive" nature, patient
satisfaction is considerably high, and recurrence of staining or
loss of vitality of treated teeth has not been reported. During all
these years working, we have not observed any postoperative
sensitivity.
It should also be noted that if enough enamel is removed to allow
thermal sensitivity, the stain involved must be too deep for
enamel microabrasion correction alone, and a bonded restoration
is indicated
Advantages:
Minimum discomfort to the patient
Can be easily done in less time than operator
Useful in removing superficial stains
The surface of treated teeth is smooth and shiny in nature
Disadvantage
The major problems associated with this technique is the
danger of using high concentrated hydrochloric acid
Not effective for deeper stains
Removal layer of enamel
Yellow discoloration of teeth in some cases after
treatment
 Microabrasion Macroabrasion

Ensures better control for the removal High speed instrumentation

of tooth structure

Recommended over macroabrasion for Technique sensitive to operator ability

the treatments of superficial defects

Its faster and does not need the use of

rubber dam

Defect removal is easier

Microabrasion present a considerably regular, smooth and
lustrous enamel surface that increases over time. Olin et al
highlighted that this technique is believed to modify the
optical properties of enamel. Donly et al coined the term
"abrosion" for this phenomenon.
 How much enamel layer
is removed?
The amount of enamel removed by microabrasion depends
on the number of applications of the concentrated
hydrochloric acid/pumice. Eg;
- 1 and 10 applications of the mixture for 5 seconds each,
12 to 46 µm respectively. (Kendell)
- 3 and 15 applications for 5 seconds, 25 and 140 µm,
respectively. (Sundfeld et al)
- 12 applications for 30 seconds, 22 µm. (Alves et al)
 Instructions to the
patient
Avoid staining beverages
Proper brushing
Topical fluoride applications
Conclusion
Whether microabrasion is used alone or
in combination with macroabrasion,
both procedures have widespread
applications in dentistry. Enamel
microabrasion is a permanent and
durable treatment modality by which
enamel defects can be removed.
References
 1. Croll TP. Enamel microabrasion: Observations after 10 years. J
Am Dent Assoc 1997;128:Suppl:45S-50S.
 2. McCloskey RJ. A technique for removal of fluorosis stains. J Am
Dent Assoc 1984;109:63-64.
 3. Croll TP, Cavanaugh RR. Enamel color modification by controlled
hydrochloric acid-pumice abrasion. I. Technique and examples.
Quintessence Int 1986;17:81-87.
 4. Beall AE. Can a new smile make you look more intelligent and
successful? Dent Clin North Am 2007;51(2):289-97, vii.
 5. 1. Sundfeld RH, Franco LM, Gonçalves RS, de Alexandre RS,
Machado LS, Neto DS. Accomplishing esthetics using enamel
microabrasion and bleaching-a case report. Oper Dent.2:223–227.
 014;39
Thank you