Enamel microabrasion: An overview of clinical and scientific considerations

Abstract

Superficial stains and irregularities of the enamel are generally what prompt patients to seek dental intervention to improve their smile. These stains or defects may be due to hypoplasia, amelogenesis imperfecta, mineralized white spots, or fluorosis, for which enamel microabrasion is primarily indicated. Enamel microabrasion involves the use of acidic and abrasive agents, such as with 37% phosphoric acid and pumice or 6% hydrochloric acid and silica, applied to the altered enamel surface with mechanical pressure from a rubber cup coupled to a rotatory mandrel of a low-rotation micromotor. If necessary, this treatment can be safely combined with bleaching for better esthetic results. Recent studies show that microabrasion is a conservative treatment when the enamel wear is minimal and clinically imperceptible. The most important factor contributing to the success of enamel microabrasion is the depth of the defect, as deeper, opaque stains, such as those resulting from hypoplasia, cannot be resolved with microabrasion, and require a restorative approach. Surface enamel alterations that result from microabrasion, such as roughness and microhardness, are easily restored by saliva. Clinical studies support the efficacy and longevity of this safe and minimally invasive treatment. The present article presents the clinical and scientific aspects concerning the microabrasion technique, and discusses the indications for and effects of the treatment, including recent works describing microscopic and clinical evaluations.

Keywords: Dental bleaching; Enamel microabrasion; Enamel surface; Esthetic treatment; Fluorosis; Hypoplasia.

Figures

Figure 1

Indications for enamel microabrasion. Tooth staining from A: Fluorosis; B: Mineralized white spots.

Figure 2

Deep enamel staining due to hypoplasia. A: Hypoplasia; B: Ineffective microabrasion treatment of the right central incisor.

Figure 3

Transillumination to determine staining depth. A: Enamel hypoplasia in both central incisors; B, C: Transillumination to evaluate the staining.

Figure 4

Depth of enamel removal. Polarized light microscopy showing the ground tooth section after enamel microabrasion with Opalustre (reprinted with permission from Sundfeld et al[44]).

Figure 5

Enamel alterations after microabrasion. Scanning electron microscopy showing the acid conditioning pattern on the enamel surface caused by microabrasion with A: Phosphoric acid and pumice; B: Opalustre; C: Confocal laser scanning microscopy showing the minimal alteration of the enamel surface, but intact subsurface, after microabrasion with Opalustre.

Figure 6

Resolution of fluorosis staining by microabrasion. A: Clinical case of fluorosis before treatment; B: Results after enamel microabrasion (reprinted with permission Machado et al[58]).