Microabrasion - A Conservative Approach for Mild to Moderate Fluorosis – A Case Report

Abstract

The undesirable discoloration or pitting of teeth due to fluorosis or developmental defects like amelogenesis imperfecta or enamel hypoplasia pose a challenge to the clinician to cater to the aesthetic requirements of patients. Fluorosis had been reported way back in 1901. There are treatment options depending upon individual cases as follows: microabrasion / macroabrasion, bleaching, composite restoration, veneers or full crowns. For the aesthetic enhancement of stains associated with mild to moderate fluorosis enamel microabrasion is the preferred treatment. This technique involves removal of entrapped stains by rubbing of slurry containing HCl acid and an abrasive agent on the stained enamel surface. But if the depth of the defect is more then microabrasion can be done in conjunction with bleaching or bonded restorations can be done to achieve optimal aesthetics. Casein phospopeptide - Amorphous calcium phosphate (CPP – ACP) can be topically applied after microabrasion which enhances remineralisation and prevents post-operative sensitivity. The present paper illustrates the management of mild to moderate dental fluorosis by microabrasion to remove stains on the enamel surface followed by remineralisation using CPP - ACP paste. An unaesthetic smile has psychological impact especially on young patients and lowers their confidence.1 Discoloration of the young permanent anterior teeth is mostly seen due to varying developmental defects. This could be due to extrinsic aetiology such as those caused by coffee, tea, red wine and tobacco or due to intrinsic aetiology. The intrinsic stains may be due to pre-eruptive or post-eruptive causes.2 Pre-eruptive causes of intrinsic stains include dentinogenesis imperfecta and fluorosis, whereas post-eruptive causes of intrinsic stains include tetracycline dentine staining or due to injuries.3 The excessive and chronic ingestion of fluoride during amelogenesis leads to fluorosis which can be skeletal or dental depending upon the intake.4,5 Dental fluorosis is characterized by white opaque flecks on teeth or yellow to brown discolorations with pitting on the enamel surface.6,7 The enamel microabrasion is an effective and non-invasive procedure for removing the stains limited to outer enamel layer.7,8 It uses a rubber cup along with abrasive materials and chemical solutions.9,10 Currently, many products are commercially available for enamel microabrasion such as Prema Compound (Premier Dental Products, Norristown, PA, USA) containing 15 % HCl and Opalustre (Ultradent, South Jordan, UT, USA) containing 6.6 % HCl and silicon carbide.7 (Table 1) Since these products are expensive, the prototype paste containing 18 % HCl and pumice, as described by Croll in 1986 is most commonly used in clinical practice.8