There are several causes and types of teeth discolorations and each of them need careful diagnosis and examination in order to select the proper treatment. Using home bleaching and microabrasion techniques can be considered one minimal invasive approach for the treatment of these discolorations. The aim of this article is to show how to achieve success through the combination of bleaching, microabrasion and direct restorative bonding, to reestablish the natural appearance of discolored teeth and to improve our patients’ self-esteem.
Fig.1
A 23-year-old male patient visited our dental clinic complaining about the brown discolouration on his central incisor, asking for a solution to have a brighter smile.
Fig.2
Upper dental arch of the patient: a big brownish spot on tooth 11. Although brown discolorations respond well to bleaching alone, microabrasion and direct restorations might occasionally be combined with bleaching, depending on the entity of the discoloration. Both treatments are considered minimally invasive, thus being viable options for the treatment of discoloration. When a combined treatment is needed, there are no guidelines about which procedure should be carried out first. Although both techniques are designed to improve the appearance of teeth, it is known that their action mechanism is different. The microabrasion technique removes stain from the affected enamel, while bleaching involves the application of an oxidizing agent that penetrates the enamel and dentin resulting in teeth whitening. After discussing the treatment plan with the patient we decided to start with a home bleaching treatment.
Fig.3
One or two gel syringes should be delivered to the patient, so that the treatment can be done for a week. The patient should be instructed to report any abnormal change of the teeth and gingival tissue The selected bleaching agent was Carbamide Peroxide 16%, to be used for 2-3 weeks (White Dental Beauty Teeth Whitening gels) from 2-4 h as long as no sensitivity is reported.
Fig.4
The upper and lower teeth showed significantly brighter color after the bleaching with Carbamide Peroxide 16% (White Dental Beauty Teeth Whitening gels). The brownish spot decreased in size and color saturation.
Fig.5
After three weeks , the teeth become brighter and no sensitivity was reported.
Fig.6
As the spot decreased in size and became more localized, we decided to perform the microabrasion treatment as a minimally invasive procedure to remove the superficial enamel lesion and smoothen the surface irregularities.
Fig.7
Absolute isolation with rubber dam for application of microabrasive products based on hydrochloric acid to provide excellent protection of gums, tongue and lips, and ensure perfect sealing after infiltration.
Fig.8
Closer view of the lesion.
Fig.9
The products used for microabrasion based on hydrochloric acid and abrasive silica particles should be placed on the labial surface of affected teeth. A contra angle and a silicone point for polishing resin composite can be used at low speed to firmly rub the labial surface from 10 to 20 second and then completely removed. After each application, the result of the procedure should be evaluated with the teeth moistened to simulate their natural appearance.
Fig.10
Side view, after the first application, The lesion began to fade.
Fig.11
Side view after the second microabrasion cycle.
Fig.12
Side view after the third application.
Fig.13
After multiple applications the lesions are completely removed, resulting in a slight concavity in the enamel surface. So we need to use composite resin to restore the buccal surface of the tooth.
Fig.14
Enamel etching for 30 seconds.
Fig.15
Multiple coats of bonding agent are applied and air-blown after 20 seconds for 5 seconds to let the solvent evaporate, and to thin the adhesive layer. Light curing for 30 seconds.
Fig.16
Application of a thin layer of WE Filtek Z350 XT and light curing.
Fig.17
After finishing and polishing , minimally invasive removal of the entire lesion.
Fig.18
Side view, after finishing and polishing.
Fig.19
One week follow up.
Fig.20
Close-up view, complete removal of the lesion.
Fig.21
One week follow up.
Fig.22
Before and after bleaching and micro-abrasion.
Fig.23
Before and after, final result.
Conclusions
The combined treatment, including home bleaching and microabrasion, is often more effective as a minimal invasive approach for the treatment of tooth discoloration than other invasive procedures.
Bibliography
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4. Bezerra-Júnior DM, Silva LM, Martins Lde M, Cohen-Carneiro F, Pontes DG. Esthetic rehabilitation with tooth bleaching, enamel microabrasion, and direct adhesive restorations. Gen Dent. 2016 Mar-Apr;64(2):60-4
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