Macroabrasion, an alternative for anterior deep white spots

In the white lesions treatment in the anterior teeth we should try to use a strategy that preserves the maximum healthy enamel and dentin.

In this perspective, three types of treatment can be used: Infiltration with Icon, Microabrasion with gels or aluminum oxide or Macroabrasion.

When the stains are very deep and intense some times the more conservative treatments are not totally effective. Macroabrasion may be an alternative in solving these cases.

The present clinical case intends to share a way to approach this type of lesions with the macroabrasion procedure.

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Fig.1
Some ultra-conservative procedures like the Micro-abrasion and Infiltration (Icon) should be a first option to lead with superficial white and yellow spots.

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Fig.2
Initial situation. Young female patient was not happy with the white and yellow spots on the upper central incisors.

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Fig.3
In a close up view we can observe better this white lesions.

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Fig.4
Lateral view of the initial situation.
As a first step we advise the patient to make a external beaching treatment (home bleaching with 10% carbamide peroxide).

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Fig.5
After make the bleaching treatment for toow weeks, the patient return for observation an removal of the white spots.

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Fig.6
After the bleaching treatment we can observe a value increase of the tooth enamel and the decrease of the yellow spots intensity.

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Fig.7
testo sotto immagine

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Fig.8
One way to see better the location and deepness of the spots is use a transilumination. In alternative we can use a light cure unit as a trasiluminater.

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Fig.9
After isolation with rubber dam and ready to start remove the lesions.

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Fig.10
In the macroabrasion procedure we should use a round bur in slow speed, in order to be more conservative.

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Fig.11
Detail of the bur removing the white lesion and the enamel cavity.

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Fig.12
To check if the removal of the lesion is sufficient, we should observe the tooth wetted with water. If the lesion is not evident or too weak, the restorative procedure can be initiated.

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Fig.13
A smooth bevel was done with a red Sof-Lex disc (3M) to improve the transition between the restoration and the natural tooth.

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Fig.14
Aspect of the prepared cavity before beginning the restorative procedure.

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Fig.15
Etching and bonding application (Scotchbond Universal, 3M).

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Fig.16
Detail of the bonding application (Scotchbond Universal, 3M).

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Fig.17
For the composite resin shade we use the same shade as the natural enamel (A1). Because we whant to replace the natural enamel we only use enamel composite resin opacity (Filtek Supreme XTE enamel A1, 3M).

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Fig.18
Smoothing the enamel composite resin with a brush.

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Fig.19
Finishing and polishing steps. We start with a light grain discs (Sof-Lex dark orange and light orange).

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Fig.20
To create the macro and micro-texture details we use a fine grain burs in low speed.

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Fig.21
To achieve a enamel like final gloss we use felts with diamond paste.

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Fig.22
Detail of the tooth surface immediately after removing the rubber dam.

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Fig.23
After hydration. We can observe the natural aesthetic appearance.

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Fig.24
Details of the composite resin texture details and integration with the surrounding enamel.

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Fig.25
Final outcome. With the conservative removal of the white and yellow spots, a suitable and natural aesthetic result was achieved, balanced with the smile.

Conclusions

The macroabrasion procedures should be placed as a conservative option in the treatment of white lesions in the anterior teeth.
With a conservative procedure, and using a simple restorative technique we can restore the natural aesthetics to the affected teeth.

Bibliography

Croll T. Enamel Microabrasion. Chicago: Quin- tessence, 1991:27–60.
R. Soares, I. Noronha de Ataide, M. Fernandes, R. Lambor, Esthetic Management of White Spot Lesions – A Minimally Invasive Approach, Journal of Advanced Medical and Dental Sciences Research |Vol. 2|Issue 4| October-December 2014; 105-110.
H. Kubo, T.P. Leal, R.S.Navarro, F.S. Sousa, I.T. Pisa, Graduate Program in Dentistry, University
Paulista, São Paulo, Brazil, 2Camilo Castelo Branco University, São Paulo, Brazil, Department of Health Informatics, Universidade Federal de São Paulo,São Paulo, Brazil, Vanish XT extended contact Varnish, Reduction in Dental Enamel Demineralization, Expertise 2013 Scientific facts; 108.
Magne P. Megabrasion: A conservative strategy for the anterior dentition. Pract Periodontics Aesthet Dent 1997;9:389–395.
Benbachir N, Ardu S, Krejci I. Indications and limits of the microabrasion technique. Quintessence Int. 2007 Nov-Dec;38(10):811-5.
Martos J, Gewehr A, Paim E. Aesthetic approach for anterior teeth with enamel hypoplasia. Contemp Clin Dent. 2012 Apr;3(Suppl 1):S82-5.
Salat A, Devoto W, Manauta J. Achieving a precise color chart with common computer software for excellence in anterior composite restorations. Eur J Esthet Dent 2011;6:280–296.

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