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ConScientiae Sade, 2009;8(1):133-137.
133
Enamel Microabrasion in Pediatric
Dentistry: Case Report
Adriana Yuri Tashima
1
; Janaina Merli Aldrigui
2
; Sandra Kalil Bussadori
3
; Marcia Turolla Wanderley
4
1
Postgraduated in Orthodontics and Pediatric Dentistry, Faculdade de Odontologia USP.
2
Student of Postgraduation of Orthodontics and Pediatric Dentistry, Faculdade de Odontologia USP.
3
PhD of the Rehabilitation Sciences Postgraduation Program Uninove.
4
PhD of the Discipline of Pediatric Dentistry of Department of Orthodontics and Pediatric Dentistry, Faculdade de Odontologia USP.
Postal address
Marcia Turolla Wanderley
Av. Professor Lineu Prestes, 2227, Cidade Universitria
05508-900 So Paulo SP [Brasil]
marciatw@usp.br
Recebido em 28 jan. 2009. Aprovado em 1 mar. 2009
Abstract
Enamel microabrasion technique is a conservative method that improves the appe-
arance of the tooth by restoring bright and superficial smoothness, without causing
significant structural loss. It is a safe method that may be used even in the treat-
ment of young children. This paper describes the microabrasion technique using
Opalustre (Ultradent Products, Inc) applied over incipient carious lesions which
were remineralized but pigmented, aesthetically compromising deciduous teeth.
Key words: Deciduous tooth; Enamel microabrasion; Pediatric dentistry.
ConScientiae Sade, 2009;8(1):133-137.
134
Enamel Microabrasion in Pediatric Dentistry: Case Report
Introduction
The first report about hydrochloric acid
application used to improve the aesthetics of
teeth with fluorosis was done by Dr. Kane
1
, in
1916. Since the results obtained were favorable,
researches were developed in order to verify
the effectiveness of the microabrasion tech-
nique using different concentrations of hydro-
chloric acid (6.6% to 18%) and phosphoric acid
(30% to 40%) in association with abrasives. The
objective of these researches was to obtain a
long-lasting result that was safe, even for de-
ciduous teeth
1-9
.
Literature shows that this technique
should be considered as the first treatment op-
tion when trying to improve the aesthetics of
teeth that present intrinsic stains (fluorosis) or
extrinsic superficial enamel stains. The clinical
result obtained is directly related to the depth
of the stains/defects and, thus, the differential
diagnosis of such alterations is essential
2, 8, 10-12
.
Microabrasion is effective, safe and may
be used in order to improve the aesthetics of
children and adolescents, as long as the patient
is cooperative. This technique causes reduced
wear of tooth surface and minimum discomfort
to the patient
1-3, 7-8, 10, 13-14
.
The purpose of this paper is to illustrate
the microabrasion technique using Opalustre

(Ultradent Products, Inc) applied over inactive
white spot lesions which had been pigmented
and were present on deciduous teeth.
Case Report
A five-year-old male patient sought treat-
ment at the Specialization in Pediatric Dentistry
clinic of the So Paulo State Dentists Syndicate.
No relevant systemic alteration was observed
during anamnesis, except for the use of a medi-
cation containing ferrous sulfate. The mother
signed an informed consent, allowing the treat-
ment of her child. During clinical examination,
it was noted that the child presented great coro-
nal destruction of the upper deciduous incisors,
occlusal cavities on the molars, inactive white
spot lesions with brown stains added to superfi-
cial cavities on the buccal and proximal surfaces
of the deciduous canines and molars.
The first step of the treatment involved the
removal of the infected areas and the modifica-
tion of dietary and oral hygiene habits. After
accomplishing this first step, the microabra-
sion technique using Opalustre

(Ultradent
Products, Inc) was chosen to aesthetically im-
prove the teeth that presented pigmentation.
This material contains hydrochloric acid at 6.6%
and silicon carbide microparticles, it is purple
and it comes in syringes.
The sequence of the enamel microabrasion
technique with Opalustre

(Ultradent Products,
Inc) used in this clinical case was: topical anes-
thesia; infiltrative anesthesia; isolation by rub-
ber dam of the upper left quadrant (primary
canine and first and second molars) (Figure 1);
dental prophylaxis; application of 1 mm of the
product (Figure 2); abrasion using a rubber cup
in slow speed and under slight compression
during 10 seconds (Figure 3); abundant rinsing
after each application, followed by visual ob-
servation of the removal of the spots and of the
smoothness of the wet surface. After 4 applica-
tion of Opalustre

, done in a single session, it is

possible to visualize the removal of stains and
the aesthetic improvement on the wet surface,
Figure 1: Initial clinical aspect of the upper
left quadrant after isolation by rubber
dam. Notice the presence of inactive white
spots that were remineralized and present
different degrees of brown pigmentation
added to small cavities
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ConScientiae Sade, 2009;8(1):133-137.
135
Tashima AY et al.
without need for aesthetic reconstruction. After
polishing the region with felt discs and paste
at slow speed (Figure 4), a neutral fluoride gel
at 2% was applied during 1 minute (Figure 5).
Removal of the stains required 4 applications,
done in a single session, and a vitreous aspect
of the surface was observed, with immediate
aesthetic improvement. At the maintenance ap-
pointment, after 1 month (Figure 6), it was ob-
served that the shiny aspect and the surface
smoothness were maintained and that there was
absence of pain or sensitivity on teeth that had
been treated with microabrasion.
Discussion
The aesthetic treatment has not exclusive-
ly concerned adults. Children and their parents
are becoming more and more appreciative of a
beautiful smile during childhood, seeking and
demanding resolutions to aesthetic problems.
According to Welbury and Shaw (1990)
15
, aesthet-
ic problems may psychologically affect patients,
especially teenagers, and may interfere in their
social life.
Literature shows that enamel microabrasion
should be the first option of treatment because
it is a procedure that is less invasive and more
conservative. It only requires a small amount of
structure removal, it doesnt cause post-operative
pain or sensitivity, and, in the majority of cases,
it can be done in a single session causing mini-
mum discomfort to the patient
1,7,10,16-18
. Other ad-
vantages of this technique include: immediate,
Figure 3: Mechanical removal of stains using
a rubber cup at slow speed during 10 seconds
Figure 2: Application of 1mm of the
Opalustre (Ultradent Products, Inc) paste
over the stains on the affected teeth in the
vestibular face
Figure 4: Polishing of the teeth using felt
discs and paste at slow speed
Figure 5: Application of neutral topical
fluoride gel at 2% during 1 minute
Figure 6: Aspect at the one-month
maintenance appointment: observe that the
characteristics obtained were maintained
ConScientiae Sade, 2009;8(1):133-137.
136
Enamel Microabrasion in Pediatric Dentistry: Case Report
permanent and lasting results due to the fact that
microabrasion involves the removal of the stain
instead of just covering up the stain or altering
the enamel
2,4,6,10-12,19
; shorter time required for the
procedure which is easy to execute
2,6
; elimination
of the need for dental cavity preparation or re-
storative materials
6,11-12,18
; it does not cause injuries
either to the pulp or to the periodontal tissue
2, 10
.
The association of an acid and an abrasive
agent may be used in the treatment of teenagers
9,
11-12
and children who are at least 2 years old
7,13

as long as protective measures are taken to keep
save the eyes and the soft tissue. Such measures
must be followed even when using a less concen-
trated acid
2,4,12
. Therefore, rubber dam isolation
is mandatory during the procedure for not only
does it protect soft tissues but it is also comfort-
able, it stops material debris from falling into
the mouth, it reduces contact with saliva, and it
is a helpful tool for the behavior management of
young patients
7
.
In the clinical case reported, 4 applications
of Opalustre

, done in one session, were neces-

sary in order to remove the brown pigmentation
found on the inactive carious lesions of primary
maxillary teeth. After using the microabrasion
technique, the coloration was improved and
a shiny surface was obtained because, during
the procedure, the demineralized layer is al-
most completely removed by the method
18
. Mild
surface abrasion of enamel demineralizes with
simultaneous acid erosion leads to the forma-
tion of a compacted mineralized tissue within
the organic areas, replacing the outer layer of
prism-rich enamel with a densely compacted
prism-free region. When light is reflected off
this surface and refracted through it, it does so
in a different manner than it would on an un-
treated surface, and these optical properties of
the newly micro-abraded surface camouflage
the remaining subsurface stains
5,8
. This vitreous
characteristic was observed in the clinical case
presented and is known as the abrosion effect
5

or enamel glaze
9
.
Using microabrasion is also advantageous
for the treatment of small structural losses in
inactive carious lesions because the technique
only causes a small amount of structure re-
moval and it also forms a regular surface, thus
decreasing the need for conventional restor-
ative treatments
6,11,12,18
. Because of the presence
of superficial cavities on the buccal surfaces of
the deciduous canines and molars was chosen
a more abrasive technique. Paic et al (2008)
20

shows that Opalustre

caused the highest tooth

substance loss compared with other products,
and Zuanon et al (2008)
21
shows that mechanical
technique (rubber cup attached to a low-speed
handpiece) removed more enamel than manual
microabrasion using a plastic spatula. The com-
bination of Opalustre

and mechanical tech-

nique resulted in a surface without roughness
and discarded the need for restoration with
composite resin even in surfaces that presented
small cavities.
Conclusion
The microabrasion technique using
Opalustre

(Ultradent Products, Inc) was effec-

tive in the removal of inactive carious white spot
lesions that had been pigmented after remineral-
ization and to produce a regular surface even in
surfaces that presented small cavities.
This technique presents a favorable and
lasting aesthetic result, without causing signifi-
cant enamel structural loss and without need for
cavity preparations. Microabrasion may be done
in a single session and it is safe to use even in
young children.
In order to obtain a favorable and lasting
aesthetic result, it is important to make an ade-
quate diagnosis of the alterations found and the
patient must be included in a preventive program
to reduce caries risk and activity.
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