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Radiology - A Quarterly Newsletter on Dental Specialties

Benefits of enamel microabrasion explored

Traditional restorative methods may be the only way to go when treating deep enamel flaws. But in cases where clinicians are unsure of the best method for improving tooth appearance, nothing is risked by first attempting enamel microabrasion.

An article in the Summer 2013 issue of the American Journal of Esthetic Dentistry describes practical principles about providing the treatment. Its findings are demonstrated in three case reports wherein the treatment was used for dysmineralization, decalcification and enamel texture flaws. Also included is a 27-year retrospective on a patient who was treated with enamel microabrasion at age ten. Supplementary to the author's report is evidence pointing to more than a quarter century of the treatment's use.

The first case concerns a 10-year-old boy with white and brown discolorations of unknown origin on his two front teeth. Fluoride was not the likely cause because he had no markings on permanent first molars and no history of excess fluoride exposure. The discoloration was removed after six applications of enamel microabrasion, immediately improving the appearance of his teeth.

The second case study focuses on a 16-year-old boy who underwent enamel microabrasion to correct flaws in the gingival half of six upper front teeth. The defects resulted from poor oral hygiene during orthodontic treatment. Decay associated with the decalcification occurred on the upper left canine. Following enamel microabrasion, the left canine was routinely restored with a bonded resin-based composite restoration.

The third case study described pitting and multiple round notches most significant in the enamel of the upper front teeth of an 8-year-old girl. The defects could have been improved with bonded resin-based composite restorations. However, because the enamel defects were superficial enough to be eliminated rather than concealed, enamel microabrasion was performed following enamel removal with a low-speed diamond bur. Three months later, the appearance of the incisors was much improved.

The fourth case illustrates the permanence of enamel microabrasion treatment. Authors recounted the experience in 1985 of a 10-year-old-girl treated for white and brown enamel discoloration of her upper front teeth. Twenty-five years later, the patient further benefitted from custom-tray carbamide peroxide tooth bleaching.

The final analysis supports the authors' view that enamel microabrasion, "used alone or in combination with dental bleaching, has proven to be a conservative method of improving tooth appearance."

They also report:

  • Enamel microabrasion preserves more tooth structure than treatments such as porcelain or resin-based composite veneering at significantly less expense.
  • The results of the treatment are permanent, whereas masking with artificial material eventually requires additional intervention.
  • Acid dissolution and bacteria accumulation are better repelled by the glass-like surface that results from a combination of abrasion and erosion than from untreated tooth surfaces.
  • In many cases, the most striking results occur when enamel microabrasion is combined with dental bleaching. "Microabrasion removes unsightly superficial defects and creates a lustrous smooth surface, while tooth bleaching whitens the deep intrinsic yellow coloration of dentin," researchers concluded.

"Microabraded teeth that are also bleached provide a brighter, whiter and healthier appearance."

Achieving a predictable color match
image: Color matching teeth

Predictable color matching for a single front tooth can be an unnerving endeavor. Color perception is so subjective that consensus on shading among even experienced clinicians is only 25 percent, according to the dental literature.

"Color in esthetic dentistry remains one of the greatest challenges clinicians face on a daily basis, where success and failure are defined in clinical practice," states an article on shade matching of anterior teeth published in the Summer 2013 issue of the American Journal of Esthetic Dentistry.

However, researchers contend there's an easy method for acquiring a predictable color match when treating a single anterior tooth: Conduct three clinical procedures. "If two of the three procedures produce results consistent with one another, a predictable clinical match can be ascertained."

They summarized the three key steps as follows:

Step one: Use conventional shade-matching techniques with shade tabs (positioned at two orientations) and take reference photographs.

Step two: Convert the reference photographs into black-and-white images to better visualize the value/translucency of the selected shade tabs relative to the tooth, using any current imaging or presentation software.

Step three: Use a digital shade-taking device based on either a point source or complete tooth-mapping system.

Researchers demonstrated their findings in the case of a 29-year-old woman with a gummy smile and an unresolved endodontic lesion toward the root of the upper left central incisor.

After the healing of an implant and provisional restoration protocol, an implant-level impression was made to register peri-implant soft tissue profile and contours. A soft tissue cast was constructed in the laboratory and a gold-alloy-based custom screw retained abutment was fabricated and gold plated. A resin transfer coping impression was made.

Steps one, two and three were then performed — with step three carried out using a complete tooth-mapping system. Diagnostic information for each step was evaluated and compared.

The first and second steps provided a match in terms of shade determination, meeting the two-steps-of-three condition. Therefore, the ceramist made the planned restoration in the laboratory.

A clinical shade try-in of the crown was performed (step three) and reference photos were repeated (step one). A digital scan was taken to assess shade differences and registered a match based on the recognized color acceptability threshold — again meeting the two-steps-of-three requirement researchers described for shade predictability.

The restoration was glazed, polished and temporarily cemented. "The definitive restoration showed harmonious and predictable integration of both shade and translucency," authors concluded.

Notes on the successful rehabilitation of a smile

A 54-year-old woman visiting a Virginia dental office reported an "overall dissatisfaction" with a smile that presented "multiple esthetic challenges" and required a "coordination of care" between surgical and restorative partners.

Her treatment ultimately produced "a pleasing outcome facilitated by periodontal surgery resulting in a modification of the gingival biotype."

Facilitating the woman's esthetic rehabilitation were Drs. Mariano Polack and Douglas Mahn, who described her treatment in the June issue of the Journal of Esthetic and Restorative Dentistry

As noted in the article, the patient had a history of orthodontic treatment that had included moving the maxillary canines into the position of congenitally missing lateral incisors. "The almond shape of the canines in the lateral incisor site created an unnatural appearance," the authors wrote. "Her teeth appeared short, and she had excessive gingival display."

Several treatment plans that called for additional orthodontics were proposed to the patient but rejected. Eventually, a plan that included crown lengthening (crestal and labial bone recontouring) and feldspathic porcelain veneers was accepted.

At one-week postoperative, sutures were removed, and the patient was instructed in oral hygiene. At an eight-week postoperative appointment, the surgical site was found to be healing well. The restorative phase of treatment began about 12 weeks after the crown lengthening procedure.

"A comprehensive and interdisciplinary approach is often necessary to achieve optimal results," the authors concluded. "Smile design will generate restorative goals that will dictate and direct adjunct procedures to enhance the esthetic outcome."

Clinical crown lengthening, they added, "can provide additional tooth structure for restoration, whereas biotype modification can create a more natural soft tissue architecture."

News You Can Use
'JADA Live' seminars to explore 3D imaging, digital dentistry
Veneers brochure cover

"JADA Live," a series of live continuing education seminars introduced last year, will continue this fall with programs on 3D imaging and digital dentistry.

Sponsored by the publishers of The Journal of the American Dental Association, three full-day CE events will feature dental experts offering the best and latest information to help dentists provide better care for their patients. Participants can earn up to seven hours of CE credit for each seminar through the ADA Continuing Education Recognition Program.

Two seminars will take place in September, with a third scheduled for early October:

  • "Modern Day Treatment Planning & The Role of 3D Imaging in the Dental Practice," Friday, Sept. 13, 8:30 a.m. – 5:15 p.m., DoubleTree Seattle Airport, 18740 International Blvd., Seattle, Wash. 98188; 206-246-8600; topics will include cone-beam computed tomographic imaging and technique selection, reducing radiation risk, patient selection, interpreting images and data, and CBCT for implant treatment planning; this seminar is cosponsored by the University of Washington School of Dentistry.
  • "Dentistry in the Digital Age: Unlock Your Practice Potential," Friday, Sept. 27, 9 a.m. – 5:30 p.m., Houston Crown Plaza River Oaks, 2712 Southwest Fwy., Houston, Texas 77098; 713-523-8448; topics will include an overview of dental technology; digital radiography for you, your practice and your patients; 3D dentistry – the final piece of the digital puzzle.
  • An encore presentation (with some variations) of "Dentistry in the Digital Age: Unlock Your Practice Potential," Friday, Oct. 4, 9 a.m. – 5:30 p.m., Omni Nashville Hotel, 250 Fifth Ave. S, Nashville, Tenn. 37201; 615-782-5300; topics will include an overview of dental technology; digital radiography for you, your practice and your patients; 3D dentistry – the final piece of the digital puzzle; and 3D imaging in the treatment of sleep apnea and craniofacial pain.

Fees for these seminars vary by location and membership status. For more information and to register for any of the seminars, visit

These independent CE activities are supported in part by DEXIS, Gendex, Henry Schein Dental, Instrumentarium, i-CAT, KaVo, Marus, Pelton & Crane and SOREDEX.

Cosmetic dental courses on tap for Annual Session

image: Nan Brown

The ADA Annual Session in New Orleans this fall will feature 23 courses on various aspects of cosmetic and esthetic dental care.

Speakers for these courses will include such experts as Drs. Louis Malcmacher, David Hornbrook, Lee Ann Brady, Bud Mopper and others. The 2013 ADA Annual Session will take place Oct. 31 to Nov. 3 in New Orleans. To explore this year's educational program, visit by Category

And for more information on Annual Session (and to register) go to

Veneers brochure coverADA offers veneers brochure

For patients to choose veneers confidently, visual aids can be useful.

Before-and-after photos, benefits of treatment and considerations for porcelain versus resin veneers are all covered in the ADA's patient brochure "Dental Veneers"

This six-panel educational resource is available in packs of 50, 100, 500 and 1,000. The ADA catalog is offering a 10 percent savings on all catalog orders with promo code 13433E through Oct. 15, 2013.

To place an order, go to or call the ADA Member Service Center at 800-947-4746.

Product Spotlight
image: JADA logoPatient care kits offer solutions

Patients have a lot to remember once they leave your office, so getting them to act on a suggested care protocol can be a bit of a struggle.

To help keep your recommendations top of the mind, Patient Care Solution Kits are available – each one containing a specially selected assortment of products from Philips Sonicare and Zoom, as well as oral hygiene treatments and educational materials to help improve compliance.

With kits available on Gum Care, Whitening Maintenance, Sensitivity Management, Cavity Protection and Orthodontics, you can be sure your patients have the right tools to reach their goals every time.

For more information, visit

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