Procedures: Microabrasion | Dr. Richard H. Berman

Procedures performed in-office

Achieving outcomes of naturally beautiful teeth

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Microabrasion

Microabrasion Examples ⟩

This patient had a noticeable brown band across his front two teeth of unknown cause. In one visit we rubber dam isolated his front two teeth and microabraded them until the stain was barely noticeable. No follow up care was required.

This patient had brown spots on her front two teeth of unknown cause. Her teeth were microabraded, then in-office bleached since we were not able to completely remove the stains without creating a crater in the enamel surface. I could have ground out the enamel and placed bonding into the hole, but this would have required replacement as the bonding failed. By not removing the stains with a drill, we were able to preserve the natural enamel surface, eliminating the need for maintenance.

This patient had prominent white spots on her two front teeth as a result of trauma to her baby teeth when she was an infant. The roots of her baby teeth hit the developing tooth buds, creating a hypocalcified spots. The remaining teeth had no damage. The lesions were removed on both teeth using microabrasion, but the larger defect required additional removal with a drill which was subsequently bonded. The other tooth (on your right, patient's left) did not require bonding.

This patient was sixteen years old when his mother brought him in for treatment. He had a combination of causes for his severe brown and white stains. He had fluorosis (brown stains) as well as generalized decalcification as a result of not brushing or flossing well (maybe at all). The first step in treating him was improve his oral hygiene. We worked for three months until his teeth were clean enough for me to consider any treatment. Once he demonstrated good homecare we began by microabrading his ten upper front teeth. This completely removed the brown stains, leaving the decalcified areas as well as a number of cavities between the teeth, which were subsequently repaired with bonded composite fillings. Follow up on this patient is critical for long term health.

This patient had pit defects in the enamel layers of his upper six teeth. Since he was a smoker these pits collected the smoke stain and looked awful. Microabrasion successfully removed the stains and smoothed out the pits. The deepest pits were filled with composite resin bonding material to slow down the accumulation of stain. The bonding over time will need to be replaced.

Sometimes teeth have either brown or white stains which are not amenable to bleaching alone. These stains are usually caused by a decalcification process of some sort (white stains) or by a defect created during tooth formation, such as fluorosis (too much fluoride intake during tooth development). Fluorosis can create severe brown stains which are within the enamel layer of a tooth. Many times these types of stains lighten significantly with bleaching, but are not eliminated without further treatment. There are four treatments to remove these stains. Microabrasion, bonding, porcelain laminates and crowns. The last three options are described in their sections on this website.

Microabrasion is a technique developed by Dr. Theodore Croll in Doylestown, PA. It utilizes a mixture of hydrochloric acid and pumice (an abrasive) which is rubbed onto the surface of the tooth repetitively until the outer layers of the enamel containing the stains are abraded away. If the stains are in the outer layers of enamel they can be successfully removed, leaving a smooth, glassy enamel surface as the finished result. This surface has been demonstrated to be more caries resistant than the original surface.

The teeth must be first isolated with a rubber dam to protect the gums from coming into contact with the acid. The pumice-acid slurry is then applied to the tooth or teeth and rubbed either manually or with a very slow speed rubber cup. After a few layers of enamel are removed, the slurry is rinsed with water and the result is evaluated. This process is repeated until the stain is gone or the process must be stopped for other reasons (enamel getting too thin or tooth getting sensitive). After the process is complete, the teeth are usually bathed in a fluoride gel in order to reduce post-operative sensitivity and the rubber dam is removed. The entire process takes less than an hour and is permanent. This is a wonderful technique to remove these types of stains, whether used alone or in combination with bleaching or bonding, it gives dramatic results.

As you will see in the following cases, I have treated cases as extreme as severe fluorosis and as simple as a small white line after braces have been removed.