1. Micro and Macro abrasion
Done by:
Albatool Baroom Lujain Qari
Doa’a Banaamah Luluah Alhagas
Lina Sirwi Rehab Saud
Group 11

2. Outline: Introduction Definition Review
Indication and contraindication
Advantages and disadvantages
Comparison
Technique
Instruction to patient
Conclusion
References

3. Introduction
Microabrasion and macroabrasion represent conservative alternatives for the reduction or elimination of superficial discoloration. As terms imply, the stained areas or defects are abraded away. These techniques do result in the physical removal of tooth structure and therefore are indicated only for stains or enamel defects that do not extend beyond a few tenths of a millimeter in depth. If the defect or discoloration still remains after treatment with microabrasion or macroabrasion, a restorative alternative treatment is indicated.

4. Definition Enamel microabrasion
Is a conservative method for removing enamel to improve discolorations limited to the outer enamel layer. (Sundfeld, et al.)
The technique results in a loss of enamel of around 25 to 200 μm, depending on the number of applications and acids concentration.
It is a technique where abrasive grit in mild acid solution placed in rubber cup, the strains are polished away. If strains are a bit deep, then macro abrasion is done.
Enamel microabrasion

5. It involves using of dental drill and finishing bur to remove the strains. In most of the cases a combination of micro and macro abrasion is done to remove the strains completely.
Macroabrasion:

6. Review of micro-macroabrasion
Chapman in 1877 was the first to bleach the teeth affected with fluorosis using oxalic acid.
The first recorded use of hydrochloric acid was done by Kane and Spring in 1916
McCloskey continued the work by taken up by Kane but he used 18% of HCl with pumice solution.
1-Chapman in 1877 was the first to bleach the teeth affected with fluorosis using oxalic acid.
2-And then the first recorded use of hydrochloric acid to remove the fluorosis stains was done by kane and Spring in 1916 they used with applying a direct flame from alcohol torch to accelerate acid penetration.
3-However, McCloskey continued the work by taken up by Kane but he used 18% of HCl with pumice solution and that technique achieved very good result with no harmful effects on the pulp or the surrounding tissues.

7. Indication Developmental discolored spot
Surface discoloration due to fluorosis
Post-orthodontics demineralization
Localized hypoplasia due to infection or trauma
Idiopathic hypoplasia where the discoloration is limited to enamel layer
They are usually smooth and white in color. If the lesion has roughened a bit, micro-abrasion coupled with re-mineralization program is an initial option.
Usually they are present on the occlusal third of the enamel surface. Its surface is smooth, hard and intact.
If the discoloration is mm deep then it can be treated with microabrasion.

8. Contraindication Extrinsic stain Dentinal stain
In cases that we can’t apply the rubber dam

9. Advantages: Minimum discomfort to the patient
Can be easily done in less time than operator
Useful in removing superficial stains
The surface of treated teeth is smooth and shiny in nature

10. Disadvantage
The major problems associated with this technique is the danger of using high concentrated hydrochloric acid
Not effective for deeper stains
Removal layer of enamel
Yellow discoloration of teeth in some cases after treatment

11. Microabrasion Macroabrasion
Ensures better control for the removal of tooth structure
High speed instrumentation
Recommended over macroabrasion for the treatments of superficial defects
Technique sensitive to operator ability
Its faster and does not need the use of rubber dam
Defect removal is easier

12. Technique using the phosphoric acid
(i) Clean the teeth to be treated with pumice and water, wash and dry.
(ii) Apply phosphoric acid 35% to enamel surface for 30 secs, wash and dry.
(iii) Remove frosted enamel with tungsten carbide composite finishing bur, running dry in an air turbine using minimal pressure, until a shiny enamel
surface reappears

13. (iv) Clean teeth with a further pumice and water slurry in a slowly rotating rubber prophylaxis cup, and then wash again.
(vi) Remove the rubber dam.
(vii) Polish the teeth with graded Soflex discs or proprietary polishing pastes.
(viii) Polish the teeth with fluoridated toothpaste for one minute.
(ix) Review in one month for sensibility testing and photographs.
(x) Review in six months to check pulpal status.

14. Technique using HCL acid
Step 1: Cleaning of tooth surface from debris and plaque to get rid of superficial staining.
Step 2: Macroabrasion was done by 12-fluted carbide or a fine grit finishing diamond bur, by moving it along the anatomy of the tooth with reduction of 0.5 mm.

15. Step 3: Isolate the teeth to be treated with rubber dam and either apply vaseline to the gingiva prior to rubber dam application or apply a layer of solid petroleum jelly or copal vanish to the margins of the rubber dam/enamel
Step 4: Polishing of tooth with graded Soflex discs or polishing pastes
Step 5: Casein phosphopeptides-amorphous calcium phosphate (CCP-ACP) application Precaution - Protective shield or eyewear should be used both by dentist and patient to avoid splatter.
in order to prevent contact of the product with the gingival tissue. . Mix 12% HCI with pumice into slurry and apply a small amount to the labial surface with a slowly rotating rubber cup, a wooden stick or flat plastic instrument rubbed over the surface for five seconds. Wash for five seconds directly into the aspirator. Repeat until the stain is reduced, up to a maximum of 10 × 5 second applications per tooth. Any improvement possible will have occurred by this time

16. This technique can be readily carried out at the dental office, since the treatment has a "nondestructive" nature, patient satisfaction is considerably high, and recurrence of staining or loss of vitality of treated teeth has not been reported. During all these years working, we have not observed any postoperative sensitivity. It should also be noted that if enough enamel is removed to allow thermal sensitivity, the stain involved must be too deep for enamel microabrasion correction alone, and a bonded restoration is indicated
However, it is possible that postoperative sensitivity may occur if too much enamel is removed.

17. Microabrasion present a considerably regular, smooth and lustrous enamel surface that increases over time. Olin et al highlighted that this technique is believed to modify the optical properties of enamel. Donly et al coined the term "abrosion" for this phenomenon.

18. How much enamel layer is removed?
The amount of enamel removed by microabrasion depends on the number of applications of the concentrated hydrochloric acid/pumice. Eg;
1 and 10 applications of the mixture for 5 seconds each, 12 to 46 µm respectively. (Kendell)
3 and 15 applications for 5 seconds, 25 and 140 µm, respectively. (Sundfeld et al)
12 applications for 30 seconds, 22 µm. (Alves et al)
Thus, the amount of enamel removed by microabrasion can be considered irrelevant.

19. Instructions to the patient
Avoid staining beverages
Proper brushing
Topical fluoride applications

20. Conclusion
Whether microabrasion is used alone or in combination with macroabrasion, both procedures have widespread applications in dentistry. Enamel microabrasion is a permanent and durable treatment modality by which enamel defects can be removed permanently. In contrast, at-home whitening products are more likely to produce fairly durable but temporary changes. The teeth will eventually return to their original color, unless patients apply periodic touch-up treatments at home on a regular basis

21. References
1. Croll TP. Enamel microabrasion: Observations after 10 years. J Am Dent Assoc 1997;128:Suppl:45S-50S.
2. McCloskey RJ. A technique for removal of fluorosis stains. J Am Dent Assoc 1984;109:63-64.
3. Croll TP, Cavanaugh RR. Enamel color modification by controlled hydrochloric acid-pumice abrasion. I. Technique and examples. Quintessence Int 1986;17:81-87.
4. Beall AE. Can a new smile make you look more intelligent and successful? Dent Clin North Am 2007;51(2):289-97, vii.
5. 1. Sundfeld RH, Franco LM, Gonçalves RS, de Alexandre RS, Machado LS, Neto DS. Accomplishing esthetics using enamel microabrasion and bleaching-a case report. Oper Dent.2:223–227. 
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22. Thank you