Macroabrasil in Hypoplasic Enamel – Case report

relato de caso

Abstract

Introduction: Enamel hypoplasia manifests as white spots that cause quantitative enamel loss due to incomplete formation of the enamel's organic matrix, often resulting in aesthetic dissatisfaction with the patient's smile. Hypoplastic spots involving not only enamel but also dentin generally require restorative treatment. The goal of macroabrasion is to partially or completely remove the white spot and subsequently restore it adhesively with composite resin, effectively and safely enhancing the smile's aesthetics. Case Description: This case report describes the step-by-step procedure of a macroabrasion performed on tooth 21. A 12-year-old patient presented at the Dentistry Clinic of the Federal University of Alfenas (Unifal-MG) expressing aesthetic dissatisfaction with their smile due to a color alteration on the incisal edge of tooth 21. During the anamnesis, the patient's guardian reported that the patient had experienced trauma while still having primary dentition. Clinical examination revealed a white spot on the enamel, diagnosed as enamel hypoplasia due to the previously reported trauma and observed structure loss in the tooth. A transillumination was performed to assess the depth of the spot. A white light was positioned on the palatal surface of tooth 21, revealing both deeper and shallower areas. Macroabrasion followed by composite resin restoration was then suggested. Prior to the actual restorative treatment, the color was selected using a shade guide – A2 (VITAPAN Classical) and prophylaxis with pumice and water was performed. The spot was then removed using high-speed rotary instruments under refrigeration with a #1012 spherical diamond bur. Since the spot was less than 1mm deep, it was possible to remove it entirely. Acid etching was then performed for 15 seconds on dentin and 30 seconds on enamel with 35% phosphoric acid (Ultraetch, Ultradent). The adhesive system was applied to dentin and enamel according to the manufacturer's instructions (Ambar – FGM), followed by light curing for 20 seconds (Valo, Ultradent). The restoration was performed under absolute isolation in an incremental manner. Composite resin increments (Z350XT, 3M ESPE – A2) were placed in the cavity, shaping the mammelons. An effect resin was then placed between the incisal edge and the tips of the mammelons to achieve an opalescence and counter-opalescence effect (Z350XT, 3M ESPE – AT). Finally, a single layer of enamel resin was placed over the entire cavity (Z350 XT, 3M ESPE – A2). Each increment was light cured separately. Immediate finishing was done with a multi-bladed bur. After 48 hours, intermediate finishing and final polishing were achieved using medium-grit abrasive disks, rubber points, silicon carbide brushes, and polishing paste with a felt brush. Results: The procedure effectively restored the aesthetics of the tooth in a conservative and immediate manner. Final Considerations: Macroabrasion followed by composite resin restoration to treat enamel hypoplasia spots appears to be a viable and conservative alternative.