Flurosis

Q U I N T E S S E N C E I N T E R N AT I O N A L

A minimally invasive treatment of severe dental fluorosis
Stefano Ardu, Dr Med Dent1/Minos Stavridakis, Dr Med Dent2/ Ivo Krejci, Prof Dr Med Dent3
This article describes a minimally invasive technique to treat a severe case of enamel fluorosis using microabrasion to eliminate the hypermineralized, white-colored, superficial enamel layer,followed by home bleaching treatment and chairside re-creation of superficial enamel microstructure. The proposed technique may improve the esthetics of fluorotic teeth without requiring other restorative procedures. Microabrasion followed by home bleaching may be an interesting alternative for the restorative treatment of teeth affected by fluorosis. (Quintessence Int 2007;38:455–458)

Key words:fluorosis, microabrasion, micromorphology, minimally invasive treatment

Fluorosis is a dental disease that affects 2.1% to 74.7% of the population.1,2 Already in the 1940s, Dean et al were able to show a strong relation between fluoride concentration in drinking water and the prevalence and severity of fluorosis.1,2 Based on the severity of enamel damage, a classification of 10 degrees offluorosis has been proposed.3 The scores range from 0, where the glossy creamy-white enamel is visible only after drying of the tooth, to 9, where the major part of the enamel is lost and a change in the shape of the tooth has occurred. Clinicians faced with this problem have different treatment options. Teeth discolored by fluorosis may be managed by bleaching, microabrasion, veneering, or artificialcrowns. The choice between these treatments depends on the severity of the disease4; however, in more severe cases the

proposed treatment option is often invasive. The problem with invasive treatments is that most patients demanding treatment for fluorosis are young adults with a life expectancy of many decades and the use of invasive procedures in the form of a prosthetic approach with veneersor crowns results in an excessive sacrifice of tooth material, thus accelerating the destruction of the tooth at an early age. Furthermore, a restorative approach is time consuming and relatively expensive. The aim of this article is to describe—and illustrate with a case report—a minimally invasive technique that improves the esthetic aspect of teeth with severe enamel fluorosis without requiringrestorative techniques.

CLINICAL PROCEDURE
The proposed minimally invasive technique is based on a combined approach of microabrasion,5 home bleaching,6,7 and enamel reshaping. Once enamel fluorosis is diagnosed (Figs 1a and 1b) by case history and clinical examination, oral hygiene instruction followed by scaling and polishing is performed, whenever necessary. During the microabrasiontreatment, the patient’s and clinicians’ eyes are protected from accidental spills by protective glasses.

1

Lecturer, Division of Cariology and Endodontology, Dental School, University of Geneva, Geneva, Switzerland.

2

Lecturer, Department of Operative Dentistry, School of Dentistry, University of Athens, Athens, Greece.

3

Professor

and

Chairman,

Division

of

Cariologyand

Endodontology, Dental School, University of Geneva, Geneva, Switzerland. Reprint requests: Dr Stefano Ardu, Ecole de Medecine Dentaire, rue Barthélemy-Menn 19, 1205 Geneva, Switzerland. E-mail: stefano.ardu@medecine.unige.ch

VOLUME 38

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NUMBER 6

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JUNE 2007

455

COPYRIGHT © 2007 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USEONLY. NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER

Q U I N T E S S E N C E I N T E R N AT I O N A L
Ardu et al

Figs 1a and 1b Views of a patient with severe enamel fluorosis. Fig 1c Microabrasion procedure under rubber dam protection.

Fig 1d Chairside fluoride gel application following microabrasion procedures. Fig...