Management of Multifactorial Stained Enamel Defects on Anterior Dentition Using a Combination Treatment of Whitening, Microabrasion, Resin Infiltration and Resin-based Composite Restoration.

OBJECTIVES: This case report describes a combination treatment composed of tooth whitening, microabrasion, resin infiltration, and resin-based composite restoration to manage multifactorial stained enamel lesions on anterior teeth. CLINICAL CONSIDERATIONS: The patient's primary concern was to improve the esthetics of their smile after about a decade of extensive orthodontic and orthognathic procedures. After clinical evaluation and history taking, the authors determined that the enamel defects were the result of carious and developmental factors. In-office tooth whitening took place in one visit, followed by micro abrasion and resin infiltration in another visit. Thirteen months later, a follow-up visit showed that the results were stable and that the patient was satisfied with the overall outcome. A small resin composite restoration was added at the follow up visit to repair a previous restoration and to reestablish the facial contours of the central incisor. CONCLUSIONS: A combination treatment protocol composed of tooth whitening, microabrasion, and resin infiltration can improve patient satisfaction and avoid unnecessary invasive treatment.

Microabrasion in the management of enamel discolorations in paediatric dentistry: a systematic review.

Structural abnormalities of the anterior teeth could be aesthetically compromising in young patients. The dentist must provide solutions while preserving dental tissue. Microabrasion approach can be a solution. We conducted a systematic literature review to evaluate whether microbrasion treatment in paediatric dentistry can improve aesthetic in cases of pre- or post-eruptive discolorations on tooth enamel. 741 articles published up to September 2021 were selected from 3 databases using the key word "microabrasion". 11 prospective studies including 6 randomized were relevant to the inclusion criteria. Microabrasion appears to be an effective and reliable technique for the management of pre and post enamel discoloration in paediatric dentistry, especially in fluorosis. More high-powered, well-conducted randomized studies with complete evaluation criteria are needed for other types of spots. Standardization of criteria for assessing treatment success and of the protocol required should be explored.

Odontología restauradora mínimamente invasiva: caso clínico / Minimally invasive restorative dentistry: a clinical case

La decoloración de las piezas dentarias puede te-ner un impacto estético y social que lleva a los pa-cientes a buscar una intervención para mejorar su sonrisa. Las manchas superficiales y las irregula-ridades del esmalte pueden deberse a hipoplasias, hipomineralización molar, fluorosis, uso de medica-mentos, manchas blancas causadas por traumatis-mos o infección en la dentición primaria, o manchas post ortodóncicas. El diagnóstico de los defectos del esmalte se realiza a través de un examen visual por transiluminación. Se han propuesto técnicas micro abrasivas con diferentes agentes para eliminar las manchas superficiales del esmalte, así también como el uso de agentes blanqueadores a baja concentra-ción para equilibrar el color de las piezas dentarias. Si las manchas son profundas se requiere de una mega abrasión y posterior restitución anatómica con resinas compuestas. Los avances tecnológicos en los materiales de restauración adhesivos permi-ten imitar las piezas dentarias naturales permitien-do la mínima destrucción de la estructura dental sin comprometer futuras opciones de restauración. El objetivo de este trabajo es mostrar una secuencia de procedimientos mínimamente invasivos para devol-ver la estética perdida en una paciente que concurre a la Cátedra de Odontología Restauradora (AU)

The discoloration of dental pieces can have an aesthetic and social impact that leads patients to seek an intervention to improve their smile. Superficial stains and enamel irregularities may be due to hypoplasia, molar hypomineralization, fluorosis, drug use, white spots caused by trauma or infection in the primary dentition, or post-orthodontic stains. The diagnosis of enamel defects is made through a visual examination by transillumination. Microabrasive techniques with different agents have been proposed to remove surface stains from the enamel, as well as the use of low-concentration whitening agents to balance the color of the teeth. If the stains are deep, a mega abrasion and subsequent anatomical restoration with composite resins are required. Technological advances in adhesive restorative materials make it possible to mimic natural teeth, allowing minimal destruction of tooth structure without compromising future restorative options. The objective of this work is to show the sequence of minimally invasive procedures to return the lost aesthetics in a patient who attends the Chair of Restorative Dentistry (AU)

Color Changes Associated with Sandblasting, Hydrofluoric Acid Etching, and Er:YAG Laser Irradiation of Milled Feldspathic Porcelain Laminate Veneers.

OBJECTIVES: To evaluate color changes in milled feldspathic porcelain laminate veneers following hydrofluoric acid etching (HFA), sandblasting (SB), or Er:YAG laser irradiation (LI). METHODS AND MATERIALS: Disc-shaped specimens (thickness=1 mm, diameter=8 mm) were milled from feldspathic porcelain blocks (n=40). Glazed specimens were randomly assigned to four subgroups (n=10 each) according to surface treatment: negative control, HFA, SB, and LI. A layer of translucent, light-cured resin cement (thickness=0.1 mm) was then applied following silanization. The color was characterized by the L*, a*, and b* uniform color space (CIE) using a reflection spectrophotometer. CIEDE2000 (ΔE00) was calculated to determine the color difference between each surface treatment and negative control groups. Data were statistically analyzed using analysis of variance (ANOVA), Kruskal-Wallis, and Dunn-Bonferroni post hoc tests. RESULTS: There were no significant differences in CIEL* and CIEb* coordinates between negative control and all surface treatment groups (p≥0.108). The SB group demonstrated significantly lower mean CIEa* (higher greenish hue) compared to other groups (p≤0.003). HFA exhibited significantly higher CIEa* (closer to red) when compared to LI (p=0.039). LI induced the smallest overall color change compared to negative control (ΔE00=1.43 [1.07]). However, the differences in ΔE00 values were not statistically significant (p=0.648). CONCLUSIONS: The tested surface treatments did not affect the lightness or the yellowness of the 1-mm-thick milled feldspathic porcelain veneers. However, sandblasting resulted in a significant increase in the greenish hue. The Er:YAG laser resulted in the closest ΔE00 (1.43) to the 50:50% perceptibility threshold (ΔE00=1.2).

Técnica combinada de microabrasión y blanqueamiento dental para tratamiento de pigmentaciones asociadas a fluorosis. Reporte de un caso / Combined technique of microabrasion and teeth whitening for treatment of surface stains associated with fluorosis. Case Report

La fluorosis dental es una condición irreversible originada durante el desarrollo dental que genera pigmentaciones intrínsecas, alteraciones en el esmalte manifestadas a manera de manchas blancas, amarillas o marrones, que perjudican la estética y repercuten en el desenvolvimiento social. El presente reporte de caso clínico describe la combinación de los procedimientos de microabrasión y blanqueamiento dental, como alternativas en la eliminación de pigmentaciones dentales. Después del diagnóstico de la patología, verificación de ausencia de lesiones pulpares y caries, una explicación minuciosa a la paciente y obtención del consentimiento informado, se realizó limpieza de las superficies dentales y, bajo aislamiento absoluto, se procedió a realizar la técnica de microabrasión mediante ácido clorhídrico al 6,6% siguiendo las instrucciones del fabricante. Concluido el procedimiento y, observando que era posible mejorar aún más la estética, se decidió ejecutar el procedimiento de blanqueamiento dental, a base de peróxido de hidrógeno al 40% en el consultorio, seguido por peróxido de carbamida al 10% aplicado en el domicilio. Al finalizar el tratamiento se observó uniformidad en el color dental, conjugados con una evidente mejora en la calidad de vida y relación social de la paciente. La combinación de procedimientos, como el reportado en este caso, constituye una excelente alternativa de tratamiento para eliminar pigmentaciones fluoróticas moderadas

Dental fluorosis is an irreversible condition caused during dental development that generates intrinsic pigmentation, enamel alterations manifested as white, yellow, or brown spots, which impair aesthetics and have an impact on social development. This clinical case report describes the combination of microabrasion and teeth whitening procedures, as alternatives in the elimination of dental pigmentations. After the diagnosis of the pathology, verification of absence of pulpal lesions and caries, a thorough explanation to the patient and obtaining informed consent; dental surfaces were cleaned and, under absolute isolation, the microabrasion technique was performed using 6.6% hydrochloric acid following the manufacturer's instructions. Once the procedure was concluded and observing that it was possible to improve the aesthetics even further, it was decided to perform the teeth whitening procedure, based on 40% hydrogen peroxide, in the dental office, followed by 10% carbamide peroxide applied at home. At the end of the treatment, uniformity in tooth color was observed, combined with an evident improvement in the quality of life and social relationship of the patient. The combination of procedures, such as that reported in this case, constitutes an excellent treatment alternative to eliminate moderate fluorotic pigmentation

[Role of enamel microabrasion associated with external bleaching in the management of patients with dental fluorosis]. / La micro-abrasion amélaire associée à l'éclaircissement externe: intérêt dans la prise en charge de la fluorose.

Dental fluorosis is a developmental anomaly affecting aesthetic appearance. The association between microabrasion and external bleaching has shown satisfactory outcomes because it improves aesthetic outcome in patients with light dental fluorosis. The purpose of this study was to update the role of this association as well as its different effects on the enamelled surface.

Comparison of the abrasive properties of two different systems for interproximal enamel reduction: oscillating versus manual strips.

BACKGROUND: The aim of the present investigation was to evaluate enamel reduction efficiency, abrasive property decay, and enamel effects between oscillating mechanical and manual systems for interproximal enamel reduction (IPR). METHODS: Three oscillating strips and three manual strips were tested on twelve freshly extracted premolars blocked in an acrylic cylinder pot by means of a material testing machine. Each strip underwent one test of 8 cycles (30 s each). Both abrasive tracks and teeth surfaces were qualitative evaluated before and after IPR by means of SEM analysis. Efficiency and abrasive property decay of both IPR systems were investigated by the amount of enamel reduction within the eight-cycle testing. Independent t-test was used to evaluate differences in variables between the two systems. RESULTS: Mechanical IPR system showed higher efficiency in terms of enamel reduction (p < 0.005) when compared with manual IPR system (0.16 mm and 0.09 mm, respectively). Quantity of removed enamel decreased throughout the 8 cycles for both systems. Less presence of enamel debris and detachment of abrasive grains were observed on mechanical strips rather than manual strips. SEM analysis revealed more regular surface of teeth undergone mechanical IPR procedures. CONCLUSION: Oscillating diamond strips showed more controlled efficiency when compared with the manual IPR system leading to a more regular enamel surface.

Dental Fluorosis Treatment Can Improve the Individuals' OHRQoL? Results from a Randomized Clinical Trial.

This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Minimally invasive esthetic improvement in a patient with dental fluorosis by using microabrasion and bleaching: A clinical report.

Dental fluorosis is a condition that produces unesthetic coloration of enamel because of excessive fluoride ingestion during enamel formation. Its appearance can range in severity from mildly white and opaque to dark brown and can lead a patient to seek dental treatment. Historically, these lesions have been masked, either with direct or indirect restorations, but more conservative treatment options are now available, including the combination of microabrasion and bleaching. This clinical report describes the use of these treatment options to address a young patient's dental fluorosis.

Dental fluorosis treatment can improve the individuals' ohrqol? results from a randomized clinical trial

Abstract This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito na qualidade de vida relacionada à saúde bucal (QVRSB) de dois protocolos de tratamento para fluorose dentária, em indivíduos incluídos em um ensaio clínico randomizado. Setenta voluntários, os quais viviam em uma área de fluorose endêmica no Brasil, e que possuíam pelo menos quatro dentes ântero-superiores com índice de Thylstrup e Fejerskov de 1 a 7, foram randomizados em dois grupos de tratamento (n= 35): GI- microabrasão de esmalte; ou GII- microabrasão associada com clareamento caseiro. A microabrasão foi realizada com ácido fosfórico 37% e pedra pomes e, o clareamento caseiro com peróxido de carbamida 10% e uso de moldeira. Os voluntários responderam um questionário antes e 1 mês após o tratamento, visando avaliar mudanças na QVRSB através do instrumento Oral Impact on Daily Performance (OIDP). Diferenças nos escores de impacto geral entre e nos mesmos grupos de tratamento foram analisadas através dos testes Wilcoxon (mesmo grupo) e Mann-Whitney (entre grupos), respectivamente. Alterações no escores dos domínios foram analisadas usando o teste Wilcoxon (a<0.05). Um mês após o tratamento, os indivíduos relataram melhora na QVRSB. Ambos os grupos apresentaram menores escores do OIDP (p<0,001), sem diferença entre eles. Os escores dos domínios comer, limpar os dentes, sorrir e estado emocioal diminuíram após o tratamento para toda a amostra. Concluiu-se que o tratamento com microabrasão melhorou a QVRSB de indivíduos vivendo em uma área de fluorose endêmica independentemente da associação com o clareamento caseiro.

Fracture resistance of simulated immature teeth after internal bleaching procedures.

The aim of this study was to evaluate the fracture resistance of simulated immature teeth after internal bleaching. The teeth were assigned as follows (n = 12/group); Group-1: The pulp chamber was filled with ProRootMTA and bleached intracoronally with sodium perborate mixed with 37% carbamide peroxide gel; Group-2: The pulp chamber was filled with ProRootMTA without bleaching; Group-3: The pulp chamber was filled with Biodentine and bleached intracoronally as Group-1; Group-4: The pulp chamber was filled with Biodentine without bleaching; and Group-5: Teeth received no intervention (control). The specimens were loaded vertically until root fracture occurred. The data were analysed with Kruskal-Wallis and Dunn tests. There was no significant difference between the fracture resistances of the experimental groups (P > 0.05). However, all experimental groups had significantly lower fracture resistance than the control group (P < 0.05). Neither the tested calcium silicate cements nor the bleaching procedures had a significant impact on fracture resistance values.

Comparative evaluation of different periods of enamel microabrasion on the microleakage of class V resin-modified glass ionomer and compomer restorations: An In vitro study.

CONTEXT: The design of the class V cavity presents a clinical challenge in the field of adhesive dentistry as the margin placement is partially in enamel and partly in dentin, and the trouble associated with this design is the microleakage at the dentinal margin. When these restorations undergo microabrasion due to cosmetic reasons, this trouble aggravates to the significant levels. AIMS: The aim of this study was the measurement of microleakage of class V glass ionomer restorations over two different periods of enamel microabrasion. SETTINGS AND DESIGN: This in vitro experimental study was conducted on 120 class V cavities which had been prepared on the buccal and lingual surfaces of 60 sound human premolars. One-half of the cavities were restored with the resin-modified glass ionomer cement (GIC) (60 cavities) and another half with the compomer (60 cavities). Finishing and polishing were performed. SUBJECTS AND METHODS: Then, the teeth were classified into six groups (n = 20). Microabrasion treatment was performed with Opaluster (Ultradent Product Inc., South Jordan, UT, USA) for 0 (control no treatment), 60 and 120 s. Then, teeth were thermocycled between 5°C and 55°C, immersed in rhodamine B solution (24 h), and sectioned longitudinally in buccolingual direction. Dye penetration was examined with stereomicroscope (×10). Microleakage scores were statistically analyzed. The mean occlusal margin scores and gingival margin scores were compared between all the groups using the Kruskal-Wallis test, Mann-Whitney U-test, Wilcoxon signed-rank test, and post hoc comparison. There was a significant difference between Group 1a, Group 2a, Group 1b, Group 2b, Group 1c, and Group 2c. STATISTICAL ANALYSIS USED: Statistical analysis used in this study was Kruskal-Wallis test, Mann-Whitney U-test, Wilcoxon signed-rank test, and post hoc comparison. RESULTS: The least microleakage scores were observed in occlusal margins of control groups (without microabrasion). Moreover, in both restorations, the microleakage scores in occlusal margins were higher than gingival margins, and compoglass had less microleakage in occlusal and occlusal plus axial walls of class V cavities compared with resin-modified GIC. Whereas, the light-cured glass ionomer had less microleakage in the gingival and gingival plus axial walls of class V cavities when compared with compoglass. CONCLUSIONS: The least microleakage scores were observed in occlusal margins of control groups (without microabrasion). Moreover, in both restorations, the microleakage scores in occlusal margins were higher than gingival margins.

A comparison of various minimally invasive techniques for the removal of dental fluorosis stains in children.

CONTEXT: Dental fluorosis is caused by successive exposure to high concentrations of fluoride during tooth development leading to enamel with lower mineral content and increased porosity. AIMS: The aim of the study was to evaluate and compare the effectiveness of minimally invasive techniques for the removal of dental fluorosis stains in children in vivo. DESIGN: Ninety children in the age group of 10-17 years were selected. MATERIALS AND METHODS: The study sample was equally and randomly divided into three groups; Group 1: In-office bleaching with 35% hydrogen peroxide (HP) activated by light-emitting diode (LED) bleaching unit (35% HP), Group 2: Enamel microabrasion (EM) followed by in-office bleaching with 44% carbamide peroxide gel (EM), Group 3: In-office bleaching with 5% sodium hypochlorite (5% NaOCl). Statistical analysis was done using one-way ANOVA test. RESULTS: Bleaching with 35% HP activated by LED bleaching unit and EM followed by bleaching with 44% carbamide peroxide were equally effective for the removal of dental fluorosis stains in children in vivo. However, bleaching with 5% NaOCl could not completely remove moderate to severe stains. It was effective in removing only mild stains. Bleaching and microabrasion procedures caused slight decrease in tooth sensitivity readings by electric pulp vitality tester which continued to increase over time. However, none of the patients reported sensitivity in their teeth at any point of time. Patients were highly satisfied with the treatment outcome postoperatively but reported slight relapse of color in the three groups. CONCLUSIONS: Bleaching and microabrasion techniques can consider as an interesting alternatives to conventional operative treatment options.

Mega-abrasion: Case History Report on Management of a Fluorosis-Affected Patient.

Different approaches ranging from veneers and crowns to employing the more conservative use of freehand resin composites have been proposed to correct esthetic problems caused by enamel fluorosis (EF). However, the protocol of mega-abrasion followed by microabrasion may be used as an alternative. It is less invasive and can minimize the unesthetic brown-to-whitish spots caused by EF. This article describes an easy and low-cost technique for managing enamel defects in a patient with severe enamel fluorosis.

¿Qué material y técnica seleccionamos a la hora de realizar un blanqueamiento dental y por qué? Protocolo para evitar hipersensibilidad dental posterior / Which is the material and technique do we select when it comes to teeth whitening due to? Protocol to prevent posterior dental hypersensitivity

Los tratamientos blanqueadores actuales pretenden mejorar la calidad estética de la sonrisa de los pacientes, aplicando técnicas y materiales mínimamente invasivos. Existen en el mercado numerosos productos al alcance tanto del público como de los profesionales odontológicos cuya acción se basa en un contacto directo a diente, en una franja de tiempos y en un sistema de aplicación determinado, de materiales como peróxidos de hidrógeno o carbamidas, a diferentes concentraciones. En general, aquellos de concentraciones altas se utilizan ante tratamientos en la clínica dental, siendo menor la exposición del diente en tiempo, el material más ampliamente utilizado en este tipo de blanqueamiento tiende a ser la carbamida. Mientras que para evitar hipersensibilidad dental posterior, daños en la mucosa oral y perioral e incluso el potencial carcinogénico que tienen los blanqueamientos, cada vez se ha pasado a utilizar materiales a baja dosis, de uso diario durante un tiempo determinado, en el hogar por parte del paciente, a base de peróxido de hidrógeno (AU)

Current bleaching treatments aim to improve the aesthetic quality of the patients' smile, applying minimally invasive techniques and materials. There are many products on the market available to both the public and dental professionals whose action is based on a direct contact with a tooth, in a time band and in a specific application system, of materials such as hydrogen peroxide or carbamides, a different concentrations. In general, those with high concentrations are used in dental clinic treatments, with less exposure of the tooth in time, the material most widely used in this type of bleaching tends to be carbamide. Whereas, in order to avoid posterior hypersensitivity, oral and perioral mucosal damage and even the carcinogenic potential of bleaching, the use of low-dose, daily-use materials for a given time in the home has been increasingly used Of the patient, based on hydrogen peroxide (AU)

Management of post-orthodontic white spot lesions: an updated systematic review.

Background/objectives: The management of post-orthodontic white spot lesions is based on remineralization strategies or a minimal-invasive camouflage of the lesions. Aim: The aim of this systematic review was to identify and assess the quality of evidence for the various clinical technologies. Search methods: Four databases were searched for relevant literature published in English between 2011 and 31 October 2015 according to a pre-determined PICO. Only controlled clinical studies were considered. Abstract lists and the selected full-text papers were independently examined by two reviewers and any differences were solved in consensus. The Cochrane handbook and the AMSTAR tool were used for grading the risk of bias. The quality of evidence was rated according to GRADE. Results: Out of 280 identified publications, seven studies on remineralization, micro-abrasion and resin infiltration met the inclusion criteria. Two of them were assessed with low risk of bias. No pooling of results was possible due to study heterogeneity. The quality of evidence for all technologies was graded as very low. Limitations: Only papers published in English with more than 20 adolescents or young adults were considered. Furthermore, a follow-up period of at least 8 weeks was required. The publication bias could not be assessed due to the paucity of included trials. Conclusions/clinical implications: There is a lack of reliable scientific evidence to support re-mineralizing or camouflaging strategies to manage post-orthodontic white spot lesions. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

Direct Composite Restorations to Mask Intrinsic Staining: An Eighteen-Year Follow-Up.

In this case example, the use of direct composite resin allowed for a relatively simple, conservative treatment that provided excellent function and aesthetics, while preserving healthy dental tissue. The importance of continued follow-up and a periodic maintenance and minor repair process will ensure longevity of the restorations, as aesthetics, and the occlusion.

Comparison of different methods of cleaning and preparing occlusal fissure surface before placement of pit and fissure sealants: An in vivo study.

AIM: To evaluate an individual method of cleaning and preparing occlusal fissure surface before placement of pit and fissure sealant and to determine a method for better retention of the sealant. MATERIALS AND METHODS: The present study consisted of 100 young permanent molar teeth divided into four equal groups: Group 1-Brushing only, Group 2-Application of pumice slurry, Group 3-Surface conditioning, and Group 4-Control (without any preparation). Subsequent to fissure preparation, the fissures were etched using 37% phosphoric acid except for Group 3, which was etched using 10% maleic acid for 30 s. The samples were then rinsed for 10 s using air water spray of the three-way syringe and dried using oil-free compressed air with a hand pump air pressure syringe. After ensuring a frosted appearance of the enamel at the fissure entrance, pit and fissure sealants were applied on the surface according to manufacturer's instructions. All the cases were clinically evaluated for retention after 3 months, 6 months, and 12 months of application and the retention rate was assessed based on the criteria proposed by Simonsen. RESULTS: The pumice slurry group and surface conditioning group showed results with 100%, 96%, and 92% complete retention seen at 3 months, 6 months, and 12 months, respectively. CONCLUSION: The pumice slurry group and surface conditioning group showed a significantly higher retention when compared to the brushing group, whereas the control group (without any preparation) showed the least retention when compared to all the other groups.

Diagnosis and conservative treatment of skeletal Class III malocclusion with anterior crossbite and asymmetric maxillary crowding.

A man, aged 28 years 9 months, came for an orthodontic consultation for a skeletal Class III malocclusion (ANB angle, -3°) with a modest asymmetric Class II and Class III molar relationship, complicated by an anterior crossbite, a deepbite, and 12 mm of asymmetric maxillary crowding. Despite the severity of the malocclusion (Discrepancy Index, 37), the patient desired noninvasive camouflage treatment. The 3-Ring diagnosis showed that treatment without extractions or orthognathic surgery was a viable approach. Arch length analysis indicated that differential interproximal enamel reduction could resolve the crowding and midline discrepancy, but a miniscrew in the infrazygomatic crest was needed to retract the right buccal segment. The patient accepted the complex, staged treatment plan with the understanding that it would require about 3.5 years. Fixed appliance treatment with passive self-ligating brackets, early light short elastics, bite turbos, interproximal enamel reduction, and infrazygomatic crest retraction opened the vertical dimension of the occlusion, improved the ANB angle by 2°, and achieved excellent alignment, as evidenced by a Cast Radiograph Evaluation score of 28 and a Pink and White dental esthetic score of 3.

Esthetic rehabilitation with tooth bleaching, enamel microabrasion, and direct adhesive restorations.

The aim of this case report is to report esthetic rehabilitation with combined tooth bleaching, enamel microabrasion, and anterior restoration replacement in a 26-year-old man. Clinical examination showed deficient restorations in the maxillary anterior teeth, significant discoloration of the maxillary left central incisor, and hypoplastic stains affecting the maxillary right lateral incisor. A radiograph of the left central incisor showed satisfactory endodontic treatment, allowing preparation for the walking bleach technique. For 3 weeks, 37% carbamide peroxide in the pulp chamber was renewed every week. In-office bleaching with 35% hydrogen peroxide was also performed on the maxillary teeth. After 21 days, all teeth had been bleached to shade A1. After bleaching was completed, enamel microabrasion of the maxillary right lateral incisor was conducted with 6% hydrochloric acid. In later sessions, microhybrid composite resin restorations were placed in all 4 maxillary incisors. A combination of dental bleaching techniques, enamel microabrasion, and resin restorations was a successful and conservative choice for reestablishing the natural appearance of discolored teeth, improving the self-esteem of the patient.