Treatment of Intrinsic Discolouration in Permanent Anterior Teeth Flashcards
What options are available for treatment of intrinsic discolouration in permanent anterior teeth?
- enamel micro abrasion
- bleaching
- vital
- surgery
- home
- non-vital
- inside/outside technique
- walking bleach
- vital
- resin infiltration technique
- ICON
- localised composite restoration
- veneers
- composite
- direct
- indirect
- composite
For what types of discolouration must pre-op records be recorded and why?
- all types of discolouration
- standardisation of recording
- show success of treatment
- patient might not notice clinically
What pre-op records should be taken for discoloured teeth?
- clinical photos
- shade
- of defect
- of background
- sensibility test
- compare before and after
- can be increased
- bleaching
- microabrasion
- can be decreased
- composite
- resin infiltration
- diagram of defect
- radiographs if clinically indicated
- must know periapical status
- check root status
hypoplastic/hypomineralised teeth)
- patient assessment
- VAS
- visual analogue scale
- VAS
What materials are used for enamel microabrasion?
- 18% hydrochloric acid
- pumice
Before starting microabrasion, what safety measures must be carried out?
- PPE must be worn at all times
- patient must wear goggles and a bib
- 18% HCl used
- holes in clothes
- eye injury
- skin and lip burns
- 18% HCl used
- clean teeth with pumice and water
- remove plaque, pellicle, food debris
- petroleum jelly applied to gingiva and lips
- burns heal quickly
- poor aesthetics
- very white colour
- rubber dam placed
- caulking agent around gingival margins
- oroseal
- caulking agent around gingival margins
- sodium bicarbonate guard placed
- sodium bicarbonate mixed with water
- placed on dam behind teeth
- if HCl is dropped it is neutralised
- sodium bicarbonate available
- apply on rinsing
Describe the process of micro abrasion
- dam and wedjets placed
- edges of dam must be inverted
- HCl and pumice slurry applied
- slowly rotating rubber cup
- mixture pressed into tooth
- medium-firm pressure
- 10 x 5 or 5 x 10 second applications
- for each tooth
- wash directly into aspirator each time
- polish teeth
- finest soflex disc
- fluoride varnish application
- Profluorid
- not Duraphat due to yellow colour
- Profluorid
- final polish with toothpaste
After microabrasion, what is the purpose of polishing with a fine so flex disc?
- produces a compacted, relatively prismless layer of surface enamel
- altered optical properties
- intrinsic discolouration less perceptible
- results in a shiny appearance
Is microabrasion more effective at targeting the white or the brown spots of fluorosis?
brown
When might microabrasion be used?
- decalcification after ortho
- fluorosis
- lesions caused by trauma to primary teeth
How many microns of enamel are removed by one session of microabrasion?
100 microns
What kits are available for microabrasion and what variations exist?
- Opalustre/Ultradent
- 6.6% HCl
- silicon carbide particles
- bristled rubber cups
- Prema Kit
- 10% HCl
- fine grit silicon carbide
- neither are as fast as 18% HCl
- safer as reduced acid strength
What are the advantages of microabrasion?
- easily performed
- conservative
- inexpensice
- teeth need minimal post-op maintenance
- fast-acting/results in one session
- removes yellow-brown and white stains
- effective
- results are permanent
- can use before or after bleaching
What are the disadvantages of micro abrasion?
- removes enamel
- HCl acid compounds are caustic
- protective apparatus required
- prediction of treatment outcome is difficult
- must be done in the dental surgery
- cannot be delegated
- sensitive for patients with sensitivity
How is micro abrasion reviewed?
- review 4-6 weeks after micro abrasion
- take post-op photographs
- sensibility tests
- VAS
What post-operative instructions must be given to a patient after microabrasion?
- teeth are dehydrated after procedure
- increased porosity
- will take up whatever is consumed
- do not eat highly coloured food or drink
- 24 hours post op
- if would stain a white t-shirt, avoid
What is the GDC guidance on bleaching of permanent teeth in children?
‘products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person under 18 years of age except where such use is intended wholly for the purpose of treating or preventing disease’