Enamel Microabrasion

This is a young university female student who was very unhappy with the appearance of her teeth. The white spots started to appear during her orthodontic treatment. This happens when teeth with braces aren’t cleaned very well, leaving a lot of bacteria growing around the braces. The white areas are acid-damaged enamel, the acid being produced by the bacteria on the teeth. The yellow areas are the natural colour of her teeth. She wanted a simple solution, to have a brighter and more even smile.

After examination and discussions with her, we decided that a three-step approach was needed, with Enamel Microabrasion, Aesthetic Contouring and, finally, Tooth Whitening to produce the most pleasing result for the least effort and cost.

When is Enamel Microabrasion performed?

Many people have discoloured enamel - usually white spots or patches, but it can be yellow/brown areas - on the surface of the tooth, like a coat of paint. In this case, acid damaged enamel was the cause, but genetics would be the most common cause for other people. Enamel Microabrasion helps to improve the appearance of these teeth by polishing off the superficial discolourations.

What is Enamel Microabrasion?

Enamel Microabrasion is the delicate, precise, harmless and painless removal of a very, very thin layer of discoloured enamel to produce a more evenly-coloured tooth surface.

What does the treatment procedure involve?

Depending on what is needed, Microabrasion can be performed alone or as part of a multi-step procedure. To achieve the best outcome, Microabrasion is performed first. This improves the surface of the teeth but not the shape. Quite commonly (but not always), Aesthetic Contouring is required as well to improve the shape of the teeth. Finally, Tooth Whitening may be required at some point to enhance the final result, if the patient’s natural tooth colour is too dark. Microabrasion done to a high standard is completely painless and harmless with no local anaesthetic required. The teeth become smoother, stronger and more aesthetically pleasing

Is there any after care following Enamel Microabrasion?

The patient is encouraged to use Tooth Mousse, which is rich in minerals (the ‘building blocks’ of teeth). There is a short window of opportunity after the Microabrasion for these minerals to penetrate the enamel more easily and strengthen it. For the rest of that day, drinking plain water or plain milk is fine, however, anything else should be through a straw as the teeth can stain easily during this time. The next day the teeth are back to normal.

Limitations of enamel Microabrasion?

Enamel Microabrasion can dramatically enhance a person’s smile by harmonising the tooth colour. It always works, however, it cannot always completely eliminate white/yellow/brown areas where the discolouration is more deeply ingrained. There is no way of knowing precisely how deep the discolouration goes and therefore how much improvement there will be. It will at least reduce the size of the ingrained area and so the appearance will always be better. Enamel Microabrasion is a very conservative and superficial procedure and does not harm the enamel. Removing deeper discolouration would damage the enamel and require a filling to repair the damage.

How long do the results last?

Enamel Microabrasion is permanent. The discoloured enamel doesn’t come back.

Tooth Coloured Fillings

What are Tooth Coloured Fillings?

Tooth Coloured Fillings, or composite resins, are used to replace missing tooth structure - to treat decay, replace old defective fillings or restore chipped and worn teeth. The material is a mixture of resin (plastic) and small glass particles (silica), which can be shaped by hand before it is cured with blue light. It is then shaped and polished so it conforms to the desired tooth shape to fully restore the lost tooth structure.

What are the advantages of Tooth Coloured Fillings?

The advantage of using Tooth-coloured fillings are that they closely mimic natural tooth structure to restore function without compromising the strength of your teeth or the quality of your smile and have excellent aesthetics. They are superior to traditional metal fillings which can tarnish and darken tooth structure overtime and very commonly crack and break, requiring much more extensive treatment.

What are the disadvantages of traditional Tooth Coloured Fillings?

There are two major problems with traditional Tooth Coloured Fillings, which is associated to the fact that all composite resins shrink when they set. The first problem is that the traditional approach to placing Tooth Coloured Fillings can create massive shrinkage and significant stress on the tooth as a result. This can cause the tooth to fracture which only compounds the problem. The other major problem with shrinkage of composite resins is that this can create microscopic gaps between the filling and the tooth. Bacteria can easily find their way into these gaps which facilitates further decay and requires replacement of the filling. If the filling is replaced in this traditional technique then the same problem can recur and the cycle repeats itself resulting in further destruction of tooth structure.

So what’s the solution?

By using the leading composite resin and bonding technology, it is possible to completely seal tooth structure with an air-tight/water-tight seal and a minimal and harmless amount of shrinkage. For this to occur, a specific technique must be used. It’s called a multi-layered, multi-coloured, bonded composite resin technique. However, this technique is rarely performed as it requires precision, patience, time to complete and requires a high skill level. The end result though, significantly reduces stress on the tooth, produces a superb aesthetic result and is very long lasting.

What does the treatment procedure involve?

With modern technology, some things can be done comfortably with no local anaesthetic required. Depending on your situation, the appointment may begin with local anaesthetic which is administered comfortably and painlessly with our unique technique. This ensures that the teeth to be worked on are totally, peacefully asleep with no sensitivity. Most of the time, we use the rubber dam (a very thin, rubber shield) to isolate some of the teeth in the area. It acts like a ‘rain coat’ to keep everything out of your mouth - no water, no sucker, no powdered filling material - no mess. The inability to relax is the only thing that can make you uncomfortable, so we coach you on the best way to relax. The decay or defective dental work is removed and the tooth surfaces are sandblasted spotlessly clean, a very important first step in bonding process to achieve an ‘air-tight, water-tight seal. The best bonding agent is applied to seal the tooth and composite resin is placed in multiple steps and light-cured (set) with different light intensities, to minimise shrinkage and stress on the tooth. Finally the resin surface is contoured, shaped and polished to a smooth finish which mimics an natural tooth.

What are the limitations of Tooth Coloured Fillings?

Composite resins, like other filling materials, are not suitable to restore very large cavities. When there is significant loss of tooth structure, a crown offers better function and protection of the remaining tooth structure. However, composite resins can be an interim solution, until a crown can be placed. If the delay is not too long, the material can be left in the tooth when the crown is done.

How long do Tooth Coloured Fillings last?

Composite resins restorations are very technique sensitive. However, if done with the technique outlined, they can have a very successful, long-term outcome with no finite lifespan, if the teeth are looked after appropriately. Longevity is compromised by 2 main factors - lack of proper tooth cleaning (resulting in decay of the tooth) and tooth grinding during sleep (which can break teeth). We encourage regular check-ups and hygiene sessions to pick up any problems before they become serious and we teach you the proper cleaning techniques necessary to achieve low maintenance teeth. Normal chewing is not normally a problem, however, if any significant tooth grinding is present, your teeth must be protected during sleep or the longevity of your dentition in general is compromised and they require greater maintenance as you get older.

What are Preventative Resin Restorations?

A preventative resin restoration is a type of Tooth Coloured Filling, or composite resin, that is used to treat and prevent more decay in the fissures and grooves on the biting surface of molar teeth. Genetically, some people have teeth with have deep fissures that retain plaque bacteria. When this bacteria can’t be cleaned away this results in decay. Preventive Resin Restorations are a minimalist, non-invasive way of cleaning out the deep fissures by removing only the decay and the unhealthy tooth structure. The bonded composite resin is then placed as described above. The result is a more cleanable tooth surface. This is commonly used in kids or young adults, preferably soon after back teeth erupt and before too much decay sets in. It’s then a simple and very safe procedure that often requires no local anaesthetic.

Fissure Seals vs Preventative Resin Restorations

Fissure sealing is the traditional method of preventing decay in the grooves on the biting surfaces of molar teeth. There is no removal of decay and a flowable resin is placed over the decay in the fissures and set. We stopped doing them here many years ago, because the failure rate is very high (about 90% failure at 5 years). However, the failure rate for properly done Preventive Resin Resin Restorations is not zero, but it’s very low.

Maryland Bridges

This bright 19 year old girl has always tried to hide her smile because she was missing a front tooth. She had been wearing a denture which didn’t match very well and it had been an inconvenience socially, especially on starting university. She also didn’t like the same tooth on the other side because it is small in comparison to the missing tooth.

After thorough examination and discussion, we decided that the best approach was a ‘bonded Maryland Bridge’ instead of an implant, to replace the missing tooth and a porcelain veneer to correct the shape of the small tooth on the other side.

What is a Maryland Bridge?

A Maryland Bridge replaces the missing tooth by bonding a porcelain tooth to the adjacent teeth. To do this, the inside surface of the adjacent tooth is minimally prepared, to which a thin shell of porcelain is bonded in order to hold the porcelain tooth in place.

It is is usually a superb option for treating missing lateral incisor as in this case.

Why is an implant less suitable in this situation?

An implant is anchored into the jaw and has a tooth attached on top. It requires relatively invasive surgery to place it and is also relatively expensive. Because she is young, over time her upper jaw, teeth, gums and face will continue to grow downwards. However, an implant does not grow downwards along with the rest of the teeth and stays at its original level, which makes the implant tooth looks like it’s sinking into the gum. Due to this, it will need to be replaced eventually and it will become a very long tooth which looks wrong.

Advantages for Maryland bridge:

• Relatively simple and minimally invasive procedure

• Avoids implant surgery

• Much less expensive than an implant (about a third of the cost of an implant)

• The Maryland Bridge moves with the other teeth over time and remains in harmony with them. It doesn’t need to be replaced because it looks ‘wrong’

• Long lasting aesthetics

Disadvantages for Maryland bridge:

• The need to minimally prepare the canine to hold the Maryland bridge (but much, much less invasive than implant surgery)

To achieve the natural end result, she did tooth whitening, minor aesthetic contouring and micro-abrasion to correct the colour and white spots on her front teeth. The smaller tooth on the other side was lengthened by a minor gum-lift. Finally, she received the Maryland Bridge and the porcelain veneer. She also wears a night guard to protect her teeth from grinding, which also protects the porcelain work. She was very pleased, knowing that the natural results are long lasting and will provide decades of good service, with proper care.