Clareamento dentário e microabrasão do esmalte de dentes acometidos pela hipomineralização molar incisivo e fluorose: relato de caso

Abstract

This study seeks to present a clinical case that combines different tooth whitening and microabrasion techniques to treat opaque white spot lesions caused simultaneously by dental fluorosis and incisor molar hypomineralization (IMH) in anterior teeth. Female patient, now 18 years old, received several treatments at the Pediatric Dentistry clinic, initially with sealings and restorations on molars, mistaken as enamel hypoplasia. It was later confirmed to be a case of MIH. However, there were opacities in the permanent incisors and canines, characteristic of MIH lesion, in tooth 13, which presented a well-defined white stain, and fluorosis in teeth 11, 12, 21, 22 and 23, which presented diffuse white staining in the third mid-incisal of the buccal surface of the teeth. The treatment started in 2022 included adaptation of the oral environment, vital tooth whitening and microabrasion of the enamel of the affected teeth. For whitening, a combined at-home and in-office technique was used. Preventive measures were adopted to minimize tooth sensitivity, while initial tooth color was recorded at 2M3 and later improved to 2M1 and 2M2 on the upper and lower teeth, respectively. Observing a lesser progression of color in the lower teeth, we opted for an additional in-office whitening session in this region, reaching the 1M2 color. Microabrasion was applied in four clinical sessions, aiming to remove or reduce opacities, but some areas showed less impressive results, especially tooth 13 affected by IMH. The patient demonstrated great satisfaction with the final results. The combination of home and office whitening therapies, associated with enamel microabrasion, proved to be effective in standardizing the color of upper anterior teeth affected by fluorosis. Although it was expected that bleaching techniques would be less effective on the opacity caused by IMH in tooth 13, due to the depth of the stain, the procedures generated notable results overall.