Acid pumice microabrasion technique
I originally posted this information as a reponse to a query on GDPUK:
See this link to see this and other comments in context:
Microabrasion Technique
If you see a patient with brown or white mottling especially on central incisors is is an ideal case for acid pumice microabrasion. I really would give it a go. It works best on these types of external stain or fluorosis which are often caused by a trauma to the primary teeth. The brown stains come off particularly well.
You ask if acid pumice is permanent and the answer broadly is yes. You are removing the very top layer of the enamel and this is where the stain or imperfection is located. The problem comes when you use acid pumice on an intrinsic stain which will not respond well; if that’s the case just stop the abrasion procedure having only removed a few hundred micrometers of enamel.
I’ve done a few of these cases in the hospital environment but recently I’ve done a few in practice (BTW both have turned out brilliantly but it’s all about case selection and picking up when a stain is external).
I use the method described in Wellbury’s “Paediatric dentistry” 3rd edition it goes:
• Preop: vitality tests, photographs
• Clean with pumice
• Isolate teeth with rubber dam
• Place bicarbonate of soda and water slurry around teeth (especially palatal to stop erosion where you can’t see) the bicarb neutralizes the acid on contact
• Mix 18% hydrochloric acid with pumice into a slurry, apply small amount for 5 seconds then wash for 5 seconds, you can use slowly rotating rubber cup or even rub with wooden spatula
• Repeat until stain removed. UP to maximum of 10 applications (any improvement will have occurred by this time if it’s going to i.e. the stain is not external)
• Apply non acidulated fluoride drops (colorless) for 3 mins
• Remove dam
• Polish with fine soft flex discs
• Polish teeth with white toothpaste for 1 min
• Review in 1 month; post of vitality tests and photographs
The only variance I have on this technique is that I tend to do the microabrasion over two visits say doing 7 applications the first time then assessing the improvement/ sensitivity before doing the next 3.
As for getting the equipment:The bicarb and pumice are easy and Fluoride drops can be ordered from any pharmacy
18% HCL is only available on special order from the pharmacy so it costs £200 per bottle. Instead I use 10% which is available for about £10. The only difference is that you you can apply the acid slightly longer or for more applications as you will remove less enamel each time. If I use 10% I allow myself 15 applications to the teeth. It has worked really well used like this but I have no evidence to back up using more applications at a lower percentage.
Of course the acid pumice does not always work completey ; but Vital bleaching imho is unlikely to work well for this type of stain. If acid pumice fails or the results are unsatisfactory my ladder of reconstruction would be
• Acid pumice
• Localized stain removal/ beveling and localised composites
• Direct Composite veneers
• Porcelain veneers (when pt older and pulps are smaller)
I must mention that is is really important to make sure the patient does not eat heavily coloured fods for the first 2 weeks after the acid pumice (e.g. curry, sweets, red wine).
The newly exposed calciumhydroxyapetitie will be more likely to pick up stain before it becomes more mineralised with fluoride.
Apparently the teeth can come back looking blue or green if the patient likes particually coloured sweets. Not that I’ve seen it myself but the idea is terrifying enough for me to flag it up!
