(6) rubber dam;
(7) rubber prophylaxis cup;
(8) Soflex discs (3M);
(9) 18% hydrochloric acid.
Technique
- Perform preoperative vitality tests, take radiographs and photographs (519HFig. 10.1
(a)). - Clean the teeth with pumice and water, wash, and dry.
- Isolate the teeth to be treated with rubber dam, and paint Copalite varnish around
the necks of the dam or vaseline under the dam. - Place a mixture of sodium bicarbonate and water on the dam behind the teeth, as
protection in case of spillage (520HFig. 10.1 (b)). - Mix 18% hydrochloric acid with pumice into a slurry and apply a small amount to
the labial surface on either a rubber cup rotating slowly for 5 s or a wooden stick
rubbed over the surface for 5 s (521HFig. 10.1 (c)), before washing for 5 s directly into an
aspirator tip. Repeat until the stain has reduced, up to a maximum of 10 × 5-s
applications per tooth. Any improvement that is going to occur will have done so by
this time. - Apply the fluoride drops to the teeth for 3 min.
- Remove the rubber dam.
- Polish the teeth with the finest Soflex discs.
- Polish the teeth with fluoridated toothpaste for 1 min.
- Review in 1 month for vitality tests and clinical photographs (522HFig. 10.1 (d)).
- Review biannually checking pulpal status.
Critical analysis of the effectiveness of the technique should not be made
immediately, but delayed for at least 1 month as the appearance of the teeth will
continue to improve over this time. Experience has shown that brown mottling is
removed more easily than white, but even where white mottling is incompletely
removed it nevertheless becomes less perceptible. This phenomenon has been
attributed to the relatively prismless layer of compacted surface enamel produced by
the 'abrosion' technique, which alters the optical properties of the tooth surface.
Long-term studies of the technique have found no association with pulpal damage,
increased caries susceptibility, or significant prolonged thermal sensitivity. Patient
compliance and satisfaction is good and any dissatisfaction is usually due to
inadequate preoperative explanation. The technique is easy to perform for the operator
and patient, and is not time consuming. Removal of any mottled area is permanent