Clinical Efficacy of Antivet Versus Phosphoric Acid and Hydrochloric Acid in Microabrasion

Clinical Efficacy of Antivet Versus Phosphoric Acid and Hydrochloric Acid in Microabrasion Technique for Treatment of Stained Teeth: Randomized Clinical Trial

This clinical trial will be conducted to assess the clinical efficacy of using Antivet cleaning enamel solution or hydrochloric acid and phosphoric acid in microabrasion technique for mild to moderate intrinsic stained teeth.

• Oral prophylaxis will be provided by scaling and polishing of discolored teeth. Next, pre-operative color photographs of the teeth will be taken using a digital camera at a pre-established, standardized setting and focal length.

• tooth/teeth will be isolated with a Nic Tone dental dam and vaseline will be placed on gingival sulcus before placing dental dam.

• patient will be seated at a 45 degree angle.

• 5 drops of Antivet will be placed in the plastic mixing well that comes with the kit.Apply the ANTIVET solution over the tooth's surface using a well condensed cotton pellet (approximately a 3 mm diameter), the cotton pellet will be holded with the pliers that were provided in the kit and the pellet will be rubbed onto the surface in a sweeping motion from cervical to incisal.

• When the cotton pellet is pigmented by the tooth's staining, a new one will be used, the pellet will be saturated with the solution and the procedure will be repeated, this process will be repeated until the stain is removed. This process may take about 1 to 5 minutes per tooth. It should take no longer than 15 minutes from the moment the solution contacts the tooth's surface.

• The tooth must not be dry at any given moment, otherwise the Antivet solution will not work properly.

• Before completing treatment, the last application will be applied with a new pellet and sweeping movements will be made from the distal surface towards the midline of the tooth.

• Once the tooth surface is free of stains, A dry cotton pellet or gauze will be used to remove any excess solution on the enamel.

• In a separate mixing well the NEUTRALIZING SOLUTION will be dispensed, the solution will be applied onto the tooth surface using a brush or microbrush and let it sit for 2 minutes. It is of utmost importance that the neutralizing solution will be applied completely up to the gingival margin.

• the dental dam will not removed until you the process has been completed with the neautralizing agent.

• The last step will be rinsing with water.

• postoperative photographs will be taken after one hour with the same condition as mentioned above.

• Pre- and post-operative photographs of each patient will be shown to clinician other than operator who is unaware of the modality of treatment given to each group of patients. Then he will evaluate a score for improvement in appearance using a visual analog scale.

  ►B. Comparator Group 1

• Oral prophylaxis will be provided by scaling and polishing of discolored teeth. Next, pre-operative color photographs of the teeth will be taken using a digital camera at a pre-established, standardized setting and focal length.

• tooth/teeth will be isolated with a Nic Tone dental dam and vaseline will be placed on gingival sulcus before placing dental dam.

• patient will be seated at a 45 degree angle.

• Equal quantities from phosphoric acid 37% and aluminium oxid 50 micron will be mixed, thick mix will be applied on the affected tooth/teeth and will be rubbed with a rubber cup in a low-speed contra-angle handpiece for 60 seconds of each application. Every patient will be received the entire microabrasion treatment in a single appointment with a maximum of 6 applications. At the end of the treatment, MI Paste (GC America) will be applied for four minutes and then rubber dam will be removed.

• Patients will be instructed not to drink any colored drinks like tea, coffee and cola for 72 hours.

• postoperative photographs will be taken after one hour with the same condition as mentioned above.

• Pre- and post-operative photographs of each patient will be shown to clinician other than operator who is unaware of the modality of treatment given to each group of patients. Then he will evaluate a score for improvement in appearance using a visual analog scale.

C. Comparator Group 2

• Oral prophylaxis will be provided by scaling and polishing of discolored teeth. Next, pre-operative color photographs of the teeth will be taken using a digital camera at a pre-established, standardized setting and focal length.

• tooth/teeth will be isolated with a Nic Tone dental dam and vaseline will be placed on gingival sulcus before placing dental dam.

• patient will be seated at a 45 degree angle.

  • Microabrasion will be conducted using Opalustre (Ultradent Products Inc, South Jordan, UT, USA) will be applied onto the stained areas of the teeth. The microabrasion technique will be performed according to the manufacturer's instructions.
  • A fine-grit diamond abrasive bur will be used initially for 5 to 10 seconds on the stained areas of the tooth to help the microabrasion slurry penetrate into the enamel. This will be followed by drying of the teeth and application of the microabrasion slurry of approximately 1- to 3-mm thickness onto the stained regions of the teeth using rubber prophy cups (OpalCups, Ultradent Products Inc) for 60 seconds.
  • The teeth will be rinsed with water between slurry applications. Depending on the stain reduction, microabrasion will be repeated up to six times during the same appointment to achieve the desired result.
  • At the end of the treatment, MI Paste (GC America) will be applied for four minutes and then rubber dam will be removed.
  • Patients will be instructed not to drink any colored drinks like tea, coffee and cola for 72 hours.
  • postoperative photographs will be taken after one hour with the same condition as mentioned above.
  • Pre- and post-operative photographs of each patient will be shown to clinician other than operator who is unaware of the modality of treatment given to each group of patients. Then he will evaluate a score for improvement in appearance using a visual analog scale.

1. Eligibility Criteria of participants:

   Inclusion Criteria:

   • Patients with moderate to mild stained teeth.
   • 16-50 years.
   • Males or Females.
   • Co-operative patients approving to participate in the study.

   Exclusion Criteria:

   • High caries index with poor oral hygiene.
   • Severe medical complications.
   • Pregnancy.
   • Xerostomia.
   • Lack of compliance.
   • Smokers

2. Eligibility Criteria of teeth:

Inclusion Criteria of teeth:

• Anterior teeth.
• Mild to moderate intrinsic or extrinsic stains.
• Vital and non-sensitive anterior teeth.

Exclusion criteria of the teeth:

• pitted enamel.
• carious teeth.
• Deep lesions.
• Severe periodontal problems.
• Previous treatment for the stained teeth