# Minimally Invasive Dentistry for Pre-Eruptive Enamel Lesions--A Case Series
###### Abstract  
Pre-erruptive enamel lesions occur during tooth formation and include fluorosis, traumatic hypomineralization, and molar incisor hypomineralization. Minimally invasive treatment approaches, such as microbrasion, should be considered for these cases. This article presents a case series of three patients with pre-eruptive enamel defects in esthetically compromised tooth regions which were treated with the microabrasion technique: two fluorosis cases, moderate and advanced, and one hypomineralization case of traumatic etiology. In Cases 1 and 3, there was a significant improvement in esthetics with a total resolution of the enamel defects. However, a slight yellowish coloration may be detected at close observation. In Case 2 (advanced fluorosis), although there was no full resolution of the white spots, there was a clear improvement in esthetics. Microabrasion is a safe and effective, minimally invasive treatment for pre-eruptive enamel lesions. It does not require local anesthesia, it is less destructive than restorative interventions, and allows good esthetic outcomes with no significant postoperative sensitivity. Its efficacy is directly related to the lesions' severity and depth. Although there are some limitations, further improvement can be achieved with dental bleaching. More invasive treatments might be considered if results are still unsatisfactory. Keywords:enamel; fluorosis; hypomineralization; microabrasion; minimally invasive +
Footnote †: journal:to plaque accumulation such as the labial cervical third or around orthodontic appliances. They are chalky-white and most present well-defined outlines and a continuous enamel surface with a slight roughness [1,4]. On the other hand, pre-eruptive lesions occur during tooth formation and include fluorosis, traumatic hypomineralization, and molar incisor hypomineralization, among others [1]. Dental fluorosis results from the excessive fluoride incorporation during amelogenesis. Clinically, it translates as symmetrical lesions of homologous teeth and affects several teeth at once [1]. [PERSON] et al. [5] proposed a classification for fluorosis--the Tooth Surface Index of Fluorosis (TSIF)--by which the teeth are classified from 0 to 7 based on the extent of coronal involvement and clinical appearance. In milder cases (TSIF 1-3) there is a progression of the affected tooth surface area by white enamel defects. At more advanced stages (TSIF > 4) the enamel presents alterations in surface texture, such as pits and fissures, and/or color changes [1,5]. Another example of pre-eruptive white enamel lesions, traumatic hypomineralization, results from periodontal trauma of the deciduous preceding teeth or periapical infections during the maturation stage of the ameloblasts [1]. Clinically, lesions may present with different shapes, outlines, localization, and color, but they mostly appear as punctiform lesions on the incisal third of only one tooth, usually a maxillary anterior tooth, in a unilateral pattern. The opponent mandibular tooth may also be affected [1]. Regarding molar incisor hypomineralization (MIH), it is characterized by the appearance of well-defined white, yellowish, or brownish opacities limited to the occlusal half of at least one of the first permanent molars associated, or not, with lesions of permanent incisors [1]. It may also affect, although less commonly, canine cusps and second permanent molars. Unlike WSLs, fluorosis, and traumatic hypomineralization, the lesions are not located at a subsurface level. Instead, MIH begins at the dentin-enamel junction and progresses outward [1]. Differential diagnosis might be difficult sometimes, but it is essential for the treatment success and improvement in esthetics. Before considering a more invasive restorative approach for these enamel defects, minimally invasive procedures must be considered in an attempt to improve esthetics with minimal tooth structure loss.