Sunteți pe pagina 1din 11

2ESTORATIVE$ENTISTRY

)AIN!0RETTY
2OGER0%LLWOOD 0AUL!"RUNTONAND!MIN!MINIAN

6ITAL4OOTH"LEACHINGIN$ENTAL
0RACTICE0ROFESSIONAL"LEACHING
!BSTRACT!SDENTALHEALTHIMPROVES WITHTHECONCURRENTDROPINTHEPROVISIONOFBASICRESTORATIVECARE PATIENTSARENOWASKINGTHEIR
DENTISTSTOPROVIDEAESTHETICTREATMENTSRATHERTHANTHETREATMENTOFDISEASE4OOTHBLEACHINGISONESUCHTREATMENTTHATISFREQUENTLY
DESCRIBEDINCONSUMERMAGAZINESANDTELEVISIONSHOWS DRIVINGCONSUMERINTERESTINTHIS APPARENTLY BENIGNTHERAPY4HISTHREE PARTSERIES
DEMONSTRATESTHETECHNIQUESTHATCANBEEMPLOYED WITHINTHEDENTALPRACTICEORUNDERTHESUPERVISIONOFACLINICIAN THOSESYSTEMSTHAT
CANBEBOUGHTBYPATIENTSOVERTHECOUNTERAND FINALLY ADISCUSSIONOFTHEBIOLOGICALEFFECTSOFPEROXIDE CONTAININGSOLUTIONSANDTHELEGAL
POSITIONONSUCHPRODUCTSINTHE5+
)NTHISSECTION WEWILLDESCRIBETHECOMMONMETHODSBYWHICHTEETHCANBEBLEACHED EITHERBYTHECLINICIANDIRECTLY ORUNDER
HISHERSUPERVISIONBYTHEUSEOF@ATHOMEKITS%FFICACYANDSAFETYISSUESWILLBEDESCRIBED
#LINICAL2ELEVANCE#LINICIANSSHOULDBEABLETODISCUSSTHEMERITS RISKSANDLIKELYSUCCESSOFAVARIETYOFBLEACHINGTREATMENTSWITHTHEIR
PATIENTSAND INDOINGSO ASSISTINTHEPROCESSOFOBTAININGINFORMEDCONSENT
$ENT5PDATE 
4HENATIONSDENTALHEALTHISCHANGING AND
THEREISASHIFTINTHE5+DENTALPARADIGM
FROMTHETREATMENTSOLELYOFDISEASENOWTO
INCLUDETHEPROVISIONOFAESTHETICSERVICES
3UCHSERVICESAREINCREASINGLYDEMANDEDBY
OURPATIENTSANDRANGEFROMTHEPROVISION
OFTOOTH COLOUREDRESTORATIVEMATERIALS
VENEERS CERAMICCROWNS ORTHODONTICSAND
OFCOURSE TOOTHWHITENING

)!0RETTY "$3(ONS -3C 0H$ -&$3


2#3%D 3ENIOR,ECTURERIN2ESTORATIVE
$ENTISTRYAND2ESEARCH&ELLOW 5NIVERSITY
OF-ANCHESTER 20%LLWOOD "$3 -3C
-$3 0H$ 3ENIOR,ECTURERIN$ENTAL
0UBLIC(EALTH $ENTAL(EALTH5NIT
5NIVERSITYOF-ANCHESTER 0!"RUNTON
0H$ -3C "#H$ &$3 2EST$ENT 2#3%D
0ROFESSORAND(ONORARY#ONSULTANTIN
2ESTORATIVE$ENTISTRY 5NIVERSITYOF,EEDS
AND!!MINIAN "$3 -3C -&$32#03
-2$ 2#30ROS ,ECTURERIN2ESTORATIVE
$ENTISTRYAND3PECIALISTIN0ROSTHODONTICS
5NIVERSITYOF-ANCHESTER -ANCHESTER 5+

$ENTAL5PDATE

#AUSESOFTOOTHDISCOLORATION
4HEREISAPLETHORAOFCAUSESOF
TOOTHDISCOLORATIONAND COMMONLY STAINS
ORDISCOLORATIONSAREDIVIDEDINTOTHOSEOF
EXTRINSICORINTRINSICORIGIN!LSO AFURTHER
CLASSIFICATIONOFINTERNALIZEDSTAINHASBEEN
SUGGESTED!NYGIVENTOOTHCANEXHIBIT
EITHERONE ORACOMBINATION OFTHESE)T
ISIMPORTANTTOIDENTIFYTHECAUSEOFTOOTH
DISCOLORATIONPRIORTOCOMMENCEMENTOF
TREATMENTASTHESUCCESS OROTHERWISE OF
SUCHPROCEDURESISHEAVILYDEPENDENTON
CORRECTDIAGNOSIS)TISALSOIMPORTANTTO
NOTETHAT INTHEAUTHORSEXPERIENCE MANY
PATIENTSWILLPRESENTFORTOOTHWHITENING
WHENTHEREISNOOBVIOUSDISCOLORATION
THEPATIENTMERELYWISHINGTOHAVE@WHITER
TEETH
#OMMONCAUSESFORTOOTH
DISCOLORATIONARESHOWNIN4ABLE WITH
EXAMPLESIN&IGURESAND$ISCUSSIONWITH
THEPATIENT ATHOROUGHHISTORY INCLUDING
ADIETANDSOCIALHISTORY CANHELPINTHE
DETERMINATIONOFTHECAUSEOFEXTRINSIC
STAINING&OREXAMPLE HEAVYTEACOFFEEWINE
DRINKERSAREESPECIALLYPRONETOEXTRINSIC

STAINING ASARETHOSEWHOSMOKECIGARETTES
0ATIENTEDUCATIONWITHREGARDTOTHECAUSE
OFTHEIRTOOTHSTAININGISLIKELYTOINCREASE
THESUCCESSOFTHETREATMENT ESPECIALLYIF
SUCHHABITSAREREDUCEDPOST OPERATIVELY
4HEPROVISIONOFAWHITER BRIGHTERSMILE AND
THEDESIRETOKEEPITTHATWAY CANPROVETO
BEAPOWERFULMOTIVATOR
)NTRINSICDISCOLORATIONIS
THERESULTOFACHANGETOTHESTRUCTURAL
FORMORCOMPOSITIONOFTHEDENTALHARD
TISSUES4HEREAREANUMBEROFMETABOLIC
DISEASESANDSYSTEMICFACTORS ASWELL
ASPHARMACEUTICALPRODUCTS WHICHCAN
AFFECTTHEDEVELOPINGDENTITION%XTRINSIC
DISCOLORATIONISPRESENTONTHESURFACE
OFTHEENAMEL ORACQUIREDPELLICLE ANDIS
GENERALLYSEPARATEDINTOAMETALLICORNON
METALLICORIGIN)NTERNALIZEDSTAINSARETHOSE
INTRINSICSTAINSTHATOCCURSUBSEQUENTTO
DENTALDEVELOPMENT ENTERINGTHEDENTAL
HARDTISSUESTHROUGHENAMELDEFECTSOR
THENATURALLYPOROUSSURFACEOFEXPOSED
DENTINE3UCHDEFECTSCANBEDEVELOPMENTAL
ORACQUIRED
)TISIMPORTANTTODETERMINE
*UNE

2ESTORATIVE$ENTISTRY

)NTRINSIC
!MENABLETOBLEACHINGTREATMENT9OR8










9
9
8
8
9
9
8
9
8
9

!LKAPTONURIA
#ONGENITALERYTHOPOIETICPROHYRIA
!MELOGENESISIMPERFECTA
$ENTINOGENESISIMPERFECTA
4ETRACYCLINESTAINING
&LUOROSIS
%NAMELHYOPLASIA
0ULPALHAEMORRHAGICPRODUCTS
2OOTRESPORTION
!GEING

%XTRINSIC
.ON METALLIC




9
9
9
9
9

$IETRYCOMPONENTS
"EVERAGES
4OBACCOnSMOKELESSORTRADITIONAL
-OUTHWASHES
-EDICAMENTS

9
9
9
9
9

#OPPER
)RON
0OTASSIUMPERMANGANATE
3ILVERNITRATESALT
3TANNOUSFLUORIDE

%XTRINSIC
-ETALLIC




)NTERNALISED

9

!SPEREXTRINSIC

4ABLE#AUSESOFTOOTHDISCOLORATION

THECAUSESOFDISCOLORATIONANDTHEN
ASSESSWHICHTREATMENT ORCOMBINATION
OFTREATMENTS CANBEEMPLOYED&OR
EXAMPLE INTHESEVERECASEOFTETRACYCLINE
STAINING SHOWNIN&IGUREE ITISUNLIKELY
THATBLEACHINGWILLPRODUCEANACCEPTABLE
AESTHETICRESULT HOWEVER THEUSEOFA
PEROXIDEBLEACHINGSYSTEMPRIORTO FOR
EXAMPLE THEPROVISIONOFPORCELAINVENEERS
MAYIMPROVETHEOUTCOMEOFTHETREATMENT
BYREDUCINGTHENEEDFOROPAQUINGAGENTS

)MPORTANCEOFTOOTHCOLOUR
!NUMBEROFINDICESINCLUDETHE
TERM@AESTHETICWITHINTHEIRDEFINITIONOF
ORALHEALTH MOSTPARTICULARLYTHOSEOFTHE
*UNE

7ORLD(EALTH/RGANIZATION4HEPRESENCEOF
NOTICEABLEDISCOLORATIONOFTHETEETHCANBE
APHYSICALHANDICAPTHATCANIMPACTUPONA
PERSONSSELF IMAGE SELF CONFIDENCE PHYSICAL
ATTRACTIVENESSANDEMPLOYABILITY!STUDY
ASSESSINGTHEIMPACTOFTEETHONPERSONAL
AESTHETICSATISFACTIONFOUNDTHATDENTAL
VARIABLESINCLUDINGTOOTHCOLOUR WERE
MOREIMPORTANTTHANORTHODONTICVARIABLES
SUGGESTINGTHATTHEAPPEARANCEOFTHE
TEETHWASAGREATERCONTRIBUTINGFACTORTO
ANAESTHETICSMILETHANTHEIRPOSITIONWITHIN
THEARCH)TISTHEREFOREWRONGSIMPLYTO
DISMISSSUCHPATIENTCONCERNSAS@TRIVIAL
!FURTHERSTUDY INWHICH
PATIENTSWEREQUESTIONED FOUNDTHATTHE
APPEARANCEOFTHEDENTITIONWASMORE

IMPORTANTTOWOMENTHANMEN ANDTHAT
TEETHPLAYEDAMOREIMPORTANTROLEIN
AESTHETICDEFINITIONTOYOUNGERRATHERTHAN
OLDERPATIENTS4HEPERCEPTIONTHATWHITE
TEETHWEREMOREBEAUTIFULDECREASEDWITH
INCREASINGAGE ALTHOUGHMANYPRACTITIONERS
WILLTESTIFYTOTHENUMBEROF6ITA!SHADE
DENTURESTHATTHEYPRESCRIBE

-ETHODSOFTOOTHWHITENING
USINGPEROXIDEANDRELATED
PRODUCTS
)TISOUTWITHTHESCOPEOF
THISPAPERTODESCRIBETHEMULTITUDEOF
TREATMENTOPTIONSFORDISCOLOUREDTEETH FOR
EXAMPLEDIRECTANDINDIRECTRESTORATIONS
)NSTEAD THEMETHODSBYWHICHPEROXIDE
ANDPEROXIDE RELATEDPRODUCTSCANBE
APPLIEDTOTHEDENTITIONWILLBEILLUSTRATED
-ETHODSDESCRIBEDWITHINTHISPARTOFTHE
SERIESAREASFOLLOWS
(OMEBLEACHINGUNDERTAKENBYTHE
PATIENTATHOME MOSTFREQUENTLYWITH
CUSTOMTRAYS
!SSISTEDBLEACHINGANIN PRACTICE
SUPPLEMENTTOHOMEBLEACHING
0OWERBLEACHINGAPRACTICE ONLYTHERAPY
WITHHIGHLEVELSOFHYDROGENPEROXIDE
WHICHISOFTENACTIVATEDBYALIGHTOROTHER
MECHANISM
&IGUREILLUSTRATESANEXAMPLEOF
ARANGEOFPRODUCTSOFFERINGTHESEOPTIONS
/NLYTREATMENTSFORVITALTEETHWILLBE
DESCRIBED ALTHOUGHMANYOFTHESYSTEMS
DESCRIBEDCANBEUSEDASADJUNCTSTOTHE
INSIDE OUTSIDEORWALKINGBLEACHMETHODS
2EADERSAREREFERREDTOTHEEXCELLENTARTICLE
BY0OYSERETAL
(OMEBLEACHING

$ENTISTSHAVEBEENBLEACHING
TEETH USINGONEMETHODORANOTHER FOROVER
YEARS(AYWOODAND(EYMANNWERE
THEFIRSTTODESCRIBETHEHOMEBLEACHING
METHOD WHICHHASBEENREFINEDBUT
REMAINSFUNDAMENTALLYTHESAME(OME
BLEACHINGHASMANYADVANTAGESOVERTHE
OTHERMETHODSINCLUDING
6ERYLITTLECLINICIANTIMEINVOLVED
5SUALLYMOREECONOMICALTHANPOWEROR
ASSISTEDBLEACHING
0ATIENTSCANBLEACHTHEIRTEETHATTHEIR
CONVENIENCEWITHSOMECHOOSINGTO
UNDERGOBLEACHINGONLYATNIGHT WHILE
OTHERS PREFERRINGAMOREEXPEDITIOUSRESULT
$ENTAL5PDATE

2ESTORATIVE$ENTISTRY

&IGURE%XAMPLESOFINTRINSICTOOTHDISCOLORATIONA ENAMELHYPOPLASIAB TRAUMAC MILDFLUOROSIS


D SEVERE FLUOROSIS E SEVERE TETRACYCLINE STAINING F MILD TETRACYCLINE STAINING G DENTINOGENESIS
IMPERFECTAH AMELOGENESISIMPERFECTAI PULPALHAEMORRHAGICPRODUCTJ AGEING WITHEXPOSUREOF
ROOTSURFACES

$ENTAL5PDATE

MAYALSOCHOOSETOWEARTHEIRBLEACHING
TRAYDURINGTHEDAY
0ATIENTSMAYFINDTHERUBBERDAM
APPLICATIONINVOLVEDINPOWERBLEACHING
UNCOMFORTABLE ALTHOUGHTHEUSEOFRESIN
TISSUEPROTECTORSMAYALLEVIATETHESE
PROBLEMS
4HEREARE OFCOURSE SOMEDISADVANTAGES
0ATIENTSMUSTENGAGEINTHEIRTREATMENT
ANDWEARTHEIRBLEACHINGTRAYS
-ANYPATIENTSWANTINSTANTRESULTSAND
WILLREQUESTTREATMENTSTHATTAKEHOURS
RATHERTHANWEEKS
(OMEBLEACHINGPRODUCTSARE
GENERALLYFORMULATEDFROMCARBAMIDEUREA
PEROXIDE USUALLYINTHECONCENTRATIONRANGE
OF ALTHOUGHSOMEMANUFACTURERS
PROVIDELOWDOSEHYDROGENPEROXIDE
SYSTEMSAROUND 2ESEARCHSUGGESTS
THATTHECONCENTRATIONOFTHEPEROXIDE
HASLITTLEEFFECTONOVERALLSHADECHANGE
BUTITWILL INHIGHERDOSES DECREASETHE
TIMENEEDEDTOACHIEVECHANGE/THER
FACTORS SUCHASTHEVISCOSITYOFTHEMATERIAL
ANDTHEADAPTATIONOFTHETRAY APPEARTO
BEASIMPORTANT!SWILLBEDISCUSSEDIN
MOREDETAILINTHEFINALPAPER THESALEOF
CARBAMIDEORHYDROGEN PEROXIDEPRODUCTS
FORVITALBLEACHINGISILLEGALINTHE5+
/NEMANUFACTURER 5LTRADENT/PTIDENT
5+ ISPROVIDINGANON PEROXIDEPRODUCT
/PALESCENCE300LUS WHICHCONFORMSTO
THECOSMETICDIRECTIVEASITCONTAINSONLY
SODIUMPERBORATE)TISIMPORTANTTONOTE
THATSODIUMPERBORATE INTHEPRESENCEOF
WATER ISCONVERTEDTOHYDROGENPEROXIDE
ALBEITTOALESSERDEGREETHANCARBAMIDE
PEROXIDE&IGURE !LLCARBAMIDEPEROXIDE
PRODUCTSSHOULDBESTOREDREFRIGERATED
UNTILUSE ANDPATIENTSSHOULDBEINSTRUCTED
TOKEEPTHEIRPRODUCTSINTHEFRIDGE BUT
LEAVETHECURRENTLYUSEDSYRINGEATROOM
TEMPERATURE TOPREVENTANYSENSITIVITY
ASSOCIATEDWITHCHILLEDGELS
(OMEBLEACHINGWILLGENERALLY
BEOFUSETOPATIENTSWITHMILDDISCOLORATION
GENERALLYUNIFORMLYYELLOWORYELLOW
BROWN ORTHOSEWHOSIMPLYREQUIRE
LIGHTERTEETHWITHOUTHAVINGANYOBVIOUS
DISCOLORATION4HESYSTEMGENERALLY
REQUIRESTWOAPPOINTMENTSWITHTHREEOR
FOURREVIEWS DEPENDINGONTHEDEGREEOF
CHANGEREQUIRED
0ROCEDURE

!FULLHISTORYANDEXAMINATION
*UNE

2ESTORATIVE$ENTISTRY

&IGURE  %XAMPLES OF EXTRINSIC TOOTH DISCOLORA


TIONA PIPESMOKINGB CHLORHEXIDINEUSAGEC
BACTERIALPRODUCTS

&IGURE%XAMPLEOFASINGLE BRANDEDRANGEOFPRODUCTSOFFERINGATHOME ASSISTEDANDPOWERBLEACHING


WITHCONTENTSANDPRESENTATIONOFEACHOFTHEBLEACHINGPRODUCTS

*UNE

SHOULDBECONDUCTEDSUPPORTEDBYANY
SPECIALINVESTIGATIONSINDICATED ANDTHE
AETIOLOGYOFTHEDISCOLORATIONESTABLISHED
!CLINICALPHOTOGRAPHSHOULDBETAKEN
DEMONSTRATINGTHE@BEFOREAPPEARANCE
3OMEDENTISTSFINDITUSEFULTOINCLUDEA
SHADEGUIDETABMATCHINGTHECURRENT
PRESENTATIONWITHINTHEPHOTOGRAPH!
THOROUGHSCALEANDPROPHYLAXISSHOULDBE
UNDERTAKENTOREMOVEANYGROSSEXTRINSIC
STAINS)FANYRESTORATIONSAREPRESENTON
THETEETHTOBEBLEACHEDTHEYSHOULDBE
CHECKEDFORMARGINALINTEGRITY!NYFAILING
RESTORATIONSSHOULDBEREPLACEDATTHISTIME
ALTHOUGHTHEYSHOULDONLYBECONSIDERED
ASPROVISIONALASTHECHANGEINTOOTHSHADE
WILLREQUIREFURTHERRESTORATIONSTOBEPLACED
FOLLOWINGCOMPLETIONOFTHETREATMENT
'ENERALLY THERESTORATIONSCAN
BE@REPAIREDBYREMOVINGAPPROXIMATELY
MMFROMTHEFACIALSURFACEANDANEW
LAYEROFCOMPOSITEADDEDTOMATCHTHENEW
TOOTHSHADE !NUMBEROFMANUFACTURERS
NOWPROVIDESHADEGUIDESANDMATCHING
COMPOSITESTOREFLECTBLEACHEDENAMEL
SHADESEG4ETRIC&LOW 6IVADENT 53! 
3HOULDPATIENTSPRESENTWITH
NUMEROUSCOMPOSITERESTORATIONS WHETHER
FAILINGORNOT ITMUSTBEACCEPTEDBYTHE
PATIENTTHATTHESEWILLNEEDTOBEREPLACED
FOLLOWINGBLEACHING4HEEXPENSEOFTHIS
INCOMBINATIONWITHBLEACHING MAYDIRECT
ATREATMENTPLANTOWARDSANINDIRECT
APPROACH SUCHASVENEERS!GREEMENT
BETWEENTHECLINICIANANDTHEPATIENTIS
ESSENTIALINTHISPROCESS
!LGINATEIMPRESSIONSSHOULD
NOWBETAKENOFTHOSEARCHESTHATARETOBE
BLEACHED)MPRESSIONSAREPOUREDINSTONE
ANDAMODELISPRODUCEDANDTRIMMED
4HEREISCONFLICTINGEVIDENCEASTOWHETHER
ORNOTRESERVOIRSAREESSENTIALFOREITHER
INCREASEDPATIENTCOMFORT ORTOINCREASE
THEVOLUMEOFBLEACHINGMATERIALAVAILABLE
/NESTUDY USINGACROSS ARCHDESIGNWITH
ORWITHOUTRESERVOIRS FOUNDTHATTHEREWAS
NODIFFERENCEINEITHERBLEACHINGEFFICACY
ORGINGIVALSENSITIVITY)FARESERVOIRIS
REQUIREDANDTHISISUSUALLYSPECIFIEDIN
THEMANUFACTURERSINSTRUCTIONS ITCANBE
CREATEDUSINGALIGHT CUREDRESINMATERIAL
SUCHAS,#"LOCK/UT2ESIN5LTRADENT
/PTIDENT 5+ !BOUTMMOFMATERIALIS
APPLIEDTOTHETEETH-OSTLABORATORIES
WILLPLACETHEMATERIALMMSHORTOFTHE
GINGIVALMARGININORDERTOPREVENTGINGIVAL
DAMAGEANDLEAKAGEOFTHEMATERIAL
$ENTAL5PDATE

2ESTORATIVE$ENTISTRY

&IGURE  A 4HE FORMATION OF HYDROGEN PEROX


IDE FROM SODIUM PERBORATE B 4HE FORMATION OF
HYDROGEN PEROXIDE FROM CARBAMIDE PEROXIDE C
4HE PRESENTATION OF /PALESCENCE 30 n A SODIUM
PERBORATECONTAININGWHITENINGPRODUCT

&IGURE0REPARATIONOFTHEMODELA THEMAXILLARYCASTTRIMMEDCORRECTLYFORTRAYPRODUCTIONB BLOCK


RESINISAPPLIEDTOTHETEETHC THISISTHENLIGHTCUREDD SOFTTRAYMATERIAL THISISOFTENSUPPLIEDWITH
THEBLOCKRESINKITSE COMPLETEDBLOCK OUT NOTETHATTHERESINEXTENDSTOTHEGINGIVALMARGINENSUR
INGTHATTHECERVICALTHIRDISADEQUATELYBLEACHEDF PLACEDINVACUUMFORMER.OTETHEUSEOFREGULAR
DENTALWAXISNOTRECOMMENDEDASTHISWILLBELOSTDURINGTHETRAYPRODUCTIONPROCESS(EATRESISTANT
WAXESAREAVAILABLE

$ENTAL5PDATE

(OWEVER THECERVICALTHIRDOFENAMELIS
GENERALLYTHEDARKESTANDTHISPRACTICE
MAYREDUCETHEEFFECTIVENESSOFTREATMENT
ESPECIALLYINTHOSEPATIENTSCONCERNED
ABOUTCERVICALDARKNESS7ITHTHEHIGH
VISCOSITYGELSANDLOWPEROXIDECONTENTS
OFTODAYSBLEACHINGSOLUTIONS RESERVOIRS
CANBEEXTENDEDTO BUTNOTBEYOND THE
GINGIVALMARGININSUCHCASES#AREFUL
NOTESTOTHELABORATORYAREESSENTIAL
&IGURE 
&OLLOWINGPREPARATIONOFTHE
MODEL THETRAYISNOWPRODUCEDUSING
AVACUUM FORMER!NUMBEROFDENTAL
SUPPLYCOMPANIESAREPROVIDINGTHESE
DEVICESFORUSEINPRACTICEEG5LTRA
&ORM 5LTRADENT /PTIDENT 5+ ANDTHOSE
CLINICIANSCONSIDERINGCONDUCTINGA
LARGENUMBEROFBLEACHINGTREATMENTS
ANDORTHEPROVISIONOFSOFTSPLINTSAND
MOUTHGUARDSMAYCONSIDERPURCHASING
SUCHAUNIT/NSITETRAYPRODUCTIONCAN
ALSOREDUCETHENUMBEROFVISITSANDCOST
OFTHEPROCEDURE!TRAINEDAUXILIARYCAN
UNDERTAKETHEPRODUCTIONOFSUCHTRAYS
4RAYTRIMMINGISANESSENTIAL
STAGEANDCANBEUNDERTAKENINPRACTICE
ORATTHELABORATORY4HISISDEMONSTRATED
IN&IGURE!NYLABORATORY TRIMMEDTRAYS
SHOULDBECAREFULLYEXAMINEDPRIORTO
PLACEMENT4RAYSWITHOUTRESERVOIRSSHOULD
NOTEXTENDOVERANYSOFTTISSUESAND AS
SUCH AREBESTTRIMMEDTOASCALLOPED
MARGINFOLLOWINGTHEGINGIVALCONTOUR
WHILETHOSEWITHRESERVOIRSSHOULDHAVE
LIGHTCONTACTWITHTHEGINGIVAETOPREVENT
LOOSENESS3EVERALMANUFACTURERSPRODUCE
SPECIALIZEDSCISSORSFORTHISPURPOSEEG
5LTRA 4RIM 5LTRADENT /PTIDENT5+ 
4HETRAYSSHOULDBEDELIVERED
TOTHEPATIENTWITHCAREFULDEMONSTRATION
OFINSERTIONANDREMOVALANDTHE
PLACEMENTOFBLEACHINGSOLUTIONWITHIN
THETRAYS&IGURE )NSTRUCTIONSSHOULD
BEVERBALANDWRITTENANDAREVIEW
APPOINTMENTSHOULDBEMADEWITHIN
DAYS0ATIENTSSHOULDBETOLDTOCEASE
USEOFTHEIRBLEACHINGTRAYSIFTHEYNOTICE
SENSITIVITYORGINGIVALIRRITATIONANDMAKE
ANAPPOINTMENTWITHTHEPRACTICE)TIS
OFTENWISETOPROVIDETHEPATIENTSWITH
THEIRCOMPLETEDMODELSSOTHAT SHOULD
TRAYSBELOSTORDAMAGED THEYCANRETURN
TOHAVEADDITIONALTRAYSPRODUCED
"LEACHINGTRAYSSHOULDNOTBE
WORN@ASMUCHASPOSSIBLE-ANUFACTURERS
GENERALLYRECOMMENDHOURSINTHE
*UNE

2ESTORATIVE$ENTISTRY

DAYANDNIGHT TIMEWEAR4HESESHOULDBE
ADHEREDTO VARYINGONLYTHEDURATIONOF
TREATMENTEGDAYS DAYS DEPENDING
ONTHESEVERITYOFTHEDISCOLORATIONAND
THETEETHSSUSCEPTIBILITYTOBLEACHING
ASSESSEDFOLLOWINGTHEFIRSTREVIEW&OR
SEVERESTAINS SUCHASTHOSESEENFOLLOWING
TETRACYCLINEADMINISTRATIONATTHETIMEOF
TOOTHDEVELOPMENT ATREATMENTPERIODOF
SIXMONTHSMAYBEREQUIRED
%FFECTIVENESS

&IGURE0RODUCTIONOFTHETRAY4HECASTISREMOVEDFROMTHEVACUUMFORMEDTRAYINTACT4HISCANBEPRO
VIDEDTOTHEPATIENTFORSAFE KEEPINGSHOULDFURTHERTRAYSBEREQUIREDA 'ROSSTRIMMINGISUNDERTAKEN
INITIALLYB FINESCALLOPINGTOTHEGINGIVALMARGINISTHENUNDERTAKENC FINALRESULT&URTHERTRIMMING
MAYBEREQUIREDFOLLOWINGFITTOENSURETHATNOGINGIVALTISSUEISCOVERED

2ESULTSFROMATHOMEBLEACHING
CANBEIMPRESSIVE&IGURE BUTTHESEARE
BASEDUPONCAREFULCASESELECTIONANDGOOD
PATIENTCOMPLIANCE2ESEARCHDESCRIBINGTHE
EFFICACYOFTHISTREATMENTIS HOWEVER LIMITED
WITHTHEVASTMAJORITYOFARTICLESDESCRIBING
CASEREPORTS ANDONLYAFEWCLINICALSTUDIES
AREAVAILABLEFORREVIEW
)NTERMSOFSHADECHANGE ONE
STUDYDESCRIBEDTHEUSEOFCARBAMIDE
PEROXIDE#0 NIGHTLYFORTWOWEEKS
PATIENTS WITHANAVERAGESHADECHANGEOF
UNITSLIGHTERUSINGTHE6ITASHADEGUIDE
4HESEPATIENTSWEREFOLLOWEDUPTWOYEARS
LATERWHENITWASFOUNDTHATTHETEETHHAD
AGAIN ONAVERAGE DARKENEDBYTWOSHADE
UNITS WITHTHEMAJORITYOFTHERELAPSE
OCCURRINGWITHINMONTHSOFTREATMENT
COMPLETION.OPATIENTSTATEDTHATTHEY
HADFELTTHENEEDTORE BLEACHTHEIRTEETH
!NOTHERSTUDYONSTABILITYEXAMINED
PATIENTSWHOHADUNDERTAKENA
CARBAMIDEPEROXIDEREGIMEANDSTATED
THATTHEIRTOOTHCOLOURWASSTABLEAFTER
YEARS
3IDE EFFECTS

&IGURE0ATIENTFILLINGTRAY)TISIMPORTANTTHATTHEPATIENTISSHOWNADEMONSTRATIONOFTHETECHNIQUE
FORFILLINGTHETRAY ANDTHENEEDNOTTOOVERFILLTHETRAYSHOULDBEEMPHASIZED

&IGURE%XAMPLEOFRESULTSFOLLOWINGHOMEBLEACHINGWITHCARBAMIDEPEROXIDE WITHTWOWEEKS
OFNIGHT TIMEWEAR

*UNE

4HEMOSTCOMMONLYREPORTED
SIDE EFFECTOFVITALHOMEBLEACHING
ISTOOTHSENSITIVITY)NCIDENCEREPORTS
VARY BUTBETWEENOFPATIENTS
REPORTINCREASEDTOOTHSENSITIVITY4HE
HYPERSENSITIVITYISSHORT LIVED WITHMOST
SYMPTOMSLASTINGLESSTHANFOURDAYSAND
ALLRESOLVINGONCETREATMENTISCOMPLETED
-UCOSALIRRITATIONHASALSOBEENASSOCIATED
WITH#0USE INTRIALSBETWEEN
OFPATIENTSREPORTINGGINGIVALIRRITATION
)NTHISSTUDY THOSEPATIENTSWHOCHANGED
THEIRBLEACHINGSOLUTIONMORETHANONCEA
DAYWEREMORESUSCEPTIBLETOSIDE EFFECTS
THANTHOSEWHOCHANGEDTHESOLUTIONONCE
DAILY
)TISINTERESTINGTONOTETHAT
$ENTAL5PDATE

2ESTORATIVE$ENTISTRY

9OTUEL$ENTAL/FFICE"IOCOSMETICS -ADRID
3PAIN #0 7HITE3PEED$ISCUS$ENTAL
#ALIFORNIA 53! #0 OR,IFE ,IKE,IFE
,IKE #ALIFORNIA 53! #0!SSISTED
BLEACHINGSITSBETWEENTHEWELLESTABLISHED
HOMEBLEACHINGPROCEDURESANDTHENOVEL
POWERBLEACHINGSYSTEMSTHATAREGAINING
POPULARITY ESPECIALLYINTHE534HEASSISTED
BLEACHINGTECHNIQUEISPOPULARASITREQUIRES
NOGINGIVALPROTECTIONAND THEREFORE ISA
SIMPLERTECHNIQUE(OWEVER ASITEMPLOYS
#0RATHERTHANHYDROGENPEROXIDE THE
SHADECHANGESWILLBELESSDRAMATICTHAN
POWERBLEACHING

0ROCEDURE

#0WITHNIGHT TIMEUSE OVERAPERIOD


OFTWOWEEKS SHOULDPRODUCEACCEPTABLE
RESULTSWHILEMINIMIZINGTOOTHSENSITIVITY
ANDGINGIVALIRRITATION

4HISISMUCHTHESAMEASHOME
BLEACHINGINWHICHALGINATEIMPRESSIONS
ARETAKENANDBLEACHINGTRAYSPRODUCED
)FTHEASSISTEDBLEACHINGISTOAUGMENT
AHOMEBLEACHINGTREATMENT ITMAYBE
ADVISABLETOHAVETWOSETSOFBLEACHING
TRAYSPRODUCEDTOPERMITASETTOREMAIN
INTHEPRACTICE4HETEETHSHOULDUNDERGO
ATHOROUGHPROPHYLAXISANDCHEEKAND
LIPRETRACTORSSHOULDBEPLACED4HESELF
EXPANDINGRETRACTORSARERECOMMENDED
4HETRAYSHOULDTHENBEFILLEDWITHTHE#0
PRODUCT ENSURINGTHATITISNOTOVERFILLED
ANDINSERTED!NYEXCESSBLEACHINGMATERIAL
SHOULDBEWIPEDFROMTHEGINGIVAEUSINGA
COTTONWOOLROLL
4HETRAYISGENERALLYLEFTINSITU
FORMINUTESANDTHEPATIENTSHOULDBE
SUPERVISEDDURINGTHEENTIREPROCEDURE
7HENTHETRAYISREMOVED SUCTIONSHOULD
BEAPPLIEDTOEACHTOOTHTOREMOVETHE
BLEACH FOLLOWEDBYCOPIOUSRINSINGWITH
HIGHVOLUMEASPIRATION
4HEPROCEDURESHOULDBE
REPEATEDASNECESSARY BUTATLEASTDAYS
SHOULDBELEFTBETWEENEACHASSISTED
BLEACHINGSESSIONINORDERTOASSESSTHE
BLEACHINGEFFECTPROPERLY

!SSISTEDBLEACHING

%FFICACY

!SSISTEDBLEACHINGCANEITHER
BECONDUCTEDASASERIESOFTREATMENTS
WITHINTHEPRACTICEENVIRONMENTALONE OR
ASASUPPLEMENTOR@BOOSTTOAN@AT HOME
BLEACHINGREGIME4HECONCENTRATIONSOF
BLEACHINGSOLUTIONARETYPICALLYHIGHER
WITHCARBAMIDEPEROXIDECONCENTRATIONSOF
 WITHPRODUCTSSUCHAS/PALESCENCE
1UICK5LTRADENT /PTIDENT 5+ #0

6ERYLITTLERESEARCHEXISTS
DESCRIBINGTHEUSEOFASSISTEDBLEACHING
/NETRIALDESCRIBESTHEUSEOFATHOME
BLEACHINGWITH#0WITHASSISTED
BLEACHINGOF#0MINUTES TWO
APPLICATIONS ANDFOUNDTHATTHOSEPATIENTS
WHOHADONLYTHEIN PRACTICETREATMENTS
HADASIGNIFICANTLYREDUCEDSHADECHANGE
COMPAREDWITHTHOSEUSINGTHECOMBINED

&IGURE0LACEMENTOFRUBBERDAMA WAXED FLOSSUSEDTOPUSHRUBBERDAMTHROUGHINTER PROXIMAL


SPACESB SLIPKNOTAROUNDEACHTOOTHC USEOFINSTRUMENTTOPUSHFLOSSBELOWCINGULUMD FLOSSKNOT
ENABLESCERVICALTHIRDOFTOOTHTOBEEXPOSEDE CONTINUEAROUNDALLTEETHANDTHENCUTFLOSSASCLOSETO
KNOTASPOSSIBLEF FINISHEDRESULT

ANUMBEROFSTUDIESHAVEREPORTEDAN
INCREASEINGINGIVALHEALTHFOLLOWING
BLEACHINGPROCEDURES4HEREARETWO
POSSIBLEEXPLANATIONSFORTHISFIRST THATTHE
BLEACHINGSOLUTIONISTOXICTOTHEBACTERIA
WITHINTHEGINGIVALCREVICE ANDSECONDLY
THATPATIENTSUNDERGOINGBLEACHINGTAKE
ANINCREASEDINTERESTINTHEIRTEETHAND
MAYIMPROVETHEIRORALHYGIENEDURINGTHE
TREATMENT
3EVERALTRIALSHAVEREPORTED
THAT WHILEHIGHERCONCENTRATIONSOF#0
MAYRESULTINFASTER ANDINSOME BUTNOTALL
CASESMOREPROFOUNDCOLOURCHANGES THE
INCREASEDRISKOFSIDE EFFECTSDONOTJUSTIFY
THEIRUSE4HEDATACURRENTLYSUGGESTTHAT

$ENTAL5PDATE

*UNE

2ESTORATIVE$ENTISTRY

SYSTEM4HESYSTEMSAREGENERALLY
MARKETEDASGIVINGA@BOOSTTOHOME
BLEACHING WHICHMAYBEOFUSETOPATIENTS
WHOREQUIRETHEIRSHADECHANGEINASHORT
PERIOD
3IDE EFFECTS

.OSTUDYHASEXAMINEDTHE
CONCENTRATIONSOF#0EMPLOYEDINASSISTED
BLEACHINGINRELATIONTOTOOTHSENSITIVITY
ORGINGIVALEFFECTS BUTSTUDIESEXAMINING
HIGHERLEVELSOF#0INAT HOMESYSTEMS
EGUPTO#0 REPORTAHIGHERLEVELOF
SENSITIVITY3EVERALSTUDIESHAVEEXAMINED
THEEFFECTOF#0ONTOOTHSURFACESAND
FOUNDTHATANINCREASEDENAMELROUGHNESS
ISSEEN ALTHOUGHTHISISNOTTHOUGHTTOBE
CLINICALLYRELEVANT
0OWERBLEACHING

4HESEPROCEDURESUSEHIGH
CONCENTRATIONSOFHYDROGENPEROXIDES
TYPICALLY ANDMUSTONLYBEUSED
WITHCORRECTLYPLACEDSOFT TISSUEPROTECTION
4HESETREATMENTSAREGENERALLYFOR
MINUTESANDMAYINVOLVETWOORMORE
SESSIONS SEPARATEDBYATLEASTDAYS FOR
MAXIMALSHADECHANGETOBESEEN(OWEVER
ONEOFTHEADVANTAGESOFTHISOPTIONIS
THATMOSTPATIENTSWILLSEEAPROFOUND
CHANGEAFTERONEEXPOSURE!SWITHTHE
PREVIOUSMETHODDESCRIBED CASESELECTION
ISCRUCIAL7RITTEN INFORMEDCONSENTSHOULD
BEOBTAINEDFROMPATIENTSUNDERGOING
THISPROCEDURE)TSHOULDBENOTEDTHATA
GREATDEALOFTHEINSTANTEFFECTNOTEDBY
PATIENTSUNDERGOINGTHISTREATMENTMAYBE
ATTRIBUTEDTOTOOTHDEHYDRATIONTHATCAN
OCCUROVERTHEMINUTESTHATTHETEETH
AREISOLATED
0ROCEDURE

&IGURE0LACEMENTOFLIGHT CUREDRESINSHIELDA 2ESINDAM @0AINT ON$AMANDB SPECIALLYDESIGNED


LIPRETRACTORSTHATALSOPROVIDEABITEBLOCKANDTONGUERETRACTOR THESEARESPECIALLYSUITEDTOTHEAPPLICA
TIONOFHIGHCONCENTRATIONPEROXIDEPRODUCTSC "ITEBLOCKANDRETRACTORINPLACED 2ESINISAPPLIED
DIRECTLYTODRYGINGIVAEE ,IGHTCURINGSHOULDBEUNDERTAKENININCREMENTS GENERALLYONEORTWOTEETH
ATATIME4HISPREVENTSTHEMATERIALRUNNINGONTOTHETOOTHSURFACESF !NYEXCESSMATERIALSHOULDBE
CAREFULLYTRIMMEDUSINGA.OSCALPELG &INISHEDRESULTWITHASPIRATORPRESENTH &OLLOWINGCOMPLE
TIONOFBLEACHINGCYCLE THEGELSHOULDBEREMOVEDWITHAIRANDHIGHPOWERSUCTIONINITIALLYI 4HERESIN
SHIELDCANTHENBEREMOVED4HISSHOULDCOMEAWAYASASINGLEUNIT DEMONSTRATINGTHEBARRIEREFFECTJ
%XAMPLEOFTHEREMOVED INTACT RESINGINGIVALSHIELD

*UNE

!SWITHALLBLEACHING
TREATMENTS ATHOROUGHHISTORYAND
EXAMINATIONSHOULDBEUNDERTAKENPRIOR
TOCOMMENCINGPOWERBLEACHING!N
INITIALPHOTOGRAPHSHOULDBETAKENAND
PRE TREATMENTSHADEASSESSED0ROPHYLAXIS
WITHORWITHOUTGROSSSCALINGSHOULDBE
CONDUCTEDPRIORTOTHEPLACEMENTOFTHE
GINGIVALPROTECTION4HEREARETWOMAIN
MEANSBYWHICHTHEGINGIVALANDPERI
GINGIVALTISSUESCANBEPROTECTEDDURING
POWERBLEACHINGEITHERUSINGRUBBERDAM
ORBYALIGHT CUREDRESINSHIELD
$ENTAL5PDATE

2ESTORATIVE$ENTISTRY

&IGURE  'INGIVAL BURN AS A RESULT OF FAILURE TO


PLACE EFFECTIVE GINGIVAL PROTECTION DURING POWER
BLEACHING

2UBBERDAMAPPLICATION

4HISPROCEDURECANBETIME
CONSUMINGBUTISOFTENCONSIDEREDTHE
MOSTEFFECTIVEMEANSOFGINGIVALPROTECTION
4HETECHNIQUEISPOPULARIN.ORTH!MERICA
WHEREDENTALASSISTANTSCANPLACERUBBER
DAM THUSLIMITINGTHEAMOUNTOFCLINICIAN
TIMEINVOLVEDINTHEPROCEDURE&IGURE
DEMONSTRATESTHEAPPLICATIONPROCESS4HOSE
EXPERIENCEDWITHRUBBERDAMCOULDEXPECT
TOPLACETHISTYPEOFPROTECTIONWITHIN
MINUTES

&IGURE-IXINGHYDROGENPEROXIDEA THEPOWDERISINTRODUCEDTOTHELIQUIDBYPRESSINGDOWNON
THERELEASECAPB ARROWSHOWSTHEBROKENSEALTHEPOWDERANDLIQUIDCANNOWBEMIXEDBYGENTLE
AGITATIONC THEACTIVATORISADDEDANDTHECONTENTSBEGINTOGELD THEFINISHEDPRODUCTATHICKGEL
THATCANBEPLACEDONTOTHETEETH

,IGHT CUREDRESINSHIELDAPPLICATION

0RIORTOTHEPRODUCTIONOF
SPECIALIZEDPRODUCTS THEUSEOFBLOCK OUT
RESINSTHESAMEUSEDINTHEPRODUCTION
OFTHEBLEACHINGTRAYS EG,#"LOCK OUT
5LTRADENT /PTIDENT 5+ +ARISMA,#3PACER
# $ENT WASRECOMMENDEDFORAPPLICATION
TOGINGIVALTISSUES4HESESYSTEMSWERE
ADEQUATE ALTHOUGHPATIENTSCOMPLAINEDOF
PAINFROMTHEEXOTHERMICSETTINGREACTION
7ITHTHEINTRODUCTIONOFTHENEW@PAINT ON
DAMSYSTEMS SPACERRESINSSHOULDNOLONGER
BEUSEDFORGINGIVALPROTECTION
4HEPAINT ONDAMSAREGENERALLY
METHACRYLATEPRODUCTSTHATARELIGHTCURED
ANDINDICATEDFORTHEPROTECTIONOFGINGIVAL
TISSUESFROMBLEACHING MICROABRASIONAND
#LASS6COMPOSITEPLACEMENT%XAMPLES
INCLUDE/PAL $AM5LTRADENT /PTIDENT 5+
0AINT /N$AM$EN -AT AND1UITE 7HITE
0AINT /N$AM$ENMED #ALIFORNIA 53! 
&IGUREDEMONSTRATESTHEUSEOFTHISTYPE
OFPRODUCT
4HEPAINT ONDAMSAREWELL
TOLERATEDBYPATIENTS OFTENMORESOTHAN
RUBBERDAM BUTARESTILLTIMECONSUMINGTO
PLACEANDEXPERIENCEISNECESSARYTOREDUCE
THEAMOUNTOFMATERIALCOVERINGTHETEETH

$ENTAL5PDATE

THATREQUIRESSCALPELREMOVAL4HEPAINT ON
DAMSCANALSOBEUSEDTOREPAIRANYSPLITSOR
BREACHESWITHINTHERUBBERDAMIFTHISFORM
OFPROTECTIONHASBEENUSED
7HETHERATRADITIONALDAMOR
RESIN SHIELDISUSED ITISESSENTIALTHATITIS
ANEFFECTIVEBARRIERTHATPREVENTSEXPOSURE
OFTHEGINGIVALTISSUESTOTHEHIGHLY
CONCENTRATEDPOWERBLEACHINGSOLUTIONS
&AILURETOACHIEVETHISCANRESULTINSEVERE
GINGIVALBURNS&IGURE 

"LEACHINGMETHOD

4HISISDEPENDENTONTHESYSTEM
BEINGUSEDAND INPARTICULAR WHETHERITIS
ABLEACHINGGELSUCHAS/PALESCENCE%XTRA
5LTRADENT /PTIDENT 5+ ORAMORELIQUID
CREAMTYPEAPPLICATIONEG(I ,ITE 3HOFU 
-ANYPOWERBLEACHINGSYSTEMSWILLREQUIRE
ACTIVATION ANDTHISISACHIEVEDBYEITHERA
CHEMICALMIXINGPROCESS LIGHTACTIVATION
FROMEITHERACURINGLIGHT OPERATORYLIGHTOR
SPECIALLYDESIGNEDUNIT ORACOMBINATIONOF
BOTHCHEMICALANDLIGHTACTIVATION%ARLIER
SYSTEMSEMPLOYEDHEATACTIVATION BUT
THESEARENOWUNCOMMON&OREXAMPLE

/PALESCENCE%XTRAISSUPPLIEDINASINGLE
SYRINGETHATISEXPRESSEDDIRECTLYONTOTHE
TEETHANDTHENACTIVATEDBYACURINGLIGHT
WHILE(I ,ITESIMPLYREQUIRESMIXINGTHE
ACTIVATIONAGENTISMANGANESESULPHATE
ALTHOUGHITCANBESUPPLEMENTEDWITHLIGHT
CURINGTOREDUCETHEACTIVATIONTIMEFROM
TOMINUTES
!COMMONMETHODOFPOWER
BLEACHMIXINGISEMPLOYEDBYTHE9OTUEL
SYSTEM ANDISDEMONSTRATEDIN&IGURE)T
ISIMPORTANTTHATALLBLEACHINGSOLUTIONS BUT
ESPECIALLYTHOSEWITHHIGHCONCENTRATIONS
OFHYDROGENPEROXIDE AREKEPTSEALEDAND
REFRIGERATED&AILURETODOTHISWILLLEADTO
OXIDATIONANDAREDUCTIONINBLEACHING
ABILITY
/NCETHEPOWERBLEACHINGGEL
HASBEENMIXED THEGINGIVALPROTECTION
CHECKEDANDAPROPHYLAXISUNDERTAKEN
ITISAPPLIED GENERALLYTOATHICKNESSOF
MMACROSSTHETEETH)FRUBBERDAM
ISBEINGUSED THENTHELINGUALSURFACES
MAYALSOBECOVEREDTOPRODUCEENHANCED
RESULTS-ANUFACTURERSINSTRUCTIONSSHOULD
OFCOURSE BECLOSELYFOLLOWEDANDMOST
RECOMMENDABLEACHINGTIMEOFMINUTES
*UNE

2ESTORATIVE$ENTISTRY

FOLLOWEDBYHIGHPOWERSUCTIONAND
REAPPLICATION'ENERALLY NOMORETHANTHREE
APPLICATIONSSHOULDBEAPPLIED ANDMOST
PATIENTSFINDTHISACCEPTABLE ALTHOUGH
THOSEUNUSEDTORUBBERDAMMAYASKFOR
SHORTERAPPOINTMENTS
/NCECOMPLETED THEDAMIS
REMOVEDUSUALLYBYCAREFULLYCUTTING
THROUGHTHEFLOSSWITHASCALPEL
ANDTHETEETHPROVIDEDWITHAFLUORIDE
PROPHYLAXISANDPHOTOGRAPHS
%FFICACY

!RECENTSTUDYDEMONSTRATED
THATHYDROGENPEROXIDE APPLIEDFOR
ATOTALOFMINUTESTHREEMINUTE
APPLICATIONS RESULTEDINNINESHADE
CHANGESWITHATWOSHADEREBOUNDAFTER
DAYS4HISDEGREEOFSHADECHANGEHAS
BEENREPLICATEDINOTHERTRIALS ALTHOUGH
THEDEGREEOFRELAPSEDOESDIFFER4HIS
MAYBEASUBJECTEFFECT DEPENDING
UPONTHEORIGINALCAUSEOFTHESTAINING
#ERTAINLY THOSEPATIENTSWHOAREPROVIDED
WITHAT HOMEBLEACHINGKITSSUBSEQUENT
TOAPOWERBLEACHINGTHERAPYMAINTAIN
THEIRCOLOURCHANGEFORLONGER#OLOUR
STABILIZATIONOFPOWERBLEACHEDTEETH
ISGENERALLYSEENWITHINSIXWEEKS!N
INTERESTINGUSEOFPOWERBLEACHINGISITS
APPLICATIONTOFLUOROTICTEETH WHEREIT
HASBEENSHOWNTOBLEACHNON FLUOROTIC
AREAS RESULTINGINAMOREUNIFORM
APPEARANCE0OWERBLEACHINGHASALSO
BEENRECOMMENDEDFORPATIENTSWITH
TETRACYCLINESTAINING
4HELITERATUREREPORTS
SIGNIFICANTSHADECHANGESACHIEVEDWITH
HYDROGENPEROXIDECONCENTRATIONSUSED
WITHINPOWERBLEACHINGPRODUCTS.O
STUDYWASFOUNDTHATDEMONSTRATEDANY
FAILUREOFTHESEPRODUCTS ALTHOUGHSOME
AUTHORSHAVECLAIMEDTHATEQUIVALENT
RESULTSCANBEOBTAINEDWITHAT HOME
BLEACHING ALTHOUGHOVERALONGER
PERIOD4HEUSEOFPOWERBLEACHINGIN
MILDFLUOROSISCASESMAYBEHELPFULAND
MAYAVOIDTHENEEDFORMICRO ABRASION
)NDIVIDUALSWITHSEVERESTAININGWILLALMOST
CERTAINLYNEEDPOWERBLEACHINGIFVENEERS
ANDCROWNSARETOBEAVOIDED ALTHOUGH
ARECENTSTUDYSUGGESTSTHAT@DIRECT TO
CONSUMERPRODUCTS WHICHWILLBECOVERED
INTHESECONDPARTOFTHISSERIES MAY IF
USEDOVERALONGPERIOD RESULTINSHADE
CHANGESINSUCHPATIENTS 
*UNE

3IDE EFFECTS

'INGIVALDAMAGE SUCHASTHAT
SEENIN&IGURE HASBEENREPORTEDBUT
CANNOTBECONSIDEREDASASIDE EFFECTPER
SE BUTMOREAREFLECTIONOFPOORCLINICAL
TECHNIQUE4OOTHSENSITIVITYANDGINGIVAL
IRRITATIONHAVEBEENREPORTEDWITHPOWER
BLEACHINGSYSTEMS WITHONESTUDYSTATING
THATOFPATIENTSREPORTEDMODERATETO
GREATLYINCREASEDSENSITIVITYONEWEEKAFTER
TREATMENT2EPORTEDLEVELSOFSENSITIVITY
GINGIVALREDNESSANDIRRITATIONDONOT
APPEARTOBEHIGHERTHANTHOSEFORAT HOME
BLEACHING
%FFECTSOFHIGHCONCENTRATIONS
OFHYDROGENPEROXIDEONDENTALMATERIALS
ENAMELANDDENTINEWILLBECOVEREDINTHE
THIRDARTICLEOFTHISSERIES

3UMMARY
"LEACHINGWITHPEROXIDE
CONTAININGPRODUCTSAPPEARSTOBEA
HIGHLYEFFECTIVEMEANSBYWHICHTEETH
CANBELIGHTENED.ODENTALPROCEDURE
ISRISKFREE BUTBLEACHINGSYSTEMS IF
CORRECTLYEMPLOYED APPEARTOHOLDVERY
LITTLERISK ALTHOUGHGINGIVALDAMAGEIN
POWERBLEACHINGCANBESEVEREIFGINGIVAL
PROTECTIONISABSENTORINADEQUATELY
PROVIDED3ENSITIVITYFOLLOWINGBLEACHING
SEEMSTOBETHEMOSTCOMMONCOMPLAINT
ANDISUSUALLYRESOLVEDAFTERWEEKS
POSTTREATMENT4HELITERATUREDOESNOT
CURRENTLYSUPPORTTHECONTENTIONTHATONE
SYSTEMISMOREEFFECTIVEATEITHERBLEACHING
EFFICIENCYORREDUCINGSIDE EFFECTSANDTHE
MAINDETERMINANTFORTREATMENTCHOICE FOR
PATIENTSATLEAST APPEARSTOBETIME
)TIS OFCOURSE ESSENTIALTO
REMINDPATIENTSTHATTHEREISNOSUCH
THINGASADEFINEDTREATMENTCOURSE(OME
BLEACHINGISOFTENDESCRIBEDASWEEKSIN
DURATION BUTPERHAPSABETTEREND POINT
WOULDBEWHENEITHERNOFURTHERCHANGE
ISSEEN ORWHENTHEDESIREDCHANGE
HASBEENACHIEVED4HISWILLDEPENDON
AETIOLOGY FOREXAMPLE TETRACYCLINESTAINING
HASBEENSHOWNTOREQUIREMONTHSOF
TREATMENT0OWERBLEACHINGISRAPID BUT
WILLFREQUENTLYREQUIRETWOORTHREEVISITSTO
ACHIEVEASTABLERESULT4HESEVISITSSHOULD
BEPLACEDAWEEKAPARTTOREDUCESENSITIVITY
0ATIENTSSHOULDALSOBEINFORMEDTHATA
RANGEOFMAINTENANCEOPTIONSAREAVAILABLE
INCLUDINGSPORADICAT HOMETRAYUSE PAINT
ONORSTRIPPRODUCTS

0ATIENTSSHOULDBEFULLYINFORMED
OFALLTHETREATMENTOPTIONSAVAILABLETO
THEMANDTHEBENEFITSANDRISKSOFEACH
4HEOCCURRENCEOFRELAPSEINALLBLEACHING
SYSTEMS WHICHISSEENMOSTPROFOUNDLYIN
POWERBLEACHEDTEETH SHOULDBEINCLUDED
INANYINFORMEDCONSENTPROCEDURE AS
SHOULDTHERISKSOFTRANSIENTSENSITIVITYAND
GINGIVALIRRITATION
!TTHETIMEOFWRITING THEUSE
OFPEROXIDE CONTAININGPRODUCTSFORTOOTH
BLEACHINGISILLEGALWITHINTHE5+4HEUSEOF
SODIUMPERBORATE CONTAININGPRODUCTSFOR
SUCHPROCEDUREISLEGALINTHE5+

2EFERENCES
 !DDY- -ORAN*-ECHANISMSOF
STAINFORMATIONONTEETH INPARTICULAR
ASSOCIATEDWITHMETALIONSAND
ANTISEPTICS!DV$ENT2ES

 3CHWARTZ2 2OBBINS*7 3UMMIT*"

$OS3ANTOS*&UNDAMENTALSOF
/PERATIVE$ENTISTRY!#ONTEMPORARY
!PPROACH,ONDON1UINTESSENCE
0UBLISHING 
 3ARRETT$#4OOTHWHITENINGTODAY
*!M$ENT!SSOC 
QUIZ
 7ATTS! !DDY-4OOTHDISCOLOURATION
ANDSTAININGAREVIEWOFTHE
LITERATURE"R$ENT* 

 3ADAN! ,EMON22#OMBINING
TREATMENTMODALITIESFORTETRACYCLINE
DISCOLOREDTEETH)NT*0ERIODONTICS
2ESTORATIVE$ENT 
 7ORLD(EALTH/RGANIZATION(EALTHFOR
THEST#ENTURY7(/ 
 +ELLEHER-' 2OE&*4HESAFETY IN
USEOFCARBAMIDEPEROXIDE
/PALESCENCE FORBLEACHINGTEETH
UNDERTHESUPERVISIONOFADENTIST

"R$ENT* 
 .EUMANN,- #HRISTENSEN#
#AVANAUGH#$ENTALESTHETIC
SATISFACTIONINADULTS*!M$ENT!SSOC
 
 6ALLITTU0+ 6ALLITTU!3 ,ASSILA60
$ENTALAESTHETICSASURVEYOF
ATTITUDESINDIFFERENTGROUPSOF
PATIENTS*$ENT 
 "RISMAN! (IRSCH3- 0AIGE(

(AMBURG- 'ELB-4OOTHSHADE
PREFERENCESINOLDERPATIENTS
$ENTAL5PDATE

2ESTORATIVE$ENTISTRY

'ERODONTICS 
 0OYSER.* +ELLEHER-' "RIGGS0&!
-ANAGINGDISCOLOUREDNON VITAL
TEETH4HEINSIDEOUTSIDEBLEACHING
TECHNIQUE$ENT5PDATE 

 (AYWOOD6" (EYMANN(/
.IGHTGUARDVITALBLEACHING
1UINTESSENCE)NT 
 3ULIEMAN- !DDY- -AC$ONALD%

2EES*34HEEFFECTOFHYDROGEN
PEROXIDECONCENTRATIONONTHE
OUTCOMEOFTOOTHWHITENINGAN
INVITROSTUDY*$ENT 

 "LUM)2 -JOR)! 3CHRIEVER!
(EIDEMANN$ 7ILSON.($EFECTIVE
DIRECTCOMPOSITERESTORATIONS
REPLACEORREPAIR!SURVEYOF
TEACHINGIN3CANDINAVIANDENTAL
SCHOOLS3WED$ENT* 

 4EZVERGIL! ,ASSILA,6 6ALLITTU0+
#OMPOSITE COMPOSITEREPAIRBOND
STRENGTHEFFECTOFDIFFERENTADHESION
PRIMERS*$ENT 
 -ATIS"! (AMDAN93 #OCHRAN-!
%CKERT'*!CLINICALEVALUATIONOF
ABLEACHINGAGENTUSEDWITHAND
WITHOUTRESERVOIRS/PER$ENT
 
 ,EONARD2( *R 6AN(AYWOOD"

#APLAN$* 4ART.$.IGHTGUARDVITAL
BLEACHINGOFTETRACYCLINE STAINED
TEETHMONTHSPOSTTREATMENT
*%STHET2ESTOR$ENT 
DISCUSSION
 $AHL*% 0ALLESEN54OOTHBLEACHING
ACRITICALREVIEWOFTHEBIOLOGICAL
ASPECTS#RIT2EV/RAL"IOL-ED

 
 3WIFT%* *R -AY+. *R 7ILDER!$*R
(EYMANN(/ "AYNE3#4WO YEAR
CLINICALEVALUATIONOFTOOTHWHITENING
USINGANAT HOMEBLEACHINGSYSTEM

*%STHET$ENT 
 2ITTER!6 ,EONARD2( *R 3T'EORGES
!* #APLAN$* (AYWOOD6"3AFETYAND
STABILITYOFNIGHTGUARDVITALBLEACHING
TOYEARSPOST TREATMENT*%STHET
2ESTOR$ENT 
 4AM,4HESAFETYOFHOMEBLEACHING
TECHNIQUES*#AN$ENT!SSOC
 
 ,EONARD2( *R (AYWOOD6" 0HILLIPS#

2ISKFACTORSFORDEVELOPINGTOOTH
SENSITIVITYANDGINGIVALIRRITATION
ASSOCIATEDWITHNIGHTGUARDVITAL
BLEACHING1UINTESSENCE)NT
 
 2EINHARDT*7 %IVINS3% 3WIFT%*
*R $ENEHY'%!CLINICALSTUDY
OFNIGHTGUARDVITALBLEACHING
1UINTESSENCE)NT 
 "ENTLEY#$ ,EONARD2( #RAWFORD**
%FFECTOFWHITENINGAGENTSCONTAINING
CARBAMIDEPEROXIDEONCARIOGENIC
BACTERIA*%STHET$ENT 

 $ELIPERI3 "ARDWELL$.

0APATHANASIOU!#LINICALEVALUATION
OFACOMBINEDIN OFFICEANDTAKE
HOMEBLEACHINGSYSTEM*!M$ENT
!SSOC 
 #AVALLI6 !RRAIS#! 'IANNINI-
!MBROSANO'-(IGH CONCENTRATED
CARBAMIDEPEROXIDEBLEACHINGAGENT
EFFECTSONENAMELSURFACE*/RAL
2EHABIL 
 +UGEL' &ERREIRA34HEARTANDSCIENCE















OFTOOTHWHITENING*-ASS$ENT3OC
 
!L3HETHRI3 -ATIS"! #OCHRAN-!
:EKONIS2 3TROPES-!CLINICAL
EVALUATIONOFTWOIN OFFICEBLEACHING
PRODUCTS/PER$ENT 

:EKONIS2 -ATIS"! #OCHRAN-!
!L3HETRI3% %CKERT'* #ARLSON4*
#LINICALEVALUATIONOFIN OFFICEAND
AT HOMEBLEACHINGTREATMENTS/PER
$ENT 
"USSADORI3+ DO2EGO-! DA3ILVA0%
0INTO-- 0INTO!#%STHETIC
ALTERNATIVEFORFLUOROSISBLEMISHES
WITHTHEUSAGEOFADUALBLEACHING
SYSTEMBASEDONHYDROGENPEROXIDE
AT*#LIN0EDIATR$ENT 

6ISCIO$ 'AFFAR! &AKHRY 3MITH3 8U4
0RESENTANDFUTURETECHNOLOGIESOF
TOOTHWHITENING#OMPEND#ONTIN%DUC
$ENT3UPPL 3QUIZ
3
+UGEL' !BOUSHALA! :HOU8
'ERLACH27$AILYUSEOFWHITENING
STRIPSONTETRACYCLINE STAINEDTEETH
COMPARATIVERESULTSAFTERMONTHS
#OMPEND#ONTIN%DUC$ENT
! QUIZ
4AVARES- 3TULTZ* .EWMAN-
3MITH6 +ENT2 #ARPINO%ETAL,IGHT
AUGMENTSTOOTHWHITENINGWITH
PEROXIDE*!M$ENT!SSOC
 
'ALLAGHER! -AGGIO" "OWMAN*
"ORDEN, -ASON3 &ELIX(#LINICAL
STUDYTOCOMPARETWOIN OFFICE
CHAIRSIDE WHITENINGSYSTEMS*#LIN
$ENT 

!BSTRACTS
./-/2%&/2-/#2%3/,
)STHERELIFEAFTER"UCKLEYSFORMOCRESOL
0ART))n$EVELOPMENTOFAPROTOCOLFORTHE
MANAGEMENTOFEXTENSIVECARIESINTHE
PRIMARYMOLAR#,0ATCHETT 63RINIVASAN
0*7ATERHOUSE)NTERNATIONAL*OURNALOF
0AEDIATRIC$ENTISTRY n
&ORMOCRESOLHASBEENTHEMEDICAMENTOF
CHOICEFORPULPOTOMYTREATMENTOFPRIMARY
MOLARTEETHFORMANYYEARS4HISISALLSETTO
CHANGENOWTHATTHE)NTERNATIONAL!GENCY

$ENTAL5PDATE

FOR2ESEARCHON#ANCERHASCLASSIFIEDIT
ASACARCINOGEN4HISPAPEREXPANDSON
THEBACKGROUNDTOTHISDECISION THEN
DESCRIBESTHEPROCESSUSEDTOARRIVEAT
ANEWEVIDENCE BASEDPROTOCOLFORTHE
MANAGEMENTOFTHEPULPALLYINVOLVED
PRIMARYMOLAR
!NEXPERTGROUPOFSPECIALIST
PAEDIATRICDENTISTSINCLUDINGHOSPITAL
ANDACADEMICSTAFF REVIEWEDAVAILABLE
LITERATUREANDDEVELOPEDAPROTOCOLFORTHE
MANAGEMENTOFTEETHTHATREQUIREAVITAL

PULPOTOMYINCLUDINGACOMPREHENSIVE
FLOWCHARTTOAIDTHEDECISIONPROCESS 4HIS
PAPERSUGGESTSTHATFERRICSULPHATEISTHE
MATERIALOFCHOICEINTHISCIRCUMSTANCE
HOWEVERTHEAUTHORSDONOTPROVIDEANY
RECOMMENDATIONSFORMANAGEMENTOF
PRIMARYMOLARSWHERETHEPULPMAYHAVE
BECOMENON VITAL)TSALSOASHAMETHATNO
PRIMARYCAREPRACTITIONERSWEREINVOLVEDIN
THEWORKINGGROUP
0AUL!SHLEY
%ASTMAN$ENTAL)NSTITUTE
*UNE

S-ar putea să vă placă și