Everyday dental bleaching – A clinical case
Our everyday dental bleaching protocol is presented in this clinical case; at home bleaching was proposed with 10% carbamide peroxide during the night (White Dental Beauty, Optident).
Initial colour was taken with the Vita 3Dmaster Bleach Shade Guide (1), the best shade guide for whitening for different reasons (2) We chose the most similar sample, 4M2 of the shade guide and we placed it near the natural tooth, on the same vertical plane as the natural tooth, and with a black photographic background (Flexipalettes, Smile Line)
Picture before bleaching with cheek retractors and patient in occlusion.
Picture before bleaching, smiling. After the pictures we took impressions to prepare a whitening tray and schedule a second appointment in which we’ll give our patient the instructions and a third one for a check-up. Patient always should have the appointment before leaving the clinic. We suggest to bleach for 10 days as a reference but, as the patient had a whiter crown, he was instructed to check the color in the mirror and stop bleaching when color from the crown matches the color obtained with the bleaching.
After 10 days of Carbamide Peroxide 10% (White Dental Beauty, Optident) (3) with a bleaching tray. He wore the tray during the night. We verified the color obtained with the same shade guide and the color that matched the best was 1M1,5, which is a good result.
He did upper and lower arch
The patient was satisfied with the result and we gave him some tips to preserve the effects of the treatment for longer.
Before bleaching (picture on the left) and after bleaching (on the right).
Bleaching is an everyday procedure which we propose to all our patients. Not only to patients without restorations or crowns, as you can see, bleaching can be suggested to patients with restorations, especially with old crowns which colour matched that of the teeth when placed, but not anymore as time has gone by. We can also bleach in presence of old composites as we are able to modify composites directly in the mouth in an easy way. We usually propose the at home bleaching option as it is the most cost-effective and safest way of whitening teeth without or with minimum side effect occurrence, minimizing the bothering tooth sensitivity following an in office bleaching. We share this opinion with other bleaching experts for example, with Dr Van Haywood, Professor in the Department of Oral Rehabilitation, School of Dentistry, Medical College of Georgia (MCG). In patients with old crowns we ask them to bleach until the color matches their old crown, patients are usually very good at this homework when they feel they are responsible for obtaining the right whitening degree.
So when patients ask: Can i get my teeth whitened if I have crowns, veneers, composites?
You should answer: It is always possible but in some cases you should modify or remake your old restorations. But not always. We should always evaluate the specific case.