External Dental Bleaching

24 Nov 2017 - 14258

This young hospitality student patient came to the office to have a color smile improvement. Indeed, he was evaluated with the chief complaint of discolouration of teeth.

Good periodontal health, no gingival recessions, decay or history of tooth sensitivity was reported.

Starting shade: 2M2 (VITA 3D-Master)

Treatment plan: An External Tray-Based tooth bleaching was proposed for this patient.

Product used: White Dental Beauty 16% 1H/day for 15 days.

Fig. 1

Initial situation 

Fig. 2

Initial Smile 

Fig. 3

Initial 

Fig. 4

Initial picture with the vita 3d master bleached guide. (For more information about this bleached guide,  see article by Anna Salat “Say hello and take color” 

Fig. 5

Initial with polarized picture and the grey card to compare with precision initial and final picture on a screen.  

Fig. 6

After professional tooth cleaning alginate impressions were taken of the upper and lower arch for office bleaching tray fabrication. 

Fig. 7

Impression has to be precise but alginate is enough for that. 

Fig. 8

Very basic models were fabricated with Earth Stone (TAK SYSTEMS) dental plaster. Base construction was unnecessary for our purposes.

Reduce the overall thickness of the model to dental arches facilitate tray adaptation while vacuum formed.

Fig. 9

The buccal surface of models teeth can be blocked out to create a reservoir for the bleaching gel before tray fabrication even when there are no differences in the rate of bleaching with or without reservoirs. 

Fig. 10

Detail of the model. The model has to be precise especially in the tooth-gingiva transition in order to create an accurate tray  to avoid extrusion of the bleaching gel.  

Fig. 11

The base-free model makes it possible to fabricate a more precise custom tray with the in-office vacuum machine (Easy Vac Plus). Then 1 mm soft thermo-forming sheets are used to fabricate the tray. Indeed it’s very comfortable for the patient. 

There is no need to scallop the tray on each tooth. Only One or Two millimeter above the cervical area of each tooth. 

Custom trays are checked for accuracy of fit, tissue adaptation, retention and occlusion and the patient is shown how to insert the custom trays and to apply 16% Carbamide peroxide gel in the amount of a drop per tooth.

Fig. 12

The result after 15 days bleaching was satisfying for the patient.

Fig. 13

Final result 

Fig. 14

Final result with polarized picture and the grey card to compare with precision

Fig. 15

Final smile

Fig. 16

Final result in patient face 

Fig. 17

Digital composition, at the left before, at the right after. Crossed polarized light.

Fig. 18

Digital composition, at the left after, at the right before. Twin flash with diffusers light

Fig. 19
Fig. 20
 

Conclusions

This treatment with White dental beauty 16% 1h/day is proven to be effective and predictable. Teeth can achieve visible whitening in less than two weeks. We can bleach teeth even in those cases in which the “wow effect” is most difficult to achieve, when the starting point is “rather white” or “not very yellow” especially found in young patients.

Bibliography

  1. Matis BA, Cochran MA, Eckert G. Review of the effectiveness of various tooth whitening systems. Oper Dent. 2009 Mar-Apr;34(2):230-5.

  2. Akal N, Over H, Olmez A, Bodur H. Effects of carbamide peroxide containing bleaching agents on the morphology and subsurface hardness of enamel. J Clin Pediatr Dent. 2001 Summer;25(4):293- 6.

  3. Dahl JE, Pallesen U. Tooth bleaching – a critical review of the biological aspects.Crit Rev Oral Biol Med. 2003;14(4):292-304.

  4. Haywood VB, Sword RJ. Tooth bleaching questions answered. Br Dent J. 2017 Sep 8;223(5):369–80.

  5. Li Y, Greenwall L. Safety issues of tooth whitening using peroxide-based materials. Br Dent J. 2013 Jul;215(1):29–34.

  6. http://styleitaliano.hime.host/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/