63 Overview of products used for home bleaching
(Adapted from CRA Newsletter, April 1997)
Fabricating a Bleaching Tray
Bleaching trays are medicament carriers that keep the bleaching gel in a certain position on the tooth. They are made of soft plastic. It is important that the trays adapt well to prevent the bleaching agent from being quickly diluted by saliva, which could reduce its effect.
The bleaching agents should only and exclusively be located on the teeth and not on the gingiva. If the tray adapts insufficiently, allowing the bleaching agent to leak, it can lead to gingival irritations over a longer period of application.
64 Reservoir formation for the bleaching agent in the tray adjacent to the tooth
A reservoir for the bleaching agent is formed on the facial surface in the tray. The reservoir extends to within approx. 1 mm of the tray margin.
65 Making the bleaching tray
Left: Light-cured blocking resin is placed where the reservoirs are going to be located.
Right: The overextended tray is cut to its right extension.
66 Completing the tray
Left: The tray margins are readapted with a flame in order to enable optimal marginal adaptation.
Right: Finished bleaching tray.
In order to achieve a greater effect with the bleaching agent, a reservoir is created on the tooth surface by means of a light-cured plastic. The tray material is available in thicknesses of 0.053–0.06 inches. The thicker tray material is preferred for patients with a tendency to grind their teeth.
The illustrations (Figures 64–66) show the procedure for making a bleaching tray. The technique can also be used to manufacture a medicament carrier.
In-Office Bleaching
In-office bleaching is carried out using more aggressive materials and consequently leads to quicker results. Products with a higher concentration of bleaching agents (e.g., Quickstart with 35% carbamide peroxide or Accel with 35% H2O2) are mainly used. Because of their aggressivity, one must keep an eye on the bleaching process and make sure that the gingiva is sufficiently protected by the rubber dam.
The drawback of in-office bleaching is the expensive treatment time.
Indications
—Goal: fast result
—The patient prefers the treatment to be conducted in the office
—Only single teeth to be bleached
—As a preprosthetic procedure
Contraindications
—Patients with hypersensitive teeth
—Patients with large fillings
Treatment Procedure
1. Diagnosis and treatment planning as in the case of the home bleaching procedure (oral diagnosis, professional tooth cleaning, radiographs).
2. Color determination together with the patient.
3. Preoperative photographs.
4. Placing the rubber dam.
5. Place bleaching agent and replace after 10–20 minutes. A treatment lasts 30 to a maximum of 60 minutes and normally causes a color change of 1 to 1.5 shades on the Vita color scale.
6. After the rubber dam has been removed, remineralize the teeth with a fluoride gel.
The treatment can be repeated two to four times.
Possible Postoperative Complications
Gingiva etching: Let the patient rinse for a few minutes. Most gingiva irritations disappear after two hours.
Pain: Raised level of sensitivity usually vanishes within a few days. Use toothpaste for hypersensitive teeth as a possible accompanying treatment.
67 Bleaching procedure
Since one is working with highly concentrated bleaching agents, it is necessary that a rubber dam be applied before treatment is carried out. Fresh bleaching agent is placed on the teeth at 10-minute intervals. The bleaching process can be accelerated by exposing the tooth being bleached to the light of a polymerization lamp.
68 Effect of a 30-minute in-office bleaching treatment
69 Bleaching agents for in-office bleaching
Highly concentrated carbamide peroxide (35%) or concentrated hydrogen peroxide (35%) is used for in-office bleaching.
70 Useful bleaching agents, composition, and effects of external factors
Power Bleaching with Superoxol
1. The patient's face and, above all, the eyes must be protected since one is working with aggressive chemicals. Dentist and patient should wear goggles; cover the patient's face.
2. Protect the gingiva with Vaseline or Orabase in case the rubber dam leaks.
3. Position the rubber dam. The holes should be made small to optimize the sealing ability. Invert the rubber dam.
4. Clean the teeth with pumice and water; do not use a polishing paste containing fluoride.
5. Stir the bleaching paste and place it on the teeth.
6. The additional use of heat and light speeds up the bleaching process. It is important, though, that the patient does not experience any pain due to the heat being used. Most patients can tolerate 50—60 °C. These temperatures are also tolerated when making a hydrocolloid impression. Do not use the heat on the tooth for more than one minute. Then wait for another minute before the heat is reapplied.
7. The power bleaching process should be stopped after 10 –30 minutes, even if the goal has not been achieved. If pain is registered, the treatment must be stopped immediately.
8. Remove the source of heat and wait five minutes so that the teeth can cool down. Then, the remaining bleaching agent is rinsed away using plenty of water and sucked away.
9. Finish the procedure by treating all teeth with a neutral sodium fluoride gel for two to three minutes, whereupon the rubber dam is removed. The patient should then rinse the mouth carefully.
Possible Side Effects
Instruct the patient that the teeth may be somewhat sensitive over the next few days. After approximately two weeks, the outcome of the bleaching treatment is reassessed and, if necessary, the teeth are bleached again.
Patient Information for Home Bleaching
Home