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Bleach

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  • 1. “The lightening of the color of tooth through the application of a chemical agent to oxidize the organic pigmentation in the tooth” Sturdevant
  • 2. EXTRINSIC TOOTH DISCOLOURATIONINTRINISIC TOOTH DISCOLOURATIONINTERNALISED DISCOLORATION
  • 3.  Light enamel discolouration Mild Tetracycline discolouration Endemic fluorosis discolouration Age related discolouration
  • 4.  Extremely large pulp chambers Other causes of hypersensitivity such as exposed root surfaces Hyperemia associated with orthodontic tooth movement . Severe loss of enamel Teeth exhibiting gross or microscopic enamel cracking Extremely dark teeth , especially those with banding Teeth with composite restorations
  • 5. Bleaching BLEACHINGtechniques VITAL NONVITALInoffice At home Inoffice At home Thermocatalytic Night guard Power bleaching Thermocatalytic Walking bleach Photothermocatalytic
  • 6. Based upon the tooth involved bleaching techniques are of two types- Non Vital Vital Based upon where the procedure is performed- In office Home applied
  • 7. This technique describe the bleaching of teeth that have become discolored by the diffusion into the dentinal tubules of haemoglobin breakdown products from necrotic pulp tissue.INDICATIONS- Discolored non vital teeth. Well condensed gutta percha root filling. No clinical or radiological signs of periapical disease.
  • 8.  Heavily restored tooth Staining due to amalgamArmamentarium Rubber dam Zinc phosphate cement 37%phosphoric acid 30- volume hydrogen peroxide Sodium perborate powder Cotton wool Glass ionomer cement White gutta percha Composite resin
  • 9.  Take preoperative periapical radiograph Place rubber dam, isolate the teeth. Clean the teeth with pumice
  • 10.  Remove palatal restoration & pulp chamber restoration. Remove root filling to the level of the dentogingival junction by use of burs. Place 1mm of Zinc phosphate cement over the gutta percha
  • 11.  Freshen dentine with a round bur. Etch the pulp chamber with 37% phosphoric acid for 30-60 sec. Mix the hydrogen peroxide and sodium perborate into a thick paste and place it into the tooth with a flat plastic instrument. To activate the bleaching action, expose the tooth to heat. Place a dry piece of cotton over the perborate mixture.
  • 12.  Seal the cavity with a glass ionomer cement. Repeat the process at weekly interval. Place non-setting calcium hydroxide into the pulp chamber for two weeks. Seal with glass ionomer cement. Finally restore the tooth with white gutta percha and composite resin.
  • 13. This technique involves the external application of hydrogen peroxide to the surface of tooth followed by its activation with a heat source.INDICATION Very mild tetracycline staining without obvious banding. Mild fluorosis Yellowing due to ageing Single teeth with sclerosed pulp chamber and canals.
  • 14.  Take periapical radiographs and performs vital test Apply topical anaesthetic to gingival margins. Coat the buccal and palatal gingiva with orabase gel .
  • 15.  Isolate each tooth to be bleached and the end teeth should be clamped. Teeth are pumiced to remove stains and excess oraseal.
  • 16.  Etch the labial and palatal/lingual surface of the teeth with phosphoric acid for 60 sec and dry it.
  • 17.  Soak a strip of gauze in the 35%hydrogen peroxide and cover the teeth to be bleached. The bleaching illuminator is turned on for 30 min with a sensor placed just under and in front of arch being bleached.
  • 18.  After 30 minute , the gauze and rubber dam are removed. The patient is asked to brush the teeth , to remove any excess oraseal
  • 19.  The teeth are polished with shofu stone.
  • 20. This technique involves the daily placement of carbamide peroxide gel into a custom fitted tray of either the upper or lower arch.INDICATION1. Mild fluorosis.2. Moderate fluorosis as adjunct to hydrochloric acid.3. Yellowing due to ageing.
  • 21.  Upper impression and working model. Soft mouthguard. 10% carbamide peroxide gel.REACTION Carbamide peroxide [10%] breaks down in mouth to form 3% hydrogen peroxide and 7% urea. Urea and hydrogen peroxide due to there low molecular weight diffuse through enamel and dentine.
  • 22.  Take an alginate impression of the arch to be treated and make working model in stone. Relieve the labial surface of the teeth by 0.5mm and make a soft , pull down , as a mouthguard. vacuum formed splint Instruct the patient how to apply gel into the mouthguard.
  • 23.  Length of time the guard should be worn depends on the product. After 2 weeks check that the patient is not experiencing any sensitivity.
  • 24. This is a controlled method of removing surface enamel in order to eliminate discoloration that are limited to the outer enamel layer.INDICATION-1. Fluorosis2. Idiopathic3. Post orthodontic treatment demineralization4. Prior to veneer placement for well- demarcated stains.5. Whitebrown surface staining e.g- secondary to primary predessor infection or trauma [Turner teeth]
  • 25. ARMAMENTARIUM1. Bicarbonate of soda/ water.2. Copalite varnish.3. Fluorinated toothpaste.4. Non-acidulated fluoride5. Pumice6. Rubber dam7. Soflex discs8. 18% hydrochloric acid.9. Acid pumice microabrasive kit
  • 26. TECHNIQUE1. Perform preoperative vitality test2. Clean the teeth with pumice and water, wash and dry.3. Isolate the teeth to be treated with rubber dam, and paint copalite varnish around the necks of the dam
  • 27.  Place a mixture of sodium bicarbonate and water on the dam behind the teeth. Mix8%hydrochloric acid with pumice into a slurry and apply a small amount to the labial surface by either a rubber cup rotating slowly for 5 sec or by a wooden stick rubbed over the surface for 5 sec.
  • 28.  Apply the fluoride drops to the teeth for 3 minute Remove the rubber dam. Polish the teeth with soflex discs. Polish the teeth with fluorinated toothpaste for 1 minute. Review in 1 month for vitality tests and clinical radiographs.
  • 29.  Esthetics in Dentistry – Ronald E. Goldstein Volume I Welbury RR. Paediatric dentistry 2 edn , Oxford university Press, 2001: 204- 5 McDonald RE, Avery DR, Dean JA. Dentistry for the child and adolescent 8th edn, Mosby, 2004 :133-5, 447-8 The Art & Science of Operative Dentistry- 2nd edn, Clifford M. Sturdevant
  • 30. THE EXCELLENCE OF EVERY ART IS ITSINTENSITY , CAPABLE OF MAKING ALLDISAGEEABLE EVAPORATE, FROM THEIRBEING IN CLOSE RELATIONSHIP WITHBEAUTY AND TRUTH. -JOHN KEATS