bleaching of discolored tooth, bleaching materials, bleaching techniques, complications of bleaching

1. Bleaching of discolored
teeth
Dr Bindu kumari
(BDS)

2. What is bleaching?
 Bleaching may be defined as the
lightening of the color of tooth through
the application of a chemical agent to
oxidize the organic pigmentation in the
tooth.
 Tooth whitening (termed tooth
bleaching when utilising bleach), is
either the restoration of a natural tooth
shade or whitening beyond the natural

3. Goal of bleaching
 Restoration of normal tooth color

4. Bleaching materials
 carbamide peroxide,
 hydrogen peroxide,
 sodium perborate and
 calcium peroxide

5. Hydrogen peroxide
 Used in dentistry
 As a whitening agent
 Conc. = 5- 35%
 Low molecular weight
 Can penetrate dentin

6.  It is clear, Colorless and odorless liquid.
 Stored in light- proof amber bottel.
 Unstable
 Kept away from heat
 Care should be taken while handling
 Ischemic effect on skin and mucous
membrane cause a chemical burn.
 Used in walking bleaching
 3- 7.5% (used in home bleach)

7. Sodium perborate
 Stable , white powder
 3 types- sodium perborate
monohydrate
,, ,, ,, trihydrate
,, ,, ,,
tetrahydrate

8.  Powder is water soluble , decompose
into
Sodium metaborate and hydrogen
peroxide, releasing oxygen.
 When mixed into a paste with
superoxol, paste decomposes into
sodium metaborate, water and
oxygen.
 Used in walking bleach.

9. Carbamide peroxide
 Also known as urea hydrogen
peroxide
 Conc. = 3- 45%
 10% carbamide peroxide urea,
ammonia, carbon dioxide and 3.5%
hydrogen peroxide

11. Over-the-counter bleaching
agent
It include
 Tray system
 Trayless system
 Chewing gums
 Tooth pastes
 Bleaching strips
 Paint-on products
(these products primarily work by
removing extrinsic surface stain only)

12. Bleaching mechanism

13. Classification

15. Home bleaching
 Also called nightguard bleaching.
 More commonly used technique.
 Easy to perform
 Less expensive
 Uses a custom fit tray with
10%carbamide peroxide

16. Indications
• Superficial enamel discoloration
• Mild yellow discoloration
• Brown fluorosis discoloration
• Age- related discoloration

17. Contraindication
• Severe enamel loss
• Hypersensitive teeth
• Bruxism
• Presence of caries
• Defective coronal restoration
• Allergy to bleaching gels

18. Steps of tray fabrication
• Take a impression and make a stone
model
• Trim the model
• Place the stock out resin and cure it
• Apply separating media
• Choose the tray sheet material
• Nature of material used for fabrication of
bleaching tray is flexible plastic. Most
common tray material used is ethyl vinyl
acetate.

19. • Cast the plastic in vacuum tray
forming machine.
• Trim and polish the tray.
• Checking the tray for correct fit,
retention and over extension.
• Demonstrate the amount of bleaching
material to be placed.

20. Treatment regimen
 Preoperative photographs are
important .
( patient might forget the original
shade)
 Patients should brush his/her teeth
prior to application of the tray.
(surface debris minimize effective
contact of bleaching agent)
 Place enough bleaching agent into
the tray to cover the facial surface
of the teeth.

22.  Tray should be worn for a period of 4
hours for every session.
(reduce the time period if sensitivity is
experienced . If sensitivity is not issue
, patient can repeat the bleaching
session for second time in same day)
• Remove the tray from 2nd molar region
in a peeling action.

24. • Rinse off the bleaching agent from the
surface of the teeth.
• Tray should be gently brushed to
remove the bleaching agents.
• Number of days required to achieve
desired results is chiefly dependent on
the original extent of tooth
discolouration, duration of bleaching in a
day, and patient compliance.
• Results can be seen as early as 2-14
days or may take as long as 6-

25. Bleaching of vital teeth in
office
Thermocatalytic process
 Equipment needed-
1. Power bleaching material
2. Tissue protector
3. Activating source
4. Protecting cloth and eye wear
5. Mechanical timer

26.  Light sources
1. Conventional bleaching light
2. Tungsten halogen curing light
3. Xenon plasma light
4. Argon and CO2 lasers
5. Diode laser light

27. Indication
• Mild fluorosis and
tetracycline stain.
• Superficial stain
• In order to match
the existing color of
the crown that is
lighter than natural
teeth.
Contraindication
• extensive caries
• Hypersensitive
teeth
• Exposed root
surface
• Severe
discolorations
• Extensive
restoration

28. Procedure
1. Evaluate the tooth color with a shade
guide.
2. Protect the gingival tissues with
orabase or vaseline and isolate the
teeth with a rubber dam.
3. Place protective sunglasses over the
patient’s and operator’s eyes.
4. Clean enamel surface with pumice and
water.

29. 8. Remove the heat source and allow
teeth to cool down for a at least 5
min.
9. Pumice is used to on the teeth to
remove residual exposed gel from
enamel surface.
10. Irrigate thoroughly, dry the teeth
and gently polish them.

30. 5. Apply 30-35% hydrogen peroxide
liquid or gel on the labial surface of
the teeth using cotton pellet.
6. Apply heat with a heating device or a
light source. The temp. should be
maintained between 125- 140 degree
F (52-60 degree C).
7. The treatment time should not
exceed 30 min even if the result is
not satisfactory.

31. 11. Apply neutral sodium fluoride gel 3-5
minutes.
12. Any bonded restoration on
bleaching surface and tea, coffee
etc. avoid for 2 weeks.

33. Non-thermocatalytic bleaching
In this technique, heat source is not used.
Commonly used solution for bleaching
Name composition
1.Superoxol 5 partsH2O2: 1 part
ether
2. McInnes
solution a) 5part of H2O2(30%)
b)5part of HCl(36%)
c)1part of ether(0.2%)
3.Modified a) H2O2 (30%)

34. Microabrasion technique
It is a procedure in which microscopic
layer of enamel is simultaneously
eroded and abraded with a special
compound( usually contains 18% of
hydrochloric acid) leaving a perfectly
intact enamel surface behind.

37. Indications
• Developmental intrinsic stains and
discolorations.
• Superficial surface enamel stains and
opacities
• Yellow- brown stain
• Multicolor stain(brown, grey or yellow)
• Superficial hypoplastic enamel
• Areas of enamel fluorosis

38. • White patches and white spot
• Decalcification lesions from stasis of
plaque and from orthodontic bands.
• Some irregular surface texture

39. Contraindication
• Age related staining
• Tetracycline staining
• Deep enamel hypoplastic lesions
• Some concentric areas of
hypocalcification that extend to the
dentin
• Most amelogenesis imperfecta

40. • Most dentinogenesis lesions
• Carious lesion underlying regions of
decalcification
• Areas of deep enamel and dentin
stain.

41. Bleaching of non- vital tooth
 Walking bleaching ( at home)
It involves use of chemical agents within
the coronal portion of an
endodontically treated tooth to remove
the tooth discoloration.

42. Indication
• Discoloration of pulp chamber
• Dentin discoloration
• Discoloration not amenable to
extracoronal bleaching

43. Contraindication
 Superficial enamel discoloration
 Defective enamel formation
 Severe dentin loss
 Presence of caries
 Discolored composites

44. Steps
1. Take a radiograph to access the quality
of obturation.
2. Evaluate the quality and shade of
restoration if present. If restoration is
defective , replace it.
3. Evaluate tooth color with shade guide.
4. Isolate tooth with rubber dam.
5. Re-establish the access-cavity.
6. Remove the coronal gutta percha
,expose the cavity and refine the cavity.

45. 7. Seal the orifice of the root canal with at
least 1mm intracoronal barrier over the
gutta-percha to prevent percolation of
the bleaching agent into the apical area.
GIC, resin-modified GIC, cavit, or mineral
trioxide aggregate(MTA) can be used as
barrier material, of which MTA is
superior.

46. The level of the barrier material should
be 1mm incisal to cementoenamel
junction.
It is important to confine the bleaching
agents to the crown of the tooth above
the level of bone.

47. 8. Mix sodium perborate powder with
distilled water. In case of sever stains,
3% hydrogen peroxide can be used.
9. Carry the thick paste into the pulp
chamber. Make sure the entire facial
surface of the pulp chamber is covered
with the paste.
10. Place the small cotton pellet, slightly
moistened with H2O2, over the
bleaching paste.

48. 11. Seal the access cavity to a thickness
of 3mm using an adhesive material.
12. The maximum bleaching effect is
attained about 24 hour after the
treatment,
13. Patient should return in 3-7 days for
evaluation of results.
14. If too dark shade, additional bleaching
is necessary.
15. If shade is too light, the tooth should be
permanent restored.

51. Thermocatalytic bleaching( in-office)
• After preparation of the tooth as
previously described, a loose mat of
cotton is placed on the labial surface
and another is placed in the pulp
chamber of the tooth to be bleached.
• The cotton mats are saturated with
30% H2O2.
• The solution is activated by exposing
to the light and heat from a powerful
light.

52.  The tooth is subjected to usually 5-6
minute exposures, and one replenishes
the bleaching solution in frequent
intervals.
 On completion of the bleaching, a pellet
of cotton moistened with H2O2, or
sodium perborate, is sealed in the pulp
chamber until the following
appointment.

53. Complications ( intracoronal
bleaching)
1. External root resorption
2. Chemical burn
3. Inhibition of resin polymerization