This document discusses tooth colour and discolouration. It notes that teeth have natural variations in colour from darker at the root to lighter at the incisal edge. Tooth colour can also be affected by intrinsic and extrinsic factors like staining, aging, and systemic conditions. The document examines classification and causes of discolouration and various treatment options like bleaching, restorations, and doing nothing. Bleaching techniques like home, in-office, and non-vital bleaching are described in detail along with how they work to break down stain molecules. Comparisons are made between treatment methods.
Presentation about Internal, or non-vital bleaching, will updated more in the future hopefully.
This presentation aims to introduce basic principles, agents, and other details of internal bleaching, as it is one of the ways to achieve the conservative approach in modern dental care.
This document discusses different methods for bleaching teeth, including at-home bleaching with trays, in-office bleaching, and bleaching of non-vital teeth. It describes the various bleaching agents used such as hydrogen peroxide, sodium perborate, and carbamide peroxide. Home bleaching typically involves custom-fitted trays with 10% carbamide peroxide worn 4 hours per day. In-office bleaching uses higher concentrations of hydrogen peroxide applied with heat or light activation. Bleaching of non-vital teeth isolates the tooth and places bleaching agents into the pulp chamber.
This document provides an overview of single visit endodontics. It discusses the history and increased acceptance of single visit root canals due to advances in technology. The document outlines indications and contraindications for single visit root canals and notes the practice management, patient, and clinician advantages which include reduced stress, cost and number of visits. Guidelines for performing single visit root canals including case selection criteria and pain control methods are also summarized.
This document discusses strategies for minimally invasive endodontics. It emphasizes preserving tooth structure to maximize strength and longevity. Smaller access openings and conservative root canal shaping are recommended to avoid weakening tooth structure. Thorough disinfection can still be achieved with smaller canal preparations when combined with improved irrigation methods. Restorations should maintain coronal and peri-cervical tooth structure to reinforce the tooth through the "ferrule effect." The goal of minimally invasive endodontics is effective treatment while minimizing structural damage to teeth.
Introduction
History
Bleaching agent
Classification of Bleaching technique.
Vital bleaching technique
Effect of vital bleaching on tooth structure
Effect of vital bleaching on tetracycline stain
Effect of vital bleaching on Fluorosis stain
Effect of vital bleaching on restorative material
Conclusion
References
Retentive features of a cavity
Indications and contraindication
Advantages and disadvantages
Types of pins
Cemented pins
Friction locked pins
Self threaded pins –(TMS)
Thread mate system
Regular , minim, manikin, minuta
Standard, self shearing, two in one, link series, link plus
Factors involved
Mechanical aspect
Anatomical aspect
Mechano-anatomical principles
Mechanical aspects of Pin-Retained restoration
Pins and tooth structure
Stressing capabilities of pins
Retention of pins in dentin
Microcracking and crazing
Pins and restorative materials
Effect of pins on strength of restorative materials
Retention of pins to restorative material
This document discusses various techniques for tooth bleaching, including:
1. Non-vital bleaching which involves placing a hydrogen peroxide mixture into the tooth to lighten discoloration from pulp necrosis.
2. In-office bleaching which applies hydrogen peroxide gel to the tooth surface followed by heat activation to diffuse the peroxide into the tooth.
3. At-home bleaching which uses a custom tray with carbamide peroxide gel worn overnight to slowly lighten teeth.
The document provides details on the procedures, indications, and risks/benefits of different bleaching methods.
Presentation about Internal, or non-vital bleaching, will updated more in the future hopefully.
This presentation aims to introduce basic principles, agents, and other details of internal bleaching, as it is one of the ways to achieve the conservative approach in modern dental care.
This document discusses different methods for bleaching teeth, including at-home bleaching with trays, in-office bleaching, and bleaching of non-vital teeth. It describes the various bleaching agents used such as hydrogen peroxide, sodium perborate, and carbamide peroxide. Home bleaching typically involves custom-fitted trays with 10% carbamide peroxide worn 4 hours per day. In-office bleaching uses higher concentrations of hydrogen peroxide applied with heat or light activation. Bleaching of non-vital teeth isolates the tooth and places bleaching agents into the pulp chamber.
This document provides an overview of single visit endodontics. It discusses the history and increased acceptance of single visit root canals due to advances in technology. The document outlines indications and contraindications for single visit root canals and notes the practice management, patient, and clinician advantages which include reduced stress, cost and number of visits. Guidelines for performing single visit root canals including case selection criteria and pain control methods are also summarized.
This document discusses strategies for minimally invasive endodontics. It emphasizes preserving tooth structure to maximize strength and longevity. Smaller access openings and conservative root canal shaping are recommended to avoid weakening tooth structure. Thorough disinfection can still be achieved with smaller canal preparations when combined with improved irrigation methods. Restorations should maintain coronal and peri-cervical tooth structure to reinforce the tooth through the "ferrule effect." The goal of minimally invasive endodontics is effective treatment while minimizing structural damage to teeth.
Introduction
History
Bleaching agent
Classification of Bleaching technique.
Vital bleaching technique
Effect of vital bleaching on tooth structure
Effect of vital bleaching on tetracycline stain
Effect of vital bleaching on Fluorosis stain
Effect of vital bleaching on restorative material
Conclusion
References
Retentive features of a cavity
Indications and contraindication
Advantages and disadvantages
Types of pins
Cemented pins
Friction locked pins
Self threaded pins –(TMS)
Thread mate system
Regular , minim, manikin, minuta
Standard, self shearing, two in one, link series, link plus
Factors involved
Mechanical aspect
Anatomical aspect
Mechano-anatomical principles
Mechanical aspects of Pin-Retained restoration
Pins and tooth structure
Stressing capabilities of pins
Retention of pins in dentin
Microcracking and crazing
Pins and restorative materials
Effect of pins on strength of restorative materials
Retention of pins to restorative material
This document discusses various techniques for tooth bleaching, including:
1. Non-vital bleaching which involves placing a hydrogen peroxide mixture into the tooth to lighten discoloration from pulp necrosis.
2. In-office bleaching which applies hydrogen peroxide gel to the tooth surface followed by heat activation to diffuse the peroxide into the tooth.
3. At-home bleaching which uses a custom tray with carbamide peroxide gel worn overnight to slowly lighten teeth.
The document provides details on the procedures, indications, and risks/benefits of different bleaching methods.
This document discusses dental discoloration, its causes, and bleaching treatments. It covers extrinsic and intrinsic causes of staining and describes different types and degrees of tetracycline and fluorosis staining. Bleaching mechanisms and materials including hydrogen peroxide, sodium perborate, and carbamide peroxide are explained. Intracoronal and extracoronal bleaching techniques and their potential adverse effects are summarized.
Veneers are a conservative treatment to improve the appearance of teeth. They involve bonding thin facings of tooth-colored material to the front of teeth. Veneers can be made of composite resin, porcelain, or other ceramic materials. They are either bonded directly during a single appointment or indirectly with impressions taken and veneers fabricated by a dental laboratory over two appointments. Veneers can repair damage, close gaps, change the shape or length of teeth, or improve discoloration while minimizing the removal of tooth structure. The choice of material and technique depends on the specific needs and preferences of the patient.
Non-carious cervical lesions are caused by a combination of erosion, abrasion, and abfraction and affect half the population. Erosion is chemical wear from acids like those in citrus fruits and drinks. Abrasion is mechanical wear, like from overly vigorous brushing. Abfraction is stress-related wear from forces like clenching. These lesions are diagnosed through history, examination, and radiographs. Treatment depends on the severity but may include desensitization, restorations using composites or glass ionomers, endodontics, or periodontal procedures.
The document discusses the history and techniques of tooth bleaching. It notes that early attempts in the 19th century used highly dangerous caustic materials. By the late 1800s, oxidizing agents like hydrogen peroxide, sodium peroxide, and chlorine began to be used. In the 1960s, techniques were developed where bleaching agents were placed directly into pulp chambers of non-vital teeth for weeks, called "walking bleaches". Later techniques in the 1990s combined internal placement of agents with external bleaching trays to bleach from both inside and outside simultaneously. The document traces the evolution of bleaching from dangerous early methods to safer modern techniques.
This document discusses the process and effects of intracoronal bleaching. It involves placing bleaching agents such as superoxol and sodium perborate into the tooth chamber. The bleaching solution is then heated using a bleaching stick or light curing unit and repeated until the desired color is achieved. Some potential side effects include tooth sensitivity, effects on enamel and the pulp, decreased bond strength of composites, and toxicity from ingesting high concentrations of hydrogen peroxide.
MTA is a biocompatible material introduced in 1993 as a repair material with properties like sealing ability, tissue regeneration, and antibacterial effects. It has applications in pulp capping, pulpotomy, apexification, root-end fillings, and repair of root perforations. MTA sets into a hard material with high pH and promotes mineralized tissue formation. It has advantages over calcium hydroxide in applications requiring hard tissue barriers.
This document summarizes recent advances in rebuilding lost enamel structure through biomimetics. It discusses the mechanisms of demineralization and remineralization, and the requirements of effective remineralizing agents. Both fluoride and non-fluoride strategies are examined, including casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), nano-hydroxyapatite, bioactive glass, arginine, and tricalcium phosphate. CPP-ACP, which mimics proteins found in saliva, and bioactive glass materials like NovaMin and bioglass, are highlighted as effective remineralizing agents. The document provides details on the compositions and mechanisms of various strategies to promote remin
The document discusses working length determination in endodontics. It defines working length as the distance from a coronal reference point to the point where canal preparation and obturation should terminate. This is usually 1mm short of the apical foramen. Several methods of determining working length are discussed, including radiographic methods and the use of electronic apex locators, which provide objective measurements with high accuracy. Consequences of working length that is too long or too short are also outlined.
The document discusses various shade selection techniques for dental restorations, including using commercial shade guides to select the hue, chroma, and value of the shade by making comparisons under different lighting conditions. It focuses on the Vita Classic shade guide system and the recommended four-step process of hue selection, chroma selection, value selection, and final check/revision. Proper shade selection is important for achieving natural-looking dental restorations that match the colors of a patient's teeth.
Dental caries is defined as a localized pathological process caused by acids produced by bacteria in dental plaque that leads to demineralization of tooth hard tissues. Diagnosis of caries involves detecting lesions, assessing activity, and determining risk factors to identify lesions requiring treatment and persons at high risk. A variety of tools can be used for caries diagnosis including visual inspection, fiber-optic transillumination, and diagnostic technologies assessing properties like fluorescence. The International Caries Detection and Assessment System (ICDAS) provides a standardized visual method for caries detection and assessment and has demonstrated validity though performance varies depending on tooth type and surface.
This document discusses different methods of cosmetic tooth whitening or bleaching. It describes intrinsic and extrinsic tooth discoloration and their causes. The main methods covered are in-office bleaching, laser bleaching, and dentist-prescribed home bleaching kits. In-office bleaching uses high concentration peroxide gels applied by the dentist. Home bleaching involves patients wearing custom-fitted trays with lower concentration peroxide gels overnight. Non-vital bleaching treats discoloration inside teeth without pulps. Factors like concentration, time, temperature, and additives affect bleaching results. Potential side effects include temporary tooth sensitivity.
Dental veneers are custom shells made of tooth-colored materials that are bonded to the front of teeth to improve their color, shape, size or alignment, and can be made of either composite or porcelain; they are used to treat issues like discoloration, crooked teeth, gaps or cracks and improve the aesthetics and function of the smile. The document discusses the different types of veneers, their applications, benefits and risks, as well as the procedures for applying both composite and porcelain veneers.
Researchers are developing new non-fluoride remineralization systems that go beyond traditional fluoride-based remineralization. These include biomimetic approaches that use peptides and proteins to regenerate enamel crystals as well as methods that enhance fluoride efficacy such as casein phosphopeptide systems. Some promising new technologies utilize electric currents, nanoparticles, or glass materials to help teeth take up minerals. These novel remineralization therapies aim to better treat cavities while reducing risks from high fluoride use.
A short slideshow covering the basics of Intrusive luxation and total avulsion, from an endodontic point of view.. Highlight are the photographs chosen with care to explain the points well. Ideal for under-graduate and Post-graduate students. Based on Grossman's Endodontic Practice, 13th Edition.
Minimally invasive endodontics by Dr. JAGADEESH KODITYALAJagadeesh Kodityala
This document discusses principles of minimally invasive endodontics. It defines minimally invasive dentistry and lists the primary goals of endodontics as tooth retention and preventing/managing pulpal and periapical disease while preserving structural integrity. The document discusses strategies for minimally invasive access cavity preparation and shaping of the root canal space. It emphasizes the importance of conserving tooth structure, maintaining smaller canal sizes when possible, and avoiding excessive dentin removal to strengthen teeth and reduce fracture risks.
This document discusses local anesthesia techniques for pediatric dental patients. It defines pain and local anesthesia, and describes the components of local anesthetic solutions. It provides details on topical anesthetics and various injection techniques for mandibular and maxillary teeth, including inferior alveolar nerve block, mental nerve block, and local infiltration. Supplemental techniques like periodontal ligament injections are also covered. The document discusses metabolism of local anesthetics, maximum recommended doses, and potential complications. It concludes by mentioning new techniques like jet injection and computer-controlled delivery systems.
- An inlay is a restoration constructed externally and then cemented into a prepared tooth cavity. An onlay covers one or more cusps and adjoining occlusal surface.
- Indirect restorations like inlays and onlays are used for large restorations, endodontically treated teeth at risk of fracture, and dental rehabilitation with cast metals. They allow for better control of contours compared to direct restorations.
- Disadvantages include requiring more appointments, higher chair time, need for temporary restorations, higher costs, and being more technique sensitive.
pulpotomy procedures in primary dentitionParth Thakkar
A pulpotomy involves removing the inflamed coronal pulp while leaving the healthy radicular pulp intact. The aim is to relieve pain and allow for root development. Formocresol pulpotomy is commonly used and involves applying formocresol to the exposed pulp stump to fix tissues and eliminate microorganisms. It is performed using either a single-stage or two-stage technique. Other materials used include calcium hydroxide, glutaraldehyde and ferric sulfate. Success rates depend on strict case selection and technique.
This document discusses direct and indirect pulp capping procedures. Indirect pulp capping involves covering the deepest layer of remaining carious dentin with a biocompatible material to prevent pulp exposure and stimulate tertiary dentin formation. Direct pulp capping places a protective dressing directly over an exposed pulp to preserve its vitality. Various materials used for both procedures are discussed, along with their advantages and disadvantages. The document provides details on performing indirect and direct pulp capping clinically and factors affecting their success.
This document provides information on the classification and treatment of tooth discoloration. It begins with an introduction on the importance of properly diagnosing the cause of discoloration in order to determine the appropriate treatment. Tooth discoloration is then classified in various ways, including by location (intrinsic, extrinsic, internalized), etiology (pre-eruptive, post-eruptive causes), and chemistry of the staining agent. Diagnosis involves taking a medical history and pretreatment photos in order to analyze the cause. Potential treatments discussed include prevention methods, scaling, microabrasion, macroabrasion, veneers, bleaching of vital and non-vital teeth, and the use of various agents
The document discusses the causes and management of tooth discoloration, noting that it can be either extrinsic from external stains or intrinsic due to changes in the tooth structure, and treatments include removing surface stains, bleaching techniques, and restorative options like veneers or crowns to mask discoloration. Non-vital bleaching involves removing filling material and gutta percha, sealing off the root canal with GIC, and placing carbamide peroxide gel inside the tooth.
This document discusses dental discoloration, its causes, and bleaching treatments. It covers extrinsic and intrinsic causes of staining and describes different types and degrees of tetracycline and fluorosis staining. Bleaching mechanisms and materials including hydrogen peroxide, sodium perborate, and carbamide peroxide are explained. Intracoronal and extracoronal bleaching techniques and their potential adverse effects are summarized.
Veneers are a conservative treatment to improve the appearance of teeth. They involve bonding thin facings of tooth-colored material to the front of teeth. Veneers can be made of composite resin, porcelain, or other ceramic materials. They are either bonded directly during a single appointment or indirectly with impressions taken and veneers fabricated by a dental laboratory over two appointments. Veneers can repair damage, close gaps, change the shape or length of teeth, or improve discoloration while minimizing the removal of tooth structure. The choice of material and technique depends on the specific needs and preferences of the patient.
Non-carious cervical lesions are caused by a combination of erosion, abrasion, and abfraction and affect half the population. Erosion is chemical wear from acids like those in citrus fruits and drinks. Abrasion is mechanical wear, like from overly vigorous brushing. Abfraction is stress-related wear from forces like clenching. These lesions are diagnosed through history, examination, and radiographs. Treatment depends on the severity but may include desensitization, restorations using composites or glass ionomers, endodontics, or periodontal procedures.
The document discusses the history and techniques of tooth bleaching. It notes that early attempts in the 19th century used highly dangerous caustic materials. By the late 1800s, oxidizing agents like hydrogen peroxide, sodium peroxide, and chlorine began to be used. In the 1960s, techniques were developed where bleaching agents were placed directly into pulp chambers of non-vital teeth for weeks, called "walking bleaches". Later techniques in the 1990s combined internal placement of agents with external bleaching trays to bleach from both inside and outside simultaneously. The document traces the evolution of bleaching from dangerous early methods to safer modern techniques.
This document discusses the process and effects of intracoronal bleaching. It involves placing bleaching agents such as superoxol and sodium perborate into the tooth chamber. The bleaching solution is then heated using a bleaching stick or light curing unit and repeated until the desired color is achieved. Some potential side effects include tooth sensitivity, effects on enamel and the pulp, decreased bond strength of composites, and toxicity from ingesting high concentrations of hydrogen peroxide.
MTA is a biocompatible material introduced in 1993 as a repair material with properties like sealing ability, tissue regeneration, and antibacterial effects. It has applications in pulp capping, pulpotomy, apexification, root-end fillings, and repair of root perforations. MTA sets into a hard material with high pH and promotes mineralized tissue formation. It has advantages over calcium hydroxide in applications requiring hard tissue barriers.
This document summarizes recent advances in rebuilding lost enamel structure through biomimetics. It discusses the mechanisms of demineralization and remineralization, and the requirements of effective remineralizing agents. Both fluoride and non-fluoride strategies are examined, including casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), nano-hydroxyapatite, bioactive glass, arginine, and tricalcium phosphate. CPP-ACP, which mimics proteins found in saliva, and bioactive glass materials like NovaMin and bioglass, are highlighted as effective remineralizing agents. The document provides details on the compositions and mechanisms of various strategies to promote remin
The document discusses working length determination in endodontics. It defines working length as the distance from a coronal reference point to the point where canal preparation and obturation should terminate. This is usually 1mm short of the apical foramen. Several methods of determining working length are discussed, including radiographic methods and the use of electronic apex locators, which provide objective measurements with high accuracy. Consequences of working length that is too long or too short are also outlined.
The document discusses various shade selection techniques for dental restorations, including using commercial shade guides to select the hue, chroma, and value of the shade by making comparisons under different lighting conditions. It focuses on the Vita Classic shade guide system and the recommended four-step process of hue selection, chroma selection, value selection, and final check/revision. Proper shade selection is important for achieving natural-looking dental restorations that match the colors of a patient's teeth.
Dental caries is defined as a localized pathological process caused by acids produced by bacteria in dental plaque that leads to demineralization of tooth hard tissues. Diagnosis of caries involves detecting lesions, assessing activity, and determining risk factors to identify lesions requiring treatment and persons at high risk. A variety of tools can be used for caries diagnosis including visual inspection, fiber-optic transillumination, and diagnostic technologies assessing properties like fluorescence. The International Caries Detection and Assessment System (ICDAS) provides a standardized visual method for caries detection and assessment and has demonstrated validity though performance varies depending on tooth type and surface.
This document discusses different methods of cosmetic tooth whitening or bleaching. It describes intrinsic and extrinsic tooth discoloration and their causes. The main methods covered are in-office bleaching, laser bleaching, and dentist-prescribed home bleaching kits. In-office bleaching uses high concentration peroxide gels applied by the dentist. Home bleaching involves patients wearing custom-fitted trays with lower concentration peroxide gels overnight. Non-vital bleaching treats discoloration inside teeth without pulps. Factors like concentration, time, temperature, and additives affect bleaching results. Potential side effects include temporary tooth sensitivity.
Dental veneers are custom shells made of tooth-colored materials that are bonded to the front of teeth to improve their color, shape, size or alignment, and can be made of either composite or porcelain; they are used to treat issues like discoloration, crooked teeth, gaps or cracks and improve the aesthetics and function of the smile. The document discusses the different types of veneers, their applications, benefits and risks, as well as the procedures for applying both composite and porcelain veneers.
Researchers are developing new non-fluoride remineralization systems that go beyond traditional fluoride-based remineralization. These include biomimetic approaches that use peptides and proteins to regenerate enamel crystals as well as methods that enhance fluoride efficacy such as casein phosphopeptide systems. Some promising new technologies utilize electric currents, nanoparticles, or glass materials to help teeth take up minerals. These novel remineralization therapies aim to better treat cavities while reducing risks from high fluoride use.
A short slideshow covering the basics of Intrusive luxation and total avulsion, from an endodontic point of view.. Highlight are the photographs chosen with care to explain the points well. Ideal for under-graduate and Post-graduate students. Based on Grossman's Endodontic Practice, 13th Edition.
Minimally invasive endodontics by Dr. JAGADEESH KODITYALAJagadeesh Kodityala
This document discusses principles of minimally invasive endodontics. It defines minimally invasive dentistry and lists the primary goals of endodontics as tooth retention and preventing/managing pulpal and periapical disease while preserving structural integrity. The document discusses strategies for minimally invasive access cavity preparation and shaping of the root canal space. It emphasizes the importance of conserving tooth structure, maintaining smaller canal sizes when possible, and avoiding excessive dentin removal to strengthen teeth and reduce fracture risks.
This document discusses local anesthesia techniques for pediatric dental patients. It defines pain and local anesthesia, and describes the components of local anesthetic solutions. It provides details on topical anesthetics and various injection techniques for mandibular and maxillary teeth, including inferior alveolar nerve block, mental nerve block, and local infiltration. Supplemental techniques like periodontal ligament injections are also covered. The document discusses metabolism of local anesthetics, maximum recommended doses, and potential complications. It concludes by mentioning new techniques like jet injection and computer-controlled delivery systems.
- An inlay is a restoration constructed externally and then cemented into a prepared tooth cavity. An onlay covers one or more cusps and adjoining occlusal surface.
- Indirect restorations like inlays and onlays are used for large restorations, endodontically treated teeth at risk of fracture, and dental rehabilitation with cast metals. They allow for better control of contours compared to direct restorations.
- Disadvantages include requiring more appointments, higher chair time, need for temporary restorations, higher costs, and being more technique sensitive.
pulpotomy procedures in primary dentitionParth Thakkar
A pulpotomy involves removing the inflamed coronal pulp while leaving the healthy radicular pulp intact. The aim is to relieve pain and allow for root development. Formocresol pulpotomy is commonly used and involves applying formocresol to the exposed pulp stump to fix tissues and eliminate microorganisms. It is performed using either a single-stage or two-stage technique. Other materials used include calcium hydroxide, glutaraldehyde and ferric sulfate. Success rates depend on strict case selection and technique.
This document discusses direct and indirect pulp capping procedures. Indirect pulp capping involves covering the deepest layer of remaining carious dentin with a biocompatible material to prevent pulp exposure and stimulate tertiary dentin formation. Direct pulp capping places a protective dressing directly over an exposed pulp to preserve its vitality. Various materials used for both procedures are discussed, along with their advantages and disadvantages. The document provides details on performing indirect and direct pulp capping clinically and factors affecting their success.
This document provides information on the classification and treatment of tooth discoloration. It begins with an introduction on the importance of properly diagnosing the cause of discoloration in order to determine the appropriate treatment. Tooth discoloration is then classified in various ways, including by location (intrinsic, extrinsic, internalized), etiology (pre-eruptive, post-eruptive causes), and chemistry of the staining agent. Diagnosis involves taking a medical history and pretreatment photos in order to analyze the cause. Potential treatments discussed include prevention methods, scaling, microabrasion, macroabrasion, veneers, bleaching of vital and non-vital teeth, and the use of various agents
The document discusses the causes and management of tooth discoloration, noting that it can be either extrinsic from external stains or intrinsic due to changes in the tooth structure, and treatments include removing surface stains, bleaching techniques, and restorative options like veneers or crowns to mask discoloration. Non-vital bleaching involves removing filling material and gutta percha, sealing off the root canal with GIC, and placing carbamide peroxide gel inside the tooth.
The document discusses different tooth bleaching techniques including night guard vital bleaching using 16% or 10% carbamide peroxide started over one or two weeks, in-office bleaching using light, heat or chemical activation, and non-vital bleaching. It also mentions enamel microabrasion and over-the-counter bleaching options. The techniques vary in strength and whether performed at home or in a dental office.
This document discusses dental bleaching, including that it can lighten intrinsic and extrinsic stains, is done either in a dental office or at home, and depends on factors like age, habits, and trauma. It notes the risks can include chemical burns, sensitive teeth, and over-bleaching. It also recommends maintaining results by avoiding dark foods for a week after, not smoking, good oral hygiene, and continuing whitening products.
The document discusses vital tooth bleaching. It begins by outlining the indications for bleaching, such as moderate tooth discolouration from fluorosis or aging. Contraindications include severe stains, hypersensitivity, or active caries.
At-home bleaching involves custom-fitted trays containing 10% carbamide peroxide, which breaks down to release hydrogen peroxide. The process involves taking impressions to fabricate trays that deliver the bleaching agent to the teeth overnight. Factors like concentration, temperature, pH, and time influence the bleaching effect.
This document provides an overview of dental bleaching (tooth whitening). It discusses the various causes of tooth discoloration and the mechanisms by which bleaching works to lighten teeth. The main types of bleaching are described as non-vital bleaching for discolored non-living teeth and vital bleaching for living teeth, which can be done at home or in-office with light acceleration. Safety concerns are noted along with the need for more long-term studies. Natural bleaching methods using ingredients like strawberries, baking soda, and other fruits are mentioned but caution is advised about enamel damage if overused.
Nonvital pulp therapy in pediatric dentistryPriyank Pareek
The document discusses techniques for pulpectomy procedures in primary teeth. It describes removing necrotic pulp tissue from the root canals and coronal portion of teeth to maintain the tooth. Key steps include isolating the tooth, removing caries, accessing and cleaning canals, drying canals, and filling canals with zinc oxide eugenol. The goals are to resolve infection, show healing on x-rays, and allow normal resorption and eruption of permanent teeth.
This document provides an overview of tooth discoloration and its management. It discusses classifications of extrinsic and intrinsic discoloration and their causes. Extrinsic stains are located on the tooth surface and can be removed by prophylaxis, while intrinsic stains are within the tooth structure. Tetracycline staining occurs when tetracycline antibiotics are taken during tooth development. Enamel hypoplasia is a defect resulting in less enamel. Management of extrinsic stains involves prophylaxis or macroabrasion. Intrinsic stains are managed using microabrasion, bleaching, composite restorations, or porcelain veneers. A combination of treatments may be used.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document discusses tooth colour and bleaching techniques. It begins by describing the natural colours of teeth and factors that affect tooth colour. It then discusses intrinsic and extrinsic tooth discolouration, their causes, and management options. Bleaching techniques are summarized, including home bleaching using trays, in-office bleaching, and non-vital bleaching. Risks and management of sensitivity are also covered. Lasers can be used to enhance bleaching but have higher costs and potential sensitivity risks.
The document discusses the structure of teeth and common oral health problems. It describes the distinct parts of a tooth including the crown, root, and neck. Important structures within teeth like enamel, dentin, and pulp cavity are also outlined. Common oral issues explained include dental caries, periodontal diseases, dental staining, oral malodor, dentinal hypersensitivity, dry mouth, and dental calculus. Treatment options for these problems focus on reducing bacteria, remineralizing teeth, and removing plaque and calculus deposits.
The document discusses the history, causes, materials, and techniques of tooth bleaching. It begins with the earliest known uses of tooth whitening in the 1300s and progresses to modern techniques. The main causes of tooth discoloration discussed are extrinsic stains from foods/drinks and intrinsic stains from issues such as tetracycline use, fluorosis, and pulpal pathology. Common bleaching materials mentioned are hydrogen peroxide, carbamide peroxide, and sodium perborate. Techniques covered include in-office bleaching using these agents along with light activation, and home bleaching using custom-fitted night guards. Advantages and disadvantages are also briefly touched on.
Tooth bleaching, or whitening, involves the application of a chemical agent to oxidize organic pigmentation in the tooth and lighten its color. There are several techniques and materials used for bleaching, with the most common being at-home bleaching trays containing a low concentration carbamide peroxide gel or in-office bleaching using a high concentration hydrogen peroxide or sodium perborate paste. The bleaching agents work by generating free radicals that oxidize chromophores within the enamel and dentin to disrupt the molecular structures responsible for tooth discoloration.
This document summarizes dental whitening materials and procedures. It discusses the intrinsic and extrinsic causes of tooth discoloration and summarizes ancient practices and modern perceptions of tooth whitening. Methods described include take-home whitening trays using carbamide or hydrogen peroxide gels or in-office whitening using higher concentration hydrogen peroxide or carbamide peroxide gels applied with a light activator. Advantages include comfort and satisfaction while disadvantages include potential tooth sensitivity. Popular brand names and products are also mentioned.
This document provides information on tooth discoloration and bleaching. It begins by classifying tooth discoloration as either extrinsic or intrinsic. Extrinsic discoloration occurs on the tooth surface, while intrinsic discoloration is within the enamel or dentin. Common causes of each type are described. The document then discusses bleaching, defining it as lightening tooth color with a chemical agent. Common bleaching agents like hydrogen peroxide, sodium perborate, and carbamide peroxide are explained. The mechanism of bleaching, which involves chemical reactions that convert colored molecules, is also summarized. Factors that affect bleaching are noted.
This document summarizes information about dental whitening procedures. It discusses the history of tooth whitening and attractiveness of smiles. It describes causes of tooth discoloration including extrinsic stains from foods/drinks and intrinsic stains from tetracycline use or fluorosis. The document outlines in-office whitening techniques using customized trays or strips with hydrogen or carbamide peroxide gels applied for 1 hour. Take-home whitening involves trays filled with lower concentration peroxide gels worn overnight for 2-4 weeks. Various whitening products and their active ingredients are also mentioned.
This document summarizes information about dental whitening procedures. It discusses the history of tooth whitening and attractiveness of smiles. It describes causes of tooth discoloration including extrinsic stains from foods/drinks and intrinsic stains from tetracycline use or fluorosis. The document outlines in-office whitening techniques using customized trays or strips with hydrogen or carbamide peroxide gels applied for 1 hour. Take-home whitening involves trays filled with lower concentration peroxide gels worn overnight for 2-4 weeks. Various whitening products and their active ingredients are also mentioned.
This document summarizes information about dental whitening materials and procedures. It discusses the history and social perceptions of tooth color. Both intrinsic and extrinsic tooth stains are described. Common whitening agents like carbamide peroxide and hydrogen peroxide are outlined. In-office whitening techniques involving customized trays or strips are summarized, as are at-home whitening methods using custom trays over 1-4 weeks. Advantages include comfort and satisfaction, while disadvantages include potential tooth sensitivity. Popular whitening brands and their active ingredients are listed.
The document provides a detailed overview of tooth bleaching (whitening), including its history, causes of tooth discoloration, materials used, and different techniques. It discusses how bleaching works through redox reactions that oxidize chromogens. Key points include:
- Tooth bleaching has been practiced since the 1300s using various agents like honey, salt, vinegar, nitric acid and chlorine compounds. Modern techniques use hydrogen peroxide, carbamide peroxide, or sodium perborate.
- Discoloration can be intrinsic, due to factors like tetracycline use or fluorosis, or extrinsic from dietary or metallic stains.
- Bleaching is indicated for mild to moderate dis
Discoloration of teeth / dental implant courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
BLEACHING TECHNIQUES IN RESTORATIVE DENTISTRY.pptx Whitening of root-filled t...SadhuAbhijeet
This document discusses various techniques for bleaching teeth, including vital bleaching methods like nightguard bleaching using carbamide peroxide gels and bleaching of non-vital teeth using walking bleach. It also covers the causes of tooth discoloration like extrinsic stains from foods/drinks, intrinsic stains from fluorosis, tetracycline use, and illnesses during tooth formation. Classification systems for different types and severities of stains are presented.
This document provides information about oral hygiene, dental health, dental caries, and various dental products. It discusses the three layers that make up teeth, how dental caries form due to plaque bacteria producing acid, and the role of fluoride in preventing dental caries. It also describes common dental products like sodium fluoride, which is used to prevent tooth decay, calcium carbonate and zinc chloride, which are used as abrasives and desensitizers in dentifrices. Zinc eugenol cement, composed of zinc oxide, eugenol and other ingredients, is discussed as a temporary dental filling material.
This document discusses tooth discoloration, including its classification, etiology, and management. It covers intrinsic discoloration caused by factors like dental fluorosis, tetracycline, and certain systemic diseases. Extrinsic discoloration from substances like coffee, tea, and smoking is also addressed. Treatment options depending on the cause and severity of discoloration are presented, with bleaching and restorations discussed in detail. Vital bleaching techniques and factors affecting bleaching outcomes are also summarized.
This document discusses tooth discoloration including classification, etiology, and management. It describes intrinsic discoloration which occurs inside tooth structure from factors like dental fluorosis, tetracycline, and certain systemic diseases. Extrinsic discoloration is caused by external staining from foods, drinks, smoking. Treatment options depend on the cause and severity but may include bleaching, microabrasion, veneers, or crowns. Bleaching can be performed internally for non-vital teeth or externally with trays containing a bleaching agent. Factors like concentration, time, and protection of pulpal health affect bleaching outcomes.
The document discusses various dental products including anticaries agents, cleaning agents, and desensitizing agents. It describes the roles of calcium carbonate, sodium fluoride, and stannous fluoride as anticaries agents. It explains the mechanisms of dental caries/plaque formation and how fluoride prevents caries by forming fluorapatite. It also discusses the administration and potential side effects of fluoride overdose. Zinc chloride and strontium chloride are provided as examples of desensitizing agents.
low birth weight presentation. Low birth weight (LBW) infant is defined as the one whose birth weight is less than 2500g irrespective of their gestational age. Premature birth and low birth weight(LBW) is still a serious problem in newborn. Causing high morbidity and mortality rate worldwide. The nursing care provide to low birth weight babies is crucial in promoting their overall health and development. Through careful assessment, diagnosis,, planning, and evaluation plays a vital role in ensuring these vulnerable infants receive the specialize care they need. In India every third of the infant weight less than 2500g.
Birth period, socioeconomical status, nutritional and intrauterine environment are the factors influencing low birth weight
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
2. COLOURCOLOUR
Teeth made of many colours, with natural gradation fromTeeth made of many colours, with natural gradation from
the darker cervical to the lighter incisal thirdthe darker cervical to the lighter incisal third
Variation affected by thickness of enamel and dentine,Variation affected by thickness of enamel and dentine,
and reflectance of different coloursand reflectance of different colours
Blue, green and pink tints in enamel, yellow through toBlue, green and pink tints in enamel, yellow through to
brown shades of dentine beneathbrown shades of dentine beneath
Canine teeth darker than lateral incisorsCanine teeth darker than lateral incisors
Teeth become darker with age (secondary/tertiaryTeeth become darker with age (secondary/tertiary
dentine, tooth wear/dentine exposure)dentine, tooth wear/dentine exposure)
3. COLOURCOLOUR
Tooth colour affected by:Tooth colour affected by:
individual interpretationindividual interpretation
time of daytime of day
patient positioning/ angle tooth is viewed atpatient positioning/ angle tooth is viewed at
skin tone (make-up)skin tone (make-up)
surrounding conditions (e.g. lighting in clinic)surrounding conditions (e.g. lighting in clinic)
4. CLASSIFICATION OF TOOTHCLASSIFICATION OF TOOTH
DISCOLOURATIONDISCOLOURATION
Extrinsic discolourationExtrinsic discolouration
Intrinsic discolourationIntrinsic discolouration
5. AETIOLOGY OF DISCOLOURATIONAETIOLOGY OF DISCOLOURATION
Extrinsic Discoloration:Extrinsic Discoloration:
Stains (chromogens) that lies on/attach to theStains (chromogens) that lies on/attach to the
tooth surface or in the acquired pellicle, ortooth surface or in the acquired pellicle, or
The incorporation of extrinsic stain within theThe incorporation of extrinsic stain within the
tooth substance following dental development.tooth substance following dental development.
It occurs in enamel defects and in the porousIt occurs in enamel defects and in the porous
surface of exposed dentinesurface of exposed dentine
6. AETIOLOGY OF DISCOLOURATIONAETIOLOGY OF DISCOLOURATION
Extrinsic Discolouration:Extrinsic Discolouration:
E.g.E.g.
•Plaque, chromogenenicPlaque, chromogenenic
bacteriabacteria
•Mouthwashes (chlorhexidine)Mouthwashes (chlorhexidine)
•Smoking / chewing tobaccoSmoking / chewing tobacco
•Beverages (tea, coffee, redBeverages (tea, coffee, red
wine, cola)wine, cola)
•Foods (curry, cooking oils andFoods (curry, cooking oils and
fried foods, foods withfried foods, foods with
colorings, berries, beetroot)colorings, berries, beetroot)
• Iron supplementsIron supplements
7. AETIOLOGY OF DISCOLOURATIONAETIOLOGY OF DISCOLOURATION
Intrinsic Discolouration:Intrinsic Discolouration:
Intrinsic discolouration occurs following aIntrinsic discolouration occurs following a
change to the structural composition or thicknesschange to the structural composition or thickness
of the dental hard tissues.of the dental hard tissues.
9. MANAGEMENT OFMANAGEMENT OF
DISCOLOURED TEETHDISCOLOURED TEETH
Treatment options:Treatment options:
1.1.No treatmentNo treatment
2.2.Removal of surface stainRemoval of surface stain
3.3.Bleaching techniquesBleaching techniques
4.4.Operative techniques to mask underlyingOperative techniques to mask underlying
discolourationdiscolouration
VeneersVeneers
CrownsCrowns
10. Treatment option Indications Advantages Disadvantages
No treatment Patient with poor oral
hygiene/ caries/ PA
pathology, large ant
restorations/crowns
Non invasive, no cost Will not address
patients aesthetic
concerns
Removal of surface
stain
-Scale and polish
-Microabrasion
-Extrinsic staining
-Fluorosis, white spot
demineralisation,
enamel hypoplasia
Non/minimally invasive May not improve
aesthetics significantly,
may require further Rx
Microabrasion- soft
tissue irritation/
excessive tooth prep
(technique sensitive)
Bleaching
-Home bleaching,
Walking bleach
-See later slides
Non/minimally invasive Cost, limitation on
shade improvement (a
few shade lighter only),
may fail/ need
repeating, compliance
(home bleaching)
Restorative treatment
-Veneers, crowns
Severely discoloured
teeth, e.g. tetracycline
staining (may bleach
1st
)
Unaesthetic tooth
morphology (e.g. AI/DI)
Heavily restored teeth
May achieve a more
aesthetic result
Destructive, irreversible
(tooth tissue removal),
changes natural shape
of teeth, cost,
maintenance, oral
hygiene compliance
(interdental cleaning)
11. TO BLEACH OR NOT TO BLEACH?TO BLEACH OR NOT TO BLEACH?
12. GENERAL INDICATIONSGENERAL INDICATIONS
Generalised stainingGeneralised staining
AgeingAgeing
Extrinsic stain - Smoking and dietary stains (tea/coffee etc)Extrinsic stain - Smoking and dietary stains (tea/coffee etc)
FluorosisFluorosis
Tetracycline staining (? in combination with restorative techniques)Tetracycline staining (? in combination with restorative techniques)
Traumatic pulpal changesTraumatic pulpal changes
White spotsWhite spots
Brown spots (not as good response)Brown spots (not as good response)
13. CONTRAINDICATIONSCONTRAINDICATIONS
Patients with high/unrealistic expectations
Decay and active peri-apical pathology (must be
resolved first)
Pregnancy/Breastfeeding
Sensitivity/cracks/exposed dentine
Existing crowns / large restorations (anteriorly)
Elderly patients with visible recession and yellow
roots (roots don’t bleach as readily as crowns)
14. EFFECTS ONEFFECTS ON
Soft tissuesSoft tissues
Cervical resorptionCervical resorption
PulpPulp
Hardness of teethHardness of teeth
Tooth coloured restorationsTooth coloured restorations
Adhesive bond strengthAdhesive bond strength
-changes composition of enamel and dentine, therefore defer-changes composition of enamel and dentine, therefore defer
definitive adhesive restorations until 2 weeks (at least 10 days)definitive adhesive restorations until 2 weeks (at least 10 days)
after bleaching completedafter bleaching completed
15. BLEACHINGBLEACHING
DefinitionDefinition
““any treatment procedure orany treatment procedure or
method a dental professionalmethod a dental professional
might prescribe to whiten themight prescribe to whiten the
color and brighten yourcolor and brighten your
teethteeth””
10-15% carbamide peroxide10-15% carbamide peroxide
used as a oral disinfectantused as a oral disinfectant
since late 1960s – LONGsince late 1960s – LONG
CLINICAL HISTORYCLINICAL HISTORY
16. BLEACHING TECHNIQUESBLEACHING TECHNIQUES
Vital bleaching :Vital bleaching :
• Home use of 10 % (15%, 20% ALSO)Home use of 10 % (15%, 20% ALSO)
carbamide peroxide in a dental traycarbamide peroxide in a dental tray
• ““In office bleaching” (~30% carbamideIn office bleaching” (~30% carbamide
peroxide) carried out in single visit (photoperoxide) carried out in single visit (photo
initiation) plus additional home use ofinitiation) plus additional home use of
carbamide peroxide 10% to “top up”carbamide peroxide 10% to “top up”
Non-vital bleaching :Non-vital bleaching :
• (A.k.a Walking bleaching)(A.k.a Walking bleaching)
• The ‘Inside/Outside’ method using 10 %The ‘Inside/Outside’ method using 10 %
carbamide peroxidecarbamide peroxide
17. MATERIALSMATERIALS
1.1. Hydrogen peroxide (HP):Hydrogen peroxide (HP): HH22OO22
2.2. Carbamide peroxideCarbamide peroxide: CH: CH66NN22OO33 much more stablemuch more stable
than hydrogen peroxide, hence it’s preferred usethan hydrogen peroxide, hence it’s preferred use
• Urea stabilises and buffers HP – shelf life!Urea stabilises and buffers HP – shelf life!
• A 10% Carbamide peroxide solution containsA 10% Carbamide peroxide solution contains
3% HP, 7% Urea3% HP, 7% Urea
1.1. Tetrahydrate sodium perborate:Tetrahydrate sodium perborate: NaBONaBO33 (Borax)(Borax)
mixed with water- decomposes to HP.mixed with water- decomposes to HP.
18. MATERIALSMATERIALS
Why 10% CP most widely used?Why 10% CP most widely used?
• 10% is the only bleaching concentration10% is the only bleaching concentration
approved by the FDIapproved by the FDI
• Higher concentrations= increased sensitivityHigher concentrations= increased sensitivity
and harmful effectsand harmful effects
19. MODE OF ACTIONMODE OF ACTION
Thought to be due to the ingress of oxidisersThought to be due to the ingress of oxidisers
and oxygenating molecules through enameland oxygenating molecules through enamel
micropores.micropores.
Break/cleave pigment bonds and allowBreak/cleave pigment bonds and allow
molecules to diffuse through the toothmolecules to diffuse through the tooth
&/or become smaller and absorb less light&/or become smaller and absorb less light
and hence appear lighterand hence appear lighter
20. MODE OF ACTION 2MODE OF ACTION 2
When bleach is applied to the
tooth it passes from the incisal
edge to the apex of the tooth
through the enamel, dentin &
pulp chamber within 5- 15
minutes.
Hydrogen Peroxide breaks
down very rapidly to water, an
oxygen ion and oxygen free
radicals. The 3 or 4 most
active free radical species are
OH- 95%, OOH- 2.3% & O-
2.3%.
H2O
OOH-
O-
OH-
H2o2
O2
21. MODE OF ACTION 3MODE OF ACTION 3 The oxygen molecules then
attach to the double carbon
bonds (colour stain molecules)
and break them down into
single carbon bonds, thus
disfiguring their internal colors.
The Single carbon bonds
reflect light and therefore
make teeth appear brighter
and whiter. The changed
molecules are now translucent.
The molecules may also now
diffuse through the pores more
readily because of their
reduced size
OH-
OOH-
O-
DCB
DCB
SCB SCB
BREAK DOWN THE
STAIN MOLECULES
24. NON-VITAL BLEACHINGNON-VITAL BLEACHING
Spasser (1961) - sodium perborate sealed within canalSpasser (1961) - sodium perborate sealed within canal
(walking bleach)(walking bleach)
Nutting and Poe (1963, 1967) – combination walking bleachNutting and Poe (1963, 1967) – combination walking bleach
(perborate and HP)(perborate and HP)
Now carbamide peroxide 10% used widelyNow carbamide peroxide 10% used widely
Known as walking bleachingKnown as walking bleaching
Indications:Indications:
To whiten endodontically treated, discolored teeth.To whiten endodontically treated, discolored teeth.
25. NON-VITAL BLEACHING-NON-VITAL BLEACHING- RISK:RISK:
• External (cervical) resorption, especiallyExternal (cervical) resorption, especially
when used with thermocatalytic activationwhen used with thermocatalytic activation
(heated instrument within pulp chamber)(heated instrument within pulp chamber)
• Heithersay found incidence increased whenHeithersay found incidence increased when
associated with trauma (3.9-9.7%) andassociated with trauma (3.9-9.7%) and
orthodontic treatment (24%)orthodontic treatment (24%)
26. CLINICAL RELEVANCE:CLINICAL RELEVANCE:
Pre-operative radiographPre-operative radiograph
• ensure no pathology (external resorption)ensure no pathology (external resorption)
prior to commencing procedureprior to commencing procedure
• medico-legalmedico-legal
Warn patient if previous orthodontic treatmentWarn patient if previous orthodontic treatment
or trauma- higher riskor trauma- higher risk
Sealing GP with a 2mm RMGIC (minimum 2mmSealing GP with a 2mm RMGIC (minimum 2mm
to prevent ingress of bleach into pulp chamberto prevent ingress of bleach into pulp chamber
27. WARNINGSWARNINGS
Warn patient:Warn patient:
• May not improve shadeMay not improve shade
• May reverse, and patient may need to repeat procedure inMay reverse, and patient may need to repeat procedure in
future at own costfuture at own cost
• May require other treatment: veneer/crownMay require other treatment: veneer/crown
• Tooth is hollow whilst carrying out bleaching and patient mustTooth is hollow whilst carrying out bleaching and patient must
be careful, do not bit into hard foods, tooth may fracture!be careful, do not bit into hard foods, tooth may fracture!
• Cervical resorption? Previous trauma/orthoCervical resorption? Previous trauma/ortho
• If temp filling lost must see dentist urgently (walking bleach)If temp filling lost must see dentist urgently (walking bleach)
28. NON-VITAL BLEACHINGNON-VITAL BLEACHING
1.1.History taking & examinationHistory taking & examination
2.2.Examine the radiograph to establish adequate RCFExamine the radiograph to establish adequate RCF
3.3.Take shade and photographTake shade and photograph
4.4.Rubber dam isolation- single toothRubber dam isolation- single tooth
5.5.Remove all filling material and gutta percha 2-3mm apical to CEJ.Remove all filling material and gutta percha 2-3mm apical to CEJ.
6.6.All restorative material must be removed to allow bleaching agentAll restorative material must be removed to allow bleaching agent
to contact the internal tooth structure.to contact the internal tooth structure.
7.7.Mix RMGIC and place 2mm thickness to assure a seal. Light cureMix RMGIC and place 2mm thickness to assure a seal. Light cure
for 20s.for 20s.
8.8.Express Carbamide Peroxide into the cavity (use a small tip, e.g.Express Carbamide Peroxide into the cavity (use a small tip, e.g.
the tips used for acid etch).the tips used for acid etch).
29. NON-VITAL BLEACHINGNON-VITAL BLEACHING
9.9. Place tiny cotton pellet into gel. Leave 1.0 to 1.5mm of space toPlace tiny cotton pellet into gel. Leave 1.0 to 1.5mm of space to
accommodate the provisional restoration.accommodate the provisional restoration.
10.10. Place a GIC provisional restorative material to seal the accessPlace a GIC provisional restorative material to seal the access
opening, check occlusion.opening, check occlusion.
11.11. Repeat the procedure every 3 to 7 days until the desired colorRepeat the procedure every 3 to 7 days until the desired color
change is achieved.change is achieved.
12.12. Remove provisional restorative material and bleaching materialRemove provisional restorative material and bleaching material
to level of GI sealing material. Rinse and clean access opening.to level of GI sealing material. Rinse and clean access opening.
Place a temp restoration.Place a temp restoration.
13.13. A definitive resin composite restoration of a light colour shouldA definitive resin composite restoration of a light colour should
not be placed before 14 days after the bleaching process.not be placed before 14 days after the bleaching process.
30.
31. ““INSIDE-OUTSIDE” BLEACHINGINSIDE-OUTSIDE” BLEACHING
Essentially same technique as Non vital bleachingEssentially same technique as Non vital bleaching
1.1.Pre-op radiograph (assess endo)Pre-op radiograph (assess endo)
2.2.Re-open access cavityRe-open access cavity
3.3.Ensure chamber free of Gutta perchaEnsure chamber free of Gutta percha
4.4.Seal off the root filling with resin-modified GICSeal off the root filling with resin-modified GIC
5.5.Place the 10% gel (may be higher) into a single toothPlace the 10% gel (may be higher) into a single tooth
tray with labial and lingual reservoirs.tray with labial and lingual reservoirs.
6.6.Insert tray into the mouth. Remove excess as necessary.Insert tray into the mouth. Remove excess as necessary.
This should be kept in position for at least 2 to 3 hoursThis should be kept in position for at least 2 to 3 hours
and preferably overnight.and preferably overnight.
7.7.Clean the access cavities out with a toothbrush orClean the access cavities out with a toothbrush or
interproximal brush.interproximal brush.
32. ““INSIDE-OUTSIDE” BLEACHINGINSIDE-OUTSIDE” BLEACHING
8.8. No limit to how many times the material can be changedNo limit to how many times the material can be changed
and changing the material every 2 to 3 hours will probablyand changing the material every 2 to 3 hours will probably
speed up the process.speed up the process.
9.9. The access cavity should ideally left open for no longer thanThe access cavity should ideally left open for no longer than
necessarynecessary
10.10. The chamber should be cleaned out thoroughly andThe chamber should be cleaned out thoroughly and
temporised.temporised.
11.11. A definitive resin composite restoration of a light colourA definitive resin composite restoration of a light colour
should not be placed until 14 days after the bleachingshould not be placed until 14 days after the bleaching
process.process.
33.
34. PROTOCOL 1- HOME BLEACHINGPROTOCOL 1- HOME BLEACHING
(AKA NIGHT GUARD VITAL(AKA NIGHT GUARD VITAL
BLEACHING)BLEACHING)
Make aMake a diagnosisdiagnosis of the cause(s) ofof the cause(s) of
discolouration and record this in the notes.discolouration and record this in the notes.
Treatment plan: Discuss the variousTreatment plan: Discuss the various
alternative treatment options to bleachingalternative treatment options to bleaching
teeth, e.g. no treatment, veneers, crowns.teeth, e.g. no treatment, veneers, crowns.
Check that the patient is not allergic toCheck that the patient is not allergic to
peroxide or plastic.peroxide or plastic.
Identify the teeth for bleachingIdentify the teeth for bleaching
**check their periapical status on radiograph.**check their periapical status on radiograph.
35. PROTOCOL 2PROTOCOL 2
• Record the shade of the
discoloured teeth and write that
in the notes.
• Photograph if possible (with
shade tab)
• Obtain patient consent
• Warn restorations will not
change colour*
• Take alginate impressions for
tray- lab prescription*
• Fit bleaching trays, ensure
good fit and comfortable
• Advise patient on procedure-
demo use, give leaflets
37. PATIENT INFORMATIONPATIENT INFORMATION
Using the 10% CPUsing the 10% CP
(Home Bleaching )(Home Bleaching )
1.1. Brush teeth and floss as normal before each use.Brush teeth and floss as normal before each use.
2.2. Advise the patient to remove the tip from the syringe containing the 10%Advise the patient to remove the tip from the syringe containing the 10%
carbamide gel and to extrude a little (~1mm) of the gel into the deepercarbamide gel and to extrude a little (~1mm) of the gel into the deeper
and front parts of the tray. (No more than ½ a syringe). Place geland front parts of the tray. (No more than ½ a syringe). Place gel in thein the
traytray on the cheek and the tongue side of the back teeth.on the cheek and the tongue side of the back teeth.
3.3. Seat the tray over the teeth and press down firmly.Seat the tray over the teeth and press down firmly.
4.4. A finger, a tissue, or a soft toothbrush should be used to remove excessA finger, a tissue, or a soft toothbrush should be used to remove excess
gel that will flow beyond the edge of the tray.gel that will flow beyond the edge of the tray.
38. PATIENT INFORMATIONPATIENT INFORMATION
5.5. Rinse gently and do not swallow. The tray is usually wornRinse gently and do not swallow. The tray is usually worn
whilst sleeping or a minimum ofwhilst sleeping or a minimum of 2 hours2 hours..
6.6. In the morning, remove the tray and brush the residual gelIn the morning, remove the tray and brush the residual gel
from the teeth. Rinse out the tray and brush it. Store it in afrom the teeth. Rinse out the tray and brush it. Store it in a
safe container.safe container.
The patient should not eat, drink or smoke while bleachingThe patient should not eat, drink or smoke while bleaching
trays in mouth.trays in mouth.
10% CP should not be exposed to heat (decomposes),10% CP should not be exposed to heat (decomposes),
sunlight or extreme cold. Store in a fridge and keep away fromsunlight or extreme cold. Store in a fridge and keep away from
reach of children.reach of children.
39. PATIENT INFO 2PATIENT INFO 2
• Advise the patient that it will probably takeAdvise the patient that it will probably take
about 2-6 weeks to achieve satisfactory resultabout 2-6 weeks to achieve satisfactory result
• Nicotine stain 1-3 monthsNicotine stain 1-3 months
• Tetracycline stain 2-6 months, sometimes 12Tetracycline stain 2-6 months, sometimes 12
• Further restorationsFurther restorations
may be requiredmay be required
40. POST WHITENING INSTRUCTIONSPOST WHITENING INSTRUCTIONS
The Next 24 – 48 hours are important in enhancing &The Next 24 – 48 hours are important in enhancing &
maximizing whitening results.maximizing whitening results.
Avoid substances which may stain teethAvoid substances which may stain teeth
Such as: Red wine, coca cola, coffee, teaSuch as: Red wine, coca cola, coffee, tea
SensitivitySensitivity: Teeth can be sensitive for 24-48 hours: Teeth can be sensitive for 24-48 hours
(esp after in office bleaching). It can range from a(esp after in office bleaching). It can range from a
dull ache in the teeth to sharp pains various teeth.dull ache in the teeth to sharp pains various teeth.
Take Panadol or Nurofen as required.Take Panadol or Nurofen as required.
41. SENSITIVITYSENSITIVITY
55% to 75% of patients experience sensitivity
Cause:
•Passage of
hydrogen peroxide
through enamel
and dentine to the
pulp
42. SENSITIVITYSENSITIVITY
At risk patients:At risk patients:
Large pulp chambersLarge pulp chambers
Exposed root surfacesExposed root surfaces
Abfraction, attrition, erosion,Abfraction, attrition, erosion,
abrasion lesionsabrasion lesions
Over wearing of traysOver wearing of trays
Improper fit of traysImproper fit of trays
High concentrations ofHigh concentrations of
bleaching agentbleaching agent
43. •Decrease wearing time/concentrationDecrease wearing time/concentration
•Desensitizing toothpasteDesensitizing toothpaste
•Potassium nitratePotassium nitrate
• works on the nerve of the toothworks on the nerve of the tooth
•10 - 30 mins in a tray10 - 30 mins in a tray
•Neutral Sodium FluorideNeutral Sodium Fluoride
•occludes the dentinal tubules ( 4-6 weeks)occludes the dentinal tubules ( 4-6 weeks)
•Relief gel,Tooth mousseRelief gel,Tooth mousse
•Amorphous Calcium PhosphateAmorphous Calcium Phosphate
TREATMENT OF SENSITIVITY
Editor's Notes
Pt perceptions of the “Hollywood Smile” has no doubt increased interest in cosmetic rx