Teeth whitening techniques

Intro:

Your teeth can discolor by the diverse causes, what supposes an important esthetic commitment when it is a question of previous teeth, and implies the need to be able to offer to the patient satisfactory therapeutic alternatives in these cases. The tooth whitening done in consultation with splints and a high concentration of whitening agents quimioactivados is a useful, relatively simple and somewhat aggressive, when performed in a controlled manner and under the direct supervision of the dentist gets immediate good clinical results. For this purpose, we can use two types of splints: the usual whitening home with reservoirs of a millimeter and splints specifically designed for this mode of bleaching, with pools of three or four millimeters more capacity with regard to the former.

The purpose of this therapeutic modality is the whitening optimize and facilitate the implementation of the intense action of agents used in bleaching techniques that are made in consultation and reduce the risks associated with the use of them caused by contact between these agents whitening and oral tissues of the patient.

Procedure:

Figure 1. Illumina system dental whitening powder / liquid dual syringe quimioactivable.

Whitening agent:
The bleach product used in this case (Fig. 1) is the Dentsply, which is in the form of powder and liquid contents of two syringes: the first or syringe A, is hydrogen peroxide 30% in liquid form and in the second or syringe B powder (poli-metil-vinil-eter maleic salts of sodium and calcium, and titanium dioxide), once all components become mixed consistency of gel, with a concentration of hydrogen peroxide of 15%.

Clinical technique:

This is a patient of 23 years who came to the consultation by submitting a dental discoloration tetracycline intake in children, severe and moderate periodontal disease (maxillary arch) / severe (mandibular arch) controlled (fig. 2). We performed clinical and radiological diagnosis and taking the color of teeth to whiten teeth by the use of dental colorimeter Shade EX (Shofu). On this occasion, and after assessing the type and degree of discoloration as well as periodontal problems afflicting the patient is scheduled with the home whitening splints of the maxillary arch and bleaching in the consultation with splints of the mandibular arch to avoid prolonged contact between the bleaching agents and areas exposed roots of the teeth of the mandibular arch where the problem was more advanced periodontal. We informed the patient of the risks associated with this type of therapy and the plan of treatment and confirmed in writing their acceptance of them by signing an informed consent.

Figure 2. Pre-bleaching event of tetracycline discoloration by a severe and moderate periodontal disease

Figure 3. Whitening splint and the working model on which it was made with 3 mm separator covering teeth

Alginate impressions were taken for the manufacture of bleaching splints, splint for use at home with pool, 1 mm for the maxillary arch and a splint for use in consultation with the reservoir 3 mm for the mandibular arch (Fig. 3 ); splints that in both cases must meet the quality criteria of splinting teeth (adjusted, festoons, retentive, stable and non-iatrogenic).

After photographic records and the isolation of the initial operative field, led to the initial preparation of the teeth to facilitate the action of the whitening product, therefore removing the plaque and discolor the extrinsic surface of the teeth with a brush mounted on a contra?ngulo and pumice, washed with ethanol surfaces of teeth to increase its permeability to bleaching agent and found the effectiveness of the isolation felt by asking the patient if the taste of alcohol. Then it proceeded with the application of a bleaching product on the teeth of the patient (Fig. 4) using the splint for use in the consultation for 45 minutes. After the treatment session the splint was removed with bleach and the product is completely removed from the remains of the tooth surface is removed and the rubber dam was the color of teeth. Fig. 5 shows the final result after the bleaching of the mandibular arch one weeks after the meeting accomplished.

Figure 4. Application of a bleaching product on the teeth of the patient

Figure 5. Week after completing therapy with Illumina.

Discussion:

Vital tooth bleaching in the consultation highlighted by a procedure that is performed under the direct supervision of professional, not dependent on the proper performance of the implementing rules by the patient outside the clinic, in addition to the need for reduced treatment time to achieve results similar to those achieved using the techniques home. The mode of tooth whitening quimioactivado presents also the advantage of not requiring external activation, while avoiding risks that may be associated with such procedures when they are not implemented in a rigorous and correct (5-7). In the case of the product that we used, Illumina E, add gummy consistency of it, which allows a convenient application and immobility once placed on the teeth to be bleached, which lowers the risk of contact between the patient’s oral tissues and whitening product in comparison to other whitening products used in these techniques and more fluid consistency. Like the rest of techniques carried out in the consultation, where indicated, it can complement the home bleaching treatment procedures in order to obtain more successful outcomes and perpetuates the temporal performance through this kind of therapy.

The color of the dental records should be made final a week after finishing the last bleaching session, at which time the color can be considered stable. The color was recorded using a colorimeter because it is a procedure for objective quantification of the change of color in comparison with techniques using subjective valuation guides for dental use color.

Conclusion:

Depending on the results we can say that money queamiento in consultation with dental splints and high concentration of whitening agents quimioactivables is an effective technique with which, after a single session can be successful with a discoloration as presented .