By Dr. Fábio Luiz Andretti
A 29-years-old patient looks for doing a teeth whitening after the orthodontic braces removal. She complained of yellowed teeth and reported sensitiveness of first upper molar (26).
Pic. 1. Initial aspect of teeth right after removal of of orthodontic braces and remains of the material used to fixate the brackets.
Pic. 2. Note the excellent gingival health state.
After the diagnosis and initial exam, all causes of sensitiveness must be eliminated or controlled. The sensitiveness on tooth 26 was determined after prophylaxis and a careful clinical exam: a probable abfraction lesion. After prophylaxis and adequate relative isolation, a light curing glass ionomer based varnish was applied and cured. After the usual recommendations of hygiene and feed habits controls, the patient was considered ready to receive dental whitening treatment.
Considering that the patient was extremely collaborative, her hygiene was great and the dental sensitiveness risk was minimum, the using of carbamide peroxide at 37% in the tray, 20 minutes a day for just two weeks was proposed. This is only possible because carbamide peroxide is extremely safe. This technique can only be used in selected cases and never with hydrogen peroxide.
Note the whitening result after two weeks of gel use. After this period, the patient used a syringe of 16% gel (Power bleaching 16%) for a week to assure a longer result, better stability and smaller color return. Beyond the satisfaction with the result, the absence of sensitiveness is one of the best experiences that patients that seek dental whitening can experience.
Pic. 3. Teeth aspect before (left) and after (right) two week whitening (only 20 minutes a day).
The safety of whitening gels based on carbamide peroxide (Power Bleaching, BM4) associated with the correct diagnosis and selection of the best technique warrants safe, predictive and comfortable result to both professional and patient.
Bernardon JK, Sartori N, Ballarin A, Perdigão J, Lopes GC, Baratieri LN (2010) Clinical Performance of Vital Bleaching Techniques. Operative Dentistry: Jan 2010, Vol. 35, No. 1, pp. 3-10.
Bernardon JK, Ferrari P, Baratieri LN, Rauber GB (2015) Comparison of treatment time versus patient satisfaction in at-home and in-office tooth bleaching therapy J Prosthet Dent: Dez 2015, Vol. 114, No. 12, pp. 826-830.