By Dr. Fábio Luiz Andretti
Despite all technological evolution that has accompanied our profession, unfortunately, dental whitening has still being associated to the occurrence of dental sensitiveness, use of individual trays for hours (when not trough night) and mandatory use of patient’s soft tissue protection (gingival barriers) that demands office time. With the objective of reducing the occurrence of dental sensitiveness by whitening, the manufacturers have been including desensitizer substances as nitrates, fluorides and oxalates.
This clinical case report presents a simple and safe alternative for dental whitening, without report of dental sensitiveness.
Pic. 1 to 3. Initial patient aspect, unsatisfied with her teeth color despite her beautiful smile.
After Anamnesis and detailed clinical exam an office whitening association using a carbamide peroxide based whitening gel (Power bleaching 37%) was chosen. This product contain a last generation Carbopol® that makes it extremely stable, not needing and easy to apply. The gel was applied three consecutive times (40 minutes per appliance). Howerver, in patients with a history of sensitiveness in prior attempts of teeth whitening, this time can be reduced. This product can be applied several times in the same day, for several days in a whole and still be used without the gingival barrier. For that, the gel must be applied in a thicker possible layer.
Pic. 4 to 7: After relative isolation (Pic. 4), the whitening gel (Power Bleaching 37% Office) is applied with an appliance tip (Pic. 5 and 6). As an alternative, disposable appliance tips or spatulas can be used for this end. Note the thick layer of gel applied over the teeth (Pic. 7).
We opt to associate the office whitening to home whitening to make the patient a partner for the treatment success, and because lower concentrations produce lasting results with lower color return (Brenardon et al, 2010). After impression with alginate and attainment of the plaster models, individual trays were made in EVA with 1mm thickness (Power Plac, BM4).
The selected gel to complement the result was a 10% carbamide peroxide (Power Bleaching 10%, BM4) that was used for 1 hour a day, per three weeks, as professional instruction. Because of that we opt to increase the concentration for 16% until a resulted that assured the patient’s satisfaction was reached. Por isso, optamos por aumentar a concentração para 16% até atingirmos o resultado que garantisse a satisfação da paciente.
In the cases of sensitiveness due to cold or brushing, is advisable to adjust the patient to receive the whitening. Nutritional counseling, oral hygiene instructions related to strength and brushing technique and fluoride and toothpaste containing desensitizer are recommended. If there is the need of prophylaxis (as most of the cases), is recommended to start the whitening with minimum 72 hours or, ideally, one week after prophylaxis.
Pic. 8 to 11: (8) Individual EVA trays positioned, charged with whitening gel. Note oxygen release that produces bubbles inside the trays. Time of tray use: 1hour/day. (9 and 10) three weeks after use of home whitening gel of 10% carbamide peroxide is noted a subtle improvement in teeth color (initial color A3 Vita Lumin Vaccuum scale). (11) (11) One week after new protocol of two weeks use of 16% gel (Power Bleaching 16%) a considerable improve in teeth color can be seen.