Bleaching Final 2019 PDF

‫بسم هللا الرحمن الرحيم‬
Professor. Abdulwahab I. Al-kholani

Treatment of Discoloured Teeth (Bleaching)
or Tooth whitening
Professor Abdulwahab Al-kholani

Lecture contents
Tooth Bleaching - Terminology
Tooth Bleaching - Techniques
Tooth Stains
Extrinsic Tooth Stains
Intrinsic Tooth Stains
Combination
Treatment of Discolored Teeth
Indications and contra indications of bleaching
Microabrasion Technique
Home, Chemical and power bleaching
Sensitivity
Advantages and disadvantages of Bleaching
Internal bleaching stages
Discoloration after Bleaching
Clinical Recommendations
Overall Conclusions

Tooth Bleaching or Tooth whitening

Bleaching Techniques
For vital teeth For non vital teeth

Internal “Non-vital”
i.e. Root-filled
“Vital”
External i.e. Normal pulp

Bleaching Techniques for (vital) Teeth
Home bleaching Chemical in office Power office bleaching

bleaching

Bleaching Techniques for (non vital) Teeth
Internal bleaching

Street bleaching

Street bleaching

Tooth Stains
• Extrinsic  Intrinsic  Extrinsic & Intrinsic
It is essential to determine the cause of

the discolouration prior to treatment

Extrinsic Tooth Discolourations
• Cigarettes, pipes, cigars, chewing

tobacco - yellowish-brown to black
• Marijuana - dark brown to black rings


• Coffee, tea, foods - brown to black
• Poor oral hygiene - various colours


• Coffee, tea, foods - brown to black
• Poor oral hygiene - various colours
• Fluorosis - White, yellow, brown,

grey, and/or black

Intrinsic Tooth Discolourations
• Genetic conditions
• Amelogenesis imperfecta - brown, black
• Systemic Conditions
• Jaundice - blue-green or brown

• Medications during tooth development
• Tetracyclines, fluoride - many colours

• Medications during tooth development
• Tetracyclines, fluoride - many colours
• Body by-products
• Bilirubin - blue-green or brown
• Haemoglobin - grey, black

• Pulp changes

• Pulp changes
• Pulp canal obliteration (PCO)
• Increased dentine thickness - yellow

• Pulp changes
• Pulp necrosis (PN)

• With haemorrhage - grey, black
• Release of haemoglobin and iron
• e.g. trauma

• Pulp changes
• Pulp necrosis (PN)

- With haemorrhage - grey, black
Release of haemoglobin and iron
e.g. trauma
- No haemorrhage - grey-brown
Protein degradation products

• Iatrogenic causes

• Trauma during pulp extirpation
• Pulp tissue remnants in pulp chamber

• Restorative materials
• Amalgam, composite, gold, pins, etc
• Esp. if marginal breakdown or leakage

• Endodontic materials
• Medicaments, sealers, temp. fillings, etc.



 All usually brown, grey or black

Extrinsic and Intrinsic Discolouration

• Fluorosis
• White, yellow, brown,
grey, and/or black
• Often with mottled enamel

• Fluorosis
• White, yellow, brown,
grey, and/or black
• Often with mottled enamel
• Ageing
• Yellow
• Often with added discolouration
effects of tooth wear, cracks,
restorations, illness, etc


Determine the cause of the discoloration

Determine the cause of the discoloration
 This will indicate the treatment approach

• Intrinsic stains • Extrinsic stains
• Internal Bleaching • Change addictive behaviour / habits

- after RCF • Prophylaxis
• Full mouth cleaning and scalling
• Enamel microabrasion
• Bleaching

Treatment of Discoloured Teeth
Is their an alternative solution to bleaching and whitening ?

• Alternatives to bleaching and whitening
• Labial veneer restorations
Porcelain, composite resin

• Alternatives to bleaching and whitening
• Labial veneer restorations
• Porcelain, composite resin
• Crowns
• Porcelain, Zircon, composite resin, acrylic
BEFORE AFTER

Micro abrasive Technique
Whiteness RM is a stain remover by microabrasion, which has

in its composition hydrochloric acid at 6% and silicon carbide,
that is extremely hard and sharp, which gives it a greater
effectiveness when compared to other abrasives such as
pumice stone, which is softer and not sharp. Thus, Whiteness
RM can be considered a medium-power product with high
effectiveness, because it combines medium acid content with
high effectiveness of silicon carbide.
Kit
1 syringe with 2g
• 10 applicator tips
• 1 spatula
• Instructions for Use

Micro abrasive Technique
INDICATIONS
Controlled chemical and mechanical removal of enamel stained by fluorosis,

enamel hypoplasia, structural defects that cause pigmentation, or white stains
from inactive caries.

Microabrasion

Home Bleaching

Shammah Or khat

Home Bleaching

Chemical Bleaching

Sensitivity
Desensitizers

Desensitizers

Step by step
Step 1
After prophylaxis, apply the desensitizing gel uniformly on the teeth (use a brush or
Cavibrush micro applicator – FGM) and wait for a minimum of 10 minutes.
Step 2
After the application time, remove the gel from the teeth with cotton and plenty of
water. The patient should avoid swallowing the desensitizer.
Notas
1 – Repeat application of the desensitizer as needed or in the case of dental whitening,
accompanying the time of the treatment. The number of application should not exceed
once a day.
2 – In the case of use for prevention of sensitivity during in-office dental whitening, it is
recommended to apply Desensibilize KF 2% before the application of the whitening gel.

Advantages of Bleaching
• Quick
• Cheap
• Predictable
• Can be re-done
• Conservative procedure (compared to crowning)
• Original crown form or size retained
• No change to the occlusion
• Restores natural colour and translucence
• No effect on the periodontal tissues (if instruction applied properly)

Disadvantages of Bleaching
• Caustic solutions
• Can change the structure of tooth substance
• Not always gives permanent result
• Post operative sensitivity and discoloration in some cases

• Possible reasons (Howell 1981)
• Marginal break down of restoration – marginal gaps
• Bacteria and their by-products
• Food, drinks “Leakage”

• Possible reasons (Howell 1981)
• Marginal break down of restoration
• Bacteria and their by-products

• Food, drinks
• Permeability of tooth
• Saliva or tissue fluid
• Food, Drinks

Bleaching – Stages
Internal bleaching

Bleaching - Stages
1. Assess the RCF
 Re-do RCF if any doubt - usually!!!

Bleaching - Stages
1. Assess the RCF
 Re-do RCF if any doubt - usually!!!

Bleaching - Stages
• Assess and ? re-do the RCF
• Remove RCF to below C-EJ

Bleaching - Stages
• Base over RCF – Barrier

Bleaching - Stages
• Rubber Dam; Access

Bleaching - Stages
• Acid etch, wash & dry

Bleaching - Stages
• Place thick paste of H2O2/Na Perborate

Mix Sodium Perborate with 18% Hydrogen
peroxide on a glass slab.

Make sure you mix enough Sodium perborate powder with 18% H2O2 liquid to get a mushy consistency

Condense the mixture into the tooth chamber, and allow
~3 mm space from the orafice.

Bleaching - Stages
• Temporary filling

Bleaching - Stages
RCF
Barrier
(GIC)
Bleaching
paste

Bleaching - Stages
• Base over RCF –Barrier
• Temporary filling - Cavit
• Review after 1 week
• Repeat if necessary
• Restore access cavity
 Temporary for minimum 2 weeks
 Then do GIC/composite

Final Restoration of Access Cavity
• “Sandwich technique”
 GIC - dentine replacement

 Composite resin - enamel replacement
• Benefits:
• Reduce “microleakage”
• Maintain colour
• “Strengthen” tooth

Bleaching - Stages
• Base over RCF - Cavit
• Temporary filling - Cavit
• Review after 1 week
• Repeat if necessary
• Restore access cavity
• Review - 6 mths, 2-3 yrs, etc

Before
Final result

Before Final result

Power office bleaching

Power or office
bleaching

Clinical Recommendations
• After internal bleaching: • After power bleaching:

• Delay the final restorations for
at least 14 days • Advice patient to stop khat
chewing and smoking and
minimize cola, tea and
coffee intake for 2-3 weeks.

Thank you

Bleaching Final 2019 PDF

Uploaded by

Copyright:

Available Formats

Bleaching Final 2019 PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Bleaching Final 2019 PDF

Uploaded by

Copyright:

Available Formats

‫بسم هللا الرحمن الرحيم‬

Professor. Abdulwahab I. Al-kholani

Professor Abdulwahab Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

For vital teeth For non vital teeth

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Home bleaching Chemical in office Power office bleaching

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

• Extrinsic  Intrinsic  Extrinsic & Intrinsic

It is essential to determine the cause of

Professor. Abdulwahab I. Al-kholani

• Cigarettes, pipes, cigars, chewing

• Marijuana - dark brown to black rings

Professor. Abdulwahab I. Al-kholani

• Cigarettes, pipes, cigars, chewing

• Marijuana - dark brown to black rings

• Coffee, tea, foods - brown to black

• Poor oral hygiene - various colours

Professor. Abdulwahab I. Al-kholani

• Cigarettes, pipes, cigars, chewing

• Marijuana - dark brown to black rings

• Coffee, tea, foods - brown to black

• Poor oral hygiene - various colours

• Fluorosis - White, yellow, brown,

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

• Pulp necrosis (PN)

Professor. Abdulwahab I. Al-kholani

• Pulp necrosis (PN)

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

• Trauma during pulp extirpation

Professor. Abdulwahab I. Al-kholani

 All usually brown, grey or black

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani

Determine the cause of the discoloration

Professor. Abdulwahab I. Al-kholani

Determine the cause of the discoloration

 This will indicate the treatment approach

Professor. Abdulwahab I. Al-kholani

• Intrinsic stains • Extrinsic stains

• Internal Bleaching • Change addictive behaviour / habits

Professor. Abdulwahab I. Al-kholani