Achieving significant whitening results with home bleaching
Rhona Eskander presents a straightforward tooth whitening case where the patient’s tooth shade was transformed from A3 to B1
Since the introduction of nightguard vital bleaching (tray bleaching) in 1989 (Haywood and Heyman, 1989), tooth whitening treatment uptake has seen a huge rise. One of the most common questions raised by dental professionals is: ‘What bleaching technique works best?’
The mechanism of action is the oxidation of organic pigments or chromogens in the tooth. Varying approaches take different amount of times, owing to differences in concentration or exposure time. The most important factors in the efficacy of any bleaching treatment, however, are the concentration of the bleaching agent and duration of the exposure time.
This medically fit and well 36-year-old female attended complaining of discolouration of her teeth. The patient’s history was taken and included collating her opinions regarding the cause of her tooth discolouration, her history of allergies and information regarding any past problems with tooth sensitivity.
During the discussion, the patient expressed concerns about her tooth discolouration, which she had experienced for more than five years. The patient had an anterior open bite and two fillings on the lower teeth.
Her periodontal health was adequate, however she had some calculus build-up. Her initial colour was recorded on the Vita shade guide and was A3.
The Vita shade guide allows measurement of the shades of the teeth by a subjective visual method (Vitapan Classical, Vita Zahnfabrik), which builds incrementally through six different shades. This allows us to make a comparison of the colour of the teeth before and after whitening.
A word on whitening options
The author chose Philips Zoom whitening for this case. Patients can choose between in-clinic whitening and Daywhite/Nitewhite home tooth whitening, all of which achieve clinically proven results.
Its light-activated chairside whitening system achieves results while the patient is in the practice – up to seven shades in 60 minutes, according to research carried out by the University of Texas. This is because Philips Zoom Whitespeed uses an LED light to accelerate the whitening process. In-clinic and at-home whitening together provide the gold standard in tooth whitening, according to this author.
The take-home system uses whitening trays that are created to fit snugly over the teeth. Into these the whitening gel is dotted and the trays are worn either in the day or at night, for a prescribed number of hours to suit the patient’s lifestyle.
Maximum results are achieved within seven to 14 days; however, your patient’s teeth will be significantly whiter in as little as three days. The whitening gels in all Zoom products also provide sensitivity control and enamel protection due to their amorphous calcium phosphate formulae, which is a desensitising agent.
Carbamide peroxide is the most commonly used whitening agent due to its effectiveness, speed, and minimal side effects, while achieving desirable results. Side effects include tooth hypersensitivity, gingival irritation, tooth surface roughening, and softening or degradation of marginal sealing of composite restorations.
The patient chose Zoom Daywhite for her convenience, as her job sometimes required her to work night shifts. Polyvinysilicone impressions were taken to make her bespoke tooth whitening trays. The trays were given to the patient a few days later along with a Zoom Daywhite system kit.
The patient was shown how to place the gel in the trays, and this was reinforced by showing her a demonstration video. The patient was instructed to place the gel in the trays twice a day and wear them every day for 30 minutes each time. Only the upper tray was given at this point, to allow a direct comparison of the effectiveness of the whitening system.
After two weeks the patient was reviewed; as you can see from Figures 3 and 4, the colour of the patient’s teeth changed dramatically. At this stage the lower tray was given to the patient and she was instructed to do the same with the lower teeth.
The results were excellent – the patient achieved shade B1 on the Vita shade guide.
The patient was advised that to extend the longevity of newly whitened teeth she should do the following:
- At-home follow-up or maintenance whitening – implemented immediately or performed as infrequently as once a yearAvoid dark-coloured foods and beverages for at least a week after whitening
- Whenever possible, sip dark-coloured beverages with a straw
- Practise excellent oral hygiene – brushing and flossing after meals and at bedtime.
Professionally dispensed take-home whitening kits can produce the best results over the long haul. Take-home kits incorporate an easy-to-use lower-concentration peroxide gel that remains on the teeth for an hour or longer.
Haywood VB, Heyman HO (1989) Nightguard vital bleaching. Quintessence Int 20(3): 173-176
Haywood VB, Leonard RH, Dickinson, GL (1997) Efficacy of six months of nightguard vital bleaching of tetracycline-stained teeth. J Esthet Dent 9(1): 13-19
Leonard RH, Haywood VB, Caplan DJ, Tart ND (2003) Nightguard vital bleaching of tetracycline-stained teeth: 90 months post treatment. J Esthet Rest Dent 15(3): 142-153
Shethri SA, Matis BA, Cochran MA, Zekonis R, Stropes M (2003) A clinical evaluation of two in-office bleaching products. Oper Dent 28(5): 488-495
Tam L (2001) Effect of potassium nitrate and fluoride on carbamide peroxide bleaching. Quintessence Int 32(10): 766-770
Dr Rhona Eskander graduated from Leeds University and completed her vocational training in Kent. During this year she won the prize for Best Case Presentation – a complex restorative case which involved several disciplines in dentistry. She is a fully certified Inman Aligner provider and a Platinium Invisalign provider allowing execution of orthodontics. Rhona trained in facial aesthetics at Face Academy. She won the Facial Aesthetics – Botulinum Toxin case award at the Aesthetic Dentistry Awards 2017.
This article was originally published in the April 2018 issue of Aesthetic Dentistry Today. Read more articles like this in Aesthetic Dentistry Today and gain three hours’ verifiable CPD with every issue. Click here to subscribe or call 01923 851 777. Get in touch via Twitter @AesDenToday or facebook.com/AesDenToday.