Teeth Bleaching

Potential Results
A B
 To Bleach

- Bleaching is one option towhiten teeth.

- Variety of bleaching options.

- Over whelming for patients.

Bleaching Mechanism

The process of bleaching with chemical materials
depend on changing in the color of particles
attached to collagen and not on whitening of
hydroxyl apatite crystals in the enamel and
dentine.

The peroxide solutions will flow easily into
enamel and dentine.

The active ingredient is hydrogen peroxide, an oxidizing
agent.

It diffuses through the organic matrix of enamel and

dentin.

Produces free radicals, which are responsible for the

bleaching process (oxidation).

These free radicals open the highly pigmented carbon

rings and converting them into chains, which are lighter
in color.
Etiology of Tooth Discoloration
 1- Extrinsic Stains

These stains may be related to poor oral hygiene, existing

restorations, gingival bleeding, plaque accumulation,
eating habits, or the presence of chromogenic
microorganism.
A B

Secondary to colored food, drinks (tea, coffee,
cola), tobacco products, smokeless tobacco.
 2- Intrinsic Stains

- Medication given systemically, e.g. tetracyclin,

minocyclin.
- Fluorosis.
- Dental caries.
- Old restorations showing through, e.g. amalgam.
- Trauma.
- Heredity.
A B
 3- Aged Related Color Changes

- Thinned enamel.

- Darkened dentin due to deposition of

secondary dentin, more yellowish.
BLEACHING TREATMENTS

Techniques of whitening is dependent on the
vitality of the teeth,

Or

If the whitening will be done at home or chair
side in the clinic.
 Bleaching of non vital teeth

These teeth are changed in color after endodontic
treatment.

A- dissolve of tissues during the pulpal necrosis period have a

major role in teeth discoloration or;

B- it may be caused by accumulation of blood into dentine

secondary to trauma or;

C- caused by silver cones, cements, therapeutic drugs placed

into the root canals.
 Nonvital Bleaching Procedures

1- In-Office Nonvital Bleaching Technique.

2- Walking Bleach Technique.

 In-Office Nonvital Bleaching Technique

The in office bleaching for nonvital teeth historically has

involved a thermocatalytic technique consisting of the
placement of 35% hydrogen peroxide liquid into the
debrided pulp chamber and acceleration of the oxidation
process by placement of a heating instrument into the pulp
chamber.

A more recent technique uses 35% hydrogen
peroxide pastes or gels that require no heat. This
technique is frequently the preferred in-office
technique for bleaching nonvital teeth.

In both techniques, it is imperative that a sealing
cement (resin-modified glass-ionomer cement is
recommended) be placed over the exposed root
canal filling before application of the bleaching
agent to prevent leakage and penetration of the
bleaching material in an apical direction.


) (Diastema .

 Walking Bleach Technique

Placing of rubber dam.

Removal of all materials in the coronal part.

Removing of 1- 2 mm of GP.

Enlargement of the endodontic access opening.

Placement of resin-modified glass-ionomer liner to seal the
gutta-percha of the root canal filling from the coronal
portion of the pulp chamber and insure a complete sealing
of dentinal tubules that prevent passage of bleaching
materials into these tubules.

Removal of excess cements, the discolored
dentine must be completely exposed.

A creamy paste of saline or sterile anesthetic
solution with sodium perborate are then placed to
fill the cavity to 2 mm less than external borders
of the tooth, never contact the enamel borders.

Close the cavity with temporary restoration.

The bleaching paste is active during the first 24
hours and then will decrease in efficiency.

The paste should be changed after 3-5 days and
this procedure should be repeated 1-3 times to
ensure a good prognosis of treatment.

After finishing, the cavity should be rinsed and a
paste of calcium hydroxide is then placed to
prevent apical resorption.

The temporary restoration is then placed for 2
weeks then cavity should rinsed to remove
calcium hydroxide and a final restoration is used
to close the tooth.
 Bleaching of vital teeth

Teeth that have yellow orange discolorations

are the most respond to treatment.
 Vital Bleaching Procedures

1- In-Office Vital Bleaching Technique.

2- Dentist Prescribed-Home Applied Technique.

 In-Office Vital Bleaching Techniques

This procedure required an adequate application

of rubber dam.

Placement of vaseline or cocoa butter on the
patients lips before placement of rubber dam,
then isolate the anterior teeth (and sometimes the
first premolars) with a heavy rubber dam to
provide maximum retraction of tissue and an
optimal seal around the teeth.

Application of hydrogen peroxide 30%-35%.

It may be a paste or gel.

We use a light to generate heat may accelerate
the oxidation reaction of the hydrogen peroxide
and expedite treatment through a thermocatalytic
effect.

Rinse the teeth thoroughly after 30 minutes,
removing of rubber dam.

The patient must be aware that he will experienced
teeth sensitivity after this treatment.

Repeat this process one time per week and it will
require from 2- 6 weeks and each time we applied
the bleaching material for 30-45 minutes.
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Clean teeth with pumics.

Record pre-op shade.

Isolate teeth as close to

the gingival margin as
possible with rubber dam
(no tears, leakage, fully
inverted).

Place the gel material on the teeth for 30 min.

May need to refresh
with hydrogen peroxide
if the gel appear too dry.

Rinse and clean; remove
rubber dam and record
post-op shade.
 Dentist Prescribed-Home Applied
Technique

Making impression with alginate to perform a
nightguard tray.

When the night guard is adequately preformed,

A (10-15%) gel of carbamide peroxide is
placed into the guard.

In addition to this type of whitening there is
another commercial products such as whitening
toothpaste contains carbamide peroxide or
whitening strips that contains hydrogen peroxide
in different concentrations.

Total treatment time using an overnight approach
is usually 1 to 2 weeks.
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