Bleach

“The lightening of the color of tooth through the
application of a chemical agent to oxidize the
organic pigmentation in the tooth”

Sturdevant

EXTRINSIC TOOTH DISCOLOURATION

INTRINISIC TOOTH DISCOLOURATION

INTERNALISED DISCOLORATION

 Light enamel discolouration

 Mild Tetracycline discolouration

 Endemic fluorosis discolouration

 Age related discolouration

 Extremely large pulp chambers
 Other causes of hypersensitivity such as exposed root surfaces
 Hyperemia associated with orthodontic tooth movement .
 Severe loss of enamel
 Teeth exhibiting gross or microscopic enamel cracking
 Extremely dark teeth , especially those with banding
 Teeth with composite restorations

Bleaching BLEACHING
techniques

VITAL NONVITAL

Inoffice At home Inoffice At home

Thermocatalytic
Night guard
Power bleaching
Thermocatalytic Walking bleach
Photothermocatalytic

Based upon the tooth involved bleaching
techniques are of two types-
 Non Vital
 Vital

Based upon where the procedure is
performed-
 In office
 Home applied

This technique describe the bleaching
of teeth that have become discolored
by the diffusion into the dentinal
tubules of haemoglobin breakdown
products from necrotic pulp tissue.

INDICATIONS-

 Discolored non vital teeth.
 Well condensed gutta percha root
filling.
 No clinical or radiological signs of
periapical disease.

 Heavily restored tooth
 Staining due to amalgam

Armamentarium
 Rubber dam

 Zinc phosphate cement

 37%phosphoric acid

 30- volume hydrogen peroxide

 Sodium perborate powder

 Cotton wool

 Glass ionomer cement

 White gutta percha

 Composite resin

 Take preoperative
periapical
radiograph

 Place rubber dam,
isolate the teeth.

 Clean the teeth
with pumice

 Remove palatal
restoration & pulp
chamber restoration.

 Remove root filling to
the level of the
dentogingival junction
by use of burs.

 Place 1mm of Zinc
phosphate cement
over the gutta percha

 Freshen dentine with a
round bur.
 Etch the pulp chamber
with 37% phosphoric
acid for 30-60 sec.
 Mix the hydrogen
peroxide and sodium
perborate into a thick
paste and place it into
the tooth with a flat
plastic instrument.
 To activate the
bleaching action, expose
the tooth to heat.
 Place a dry piece of
cotton over the
perborate mixture.

 Seal the cavity with
a glass ionomer
cement.
 Repeat the process
at weekly interval.
 Place non-setting
calcium hydroxide
into the pulp
chamber for two
weeks.
 Seal with glass
ionomer cement.
 Finally restore the
tooth with white
gutta percha and
composite resin.

This technique involves the external
application of hydrogen peroxide to the
surface of tooth followed by its
activation with a heat source.

INDICATION
 Very mild tetracycline staining without
obvious banding.
 Mild fluorosis
 Yellowing due to ageing
 Single teeth with sclerosed pulp
chamber and canals.

 Take periapical
radiographs and
performs vital test

 Apply topical
anaesthetic to
gingival margins.

 Coat the buccal
and palatal gingiva
with orabase gel .

 Isolate each
tooth to be
bleached and the
end teeth should
be clamped.

 Teeth are
pumiced to
remove stains
and excess
oraseal.

 Etch the labial
and
palatal/lingual
surface of the
teeth with
phosphoric acid
for 60 sec and
dry it.

 Soak a strip of
gauze in the
35%hydrogen
peroxide and cover
the teeth to be
bleached.

 The bleaching
illuminator is turned
on for 30 min with
a sensor placed just
under and in front
of arch being
bleached.

 After 30 minute
, the gauze and
rubber dam are
removed.

 The patient is
asked to brush
the teeth , to
remove any
excess oraseal

 The teeth are
polished with
shofu stone.

This technique involves the daily placement
of carbamide peroxide gel into a custom
fitted tray of either the upper or lower
arch.

INDICATION
1. Mild fluorosis.
2. Moderate fluorosis as adjunct to
hydrochloric acid.
3. Yellowing due to ageing.

 Upper impression and working model.
 Soft mouthguard.
 10% carbamide peroxide gel.

REACTION
 Carbamide peroxide [10%] breaks down in
mouth to form 3% hydrogen peroxide and
7% urea.
 Urea and hydrogen peroxide due to there
low molecular weight diffuse through
enamel and dentine.

 Take an alginate
impression of the arch
to be treated and make
working model in stone.

 Relieve the labial
surface of the teeth by
0.5mm and make a soft
, pull down , as a
mouthguard. vacuum
formed splint

 Instruct the patient how
to apply gel into the
mouthguard.

 Length of time
the guard should
be worn depends
on the product.

 After 2 weeks
check that the
patient is not
experiencing any
sensitivity.

This is a controlled method of removing
surface enamel in order to eliminate
discoloration that are limited to the outer
enamel layer.

INDICATION-
1. Fluorosis
2. Idiopathic
3. Post orthodontic treatment demineralization
4. Prior to veneer placement for well- demarcated stains.
5. Whitebrown surface staining e.g- secondary to
primary predessor infection or trauma [Turner teeth]

ARMAMENTARIUM
1. Bicarbonate of soda/ water.
2. Copalite varnish.
3. Fluorinated toothpaste.
4. Non-acidulated fluoride
5. Pumice
6. Rubber dam
7. Soflex discs
8. 18% hydrochloric acid.
9. Acid pumice microabrasive kit

TECHNIQUE

1. Perform
preoperative vitality
test
2. Clean the teeth
with pumice and
water, wash and
dry.
3. Isolate the teeth
to be treated with
rubber dam, and
paint copalite
varnish around the
necks of the dam

 Place a mixture of
sodium bicarbonate
and water on the
dam behind the
teeth.
Mix8%hydrochloric
acid with pumice
into a slurry and
apply a small
amount to the labial
surface by either a
rubber cup rotating
slowly for 5 sec or
by a wooden stick
rubbed over the
surface for 5 sec.

 Apply the fluoride
drops to the teeth
for 3 minute
 Remove the rubber
dam.
 Polish the teeth with
soflex discs.
 Polish the teeth with
fluorinated toothpaste
for 1 minute.
 Review in 1 month for
vitality tests and
clinical radiographs.

 Esthetics in Dentistry – Ronald E. Goldstein
Volume I
 Welbury RR. Paediatric dentistry 2 edn ,
Oxford university Press, 2001: 204- 5
 McDonald RE, Avery DR, Dean JA.
Dentistry for the child and adolescent 8th
edn, Mosby, 2004 :133-5, 447-8
 The Art & Science of Operative Dentistry-
2nd edn, Clifford M. Sturdevant

THE EXCELLENCE OF EVERY ART IS ITS

INTENSITY , CAPABLE OF MAKING ALL

DISAGEEABLE EVAPORATE, FROM THEIR

BEING IN CLOSE RELATIONSHIP WITH

BEAUTY AND TRUTH.
-JOHN KEATS

Bleach

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Bleach