A clinical case by our Community member Dr. Sara Laface
This article and its content are published under the Author’s responsibility as an expression of the Author’s own ideas and practice. Styleitaliano denies any responsibility about the visual and written content of this work.
Can you imagine a perfect smile with dark teeth?
The answer is no. As the color (shade) is one of the main aspects of dental aesthetics we should focus on giving our patients the best solution in terms of aesthetics, while keeping our procedures safe, and minimally invasive.
For this reason, at home-bleaching is to be considered the best option when we have well balanced tooth shapes and correct alignment. Indeed, in such cases, all we need is a color improvement.
This patient came to our clinic from abroad with a specific request. She wanted “white” teeth, free of discolorations or stains.
Intra-oral and extra-oral pictures are mandatory for the right documentation of the bleaching progress. Stains from previous adhesive procedures were still on the surface of some of her teeth.
We used the VITA Bleachedguide 3D-MASTER® to assess the initial shade of the canines, the darkest teeth to bleach in this case.
For the best result in terms of bleaching and safety, we chose, together with the patient, a home-bleaching strategy: conservative, successful and safe.
Digital impressions were taken using the iTero Scanner.
1mm reservoires are digitally designed on the buccal surfaces of selected teeth.
Sagittal view of the digital impression without and with the reservoir.
Reservoires are made to completely cover the buccal surface, with a 1 mm distance from the gingival margin.
The digital workflow allows for accurate thickness control.
3D printed dental model with reservoirs on the teeth.
The patient reported no dental sensitivity during the treatment.
We moved the shade of the patient from a 4 M2 shade to 0 M1 one. We reached the whitest point of the VITA shade with high satisfaction of the patient. A homogeneous shade was reached on all teeth. Also, the dyschormia was solved.
Tooth bleaching is most often requested treatment in our office. To achieve the best result we mostly suggest athome treatments with customized trays and carbamide peroxide gel.
Gel options available are 5%, 10% and 16% carbamide peroxide, along with 6% hydrogen peroxide (White Dental Beauty). The NOVON® technology included in each gel avoid dental sensitivity during and after bleaching, thanks to its ability of rising an acid pH up to an alkaline value of 8.5.
Digital impressions are universally accepted as the most comfortable, and the digital workflow makes the process faster and more accurate. A dental shade guide like VITA Bleachedguide 3D-MASTER® is mandatory as an objective visual assessment tool for tooth whitening.
1. Llena C, Villanueva A, Mejias E, Forner L. Bleaching efficacy of at home 16% carbamide peroxide. A long-term clinical follow-up study. J Esthet Restor Dent. 2020;32(1):12–8.
2. Meireles SS, Heckmann SS, Leida FL, Santos IS, Bona Ád, Demarco FF. Efficacy and Safety of 10% and 16% Carbamide Peroxide Tooth-whitening Gels: A Randomized Clinical Trial. Oper Dent. 1 gennaio 2008;33(6):606–12.
3. Marshall MV, Cancro LP, Fischman SL. Hydrogen Peroxide: A Review of Its Use in Dentistry. J Periodontol. 1995;66(9):786–96.
4. Ghaleb M, Orsini G, Putignano A, Dabbagh S, Haber G, Hardan L. The Effect of Different Bleaching Protocols, Used with and without Sodium Ascorbate, on Bond Strength between Composite and Enamel. Materials. gennaio 2020;13(12):2710.
5. Orilisi G, Tosco V, Monterubbianesi R, Notarstefano V, Özcan M, Putignano A, et al. ATR-FTIR, EDS and SEM evaluations of enamel structure after treatment with hydrogen peroxide bleaching agents loaded with nanohydroxyapatite particles. PeerJ. 2021;9:e10606.