Dental bleaching and spot removal: goals and mistakes

Tooth bleaching and spot removal are frequent requests of our patients, or situations we bump into and want to solve for our patients’ aesthetic satisfaction. Moreover, bleaching procedures shouldn’t be considered as an isolated treatment, but as a minimally invasive part of a more extensive treatment plan.

Starting from whiter teeth facilitates all of our rehabilitation procedures whether they are very complex or simple cases.

styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.1

This 27-year-old patient wanted to improve his smile, in particular, he asked to get whiter and more harmonious teeth.
As a protocol,  we start treating the upper arch.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.2

We started by temporarily covering the brown spots on teeth 22 and 23, and building new canine guides; it is better to do it in the beginning so you can adjust them during the following appointments and verify function.


styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.3

On the central incisors were white spots that he wanted to eliminate, as well as the abraded canines that were described by the patient as “short”.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.4

Dark spots tend to be more superficial than white ones.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.5

Furthermore, these composites together with the elements of the lower jaw will serve as a chromatic reference for bleaching
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.6

A polarized picture of teeth 22 and 23 with remarkable brown spot discolorations.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.7

Polarized picture of teeth 11 and 12.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.8

Polarized picture of the central incisors.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.9

Abrasion on tooth 23.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.10

Abrasion on tooth 13.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.11

Restoration on tooth 13.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.12

Restoration on teeth 22 and 23.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.13

Baseline color before bleaching.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.14

Delivery of the upper soft tray, with carbamide peroxide 16% White Dental Beauty.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.15

1 week control.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.16

After one week we can already see the difference between the bleached upper teeth and the composite restorations, and the lower arch which was not bleached yet.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.17

2 weeks control
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.18

20 days after infiltration and new restorations 
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.19

Icon Etching
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.20

Sandblasting. The white spots on the central incisor was too deep, and even with different etchant applications, I did not get the desired result, so I decided to sandblast with 27 microns aluminum dioxide.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.21

Post-sandblasting etch.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.22

Rinsing with the specific alcohol dedicated to pre-visualize the result.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.23

Teeth covered with alcohol.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.24

I removed the superficial layer of the restorations I wanted to replace.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.25

After etching.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.26

ICON infiltration.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.27

Immediate post operative picture.
In this phase there was actually a mistake; as many of you might have thought, having performed microabrasion, I should have filled the defect with some composite in addition to the ICON resin.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.28

In fact, this defect in I will fill with a following restoration.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.29

Lateral view.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.30

The difference in color between upper and lower teeth.
The defect on the surface of tooth 11.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.31

MDP picture with diffusers.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.32

MDP image: the deference between bleached and non-bleached teeth is even clearer.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.33

Post-operative: composite addition on tooth 11.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.34

Polarized view.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.35

Lateral views to highlight the difference between upper arch bleached and lower arch not bleached.
styleitaliano style italiano bleaching dental tooth spot white brown removal infiltration resin non invasive whitening aesthetic

Fig.36

 

Conclusions

 

Diagnosis is the key point to manage bleaching and resin infiltration.

The proper selection of the case and the patient always makes the difference: even though we can  sometimes make up for mistakes thanks to our skills, it is always better avoiding problems than finding a solution!

Remember, bleach before you infiltrate, because afterwards, it’ll be too late. When you infiltrate, if you need to remove enamel even if just a little bit by sandblasting , remember to add composite to the resin.

Combining bleaching and resin infiltration is a great simple conservative, non-expensive  and predictable solution for many cases of  dyschromic anterior teeth.

Bibliography

Loguercio AD, Servat F, Stanislawczuk R, Mena-Serrano A, Rezende M, Prieto MV, Cereño V, Rojas MF, Ortega K, Fernandez E, Reis A. Effect of acidity of in-office bleaching gels on tooth sensitivity and whitenings: a two-center double-blind randomized clinical trial. Clin Oral Investig. 2017 Dec;21(9):2811-2818.

Attal JP, Atlan A, Denis M, Vennat E, Tirlet G. White spots on enamel: treatment protocol by superficial or deep infiltration (part 2). Int Orthod. 2014 Mar;12(1):1-31

Salat A. Post orthodontic white spots. Style Italiano.

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