Documenting the Evolution of Bleaching Treatment with Mobile Dental Photography

A clinical case by our Community member Dr. Rim Bourgi

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.

White, considered one of the first colors used in art, is a symbol of peace and prosperity. It is an embodiment of beauty, and it shapes people’s smiles. Teeth discoloration is one of the main common issues that patients face throughout their lifetime and the best solution for this problem is bleaching. One of the most popular techniques used in dentistry is home bleaching, the minimally invasive, yet most effective treatment for tooth discoloration. How can a dentist effectively document and evaluate a discoloration? Since the Mobile Dental Photography (MDP) concept relies on using oral photographs captured by a smartphone with dedicated auxiliary lighting (Smile Lite MDP, Smileline), the aim of this article is to showcase the significance of MDP in assisting dental practitioners. This case focuses on the evaluation and treatment planning while maintaining a satisfactory state of mind for the patient’s well-being by showing the evolution of the treatment.

patient with yellow teeth asking to improve tooth color style italiano styleitaliano

Fig.1
A 21-year-old male visited our dental clinic and asked us to figure out a solution for his dental discoloration issue, without drilling.

first assessment picture with smile lite mdp before bleaching style italiano styleitaliano

Fig.2
An initial picture is crucial to determine the proper shade and to assess the bleaching progress (the initial shade obtained in this case was A3 VITA classical).
To take this picture a smartphone and Smile Lite MDP device were used. The lateral lights were turned ON and covered with the white diffuser. Two retractors and one black contrastor (Flexipalette, Smile Line, Switzerland) were used.

polarized MDP picture before belaching style italiano styleitaliano

Fig.3
Using the polarizing filter of the Smile Lite MDP device (Smile Line, Switzerland), an initial polarized photograph was taken to compare the shade without reflection. Only the central light is ON in this kind of picture.

bleaching tray and peroxide gel box style italiano styleitaliano

Fig.4
16% carbamide peroxide (Teeth whitening gels, White Dental Beauty) was chosen as a bleaching product. The patient was given instructions on how to insert the custom trays (one drop per tooth, 2-4 hours/day for 2 weeks).

result after two weeks at home bleaching style italiano styleitaliano

Fig.5
Final result. The color obtained was assessed with the same shade guide and the most suitable was B1, which is a good result.

polarized MDP picture of bleached teeth style italiano styleitaliano

Fig.6
The final result, after 15 days of bleaching with a polarized picture, was satisfying for the patient. Several white spots were highlighted after the bleaching process which will be treated later on.

comparison between starting shade and bleaching result style italiano styleitaliano

Fig.7
The final color obtained compared to the initial A3 shade VITA classical shade guide. We can notice the difference between the initial shade and the final result with this polarized picture, the patient is able to see the difference and appreciate the work done.

patient happy with dental whitening white dental beauty style italiano styleitaliano

Fig.8
The patient was happy with the result.

Conclusions

Nowadays, the use of bleaching agents has been greatly improved. A large variety of products have been developed due to the demand of such minimally invasive techniques. For home treatment, 5%, 10% and 16% carbamide peroxide exist, along with 6% hydrogen peroxide (Teeth whitening gels, White Dental Beauty); lower concentrations are used for patients with dental hypersensitivity. The “pH jump” of the NOVON® technology which causes the pH to rise and attain an alkaline range of 8.5, explains the decrease of dental sensitivity during and after bleaching in White Dental Beauty bleaching material.
A dental shade guide might increase the reliability of visual comparisons of tooth whitening efficacy as well as a spectrophotometer (OptiShade StyleItaliano).
Smile Lite MDP provides the opportunity to obtain high-quality photographs in an efficient way; furthermore, it allows both dentists and patients to visualize the progress of the treatment in a bigger scale.

Bibliography

1. Hardan LS. Protocols for Mobile Dental Photography with Auxiliary Lighting. Quintessence Publishing Co; 2020.
2. Manauta J, Salat A. Layers, An atlas of composite resin stratification. Quintessence Publishing Co; 2012.
3. Hardan LS, Moussa C. Mobile dental photography: a simple technique for documentation and communication. Quintessence Int. 2020;51(6):510-518.
4. Orilisi G, Tosco V, Monterubbianesi R, et al. ATR-FTIR, EDS and SEM evaluations of enamel structure after treatment with hydrogen peroxide bleaching agents loaded with nano-hydroxyapatite particles. PeerJ. 2021;9:e10606.
5. 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 (Basel). 2020;13(12):2710.

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