Follow the White Approach: Document, Bleach, and Maintain

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.

People who desire to lighten their teeth frequently seek dental bleaching in order to improve the appearance of their smile. It is a safe yet fruitful course of action that can be accomplished using various concentrations as well as processes of bleaching gel. Further, gels with hydrogen peroxide (HP) or carbamide peroxide (CP) are used and their application systems differ based on the concentration of the active ingredient, which bleaches the tooth by oxidation-reduction reactions of the free radicals.

Patients could experience dental color rebound in as short as 60 days, thus it is important to pay attention to the maintenance of bleaching outcomes. Such people are more likely to inquire about home-care measures recommended by professionals. Certain patients may choose to improve the tooth color after dental bleaching and return once or twice a year for touch-up conservation protocol at the dental office, whereas others who prefer home oral hygiene-based approaches may choose to use powered toothbrushes, because this protocol removes more stain and plaque than manual toothbrushes used alone. Other bleaching chemicals available in the marketplace include over-the-counter (OTC) products such as bleaching toothpastes, strips, and mouthwashes. When compared to home bleaching, these chemicals may be inadequate. However, as a result of their stain removal capacity, they can be used as an alternative for color maintenance after whitening under the supervision of a dentist. Furthermore, fluoridated bleaching gels, nano-carbonate apatite, or fractional CO2 laser may help with post-bleaching maintenance by encouraging enamel remineralization by means of fluoride acquisition or limiting stain absorption. It is noteworthy to mention that color changes following dental bleaching can be expressed by different tools with the most used the standard shade guide. This tool might be subjective and is influenced by many factors such as the age of the observer, the experience, and the lightning condition. Since the concept of Mobile Dental Photography (MDP) is based on using oral images captured by a smartphone with auxiliary illumination so called Smile Lite MDP (Smile Line, Switzerland), the purpose of this article is to highlight the importance of MDP in supporting dental practitioners. This case focuses on the documentation of at–home bleaching procedure followed by a post-bleaching maintenance technique.

style italiano styleitaliano initial situation dental photography Smile lite MDP2

Fig.1
A 35-year-old female visited the dental clinic and asked to figure out a solution for her teeth discoloration issue that she is been facing without a drilling intervention.
The light conditions that can be captured with the digital single-lens reflex (DSLR) device have to be reproduced with mobile phones during the transition towards the use of smartphones for dental photography. This is when the concept of Smile Lite MDP was conceived. In this manner and prior to the process, an initial photograph is required to document the progression of the teeth color before and after the bleaching treatment. This image was captured using the Smile Lite MDP2 (Smile Line, Switzerland) at full power and the S22 Ultra smartphone.
Six LEDs on each lateral light and eight LEDs on the central light were turned ON and covered with the white diffuser, thus softening the light.

style italiano styleitaliano initial shade Smile lite MDP2

Fig.2
An edge-to-edge photograph taken using the Smile Lite MDP2 comparing color deviations between the tooth and the shade guide. The initial shade obtained in this case was D2 VITA classical.
Six LEDs on each lateral light were turned ON and eight LEDs on the central light were turned OFF and covered with the white diffuser, thus softening the light.

style italiano styleitaliano initial picture with retractors

Fig.3
Initial picture with retractors and teeth in occlusion. This picture was also captured with the Smile Lite MDP2 at full power.

style italiano styleitaliano dental photography importance of Smile Lite MDP2

Fig.4
The new Smile Lite MDP2 provides a novel, modern, lighter, slimmer design with integrated handle, and latest generation daylight LEDs.
Smile Lite MDP2 adheres to the philosophy of being a mini studio, with an independent and adjustable central light, lateral lights, and the new option of diffusing all lights, including the central one, with a special diffuser, as well as the ability to take polarized photographs alongside a special filter positioned on the central light.

style italiano styleitaliano home bleaching white dental beauty tooth whitening gels

Fig.5
In this case, a 16% CP (White Dental Beauty, UK) was chosen. The patient was shown how to place the customized trays (one drop per tooth, 1-2 hours per day for two weeks).

style italiano styleitaliano white dental beauty teeth whitening gels
style italiano styleitaliano white dental beauty teeth whitening gels
style italiano styleitaliano importance of home bleaching white dental beauty tooth whitening gels

Fig.6
Currently, the technique of home bleaching with individual trays is being increasingly used. In addition, the high level of demand for this type of treatment has resulted in the growth of a market for bleaching products. The literature supports the efficacy of this method.
There are 5%, 10%, and 16% CP available for home use, as well as 6% HP (Teeth whitening gels, White Dental Beauty). It is worth noting that all White Dental Beauty gels use NOVON Patent Formula for maximum efficacy and reduced sensitivity. This gel provides a superior stability, an enhanced whitening, and a greater patient compliance.
The 5% CP Mild was created specifically for those with sensitive teeth. The 6% HP is a fast-acting solution that can be used 1-2 hours per day.

style italiano styleitaliano home bleaching after two weeks

Fig.7
Final outcome after two weeks of home bleaching. The shade guide was transformed from D2 (the color of the shade guide in the picture) to B1 (the color of the teeth). This can be viewed in the photograph taken with the help of MDP2 and is recognized as an aesthetically pleasing effect.

style italiano styleitaliano maintenance procedure white dental beauty Strips

Fig.8
Throughout or just following a bleaching session, tooth discoloration is reachable if pigments of beverages and food are consumed during that time. Hence, it was believed that freshly bleached teeth subjected to some surface treatments was an efficient approach to lessen the uptake of stains and keep the result of whitening for a long time. In this case, the professional dissolving whitening Strips P3 (White Dental Beauty, UK) were used for maintenance (strips on upper and lower teeth for 5 days each 2 months).

style italiano styleitaliano maintenance procedure white dental beauty Strips P3

Fig.9
Professional dissolving whitening Strips P3 (White Dental Beauty) were used for maintenance.
Different possible approach existed to reverse the damage of staining enamel after bleaching: the use of antioxidant, remineralizing agents (toothpaste, CPP-ACP, Remin pro paste, NaF mouthwash), power toothbrush, OTC agents, fluoridated bleaching agent, CO2 laser, nano-hydroxyapatite, and arginine. As P3 was considered an easy approach, thus it was the choice for this patient. The strip must be applied to the buccal side of the upper and lower teeth and then flipped to the palatal and lingual side to be dissolved in 15 minutes approximately.

style italiano styleitaliano before and after home bleaching

Fig.10
Before and after bleaching followed by the strips application.

style italiano styleitaliano recipe of white approach home bleaching white dental beauty tooth whitening gels Strips P3 Smile Lite MDP2

Fig.11
The recipe of white approach shown below should be considered:
1- Document: this could be possible by MDP2.
2- Bleach: this could be possible by teeth whitening gels, White Dental Beauty.
3- Maintain: this could be possible by whitening Strips “P3”.

Conclusions

Throughout history, white teeth have been used to assess physical attractiveness.
Because of certain well-known benefits, at-home dentist-supervised bleaching with personalized trays is more popular than in-office techniques: decreased risk and degree of tooth sensitivity, less dental office visits, and lower cost to get the same whitening outcomes as those produced with higher concentrations of agents employed in the in-office bleaching process.
The use of bleaching chemicals for home bleaching has risen significantly in recent years. Given the desire for such minimally invasive treatments, a wide range of products with lower concentrations have been produced such as the 16% CP from White Dental Beauty.
A dental shade guide, along with a colorimeter (Optishade, Smile Line, Switzerland), may improve the reliability of visual comparisons of teeth whitening efficacy, and might be suitable for tracking the bleaching outcome.
Smile Lite MDP2 allows both dentists and patients to visualize the evolution of bleaching procedure in a bigger scale.
The professional dissolving whitening Strips P3 (White Dental Beauty, UK) were considered a magical solution for maintenance.
All things considered, any dental approach must follow a specific recipe to be successful. This includes throughout the therapy processes, numerous instruments and materials. In this article the combination of three rules including MDP2, Teeth whitening gels, White Dental Beauty, and P3 Strips were considered effective for a predictable and a long-lasting white outcome.

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. Hardan L, Bourgi R, Cuevas-Suárez CE, Lukomska-Szymanska M, Monjarás-Ávila AJ, Zarow M, Jakubowicz N, Jorquera G, Ashi T, Mancino D, Kharouf N, Haikel Y. Novel Trends in Dental Color Match Using Different Shade Selection Methods: A Systematic Review and Meta-Analysis. Materials (Basel). 2022;15(2):468.
    5. Hardan, L. Mobile dental photography (MDP): A new era in dental documentation. Int Arab J Dent. 2017;8(3):6.
    6. Hardan L, Bourgi R, Cuevas-Suárez CE, Ghaleb M, Kharma K, Harouny R, Radwanski M, Lukomska-Szymanska M. Can Sodium Ascorbate Increase the In Vitro Bond Strength of the Interface between a Composite and Bleached Enamel?. Coatings. 2023 Jun 8;13(6):1064.
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A specific case focusing on documenting an at-home bleaching procedure followed by post-bleaching maintenance technique will be explored to illustrate these concepts further.