Mastering Mobile Dental Photography as a Method of Whitening Documentation

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.

Dental bleaching occurs through the action of bleaching agents such as hydrogen peroxide (HP) or carbamide peroxide (CP) when they come into contact with the teeth. These agents penetrate the tooth enamel and dentin, where they break down into reactive oxygen species (ROS), including free radicals. These ROS then oxidize and break down the organic molecules responsible for tooth discoloration, such as chromogens and stains, resulting in a whitening effect. The process of oxidation-reduction reactions initiated by the free radicals helps to lighten the tooth shade and improve the overall appearance of the smile.

An example of bleaching gels commonly used for at-home treatments is the White Dental Beauty range by Optident. These products come in various concentrations of HP or CP, providing dental professionals with flexibility to customize treatment according to individual patient needs and preferences. Formulated to deliver effective whitening results while minimizing sensitivity and protecting tooth enamel, White Dental Beauty gels are trusted by dental professionals for their safety and reliability. With options suitable specifically for at-home bleaching procedures, White Dental Beauty offers patients a convenient and dependable solution for achieving a brighter smile.

Mobile Dental Photography (MDP) revolutionizes modern dental practice, offering practitioners a powerful tool for capturing high-quality images of the oral cavity. MDP utilizes smartphones equipped with auxiliary illumination devices such as Smile Lite MDP from Smile Line, Switzerland, allowing for precise documentation, diagnosis, and treatment planning. With MDP1 and MDP2 systems available, dental professionals can choose the equipment that best suits their practice needs. These images can be stored electronically, facilitating easy access and integration into patient records for future reference. MDP not only enhances clinical efficiency but also facilitates communication between dental team members and patients. By sharing these images, practitioners can educate patients on their oral health status and treatment options, fostering greater understanding and collaboration. Moreover, MDP supports evidence-based decision-making in dental care, empowering clinicians to make informed choices for optimal patient outcomes. Integrating MDP into routine practice enhances patient care and satisfaction, ultimately leading to improved clinical outcomes and a better overall dental experience.

Many individuals seek dental bleaching to enhance the aesthetics of their smile, a safe and effective procedure that employs various concentrations and methods of bleaching gel. However, patients may encounter dental color rebound within as little as 60 days post-treatment, emphasizing the importance of maintenance. Some opt for professional touch-up appointments at dental offices, while others prefer home-based oral hygiene methods, such as powered toothbrushes, known for their superior stain and plaque removal compared to manual brushing alone. Over-the-counter (OTC) bleaching products like toothpastes, strips, and mouthwashes are also available, albeit potentially less effective than professional methods. Nevertheless, they can aid in color maintenance under dental supervision due to their stain removal capabilities. Additionally, products like fluoridated bleaching gels, nano-carbonate apatite, or fractional CO2 laser may assist in post-bleaching maintenance by promoting enamel remineralization or limiting stain absorption. It is essential to note that assessing color changes post-bleaching often involves using tools like standard shade guides, though subjective factors such as observer age and experience, as well as lighting conditions, may influence results. Considering the utility of MDP, which utilizes smartphone-captured oral images with auxiliary illumination like Smile Lite MDP, this article underscores the significance of MDP in supporting dental practitioners. 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.

banner white dental beauty style italiano styleitaliano
banner white dental beauty style italiano styleitaliano
style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.1
A 32-year-old male presented at the dental clinic seeking a non-invasive solution for teeth discoloration. As part of the assessment, extraoral photograph was taken to document the progression of the discoloration before and after treatment. The concept of Smile Lite MDP was developed to replicate the light conditions captured by digital single-lens reflex (DSLR) devices using smartphones. For this purpose, an initial photograph was taken using the Smile Lite MDP2 (Smile Line, Switzerland) and the S22 Ultra smartphone. To achieve optimal lighting, six LEDs on each lateral light and eight LEDs on the central light were activated and covered with a white diffuser, ensuring soft illumination for accurate color representation.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.2
The initial photograph, depicting teeth in occlusion with retractors, was also taken using the Smile Lite MDP2 at maximum intensity.
An intraoral photograph was taken, emphasizing the indispensable role of such images in dental documentation. This type of photograph is essential for accurately evaluating oral health, diagnosing dental issues, and strategizing treatment plans.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.3
The significance of Smile Lite MDP2 is underscored by its ability to capture artistic photographs depicting the initial dental situation.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.4
The initial frontal view, captured using the Smile Lite MDP2, provides a comprehensive visual record of the patient’s dental status.
The Smile Lite MDP2 offers numerous benefits and holds significant importance in modern dental practice. This advanced device enables clinicians to capture high-quality intraoral and extraoral photographs with precision and clarity. By providing optimal lighting conditions, the Smile Lite MDP2 ensures accurate color representation, making it invaluable for documenting dental conditions, tracking treatment progress, and communicating with patients. Its portability and user-friendly design enhance clinical efficiency, allowing practitioners to seamlessly integrate photography into their workflow. Moreover, the Smile Lite MDP2 facilitates patient education and enhances case presentations, ultimately leading to improved patient satisfaction and better treatment outcomes.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.5
For the initial whitening documentation, essential tools include retractors, the black contraster from Smile Line, and illumination provided by either MDP1 or MDP2. To assess the initial color shade, reference to a shade guide or utilization of an OptiShade colorimeter (Smile Line, Switzerland) is imperative.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.6
The shade initially determined with the OptiShade colorimeter (Smile Line, Switzerland) was subsequently verified using the shade guide, confirming an initial shade of A2 before the whitening procedure commenced.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.7
Image Captured with Polarizing Filter: This photographic technique involves utilizing the central LEDs at maximum power (with lateral LEDs deactivated) while employing a polarizing effect above the central section of the device. Consequently, the resulting image provides precise insights into the color, brightness, and specific details of the teeth, facilitating accurate assessment. A polarized picture can be of great help in showing the difference in color compared to the shade guide, and to better frame the issue.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.8
For at-home dental bleaching, various concentrations of CP and HP are available, including 5%, 10%, and 16% CP, as well as 6% HP formulations (Teeth Whitening Gels, White Dental Beauty). Notably, all White Dental Beauty gels incorporate NOVON® patented technology to enhance efficacy and reduce sensitivity. The 5% CP Mild variant is tailored for individuals with sensitive teeth, while the 6% HP gel offers rapid results with a short application time of just 30 minutes per day. Additionally, the 16% CP and 10% CP gels can be worn during the day or night. In this particular case, a 16% CP gel (White Dental Beauty, UK) was selected for application for 1-2 hours per day over a period of 2 weeks. The patient received detailed instructions on how to correctly insert the bleaching trays and apply the gel, with the recommended dosage being a drop per tooth, equivalent to the size of half a grain of rice. Impressions for the fabrication of bleaching trays can be obtained digitally using an intraoral scanner such as the Helios 500 from Eighteeth or conventionally using alginate materials.

style italiano styleitaliano white dental beauty teeth whitening gels
style italiano styleitaliano white dental beauty teeth whitening gels
style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.9
Following the at-home bleaching treatment, an extraoral photograph was taken to document the outcome. The patient expressed satisfaction and contentment with the results, indicating a desire to maintain the achieved level of whiteness. As such, the patient sought guidance on strategies for maintaining the exceptional outcome.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.10
The intraoral photograph depicting the teeth in occlusion showcased the desired level of whiteness achieved by the patient. This image was captured utilizing the assistance of MDP2, providing a clear representation of the attained white shade.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.11
The ultimate frontal view, taken with the Smile Lite MDP2, offers a thorough visual documentation of the patient’s whitening outcome.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.12
Following two weeks of home bleaching, the final outcome revealed a notable transformation in the shade guide, progressing from the initial A2 shade to a vibrant B1 shade, matching the color of the teeth. This remarkable shift in coloration was visually captured through an intraoral photograph utilizing the advanced capabilities of the MDP2, showcasing a highly satisfactory and aesthetically pleasing result.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.13
After two weeks of treatment, the conclusive result was documented using MDP2, and the patient expressed satisfaction with the outcome, as evident from the polarized photograph.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.14
Another pivotal image achievable with MDP2 involves activating all lights without any obstruction. This setup illuminates the subject from all angles, resulting in a glossy effect that accentuates clarity and intricacy without the need for further brightness adjustments.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.15
Immediately after or shortly following a bleaching session, teeth are susceptible to discoloration if exposed to pigments from beverages and food. Therefore, it was previously thought that applying certain surface treatments to freshly bleached teeth could effectively reduce the absorption of stains and prolong the whitening results. In this instance, professional dissolving whitening strips P3 (White Dental Beauty, UK) were utilized for maintenance, with strips applied to the upper and lower teeth for five days each, every two months.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.16
The strips were applied to both the buccal and palatal/lingual surfaces of the upper and lower arches. After application, a refreshing mint flavor gradually dissolves in the mouth over approximately 15 minutes.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.17
The professional dissolving whitening strips P3, manufactured by White Dental Beauty and distributed by Optident in the UK, are designed to provide effective and convenient tooth whitening.
These strips offer a professional-grade whitening solution that can be used at home. The strips are applied directly to the teeth and gradually dissolve, delivering the whitening agent to the tooth surface. They are formulated to minimize sensitivity while effectively removing stains and brightening the teeth. The strips are typically worn for a specified duration each day over a period of time to achieve the desired level of whitening. In this case, the advantage of using the strips for maintenance is emphasized, as they contribute to prolonging the results of the whitening process.

banner white dental beauty style italiano styleitaliano
banner white dental beauty style italiano styleitaliano
style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.18
The significance of pairing an appropriate whitening product with an effective maintenance solution becomes evident. Both the patient and the dentist expressed satisfaction with the result. It is noteworthy that adherence to a white diet during maintenance is not crucial; rather, the key focus lies on the maintenance itself.

style italiano mobile dental photography tooth whitening White Dental Beauty

Fig.19
Before and after images were captured by MDP2 to comprehensively document the treatment progress. The final outcome was deemed satisfactory by both the patient and the dental practitioner, reflecting the success of the bleaching procedure.

Conclusions

The recipe for mastering mobile dental photography for whitening documentation and maintenance involves three key steps:
Document: Utilize MDP2 for comprehensive documentation of the patient’s oral condition, including before-and-after images of the whitening process.
Bleach: Employ teeth whitening gels, such as those from the White Dental Beauty range, to achieve the desired whitening results effectively.
Maintain: Utilize whitening strips, such as “P3,” for ongoing maintenance to prolong the whitening effects.
Incorporating these practices into daily clinical routines facilitates the whitening process by eliminating the need for external assistance in capturing high-quality dental images.

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.
  7. 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.

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