A growing number of patients dissatisfied with their smiles don’t just want their teeth to be well aligned, but also to be white. The term whitening is misused because it is more about rejuvenating a smile and making it look more natural by brightening it.
White is not strictly speaking a color but rather a value which is characterized by the total reflection of light radiation, which is not the case for teeth. The bleaching treatment of vital teeth is a simple, effective and long-lasting procedure, which meets this requirement and which value is confirmed by many years of clinical application. Today, it is possible to objectively quantify the effectiveness of this treatment in terms of color and more precisely by studying the variations of white, red and yellow through the collection of L*a*b digital data using the Optishade colorimeter.
Optishade is a dental colorimeter designed to measure the color of teeth, restorations, dental materials, and their appearance in the oral context. Its anatomical cone allows to obtain an ideal positioning to avoid light contamination, thus making measurements consistent. The smartphone app allows the clinician the check the color on the whole the dental surface. In addition to providing accurate numerical coordinates (L*a*b*) of the color, Optishade makes it possible to compare measurements with a complete database of shade guides.
Through this article, we will see that the follow-up of patient treatments, week after week, proves to be an objective and visual means for comparing the evolution of the treatment. Combined with photography, the weekly reading of Lab values not only allows practitioners to monitor the effectiveness and progress of treatment, but also constitutes a powerful communication tool with patients who will objectively assess the success of the treatment.
Fig.1
A 50-year-old female patient came to the clinic in order to improve her smile. Her main complaint was about color. After clinical examination, we decided to go for a bleaching treatment. Before starting, dental scaling was performed and extra and intra-oral pictures were taken in order to record the starting point to allow for comparison at the end of the treatment. Optical impressions are sent to the laboratory to fabricate bleaching trays. We decided to go with Carbamide Peroxide 10% during 3 weeks (Teeth Whitening Gel, White Dental Beauty, UK) overnight.
Fig.2
In the same appointment, the starting color was recorded using the Optishade. This is an important moment to take to explain the L*a*b numbers to our patient. With an L*<70% the teeth have low value, with 8% of red and 18% of yellow the teeth have high chromaticity. The patient was then aware that treatment would increase L* and decrease a*b*. We can set goals as well, such as telling the patient that we would like to reach an L* value around 80%, and to obtain a*<5% and b*<15%.
Fig.3
One week later, the same measurements were taken.
The patient reported no pain or sensitivity, and told us she had noticed a change in her smile. We could confirm her thoughts by showing her L*a*b* numbers: L* had increased, a* and b* had decreased. This is an objective and scientific way to validate the success of the treatment.
Fig.4
The treatment was performed during 3 weeks and comparing each picture showed the effectiveness of the home bleaching. The last picture on the lower right corner is 1 month after the initial picture.
Fig.5
The same comparison was done with Optishade numbers and confirm the results. The cross polarized pictures taken by Optishade showed visible results as well.
Fig.6
A chart was also built and filled in with L*a*b* data each week to study the evolution of the treatment.
This chart makes it easy to explain the patient our goals and limits for the bleaching treatment (courtesy Dr. Ruitort, Nice, France). In this case, according to the age and the enamel thickness of the patient, we could state that continuing the treatment wouldn’t have changed the final result.
Fig.7
Thanks to Optishade we can provide a comparison between the beginning and the end of the treatment. The Delta is very important showing the effectiveness of this procedure. The opacity of the enamel has increased significantly giving the smile the « white » desired result.
Fig.8
This second case shows a younger patient (30 years old) who wanted a brighter smile for his wedding. The same procedure (clinical examination, dental scaling, impressions) was used, as well as the same recording protocol.
Fig.9
In this case, 80% of white is reached after one month treatment. a* is under 5% and b* under 20%.
Fig.10
The pictures show the positive evolution of the brightness of the smile.
Fig.11
The Delta is less important than the previous case but the result is better, probably because of the higher thickness of the enamel of this young patient.
Fig.12
We always show our patients the curves of the Lab values to allow them to better understand progress during treatment.
Fig.13
This last picture of Optishade recording may help colleagues. Sometimes we have patients that want “whiter teeth” or “more bleaching gel”, or that say they have never bleached their teeth before, but we know it is not true. Thanks to Optishade, in this case, with more than 80% of “white”, less than 5% of “red”, and less than 15% of “yellow” components we can tell the patient that a new bleaching treatment will not improve her smile. This is an objective way to communicate with patients.
Conclusions
In recent years, bleaching treatments have taken an important place in aesthetic conservative treatments. Current techniques offer the possibility of meeting most of our patients’ wishes. The majority of discolorations can be treated with these therapies. At home treatments remain the primary choice of practitioners, and, until recently, their assessment has remained subjective. Today, the analysis and quantification of colorimetric variations are made possible and objective thanks to the study of L*a*b* values using the Optishade colorimeter. Beyond this follow-up use, the Optishade associated with the Matisse software allows for accurate reproduction of the color by the laboratory.
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