Post-Bleaching Maintenance for Long-Lasting Results

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.

Bleaching serves as a powerful tool in modern dentistry, offering patients a non-invasive approach by utilizing agents like hydrogen peroxide (HP), carbamide peroxide (CP), and sodium perborate to address tooth discoloration.

Numerous devices and techniques are employed for color assessment, including color scales, colorimeters, spectrophotometers, and digital photography.

How can dentists ensure their patients maintain white teeth and a confident smile? One promising solution lies in the use of Professional Dissolving Whitening Strips P3 (White Dental Beauty, UK) as a maintaining agent after a precise home bleaching protocol. These strips, containing 6% HP along with two phosphates, are designed to preserve tooth color post-bleaching while sustaining a bright smile. The inclusion of “P3” in the product name signifies this unique formulation. By incorporating such innovative products into their practice, dentists can empower patients to maintain the aesthetic results of their treatment, boosting confidence and satisfaction.

The main emphasis of this article is on a comprehensive home bleaching protocol supplemented by meticulous maintenance using dental strips, tailored to manage the unique challenges presented by teeth discoloration, which can significantly impact patients’ aesthetic concerns. Additionally, a key objective is to demonstrate the impact of a non-white diet on teeth maintenance following bleaching, thereby providing supplementary insights into the patient’s dental transformation.

styleitaliano style italiano Initial situation discoloure teeth discoloration post-bleaching home bleaching white dental beauty teeth whitening gels tooth whitening

Fig.1
A frontal photograph captures the patient smiling, showcasing their upper and lower teeth. The patient’s lips are gently parted, revealing a natural and relaxed smile. The teeth appear aligned and healthy overall, yet there is noticeable discoloration present on anterior teeth.

styleitaliano style italiano post-bleaching home bleaching used white dental beauty teeth whitening gels tooth whitening

Fig.2
In this case, home bleaching was administered, with the patient receiving instruction on the application of the bleaching agent. By employing a custom fit tray, a 16% CP gel, from White Dental Beauty (UK), was applied for 2-4 hours daily over a four-week period. The CP gel, equivalent to a drop per tooth (about half the size of a rice grain), was dispensed to the patient in eight gel syringes. Notably, the use of Novon technology resulted in no reported sensitivity during the bleaching process.
It is worth mentioning that custom fit trays can be obtained through conventional methods or digitally using an intraoral scanner like Helios 500 (Eighteeth, Changzhou, China).

style italiano styleitaliano white dental beauty teeth whitening gels
style italiano styleitaliano white dental beauty teeth whitening gels
styleitaliano style italiano before and after post-bleaching home bleaching white dental beauty teeth whitening gels tooth whitening

Fig.3
A comprehensive edge-to-edge photograph, captured with the Smile Lite MDP2 (SmileLine, Switzerland), was utilized to show color disparities between the teeth and the shade guide. The initial shade recorded for this case was A2 on the VITA classical scale. After four weeks of bleaching, the shade was assessed as B1 based on the shade guide. This outcome is visually satisfactory, as depicted in the accompanying image.

styleitaliano style italiano MDP2 Handle post-bleaching home bleaching white dental beauty teeth whitening gels tooth whiteningstyleitaliano style italiano post-bleaching home bleaching white dental beauty teeth whitening gels tooth whitening

Fig.4
Recently introduced, the MDP2 now features a convenient handle that simplifies the process of capturing photographs. With this handle, clinicians can easily take pictures with a simple click of a button, enhancing workflow efficiency. In this instance, photographs were taken by holding the shade guide in one hand and the MDP handle in the other, allowing for seamless and precise image capture. A future article will discuss a step-by-step protocol for using the handle of the MDP2.

styleitaliano style italiano importance of MDP2 post-bleaching home bleaching white dental beauty teeth whitening gels tooth whitening

Fig.5
The Smile Lite MDP2 is a handy tool in modern dentistry, allowing for clear and precise intraoral and extraoral photos. It ensures accurate color depiction and helps document dental conditions effectively. With its easy-to-use design and portability, the Smile Lite MDP2 streamlines clinical processes, making it easier for dentists to incorporate photography into their routines. Plus, it enhances patient understanding and improves case presentations, leading to better treatment results and happier patients.

styleitaliano style italiano final situation of the lower arch post-bleaching home bleaching white dental beauty teeth whitening gels tooth whitening

Fig.6
The lower teeth display a bright and shiny appearance.

styleitaliano style italiano P3 strips application on the mandibula post-bleaching home bleaching white dental beauty teeth whitening gels tooth whitening

Fig.7
The maintenance protocol commenced with the application of P3 strips, which were documented on the lower arch to facilitate ease of use for the patient at home. Furthermore, the P3 Professional Dissolving Whitening Strips from White Dental Beauty, UK, come in a pack of 28 strips, each infused with a refreshing mint flavor.
First, peel the strip from the corner and carefully remove it.
Second, apply the strip to the teeth according to the instructions shown in the picture (the strips were applied to the buccal side).

styleitaliano style italiano P3 strips application on the mandibula post-bleaching home bleaching white dental beauty teeth whitening gels tooth whitening

Fig.8
Subsequently, the strips were flipped to the lingual side for the mandibula.

styleitaliano style italiano Tips for white smile post-bleaching home bleaching white dental beauty teeth whitening gels tooth whitening

Fig.9
So far, the patient has been able to monitor the progress step-by-step by taking photographs and using both the whitening agent and strips in combination.

styleitaliano style italiano The importance of white or non-white diet post-bleaching home bleaching white dental beauty teeth whitening gels tooth whitening

Fig.10
Professional guidelines for teeth bleaching recommend that patients cease smoking and avoid foods and beverages rich in coloring agents, such as wine, soft drinks, tea, and coffee, to adhere to a “white diet”.

Research shows that teeth whitening can cause the enamel to develop irregularities, making it more prone to staining. Consuming colored foods and drinks can further alter the structure of bleached enamel, leading to additional staining. Acidic foods and beverages may also erode enamel, exposing dentin and increasing the risk of discoloration. Thus, diet can significantly impact the longevity of bleaching results.

Dental clinicians advise patients to reduce the intake of staining agents, refrain from smoking, and avoid habits that cause tooth staining, particularly after whitening, as bleaching products may change enamel texture and morphology, making it more absorbent to dyes. However, some studies suggest that the diet may not directly affect whitening effectiveness. To date, there is no standardized post-bleaching diet. Therefore, in 2024, Hardan et al., conducted a systematic review and meta-analysis to evaluate the necessity of a white diet during or after bleaching treatments. It was acknowledged that maintaining the results of the bleaching treatment does not require a white diet. Implementing recommended home-care maintenance approaches is essential for preserving the outcome of the bleaching treatment

Thus, in this case, the patient chose not to follow any dietary restrictions during and after the bleaching procedure based on the findings of the previous meta-analysis, which indicated that such restrictions are unnecessary. Therefore, the patient was advised to consume food and beverages without limitation. All in all, the patient expressed immense satisfaction and delight with the outcome, showcasing a newfound confidence in his smile. He can now enjoy eating and drinking without worry, thanks to a good maintenance regimen using the P3 strips.

Conclusions

Home bleaching has emerged as a valuable method for enhancing the aesthetics of discolored teeth. Alongside the use of bleaching agents like HP, CP, and sodium perborate, this approach incorporates various practices to optimize outcomes. Capturing comprehensive photographic documentation (MDP2), implementing a maintenance regimen (P3 strips), and adhering to a non-white diet are integral components that contribute to the success of home bleaching procedures.

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 Jun 1;51(6):510-8.
  4. Hardan L, Bourgi R, Cuevas-Suarez CE, Lukomska-Szymanska M, Monjaras-Avila AJ, Zarow M, Jakubowicz N, Jorquera G, Ashi T, Mancino D, Kharouf N. Novel trends in dental color match using different shade selection methods: a systematic review and meta-analysis. Materials. 2022 Jan 8;15(2):468.
  5. Hardan LS, Moussa C. Mobile dental photography: a simple technique for documentation and communication. Quintessence Int. 2020 Jun 1;51(6):510-8.
  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, Notarstefano V, Özcan M, Putignano A, Orsini G. ATR-FTIR, EDS and SEM evaluations of enamel structure after treatment with hydrogen peroxide bleaching agents loaded with nano-hydroxyapatite particles. PeerJ. 2021 Jan 29;9:e10606.
  8. Hardan L, Bourgi R, Flores-Ledesma A, Devoto W, Devoto E, Fernández-Barrera MÁ, Kharouf N, Cuevas-Suárez CE. Is a White Diet Necessary for Tooth Bleaching Procedures? A Systematic Review and Meta-Analysis. Dentistry Journal. 2024 Apr 22;12(4):118.

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