Three magical tools for successful dental bleaching

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.

A rising number of patients is currently demanding solutions for dental discoloration for esthetic needs. Among the treatments for dental discoloration, vital tooth bleaching is a conservative, safe, and efficient approach. This is possible thanks to the low of carbamide peroxide (CP) concentrations available for home bleaching, but also for in-office treatments using high concentrations of hydrogen peroxide (HP).
Since the introduction of the at-home bleaching procedure, fruitful outcomes have been achieved. This popular cosmetic technique provides fast results, engages reduced costs and chair-time, and is less associated to the common side effects of in-office bleaching. The research for an ideal whitening agent has urged market to launch gels containing different concentrations of CP ranging from 10% to 22% and advocated their use for a shorter period of time. Regardless of the CP concentration, suggested application time may range between 2h and 6-8h a day (or overnight). Hence, dental practitioners should select a product with comparable or greater clinical efficiency while preserving patients’ well-being. Some patients do not adapt to wear the dental bleaching tray for longer periods of time, and may request a method with enhanced comfort that reaches the same bleaching efficacy. The use of 16% CP (Teeth whitening gels, White Dental Beauty) for 2 weeks has gained popularity. The home bleaching choice using White Dental Beauty products was considered safe to treat discolored teeth and lessen tooth sensitivity. In addition, no major changes to enamel topography were observed after bleaching. The use of a dental shade guides helps determine tooth color before and after treatment, and can enhance the reliability of visual comparisons of tooth whitening outcomes. Furthermore, the use of digital photography and a new digital color measurement device (Optishade, Smile Line, Switzerland) prevent color mismatch than conventional color shade tab comparison. The efficacy of dental bleaching between the initial condition and final treatment, can be assessed by the values of ΔE, which is a numerical value for measuring color difference. Under experimental conditions, the human eye can distinguish ΔE of 1 or higher, nonetheless under clinical conditions, change must be 3.3 or above to be noticed.
The use of mobile dental photography (MDP) with auxiliary lighting (Smile Lite MDP) is today to be considered a viable, predictable means, embracing the progress of the dental bleaching treatment. MDP seems to be favorable in terms of cost effectiveness, software applications, enhanced functionalities, and highresolution photographs, which makes it suitable for getting color references. The use of a smartphone, with the help of the smile Lite MDP allows both the dentist and the patient to compare and assess dental color on a bigger scale, where details can be emphasized.
The aim of this article is to showcase the importance of using tools that are today available for all practitioners, for treating tooth discoloration and improving the smile of a patient. Moreover, documenting, using MDP, the evolution of bleaching treatment is also a purpose. This case is an effort to compare color change produced by a lower concentration of CP (Teeth whitening gels, White Dental Beauty) while using the Optishade colorimeter.

styleitaliano style italiano smile with discolored teeth

Fig.1
A 33-year-old female visited our dental office asking for a solution for her teeth discoloration issue, preferably avoiding the drilling approach. A pre-operative picture is mandatory in order to assess the starting point before treatment. This picture was taken with the help of the Smile Lite MDP device and the S22 Ultra smartphone. Six LEDs on each side of the lateral lights were turned ON and covered with the white diffusers, giving the twin flash effect.

styleitaliano style italiano teeth before whitening treatment

Fig.2
First step consisted of a dental hygiene session to remove all the stains and debris from the enamel surface. It should be noted that professional dental cleaning is an efficacious and accepted method as a first step, in line with strategies to improve oral health.

styleitaliano style italiano dental color assessment before whitening

Fig.3
After one week, the patient came to the clinic and asked for a fast home-bleaching procedure. She wanted a white smile, thus we proposed a home-bleaching solution by means of the White Dental Beauty Teeth whitening gels. This picture was taken with the help of Smile Lite MDP device and the S22 Ultra smartphone in an attempt to compare color deviations between the shade guide and the tooth. Six LEDs on each side of the lateral lights were turned ON and covered with the white diffusers, giving the twin flash effect. Two retractors and one black photographic background (Flexipalette, Smile Line, Switzerland) were used. D2 sample was placed near the natural tooth with edge-to-edge position.

style italiano styleitaliano smileline mdp dental photography
style italiano styleitaliano smileline mdp dental photography
style italiano styleitaliano smileline dental photography flexipalette
style italiano styleitaliano smileline dental photography flexipalette
styleitaliano style italiano polarized picture for color matching

Fig.4
A polarized picture can be helpful in showing the difference in color compared to the shade guide by eliminating light interference. This picture was taken by mounting the included polarizing filter on the central light of the Smile Lite MDP device (Smile Line, Switzerland). Only the central light must be ON in this kind of picture.

styleitaliano style italiano optishade colorimeter screenshot

Fig.5
Before bleaching, color was also measured with the Optishade (Smile Line, Switzerland) colorimeter. The most precise measurement is taken at the center of the image frame. Here, it corresponds to the D2 shade VITA classical shade guide.

banner optishade colorimeter app style italiano styleitaliano
banner optishade colorimeter app style italiano styleitaliano
styleitaliano style italiano optishade colorimeter

Fig.6
The Optishade colorimeter was recently launched, and can precisely measure the difference in color compared to the sole shade guide visual comparison.

styleitaliano style italiano optishade cap

Fig.7
Optishade (Smile Line, Switzerland) colorimeter has color readings aligned with a spectrophotometer. It compares the readings with common ready-made shade guides. This picture was taken by the Smile Lite MDP to show the inner part of this colorimeter when the cap was removed. Furthermore, Optishade uses an external device connected to iPhone, iPad or iPod touch precisely measuring the color. In this case it was connected to a compatible iPhone.

styleitaliano style italiano placing bleaching gel in custom whitening tray

Fig.8
For the at-home bleaching treatment, the patient was instructed on how to load and insert the bleaching trays. In this case, a 16% CP (White Dental Beauty, UK) was chosen to be applied 2-4 hours/day for one week. The CP gel was applied in the amount of a drop per tooth (the size of half rice grain), and two gel syringes were delivered to the patient.

style italiano styleitaliano white dental beauty teeth whitening gels
style italiano styleitaliano white dental beauty teeth whitening gels
styleitaliano style italiano teeth after one week bleaching

Fig.9
Result after 7 days of dental bleaching with 16% CP (Teeth whitening gels, White Dental Beauty).

styleitaliano style italiano color check after one week dental whitening

Fig.10
Intraoral picture showing the effect after 7 days of dental bleaching with 16% CP (Teeth whitening gels, White Dental Beauty). The color obtained was verified, and the most suitable was B1 from VITA classical.

styleitaliano style italiano screenshot of optishade colorimeter measurement

Fig.11
Shade change was assessed using the Optishade (Smile Line, Switzerland) which found the new color to match a B1 shade (VITA classical shade guide).

styleitaliano style italiano polarized picture comparison after dental bleaching

Fig.12
Comparing with the polarized picture. The final result can be considered as the whitest point of the VITA classical shade guide with great satisfaction of the patient.

styleitaliano style italiano smile after dental whitening treatment

Fig.13
The fast and safe result was pleasing for the patient who reported no increase in sensitivity.

styleitaliano style italiano steps to predictable bleaching with mobile dental photography color measurement and whitening gel

Fig.14
To obtain such a result in only one week you only need three magical tools for dental documentation and/or bleaching:
1. MDP: Right tool for dental documentation.
2. Optishade colorimeter: Right tool for color measurement.
3. Teeth whitening gels, White Dental Beauty: Right tool for at-home bleaching.

styleitaliano style italiano before and after dental whitening

Fig.15
Complete intraoral view of the initial and final situation.

styleitaliano style italiano smile after teeth whitening

Fig.16
Final situation. Plentiful guidelines can orient the clinician to simplify their daily clinical practice. In this case the combination of three tools was considered a magic solution for dentists aiming a feasible approach.

Conclusions

The home bleaching tool using 16% CP (White Dental Beauty products) recorded lower level of tooth sensitivity. It was considered the least aggressive method for treating discolored teeth. The Smile Lite MDP tool allows for simple use of lateral filters, and the pictures can be used to show the patient progression of the bleaching process. In addition, in the pursuit of a universal color matching system, the Smile Lite MDP was developed to provide ideal lighting conditions (5,500 K = daylight) in one unique device.
The Optishade tool tracks any color change that occur in natural teeth. In this case, it was useful for research color, shade estimation, treatment quality check, bleaching tracking, and side-to-side comparison. Furthermore, the use of Optishade colorimeter can accurately determine the tooth color before and after treatment, and can enhance the reliability of visual comparisons of tooth whitening outcomes. The combination of these three tools makes the outcome predictable, thus making the magical solution possible for everyday dentistry.

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. Hardan L, Bourgi R, Cuevas-Suárez CE, Lukomska-Szymanska M, MonjarásÁvila 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.
6. 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.
7. Hardan, L. Mobile dental photography (MDP): A new era in dental documentation. Int Arab J Dent. 2017;8(3):6.
8. Sampaio CS, Atria PJ, Hirata R, Jorquera G. Variability of color matching with different digital photography techniques and a gray reference card. J Prosthet Dent. 2019;121(2):333-339.
9. Moussa C, Hardan L, Kassis C, Bourgi R, Devoto W, Jorquera G, Panda S, Abou Fadel R, Cuevas-Suárez CE, Lukomska-Szymanska M. Accuracy of Dental Photography: Professional vs. Smartphone’s Camera. Biomed Res Int. 2021;2021:3910291.
10. Paolone G, Orsini G, Manauta J, Devoto W, Putignano A. Composite shade guides and color matching. Int J Esthet Dent. 2014;9(2):164-182.
11. Mounika A, Mandava J, Roopesh B, Karri G. Clinical evaluation of color change and tooth sensitivity with in-office and home bleaching treatments. Indian J Dent Res. 2018;29(4):423-427.
12. Mailart MC, Sakassegawa PA, Santos KC, Torres CRG, Palo RM, Borges AB. One-year follow-up comparing at-home bleaching systems outcomes and the impact on patient’s satisfaction: Randomized clinical trial. J Esthet Restor Dent. 2021;33(8):1175-1185.
13. de Geus JL, Wambier LM, Boing TF, Loguercio AD, Reis A. At-home Bleaching With 10% vs More Concentrated Carbamide Peroxide Gels: A Systematic Review and Meta-analysis. Oper Dent. 2018;43(4):210-222.

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