A clinical case by our Community member Dr Sara Laface
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Since tooth color is a key issue for patients, it is an essential topic in dental esthetics. Dentistry has moved toward methods that are safer, more conservative, and more predictable. This evolution has a substantial impact on dental bleaching, often known as whitening. Yet, since esthetic dentistry including bleaching is a subjective profession, dentists must have access to analytical tools to monitor and discuss their findings. This could be possible by using some tools such as shade tabs, spectrophotometers, colorimeters like Optishade (Smile Line, Switzerland), and the new eLAB approach as well as recent reports validating that dental digital photography might be used as one of the reliable methods for shade selection in a clinical setup. Vital teeth whitening is a conservative, safe, and effective treatment for dental discoloration. This could be accomplished by either the patient placing low concentrations of carbamide peroxide (CP) into a custom-fit tray or by the dentist inserting high concentrations of hydrogen peroxide (HP). Fruitful results have been reported since the introduction of the at-home bleaching technique. This popular cosmetic treatment produces quick results, requires less cost and chair time, and has a lower risk of side effects than in-office bleaching. Recently, the use of 16% CP (Teeth whitening gels, White Dental Beauty) has gained popularity. Thus, the aim of this article is to showcase the importance of using a lower concentration of CP to improve the confident smile of a complex patient case.
A 38-year-old male visited the dental clinic and asked to figure out a solution for his teeth discoloration issue that he is been facing. The initial situation revealed a trauma and root canal treatment on #12 more than 15 years ago. After a clinical and radiographical analyses, apical lesions were not seen, accordingly there is no need for new root canal treatments.
Other dentists suggested an extraction and implant placement on #12 and veneers on #11 and #21. However, being conservative is the key in the mission of the dentist. So, no drilling intervention was made, and the solution was done to the patient by doing only a tray.
A shot taken edge-to-edge comparing color discrepancies between the teeth and the shade guide. In this situation, the initial shade obtained was 4.5 M2.
Digital impressions were taken to make the design of the tray. In this case, hard tray 0,6mm was delivered to the patient with multiples syringes of CP 16% (Teeth whitening gels, White Dental Beauty). The patient was instructed on how to use the whitening gel (one drop per tooth, 1-2 hours per day) and was asked to follow-up (Total syringes upside: 5 x 3ml x 16%; 2 x 1.2ml x 16% for 16 weeks and downside: 1x 3ml x 16% for 5 weeks).
11 weeks follow-up for the upper arch. The color obtained was assessed with the same shade guide and the most suitable was 0M1, which is a good result. Further, he did not report any sensitivity to the bleaching procedure.
The patient was happy with the final outcome (16 weeks of home bleaching for the upper arch and 5 weeks for the lower arch).
Before and after bleaching. This comparison with the samples (shade guides) emphasizes whether and to what extent the goal has been reached.
The whitest point of the VITA shade was reached.
The change reaches a maximum. High satisfaction of the patient with a minimally invasive approach.
The tooth sensitivity was decreased with the home bleaching tool that used 16% CP (White Dental Beauty products). It was thought to be the least invasive approach of correcting stained teeth.
The dental photography helps in showing the progress of bleaching treatment for both dentists and patients in a bigger scale.
The use of a dental shade guide could enhance the reliability of visual comparisons of bleaching efficacy as well as a colorimeter (Optishade).
The use of a tray made with digital or conventional approach could both be considered as minimal invasive dentistry. With the combination of some tools presented in the office of each dentist, a predictable outcome will be achieved.
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