Bleaching Of Discolored Teeth
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Bleaching of Discolored teeth El-Tahady University 2009
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Bleaching Of Discolored Teeth
- 1. Bleaching of Discolored Teeth Dr. Ashraf Refai BDS MSc DD HMD Al-Azhar University www.arefai.edublogs.org
- 2. What options do we have? www.arefai.edublogs.org
- 3. Causes of Discoloration Extrinsic Intrinsic Discoloration Discoloration www.arefai.edublogs.org
- 4. Extrinsic Discoloration Due to deposition of pigments or calculus Causative factors Coffee Tea Smoking Doesn’t Need Bleaching – Needs Polishing www.arefai.edublogs.org
- 5. Intrinsic Discoloration Color changes of the internal tissues of the teeth • Discoloration after Local tooth formation • Discoloration during Systemic tooth formation www.arefai.edublogs.org
- 6. Intrinsic Discoloration (Local Causes) Patient related Dentist related Pulp necrosis Endodontic related • Remnants of pulp tissues left • Root canal sealers Intra-pulpal Hemorrhage • Intral canal medicaments Calcific metamorphosis Restoration related • Amalgam • Pins & posts Age www.arefai.edublogs.org
- 7. Intrinsic Discoloration (Systemic Causes) • Tetracyline staining Drug related • Endemic fluorosis (>4 PPM) • Enamel hypoplasia Developmental • Enamel hypocalcification defects • Erythroblastosis Fetalis (RH factor) Metabolic • Porphyria diseases www.arefai.edublogs.org
- 8. Necrotic Tooth www.arefai.edublogs.org
- 9. Fluorosis
- 12. Bleaching Agents Hydrogen peroxide 35% • Nascent oxygen (Superoxol) • Sodium metaborate Sodium perborate • Hydrogen peroxide • Nascent oxygen • Urea Carbamide • carbon dioxide peroxide 10% • hydrogen peroxide. www.arefai.edublogs.org
- 13. Bleaching Techniques Internal External Bleaching Bleaching Thermocatalytic Mouth Guard technique bleaching Walking Chairside bleaching bleaching www.arefai.edublogs.org
- 14. INTERNAL BLEACHING THERMOCATALYTIC TECHNIQUE www.arefai.edublogs.org
- 15. Internal Bleaching (Thermocatalytic Bleaching) • Done after root canal treatment • Tooth is polished • Temporary filling is removed • Cavity is irrigated and dried • Remove coronal gutta-percha www.arefai.edublogs.org
- 16. Internal Bleaching (Thermocatalytic Bleaching) • Place cement in the chamber • Flush pulp chamber • Apply vaseline to protect gum tissues • Place the rubber dam • Record the tooth shade www.arefai.edublogs.org
- 17. Preparation for Bleaching
- 18. Internal Bleaching (Thermocatalytic Bleaching) • Place cotton pellet with bleaching agent • Apply bleaching lamp or heat • Check shade • Process is repeated until appropriate shade is reached www.arefai.edublogs.org
- 21. INTERNAL BLEACHING WALKING BLEACHING www.arefai.edublogs.org
- 22. Internal Bleaching (Walking bleaching) • Same procedure as for thermocatalytic technique • Mix sodium perborate with inert liquid or anesthetic solution • Place in the cavity and cover with cement • Repeat every 1-2 weeks till desired shade is reached www.arefai.edublogs.org
- 23. Adverse Effects of Bleaching External Resorption Damage to Restorations Chemical Burn www.arefai.edublogs.org
- 24. Adverse Effects of Bleaching • Cervical resorption may occur • 2 Theories: – Diffusion through dentinal tubules – Combination of heat with chemical may cause cementum necrosis with inflammation of the periodontal ligament www.arefai.edublogs.org
- 26. Adverse Effects of Bleaching External Resorption Damage to Restorations Chemical Burn www.arefai.edublogs.org
- 27. External vs Internal Bleaching • Use for vital teeth • Used on the labial surface of the teeth • Less effective than internal bleaching www.arefai.edublogs.org
- 28. EXTERNAL BLEACHING MOUTH GAURD BLEACHING www.arefai.edublogs.org
- 29. Mouth Guard Bleaching • Used for mild cases • Active ingredient is 10%-15% carbamide peroxide • Decomposes in hydrogen peroxide www.arefai.edublogs.org
- 30. Mouth Guard Bleaching • 1st visit – Polish the teeth – Alginate impressions are taken – A stone cast is poured – Die relief is done – Fabrication of the plastic mouthgaurd (Vaccum formed) www.arefai.edublogs.org
- 31. Mouth Guard Bleaching • 2nd visit – Take shade – Fill mouth guard with bleaching gel – Train the patient to use the system – Used for 3-4 hours a day – Explain possible side effects – Treatment time up to a few weeks www.arefai.edublogs.org
- 32. Different Bleaching Agents Natural White Karisma Opalescence White Brite White & Brite Nite White www.arefai.edublogs.org
- 33. EXTERNAL BLEACHING CHAIR SIDE BLEACHING www.arefai.edublogs.org
- 34. Chair Side Bleaching • Photo activated or Laser activated • Higher concentrations of peroxides • Used for short periods of time • Activated with light • Zoom bleaching • Side effects www.arefai.edublogs.org
- 35. THANK YOU www.arefai.edublogs.org