Adjunct Light Dr Ahmed AlMokhadub There is no higher glory for one who professes the healing art of dentistry than of preserving the natural tissues EP Wright Vital bleaching was introduced to the profession in 1989 using 10 ID: 784969
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Slide1
In-office Vital Bleaching withAdjunct Light
Dr. Ahmed
AlMokhadub
Slide2“There is no higher glory for one who professes the healing art [of dentistry] than of preserving the natural tissues.” E.P. Wright
Slide3Vital bleaching was introduced to the profession in 1989, using 10% carbamide
peroxide in a custom bleaching tray for at-home use.
Light-assisted, in-office bleaching methods use higher concentrations of peroxide
in conjunction with supplemental light to enhance the effect of tooth whitening.
These methods tend to appeal to patients who have a desire for rapid results and
perhaps those not interested in wearing custom trays at night or those not successful with over-the-counter products
Introduction
Slide4Examination
A through clinical examination should reveal not only cases that are suitable for
inoffice
bleaching
with adjunct light, such as teeth with mild to moderate
discoloration, but also teeth that are not suitable using this method, such as patient who presents with severe intrinsic staining
Slide5Greater tooth sensitivity has been reported with in-office bleaching with adjunct light compared with no light
Risk factors for sensitivity:
existing decay
Gingival recession
cervical abrasions
history of sensitivity
Slide6This finding means that additional doses of ibuprofen may be necessary after the in-office bleaching procedure to prevent postoperative sensitivity. Applying 4% to 6% potassium nitrate gel on the lingual surface of the teeth during the appointment is another strategy to minimize tooth sensitivity.
Patients can also be provided with 600 mg of ibuprofen 30 minutes before the in-office procedure to help reduce sensitivity. However, a recent study showed that patients who received ibuprofen 30 minutes before an appointment compared with patients who received a placebo capsule reported the same level of sensitivity 1 hour after the in-office procedure, which continued up to 24 hours.
Patient identified with existing tooth sensitivity may
prebrush
for about 2 weeks with a toothpaste containing potassium nitrate to help minimize sensitivity
Slide7Concentrations of hydrogen peroxide between 15% and 40% are used for professional in-office bleaching, which poses a risk of chemical tissue damage. Also the human eyes and oral soft tissue should be protected from the blue light or ultraviolet (UV) radiation emitted from the bleaching light. A recent study reported the health risk from optical radiation of 7 commercially available bleaching lamps.
Slide8SETTING EXPECTATIONS OF TREATMENT TIME
The primary advantage that attracted patients to in-office bleaching is the expectation of rapid results.
The question of how much time is saved with in-office techniques is not easy to answer, because results can vary among patients and depend on the cause of the stains, but some general expectation should be discussed based on available clinical
evidence
Seven days of at-home bleaching with 10%
carbamide has been shown
to be equivalent to 3 times of 15-minute applications of 38% hydrogen peroxide or 5 days of at-home bleach and 1 hour’s treatment with 28% hydrogen peroxide with supplemental light.
A combination technique of in-office bleaching plus home bleaching has been shown to be more effective than in-office bleaching alone
Slide9Bernardon and colleagues compared the clinical efficacy of home bleaching, in-office bleaching (with and without light), and a combination technique of in-office bleaching plus home bleaching
Color measurements after the first week showed better bleaching results with in-office bleaching with light or the combination technique compared with the at-home bleaching alone.
After 2 weeks, there was no significant difference among the 3 techniques.
Slide10Whitening with supplemental lighting is a controversial topic in dentistry not limited to safety-related issues in nondental settings but also because of the conflicting reports published in the existing dental literature. Various types of lasers (argon, CO2, diode, potassium
titanyl
phosphate) have been investigated in vitro; some report improved bleaching results, whereas others report no significant effect.
A common concern with the use of lasers for bleaching is the potential dangers associated with increased
pulpal
temperature.POTENTIAL SOURCES OF VARIABILITY ASSOCIATED WITH BLEACHING LIGHT STUDIES
Slide11Color-measuring Instruments
visual method
Colorimeters
Spectrophotometers
imaging systems such as digital cameras
Slide12Variability Associated with Different Light Sources
high-intensity discharge (HID) lamps (metal halide, xenon arc, plasma arc)
light-emitting diode (LED) lamp
The use of light as a means of decomposing a chemical compound is known as photolysis.
It was commonly accepted that heat was responsible for the dissociation of hydrogen peroxide
Slide13An in vitro bleaching study was conducted in which a xenon arc lamp was compared with a diode laser near IR (960 nm); the study showed that the diode laser produced an unsafe temperature increase up to 12C beyond the critical threshold
Sulieman
and colleagues using a plasma arc lamp, xenon-halogen lamp, halogen lamp, and a diode laser, found the only lamp to produce
pulpal
temperatures beyond the critical threshold was the diode laser near IR (830 nm).
Photolysis of hydrogen peroxide can occur by light of wavelengths of 365 nm or lessAlso, any light with a spectrum in the UV-B range (280–315 nm) is not
acceptable for intraoral use. Many of the HID lamps used in dentistry have a spectral emission primarily in the visible spectrum (400–700 nm) and some portions of the UV-A spectrum (315–400 nm).
Slide14Carotenoids, absorbed primarily at wavelengths of 400 to 500 nm, have been used as a bleaching agent activator that also serves as a colorant, giving the otherwise colorless hydrogen peroxide a red-orange color. If the bleaching agent absorbs the light energy of any frequency, it heats and thus decomposes.