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bleaching conservative trtmt for the esthetic improvement of dicolored or stained teeth since no tooth structure is sacrificed or cut
factors in the success of bleaching cause of stain, degree of stain, bleaching agent used and strength, length of exposure, bleaching technique, vitality of tooth, cracks/restorations in tooth
contraindications of bleaching teeth stained by caries, pulpal necrosis, endo, sensitive dentin, allergies, pregnant/lactating, children, heavy smokers, excessive drinkers
nonvital teeth necrotic pulp darkens with time
vital teeth natural shading or darkening from aging
stain extrinsic-surface vs. intrinsic-inside tooth structure
dentinogenisis imperfecta and amelogenisis imperfecta bleaching will not help
tetracycline and fluorisis difficult to bleach
primary bleaching agents hydrogen peroxide, carbamide peroixide CH6N2O3, sodium perborate
hydrogen peroxide H2O2 may cause temp pulpitis, liquid or gel form, 5%-35%
carbamide peroxide (CH6N2O2) weaker oxidizing agent and more stable than H2O2, liquid or gel, 10-15%, decomposes into N2O2-10% carbamide is equivalent to 3% hydrogen peroxide
sodium perborate used w/ H2O2 for non-vital teeth...root canal-done from inside
non-vital bleaching technique cotton ball saturated w/ 35% H2O2 insertedd into pulp chamber, heated instrument is applied to cotton ball to accelerate the release of oxygen, when desired bleacing occurs, pulp chamber is filled w/ permanent filling material
vital teeth bleaching technique prof applied in office, patient applied at home, prof supervised, OTC at home-not recommended often ineffective and lack professional supervision
professionally applied in office 30-35% H2O2, isolate teeth, peroxide is painted on teeth, activated w/ a heat source, also laser bleaching being used now-argon or carbon dioxide lasers
Patient applied professionally supervised 2%,5%,10% gels dispensed into custom-made resin trays-worn 30 minutes per day
Patient applied professionally supervised-carbamide peroxide 10%, 15% custom made trays-wear during the day for multiple sessions or while sleeping
3 apt series. 1st apt med hx, informed consent, IO exam, prophy, IO pics w/ shade guide, full arch impressions
2nd apt test fit trays, patient instructions, side effects-tooth sensitivity...soft tissue irritation, written instructions, FU apt in 4-6 wks
3rd apt exam-additional bleaching if needed, usually 2-4 wks at most, IO pic-compared to before pic
Created by: jfgwinn