Bleaching and porcelain veneers: consider the combination.
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Based on current clinical experience and research, dentist-prescribed home bleaching, also referred to as nightguard vital bleaching, is a safe and effective technique for whitening teeth when a carbamide peroxide material (up to 10 percent) is used. The bleaching material should be produced by a recognised and reputable manufacturer and must be used under a dentist's supervision over a relatively short time. Mild thermal sensitivity is a common side effect; however, no long-term pulpal effects have been shown. The reduction in the bond strength of resin to freshly bleached enamel and dentine has been shown to be transient, and no clinically significant changes in surface morphology or physical properties have been shown to occur to teeth or dental restorative materials as a result of vital bleaching. As a consequence, vital bleaching has gained favour with patients and dentists alike. Significant benefit was obtained in 12 subjects using two nightguard bleaching systems which were equally effective.
An unusual case is presented of a maxillary central incisor with hemorrhagic discoloration that was successfully treated with the thermocatalytic vital bleach technique. This case emphasizes the need for a thorough radiographic and clinical examination to include vitality tests when a patient presents with a discolored tooth.
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Bleaching discolored teeth must be considered a viable treatment modality. Although it does not offer the predictability of many cosmetic options, its simplicity and economics demands attention. Combining bleaching with selected bonding and contouring can return a smile to the not-so affluent, conservative, or apprehensive patient who does not wish to face tooth reduction and full coverage.
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Extraradicular leakage of oxidizing agents during bleaching is an undesirable event and thus need to be prevented. The effect of external cervical coating of ethyl cellulose (EC) and metacrylic acid copolymer (MAC) on the radicular penetration of hydrogen peroxide during intracoronal bleaching was examined. Single rooted human premolars extracted for orthodontic reasons were used. The cementum covering the cemento-enamel junction was mechanically removed and the teeth treated endodontically and bleached with 30% hydrogen peroxide. Radicular hydrogen peroxide penetration was measured before coating the teeth and after applications of 1-3 layers of EC or 3 layers of MAC external cervical coatings. It was found that the radicular penetration of 30% hydrogen peroxide was related to the number of layers of cervical EC coatings. Application of one layer of EC did not reduce the hydrogen peroxide penetration. Two and three layers of EC reduced the hydrogen peroxide penetration by 38% and 85% respectively. Three layers of MAC reduced the radicular hydrogen peroxide penetration in 83%. Statistically, a highly significant difference was found between the teeth coated with three layers of either EC or MAC and the noncoated teeth (p < 0.001). It was concluded that application of ethyl cellulose or metacrylic acid copolymer to exposed cervical root surfaces may effectively prevent extraradicular leakage of bleaching agents.
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