Bleaching tetracycline-stained teeth. A combined approach.
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Fluorotic stains present a variety of clinical surface alteration with the modification of the enamel colour, we have a structural modification of hard tissues resulting in their hypo-mineralisation. A knowledge of the kind of surface, nature, and deepness of the discoloration is necessary in order to make the right diagnosis and so, to adapt the specific treatment which can varies from a simple general treatment based on VIT C drugs, to aesthetic veneers and includes micro-abrasion technique, and chemical bleaching methods.
The authors present the last news on the link between tetracycline and teeth hard tissues, on the diagnosis of teeth discromy and an overview on the most recent bleaching vital technics; they analyze some clinical cases.
A recently reported technique for bleaching vital discolored teeth involves the use of a mouthguard and 10% carbamide peroxide without preoperative etching or postoperative polishing of the enamel. This in vitro study evaluated the effects of the bleaching agent on the surface texture of the enamel. Thirty-three extracted teeth were subjected to 10% carbamide peroxide for a period equivalent to 5 weeks of nighttime wear. A control area on each tooth had been covered and sealed. All discolored teeth experienced lightening, but there was no difference in color between the treated and control areas; the color-changing effects apparently extend to portions of the tooth not in direct contact with the solution. Epoxy replicas of the teeth were examined under a scanning electron microscope. No etching was apparent, and no difference in surface texture between treated and control areas was detected.
BACKGROUND: Hydrogen peroxide, an agent used in the intra-coronal bleaching of root-filled teeth for over a century, has been shown to diffuse from the pulp chamber to the outer root surface. Furthermore, it has been demonstrated that destructive hydroxyl radicals, the by-products of the bleaching process, have been detected on the external root surface. The control of such diffusion may be of importance in minimizing the risk of invasive cervical resorption (ICR) which has been linked to intra-coronal bleaching of discoloured root-filled teeth using hydrogen peroxide. The aims of the present in vitro study are to quantify the diffusion of hydrogen peroxide and hydroxyl radicals to the outer root surface following intra-coronal bleaching, and to evaluate the ability of thiourea incorporated into the bleaching protocol to scavenge residual hydrogen peroxide and hydroxyl radicals. METHODS: Thirty-five single rooted premolar teeth with intact cementum at the cemento-enamel junction were used in this project. Thirty teeth were stained with red blood cells and root-filled with gutta-percha and AH26. The five unstained teeth were root-filled and constituted a negative control (Group 1). The stained teeth were divided equally into the following experimental groups and subjected to various intra-coronal bleaching regimes: Group 2--'walking bleach' with 20 microl 30 per cent w/w hydrogen peroxide; Group 3--20 microl 30 per cent w/w hydrogen peroxide and thermocatalytically activated; Group 4--20 microl acidified thiourea; Group 5--20 microl acidified thiourea and 20 microl 30 per cent w/w hydrogen peroxide; Group 6--20 microl acidified thiourea and 20 microl one per cent sodium hypochlorite; Group 7--20 microl acidified thiourea, 20 microl one per cent sodium hypochlorite and 20 microl 30 per cent w/w hydrogen peroxide. The reaction products of the bleaching process were quantified at the outer root surface using high performance liquid chromatography and electrochemical detection (HPLC-ECD). RESULTS: Results showed that hydrogen peroxide used alone in Groups 2 and 3 was able to be detected at the outer root surface in 100 per cent of the samples, and that the presence of the hydroxyl radical generated in both groups was detected in equal amounts (P < 0.05). When thiourea was incorporated into the bleaching protocols in Groups 5-7, it was shown to scavenge both hydrogen peroxide and hydroxyl radicals to a significant degree (P < 0.05). CONCLUSIONS: Acidulated thiourea is an effective scavenger of residual hydrogen peroxide and hydroxyl radicals generated during the intra-coronal bleaching of bloodstained root-filled teeth.
The sandpaper disk method for removing fluorosis stains from teeth was clinically evaluated in 93 teeth in 22 patients. A bleaching solution was first applied to the teeth, and then a sandpaper disk in a straight handpiece was rotated on the stained enamel surface. None of the patients complained of discomfort during or after the bleaching procedure.
Today, bleaching alone can be effective in restoring appearance to teeth stained from various causes. Moreover, bleaching can be combined with other restorative treatment to produce results not otherwise possible. Bleaching requires careful diagnosis and techniques but offers a relatively simple, safe, and successful way to significantly improve appearance. In the future, bleaching will be a routine, conservative treatment option.
This article reviews the literature on the use of hydrogen peroxide in three professionally administered bleaching techniques from historical, technique, and safety viewpoints. Safety over time, absolute safety, and relative safety of nonvital bleaching, in-office vital bleaching, nightguard vital bleaching, and over-the-counter bleaching kits are compared. The advantages and disadvantages of different bleaching options, as well as indications for individual or combined use of the techniques, are discussed. In addition, specific indications for the use of the nightguard vital bleaching technique are presented.
Vital bleaching is one of the least invasive, most conservative, and most cost-effective procedures to dramatically improve the aesthetic appearance of a patient's smile and self-confidence. Bleaching began as an in-office procedure and required multiple visits. With the arrival of dentist-monitored at-home procedures, bleaching has become widely known and used. This presentation evaluates the advantages of the higher viscosity adhesive formulation bleaching materials, which prevent dehydration and reduce the subsequent color change upon rehydration.
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A total of 112 severely tetracycline-stained teeth in 20 patients were treated by endodontics and nonthermal internal bleaching. All teeth were healthy, intact, and had no history of trauma. The patients were monitored for 5 to 15 years. Excellent, permanent esthetic results were obtained with no side effects. The quality of endodontic treatment and lingual access restoration were important factors in the longevity of the bleaching results.
Clinical indications for direct composite restorations have expanded in the last decade, primarily due to improved physical, aesthetic, and handling properties. As a consequence, their increased predictability has encouraged clinicians to progressively abandon amalgam. This article presents a clinical protocol to reconstruct severely damaged endodontically treated and bleached anterior teeth with particular emphasis on placement and curing techniques. Common complications encountered during the bonding of teeth that have undergone endodontic and bleaching treatments are also analyzed.
Today with the development of new restorative materials, the esthetic problems of the anterior teeth because of hypoplazies, fluorizes, fractures shape, form or color irregularities can be treated with conservative preventive and esthetic techniques such as bleaching, surface coating, cosmetic contouring and composite laminate veneering. These procedures are usefull adjuncts and economic alternatives to more extensive procedures such as crown applications. In this study, the young patients who have esthetic and psychologic problems due to color, form, shape, surface texture abnormalities and fractures of their anterior teeth were treated with bleaching, composite laminate veneer and cosmetic contouring techniques.
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