Whitening: The first step of any esthetic procedure
Dental whitening is a conservative treatment that offers important results in the harmonization of the patients’ smiles regardless of the technique used. Although this subject has already been extensively studied over the past two decades or more, there are always points that still cause questions and curiosity. The correct recommendation and the right timing to perform the whitening process while the patient is being submitted to a restoration treatment, are some of these questions.
For this reason, FGM Dental Group prepared some questions answered by specialists in the area bringing information in a straightforward way to help the readers in their day-to-day in-office procedures.
Do patients that will have prosthetic work done on anterior teeth demand whiter teeth? Do they ask about whitening procedures? By Dr. Carlos Francci.
Nowadays, in general, all the patients that require prosthetic work for the anterior teeth also seek for whiter teeth. This way it is very common to be inquired about whitening. We have to point out that there are different clinical situations. In a more simple and common situation, when classes III, IV and V restorations will be replaced on anterior teeth, it is essential to whiten teeth previously to the replacement of the restorations. It is important to point out that the restoration replacement can only be done at least one week after the last whitening application due to the reduced adhesion and to the shade stability that must be achieved. Another situation is when a partial prosthetic work is performed only in some anterior teeth. In this situation, it is mandatory to do previous whitening, to define the shade that will be used on the prosthetic pieces. One last situation is specific for prosthetic work with no-prep veneers, where the substrate shade influences the aesthetic result. We always recommend the whitening to be done before in order to obtain the whiter shade with a more translucent ceramic, with more natural chromatic effects.
How often do you perform whitening procedures before the prosthetic rehabilitation (crowns, veneers and implants)? By José Carlos Garófalo
Every time I am requested a prosthetic rehabilitation work, direct or indirect, and mainly those that do not involve all the teeth structure, it is my protocol to ask the patient if he/she intends to have a previous whitening treatment. I ask that and explain that if the previous treatment is not performed, it will be very difficult to perform it later without running the risk of the restorations color become different from the natural whitened teeth. This way, as a clinic protocol, all the indirect prosthetic rehabilitation works using crowns, veneers and implants tend to start with a dental whitening procedure.
Is there any case when the whitening procedure is not recommended before the rehabilitation? By Alessandra Reis Bastos de Oliveira
There are rehabilitation cases where some teeth have structure loss with little remainders of the crown and many restorations with indication of a treatment with the use of porcelain crowns. Whitening procedures in these cases are not feasible and unnecessary. I would not recommend whitening procedures in cases with teeth with old and severe chromatic alterations where the color change would not be effective with the whitening procedure and in which a restorative ceramic material that blocks the dark color of the dental substrate would be used.
In what step of the restorative treatment (direct and indirect) do you recommend whitening? By Paulo Sérgio Quagliatto
One of the worst problems when we intend to restore teeth directly or indirectly, after dental whitening, is the considerable technical difficulty, because the teeth become dehydrated and without the adequate chromatic stability. Another negative factor is the presence of residual oxygen for a period of 7 to 14 days1,2, which makes it difficult for adhesive techniques and consequently the failures in the restorations.
Although studies have reported the use of sodium ascorbate as antioxidante3 agent for the completion of restorations in less time than 14 days, it was still observed color instability of the remanescente4. The ideal, therefore, is that if we restore directly with composite resins, adhesion on enamel only, that we wait for 07 days, and if the adhesion is on enamel/dentin, that we wait 14 days after concluding the whitening technique. For indirect techniques, the whitening must be carried out beforehand, and the adhesive cementation should be done 14 days after the procedure is finished.
We know that whitening may interfere negatively in the adhesive cementation when
done at the same time (ex.: cementation of the prosthesis during whitening). How
long after whitening do you cement parts? By Fabiano Marson
The oxygen released by the whitening action promotes the decrease of the adhesive resistance of direct or indirect restorations to the dental structure, therefore, it is necessary to wait 2 weeks after the end of the whitening to carry out the restoration1. In order to reduce the waiting time from the end of the whitening to the restoration, many authors have recommended the use of different antioxidants, such as sodium ascorbate which has a great reducing potential2-5. However, we should wait a minimum of 14 days to take the shade. Clinical example: we are making ceramic veneers on anterior central teeth and I will take the shade of the adjacent teeth (lateral). If I do that right after the whitening, I would be having as reference a shade with a higher value because the color of the teeth has not stabilized. That way, veneers will be made in a standard that is lighter than the lateral teeth impeding cementation.
It will be necessary to send those to the lab for the adjustment of the color.
FGM Dental Group Offers Several Whitening Solutions for Clinicians
By understanding more about the whitening process, potential complications, and indications, practitioners will be better prepared to make the best recommendations to their patients. Of course, for safe and effective whitening procedures, the most effective products must be selected.
FGM Dental Group has developed several highly trusted whitening products for professional use:
- Wīt HP Maxx has been designed as a high-strength whitening gel for in-office whitening. 35% hydrogen peroxide is the whitening agent, and this gel is packaged in pre-dosed portions for convenience. PH is neutral and is maintained throughout the whitening session. This product addresses sensitivity issues with the addition of calcium to prevent demineralization.
- Wīt HP AutoMixx is a popular option made convenient with an automatic self-mixing system in a single-syringe applicator. The 35% hydrogen peroxide solution is safe for up to 50 minutes of contact without the need to replace the gel. pH is neutral and is maintained throughout the whitening session.
- Wīt Essential is a take-home treatment available from FGM Dental Group. It is suited to patients who need ongoing whitening treatment at home, under advice from their dental professional. pH is close to neutral to ensure the stability of the gel and safety of the patient. Three concentrations are available, allowing practitioners to make the best recommendations based on unique patient needs. Wīt Essential uses carbamide peroxide as the base active ingredient.
In addition to advanced whitening gels based on FGM Dental Group’s proprietary formulations, Top Dam is offered as a light-curable in-office composite protective barrier that can be used in place of a rubber dam for isolation.
FGM Dental Group’s innovation in teeth whitening and commitment to products that are not only highly effective but also incredibly safe for patients, ensures the best solutions for both in-office and at-home whitening today.
Protecting Gingiva During Teeth Whitening
Patients seeking teeth whitening with or without restoration will require protection for gum tissue. The gingiva is typically protected with a barrier during teeth whitening. The question for many dentists is focused on which type of barrier to use. Is it always necessary to use a rubber dam for teeth whitening?
A traditional dam such as a rubber sheet can be prepared and applied to the gums to seal them from chemicals used in whitening, but this adds to the complexity of the procedure and can be time-consuming for the clinician. When relative isolation is sufficient for the whitening procedure, a composite dam can be used in place of a rubber dam.
- Top Dam has been designed as a reliable and cost-efficient alternative to rubber dams. This product is made with an easy-handling formulation applied from a 2g syringe with the included applicator tips. Top Dam provides excellent protection from a light-curing material that is directly applied and easily removed. Top Dam is an essential product for clinicians performing whitening with the Wīt systems listed below.
With an effective barrier, patients will enjoy comfortable teeth whitening procedures without irritation to sensitive tissues..
References / Referencias
1 Dishman Mv, Covey Da, Baughan Lw. The Effects Of Per- Oxide Bleaching On Composite To Enamel Bond Strength. Dent Mater 1994; 10: 33–36.
2 Briso Al, Rahal V, Sundfeld Rh, Dos Santos Ph, Alexandre Rs.Effect Of Sodium Ascorbate On Dentin Bonding After Two Bleaching Techniques.Oper Dent. 2014 Mar-Apr;39(2):195-203.
Doi: 10.2341/12-054-L. Epub 2013 Jul 12.
3 Marson, F.C Et Al. Influencia Do Gel De Ascorbato De Sodio Na Resistencia Adesiva Entre Resina Composta E Esmalte Clareado, Revista De Odontologia Da Unesp. 2007; 36(1): 17-21.
4 Briso Al, Toseto Rm, Rahal V, Dos Santos Ph, Ambrosano Gm. Effect Of Sodium Ascorbate On Tag Formation In Bleached Enamel.J Adhes Dent. 2012 Feb;14(1):19-23.
5 Berger Sb, De Souza Carreira Rp, Guiraldo Rd, Lopes Mb, Pavan S, Giannini M, Bedran-Russo Ak. Can Green Tea Be Used To Reverse Compromised Bond Strength After Bleaching?. Eur J
Oral Sci 2013; 121: 377–381. 2013 Eur J Oral Sci
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