Jump star bleaching - Case report

relato de caso

Abstract

Category: Undergraduate (Bachelor’s)

Thematic Axis: Restorative Dentistry

Introduction:

Teeth with altered color and shape cause aesthetic dissatisfaction with the smile in 20 to 65.9% of people worldwide. When it comes to discolored teeth, tooth whitening can be a viable alternative. The high demand for whitening treatment is directly related to the advantages of this ultra-conservative procedure, which excludes the anesthesia step and causes little to no discomfort since the use of rotary instruments is not necessary. Although it is a simple and safe treatment, with success rates reaching 80%, it is essential to understand its limitations to achieve a more predictable prognosis. Thus, the diagnosis of color alteration is crucial for success, as the change in tooth color is directly related to the ease of achieving whitening. Patients do not always have homogeneous colors in all their teeth; some may be more saturated, as generally occurs in canines and premolars. In these cases, achieving color homogeneity of the teeth beforehand is essential for successful treatment.

Case Description:

A 21-year-old patient attended the Restorative Dentistry clinic at the Federal University of Alfenas (UNIFAL-MG) with the main complaint of tooth discoloration, leading to dissatisfaction with the smile's aesthetics. Clinical examination revealed that the teeth were healthy but with marked saturation, especially in the upper and lower canines and premolars. Radiographic examinations also confirmed the normal condition of the dental elements and supporting tissue. During the anamnesis, it was found that the color change was due to the natural saturation of the teeth, without the involvement of medications or trauma. Due to the marked color discrepancy of the canines and premolars, combined whitening was planned, starting with in-office whitening of the canines and premolars of the upper and lower arches. Before the whitening treatment itself, all teeth were cleaned with pumice paste and water. Then, the initial tooth color was checked using a VITAPAN Classical (VITA) shade guide. The recorded colors for the incisors were A2 and for the canines and premolars A 3.5. In another session, relative isolation was performed with a lip retractor and application of gingival barrier on the teeth that received the whitening agent. Then, 40% hydrogen peroxide (OpalescenceTM BoostTM, Ultradent) was applied to the buccal surfaces of the teeth in question and remained for 40 consecutive minutes. The gel was then removed first by suction and then with an air/water spray. After one week, the color of the whitened teeth was evaluated, and it was found that there was a change to A3, still not matching the color of the other teeth. Therefore, another in-office whitening session was performed, repeating the protocol described above. A new color evaluation was carried out, finding that the teeth presented the same A2 color. From that moment, the upper and lower arches were molded with alginate and a plaster model was obtained to fabricate the trays for at-home whitening. At-home whitening was performed with 10% carbamide peroxide, from the first to the first upper and lower molars. The patient was instructed to use the tray for 2 hours a day for one week and return to the clinic for a new color evaluation. After one week of at-home whitening treatment, a color change to B1 was observed. Upon achieving patient satisfaction, the treatment was completed.

Results:

At the end of the combined whitening treatment, the patient reported satisfaction with the obtained color.

Final Considerations:

Combined whitening conservatively allows for changing the color of teeth safely and effectively and with a shorter treatment time.

Descriptors:

Tooth whitening; Dental aesthetics; Carbamide peroxide; Hydrogen peroxide.

References:

1. Knezović Zlatarić D, Žagar M, Illeš D. A clinical study assessing the short-term efficacy of combined in-office/at-home whitening treatment. J Esthet Restor Dent. 2019 Mar;31(2):140-146. doi: 10.1111/jerd.12467. 2. Rodrigues JL, Rocha PS, Pardim SLS, Machado ACV, Faria-E-Silva AL, Seraidarian PI. Association Between In-Office And At-Home Tooth Bleaching: A Single Blind Randomized Clinical Trial. Braz Dent J. 2018 Mar-Apr;29(2):133-139. doi: 10.1590/0103-6440201801726.  3. Rezende M, Ferri L, Kossatz S, Loguercio AD, Reis A. Combined Bleaching Technique Using Low and High Hydrogen Peroxide In-Office Bleaching Gel. Oper Dent. 2016 Jul-Aug;41(4):388-96. doi: 10.2341/15-266-C.