A case report by Frauke Heck
The 44-year-old patient expressed her desire to have her teeth whitened. The patient‘s teeth showed severe discoloration caused by medication. The initial color before bleaching was A3.
The in-office bleaching material Bleach‘n Smile by Schütz Dental was recommended to the patient.This product is excellently suited to bleaching, for instance, devitalized teeth, disease-related discolorations or naturally darker enamel. The bleaching gel has a hydrogen peroxide content of 35 %.
The patient was advised in detail about contraindications such as exposed tooth necks, filling defects, hypersensitivities of the enamel, allergies, hypersensitivities to ingredients, pregnancy and lactation. The standard patient education also included side-effects such as hypersensitivy to cold during and after bleaching, staining in the first 48 hours, color differences to artificial tooth restorations and possible short-term irritation of the gingiva. In addition, the patient was informed that it is not possible to predict the receptivity of the enamel for the bleaching material or the resulting level of brightness.
Preparation of the treatment
All materials are layed out for treatment (fig. 3). A laser with a T8 glass rod is prepared for the additional activation of the bleaching gel. The preset program „Bleaching“ is selected for the application. The instructions and settings of the respective manufacturer must be observed exactly. A laser must only be used by personnel with the necessary qualifications. The usual protective measures for personnel, patient and other persons as well as the access regulations during the treatment must be observed strictly.
Preparing the teeth for the treatment
Before the actual treatment, the teeth are pre-cleaned using Airflow and polishing. Tartar deposits must be removed using an ultrasonic device and, if necessary, a scaler and curette.
Preparing the patient for the treatment
A relatively dry workfield is created for the application of Bleach‘n Smile by Schütz Dental. For this purpose, parotid patches are placed in the cheek to intercept the salivation from the parotid gland. The base of the mouth is covered with parotid rolls. The lips are lubricated with vaseline before OptraGate is placed. Small cotton rolls are additionally placed as required.
The gingiva is covered with Bleach‘n Smile Dental Dam. The liquid Dental Dam by Schütz Dental is also included in the bleaching set. To cover the gingiva, dry it slightly with an airstream, apply the liquid Dental Dam and cure it with a polymerization lamp.
Ensure that the gel slightly protrudes over the gingival margin to prevent the bleaching gel from penetrating under the Dental Dam. Otherwise, this could lead to gingival irritation. Gingival irritation cannot always be completely excluded. However, if some bleaching gel flows underneath the Dental Dam, this could also lead to white staining, which usually disappears a few hours after application. Patients should be informed about this possible side-effect before treatment.
Application of the bleaching gel
The bleaching gel is supplied in the practical automix syringe. First, remove the protective clamp and the cap. Replace the cap with a mixing cannula. Always prepare the syringe facing away from patient and staff. Discard the inhomogeneous mass extruded initially and apply only the mass with the gel-like consistency. Apply the gel to the labial surfaces of the teeth to be bleached with a layer thickness of approx. 1-2 mm. Next, the gel is activated by laser. Apply the laser light to each tooth for ca. 20 seconds, moving it constantly in close proximity to the tooth surface.
After approx. 10 minutes, remove the bleaching gel with the suction cannula. Any residue of the bleaching gel can be wiped off with a cotton wool roll or swab. After each session, check the result using the Vita® shade guide and inquire about the patient‘s condition. Up to three bleaching sessions are possible, as long as the patient does not encounter any hypersensitivities or other problems.
Aftercare of the teeth
After removing the bleaching gel, the patient is asked to rinse thoroughly with water. The tooth surfaces are dried and finely polished again (RDA 7 - 35). Subsequently, a gel for remineralization is applied. The After Bleaching Care Gel by Schütz Dental is included in the set. This product is also suitable for a desensitization after the bleaching process.
The patient receives the remaining After Bleaching Care Gel. A follow-up treatment with fluoride gel is also helpful. The tooth shade after the treatment is A1. The shade may still change within the next few hours. A final result is usually only visible after 2 days.
Behavior after a bleaching treatment
The patient is informed that she should avoid eating and drinking during the first hour after the treatment. In addition, coloring foods and stimulants, such as coffee, red beets, red wine or nicotine as well as acidic foods should be avoided for 48 hours. These could cause hypersensitivities and staining during the first hours after treatment due to the dehydration of the teeth by the bleaching gel.
Bleaching using Bleach‘n Smile Automix by Schütz Dental is simple and effective. The set contains all materials that are essential for bleaching and enamel remineralization. I am very satisfied with the application of the material and the final result. But, most importantly, the patient is also satisfied!
Please note: This case study is not an instruction leafet. Please adhere to the instructions provided with the material and/or equipment. The responsibility for the treatment remains with the attending dentist.
- Finished her training as Dental Assistant in Freiburg/Germany in 2005
- Upgrading training to become an advanced Dental Assistant in 2011
- Quality Management Specialist for dental practices according to ISO 9001
- Field of activity at the dental practice of Dr. Jan Loose, Rielasingen/Germany: prophylaxis, bleaching, photodynamic laser therapy, fissure sealing, Hygiene Specialist, Quality Manager
- Additional activity as self-employed Quality Management Consultant and founder of Quality4Dental
- Humanitarian aid mission with „DENTISTS WITHOUT LIMITS“ in Zambia 2018
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