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Vital Tooth Bleaching: A Case Report

Article in The Journal of Dentists · April 2014

DOI: 10.12974/2311-8695.2014.02.01.4

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24 The Journal of Dentist, 2014, 2, 24-28

Vital Tooth Bleaching: A Case Report

Niladri Maiti* and Utpal Kumar Das

Department of Conservative Dentistry & Endodontics, Guru Nanak Institute of Dental Science and Research,
Kolkata, India
Abstract: A dazzling white smile has been a symbol of beauty, health and vitality for hundreds of years. Discolouration,
especially when the front teeth are affected, means a significant disturbance of aesthetics and can decrease a patient’s
self esteem. Public demand for aesthetic dentistry, including tooth whitening, has increased in recent years. Compared
with restorative treatment modalities, whitening, also referred to as bleaching, is the most conservative treatment for
discolored teeth. This public demand for a whiter smile and improved aesthetics has made tooth whitening a popular and
often requested dental procedure, since it offers a conservative treatment option for discolored teeth. Whitening often
enhances the treatment and encourages patients to seek further aesthetic treatment. Dental bleaching offers a
conservative, simplified, and low cost approach to change the color of discoloured teeth. Current bleaching techniques
include a dentist-prescribed in-office technique, an at-home applied technique, or a combination of both. The pigments
oxidation is responsible for tooth bleaching and can be carried out with two different products; carbamide peroxide and
hydrogen peroxide. This case report reflects the remarkable change of tooth color by in-office bleaching.

Keywords: Vital bleaching, Hydrogen peroxide, Office bleaching.

I. INTRODUCTION rays. Although a dental dam would be ideal, the

placement of a dental dam will inhibit the bleaching of
The first bleaching of teeth to change color was an the cervical areas of the teeth, which will dissatisfy
in-office procedure. Currently, the most popular patients. Naturally, patients want their entire visible
systems for in-office bleaching use high concentration tooth surface to get whiter. The manufacturers have
hydrogen peroxides and are often referred to as “one- responded by providing barrier protection in the form of
hour bleaching.” These high concentration hydrogen a light-cured resin that is painted over the gingival
peroxides range from 25% to 35%. tissues.
In-office bleaching can be provided to patients as i.i. Patient Selection
either a one-visit 1–1.5 hour treatment or a multiple
visit procedure [1-4]. When treatment planning for successful esthetic
treatment for tooth discolorations, it is important to
One can use one of the light enhanced bleaching select patients with conditions that have the best
techniques, a laser-activated bleach or merely a paint- prognosis for success with bleaching.
on bleaching gel or solution. For the in-office, light-
enhanced systems, usually the light can only be used Key factors that have an effect on the final result
for bleaching. One light system is based on a plasma after bleaching include concentration of the bleaching
arc high-intensity photopolymerization device that can agent, duration of use of the bleaching agent, type of
be used for in-office whitening and for resin photopoly- tooth discoloration, color of the teeth, and patient’s age
merization. [5].

The use of high concentration hydrogen peroxide It has been reported that tooth discolorations with
gelsintraorally requires specific safety protocols. the best prognosis for whitening are the followings:

First, the doctor and patient must be wearing eye 1. Yellowing of the teeth without any systemic or
protection, and the gingival soft tissues adjacent to the developmental cause (food, smoking, aging,
procedure must have a barrier placed. Some lights staining)
generate heat and or UV rays, so a rubber dam napkin
can be used to shield the face from the light source. In 2. Mild flourosis staining
some cases, the manufacturers provide moisturizers
for the lips or sunscreen as protection from the UV 3. Mild tooth darkening due to trauma

4. Mild tetracycline staining [6-7]

*Address correspondence to this author at the Department of Conservative
Dentistry & Endodontics, Guru Nanak Institute of Dental Science and Many dentists are using vital tooth bleaching as an
Research, Kolkata, India; E-mail: dr.niladrimaiti@gmail.com
adjunct to their esthetic bonding procedures. For
E-ISSN: 2311-8695 © 2014 Savvy Science Publisher
Vital Tooth Bleaching The Journal of Dentist, 2014 Vol. 2, No. 1 25

patients dissatisfied with tooth mal position and shape in fanning motion. Then isolation was achieved with
combined with discolorations, lightening the shade of rubber dam (Figure 3).
teeth first with bleaching makes masking tooth
discolorations less difficult.

It is important that before any bonding procedure

that bleaching be discontinued for at least one week
before the restorative treatment to prevent interference
with bonding adhesion and material setting [8-11].

II. CASE REPORT

A 25 years old female patient reported to the

Department of Conservative Dentistry and Endodontics
with the chief complaint of discolouration of teeth.

During the examination of the patient, the key Figure 2: Pola Office Bleaching Kit.
clinical parameters that are focused on are good
periodontal health, no or minimal gingival recession
and the absence of decay. Additionally, questions
about any history of tooth sensitivity were asked. The
importance of this is that patients with a history of tooth
sensitivity occasionally experience mild to moderate
tooth sensitivity for 24 hours after in-office bleaching. In
the case of this patient, she had no history of any tooth
sensitivity.

III. TREATMENT PROCEDURE

Pre-operative photos are taken (Figure 1). The Figure 3: Isolation with rubber dam.
patient’s initial shade is an A3, which is verified by a
digital shade-taking device (Vita Easy shade Compact). With one Pola Office syringe, tip was firmly
attached, and carefully plunger was pulled back to
release the pressure. Contents of the syringe was
carefully extruded into the pot and immediately mixed
using a brush applicator until gel is homogeneous. A
thick layer of gel was then applied to all teeth
undergoing treatment (Figure 4). The gel was left on
teeth surfaces for 8 minutes (Figure 5). Optional curing
light can be used according to manufacturer’s
instructions (Figure 6). Suction was performed using a
surgical aspirator tip.
Figure 1: Pre-operative view.

For this patient, Pola Office was chosen (LOT NO.

122053) (Figure 2). This material contains 35%
hydrogen perioxide, which facilitates a significant
whitening procedure with a start to finish time of less
than an hour. The shorter treatment time and the
inclusion of potassium nitrate in the composition,
provides patients with less treatment and/or post-
operative sensitivity than other in-office systems.

The teeth were cleaned with pumiceslurry. Teeth Figure 4: Application of the bleaching gel with the brush
were dried, gingival barrier was applied and light cured applicator.
26 The Journal of Dentist, 2014 Vol. 2, No. 1 Maiti and Das

improvement and was very pleased with the final

outcome.

Figure 5: Bleaching gel was left for 8 minutes.

Figure 8: VITA Easyshade Advance.

Figure 6: Photo activation of the bleaching gel.

Three applications were used to complete the in

office procedure after the last application, all gel was
suctioned, then washed with water. After the
completion of the procedure, the rubber dam was
removed (Figure 7). Figure 9: After final polishing.

Patient was recalled after 3 months for follow-up

(Figure 10).

Figure 7: Post-operative view.

In this case, a bleaching LED curing light was used

and this is a cost effective and easy to use light source
for augmenting the in-office procedure. Figure 10: 3 months follow up.

The patient was asked to return in 10 days to IV. DISCUSSION

evaluate the results. Using standard visual examination
and confirmation with VITA Easy shade Advance With in-office bleaching, both proper isolation and
(Figure 8), a noticeable shade change has occurred. protection of mucosal tissues are essential. Dentists
The postoperative shade is now an A1. Final polishing may also wish to consider prescribing NSAIDs prior to
of the teeth was performed after the desired shade treatment [12] since post-treatment sensitivity is
improvement (Figure 9). The patient noticed a marked unpredictable.
Vital Tooth Bleaching The Journal of Dentist, 2014 Vol. 2, No. 1 27

The treatment schedule may also be a useful immediate gratification, in-office bleaching is one of the
method to help minimize tooth sensitivity. Multiple most requested procedures in many dental offices.
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Received on 02-10-2013 Accepted on 11-10-2013 Published on 22-04-2014

DOI: http://dx.doi.org/10.12974/2311-8695.2014.02.01.4

© 2014 Maiti and Das; Licensee Savvy Science Publisher.

This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License
(http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in
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