INSIPIRED TO IMPROVE ORAL HEALTH®
How long does the bleaching last ?
Bleaching results are very stable, but depending on the patient’s nutrition and lifestyle habits, the procedure may need to be redone periodically. Due to the safety of the bleaching agents, this should not cause concerns to the dentist or patient
Will bleaching cause tooth sensitivity ?
Tooth sensitivity is a reasonably common side effect of bleaching. If sensitivity occurs, it is transient and disappears after the completion of bleaching. However, Opalescence products are available with PF desensitizing agents already included for additional comfort. Research has shown that “just as hydrogen peroxide penetrates through the enamel and dentin and to the pulp, so does potassium nitrate. Fluoride acts primarily as a tubular blocker, plugging the holes and slowing down the fluid flow that causes the sensitivity. Potassium nitrate acts more like an analgesic or anesthetic by keeping the nerve from repolarizing after it has depolarized in the pain cycle.
Will bleaching cause problems by weakening the tooth ’s Enamel ?
Findings on the Opalescence PF product line presented at the American Association of Dental Research confirm that whitening with Opalescence PF will actually minimize sensitivity, provide anti-caries benefits, increase enamel microhardness, and improve overall enamel health
Important : Dentist supervision IS THE BEST WAY TO WHITEN!
Tooth whitening treatments today are effective/efficacious and safe if they are used appropriately and with the correct materials. This includes an initial diagnosis, professional teeth cleaning, briefing on the whitening process to be used and monitoring of the patient during the treatment phase. Self-treatment by the patient with over-the-counter (OTC) products often does not provide the results desired. Therefore, all products of the Opalescence system are medical products, and are dispensed or released only by dental practitioners.
CLINICAL POINTER
PROBLEM: STAIN UNDER HYDROPHOBIC PROVISIONAL CEMENT
SOLUTION: Use sealing provisional hydrophilic cements (i.e.: UltraTemp)
CHEMISTRIES (THE “WHY’S”):
1. Non-sealing cements allow saliva and bacteria to move between temporary and preparation.
2. Iron-containing coagulum within cut tissues is a source of iron, which reacts with hydrogen sulfide gas (rotten egg gas, H2S) produced by anaerobic bacteria in this septic environment. The reaction yields ferric sulfide, the harmless yet annoying dark surface stain shown below. This stain can occur to a lesser degree from the natural iron in blood. Additionally, non-sealing provisionals are problematic as saliva and/or bacteria removes smear layer within one week, opening tubules to bacteria.
HOW TO PREVENT:
Either use an antimicrobial temporary cement (like ZOE) which leaks, but at least prevents bacterial growth, hence no H2S, and no formation of ferric sulfide.
OR BETTER YET:
Use a quality sealing provisional cement like Ultradent’s, non-eugenol, hydrophilic, polycarboxylate, paste-to-paste UltraTemp Firm or Regular cement.
Similar staining can occur even under definitive direct or indirect restorations if contamination is on the preparation prior to bonding. Scour and/or etch as needed prior to DBA application. For scouring, we recommend Consepsis Scrub with ICB Brush.
Two weeks earlier upon preparation, ViscoStat with Dento-Infusor was used to arrest bleeding. Provisional crowns were cemented with a popular NON-sealing, hydrophobic, resin-based temporary cement. NOTE dark color migrating from gingival margin inward.
PRE-PREPARATION PACKING TECHNIQUE
To ensure cord retention during preparation, use a cord large enough to firmly compress into sulcus.
Prepack–
Open proximal contacts and place Ultrapak knitted cord soaked in hemostatic solution. Because Ultrapak compresses upon packing, use a cord size that appears too large. The thin Ultrapak Packer quickly slips cord into position. The knitted cord’s unique design (interlocking loops) facilitates easy packing and locks it into place.
Preparation –
Extend margin subgingivally by cutting partway into knitted cord which doesn’t entangle in the diamond bur. Remove remnant of cord with calcium hydroxide applicator (tiny ball end). Bleeding is minimal. A small portion of uncut tooth above the gingival attachment is preserved to record in the impression
Hemostasis emostasis & Impression –
Rub the Dento-Infusor tip against bleeding tissue as solution is slowly expressed. Rinse with a firm air/water spray to clean and check for complete hemostasis. If bleeding is noted, repeat these steps. If additional retraction is required, repack with appropriate size cord. Air dry and make impression
TISSUE MANAGEMENT FOR IMPRESSION MAKING
An “astringent” is a substance that eliminates permeability of epithelium to tissue fluid flow. The result is a dry field,
an important tissue management solution for 21st century adhesive technology.
1. Subgingival preparation with bleeding.
2. ViscoStat burnished firmly against the sulcus with Metal Dento-Infusor tip.
3. Firm air/water spray removes residual coagulum and tests tissue for quality profound hemostasis.
4. Ultrapak knitted cord is soaked in ViscoStat, packed and left for one to three minutes.
5. Remove cord, firm air/water spray and dry.
6. Predictable quality impressions.
TISSUE MANAGEMENT FOR DIRECT BONDING
1. Several Class V restorations were performed on these anterior teeth two months prior. Inadequate tissue management or inadequate removal of hemostatic and/or blood contaminants have resulted in microleakage on the maxillary right central incisor.
2. With microleakage, blood pigments move into the space between preparation and restoration, and stain the interface.
3. Isolate tissues with Ultrapak cord soaked in hemostatic solution. Firmly air/water spray/rinse excess hemostatic from the cord, tissues, and tooth surfaces to prevent contamination and resultant leakage.
4. Replaced Class V restoration three months post-op.
1. Deep Class V’s–ViscoStat and Ultrapak cord are ideal for controlling fluids (blood and sulcular). Use a firm air/water spray to remove excess hemostatic solution.
2. Successful bonded restoration.
Two weeks post-op.
INDIRECT VENEER
1. Packing Ultrapak quickly displaces tissues and improves access for indirect veneer luting. (Note tissue management for bonded luting on next page.)
TISSUE MANAGEMENT FOR INDIRECT BONDING (LUTING)
1. Well-healed tissue two weeks post-op.
2. Sulcular fluids contaminate bonding materials/preparation when not controlled.
3. Seal epithelium by gently rubbing with ViscoStat and Blue Mini Dento-Infusor tip.
4. Hemostatic agent and residual temporary cement are scoured off with Consepsis Scrub, preparing the site for application of any dentin bonding agent, including self-etching systems.
5. Wash, dry and tissue stays dry.
6. Preparation ready for final cementation.
EXPANDED APPLICATION FOR VITAL PULPOTOMY
1. Control Bleeding.
Use Dento-Infusor tip with ViscoStat or Astringedent
2. A Sustained Antimicrobial*. Apply a thin layer of ZOE mixed to a putty
3. Eugenol Barrier*.
Apply a thin layer of Ultra-Blend plus, since eugenol inhibits most resin polymerization
4. Etch.
Apply Ultra-Etch phosphoric acid or Peak SE.
*Apply ZOE and Ultra-Blend plus in minimal thickness to keep maximum dentin available for bonding.
5. Bond.
Apply PQ1 dentin bonding agent or Peak LC Bond Resin.
6. Restore.
Use flowable and/or paste composite as desired.
Remove all hemostatic and extraneous coagulum prior to placement of the thin layer of ZOE.
Clinical Pointers
PERMAFLO DC PRIMERS FOR SUBGINGIVAL DESENSITIZATION -
For root sensitivity apical to Class II fillings or crown margins:
NOTE: If sensitive roots
are supragingival, we
recommend light cure
adhesive PQ1 and thin
layer of bond or sealant
resins.
1. Disinfect root and sulcus by rubbing
with Consepsis for one minute.
Hydraulics of syringe delivery are
beneficial for reaching interproximally!
Air dry, do not rinse.
2. Using the Black Mini Brush tip, firmly rub with Primer A 10 seconds then
Primer B 10 seconds. Check sensitivity by gently blowing air on the area.
Repeat procedure until sensitivity is reduced or eliminated (usually less
than 5-7 applications.) If sensitivity recurs, anesthetize, place retraction
cord, reapply primers and seal with PermaQuick bonding resin. Air thin and
inspect for puddled resin before light curing.
CLINICAL TECHNIQUE
1. Fit EndoREZ Points to length. Verify radiographically. Ultradent’s Premium Stiff Gutta Percha may also be used.
2. Dry the canal space using the Ultradent Capillary Tip and Luer Vacuum Adapter followed by paper points
3. Using a NaviTip on a Skini Syringe filled with EndoREZ, insert the tip to 2mm short of the apex. Express the EndoREZ while withdrawing until EndoREZ is seen at the top of the canal. To avoid bubbles, keep end of tip buried in the EndoREZ while withdrawing.
4. Insert the master EndoREZ Point gutta percha cone to length. Accessory points are recommended. EndoREZ will set in the canal in about 20-30 minutes. Seer off extraneous gutta percha and restore coronal aspect. EndoREZ is conducive to lateral condensation or warm gutta percha techniques.
VIT-L-ESCENCE LAYERING TECHNIQUE
Vit-l-escence allows you to layer enamel shades over dentin shades, creating the most life-like restorations possible
1. For Class IV restorations, veneer or diastema closures, a silicon putty matrix fabricated from diagnostic wax-up is recommended.
2. Use matrix as a guide for the basic shape of the restoration, and to support the initial lingual placement of material.
3. A thin layer of Opaque Snow is used to establish lingual contour and prevent show-through. This is not necessary if tooth structure exists on lingual wall.
4. Inner dentin body layer includes the basic hue of the exposed dentin. If this is A2, an A5 would be applied at the cervical and an A4 towards the incisal. Cure and apply basic hue (A2). Create mamelons using a carver.
5. Cover body and extend enamel edge with appropriate translucent shade. To achieve a “halo” (white line at the incisal edge), place a thin roll of Pearl Frost or Opaque Snow
6. Final adjustments are accomplished with multi-fluted finishing burs. Jiffy cups, points and disks are used for smoothing. Polish with Jiffy HiShine.
MICRO RESTORATIVE
1. Small Class I preparation treated with dentin bonding agent. Restoration is filled with flowable PermaFlo through the Black Micro tip.
2. Unsurpassed adaptation of the flowable composite occurs as it fills from preparation floor up.
3. Finished, radiopaque, 0.7μm hybrid restoration. Ultimate restorative seal!
After the bonding agent, apply a thin layer of PermaFlo at the gingival margin, proximal box axial margins and internal line angles to assure quality adaptation of composite.
SUPER ADAPTIVE INTITIAL LAYER:
MASKER
Masking dark colors initially, facilitates gorgeous esthetics at the surface.
METAL MASKING:
Place a thin layer of PermaFlo Dentin Opaquer over the exposed metal and light cure for 20 seconds.
PEDIATRIC RESTORATIONS
1. Rampant caries in a three year old.
5. One year later.
2. Slow speed and large round bur to remove all caries. Stain with Sable Seek to assure all of prep is in firm mineral dentin. (Compromise where close to pulp.) Quality tissue management is an absolute here; a long #0 or #1 Ultrapak cord soaked in ViscoStat is packed first.
3. Preparations are etched and PQ1 is applied. A thin first layer of PermaFlo is applied intimately to the adhesive layer with the Black Micro 20 gauge tip and light cured.
4. One or two additional increments are applied and cured. Restorations are quickly finished with finishing burs and abrasive cups.
WHITEN YOUR SMILE - Questions Behind Tooth Whitening
There are many causes of tooth staining. Certain medicines, tooth trauma, root fillings and certain foods and beverages can cause tooth discoloration over time. Some discolorations are superficial while others are internal. Both can be effectively treated by a dentist; professional whitening is the best option to safely lighten discolored teeth.
How does bleaching work ?
The whitening process is possible “due to the ability of the carbamide peroxide and hydrogen peroxide to freely pass through enamel and dentin and to permeate to all parts of the tooth.”1 These peroxides break down into oxygen radicals, which migrate between the enamel prisms, breaking down any colored molecules that result in tooth discoloration. The structure of the tooth is not altered; the internal tooth color is simply made lighter.
“Bleaching agents break down into tiny molecules and move in all directions so even if the entire tooth is not covered with bleach, the entire tooth is whitened.”2
Numerous studies have proven the effectiveness of peroxides in whitening teeth. Enamel, dentin, existing fillings and binding materials are not affected by the whitening agents, nor are they harmed by the whitening materials.
Will bleaching affect bond strength ?
Even though bleaching agents release a great amount of oxygen into the tooth, existing bonds are not weakened.
If bleaching before bonding, allow a period of 7-10 days after bleaching. The high concentration of oxygen in the tooth could significantly and adversely affect polymerization of the resins.
