B L E A C H I N G

01. Introduction.
02. Definition
03. History
04. Factors of Discoloration
a. Intrinsic
b. Extrinsic
05. Indication
06. Contraindication
0. !aterials used for bleac"in#
0$. !ec"anis% of action
0&. 'leac"in# tec"ni(ues
a. )ital teet"
b. *on +ital teet"
10. ,t"er %et"ods
a. -asers
b. Ena%el %icroabrasion
c. .o/er bleac"in#
1
INTRODUCTION:
'leac"in# is an a#e old treat%ent0 /"ic" "as been 1erfor%ed o+er a
century.
2"e current trend to/ards cos%etic dentistry "as #enerated %ore interest in
bleac"in# as 1atient3s are as4in# for /"iter and %ore beautiful teet". ,ur society
tends to disli4e yello/in# of teet" t"at co%es /it" a#e or by +arious stains.
5"ite teet" are not only considered attracti+e but are also indicati+e of
nutritional "ealt"0 self estee%0 "y#iene 1ride and econo%ic status.
Discoloured teet" on t"e ot"er "and "a+e a far reac"in# effect on an
indi+idual bot" socially and 1syc"olo#ically.
2"e different treat%ent %odalities a+ailable are6
'leac"in#.
)eenerin#.
7ac4et cro/ns.
!icro abrasion etc.
,ut of all t"ese bleac"in# is t"e %ost co%%only used tec"ni(ue0 least
ex1ensi+e /it" %axi%u% conser+ation of toot" structure.
DEFINITION:
5"itenin# of a toot" t"rou#" t"e a11lication of c"e%i cal
a#ents to oxidi8e 9 reduce t"e or#anic 1i#%entation in t"e toot" is
ter%ed as bleac"in#.
2
HISTORY:
For vital tooth:
1877: 1
s t
1ublicat ion for bleac"in# by C"a11el /"o used oxalic
acid.
1884: Harlen used "ydro#en 1eroxide for t"e 1
s t
ti %e0 /"ic" "e
called as "ydro#en dioxide.
111: :ossentel su##ested ultra+iolet /a+es.
118: ;bbot introduced t"e co%bination of H
2
,
2
/it" "eat and
li#"t.
18: Hey/ood and Hey%ann 1ublis"ed an article on ni#"t #uard
+ital bleac"in# usin# 10< carbo%ide 1eroxide.
For !o!"vital tooth:
1848: *on=+ital bleac"in# /it" c"loride of li%e.
18#4: 2ru%ann used c"lorine fro% a solution of calciu%
"ydroc"loride and acitic acid co%%ercial na%e /as >-abarra(ue
solution3.
18$: ?arretson 1ublis"ed 1
s t
re1ort of bleac"in# non= +ital toot".
Earl% 1&&'(: @u1eroxol A30< H
2
,
2
B /as introduced.
1$8: .earson 1ac4ed su1eroxol in t"e 1ul1 c"a%ber.
1#7: C*uttin# and .oeD de%onstrated /al4in# bleac" usin#
su1eroxol and sodiu% 1erborate to ac"ie+e 1rolon#ed effect in
1ul1 c"a%ber.
Di()oloratio!:
*or%al colour of 1ri %ary teet" E bluis" /"ite.
*or%al colour of 1er%anent teet" E Fello/is" /"ite.
Colour of ena%el is deter%ined by t"e translucency of ena%el0
/"ic" s"o/s t"e colour of underlyin# dentin.
;ny alteration in colour %ay be
3
Endo#enous 9 Exo#enous ."ysiolo#ic 9 .at"olo#ic
:efractory index of teet" is 1. 5.
Ca*(+( ,or -i()olo*ratio!:
E.tri!(i) I!tri!(i)
1. Coffee and tea stains
2. Ci#arett e
3. Diet
4. 2obacco
5. *as%yt"s %e%brane
Aseen in c"ildren caused
due to reduced ena%el
e1it"el iu%B
1. 2etracycl ine stains
aB 1
s t
de#ree
bB 2
nd
de#ree
cB 3
r d
de#ree
dB 4
t "
de#ree
2. Fluorosis stains
3. 2rau%a to toot"
4. @yst%ic condition
aB Eryt "oblastosis
foetalis
bB 7aundice
cB ;%elo#enesis
i%1erfecta
dB Ena%el "y1o1lasi a
due to deficiency of
+ita%in ;0 C0D.
5. Iatro#enic discoloration
aB ;%al#a%
bB Intracanal %edi ca%ents
AGerr root sealer0 ?ross%an
sealer0 .rocosol sealerB.
T+tra)%)li!/ (tai!i!/:
2eet" are %ore susce1tibl e to tetracycli ne discolouration durin#
t"eir for%ation i. e. durin# t"e second tri %ester in +itro to rou#"ly
$ years after birt".
2etracycl ine %olecules c"elate /it" calciu% and #ets incor1orated
into t"e "ydroxya1at it e crystals.
It in+ol+es 1redo%inant l y t"e dentin.
@e+erit y of stains de1ends on t"e ti %e and duration of dru#
ad%inistration.
4 D+/r++(:
1
( t
D+/r++
= -i#"t yel lo/0 bro/n stains
4
= Hnifor%l y distributed
= *o bandin# or locali8ed concentration
= :es1onds to bleac"in# in 2 or 3 session
0
!-
D+/r++
= Dar4 #ray stains
= Extensi+e t"an 1
s t
de#ree
= :es1onds to bleac"in# in 4=6 session
1
r -
D+/r++
= Dar4 #ray stains /it" bandin#.
= :es1onds to bleac"in# best bands /ill be e+ident.
4
t h
D+/r++
= Does not res1ond to bleac"in#.
Fl*oro(i(:
Hi#" concentrat ion of fluoride in %ore t"an 411% cause %oderate
to se+ere discoloration.
.re+alence E .re%olars0 2
nd
%olars and %andibul ar and %axi%u%
incisors.
Types
!ild fluorosis = 'ro/n 1i#%entation on a s%oot" ena%el surface
= :es1onds /ell to bleac"in#
!oderate = ,1a(ue fluorosis a11ear #ray /it" /"ite
flec4s on ena%el surface.
@e+ere = 5it" 1ittin# and dar4 1i#%entat ion /it"
surface defects.
= Does not res1ond to bleac"in#
Tra*2ati) I!3*ri+(:
Causes ru1ture of blood +essel in t"e 1ul1.
Causin# diffusion of blood into dentinal tubules.
Dar4 1in4 i%%ediate after trau%a and c"an#es to 1in4is" bro/n
after so%e days.
Ca*(+(: Hae%o#lobin de#rades into "e%in0 "e%atin0 "e%atoiden and
"ae%osidrin.
Hydro#en sul1"ide 1roduced by bacteria co%bines /it"
"e%o#lobin to dar4 colour to toot".
5
S%(t+2i) Co!-itio!:
1B Eryt "roblastosis foetalis6 A:" factor
inco%1at ibil it y bet/een %ot"er and foetusB c"aracteri8ed by E
brea4do/n of eryt "rocytes.
2B 7aundice6 'luis" #reen or bro/n stains in dentin
caused by bilirubin or bili+erdin.
3B ;%elo#enesis i%1erfecta6 is a #enetic condition
/"ic" interface /it" t"e nor%al ena%el %atrix for%ation.
4B Ena%el "y1o1lasia6 caused by deficiency of
+ita%ins i. e. ;0 C0 D and calciu% and 1"os1"orus.
Iatro/+!i) -i()olo*ratio!:
aI 2rau%a durin# 1ul1 extir1ation E "e%orr"a#e
bI Failure to re%o+al of all 1ul1al re%nants.
cI ;%al#a% restoration cause E dar4 #ray.
dI ?old E dar4 bro/n /"en co%bined /it" 1roducts of decay.
eI 'rea4 do/n of restoration i. e. acryli c0 silicate and co%1osite
resins can cause t"e toot" to loo4 #rayer and discolored.
fI @il+er containin# root canal sealers i. e. CGerr rootD0 C#ross%an
sealerD.
#I )olatile oils yell o/is" bro/n stain.
"I .ins cause bluis" #rain stains.
I!-i)atio!(:
1B Discolouration of anterior teet" E after :. C. 2.
2B 2etracycl ine stains A%i ldB
3B Fluorosis
4B Hae%orr"a#ic discolouration.
5B Discolouration due to a#ein#
6B !edication discolouration
Co!trai!-i)atio!(:
1B @ensiti+e teet"
2B ,1a(ue or /"ite s1ots
3B .re#nancy
4B -actation
5B Dee1 %icrocrac4s stainin#
6
6B Extensi+e silicat e0 acryl ic or co%1osite restoration.
4at+rial( *(+- ,or 5l+a)hi!/:
1B H
2
,
2
A30=35<B e#. @u1eroxol 30<J @tarbrite 35<.
A1=10<B E#. 'rite=s%ileJ *atural /"ite.
2B Carba%ide 1eroxide
10< /it" carbo1al0 E. #. HltraliteJ ,1alescance.
10< /it"out carbo1al E. #. ?l y=oxideJ /"ite and brite
10< Carba%ide 1eroxide0 E#. *u=@%ile
3B @odiu% 1erborate
;+ailable as #ranules0 /"ic" are 1o/dered later for use.
@. .. K 309H
2
,
2
5al4in# bleac" A.asteB
@. .. K H
2
, A*e/B A-i(uidB.
Bl+a)hi!/ 2+)ha!i(2:
2"e %ec"anis% is oxidation 9 reduction 1rocess called as
Redox process.
In t"is 1rocess t"e oxidi8in# a#ent "as a free radical /it"
un1aired electrons0 /"ic" it #i+es u10 beco%in# reduced. 2"e
reducin# a#ent Ai. e. t"e substance bein# bleac"edB acce1ts t"e
electrons and beco%es oxidi8ed.
Reducing agent Oxidising agent
2oot" 'leac"in# %aterial
;fter t"e 1rocess
2oot" is oxidi8ed 'leac"in# %aterial is reduced
A,r#anic 1i#%entation of toot" oxidi8edB
4+)ha!i(2 o, +a)h 2at+rial(:
Hydro#en 1eroxide in +arious concentration is t"e 1ri%ary
%ateri al currentl y used by t"e 1rofession in t"e bleac"in# 1rocess.
Current inoffice tec"ni(ues for +ital teet" and /al4in# bleac"
tec"ni(ue use 30=35< H
2
,
2
.
7
H
2
,
2
is 1roduced and re#ulated in t"e body and after in+ol+es in
/ound "ealin# in lo/ concentrations0 also seen in eyes0 s1leen
and li+er etc i. e. it is %ore bioco%1atible.
In "i#" concentration it is bacteriostatic.
In +ery "i#" concentration it is %uta#enic 1ossibly by disru1tin#
t"e D*; strand.
H
2
,
2
H
2
,KL,I or H
2
,
2
H K ,,H or H
2
,
2
,HK,HJ H,, K
,H H
2
, KL,I and ,,H L,IKH
;ction of H
2
,
2
in toot" bleac"in# is considered to be
oxidation0 alt"ou#" t"e 1rocess is not /ell understood. It is felt t"at
t"e oxidi8ers re%o+e so%e unattac"ed or#anic %atter fro% t"e toot"
/it"out dissol+in# t"e ena%el %atrix but also %ay c"an#e t"e
discoloured 1ortion to a colourless state. AContinued lon#=ter%
treat %ent /ill result in dissolution of t"e ena%el %atrixB.
2etracycl ine stains are %ore resistant to oxidation because t"e
%ol ecul e is ti#"tl y bound to t"e %ineral in t"e ena%el 1ris% %atrix0
durin# for%ation and "ence is less accessible to i %%edi ate action.
2"erefore treat %ent ta4es a 1rolon#ed ti%e.
H
2
,
2
diffuses t"rou#" t"e or#anic %atrix of ena%el and
dentin. 'ecause t"e radicals "a+e un1aired electrons0 t"ey are
unstable and /ill attac4 ot"er or#anic %olecules for stabilit y.
Car5a2i-+ 6+ro.i-+:
2"e %aM orit y 1roduct in t"e %ar4et for ni#"t #uard bleac"in#
use 10< C. ..
C. . 3< H
2
,
2
K < urea
H
2
,
2
H
2
, K 2L,I and Hrea *H
3
K C,
2
.
H
2
,
2
is t"e acti+e in#redient /"ereas urea raises t"e 1H of t"e
solution.
8
So-i*2 6+r5orat+:
For non=+ital toot" bleac"in# sodiu% 1erborate is used /it"
H
2
,
2
called >/al4in# bleac"3 tec"ni(ue.
aB @odiu% 1erborate is a /"ite 1o/der /"ic" deco%1oses
into sodiu% %etaborate and H
2
,
2
.

@. .. @. !etaborate K H
2
,
2
.
bB 5"en @. .. is %ixed /it" H
2
,
2
it deco%1oses into
sodiu% %etaborat e0 H
2
, and ,
2
.
@. K H
2
,
2
@. %. 'orat e K H
2
, K ,
2
.
cB @. . K H
2
, @.!. 'orate K H
2
,
2
.
4)I!!+( (ol*tio!6
,ld6 Contain 30< H
2
,
2
E 'leac"es t"e ena%el
36< HCl E Etc"es t"e ena%el
0. 2< Et"er re%o+es surface debris
56561
H
2
,
2
bleac"es t"e ena%el by a 1rocess of oxidation.
HCl increases t"e 1enetration of t"e solution and "el1s in
faster action.
'ut HCl "as deleterious effect suc" asJ
aB -oss of contour
bB Irritation to #in#i+a
cB @ensiti+it y of teet"
@o C"en0 Nu and @"in# A1&&3B re1laced HCl by 20< *a,H.
*a,H is "i#"ly al4aline in nature and t"erefore dissol+es
calciu% at a slo/er rate.
9
2"e results su##est t"at 161 %ixture of H
2
,
2
/it" 20<. *a,H
is an effecti+e as old !cInnes solution and t"e calciu% dissol+ed is
%uc" less /it" t"e ne/ !cInnes solution.
; study by Dr. )ers"a *an#rani s"o/ed t"at t"e use of old
!cInnes solution resulted in loss of contour of teet". 2"e ti%e ta4en
by *e/ !cInnes solution /as double t"an t"at of old !cInnes
solution but it did not s"o/ loss of contour of t"e teet".
Dr. @"ad/ala studied t"e a%ount of calciu% dissolution /it"
o1alescence ni#"t #uard +ital bleac"in# and old !cInnes solution
and found t"at old !cInnes solution caused less calciu% dissolution
as co%1ared to *i#"t #uard +ital bleac"in#. 2"e reason for t"is /as
ni#"t #uard and +ital bleac"in# uses bleac"in# action0 /"ic" lasts for
6 "ours for 2 /ee4s /"ere as !cInnes solution "as to be used onl y
for 5 %inutes to 20 %inutes.
Tr+at2+!t 6la!!i!/:
1B :ecord 4ee1in# and 1"oto#ra1"s
2B Careful dia#nosis E 5"ic" included6 )italit y testsJ any
restorations i. e. co%1osi te0 acryl ic etc.
3B ,ral 1ro1"ylaxis and 1olis"in#6 2o #et rid of surface stains
and calciu%.
4B .re1aration of teet" to be bleac"ed i. e.
a. :ubber da%
b. .rotection of soft tissue by )aseline or ,rabase.
c. Floss to li#ate interdentall y to 1resent see1a#e of
bleac"in# a#ents into #u%s.
d. ?au8e saturated /it" cold /ater is 1laced under t"e
rubber da%.
e. .rotecti+e #lass
10
'leac"in# of +ital teet"
1B In office bleac"in#
a. 2"er%ocat al yti c = -i#"tJ Heat
b. !cInnes solution E ,ldJ *e/
2B *i#" #uard +ital bleac"in#
3B ,+er t"e counter
4B 5"ite stri1s
In office bleac"in#
aB 2"er%ocatal yt ic usin# li#"t 9 "eat
;fter t"e rubber da% 1lace%ent
2eet" is co+ered /it" 35< H
2
,
2
/it" ?au8e
2"e 1eroxide solution is acti+ated by li#"t 9 "eat.
Gee1 t"e li#"t about 30 c%s A13 inc"esB fro% t"e teet" and direct
t"e bea% to t"e surface to be bleac"ed te%1erature ran#es fro%
115O=140OF.
5"en "eat is used te%1erature is 46O=60OC.
?au8e is 4e1t /et by dis1ensin# fres" bleac"in# solution.
'leac"in# a#ent s"ould be 4e1t in contact of li#"t 9 "eat for 30
%inutes.
;fter re%o+in# t"e ?au8e0 /as" /it" co1ious a%ount of /ar%
/ater and t"en 1olis".
:e1eat t"e 1rocedure till desired s"ade is obtained.
A*eutrali8in# t"e solution /it" 5. 25< *a,ClB
2un#sten "alo#en curin# li#"t.
4)I!!+( (ol*tio!:
Ol- N+7
30< H2,2 E 'leac"in# 30< H2,2
11
36< HCl = Etc"in# 20< *a,H
0. 2< Et"er E :e%o+al of
surface debris
0. 2< Et"er E :e%o+al of
surface debris
= :ubber da% is a11lied
= ;11ly t"e 1aste on teet" for 5%ts and re1eated
after 1 %inute in le+el /it" cotton a11licators.
= ,ld !cInnes solution is neutrali8ed /it" ba4in#
soda.
= Co1ious irri#ation of /ar% /ater.
= .olis" .
Disad+anta#es of old !cInnes solution o+er+ie/.
1B -oss of contour
2B @ensiti+it y
3B Irritation to #in#i+a
Ca dissolution is %ore
Ni/ht /*ar- 5l+a)hi!/ 81&9 )ar5a2i-+ 6+ro.i-+::
!a4e 1ri %ary i %1ression and 1our a cast.
!a4e reser+oirs on t"e cast on t"e labial as1ect.
.re1are t"e 1ol yresin tray /it" t"e "el1 of +acuu% for% %ac"ine.
2"e tray is tri %%ed and extended 1%% s"ort of t"e #in#i+al
%ar#in on t"e labial as1ect to a+oid irritation of #in#i+a by t"e
bleac"in# %aterial.
2ray is t"en tried on t"e 1atient3s %out" to c"ec4 for fit.
Instructions are #i+en to t"e 1atient to load t"e tray /it" t"e #el
onl y on t"e labial as1ect and /ear t"e tray at ni#"t durin# slee1
for 6= "ours for 2 /ee4s.
If 1atient any sensiti+it y "e can discontinue /earin# t"e tray.
.atient s"ould be instructed not to bite t"e tray.
;fter tray re%o+al of t"e tray t"e 1atients brus"es off t"e
%ateri al.
12
5ee4l y c"ec4 u1 s"ould be done.
Disad+anta#es of ni#"t #uard bleac"in#.
= !ore lab 1rocedures
= .atient co%1lains of #a# reflex /"ile usin# tray
;hit+ (tri6(:
5"ic" is a t"in flexible 1ol yet"el ine stri1s /"ic" contains
5. 3< "ydro#en 1eroxide in #el for%. 2"e stri1s are used for 30
%inutes t/ice dail y for 14 days.
No! vital 5l+a)hi!/:
1B In office bleac"in#.
2B 5al4in# bleac" Aout of office bleac"in#B.
Establis" a lin#ual o1enin# of sufficient si8e to 1ro+ide access to
t"e 1ul1 c"a%ber and orifice of root canal.
2"e root canal fillin# s"ould be re%o+ed to a de1t" of 2=3 %%
a1ical to cer+ical line.
Pinc 1ol ycarboxyl at e or ca+it ce%ent s"ould be used to refill0 1=2
%% coronall y to t"e CE7.
'leac"in# s"ould ne+er be atte%1ted on any toot" t"at does not
"a+e a co%1l ete seal in t"e root canal.
1: I! o,,i)+ 5l+a)hi!/:
:ubber da% is 1laced.
2"e 1ul1 c"a%ber is filled loosel y /it" cotton fibres and t"e
labial surface is co+ered /it" a fe/ strands of cotton fibre to for%
a %atrix for retainin# t"e bleac"in# solution.
35< H
2
,
2
is used to saturate t"e cotton inside t"e 1ul1 c"a%ber
and on t"e labial surface.
Excess s"ould be /i1ed i%%ediatel y.
; t"in ta1ered instru%ent can be "eated and inserted into t"e 1ul1
c"a%ber for 5 %inutes in a se(uence of 1%t on 15 seconds off.
13
It "as been establis"ed by Cal-7+ll t"at a non=+ital toot" can
/it" stand a te%1erature of 3OC /it"out causin# 1atient
disco%fort.
;n alternati+e to acti+at e H
2
,
2
is t"e use of li#"t and "eat fro% a
bleac"in# li#"t.
2"e toot" is subM ected to 5 %inut es ex1osure and one re1lenis"es
t"e bleac"in# a#ent at fre(uent inter+als.
2"e "eatin# instru%ent and cotton can be re%o+ed. .rocess can be
re1eated for 4=6 ti %es or 20=30 %inutes eac" ti %e 1lacin# a ne/
cotton fibre.
2"is tec"ni(ue can be used alone or in co%bination /it" /al4in#
bleac".
0: ;al<i!/ 5l+a)h 85% N*tti!/ = >o+ i! 1#1::
2"is 1rocedure consists of filterin# t"e 1re1ared c"a%ber as
described 1re+iousl y /it" a 1aste of 35< H
2
,
2
and sodiu%
1erborate.
5"en sealed into t"e 1ul1 c"a%ber0 it oxidi8es and discolours t"e
stain slo/ly continuin# its acti+i t y for a lar#er 1eriod.
; s%all 1led#et of cotton /ool in 1laced o+er t"e 1aste and t"e
ca+it y is sealed /it" 1olycarboxylate or ca+it y ce%ent.
.atient s"ould return in 4= days.
4o-i,i+- 7al<i!/ 5l+a)h: 8L+o!ar- a!- St+tt+2 Bri2 +t? al? 17:
Fabrication of t"e study %odel.
-i#"t cured co%1osite are 1laced on t"e toot" or teet" to be
treated. 2"is acts as a reser+oir to be created in a +acuu%
1rocessed %out" #uard /"ose t"ic4ness is 0. 2=03 inc".
!out" #uard is tri %%ed at t"e cer+ical %ar#ins on t"e labial and
lin#ual 1ortions and tried on 1atients %out".
2"e ?. .. in t"e root canal is sealed off fro% t"e 1ul1 c"a%ber at
t"e cer+ical line and sealed /it" ?IC.
14
.atient is tau#"t "o/ to inM ect 10< carbo%ide 1eroxide into t"e
canal orifice and into t"e %out" #uard /it" a syrin#e.
.atient can use t"e %out" #uard /"ile slee1in#.
;t t"e end of t"e dail y treat%ent0 1atient rinses t"e %out" and
t"en 1laces a cotton 1ellet to 1re+ent t"e food fro% #ettin# into
t"e o1enin#.
2reat %ent 1roceeds for 3=4 days.
;nderson and -. ;. F .unenta A1&&&B @1assier su##ested t"e use
of sodiu% 1erborate and H
2
, as a /al4in# bleac" tec"ni(ue instead
of H
2
,
2
to 1re+ent cer+ical resor1tion. @odiu% 1erborate brea4s
do/n to sodiu% %etaborat e and H
2
,
2
. 2"is s"o/ed satisfactory
results.
E!a2+l 2i)ro a5ra(io!:
In 1&16 Dr. 5alter Gane of Colorado s1rin#s used 1$< HCl /it" a
/ar% instru%ent to successfull y re%o+e stains associated /it"
ende%i c fluorosis.
In 1&$4 !cClos4ey found t"at bro/n fluorosis stains can
1er%anentl y be re%o+ed by rubbin# t"e ena%el /it" 1$< HCl
acid soa4ed cotton 1ellet /ra11ed around a%al#a% condenser.
2/o year later Croll and Ca+ananau#" de+elo1ed a si%i lar
tec"ni(ues t"at in+ol+es 1ressure a11licat ion of 1$< HCl /it"
1u%ice to ac"ie+e colour %odification. 2"is /as called ena%el
%icro abrasion.
Dr. Croll belie+ed t"at t"e acid abrasi+e action of t"e co%1ound
#i+es t"e ena%el surface a su1erfine 1olis"in# as a %icrosco1ic
layer of ena%el is re%o+ed. 2"e fres"l y 1olis"ed surface t"en
de+elo1s or s"iny #lass li4e texture.
7acobson E Hunt A1&$$B re1orted 30 second a11licat ion of t"e acid
abrasi+e co%1ound usin# a %andrel and #ear reduction "and1iece
on extracted "u%an teet" /"ic" resulted in a ena%el loss of less
t"an 200 %.
15
In 1$$& Gendell re1orted 5 second a11licat ion of HCl acid 1u%ice
%ixture re%o+es 46 % of ena%el /"ic" s"ould be considerabl y
tolerable.
I%1ort ant concern of HCl 1u%i ce abrasion is t"e lo/ +iscosit y
and "i#" concentration of 1$< HCl.
2o eli %inate t"is 1roble% and ensure safety t"e +iscosity of
t"e acidic solution is increased by %ixin# 1$< HCl acid /it" (uart8
1articl es so t"at t"e solution ta4es on a /ater soluble #el li4e for%.
2"is ca%e to be 4no/n as >%odified 1$< HCl acid (uart8 E 1u%ice
abrasion tec"ni(ue3.
>ro)+-*r+:
?in#i+a is 1rotected by a layer of 1etroleu% M elly.
2oot" is isolated /ill rubber da%.
2eet" is dried and t"e 1aste consistin# 1$< HCl acid (uart8 E
1u%i ce 1articl es are a11lied /it" cotton ti1 a11lication to t"e
stained areas of ena%el.
.aste is allo/ed to re%ain for 5 seconds and t"en for 10 seconds
t"e ena%el %i croabrasion is effectuated /it" a cotton s/ab
1ressure.
;fter 10 seconds a %ar4ed de#ree of success is obtained and stain
/as re%o+ed.
;fter 15 seconds0 t"e ena%el of t"e teet" turned to a nor%al
s"ade.
;t t"e end of treat %ent teet" is /as"ed and dried /it" a neutral
sodiu% #el.
In t"is 1rocess t"e (uart8 1articl es con+ert t"e acid into a #el
for% and functions as an additional abrasi+e a#ent.
.atient is re+ie/ed after 6 %ont"s.
A-va!ta/+(:
16
:elati+el y econo%icalJ
*o lab 1rocedures
La(+r(:
2"e action is to sti%ulat e t"e catal yst in t"e c"e%ical. 2"ere is
no t"er%al effect and less de"ydrat ion of ena%el.
;r#on laser of 4$$ n% /a+e=len#t" for 30 seconds to e+aluate t"e
acti+i t y of bleac"in# #el. ;s t"e laser ener#y is a11lied0 t"e #el is
left in 1lace for 3=4 %inutes and t"en re%o+ed. 2"is 1rocedure is
re1eated for 4=6 ti%es.
;not"er 1roduct uses Ion laser tec"nolo#y. ;r#on laser is used as
described before. 2"en C,
2
laser is e%1loyed /it" anot"er
1eroxide solution to 1ro+ide 1enetration of t"e bleac"in# a#ent
into t"e toot" to 1ro+ide bleac"in# belo/ t"e surface.
;r#on laser is in t"e for% of blue li#"t and is absorbed by dar4
colour. It is an ideal instru%ent to be used in toot" /"itenin#
/"en used /it" 50< H
2
,
2
. 2"e affinit y to dar4 colour ensures
t"at t"e yell o/ bro/n colour can be easil y re%o+ed.
C,
2
laser no colour re(uire%ent. It is unrelated to t"e colour of
toot" and ener#y is e%it ted in t"e for% of "eat. It is in+isible and
1enetrates only 0. 1 %% into /ater and H
2
,
2
/"ere it is absorbed.
2"is ener#y can en"ance t"e effect of /"itenin# after t"e
initial ar#on laser 1rocess.
>o7+r 5l+a)hi!/:
2"is is done usin# xenon 1las%a arc curin# li#"t or a laser.
2"is is a li#"t cured resin #el t"at is a11lied on t"e #in#i+a and
areas of t"e teet" t"at you do not /is" to bleac". A:ubber da% is
not re(uiredB
;d+anta#es E It is faster
Disad+anta#es E unli4e rubber da%0 li1s and soft tissues are not
1rotected.
Dio-+ la(+r li/ht:
17
; true laser li#"t 1roduced fro% a solid=state source. It is ultra
fast0 ta4in# 3=5 seconds to acti+ate t"e bleac"in# of a#ent.
2"is ty1e of laser 1roduces no "eat.
Co26li)atio!( o, i!t+r!al 5l+a)hi!/:
1B Cer+ical resor1tion
= H
2
,
2
1ercolates fro% t"e access ca+it y to t"e
root surface t"rou#" t"e acid treated 1atent dentinal tubules.
= 2"is sti%ulates an infla%%at ory res1onse
tendin# to dentin resor1tion.
2B @1illa#e of bleac"in# a#ents
= ,xidisin# a#ents is easy to "andle as a 1aste t"an
a solution.
= Hse rubber da%.
= ;ny s1illa#e is diluted i %%edi atel y /it" co1ious
+olu%e of H
2
,.
3B Failure to bleac"
= Co%%onest is discolouration by %ild ions in
sil+er a%al#a%.
= H
2
,
2
i%1ro1erl y stored or ex1ired.
= In co%1let e re%o+al of co%1osi te or ?IC /"ic"
1re+ents t"e bleac"in# a#ents to 1enetrate into dentinal tubules.
4B 'rittleness of cro/n
= 'leac"in# causes coronal toot" structure to
beco%e brittle0 t"is %ay be caused due to re%o+in# of all
discoloured dentin rat"er t"an usin# t"e bleac"in# a#ent t"e
discolour dentin.
FERENCES:
18
1. C'leac"in# 2eet"D E :onald Fie%an0 :oland ?oldstein0 Da+id
?arber0 Quintessence .ublis"in# Co%1any0 Inc. 0 1&$.
2. History0 safet y and effecti+eness of current bleac"in# tec"ni(ue
and a11lication of t"e ni#"t #uard +ital bleac"in# tec"ni(ue0
Hay/ood )an '. Quintessence International0 1&&2J 23J 41=4$$.
3. Esti %at ion of dissolution of calciu% by old !cInnes solution and
ne/ !cInnes solution0 :.*a#es/ar :ao and *an#rani ). 0 Indian
Endodontic 7ournal0 1&&$J 50=53.
4. C'leac"in# teet"D ne/ %aterials and ne/ role0 :oland ?oldstein0
7;D;0 1&$J 43=52.
5. Historical de+elo1%ent of /"iteners Cclinical safet y and
efficacyD0 Hay/ood )an '. 0 Dental H1date0 1&&0 ;1ril.
6. -aser assisted bleac"in#6 ;n H1date0 7;D;0 1&&$J 12&J 14$4=
14$.
. *on=+ital toot" bleac"in#6 ; t/o=year case re1ort0 ;. 2. Hara0
-. ;. F. .i%enta0 Quintessence International0 1&&&J 30J 4$=54.
19