DEFINITION

Its the lightening of the colour of the tooth

through the application of a chemical agent
to oxidize the organic pigmentation in the tooth.
tooth

WHY BLEACHING??
Aesthetics??
Need??
Fashion??

Etiology of Tooth
Discoloration
INTRINSIC STAINS
1.Pre-eruptive Causes

a. Disease

Congenital erythropoietic porphyria

Congenital hyperbilirubinaemia
Amelogenesis imperfecta
Dentinogenesis imperfecta

b. Medications
Tetracycline staining
Fluorosis

Etiology of Tooth
Discoloration
INTRINSIC STAINS
2. Post-eruptive Causes
Pulpal changes
Dentin hypercalcification
Dental caries
Restorative materials and operative
procedures
Aging
Functional and parafunctional
changes

Etiology of Tooth
Discoloration
EXTRINSIC STAINS
1.DailyAcquiredStains

Plaque
foodandbeverages
tabaccouse
poororalhygiene
swimmerscalculus
gingivalhemorrhage

Etiology of Tooth
Discoloration
EXTRINSIC STAINS
2.Chemicals
Chlorhexidine
Metallic
Occupational exposure to metallic salts
Medicines containing metal salts

Non-Metallic
Dietary changes
Beverages(tea, coffee, cola),
Tobacco products, smokeless tobacco
Mouthrinses, medicaments

Etiology of Tooth
Discoloration
INTERNALIZED STAINS
Developmental Defects
Acquired defects
Tooth wear and gingival

recession
Dental caries
Restorative Materials

PROGNOSIS??
Discolorationduetoaging,inheriteddiscoloration,

smoking,chromogenicmaterials,trauma(evenly
distributeddiscoloration)
EXCELLENTPROGNOSIS

Worksbetterinremovingyellow,orangeandlight

muskybrowncolor
Darkbluegraystaindonotresponseaswell

PROGNOSIS
Brown fluorosis

discoloration

good prognosis, may need

micro-abrasion and at home

bleaching

White spot
not removed, only get lighter

during treatment

PROGNOSIS
Tetracyclin stains
do not typically response well
may need multiple in-office

application, extended take

home application (2 to 6
months) or combination

PROGNOSIS
Unevenpulpsize

unevenresults;smallerpulpslowertolightenordonot

lightenasmuch

Initialcolorrelapse

duetooxygentrappedintoothdiffusesoutoftooth

Longevityofcolorchange

onetothreeyears,individualvariations

Nonresponsiveteeth

extendtreatmenttimeoruseinofficebleachingasa

booster

BLEACHING
ADVANTAGES
Low cost
High success rate
No tooth alternation

BLEACHING
DISADVANTAGES
Unpredictable results
Need Re-treatment
Possible side effects

CONTRAINDICATIONS
Dental caries
Discolored restoration
Restoration showing through

BLEACHING
3 major methods for vital bleaching
In office or power bleaching
At home or tray bleaching
Over the counter bleaching

PROPERTIES OF IDEAL
BLEACHING AGENT
Be easy to apply on the tooth
Have a neutral pH
Lighten the tooth efficiently
Remain in contact with soft tissues for short periods
Be required in minimum quantity to achieve desired

results

PROPERTIES OF IDEAL
BLEACHING AGENT
Not irritate or dehydrate the oral tissues
Not cause damage to the teeth
Be well controlled by the dentist to customize the

treatment to the patients need

CONSTITUENTS OF
BLEACHING GEL
Carbamide peroxide
Hydrogen peroxide
Sodium per-borate
Thickening agent- carbopol or carboxy

polymethylene
Urea

CONSTITUENTS OF
BLEACHING GEL
Surfactant and pigment dispersants
Preservatives
Vehicle- glycerine and dentifrice
Flavors
Fluoride and 3% potassium nitrate

MECHANISM OF
BLEACHING
Degradation of high molecular weight complex

organic molecules
that reflect a specific wavelength of light
that are responsible for color of stain

RATE OF COLOR CHANGE,

AFFECTED BY
Frequency with which, solutions are to be changed
Amount of time
Viscosity of material
Rate of oxygen release
Original shade and condition of the tooth
Location and depth of discoloration
Degradation rate of material

TYPES OF BLEACHING
For Vital teeth
Home bleaching / night guard vital bleaching
In-office bleaching
Thermo-catalytic
Non-thermo-catalytic
Microabrasion

TYPES OF BLEACHING
For Non-Vital teeth
Thermo-catalytic in-office bleaching
Walking bleach /intracoronal bleaching
Inside/outside bleaching
Closed chamber bleaching
Laser Assisted bleaching

HOME BLEACHING / NIGHT

GUARD BLEACHING
INDICATIONS
Mild generalized staining
Age related discoloration
Mild tetracycline staining
Mild fluorosis
Acquired superficial staining
Stains from smoking tobacco
Color changes related to pulpal trauma or

necrosis

HOME BLEACHING / NIGHT

GUARD BLEACHING
CONTRAINDICATIONS
Teeth with insufficient enamel for bleaching
Teeth with deep and surface cracks and fracture

lines
Teeth with inadequate or defective restorations
Discolorations in adolescent patients with large

pulp chamber

HOME BLEACHING / NIGHT

GUARD BLEACHING
CONTRAINDICATIONS
Severe fluorosis and pitting hypoplasia
Teeth with large anterior restorations
Severe tetracycline staining
Teeth exhibiting extreme sensitivity to heat, cold or

sweets
Suspected or confirmed bulimia nervosa

HOME BLEACHING / NIGHT

GUARD BLEACHING
ADVANTAGES
Simple method for patients to use
Simple for dentists to monitor
Less chair time and cost effective
Patient can bleach their teeth at their

convenience

HOME BLEACHING / NIGHT

GUARD BLEACHING
DISADVANTAGES
Patient compliance is mandatory
Color changes is dependent upon amount of time

the trays are worn

Chances of abuse by using excessive amount of

bleach for too many hours per day

HOME BLEACHING / NIGHT

GUARD BLEACHING
TREATMENT REGIMEN
Wearing tray during day time allow replanishment

of the gel after 1-2 hours for maximum

concentration
Overnight use causes decrease in loss of material

due to decreased salivary flow at night and

decreased occlusal pressure.
Patient is recalled 1-2 weeks after wearing the tray

HOME BLEACHING / NIGHT

GUARD BLEACHING
MAINTENANCE after TOOTH BLEACHING
Re-bleaching can be done every 3-4 years if

necessary with re-bleaching duration of 1 week

HOME BLEACHING / NIGHT

GUARD BLEACHING
SIDE EFFECTS
Gingival irritation
Soft tissues irritation
Alter taste sensation
Tooth sensitivity

AT HOME OR TRAY
BLEACHING
10% to 22% carbamide peroxide /

6% to 10% hydrogen peroxide

Typically will attain optimal results in 2-6 weeks
Results are dose/time dependent

IN-OFFICE BLEACHING
30% to 35% hydrogen peroxide
Involve chair time; thus most expensive
Results most predictable
Good for non-compliant or unwilling patients,

also for patients demanding instant results

IN-OFFICE BLEACHING
Thermocatalytic vital tooth bleaching
Equipment needed:
Power bleach material
Tissue protector
Energizing / activating source
Protective clothing and eye wear
Mechanical timer

LIGHT SOURCE USED

FOR IN-OFFICE
BLEACHING
Conventional bleaching light
Tungsten halogen curing light
Xenon plasma arc light
Argon and CO2 lasers
Diode laser light

IN-OFFICE BLEACHING
Indications
Superficial stains
Moderate to mild stains

IN-OFFICE BLEACHING
Contraindications
Tetracycline stains
Extensive restorations
Severe discolorations
Extensive caries
Patient sensitive to bleaching agent

IN-OFFICE BLEACHING
Advantages
Patient preference
Less time than overall time needed for at-home

bleaching
Patient motivation
Protection of soft tissues

IN-OFFICE BLEACHING
Disadvantages
More chair time
More expensive
Unpredictable and deterioration of color is quicker
More frequent and longer appointment
Dehydration of teeth
Serious safety considerations
Not much research to support its use
Discomfort of rubber dam

IN-OFFICE BLEACHING
Procedure
Pumice the teeth to clean off any debris present on the

tooth surface
Isolate the teeth with rubber dam
Saturate the cotton or gauze piece with bleaching
solution ( 30-35% H2O2 ) and place it on the teeth
Depending upon light, expose the tooth / teeth
Change solution in between after every 4 to 5 minutes

IN-OFFICE BLEACHING
Procedure
Remove the solution with the help of wet gauge
Repeat the procedure until desired shade is produced
Remove the solution and irrigate teeth thoroughly with

warm water
Polish teeth and apply neutral sodium fluoride gel
Instruct the patient to avoid coffee, tea, etc. for 2
weeks
Second and third appointment are given after 3-6
weeks. This will allow pulp to settle

NONTHERMOCATALYTIC
BLEACHING
Procedure
Isolate the teeth using rubber dam
Apply bleaching agent on the teeth for five

minutes
Wash the teeth with warm water and reapply the
bleaching agent until the desired color is achieved
Wash the teeth and polish them

MICROABRASION
It is a procedure in which

a microscopic layer of enamel is simultaneously

eroded and abraded
with a special compound
leaving a perfectly intact enamel surface behind.

MICROABRASION
INDICATIONS
Developmental intrinsic stains and discolorations

limited to superficial enamel only

Enamel discolorations as a result of
hypomineralization or hypermineralization
Decalcification lesions from stasis of plaque and from
orthodontic bands
Areas of enamel fluorosis
Multicolored superficail stains and some irregular
surface texture

MICROABRASION
CONTRAINDICATIONS
Age related staining
Deep enamel hypoplastic lesions
Areas of deep enamel and dentin stains
Amelogenesis imperfecta and dentinogenesis

imperfecta cases
Tetracycline staining
Carious lesions underlying regions of
decalcification

MICROABRASION
ADVANTAGES
Minimum discomfort to patient
Can be easily done in less time by operator
Useful in removing superficial stains
The surface of treated tooth is shiny and smooth

in nature

MICROABRASION
DISADVANTAGES
Not effective for deeper stains
Removes enamel layer
Yellow discoloration of teeth has been reported in

some cases after treatment

OVER THE COUNTER

BLEACHING
6% to 14% hydrogen peroxide
Strips, wraps, paint on products
Least expensive
Results least predictable

BLEACHING OF NONVITAL TEETH

Thermocatalytic bleaching technique
Isolation
Placement of bleaching material in the tooth chamber
Heating of bleaching solution
Repeat the procedure till the required color achieves
Wash the tooth and seal the chamber with temporary

restoration
Recall the patient after 1 to 3 weeks
Do the permanent restoration

BLEACHING OF NONVITAL TEETH

Intracoronal / walking bleach
Take the radiograph to assess the quality of

obturation
Evaluate the quality and shade of restoration
Evaluate the tooth color with shade guide
Isolation
Prepare the access cavity, remove the coronal GP
points, expose the dentine and refine the cavity
Place a mechanical barrier of 2mm thick, preferably
of glass ionomer cement / zinc phosphate / IRM /
polycarboxylate cement on root filling material

BLEACHING OF NONVITAL TEETH

MECHANISM OF BLEACHING

Mix the bleaching material and place into the

chamber
After removing the excess material, place
temporary restoration over it.
Recall the patient after 1 2 weeks, and repeat the
procedure, till the desired results achieved
Restore the access cavity after 2 weeks with
composite restoration

BLEACHING OF NONVITAL TEETH

COMPLICATIONS
External root resorption
Chemical burns if using 30 35 % H2O2
Decrease bond strength of composite

BLEACHING OF NONVITAL
TEETH
Precautions to be taken for safer bleaching
Isolate tooth effectively
Protect oral mucosa
Verify adequate endodontic obturation
Use protective barriers
Avoid acid etching
Avoid strong oxidizers
Avoid heat
Recall periodically

BLEACHING OF NONVITAL
TEETH
Inside / outside OR Internal / external bleaching
Assess the obturation by taking radiograph
Isolate the tooth and prepare the access cavity by

removing gutta percha 2-3 mm below the CEJ

Place the mechanical barrier, clean the access

cavity and place a cotton pellet in the chamber to

avoid food packing
Evaluate the shade of the tooth

BLEACHING OF NONVITAL TEETH

A single dark non-vital tooth where the surrounding

teeth are sufficiently light or where other vital teeth are

also to be bleached
Check the fitting of the tray and advise the patient to

remove the cotton pellet before bleaching

Bleaching syringe can be directly placed into the

chamber before seating the tray or extra bleaching

material can be placed into the tray space
corresponding to the tooth with open chamber

BLEACHING OF NONVITAL TEETH

After bleaching, tooth is irrigated with water, cleaned

and again cotton pellet is placed in the empty space

Re-assessment of shade is done after 4-7 days
After achieving the desired shade, access cavity is

sealed, firstly with the temporary restoration, and after

2 weeks with permanent restoration

BLEACHING OF NONVITAL TEETH

Advantages
More surface area for bleach to penetrate
Treatment time in days rather than weeks
Decrease the incidence of cervical resorption
Uses lower concentration of carbamide peroxide

BLEACHING OF NONVITAL TEETH

Disadvantages
Non-compliant patients
Over-bleaching by overzealous application
Chances for cervical resorption is reduced but still

exists

BLEACHING OF NONVITAL Closed

TEETH
chamber bleaching
Instead of removing the existing restoration, the

bleaching paste is applied to the tooth via

bleaching tray

BLEACHING OF NONVITAL TEETH

Indications
In case of totally calcified canals in a traumatized

tissues
As a maintenance bleaching treatment several

years after initial intracoronal bleaching

IN-OFFICE
BLEACHING
(Clinical Protocol)
Clean teeth with

pumice
Record pre-op shade
Isolate teeth as close

to the gingival margin

as possible with rubber
dam (no tears, leakage,
fully inverted)

IN-OFFICE
BLEACHING
(Clinical Protocol)
Mix the thickening

agent with 35%

hydrogen peroxide to a
non-slumping
consistency.

Place the gel material

on the teeth for 30 min

IN-OFFICE
BLEACHING
(Clinical Protocol)
May need to refresh

with hydrogen
peroxide liquid if the
gel appear too dry
Rinse and clean;

remove rubber dam

and record post-op
shade

BLEACHING

(Laboratory Procedure for

Tray)
Trim cast to ideal

thickness for use in

vacuum former
base of cast parallel

to occlusal plane,
and 4-5mm from
gingival margin
(result in good
adaptation of tray
material)

BLEACHING

(Laboratory Procedure for

Tray)

Make tray using

vacuum former

BLEACHING

(Laboratory Procedure for

Tray)
Trim tray using #25

Bard-Parker blade

Smooth edges using

alcohol torch