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Medical Forum / General / Dentistry / May 2004

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Bleaching

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Jeffrey Krantz - 25 May 2004 00:52 GMT
Technique question for all of you experts.
I have done tray bleaching, ZOOM bleaching, and ULTRADENT 35% bleaching on
my patients and am never satisfied with the results. They really dont seem
to get particularly white.
I am taking about two hours of chairtime for the ZOOM bleaching, doing it
right by the instruction manual, I know that the material is working because
the Marginal gingiva which is not covered perfectly bleaches, but the damn
teeth dont seem to change color.
Anyone have any thoughts, any suggestions [other than laminates and
bonding]. I am talking about reasonably virgin anterior teeth, starting at a
shade a3.5 or a.3
W_B - 25 May 2004 17:56 GMT
>Technique question for all of you experts.
>I have done tray bleaching, ZOOM bleaching, and ULTRADENT 35% bleaching on
[quoted text clipped - 3 lines]
>right by the instruction manual, I know that the material is working because
>the Marginal gingiva which is not covered perfectly bleaches,

Cover the gingiva with Liquidam.
Two hours is about right, think the fastest
it could be done would be 1.5 hrs

>but the damn
>teeth dont seem to change color.

Before and after pictures with a shade tab present
will show the change.
Changes are less evident in tetracycline stain cases.

>Anyone have any thoughts, any suggestions [other than laminates and
>bonding]. I am talking about reasonably virgin anterior teeth, starting at a
>shade a3.5 or a.3

Try using some prophy paste or fine pumice to remove the pellicle before
Zoom!
--

W_B

Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
Jochen Kulow - 27 May 2004 16:18 GMT
> Technique question for all of you experts.
> I have done tray bleaching, ZOOM bleaching, and ULTRADENT 35% bleaching on
[quoted text clipped - 7 lines]
> bonding]. I am talking about reasonably virgin anterior teeth, starting at a
> shade a3.5 or a.3

Hi,
I used Tray-Bleaching for Hoem use with 3,5% for 2 Weeks. Tooth shade
improved from 4 to about 1,5. So I am stified with that.

Chair side Bleaching is working, I tried it once wit opalescence 38%.
But I think its working differently. The color changed from a yellow to
grey but it did not get brighter. I noticed the whitening through ruber
dam and drying, but this effect of course was gone the next day.

I also read some papers on bleaching. They stated that bleaching is only
possible to a certain point. More bleaching will not improve the results.

So overbleaching is not possible.

I also want to mention that high-% does couse more pain  then low-%.

In Germany chair side bleaching is way too expensive. So patients tend
to use the tray bleaching for home use.

I charged 350EURo. what are costs in other nations?

bye,

jochen
Paul - 27 May 2004 17:09 GMT
350.00 US here

> > Technique question for all of you experts.
> > I have done tray bleaching, ZOOM bleaching, and ULTRADENT 35% bleaching on
[quoted text clipped - 32 lines]
>
> jochen
W_B - 27 May 2004 17:12 GMT
>350.00 US here

$400 at home only.

$600 Zoom! (includes home trays)
--

W_B

Take out the G'RBAGE
wubbabubbazG@RBAGEyahoo.com
StovePipe - 28 May 2004 05:14 GMT
> > Technique question for all of you experts.
> > I have done tray bleaching, ZOOM bleaching, and ULTRADENT 35% bleaching on
[quoted text clipped - 10 lines]
> Hi,
> I used Tray-Bleaching for Hoem use with 3,5% for 2 Weeks. Tooth shade
I also want to mention that high-% does couse more pain  then low-%.

> In Germany chair side bleaching is way too expensive. So patients tend
> to use the tray bleaching for home use.
>
> I charged 350EURo. what are costs in other nations?

In Eastern Canada (Quebec) it varies from abouth 300$ CDN to 600$ CDN.
I'm on the 300$ end, and I also use lower dose home bleaching materials,
and we modify the models so that there is a seal at the gum line,
keeping the stuff on the teeth, not the gums. I also advocate night
bleaching (all night long)
Choos
SP

Signature

To reply: take out the TRASH...

Jochen Kulow - 28 May 2004 16:16 GMT
> In Eastern Canada (Quebec) it varies from abouth 300$ CDN to 600$ CDN.
> I'm on the 300$ end, and I also use lower dose home bleaching materials,
[quoted text clipped - 3 lines]
> Choos
> SP

How about sensitivities with night bleaching?
What % of hydrogen peroxide or carabmid peroxide?

I also used a test set. but I think the effect lowers by time when the
hydrogen peroxide is used up. I felt it after 30 minutes.

How do you seal the gum line?

Thanks,

Jochen
StovePipe - 29 May 2004 04:02 GMT
> > In Eastern Canada (Quebec) it varies from abouth 300$ CDN to 600$ CDN.
> > I'm on the 300$ end, and I also use lower dose home bleaching materials,
[quoted text clipped - 11 lines]
>
> How do you seal the gum line?

I like to use no more than 11% Carbamide Peroxide. I don't remember how
much H2O2 this ends up being... We still have a few kits made by
American Dental Hygienics, and I like them because the stuff is very
viscous. I don't know if that company is still in buisness.

How to make a locking tray:

You take good and accurate impressions of the teeth and gums. Pour them
up in a hard stone, not plaster. Then, you take a 1/2 size round bur on
the high-speed drill and trace around the buccal gum line making a score
exactly where the gum line is. This 'trough' should be at least the same
depth as the diameter of the bur. Next, you take a extra-fine red
permanent felt tipped marker (Ex: Stadtler) and trace in this trough,
all the way around the buccal, to make it visible. Now, take a
laboratory composite and paint a composite bubble onto the middle 1/2 of
each tooth surface that you want to bleach. This bubble will create a
reservoir of material in the tray. Ignore the molars.

Now, put this on the vaccuform and pull down a tray acetate or send the
model to your lab to have them make the tray.  Carefully liberate the
tray by cutting the excess away from beneath the trough area. (Don't cut
away the trough area; leave it in the tray.) Now look closely  at the
internal side of the tray: you'll see an indented line that traces the
gum line all around on the buccal side. If you don't see that
indentation, do another acetate, and this time, heat it up some more to
make it really hot and soft. The idea is that the hot acetate must mold
into that trough. NOW, LET IT COOL COMPLETELY. Now, put on your
magnifying glasses and carefully cut the excess tray material away,
leaving about a one millimeter extension outside the trough. This
trough/indentation is what seals the material into the pocket and keeps
it on the tooth surface, not allowing it to leak onto the gums.
Therefore, don't cut it away when you trim the excess material away from
the tray. Pull the excess acetate material DOWNWARDS and not outwards.

Use a viscous bleaching material to keep leaking to a minimum.

Re, sensitivity: Have your hygienist do a NEUTRAL fluoride treatment for
a couple of minutes. DON'T use acidulated fluoride. If sensitivity
persists, apply Duraflour or other paste type fluoride balm.

????? But, really, Jochen, I'm confused: Aren't you a HealOzone user? I
was told that the HealOzone can relieve sensitivities in teeth after
only a few second's exposure. Is this not true?

Further, I was also told that the HealOzone can bleach teeth after a few
more seconds' worth of exposure. In fact, they said that you can bleach
and soothe sensitive teeth all at the same time.

Again, I'm interested in knowing whether this is true or not.
Choos
SP
Signature

To reply: take out the TRASH...

Jochen Kulow - 29 May 2004 22:12 GMT
> ????? But, really, Jochen, I'm confused: Aren't you a HealOzone user? I
> was told that the HealOzone can relieve sensitivities in teeth after
[quoted text clipped - 7 lines]
> Choos
> SP

Thanks SP for your indepth explanations.

To the Healozone. In Germany there was no hint on bleaching.
The sensitivities was stated but due to the costs this cant be sold.
Normal desensitizer is payed by public insurance Healozone is privately
billed.

But I have to try that. I will tell you the results when I know them.

Jochen
 
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