Treatment Plan & Initial Steps
The treatment plan proposed to the patient consisted of thorough cavity cleaning, followed by a bleaching technique (this recommendation made the patient very curious) and direct restorative dentistry. Periodic maintenance controls and evaluation over time would be made before applying more aggressive treatments, especially when factors such as the age of the patient are considered (Fig 5.)
After isolating the field with rubber dam, cavity cleaning is performed thoroughly, using magnification (Fig 6.)
Margins were detected with a chamfer in the buccal and a butt-joint in the proximal and palatal (Fig 7.)
The transparent silicone index completed previously, allows for a simple buccal stamp of the composite material (Fig 8.)
A limited amount of enamel composite is preserved for the final restorations (Fig 9.)
The use of anatomical posterior matrices will give an adequate proximal anatomy and shape, without overhangs, completed with the dentin chosen during shade taking (Fig 10.)
The temporary composite fillings are thoroughly finished and polished (Fig 11.)
This technique makes endodontic therapy much easier to complete (Fig 12.)
When correct endodontic therapy was carried out, the gutta-percha was located 2mm below the buccal bone ridge. Before commencing a walking bleach technique, a sealer was placed above the gutta-percha in order to avoid external root resorptions due to hydrogen peroxide infiltration by the dentinal tubules complex to the periodontal ligament (Fig 13.)
White Dental Beauty has a range of high quality tooth whitening gels includes 6% hydrogen peroxide and 5% 10% & 16% carbamide peroxide with NOVON, providing great versatility and clinical freedom to whiten patients’ teeth with as little as 30 minutes a day active treatment. Powered by NOVON, which uses an intelligent pH acceleration for maximum whitening effect, speeding up the whitening process whilst still being highly effective.
NOVON is a new, patented whitening compound that comprises hydrogen peroxide, urea and sodium tripolyphosphate and is the active ingredient in a new generation of tooth whitening gels. NOVON has a unique inherent feature in that, on application, it produces a ‘pH jump’ into the alkaline pH range. This ‘pH jump’ enhances the release of perhydroxyl ions which give a faster whitening effect. NOVON – containing gels can therefore produce a similar whitening effect within a shorter timeframe, in comparison to whitening using a regular gel. Alternatively, within the same time frame, a similar level of whitening can be achieved using a lower concentration of NOVON (Hyland et al., 2014). This should be an advantage to patients with sensitive teeth.
NOVON has 4 options for home bleaching:
- 6% Hydrogen Peroxide from as little as 30 minutes a day
- 16% Carbamide Peroxide from as little as 60 minutes a day
- 10% Carbamide Peroxide 2-4 hours overnight
- 5% Mild Carbamide Peroxide 2 hours a day
In this case, after endodontic sealing and depth control (Fig 14.), White Dental Beauty 6% Hydrogen Peroxide was selected Fig 15.).
This product is chosen for its stability and high viscosity characteristics (Fig 16.)
After applying the bleaching gel into the pulp chamber, a temporary material such as reinforced Zinc Oxide was placed to obtain a good seal. The patient leaves with an appointment in a few days (Fig 17.)
The control after 5 days shows the complete disappearance of dischromia and an excellent integration with the previous build-up (Fig 18.)
After the temporary filling material and the remaining bleaching gel have been removed, a thorough cleaning of the coronal portion of the cavity was completed. In order to proceed to the bonding stage using a universal adhesive, a reverse stratification technique was undertaken, filling from the palatal to the buccal with the chosen dentin shade, reproducing the mamelons (Fig 19.)
In the free incisal space, between the mamelons and the incisal halo created during the transparent silicone stage, a blue stain was added in order to enhance the incisal translucency (Fig 20.)
Before closing the restorations palatally with a thin layer of enamel. (Fig 21.)
Finishing and polishing stage is performed using spiral wheels at low speed, leaving the buccal shape created during the transparent silicone index stage intact (Fig 22.)
Review & Check Up
The check-up shows a nice integration and an excellent aesthetic result (Fig 23.)
Similarly, the radiographic exam shows a very nice root canal and coronal filling (Fig 24.)
The patient returned for a check-up appointment showing a completely different smile. We used a very conservative and non-invasive technique that in the near future may be the base of a more complex prosthodontic approach involving partial restorations and ceramics (Fig 25. & 26.)
White Dental Beauty product range (Fig 27.)
The comparison from the initial review to the final results show a dramatic transformation:
White Dental Beauty Gels are specifically formulated, packaged and delivered with your patients in mind, ensuring you have everything you need to offer them a successful whitening treatment.
White Dental Beauty's whitening products are available worldwide from your local distributor including Optident for the UK. To order in the UK visit the White Dental Beauty manufacturer page or call +44 (0) 1943 60 50 50.
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