Light-Activated Heated Bleach Technique By: Steven P. Weinberg, DMD

Over the past 15 to 20 years, vital tooth bleaching has become an important and viable esthetic dental service. It has now become one of the most requested esthetic procedures by adult patients. Because vital tooth bleaching has proven to be a safe dental treatment, patients can expect a dental visit that will predictably improve the appearance of their teeth with minimal or no discomfort.

How to Provide Realistic Expectations for Each Patient
It’s important to take the before shade and point out their whitening potentials. The whitening potential is determined by the number of shades to achieve B1 (on the Vita Value shade guide) or B59 (on the Bioform shade guide). Here are the Vita® Value and Bioform® shade guide arrangements:

Vita Value Shade Guide:
B1, A1, B2, D2, A2, C1, C2, D4, A3, D3, B3, A3.5, B4, C3, A4, C4

Bioform Shade Guide:
B59, B51, B91, B62, B66, B52, B53, B92, B63. B54, B65, B93, B55, B69, B94, B95, B67, B56, B77, B81, B96, B83, B84, B85

Figure 1

Figure 2

For example, if the patient starts at A2 (Figure 1), there are only four shades to go to a B1 according to the Vita Value shade guide arrangement. After bleaching, shades improved to B1 (Figure 2). There were 4 shades of whitening and the patient achieved a 100% potential. Had the patient started at A2 and improved to A1 (instead of B1), they would have achieved 75% (3 out of 4 possible shades) of the potential bleaching. Helping a patient with their whitening potential makes it easier to meet the patient’s whitening expectations.

Technique
There are a variety of home bleaching systems available today. These involve the patient wearing a tray containing some percentage of either carbamide or hydrogen peroxide for several hours each day. This form of bleaching takes longer to be effective and is dependent on patient compliance. The light-activated chairside bleaching systems are a recent enhancement of tooth whitening. An activator light is shined on the teeth to enhance and accelerate the bleaching results. This can achieve similar results to tray bleaching in only one dental visit.

In this case, I used the Rembrandt® One-Hour Whitening Program because of its excellent clinical performance and the dual function of the Sapphire® Light (bleaching and fast-curing) provides maximum whitening and greater profitability. The Sapphire PAC light activates the Rembrandt Lightning Plus Gel, which contains 35% hydrogen peroxide, and 100% of the whitening potential was achieved. These excellent clinical results are being experienced by the thousands of dentists across the country utilizing the Rembrandt Smile Program.

The heated bleach procedure is as follows:

1. Preheat water in an electric water heater to 140-145 degrees F.

2. Submerge the syringe of the Rembrandt Lightning Gel Plus into the heated water for approximately 3-5 minutes.

3. Take a “before” shade with a Vita or Bioform shade tab and document with a photograph.

4. Prophy the teeth with a prophy cup and the Rembrandt Polishing Paste (contained in the bleach kit).

5. Insert the correct size lip and cheek retractor, cotton rolls and a saliva ejector.

6. Dry teeth and gingiva. Apply the Paint-on Dental Dam (supplied in the bleach kit) to surrounding gingival tissue. Apply the dam material the width of 2 teeth at a time and cure for 1-2 seconds using a curing tip on the Sapphire Light.

7. Dip a 2” x 2” gauze square in the preheated water and unfold it into a 2” x 4” rectangle.

8. Apply this heated wet gauze to the teeth, half over the facial surfaces and half over the palatal.

9 Repeat step #8 once again with a second heated wet gauze.

10. Remove wet gauze and apply a moderate amount of the heated bleach gel to each facial surface.

11. Use a disposable brush to evenly spread the gel over each tooth. The gel should be approximately 1-1/2mm thick.

12. Remove the curing tip from the Sapphire Light handle and insert the Whitening Crystal.

13. Attach the curing handle to the adjustable arm and stand.

14. Position crystal directly in front of the teeth, no more than 1/4-1/2 inch away.

15. Set the Sapphire Light to the bleaching mode (option 2) and turn light on. The light will sound 3 beeps every 15 minutes.

16. After each 15-minute cycle, turn off the light and re-activate the bleach. This consists of dipping a brush in the 145- degree water and agitating it into the bleach gel already on the teeth around the arch. This rehydrates the gel. I also apply a small amount of fresh warmed bleach gel around the arch at this time.

17. A total of four 15-minute cycles is recommended.

18. When all cycles are completed, remove the bulk of the gel, manually, using moist gauze squares. Complete the gel removal with an air/water wash and suction.

19. Remove the Paint-on Dental Dam with college pliers.

20. Polish the teeth with Rembrandt Polishing Toothpaste.

21. Document the new, lighter shade with a shade tab. Take a final photograph.

Figures 1 and 2 show before and after photos of results typically obtained with this technique.

With this light-activated heated bleach procedure, I have never had a patient who has complained of sensitivity during the treatment. Approximately 20% of my patients report a mild to moderate “ache” in their teeth about 3-4 hours after chairside bleaching. I suggest that they take 600mg of ibuprofen if they encounter any discomfort. In almost every case the ibuprofen completely eliminated their discomfort. No repeat dose of medication was needed. Thus, with light-activated heated bleaching, the dentist can provide dramatic bleaching in one hour. As with most dental procedures, patients who request tooth whitening should be given several treatment alternatives. From experience, it is known that bleaching will not correct all dark and discolored teeth. With this chairside bleaching technique, however, very effective results can be obtained even on challenging cases like tetracycline and fluorosis discolorations. It is a high-quality conservative procedure that produces excellent results for the majority of dental patients.

Den-Mat Rembrandt Sapphire PAC Light

For more information on the light activated heated bleach technique contact the Den-Mat Corp. at 1-800-445-0345 or visit them online at www.denmat.com.

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Dr. Weinberg is a clinical assistant professor in the Department of Restorative Dentistry at the University of Pennsylvania School of Dental Medicine. He’s also on the faculties of four other schools for their post-graduate esthetic programs. Dr. Weinberg opened a successful esthetic restorative private practice in 1978, and has been lecturing and teaching hands-on programs nationally and internationally for more than 18 years.

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References:
Weinberg SP, Reingold AL, Heated Bleaching: A Safe and Rewarding Method. Dentistry Today. April 1997

Zaragosa VMT, Bleaching of vital teeth: technique. Estomodeo. 1884, 9:7-30.

Abbot CH. Bleaching discolored teeth by means of 30% perhydrol and electric light rays. J. Allied dent Soc. 1918; 13:259.