intrinsic discolouration Flashcards
Tx of intrinsic discolouration
- enamel micro abrasion
- bleaching - vital/ non vital
- ICON
- localised composite
-veneers
what pre-op records needed for discoloured teeth
- standardisation of recording of aesthetic procedures
- clinical photos
- shade
- sensibility testing , check for sensitivity
- diagram of defect
- radiograph if clinically indicated
- patient assessment eg VAS etc
what is micro abrasion
enamel color modification by the controlled hydrochloric acid pumice microabrasion technique
technique for micro abrasion
HCL
- dam placed
-petrolum jelly on gingivae
- sodium bicarbonate behind teeth
- 10x5 secs of HCL slurry (100 micron)
- polish with sandpaper disc and toothpaste
why are sandpaper discs used in enamel micro abrasion
This changes the optical properties of the enamel so that areas of intrinsic discolouration become less perceptible.
some reasons to give micro abrasion
- fluorosis
-decalcification from ortho
-trauma
-hypomineralisation
advantages of microabrasion
Conservative
Inexpensive
Teeth need minimal subsequent maintainence
Fast acting
Removes yellow-brown, white an multi-coloured stains
Effective
Results are permanent
Can use before or after bleaching
disadvantages of microbrasion
Removes enamel
HCl acid compounds are caustic
Requires protective apparatus for patient, dentist and dental nurse
Prediction of treatment outcome is difficult
Must be done in dental surgery
Cannot be delegated
when to review of micro abrasion
-4-6 weeks post op
- warn patient to not eat highly coloured food right after
when can you provide bleach for under 18s
- ‘Products containing or releasing between 0.1% and 6% hydrogen peroxide cannot be used on any person under 18 years of age except where such use is intended wholly for the purpose of treating or preventing disease.’ GDC 2014
- So this includes discolouration due to hypomineralisation, trauma, fluorosis etc etc
what types of bleaching exist
vital bleaching
- chair side
-nightguard
non-vital
- inside outside technique
-walking bleach
what is the conc used for nightguard vital bleaching
10% carbamide peroxide gel
which breaks down into 3% hydrogen peroxide and 7% urea
instructions to patient who is night guard bleaching
- Brush teeth thouroughly
- Apply a little gel to tray
- Set over teeth and press down
- Remove excess
- Rinse gently, do not swallow
- Wear overnight (or for at least 2 hours)
- Remove brush try with brush and rinse with cold water
advantages of non vital bleaching
- Simple
- Tooth conserving
- Original tooth morphology
- Gingival tissues not irritated by restoration
- Adolescent gingival level not a restorative consideration
- No laboratory assistance for ‘walking bleach’
tooth selection for non vital bleaching
- Adequate root filling
- no clinical disease
- no radiological disease
- Anterior teeth without large restorations
- Not amalgam intrinsic discolouration
- Not fluorosis or tetracycline discolouration
what is walking bleaching
oxidising process which proceeds gradually over days, bleach sealed in
- Renew bleach – ideally no more than 2 weeks between appointments
- If no change after 3-4 renewals stop
- 6-10 changes total
- Regression 50% at 2-6 years
what is inside out bleaching
10% carbamide peroxide gel, can seal in if co-op an issue
access cavity open
custom mouthguard , place bleach in back of tooth and tray
worn all time except eating and cleaning
how to restore pulp chamber after bleaching
-non setting CaOH first
- then composite resin so facility to re bleach
how to prevent ECR
- layer of cement over GP
- non setting CaOH in tooth
complications of bleaching
- External cervical resorption
- Spillage of bleaching agents
- Failure to bleach
- Over bleach
- Brittleness of tooth crown
tooth mouse role after bleaching
- CPPACP
- 2 weeks after bleaching
what is resin infiltration
- infiltration of enamel lesions with low viscosity light curing resins
- surface layer is eroded, lesions desiccated and a resin infiltrant is applied.
- Resin penetrates lesion driven by capillary forces
- Infiltrated lesions lose their discoloured appearance and look similar to sound enamel.
