Management of Discoloured Incisors Flashcards
Management options for discoloured incisors
Enamel micro abrasion
Bleaching - vital/non vital
Resin infiltration - ICON
Veneers - direct/indirec
Comp resto
What is micro abrasion
Removing the stained surface layer of enamel
Advantages of microabrasion
easy
cheap
fast acting
permanent results
removes yellow/brown/white stains
minimal maintenance
Disadvantages of microabrasion
Removes enamel - sensitivity/susceptible to staining
HCL acid caustic
Requires protective apparatus for patient
Must be done in a dental surgery
Cant be delegated
Tx outcome unpredictable
Microabrasion clinical steps
PPE
Clean tooth with pumice and water
ST protection vaseline
Rubber dam + wedjets
Sodium bicarbonate guard for gingival protection
HCL pumice slurry in slowly rotating cup for 10s
Max 10x5s applications
Wash directly into aspirator after every 5s application
FV application - not duraphat
Polish with sandpaper disc (masks areas of discolouration)
Polish with toothpaste
Review in 4-6wks (take preop+post op pics
Warnings to give pt about microabrasion+ review period
Teeth become dehydrated after procedure
Avoid highly coloured food/drinks for least 24hrs
Review pt 4-6wks after and take postop pics
Indications for microabrasion
Fluorosis
Decalcification from ortho
White spots from trauma to primary incisors damaging the developing tooth germ
Enamel defect bleaching indications
Amelogenesis imperfecta
What are the different types of bleaching
EXTERNAL VITAL
- chair side 75% carbamide peroxide
- nightguard 10% carbamide peroxide
INTERNAL NON VITAL
- inside out
- walking bleach
Nightguard vital bleaching applicationinstructions for pt
Brush teeth
Apply gel over tray
Set over teeth and press down
Remove excess
Rinse gently do not swallow
Wear overnight or for at least 2hrs
Remove trays in morning, brush with TP + rinse with cold water
Approx 3-6wks, keep going until happy
Side effects of bleaching
Sensitivity
Gingival irritation
Non vital complications of bleaching
Failure of bleach
overbleach
brittleness of crown
bleach spillage
external cervical resorption
What kind of staining would be a contraindication for non vital bleaching?
AM intrinsic colour discolouration
Fluorosis/tetracycline staining
How is external cervical resorption prevented?
NSCAOH layer over GP reverses acidity placed for 2wks
Walking bleach steps
Oxidising process allowed to develop over days
Insufficient GP removed below CEJ
Clean with US
10% carbamide peroxide on cotton pledget placed
Cover with dry cotton cool
Seal in with GI
Restore pulp chamber with nscaoh for 2 wks then GIC
