Treatment of discolouration

Question 1

What pre operative records would you take for intrinsic discolouratoin?

Answer 1

• clinical photos
• shade
• sensibility testing
• diagram of defect
• radiographs if clinically indicated
• patient assessment

Question 2

What is enamel microabrasion?

Answer 2

removal of surface layer of opaque enamel

Question 3

How do you perform it?

Answer 3

PPE
Clean teeth with pumice and water
Soft tissue protection with Petrolium jelly
Rubber dam
sodium bicarbonate gaurd (prophy)

Question 4

how much does it take from enamel?

Answer 4

5-10 micron - prophy with toothpaste
5-50 micron - prophy with pumice
Use 10% HCL

Question 5

What are the disadvantages of microabrasion?

Answer 5

• Removal of enamel may cause hypersensitivity
• Requires protection of soft tissue as HCL is a corrosive substance
• Done only in dental surgery

Question 6

What are the advantages of enamel microabrasion?

Answer 6

• Easily performed
• conservative
• inexpensive
• fast acting
• remove stains
• results are permanent
• can be used before or after bleaching

Question 7

What instructions to give patient after microabrasion

Answer 7

• avoid highly coloured foods and drinks for at least 24h
• review 4-6 weeks later and take post operative radiographs

Question 8

What are the two types of bleaching?

Answer 8

• vital and non vital

Question 9

how is vital bleaching carried out ?

Answer 9

chair side - powder bleaching
or night guard vital bleaching at home

Question 10

What techniques are used in non vital bleaching?

Answer 10

• inside outside technique
• walking bleach technique

Question 11

Describe outside and inside technique?

Answer 11

• access cavity of tooth open
• custom made mouthgaurd (cut out teeth you do not want to bleach)
• patient applies bleaching agent to back of tooth and tray
• Patient keeps access cavity clean
• Replace gel every 2 hours
• wear at all times except when eating and cleaning

Question 12

What bleaching agent is used in non vital bleaching?

Answer 12

10% carbamide peroxide

Question 13

What is walking bleach technique

Answer 13

Rebber dam and vaseline
- access cavity open
- bleaching agent applied
- temporary dressing applied
- next appointment bleach renewed

Question 14

when to renew bleach for walking bleach technique?

Answer 14

• ideally no more than 2 weeks between appointments
• if no change after 3-4 renewals stop
• 6-10 changes in total
  chances of regression is 50% at 2-6 years

Question 15

What are the advantages of bleaching?

Answer 15

• simple
• tooth conserving
• original tooth morphology
• gingival tissues not irritated
• no lab assistance for walking bleach

Question 16

What agents are used in walking bleach technique?

Answer 16

30% hydrogen peroxide and sodium perborate

Question 17

What are the potential complications of non vital bleaching?

Answer 17

• external cervical resorption
• spillage of bleaching agents
• failure to bleach
• over bleaching
• brittleness of tooth

Question 18

What is resin infiltration?

Answer 18

• infiltration of enamel lesion with low viscosity light curing resins
• Surface layer is eroded, and resin is applied
• resin penetrated lesion by capillary forces
• this changes lesions colour and makes it closer to enamel.

Question 19

How to do resin infiltration?

Answer 19

Apply ICON etch then ICON dry and check and repeat until final result.

Question 20

What might be the effect of bleach on soft tissues for short term?

Answer 20

• minor ulceration and irritation
• palque reduction
• aids wound healing

Question 21

Effects of bleach on soft tissues for long term?

Answer 21

• delayed wound healing
• periodontal harm
• mutagenic potential

Question 22

What tooth mousse is advised to use after micro-abrasion and bleaching?

Answer 22

• recaldennt CPP-ACP mild derived protein
• 2 weeks after microabrasion
• 4 weeks after bleaching
  (pea size at night before bed )