Treatment of Intrinsic Discolouration in Permanent Anterior Teeth (in children & adolescents) Flashcards
What treatment options are available for intrinsic discolouration?
- enamel microabrasion
- bleaching (vital/non-vital)
- resin infiltration technique (ICON)
- localised composite restoration
- veneers
What pre-op records are required for all discoloured teeth when patients attend GDP?
- standardisation of recording of aesthetic procedures
- clinical photos
- shade [defect tooth & normal tooth]
- sensibility testing (check for sensitivity)
- diagram of defect
- radiographs (if clinically indicated)
- patient assessment
What are the pre-op steps involved in HCL pumice technique for treatment of discolouration?
- PPE & patient wears glasses and bib
- clean teeth with pumice & water (to remove pellicle/plaque)
- petroleum jelly to gingivae & lips
- rubber dam MUST be placed
- place sodium bicarbonate guard behind the teeth to neutralise any misplaced HCL
What percentage of HCL is used in microabrasion? what risk are associated?
18% HCL
- can burn mucosa/skin/eyes
- can bleach clothes if comes in contact
What is the maximum number of rotary applications of HCL in microabrasion?
10 x 5 second applications [no more than this]
What are the operative steps involved in HCL pumice technique for treatment of discolouration?
- HCL pumice slurry in slow rotating rubber cup [ MAX 10 x 5 SEC APPLICATION ]
- wash tooth directly into aspirator every 5 second application
- polish with fine sandpaper disk
- fluoride varnish application [profluorid]
Why are sandpaper discs used after microabrasion?
SEM evidence shows a compacted, relatively prismless layer of surface enamel
- This changes the optical
properties of the enamel so that areas of intrinsic
discolouration become less perceptible.
How many microns of enamel is lost after acid etching?
10 microns
How many microns of enamel is lost after HCL pumice microabrasion?
100 microns
What proprietary kits for microabrasion are available?
- Opalustre (Ultradent)
- Prema Kit 10% HCL
what are the advantages of microabrasion for discolouration?
- easy
- conservative
- inexpensive
- teeth need minimal subsequent maintenance
- fast acting
- removes yellow-brown, white & multicolour stains
- effective
- permanent results
- can use before & after bleaching
What are the disadvantages of microabrasion as a discolouration treatment?
- removes enamel
- HCL acid compounds are caustic
- requires protective apparatus for patient, dentist & dental nurse [PPE]
- prediction of treatment outcome is difficult
- must be done in dental surgery
- cannot be delegated to therapist
When should patients be reviewed after microabrasion?
4-6 weeks after microabrasion & take post-op photographs
What post-op instructions should be given to patients after microabrasion for treatment of discolouration?
warn pt to avoid highly coloured food & drinks for at least 24 hours
What types of vital bleaching are there?
- Chairside bleaching
- Night guard vital bleaching
What bleaching options are available to treat discolouration?
- Vital bleaching
- Non-vital bleaching
What product is used in nightguard vital bleaching?
10% carbamide peroxide gel
What instructions would you give to a patient who is going to do nightguard vital bleaching?
- brush teeth throughly
- apply a little gel to tray
- set over teeth & press down
- remove excess
- rinse gently, do not swallow [can skip this sometimes]
- wear overnight (or for at least 2 hours)
- remove guard, brush tray & rinse with cold water
- keep going for 3-6 weeks until acceptable colour
how does carbamide peroxide break down?
10% carbamide peroxide —> 3% hydrogen peroxide & 7% urea —> water ammonia and CO2
What are the 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 lab assistance
How are teeth selected for non-vital bleaching?
- adequate root filling
- anterior teeth without large restorations
- not amalgam intrinsic discolouration
- not fluorosis or tetracycline discolouration
How is non-vital bleaching carried out? [the clinical steps]
- drill into tooth & remove root filling below gingival margin
- bleaching agent on cotton wool
- over with dry cotton wool
- seal with GIC
- renew bleach within 2 weeks
When do you decide if the ‘walking bleach’ non-vital whitening technique isn’t going to work?
If no change after 3-4 bleach renewals
What are the steps of combination/inside out non-vital bleaching?
- access cavity of tooth open
- custom made mouth guard [cut windows in teeth not being bleached]
- pt applies bleaching agent to back of tooth & tray [10% carbamide peroxide]
- gel changes every 2 hours & worn all the time [except eating]
What are the potential complications of non-vital bleaching?
- external cervical resorption
- spillage of bleaching agents
- failure to bleach
- over bleach
- brittleness of tooth crown
How can external cervical resorption be prevented in non-vital bleaching?
Layer of cement over top of GP
- prevents bleaching agent from getting to external surface of root
What effects can occur from short term exposure of bleaching agents to soft tissues?
- minor ulceration/irritation
- plaque reduction
- aids wound healing
What effects can occur from long term exposure of bleaching agents to soft tissues?
- delayed wound healing
- periodontal harm
- mutagenic potential
What can dentists prescribe after microabrasion or bleaching to help with sensitivity?
tooth mousse
- after bleaching = 2 weeks home application
- after microabrasion = 4 weeks home application
What is resin infiltration, used for discolouration of teeth?
Infiltration of enamel lesions with low-viscosity light-curing resins
- surface layer is eroded first
What are the uses of veneers?
- aesthetics
- relative tooth position
- masking dark stain
- age
- psyche
- plaque removal
