‫بسم هللا الرحمن الرحيم‬

Professor. Abdulwahab I. Al-kholani

 Treatment of Discoloured Teeth (Bleaching)
or Tooth whitening

Professor Abdulwahab Al-kholani

 Lecture contents
Tooth Bleaching - Terminology
Tooth Bleaching - Techniques
Tooth Stains
Extrinsic Tooth Stains
Intrinsic Tooth Stains
Combination
Treatment of Discolored Teeth
Indications and contra indications of bleaching
Microabrasion Technique
Home, Chemical and power bleaching
Sensitivity
Advantages and disadvantages of Bleaching
Internal bleaching stages
Discoloration after Bleaching
Clinical Recommendations
Overall Conclusions

Professor. Abdulwahab I. Al-kholani

Tooth Bleaching or Tooth whitening

Professor. Abdulwahab I. Al-kholani

 Bleaching Techniques

For vital teeth For non vital teeth

Professor. Abdulwahab I. Al-kholani

Tooth Bleaching - Terminology

Internal “Non-vital”
i.e. Root-filled

“Vital”
External i.e. Normal pulp

Professor. Abdulwahab I. Al-kholani

 Bleaching Techniques for (vital) Teeth

Home bleaching Chemical in office Power office bleaching

bleaching

Professor. Abdulwahab I. Al-kholani

Bleaching Techniques for (non vital) Teeth

Internal bleaching

Professor. Abdulwahab I. Al-kholani

 Street bleaching

Professor. Abdulwahab I. Al-kholani

 Street bleaching

Professor. Abdulwahab I. Al-kholani

 Tooth Stains

• Extrinsic  Intrinsic  Extrinsic & Intrinsic

It is essential to determine the cause of

the discolouration prior to treatment

Professor. Abdulwahab I. Al-kholani

 Extrinsic Tooth Discolourations

• Cigarettes, pipes, cigars, chewing

tobacco - yellowish-brown to black

• Marijuana - dark brown to black rings

Professor. Abdulwahab I. Al-kholani

 Extrinsic Tooth Discolourations

• Cigarettes, pipes, cigars, chewing

tobacco - yellowish-brown to black

• Marijuana - dark brown to black rings

• Coffee, tea, foods - brown to black

• Poor oral hygiene - various colours

Professor. Abdulwahab I. Al-kholani

 Extrinsic Tooth Discolourations

• Cigarettes, pipes, cigars, chewing

tobacco - yellowish-brown to black

• Marijuana - dark brown to black rings

• Coffee, tea, foods - brown to black

• Poor oral hygiene - various colours

• Fluorosis - White, yellow, brown,

grey, and/or black

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Genetic conditions
• Amelogenesis imperfecta - brown, black

• Systemic Conditions
• Jaundice - blue-green or brown

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Genetic conditions
• Amelogenesis imperfecta - brown, black
• Systemic Conditions
• Jaundice - blue-green or brown
• Medications during tooth development
• Tetracyclines, fluoride - many colours

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations
• Genetic conditions
• Amelogenesis imperfecta - brown, black
• Systemic Conditions
• Jaundice - blue-green or brown
• Medications during tooth development
• Tetracyclines, fluoride - many colours
• Body by-products
• Bilirubin - blue-green or brown
• Haemoglobin - grey, black

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Pulp changes

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Pulp changes
• Pulp canal obliteration (PCO)
• Increased dentine thickness - yellow

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Pulp changes
• Pulp canal obliteration (PCO)
• Increased dentine thickness - yellow

• Pulp necrosis (PN)

• With haemorrhage - grey, black
• Release of haemoglobin and iron
• e.g. trauma

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Pulp changes
• Pulp canal obliteration (PCO)
• Increased dentine thickness - yellow

• Pulp necrosis (PN)

- With haemorrhage - grey, black
Release of haemoglobin and iron
e.g. trauma
- No haemorrhage - grey-brown
Protein degradation products

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Iatrogenic causes

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Iatrogenic causes
• Trauma during pulp extirpation
• Pulp tissue remnants in pulp chamber

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Iatrogenic causes
• Trauma during pulp extirpation
• Pulp tissue remnants in pulp chamber
• Restorative materials
• Amalgam, composite, gold, pins, etc
• Esp. if marginal breakdown or leakage

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Iatrogenic causes
• Trauma during pulp extirpation
• Pulp tissue remnants in pulp chamber
• Restorative materials
• Amalgam, composite, gold, pins, etc
• Esp. if marginal breakdown or leakage

• Endodontic materials
• Medicaments, sealers, temp. fillings, etc.

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Iatrogenic causes

• Trauma during pulp extirpation

• Pulp tissue remnants in pulp chamber
• Restorative materials
• Amalgam, composite, gold, pins, etc
• Endodontic materials
• Medicaments, sealers, temp. fillings, etc.

Professor. Abdulwahab I. Al-kholani

 Intrinsic Tooth Discolourations

• Iatrogenic causes
• Trauma during pulp extirpation
• Pulp tissue remnants in pulp chamber
• Restorative materials
• Amalgam, composite, gold, pins, etc
• Esp. if marginal breakdown or leakage

• Endodontic materials
• Medicaments, sealers, temp. fillings, etc.

 All usually brown, grey or black

Professor. Abdulwahab I. Al-kholani

 Extrinsic and Intrinsic Discolouration

Professor. Abdulwahab I. Al-kholani

 Extrinsic and Intrinsic Discolouration

• Fluorosis
• White, yellow, brown,
grey, and/or black
• Often with mottled enamel

Professor. Abdulwahab I. Al-kholani

 Extrinsic and Intrinsic Discolouration

• Fluorosis
• White, yellow, brown,
grey, and/or black
• Often with mottled enamel

• Ageing
• Yellow
• Often with added discolouration
effects of tooth wear, cracks,
restorations, illness, etc

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani
 Treatment of Discolored Teeth

Professor. Abdulwahab I. Al-kholani

Treatment of Discolored Teeth

Determine the cause of the discoloration

Professor. Abdulwahab I. Al-kholani

Treatment of Discolored Teeth

Determine the cause of the discoloration

 This will indicate the treatment approach

Professor. Abdulwahab I. Al-kholani

 Treatment of Discolored Teeth

• Intrinsic stains • Extrinsic stains

• Internal Bleaching • Change addictive behaviour / habits

- after RCF • Prophylaxis
• Full mouth cleaning and scalling
• Enamel microabrasion
• Bleaching

Professor. Abdulwahab I. Al-kholani

 Treatment of Discoloured Teeth

Is their an alternative solution to bleaching and whitening ?

Professor. Abdulwahab I. Al-kholani

Treatment of Discoloured Teeth
• Alternatives to bleaching and whitening
• Labial veneer restorations
Porcelain, composite resin

Professor. Abdulwahab I. Al-kholani

Treatment of Discoloured Teeth
• Alternatives to bleaching and whitening
• Labial veneer restorations
• Porcelain, composite resin
• Crowns
• Porcelain, Zircon, composite resin, acrylic

BEFORE AFTER

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
 Micro abrasive Technique

Whiteness RM is a stain remover by microabrasion, which has

in its composition hydrochloric acid at 6% and silicon carbide,
that is extremely hard and sharp, which gives it a greater
effectiveness when compared to other abrasives such as
pumice stone, which is softer and not sharp. Thus, Whiteness
RM can be considered a medium-power product with high
effectiveness, because it combines medium acid content with
high effectiveness of silicon carbide.
Kit
1 syringe with 2g
• 10 applicator tips
• 1 spatula
• Instructions for Use

Professor. Abdulwahab I. Al-kholani

 Micro abrasive Technique
INDICATIONS

Controlled chemical and mechanical removal of enamel stained by fluorosis,

enamel hypoplasia, structural defects that cause pigmentation, or white stains
from inactive caries.

Professor. Abdulwahab I. Al-kholani

Microabrasion

Professor. Abdulwahab I. Al-kholani

 Home Bleaching

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
 Shammah Or khat

Professor. Abdulwahab I. Al-kholani

Home Bleaching

Professor. Abdulwahab I. Al-kholani

Chemical Bleaching

Professor. Abdulwahab I. Al-kholani

Professor. Abdulwahab I. Al-kholani
Professor. Abdulwahab I. Al-kholani
 Sensitivity

Desensitizers

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 Desensitizers

Professor. Abdulwahab I. Al-kholani

 Step by step
Step 1
After prophylaxis, apply the desensitizing gel uniformly on the teeth (use a brush or
Cavibrush micro applicator – FGM) and wait for a minimum of 10 minutes.

Step 2
After the application time, remove the gel from the teeth with cotton and plenty of
water. The patient should avoid swallowing the desensitizer.

Notas
1 – Repeat application of the desensitizer as needed or in the case of dental whitening,
accompanying the time of the treatment. The number of application should not exceed
once a day.
2 – In the case of use for prevention of sensitivity during in-office dental whitening, it is
recommended to apply Desensibilize KF 2% before the application of the whitening gel.

Professor. Abdulwahab I. Al-kholani

 Advantages of Bleaching
• Quick
• Cheap
• Predictable
• Can be re-done
• Conservative procedure (compared to crowning)
• Original crown form or size retained
• No change to the occlusion
• Restores natural colour and translucence
• No effect on the periodontal tissues (if instruction applied properly)

Professor. Abdulwahab I. Al-kholani

 Disadvantages of Bleaching
• Caustic solutions

• Can change the structure of tooth substance

• Not always gives permanent result

• Post operative sensitivity and discoloration in some cases

Professor. Abdulwahab I. Al-kholani

 Discoloration after Bleaching
• Possible reasons (Howell 1981)
• Marginal break down of restoration – marginal gaps
• Bacteria and their by-products
• Food, drinks “Leakage”

Professor. Abdulwahab I. Al-kholani

 Discoloration after Bleaching
• Possible reasons (Howell 1981)
• Marginal break down of restoration

• Bacteria and their by-products

• Food, drinks
• Permeability of tooth
• Saliva or tissue fluid
• Food, Drinks

Professor. Abdulwahab I. Al-kholani

 Bleaching – Stages

Internal bleaching

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages
1. Assess the RCF
 Re-do RCF if any doubt - usually!!!

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages
1. Assess the RCF
 Re-do RCF if any doubt - usually!!!

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages
• Assess and ? re-do the RCF
• Remove RCF to below C-EJ

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages
• Assess and ? re-do the RCF
• Remove RCF to below C-EJ
• Base over RCF – Barrier

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages
• Assess and ? re-do the RCF
• Remove RCF to below C-EJ
• Base over RCF – Barrier
• Rubber Dam; Access

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages
• Assess and ? re-do the RCF
• Remove RCF to below C-EJ
• Base over RCF – Barrier
• Rubber Dam; Access
• Acid etch, wash & dry

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages
• Assess and ? re-do the RCF
• Remove RCF to below C-EJ
• Base over RCF – Barrier
• Rubber Dam; Access
• Acid etch, wash & dry
• Place thick paste of H2O2/Na Perborate

Professor. Abdulwahab I. Al-kholani

Mix Sodium Perborate with 18% Hydrogen
peroxide on a glass slab.

Professor Abdulwahab Al-kholani

 Make sure you mix enough Sodium perborate powder with 18% H2O2 liquid to get a mushy consistency

Professor Abdulwahab Al-kholani

 Condense the mixture into the tooth chamber, and allow
~3 mm space from the orafice.

Professor Abdulwahab Al-kholani

 Bleaching - Stages
• Assess and ? re-do the RCF
• Remove RCF to below C-EJ
• Base over RCF – Barrier
• Rubber Dam; Access
• Acid etch, wash & dry
• Place thick paste of H2O2/Na Perborate
• Temporary filling

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages

RCF

Barrier
(GIC)

Bleaching
paste

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages
• Assess and ? re-do the RCF
• Remove RCF to below C-EJ
• Base over RCF –Barrier
• Rubber Dam; Access
• Acid etch, wash & dry
• Place thick paste of H2O2/Na Perborate
• Temporary filling - Cavit
• Review after 1 week
• Repeat if necessary
• Restore access cavity
 Temporary for minimum 2 weeks
 Then do GIC/composite

Professor. Abdulwahab I. Al-kholani

 Final Restoration of Access Cavity
• “Sandwich technique”

 GIC - dentine replacement

 Composite resin - enamel replacement

• Benefits:
• Reduce “microleakage”
• Maintain colour
• “Strengthen” tooth

Professor. Abdulwahab I. Al-kholani

 Bleaching - Stages
• Assess and ? re-do the RCF
• Remove RCF to below C-EJ
• Base over RCF - Cavit
• Rubber Dam; Access
• Acid etch, wash & dry
• Place thick paste of H2O2/Na Perborate
• Temporary filling - Cavit
• Review after 1 week
• Repeat if necessary
• Restore access cavity
• Review - 6 mths, 2-3 yrs, etc

Professor. Abdulwahab I. Al-kholani

 Before

Final result

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Before Final result

Professor. Abdulwahab I. Al-kholani

 Tooth Bleaching - Terminology

Power office bleaching

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Power or office
bleaching

Professor. Abdulwahab I. Al-kholani

 Clinical Recommendations

• After internal bleaching: • After power bleaching:

• Delay the final restorations for
at least 14 days • Advice patient to stop khat
chewing and smoking and
minimize cola, tea and
coffee intake for 2-3 weeks.

Professor. Abdulwahab I. Al-kholani

 Thank you

Professor. Abdulwahab I. Al-kholani