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cosmetic dentistry_ beauty & science

I 15 special topic _ TouchWhite I cosmeticdentistry 1_2012 lowed by a clinical study of Er:YAG laser-assisted whitening.15 Both studies confirmed the Touch- White method to be safe and highly effective in shortening the activation times of the bleaching gels. Another introductory clinical study conducted at the Kozarac Dental Clinic in 2009 tested an Er:YAG laser-assisted whitening method in which the bleaching gel was illuminated for three se- quences of 20 seconds, with ten-second intervals between each sequence (according to the studies conducted by Fotona and AALZ, this illumination mode can shorten the bleaching time from ten to 15 minutes to 1.5 to two minutes).16 Five patients with 16 intrinsically stained teeth (12 vital and four non-vital) were treated with Fotona tooth- whitening gel (35 % H2O2). One to three treatment sessions were conducted depending on the in- tensity of discolouration. The results of this initial study confirmed that the Er:YAG laser applied in a three-sequence mode canbeusedsafelyandeffectivelyforthebleaching ofdiscolouredvitalandnon-vitalteeth.Sincethen, the TouchWhite procedure has been performed on numerous additional patients. In comparison with diode and Nd:YAG bleach- ing, the Er:YAG laser-assisted whitening method has proven to be more comfortable for patients, while achieving the same or better whitening ef- ficacy in shorter treatment times. As an example, Figure 2 shows before and after photographs for one of the cases. _Proper diagnosis—The key to success As with all medical treatments, the key to suc- cesswithTouchWhiteisproperdiagnosis.Dentists are often asked by patients to provide an expert opinion on the causes of tooth discolouration. Toanswerthisquestionproperlyandtoprovidethe patientwiththebestpossibletreatmentoptions,it isessentialtounderstandtherelationshipbetween tooth development and the various agents that can cause improper and undesirable tooth colour. There are more than 50 different conditions oper- ating locally or systemically that can cause devel- opmental disturbances in tooth formation. Each cosmetic dental practitioner must be able to recommend, based on prior knowledge and ex- perience, which procedure to perform in order to achievethemostdesirableresultsforthepatient— whether through bleaching or prosthetic crowns and veneers. ExperiencewithTouchWhitedemonstratesthat the conditions that can be successfully treated with the procedure are: _intrinsic discolouration in the formative phase (fluorosis—brown or opaque, and tetracycline staining); and _intrinsic discolouration in the post-formative phase (colour due to pulpal necrosis, iatrogenic factors due to root and crown fillings, and dis- colouration due to ageing). For other intrinsic discolourations, whether in the formative or post-formative phase, prosthetic solutions should be considered. _Conclusion The TouchWhite process makes use of the unique properties of the Er:YAG laser wavelength, which is well absorbed by water—the major com- ponent of aqueous bleaching gels—thus elimi- nating the need for special light-absorbing parti- cles in the gel. Since the Er:YAG laser beam is fully absorbed by the bleaching gel, it consequently does not directly heat the patient’s hard tissue or pulp. Furthermore, the laser parameters are adjusted so that the laser fluence of each laser pulse is sig- nificantly below the ablation threshold for dental tissues. Because of these optimal laser charac- teristics and protective parameter settings, the TouchWhite procedure represents the safest, most effective and minimally invasive laser-assisted tooth-whitening method available._ Editorial note: A complete list of references is available fromthepublisher. Dr Jugoslav Jovanoviç is a researcher and lecturer in the field of laser-based oral applications and dentistry.As a member of several international organisations in laser-assisted dentistry,he has published numerous articles and has lectured at domestic and international congresses and workshops.He practises laser dentistry in his privatepracticeinKozarac(BosniaandHerzegovina), where he focuses mainly on endodontics, periodontics,oral surgery and aesthetic dentistry. cosmeticdentistry _about the author