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ePaper created 2016-01-08, 09:25:11 | version 1.38.0
case report I ing teeth bleaching, we should be notified so the treatment could be paused or stopped. Periodontal therapy has been performed in the Department of Periodontology. Before starting with the teeth bleaching, it was checked that the teeth were free of plaque, calculus and extrinsic staining (Fig. 10). In order to prevent unwanted proteins and enzymes of saliva’s biofilm to interfere with the bleaching agent, mild cleaning of the teeth to be bleached was performed, with the application of a prophylaxispaste.InthePost-graduateDentalClinic oftheDepartmentofOperativeDentistryattheAris- totle University of Thessaloniki, we operate an Er,Cr:YSGG laser (2,780nm, Waterlase MD, Biolase, USA) and a yellow-colored bleaching agent used for in-office bleaching with a concentration of 38% H2O2 (Power whitening, WHITEsmile GmbH, Ger- many). The tip used is a 6mm long Z-type glass tip (MZ8) of an 800µm diameter, used with the gold handpiece of the laser system. The power settings that we have used were: output power 1.25W, pulse duration 700µsec (S-mode), while the pulse repeti- tion rate was set to 10 Hz. The dentist, the dental assistant and also the pa- tientevaluatedinitialtoothcolor.Inourcase,thepa- tient’s initial color was evaluated as A3 in the VITA Classical Shade Guide. Both the patient and the per- sonnel in the laser working area must wear safety gogglesinadvance.Lipprotectioncreamwasapplied and the working area was isolated with a cheek and lipretractor.Afterdryingteethandgumswithgentle air stream, a liquid gingival barrier was carefully ap- plied both on upper and lower teeth and was poly- merised with a fanning motion for 40 seconds. Thebleachingagentwasappliedina1-2mmthick layeroneachtooth,exceptfrom#22,duetothePFM crown.Withthepowersettingsmentionedabovewe activatedthebleachingagentfortwointervalsoften seconds on each tooth (Fig. 13), keeping the laser handpiece on a 2.5cm distance from the teeth. After theprocedure,theactivatedbleachingagentwasleft for 15 minutes and then carefully removed with high-power dry suction from the teeth. This proce- dure was repeated twice at the same appointment. Upper and lower arch were bleached in separate ap- pointments. Upper teeth’s bleaching was performed at the same appointment with the gingivectomy of thelowerarch,therebypointingouttheadvantageof theuseoflaser,intermsofabsenceofpainandbleed- ing. No soft tissue irritation was noticed, nor did the patient report feeling pain or soreness. Final color evaluationtookplacefromthedentist,thedentalas- sistantandthepatient.Tworepetitionsoftheprocess atthesameappointmentwereadequatetomovethe color of the teeth to B1 according to VITA Classical Shade Guide (Fig. 14). The patient was satisfied with the color of her teeth and the next appointment was arranged in order to close the diastemas. _Diastema Closure Diastema closure was scheduled after two weeks in order to achieve high-quality bond strength be- tween the enamel and the composite resin (Ittipu- riphatandLeevailoj2013).2 Castswerestudiedpriorto Fig. 13_Laser-assisted bleaching of the upper teeth. Note that tooth #22 has a PFM crown. Fig. 14_Immediate colour evaluation after bleaching. Fig. 15_Evaluation of gold proportions in casts prior to diastemas closure. Fig. 16_Preparation of Class V cavity on tooth #13. I 17laser4_2015 Fig. 15a Fig. 16Fig. 15b Fig. 13 Fig. 14