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Dental Tribune Middle East & Africa No. 2, 2017

31 RESTORATIVE Dental Tribune Middle East & Africa Edition | 2/2017 Dental Bleaching By Dr. Roberto Turrini, Italy Managing aesthetic restorations in presence of discolored teeth is a chal- lenge for both the clinical team and clinician, whose aim is to use meth- ods which are as minimally invasive as possible, and materials which al- low the preservation of dental tissue. Should one wish to act on the dis- coloration of either teeth which are to be restored, or on adjacent ones, it becomes essential to take action on dental tissues through bleaching and dental restoration using materi- als which allow various clinical situ- ations to be managed such as those with different tonalities be-tween the teeth: prosthetic materials which thus offer adequate uniformity in their results in those areas where it is necessary to mask the discolora- tion. The use of technology such as bleaching, and ceramic materials si- multaneously can achieve excellent cosmetic results. This article intends to explain how to integrate bleach- ing compared to prosthetic treat- ment, in terms of time, in the vari- ous cases of discoloration, and what factors to consider when choosing the timing. I) Pre-operative bleaching: Can be done on teeth which need to be restored or on those which do not have to undergo any therapeutic treatment, and we may differentiate three possible situations: - If the treatment plan includes the improvement in both arches and the restorative rehabilitation in- volves only a few teeth, then whiten- ing should be done on all the teeth, whether they need restoring or not. In this case restorative rehabilitation will be performed by matching the color obtained by whitening. We can use an in offi ce technique (Pic.1) or an home-bleaching one (Pic. 2) - If the tooth color of those elements which did not need to be restored is not corrected, then perform the bleaching only on those teeth need- ing to be restored being as less in- vasive as possible and using more transparent materials. - If the discolored tooth is instead a treated root canal lacking pin re- construction, perform the bleaching internally and externally. After rehydration of the tooth has occurred, a revaluation of the color should be made. If the result is al- ready satisfactory a more invasive restorative treatment can be avoided (Pic.3,4) Pic 1 Pic 2 Pic 3 Pic 4 Hands-On Training in Dubai Dental Bleaching Tutor: Dr. Roberto Turrini, Italy Date: 06 May 2017 | 10:00 - 18:00 Venue: InterContinental Hotel Festival City, Dubai, UAE Target Audience: Dentists, Dental Hygienists 6 CE Credits Join Hands-On Training 06 May 2017 www.cappmea.com/cadcam DUBAI Materials and methods available on the market can be used to standard- ize the color of one or more teeth. This is a determining factor when testing the ability of teeth to be whit- ened and then resorting to restora- tion which will be done by adapting to the color obtained. This procedure requires a waiting period of 20 days prior to revealing the color of the end product and its adhesive cementation. In fact, it is important that the result is stable before matching the color, because after whitening, tooth rehydration occurs with a slight decrease in value. Adhesive cementation however, should be postponed in order to avoid that the peroxides inhibit the polymerization, therefore a 20 day waiting period must elapse. II) Intra-operative bleaching: It is only used on teeth needing res- toration after performing the pre- liminary preparation of the abut- ment. It should be used to enhance the color of the abutment, and can be either external or internal if the tooth is non-vital. It can be done af- ter the preoperative bleaching or re- place it when the tooth has previous composite restorations that do not allow the bleach to reach the dental tissues. The advantage compared to preop- erative bleaching is that peroxides act on the abutment and not on the outer portion of the tooth which will then be eliminated. The prelimi- nary preparation and the choice of restorative material should be sub- sequently adjusted to the obtained result. Even for this procedure is appropri- ate to wait 20 days before pro-ceed- ing to abutment color recognition and the adhesive cementation. III) Post-operative bleaching: It only acts on non-restored teeth. It serves to even out natural teeth color to that obtained by restoration if we realize there is a color difference after realize there is a color difference after the fi nal cementation. It is carried out using a home tech- nique with the use of personalized masks or an "In-offi ce" technique by applying the whitening gel only on the teeth to be treated. When the procedure is specifi cally sched- uled and restorations are performed solely to enhance, it is essential that the operator knows the potential of the whitening products very well in order to predict the results. To ob- tain a homo-geneous result you can use the whitening technique known as Differential Method Home Care (SDMD), indicating a differential treat-ment time for each individ- ual tooth at home. Post-operative bleach-ing can be also be used to re- treat any lapses in whitening. Biblography 1. Sibilla P, Cogo E, Turrini R, Calura G, Fradeani M. The timing and operational manage- ment of the variables of bleaching in cases of rehabilitation in the aesthet- ic fi eld. Int Jour Est Dent, Autumn 2014, Vol.9, Issue 3, pg. 436. 2. Magne P, Douglas WH. Porcelain veneers: dentin bonding optimiza- tion and biomimetic recovery of the crown. Int J Prosthodont. 1999 Mar- Apr, 12 (2) :111-21 3. Krämer N, Lohbauer U, Franken- berger R. Adhesive luting of indirect Restorations. Am J Dent. 2000 Nov; 13 (Spec No): 60D-76D. 4. Vichi A, Ferrari M, Davidson CL.Infl uence of ceramic and cement thick-ness on the masking of vari- ous types of opaque posts. J Prosthet Dent. 2000 Apr; 83 (4) :412-7. 5. Chang J, Da Silva JD, Sakai M, Kris- tiansen J, Ishikawa-Nagai S.The op-ti- cal effect of composite luting cement on all ceramic crowns. J Dent. 2009 Dec, 37 (12) :937-43. Epub 2009 Aug 4. 6. Dishman MV, Covey DA, Baughan LW. The effects of peroxide bleach- ing on composite to enamel bond strength. Dent Mater. 1994 Jan; 10 (1) :33-6. 7. Amaral C, Jorge A, Veloso K, Erhardt M, Arias V, Rodrigues JA. The ef-fect of in-offi ce bleaching in combina- tion with intracoronal on enamel and dentin bond strength and den- tin morphology. J Contemp Dent Pract. 2008 Jul 1, 9 (5) :17-24. 8. Shinohara MS, AR Peris, JA Rod- rigues, LA Pimenta, Ambrosano GM.The effect of nonvital bleaching on the shear bond strength of com- posite resin using three adhesive sys- tems. J Adhes Dent. Autumn 2004; 6 (3):205-9. 9. Cogo E, Sibilla P, Turrini R. Sbian- camento dentale: metodi per il suc- cesso. Quintessenza Edizioni, Milano, Italia. 10. Spear F, Holloway J. Which all- ceramic system is optimal for ante- rior esthetics? J Am Dent Assoc. 2008 Sep; 139 Suppl: 19S-24S. 11. Chaiyabutr Y, Kois JC, Lebeau D, Nunokawa G. Effect of abutment tooth color, cement color, and ce- ramic thickness on the optical Re- sult-ing color of a CAD / CAM glass- ceramic lithium disilicate-reinforced crown. J Prosthet Dent. 2011 Feb, 105 (2) :83-90. 12. Fabbri G, Mancini R, Marinelli V, Ban G. Anterior discolored teeth re- stored with procera all-ceramic Res- torations: a clinical evaluation of the esthetic outcome based on the thick- ness of the core selected. Eur J Es-thet Dent. 2011 Spring; 6 (1) :76-86. 13. Manicone PF, Rossi Iommetti P, Raffaelli L. An overview of zirconia ce-ramics: basic properties and clini- cal applications. J Dent 2007; 35:819- 826. 14. Vagkopoulou Zirconia in den- tistry: Part 1. Discovering the nature of an upcoming bioceramic. Eur J Es- thet Dent 2009 Sumer; 4 (2): 15. Baratieri LN, Coral Neto AC, Mon- teiro Junior S, Caldeira de Andrada MA, Vieira Cardoso LC. The sandwich technique, an alternative treat-ment for tetracycline-stained teeth: a case report. Quintessence Int 1991; 22 (12) :929-933. 16. Magne M, Magne I, Bazos P Para- nhos MP. The parallel stratifi cation masking technique: an analytical approach to predictably mask discol- ored dental substrate. Eur J Esthet Dent. 2010 Winter; 5 (4) :330-9. several Dr. Roberto Turrini He works in Pesaro offi ces in restorative, dealing endodontics and prosthodontics with particular interest in esthetic dentistry. Author of several scientifi c articles pub- lished in Italian and international maga- zines, he is co-author with Dr. Enrico Cogo and Dr. Pietro Sibilla of a text about den- tal bleaching, published by Quintessence International in 2011 (“Dental bleaching: methods for success”), translated in Ger- man and Spanish and actually in transla- tion into other languages. Course Abstract Nowadays the clinician is faced with the diffi cult challenge of covering discoloration sometimes quite severe. Currently we can use extremely predictable techniques of dental bleaching, allowing sometimes to avoid the covering discolored elements, achieving excellent results in terms of aesthetics and durability. The choice of ex- tremely versatile products, together with the use of appropriate techniques, facilitates the clinician in cases of discoloration of medium severity. In contrast, in more complex situations, which require changes in shape, color and position, it is possible to use high-performance ceramic materials, in order to perform high aesthetic rehabilitations, however using minimally invasive procedures.

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