Vital Bleaching: A New Light-Activated Hydrogen Peroxide System Fred N . Hanosh, D.D.S." G. Scot1 Hanosh, D.D.S.
'
With ever increasing interest in cosmetic enhancement of dentition by dentists and patients alike, this article introduces a new light-activated bleaching system that adds up to total patient satisfaction and reduced chair time. The chairside application of hydrogen peroxide 30% was effectivein lightening a moderate case of tetracycline staining. The uniqueness of this system allows the practitioner complete control within an office setting, and it provides the patient with an immediate result. The ease of application and strict supervision of a dentist has allowed this system to satisfy recent watchdogs of the Federal Drug Administration.
v
powder-liquid system, it is potentially significantlymore stable than Superoxol. Further, because it is light rather than heat-activated, it is potentiallya much safer and predictable system to use in general practice procedures. The following case presentation illustrates the clinical application of the system.
ital bleaching has been used for many years in dentistry and is known to be a safe, reliable, and predictable technique for brightening discoloredteeth. There are essentially two types of bleaching: office conducted power bleachingIb and the more recently introduced "homebleaching" (ToothWhiteners"),which have been associated with a high degree of popularity among both dental practitioners and Although both techniques used either alone or in combination are reliably effective, there are practical clinical problems associated with each procedure. The essential component of the office bleaching procedure, 30% hydrogen peroxide (Superoxol),which must be properly heat activated on a highly controlled basis in order to attain the desired result. In the event that insufficient heat is applied to the Superoxolduring bleaching, little, if any, lightening of the teeth occurs. Should too much heat be applied, negative pulpal sequelae result. To further complicate the process, the Superoxol must be absolutely fresh or positive results are not observed. Although it is well known that home bleaching procedures are reasonably safe and predictable, particularly if carried out under the strict supervision of a dentist, recent actions by the Federal Drug Administration indicate that a *ceaseand desist" order is imminent on all such materials. The recent introduction of a stable light-activated 35% hydrogen peroxide preparation, Hi-Lite (Shofu Products. Menlo Park, CAI, for office bleaching offers a number of advantages. Because it is a two-component
Case Report A 23-year-old female patient presented in the dental office. She had undergone temporomandibular joint (TMJ)therapy for 2 years (1987-1989). Subsequently, she underwent orthodontic treatment for 2 years (19891991). She is presently in postorthodontic retention. The patient, at the onset of TMJ therapy, expressed a desire for veneer or bonding treatment in order to improve her appearance. She was quite prepared to undergo either veneer placement or cosmetic bonding on teeth numbers 5 to 12 and 21 to 28 at a cost of $6,400.00or $2,400.00, respectively. An alternative mode of treatment was offered in the form of lightactivated office bleaching, which involved a total cost of $345.00 for three office appointments, which she readily accepted.
TECHNIQUE Prior to the start of the bleaching procedure, test the peroxide to ensure its efficacybymixing a small amount of the Hi-Lite powder with the Hi-Lite liquid (35% hydrogen peroxide) and light cure for 3 minutes. The mixture should turn from green to a light yellow/off white color. If this color change does not occur or if the mixture turns brown, the hydrogen peroxide has either been contaminated or weakened, and a new bottle
'Private Practice. Paradise. California.
? Private General Practice. Paradlse. Calffomia. Address reprint requests to Fred N. Hanosh. D.D.S.and G. Scott Hanosh. 6161 Clark Road. Sulte 8.Paradise. CA 95969. 0 1992 Decker Perfodlcals Inc.
90
Light-Activated Hydrogen Peroxide System
should be used. Additional supplies required for the bleaching procedure include rubber gloves, glasses, and a composite curing light (such as the Demetron 40 1 [Demetron Inc., Danbury, CT] or equivalent are preferable).
Treatment Procedure for Vital Teeth 1. A flour of pumice prophylaxis is performed (Fig. 1). (Do not use prophy pastes containing glycerin or fluoride.) 2. Coat the entire gingiva with either Orabase or Vaseline. 3. Isolate the teeth to be bleached with a rubber dam Ligate with waxed floss for additional protection. 4. Generally. acid etching should be Used Selectively where there are areas of darker stains requiring greater bleach penetration (Fig. 2). Apply orthophosphoric acid gel (37%or less) over the entire tooth surface to be bleached. The tooth should be etched for 15 seconds and rinsed for 30 seconds. Dry the tooth before proceeding. 5. M i x 3 drops of Hi-Lite liquid with one spoonful of HiLite powder (Fig.3). (Thepowder/liquid ratio can be altered depending on desired consistency). When mixed, paste will turn green. 6. Apply paste in an approximately 2-mm thick layer over the entire surface to be bleached (Fig.4).It may be necessary to bleach the lingual surface of the tooth. 7. As the bleach is oxidized, the paste will turn from green to a light yellow/off white color. Once it is light yellow, the oxidation process has been completed. It may be necessary to reapply the fresh paste as the color changes and/or dries out so that the applied material remains active for the entire treatment. If light actimmn*is desired &radiate with the curing light until color of the paste turns from green to light yellow/off white, approximately 3 minutes (Figs. 5 and 6). If light activation is not desired, leave the paste in/ on the tooth for at least 10 minutes to allow bleaching to take place chemically (chemicalactivation). 8. Rinse the bleached surfaces thoroughly with water for 1 minute and remove the rubber dam (Fig. 7). 9. Polishthe bleached tooth using a Ceramiste Point or cup, and/or the Super Snap Buff Disk with Ultra I1 Diamond polishing paste (Shofu Products, Menlo Park, CA). 10. A light-cured sealant may be applied, if desired. In Figure 8, the maxillary and mandibular teeth are shown before bleaching. Figure 9 shows the treated maxillary teeth after one appointment, which involved three successive applications of the Hi-Lite. Note the contrast between the treated madllary anterior teeth
pisun 1. ThorOugMy
with pumice prior to bleaching.
Figure 2. Etching of specific areas prior to bleaching - for treating more pronounced 'Stains." In this Case the gingival One third is significantly darker.
eieUre
9. Powder and W i d mixed showing P e n Color of activated form.
*Lightactivation will accelerate the bleaching. Three -minute exposure to the curing light is equivalent to 10 minutes of chemical bleaching.
91
JOCRNAI. OF ESTHETIC DEhTISTRY \'OLUME 4, NUMBER 3 Mny/Junr 1992
Figure 4. Application of bleaching gel to tooth with brush. Another technique is to use gel in a centrix syringe.
Figure 7. Both sides are deactivated.This is now rinsed offand dried. and a second application can be done.
F&WG 1. Curing light may be used to accelerate the bleaching process. D o to three minutes with light. Six to seven minutes without. Total of three applications maximum per visit with 3 weeks in between subsequent visits.
Figure 8. Maxillary/mandibular teeth prior to bleaching.
Figure 6. Green side is actively bleaching and off-white side is
PYeun 9.
M a x i h y teeth after one visit (3applications total). Mandibular teeth untreated.
deactivated.
92
Light-Activated Hydrogen Peroxide System
Figure 10. Maxillary teeth after first visit and touch up of #6 and #8 gingival one third.
and the nontreated mandibular dentition. The gingival thirds of both #6 (maxillary right canine) and #8 (maxillary right central incisor) remain slightly darkened. This may well have been due to the difficulty in isolating these areas properly under the rubber dam. After removal of the rubber dam both #6 and #8 were 'spot treated" in the gingival third. The results of this spot treatment are shown in Figure 10. Figure 1 1 shows a hI1-face photograph of the patient after completion of the maxillaryanterior bleaching (fistapplication). By means of contrast, a full-face preoperative photograph showing the maxillary anterior teeth prior to bleaching is presented in Figure 12.
Figure 12. Preoperative photo. Maxillary anteriors before bleaching.
Figure 13 shows another full-facephotograph showing the treated maxillary anteriors together with the nontreated mandibular anteriors. Figure 14 shows the mandibular anterior teeth after one visit (3 applications). A comparison of the original shade (shade guide) to the postoperative shade is presented. Figure 15 shows a comparison of the mandibular anteriors to the new shade tab.
Figure 13. Photo comparing treated maxillary anteriors ver-
Figure 11. Full-face photo with completion of maxillary anterior bleaching ( b t application).
sus untreated mandibular anteriors.
93
Flgure 15. Mandibular anteriors. Comparison of new shade tab to tooth shade.
Figure 14. Mandibular anteriors after 3 applications (single \-isit). Comparison of original shade to postoperative shade.
Heavy Tetracycline Stains and Spot Bleaching
6.
Teeth with banded tetracycline stains should be treated in a localized manner. The dual activation [light and chemical)should be employed to facilitate elimination of the darker/lighter bands. For example, with the bleach applied, expose the darker bands to the light for 3 minutes. Then let the lighter bands chemicallybleach for the same duration of time. Spot bleaching can be employed where discoloration is very limited. Caution:On patients who have sensitivityor excessive stain, bleaching may require additional visits. A shorter bleaching time is recommended to prevent any potential pulp damage or discomfort to the patient. If the patient complains of any pain or excessive sensitivity during the course of the treatment, the procedure should be stopped and the tooth thoroughly rinsed.
7.
8. 9.
ligament. [Do not use a glass ionomer seal as glass ionomer cements can absorb bleach.) Etch When Necessary: In severe cases, it may be necessary to acid etch the pulp chamber for 15 seconds and irrigate for 30 seconds. This opens up the dentin tubules and enhances the effectiveness of the bleaching agent. Mu3 drops of Hi-Lite liquid with one spoonful of HiLite powder. Place the bleaching paste into the pulp chamber and, if desired, on the labial surface. As the bleach is oxidized, the paste will turn from green to a light yellow/off white color. Once it is light yellow, the oxidation process has been completed. It may be necessary to reapply the fresh paste as the color changes and/or dries out so that the applied material remains active for the entire treatment.
If light activation* is desired, irradiate with the curing light until color of the paste turns from green to light yellow/off white, approximately 3 minutes. If light activation is not desired, leave the paste in/ on the tooth for at least 10 minutes to allow bleaching to take place chemically (chemical activation).
Treatment Procedure for Nonvital Teeth 1. The flling material on the lingual surface of the nonvital tooth is removed up to approximately the
10. Rinse the tooth thoroughly with water for 1minute and dry. Remove the rubber dam. Any final residue can be polished off. 11. Polishthe bleached tooth using a Ceramiste Point or cup, and/or the Super Snap Buff Disk with Ultra I1 Diamond polishing paste. 12 Restoration: Fill the chamberwith a compositeresin (such as Shofu Lite Fil 11). If desired, first fill the chamber with either a glass-ionomer base cement, polycarboxylate cement, or a zinc phosphate cement, then cover the access openingwith a compos-
level of the base of the pulp chamber. 2. Prophylaxis using pumice is performed. [Do not use prophy pastes containing glycerin or fluoride.) 3. Coat the entire gingiva with either Orabase or Vaseline. 4. Isolate only those teeth to be bleached with a wellfitting rubber dam Ligate with waxed floss for additional protection. 5. Place Seal: A cement base is placed between the height ofbone and gingival attachment using Shofu's Hy-Bond Polycarboxylate Cement, Hy-Bond Zinc Phosphate Cement, or a resin-base cement. Place it high lingually and laterally against the internal walls to seal the canal and protect the periodontal
'Light actlvation will accelerate the bleaching. Three-minute exposure to the curing light is equivalent to 10 minutes of chemical bleaching.
94
12ight-ActivatedHydrogen Peroxide System
ite resin. Note: Recent studies have demonstrated that the bond strengths of composite materials (bonding agents) to bleached enamel are significantly reduced immediately after bleaching. I t may be prudent to wait a week to allow the enamel to remineralize prior to the final bonding and final restoration being placed.
The new light-acti\,aled bleaching system, Hi Lite (Shofu). is a safe and effective innovation in bleaching both vital and nonlital teeth. The ease of application and reduction in chair time h a s made our cosmetic practice more profitable and resulted in total patient satisfaction.
REFERENCES
Caution:Do not inhale or touchdry powder. Rinse off all exposed surfaces. Powder is not toxic in the quantities used, but as with any chemical, handle with care. Warning: Hi-Lite liquid is 35% hydrogen peroxide and is caustic. Care must be taken when handling. All operators and auxiliaq staff should wear protective rubber gloves at all times during the procedure. Eye protection should be provided for the patient as well as operators, in the event of splatter. Use a rubber dam. Avoid skin contact. Should skin contact occur, rinse extensively with water immediately. Close cap tightly and store in upright position. Refrigerate both Hi-Lite liquid and Hi-Lite powder to prolong shelf life.
1.
2. 3. 4.
5. 6.
7.
CONCLUSION
8.
The ease of application and reduction in chair time h a s made our cosmetic practice more profitable and resulted in total patient satisfaction.
95
Fienman RA. Goldstein RE. Garber DA. Bleaching teeth. Chicago: Quintessence Publishing. 1987. Jordan RE. Esthetic composite bonding. techniques and materials. Philadelphia: BC Decker, 1988. Faunce F. Management of discolored teeth. Dent Clin North Am 1983: 27(4):657-670. Jordan RE, Boksman L. Conservative 14tal bleaching treatment of discolored dentition. Compend Contin Educ Dent 1984: 5( 10):803-808. Goldstein RE. Bleaching teeth: new materials-new role. J Am Dent Assoc 1987; 115 (Special Issue):44E-52E. Nathanson D, Parra C. Bleaching vital teeth: a review and clinical study. Compend Contin Educ Dent 1987: 8:490498. Haywood VB. Overview and status of mouthguard bleaching. J Esthet Dent 1991; 3(5]:157-161. Christensen GJ. Tooth bleaching, home-use products. CRA Newsletter 1989: 13: 1.
'
With ever increasing interest in cosmetic enhancement of dentition by dentists and patients alike, this article introduces a new light-activated bleaching system that adds up to total patient satisfaction and reduced chair time. The chairside application of hydrogen peroxide 30% was effectivein lightening a moderate case of tetracycline staining. The uniqueness of this system allows the practitioner complete control within an office setting, and it provides the patient with an immediate result. The ease of application and strict supervision of a dentist has allowed this system to satisfy recent watchdogs of the Federal Drug Administration.
v
powder-liquid system, it is potentially significantlymore stable than Superoxol. Further, because it is light rather than heat-activated, it is potentiallya much safer and predictable system to use in general practice procedures. The following case presentation illustrates the clinical application of the system.
ital bleaching has been used for many years in dentistry and is known to be a safe, reliable, and predictable technique for brightening discoloredteeth. There are essentially two types of bleaching: office conducted power bleachingIb and the more recently introduced "homebleaching" (ToothWhiteners"),which have been associated with a high degree of popularity among both dental practitioners and Although both techniques used either alone or in combination are reliably effective, there are practical clinical problems associated with each procedure. The essential component of the office bleaching procedure, 30% hydrogen peroxide (Superoxol),which must be properly heat activated on a highly controlled basis in order to attain the desired result. In the event that insufficient heat is applied to the Superoxolduring bleaching, little, if any, lightening of the teeth occurs. Should too much heat be applied, negative pulpal sequelae result. To further complicate the process, the Superoxol must be absolutely fresh or positive results are not observed. Although it is well known that home bleaching procedures are reasonably safe and predictable, particularly if carried out under the strict supervision of a dentist, recent actions by the Federal Drug Administration indicate that a *ceaseand desist" order is imminent on all such materials. The recent introduction of a stable light-activated 35% hydrogen peroxide preparation, Hi-Lite (Shofu Products. Menlo Park, CAI, for office bleaching offers a number of advantages. Because it is a two-component
Case Report A 23-year-old female patient presented in the dental office. She had undergone temporomandibular joint (TMJ)therapy for 2 years (1987-1989). Subsequently, she underwent orthodontic treatment for 2 years (19891991). She is presently in postorthodontic retention. The patient, at the onset of TMJ therapy, expressed a desire for veneer or bonding treatment in order to improve her appearance. She was quite prepared to undergo either veneer placement or cosmetic bonding on teeth numbers 5 to 12 and 21 to 28 at a cost of $6,400.00or $2,400.00, respectively. An alternative mode of treatment was offered in the form of lightactivated office bleaching, which involved a total cost of $345.00 for three office appointments, which she readily accepted.
TECHNIQUE Prior to the start of the bleaching procedure, test the peroxide to ensure its efficacybymixing a small amount of the Hi-Lite powder with the Hi-Lite liquid (35% hydrogen peroxide) and light cure for 3 minutes. The mixture should turn from green to a light yellow/off white color. If this color change does not occur or if the mixture turns brown, the hydrogen peroxide has either been contaminated or weakened, and a new bottle
'Private Practice. Paradise. California.
? Private General Practice. Paradlse. Calffomia. Address reprint requests to Fred N. Hanosh. D.D.S.and G. Scott Hanosh. 6161 Clark Road. Sulte 8.Paradise. CA 95969. 0 1992 Decker Perfodlcals Inc.
90
Light-Activated Hydrogen Peroxide System
should be used. Additional supplies required for the bleaching procedure include rubber gloves, glasses, and a composite curing light (such as the Demetron 40 1 [Demetron Inc., Danbury, CT] or equivalent are preferable).
Treatment Procedure for Vital Teeth 1. A flour of pumice prophylaxis is performed (Fig. 1). (Do not use prophy pastes containing glycerin or fluoride.) 2. Coat the entire gingiva with either Orabase or Vaseline. 3. Isolate the teeth to be bleached with a rubber dam Ligate with waxed floss for additional protection. 4. Generally. acid etching should be Used Selectively where there are areas of darker stains requiring greater bleach penetration (Fig. 2). Apply orthophosphoric acid gel (37%or less) over the entire tooth surface to be bleached. The tooth should be etched for 15 seconds and rinsed for 30 seconds. Dry the tooth before proceeding. 5. M i x 3 drops of Hi-Lite liquid with one spoonful of HiLite powder (Fig.3). (Thepowder/liquid ratio can be altered depending on desired consistency). When mixed, paste will turn green. 6. Apply paste in an approximately 2-mm thick layer over the entire surface to be bleached (Fig.4).It may be necessary to bleach the lingual surface of the tooth. 7. As the bleach is oxidized, the paste will turn from green to a light yellow/off white color. Once it is light yellow, the oxidation process has been completed. It may be necessary to reapply the fresh paste as the color changes and/or dries out so that the applied material remains active for the entire treatment. If light actimmn*is desired &radiate with the curing light until color of the paste turns from green to light yellow/off white, approximately 3 minutes (Figs. 5 and 6). If light activation is not desired, leave the paste in/ on the tooth for at least 10 minutes to allow bleaching to take place chemically (chemicalactivation). 8. Rinse the bleached surfaces thoroughly with water for 1 minute and remove the rubber dam (Fig. 7). 9. Polishthe bleached tooth using a Ceramiste Point or cup, and/or the Super Snap Buff Disk with Ultra I1 Diamond polishing paste (Shofu Products, Menlo Park, CA). 10. A light-cured sealant may be applied, if desired. In Figure 8, the maxillary and mandibular teeth are shown before bleaching. Figure 9 shows the treated maxillary teeth after one appointment, which involved three successive applications of the Hi-Lite. Note the contrast between the treated madllary anterior teeth
pisun 1. ThorOugMy
with pumice prior to bleaching.
Figure 2. Etching of specific areas prior to bleaching - for treating more pronounced 'Stains." In this Case the gingival One third is significantly darker.
eieUre
9. Powder and W i d mixed showing P e n Color of activated form.
*Lightactivation will accelerate the bleaching. Three -minute exposure to the curing light is equivalent to 10 minutes of chemical bleaching.
91
JOCRNAI. OF ESTHETIC DEhTISTRY \'OLUME 4, NUMBER 3 Mny/Junr 1992
Figure 4. Application of bleaching gel to tooth with brush. Another technique is to use gel in a centrix syringe.
Figure 7. Both sides are deactivated.This is now rinsed offand dried. and a second application can be done.
F&WG 1. Curing light may be used to accelerate the bleaching process. D o to three minutes with light. Six to seven minutes without. Total of three applications maximum per visit with 3 weeks in between subsequent visits.
Figure 8. Maxillary/mandibular teeth prior to bleaching.
Figure 6. Green side is actively bleaching and off-white side is
PYeun 9.
M a x i h y teeth after one visit (3applications total). Mandibular teeth untreated.
deactivated.
92
Light-Activated Hydrogen Peroxide System
Figure 10. Maxillary teeth after first visit and touch up of #6 and #8 gingival one third.
and the nontreated mandibular dentition. The gingival thirds of both #6 (maxillary right canine) and #8 (maxillary right central incisor) remain slightly darkened. This may well have been due to the difficulty in isolating these areas properly under the rubber dam. After removal of the rubber dam both #6 and #8 were 'spot treated" in the gingival third. The results of this spot treatment are shown in Figure 10. Figure 1 1 shows a hI1-face photograph of the patient after completion of the maxillaryanterior bleaching (fistapplication). By means of contrast, a full-face preoperative photograph showing the maxillary anterior teeth prior to bleaching is presented in Figure 12.
Figure 12. Preoperative photo. Maxillary anteriors before bleaching.
Figure 13 shows another full-facephotograph showing the treated maxillary anteriors together with the nontreated mandibular anteriors. Figure 14 shows the mandibular anterior teeth after one visit (3 applications). A comparison of the original shade (shade guide) to the postoperative shade is presented. Figure 15 shows a comparison of the mandibular anteriors to the new shade tab.
Figure 13. Photo comparing treated maxillary anteriors ver-
Figure 11. Full-face photo with completion of maxillary anterior bleaching ( b t application).
sus untreated mandibular anteriors.
93
Flgure 15. Mandibular anteriors. Comparison of new shade tab to tooth shade.
Figure 14. Mandibular anteriors after 3 applications (single \-isit). Comparison of original shade to postoperative shade.
Heavy Tetracycline Stains and Spot Bleaching
6.
Teeth with banded tetracycline stains should be treated in a localized manner. The dual activation [light and chemical)should be employed to facilitate elimination of the darker/lighter bands. For example, with the bleach applied, expose the darker bands to the light for 3 minutes. Then let the lighter bands chemicallybleach for the same duration of time. Spot bleaching can be employed where discoloration is very limited. Caution:On patients who have sensitivityor excessive stain, bleaching may require additional visits. A shorter bleaching time is recommended to prevent any potential pulp damage or discomfort to the patient. If the patient complains of any pain or excessive sensitivity during the course of the treatment, the procedure should be stopped and the tooth thoroughly rinsed.
7.
8. 9.
ligament. [Do not use a glass ionomer seal as glass ionomer cements can absorb bleach.) Etch When Necessary: In severe cases, it may be necessary to acid etch the pulp chamber for 15 seconds and irrigate for 30 seconds. This opens up the dentin tubules and enhances the effectiveness of the bleaching agent. Mu3 drops of Hi-Lite liquid with one spoonful of HiLite powder. Place the bleaching paste into the pulp chamber and, if desired, on the labial surface. As the bleach is oxidized, the paste will turn from green to a light yellow/off white color. Once it is light yellow, the oxidation process has been completed. It may be necessary to reapply the fresh paste as the color changes and/or dries out so that the applied material remains active for the entire treatment.
If light activation* is desired, irradiate with the curing light until color of the paste turns from green to light yellow/off white, approximately 3 minutes. If light activation is not desired, leave the paste in/ on the tooth for at least 10 minutes to allow bleaching to take place chemically (chemical activation).
Treatment Procedure for Nonvital Teeth 1. The flling material on the lingual surface of the nonvital tooth is removed up to approximately the
10. Rinse the tooth thoroughly with water for 1minute and dry. Remove the rubber dam. Any final residue can be polished off. 11. Polishthe bleached tooth using a Ceramiste Point or cup, and/or the Super Snap Buff Disk with Ultra I1 Diamond polishing paste. 12 Restoration: Fill the chamberwith a compositeresin (such as Shofu Lite Fil 11). If desired, first fill the chamber with either a glass-ionomer base cement, polycarboxylate cement, or a zinc phosphate cement, then cover the access openingwith a compos-
level of the base of the pulp chamber. 2. Prophylaxis using pumice is performed. [Do not use prophy pastes containing glycerin or fluoride.) 3. Coat the entire gingiva with either Orabase or Vaseline. 4. Isolate only those teeth to be bleached with a wellfitting rubber dam Ligate with waxed floss for additional protection. 5. Place Seal: A cement base is placed between the height ofbone and gingival attachment using Shofu's Hy-Bond Polycarboxylate Cement, Hy-Bond Zinc Phosphate Cement, or a resin-base cement. Place it high lingually and laterally against the internal walls to seal the canal and protect the periodontal
'Light actlvation will accelerate the bleaching. Three-minute exposure to the curing light is equivalent to 10 minutes of chemical bleaching.
94
12ight-ActivatedHydrogen Peroxide System
ite resin. Note: Recent studies have demonstrated that the bond strengths of composite materials (bonding agents) to bleached enamel are significantly reduced immediately after bleaching. I t may be prudent to wait a week to allow the enamel to remineralize prior to the final bonding and final restoration being placed.
The new light-acti\,aled bleaching system, Hi Lite (Shofu). is a safe and effective innovation in bleaching both vital and nonlital teeth. The ease of application and reduction in chair time h a s made our cosmetic practice more profitable and resulted in total patient satisfaction.
REFERENCES
Caution:Do not inhale or touchdry powder. Rinse off all exposed surfaces. Powder is not toxic in the quantities used, but as with any chemical, handle with care. Warning: Hi-Lite liquid is 35% hydrogen peroxide and is caustic. Care must be taken when handling. All operators and auxiliaq staff should wear protective rubber gloves at all times during the procedure. Eye protection should be provided for the patient as well as operators, in the event of splatter. Use a rubber dam. Avoid skin contact. Should skin contact occur, rinse extensively with water immediately. Close cap tightly and store in upright position. Refrigerate both Hi-Lite liquid and Hi-Lite powder to prolong shelf life.
1.
2. 3. 4.
5. 6.
7.
CONCLUSION
8.
The ease of application and reduction in chair time h a s made our cosmetic practice more profitable and resulted in total patient satisfaction.
95
Fienman RA. Goldstein RE. Garber DA. Bleaching teeth. Chicago: Quintessence Publishing. 1987. Jordan RE. Esthetic composite bonding. techniques and materials. Philadelphia: BC Decker, 1988. Faunce F. Management of discolored teeth. Dent Clin North Am 1983: 27(4):657-670. Jordan RE, Boksman L. Conservative 14tal bleaching treatment of discolored dentition. Compend Contin Educ Dent 1984: 5( 10):803-808. Goldstein RE. Bleaching teeth: new materials-new role. J Am Dent Assoc 1987; 115 (Special Issue):44E-52E. Nathanson D, Parra C. Bleaching vital teeth: a review and clinical study. Compend Contin Educ Dent 1987: 8:490498. Haywood VB. Overview and status of mouthguard bleaching. J Esthet Dent 1991; 3(5]:157-161. Christensen GJ. Tooth bleaching, home-use products. CRA Newsletter 1989: 13: 1.
