Whitening of the tooth canal. Intracanal tooth whitening. Why does the enamel darken after treatment at the dentist

snow white beautiful smile is the best calling card. Wherein dark teeth won't be a decoration. True, after the treatment of caries, people often experience darkening of the enamel. Then the question of aesthetics comes to the fore. Previously, it was difficult to solve such a problem. However, nowadays medicine offers effective solution- intracanal teeth whitening.

Of course, you can also encounter darkened enamel when treating with leaky fillings, as well as colored pastes, or due to injuries. Various dyes also contribute. These include eating certain foods or drinks. Smoking negatively affects the color of teeth. In each case, intracanal bleaching will help.

Features of the procedure

Intracanal whitening(endobleaching) is a specific method of intracoronal correction of the color of molars. A special whitening gel is placed inside the tooth cavity. However, doctors prescribe x-ray examination to reveal discoloration of the enamel. Then a temporary filling is placed. An assessment of the condition of the teeth can be given after one to two weeks. Through the same period, the doctor conducts repeated procedure. As a rule, the result is achieved fairly quickly. According to statistics, for a full-fledged intracanal teeth whitening, about three to four procedures are enough.

The indisputable advantage of the endo whitening procedure is painlessness, high level efficiency and long-term results. Full restoration of the tooth is carried out only after obtaining the required shade. Similar procedure may be re-appointed a year later or later. It depends on how long the desired effect will be maintained in the individual case.

Before proceeding with endobleaching, it is necessary to take care of sanitation oral cavity repair any defects and carious lesions as well as tartar. To strengthen the enamel, a fluorine-containing composition is used. This results in dazzlingly white and strong teeth.

Possible side effects

In endo-bleaching are used chemical substances that destroy protein dyes. During this procedure, very active components are used that can effective impact. They allow to destroy the dyes accumulated in the filling materials. However, the first procedure may not give a noticeable effect.

Another side effect such a technique is to weaken the strength of the tooth. This is due to the fact that in a tooth that is depulped, lesions are not restored after bleaching. Therefore, the probability of fracture of the dental crown is high. Consequently, maximum amount carrying out procedures for endobleaching - four. Greater number will not only have no effect. Additional endo-bleaching procedures can only weaken the dental crown.

Experienced professionals do not recommend the use of pastes, gels or formulations intended for self-whitening. After all, such means will not have an effect on internal cavity teeth. In addition, they contain abrasive substances. They destroy the enamel, increase its sensitivity.

Basic contraindications

Endo whitening like everyone else medical procedures, is not without certain contraindications. Among them:

carious lesions of the molars;
treatment of children under the age of sixteen (when the teeth are not yet fully formed);
allergy to hydrogen peroxide;
increased sensitivity of enamel;
the presence of colored fillings;
lactation period;
pregnancy.

Intracanal teeth whitening is, in fact, a very effective procedure. It allows you to safely solve the problem with the darkening of the enamel. However, it should be remembered that before carrying out endo whitening, it is advisable to consult with a competent specialist and compare all possible advantages, as well as the disadvantages of such a procedure. pledge dazzling smile is professional approach, timely therapy and, of course, regular oral hygiene.

FAQ

First of all, one that does not hurt the gums during use. At the same time, the quality of oral hygiene depends more on whether the teeth are brushed correctly than on the shape or type of toothbrush. Concerning electric brushes, then for ignorant people they are a more preferable option; although you can brush your teeth with a simple (manual) brush. In addition, a toothbrush alone is often not enough - flosses (special dental floss) should be used to clean between the teeth.

Rinses are optional hygiene products which effectively clean the entire oral cavity from harmful bacteria. All these tools can be divided into two large groups– treatment-and-prophylactic and hygienic.

The latter include rinsing agents that eliminate bad smell and promote fresh breath.

As for therapeutic and prophylactic, these include rinses that have anti-plaque / anti-inflammatory / anti-carious effects and help reduce the sensitivity of hard dental tissues. This is achieved due to the presence of different kind biologically active components. Therefore, the rinse aid must be selected for each specific person on an individual basis, as well as toothpaste. And since the product is not washed off with water, it only fixes the effect. active components pastes.

Such cleaning is completely safe for dental tissues and less traumatic. soft tissues oral cavity. The point is that in dental clinics a special level of ultrasonic vibrations is selected, which affects the density of the stone, disrupts its structure and separates it from the enamel. In addition, in places where tissues are treated with an ultrasonic scaler (this is the name of the device for cleaning teeth), a special cavitation effect occurs (after all, oxygen molecules are released from water droplets, which enter the treatment zone and cool the tip of the instrument). Cell membranes pathogenic microorganisms are torn apart by these molecules, causing microbes to die.

It turns out that ultrasonic cleaning has a complex effect (provided that really high-quality equipment is used) both on the stone and on the microflora as a whole, cleaning it. Oh oh mechanical cleaning you won't say it. Furthermore, ultrasonic cleaning more pleasant for the patient and takes less time.

According to dentists, dental treatment should be carried out regardless of your position. Moreover, a pregnant woman is recommended to visit a dentist every one or two months, because, as you know, when carrying a baby, the teeth are significantly weakened, they suffer from a deficiency of phosphorus and calcium, and therefore the risk of caries or even tooth loss increases significantly. For the treatment of pregnant women, it is necessary to use harmless means anesthesia. The most suitable course of treatment should be selected exclusively by a qualified dentist, who will also prescribe the required preparations that strengthen tooth enamel.

Treating wisdom teeth is quite difficult due to their anatomical structure. Nonetheless, qualified specialists they are successfully treated. Wisdom teeth prosthetics are recommended when one (or more) adjacent tooth missing or it needs to be removed (if you also remove a wisdom tooth, then there will simply be nothing to chew on). In addition, the removal of a wisdom tooth is undesirable if it is located on the jaw in right place, has its own antagonist tooth and takes part in the chewing process. Also, one should take into account the fact that poor quality treatment can lead to serious complications.

Here, of course, much depends on the taste of the person. So, there are absolutely imperceptible systems attached to inside teeth (known as lingual), but there are also transparent ones. But the most popular are still metal braces having colored metal / elastic ligatures. It's really trendy!

Let's start with the fact that it's just unattractive. If this is not enough for you, we give the following argument - the stone and plaque on the teeth often provoke bad breath. And that's not enough for you? In this case, we move on: if the tartar "grows", this will inevitably lead to irritation and inflammation of the gums, that is, it will create favorable conditions for periodontitis (a disease in which periodontal pockets are formed, pus constantly flows out of them, and the teeth themselves become mobile). And this is already a direct path to loss healthy teeth. Moreover, the number of harmful bacteria at the same time increases, due to which there is an increased cariousness of the teeth.

The service life of an accustomed implant will be tens of years. According to statistics, at least 90 percent of implants function perfectly 10 years after installation, while the service life is on average 40 years. Tellingly, this period will depend both on the design of the product and on how carefully the patient takes care of it. That is why when cleaning without fail you need to use an irrigator. In addition, it is necessary to visit the dentist at least once a year. All these measures will significantly reduce the risk of implant loss.

Removal of a tooth cyst can be performed therapeutically either surgical method. In the second case we are talking about tooth extraction with further cleaning of the gums. In addition, there are those modern methods to save the tooth. This is, first of all, a cystectomy - quite complicated operation, which consists in removing the cyst and the affected root tip. Another method is hemisection, in which the root and a fragment of the tooth above it are removed, after which it (part) is restored with a crown.

As for therapeutic treatment, then it consists in cleaning the cyst by means of root canal. It is also a difficult option, especially not always effective. Which method to choose? This will be decided by the doctor together with the patient.

In the first case, teeth are used to change the color professional systems, which are based on carbamide peroxide or hydrogen peroxide. Obviously, it is better to give preference to professional bleaching.

The main disadvantage of treating caries or pulpitis is the discoloration of the treated units. First, their crown part darkens, and behind it the color and root structure change.

Before this problem solved in only one way - by covering with veneers or crowns. Now in dentistry, it has been developed and successfully applied new technique– endobleaching (otherwise intracanal bleaching).

The essence of the method

This is a method in which teeth whitening occurs by introducing bleaching agents into the root canals. This technology has revolutionized aesthetic dentistry and supplemented the list of services that meet the requirements of patients in terms of aesthetics.

Previous bleaching methods have shown good result, but only on vital (living) units. What can not be said about the change in color of non-vital elements, when the result of the procedure did not match the expected result.

Now it is possible to return the original color to those teeth in which the nerve was removed during their treatment. To appearance they did not differ from all elements of the jaw arch, the agent is introduced into the pulpless cavity and acts on the tissues from the inside.

To achieve this result, the patient will have to visit the doctor more than once. After all the preparatory procedures, the agent is injected into the cavity, which is then sealed with a temporary filling. After a certain period of time, the dentist evaluates the effect of the whitening components, and then performs a second procedure or completes the course.

The clarification of non-vital units was first proposed in 1864, but to obtain desired effect succeeded recently. In the 70s of the last century, endo-whitening began use water solution sodium perborate. Until that time, all brightening components were used as independent products and were constantly replaced.

Today, the technique of performing the procedure and the preparations for it have changed. They still contain the previously used substances, but in a different ratio, and water has been replaced by hydrogen peroxide.

Causes of darkening

A change in the tooth surface (discoloration) occurs due to external influences, problems with general health, as well as due to dental actions.

External causes

Darkening is due to:

Frequent and in in large numbers use strong tea, red wine, coffee.
from the effects of nicotine.
Due to irregular or poor oral hygiene.

These factors together or individually have a detrimental effect on the shade of the elements. jaw row. In addition to discoloration and loss of healthy shine, deposits accumulated on the surface provoke the development of various pathologies.

The correction of this type of darkening is simple - it is necessary to abandon the actions that led to darkening, enough time to allocate hygiene and carry it out correctly.

Internal causes

This group includes the following states:

Necrotic process in the pulp. The ingress of dead pulp particles into the dentin channels contributes to persistent staining of dental tissues. The depth of their passage depends on the duration of the existence of the necrotic process in the pulp.
pulpal hemorrhage. This phenomenon is considered the most common factor in the internal darkening of the teeth.
The iron sulfites in the blood impregnate the dentinal canals, which also leads to a change in the appearance of individual elements. Such staining will appear more strongly if the pulp completely dies.
Hypercalcification of dentinal tissues. With excessive formation of replacement dentin in the tooth cavity, there is a gradual deterioration in transparency and darkening of the crown part.
Age. The natural color of all jaw arch units changes with age. This is due to the thinning of the enamel layer and the deterioration of its optical performance.
In this state, scratches, cracks quickly appear, through which it is easy to internal tissues food colorings, nicotine and bacteria penetrate. They speed up the process age change colors.

Discoloration associated with the actions of the dentist

The change in color from the inside is also caused by the unprofessional actions of the doctor and some features of the materials used:

After endodontic treatment, particles of the affected pulp remain in the cavity. In this case, the discoloration is associated with the release of coloring substances into the dental tissues, which are formed during the decay of pulp residues.
Some materials introduced into root canals(iodine and phenol-based products), gradually stain dentinal tissues and adversely affect the shade.
A change in shade is also associated with a seal poorly removed from the pulp chamber. Residues decompose, causing inflammation and structural changes. As a result of this reaction, the entire surface of the tooth darkens.

The above reasons are indications for intracanal clarification.

Indications and restrictions

Based on the reasons that provoked a change in the shade of the teeth from the inside, it is advisable to carry out endo whitening under the following conditions:

age-related changes in enamel that cannot be corrected in the traditional way;
tooth injury, resulting in a hemorrhage into the pulp;
filling with resorcinol-formalin, due to which staining of the coronal part in a light pink color is noticeable;
the darkened unit is depulped;
pulp death due to periodontitis, advanced caries or pulpitis;
dentine staining due to the regular use of strong tea, coffee, when the coloring matter through microcracks on the enamel penetrated into the deeper layers.

To what extent intracanal bleaching will be justified with these indications, the dentist decides after assessing the degree of darkening and identifying the cause of this process.

Before deciding on the procedure, the patient should be aware of the limitations under which whitening by this method is not recommended:

age up to 16 years;
increased sensitivity of enamel;
periodontal disease;
allergy or reaction to hydrogen peroxide;
progressive inflammation in the mouth;
high degree of enamel abrasion;
periodontitis;
chips and cracks;
progressive extensive caries;
diabetes;
pregnancy and lactation;
thyroid pathology.

Intracanal clarification shows a poor result on a “dead” unit with a long-standing composite filling.

Advantages and disadvantages

With internal darkening, endobleaching is considered a gentle alternative to prosthetics.

In addition, there are other advantages:

painlessness;
minimal likelihood of complications;
patient safety;
the safety of neighboring units;
acceptable cost;
high efficiency.

The disadvantage is the increase in the fragility of the element, which was subjected to clarification. If the procedure is repeated many times (more than four times a year) with a short time interval, there is a possibility of its destruction.

Also negative points are:

the impossibility of clarification without replacing old colored fillings;
obligatory use of a drill;
the need for several visits to the dentist.

Preparatory activities

The first step in endo whitening is the preparation of the patient's oral cavity. First, a visual and instrumental examination is carried out.

An x-ray is required. According to its result, the doctor finds out the nature and severity of the problem, determines the process scheme, checks the quality of long-placed fillings and examines the tooth for the presence of a latent form of inflammation.

Technique

The next visit begins with the fact that the patient is asked to rinse his mouth with an antiseptic to eliminate bacterial contamination.

The main phase of intracanal bleaching takes place in the following sequence:

The choice of the future shade of enamel.
Isolate the tooth from all other units.
Removal of the old filling.
Cleaning of residues of staining substances and filling material.
Applying an insulating gasket to the mouth of the channels to avoid the ingress of a clarifying agent.
Filling the cavity with a clarifying preparation.
Closure with a temporary filling.

A week later, the process is repeated again. To get the desired result, the patient with the same time interval will have to visit the dentist 2 to 4 times. When the tooth gets desired color, is set permanent filling.

Important! To avoid the destruction of dental tissues (resorption), a person needs to come for an examination once a year and perform x-rays.

The video shows the scheme of intracanal teeth whitening.

Expected result and efficiency

Multiple studies of specialists of the Department of Dentistry of the SSMU named after I.I. Razumovsky confirm that the effectiveness of in-channel clarification is 83%.

The result may be worse if contraindications were not taken into account before execution, and the individual characteristics of the organism affected.

During the procedure, only certain patients may experience slight sensitivity and a feeling of fullness in the treated unit. The effect obtained after the procedure persists for a year, then the procedure is recommended to be repeated.

As statistics show, the number of patients using this technique is growing every year. The demand for it is explained by the fact that when carrying out the bleaching agent acts on one specific unit, keeping its shape and without damaging neighboring elements.

Possible Complications

A possible complication of endobleaching is the fragility of the hard tissues of the problematic unit. A similar effect occurs if products with a higher concentration were used for clarification.

The need for their use is explained by the strong darkening of the non-vital element, on which the action of gels with the usual composition is ineffective. For this reason, it is not recommended to this procedure more than 4 times.

Dentists warn that if the tooth was initially weakened, then after bleaching, there is a possibility of its imminent loss.

A very rare consequence is disease of the gum tissues adjacent to this unit. It develops only when an infection is introduced during the procedure.

Since the technique for performing endo whitening is significantly different from surface method, recommendations to the patient will be different.

chew on the side on which the bleached element is located;
eat sticky, hard foods;
do not eat at the same time food contrasting in temperature.

In the future, it should be borne in mind that a bleached tooth is not as reliable and durable as all the others. Therefore, it is necessary to be more careful with it during meals.

Do not neglect daily hygiene. You should also brush your teeth twice a day, but with a paste that does not contain abrasive components. To prevent the formation of plaque, use rinse aids and floss.

Price

The cost of endo-bleaching of one unit in different clinics differs, but on average, such a procedure will cost 1 thousand rubles. Price full course, consisting of several visits, is in the range of 8-10 thousand rubles.

Included in the price:

bleaching agent;
examination, including radiography;
mechanical cleaning of channels;
treatment of identified pathologies;
use of filling material.

How to restore the shine and whiteness of a smile? Intracanal teeth whitening will help you. Find out about the price of the procedure and read the reviews that are published by both patients and doctors.

With a beautiful one, you will almost be more confident in yourself, more likely to achieve your goals. Whitening pastes and special rinses will not give the same effect as intracanal bleaching. It is able to restore the natural whiteness of teeth with removed nerves.

The essence of the technique

During your first visit, you:

come through preventive examination oral cavity.
You do x-rays to identify hidden processes and the quality of seals. The doctor determines whether inflammatory diseases gums and reveals the cause of darkening of the enamel.
At the next stage, the old filling is removed and the tooth is cleaned. All materials must be carefully removed as they may stain the enamel. To prevent the substance from entering the root canals, a pad of medical cement is placed at the entry point.
This stage is completed by a temporary filling, which is installed for up to 2 weeks.

During the next visit:

The doctor applies a safe whitening gel after the filling is removed.
Endowhitening after the first time does not always meet the requirements of the patient, then the procedure is repeated and you can whole year enjoy shining healthy teeth.

System Whitening Opalescence recently appeared in dentistry, but has already managed to win the trust of doctors and patients who dream of white smile. What is this method in which the teeth become whiter and are not subjected to strong chemical attack? Opalescence is effective:

in case of age-related changes in the color of the enamel;
in relation to teeth affected by exposure to tetracycline antibiotics;
to stains from .

Indications

As before any procedure, a visit to the dentist is necessary with a conclusion about the possibility and necessity of endo whitening. He will examine the teeth and note the degree of darkening, talk about the rules of preparation and the procedure itself.

Indications for intracanal bleaching are:

significant damage to the tooth with hemorrhage;
lifeless dental nerve or pulpless tooth;
darkening or non-standard color of enamel;
cracks in the enamel, passing dyes;
silvering (gives a gray and black tint) or resorcinol-formalin filling (colors the enamel pink).

You can at home, although, it is worth noting, the effect will not be so visually noticeable.

Contraindications

It is impossible to carry out endobleaching:

Endobleaching is ineffective on dead tooth with an old filling.

Photo: before and after procedures

Preparation for endo whitening

Pictures of the teeth help the specialist determine the treatment regimen, identify the nature of the problem. Required complete sanitation oral cavity. Before the procedure, the patient rinses his mouth with an antibacterial solution to avoid infection.

The chosen method is necessary for an effective and gentle opening of the tooth:

The old filling is removed.
Checking the condition of the roots.
Inflamed areas are removed.

How is intracanal tooth whitening done?

Intracoronal bleaching is carried out after careful preparation and tooth cleaning. Then:

a whitening solution is poured into a clean tooth cavity;
a temporary filling is installed (it can be in place for up to a month);
a permanent filling is placed (when the result is visible and suits the patient).

The enamel of a bleached tooth is compared in color with others so that there is no sharp difference.

The price for intracanal whitening in proven clinics starts from 3 thousand rubles. There are prices from 1 thousand, and this is the main cost, because the procedures are not associated with the use special equipment and usually 1 tooth is made at a time.

Video: about intracanal teeth whitening.

Pros and cons

The advantages of this method are obvious:

there is no need to grind the tooth and remove the enamel layer;
painlessness and safety (in the absence of contraindications);
processing of one tooth without damaging the neighboring ones;
high whitening efficiency;
acceptable price for the procedure.

There are some disadvantages of endo whitening:

Increased tooth fragility.
Unsatisfactory results with individual characteristics organism.

The result can be sad if intracanal bleaching is not carried out in a special medical institution if the doctor does not have sufficient qualifications and experience in carrying out such manipulations. The procedure of endo whitening is not recommended to be carried out more than 4 times.

Darkening and loss of transparency of the tooth can follow the loss of viability of the pulp of the tooth, both before and as a result of endodontic treatment. So in the case of an acute injury, internal hemorrhage into the dentin occurs. Other causes are infiltration of the dentin with toxins from the necrotic pulp, drug staining, cements, metal posts, or an optical effect due to dehydration of the tooth. When only one of the incisors is affected, most practitioners are reluctant to go down the path of making a full restoration of the tooth. Over a hundred years ago bleaching of discolored teeth was described, where Superoxol was mainly used at a concentration of 30% to 35%.

Superoxol is highly oxidizing and can cause soft tissue burns. The doctor and assistant must be extremely careful when working with liquid to avoid getting it on skin and the patient's mucosa. To initiate the release of oxygen, a heated Superoxol solution is introduced into the cavity of the tooth where endodontic treatment was performed. Oxygen breaks down dark pigmented macromolecules into smaller light-colored molecules. Alternative Treatment is as follows: wet cotton swab in a mixture of Superoxol and sodium perborate, then place it in the tooth cavity and close tightly with a sealed filling for 4-7 days. This method is called "home whitening". The previously used technique of internal devital bleaching was based on the use of 30% hydrogen peroxide (namely Superoxol) and at the same time the resorption of the roots of the teeth in the cervical region ranged from 6% to 8%, in the case of combining the introduction of the material with its subsequent heating, the complication rate increased from 18 % up to 25%. The cause of external resorption of the root of a bleached tooth, as described above, is complex.

Internal whitening technique

Along with careful selection clinical cases internal bleaching remains an excellent treatment option.

Perform a clinical and radiographic examination of the tooth using all the usual additional diagnostic tools to determine the need for retreatment of the tooth.

In order to record the original shade, take an intraoral photograph of the tooth to be bleached with an appropriate sample of the original tooth shade on the ceramic shade chart, placed in close proximity to the tooth.

Spend preventive treatment selected tooth and neighboring teeth.

Probe around the tooth to determine the contour of the CEJ line. Apply rubber dam (including near standing teeth for color comparison) and the tooth to be whitened fix with flux at the level of the gingival margin. Prepare access to the cavity of the tooth. Remove all endodontic filling material, paste, cement and the necessary part of the restorative material, while the amount of dentin removed should be optimal. Ensure that all residual pulp and organic material (common sources of discoloration) is removed from the coronal pulp chamber. Remove 2-3 mm of filling material from the upper third of the root canal.

Rinse the prepared access to the tooth cavity with a small stream of water and dry well without dehydration.

Enter the compomer into the root canal and tooth cavity (in Centrix syringes or using a canal filler). Position the insulating pad so that it follows the contour of the cement-enamel joint (CEJ) line and is 1 mm higher than it. The thickness of the insulating material must be at least 2 mm.

Place a cotton swab on the inner lingual surface of the tooth. Using a syringe with a metal needle, carefully inject Superoxol into the prepared cavity.

Using a dry endodontic spreader or whitening stick (in its lower or middle part), heat the solution to no more than 15 degrees Fahrenheit above body temperature. Repeat if necessary.

Rinse the tooth under running water. Place a clean, dry cotton swab into the cavity of the tooth and cover with temporary filling material - Cavit.

Photograph the tooth with the corresponding color sample on the color chart.

Reschedule the patient one week later and note the discoloration after saturating the tooth with water.

Repeat the procedure if necessary. When the desired color is achieved, the tooth is filled with glass ionomer cement.

The patient is scheduled 2 weeks later for a permanent restoration. This will level out the residual oxygen, which is very important and prevent it. bad influence on adhesive materials.

home whitening technique

If the result is not achieved during internal bleaching in the dentist's chair, the technique home whitening recommended as additional method. For many years this method has been the most popular among dentists.

With careful selection of clinical cases, the home whitening technique remains quite successful to this day. Depending on the severity of the residual discoloration and the age of the patient, the physician should also use a mixture of sodium perborate and Superoxyl in addition to sodium perborate and water. Most cases of external root resorption occur in patients under 25 years of age. There is an assumption that young people have more wide dentinal tubules than older patients.

Acid etching of dentin opens the lumen of the dentinal tubules, thereby allowing penetration more bleaching agent (increasing the risk of pore resorption). Acid etching of dentine does not increase the effectiveness of teeth whitening and should therefore not be performed.

The doctor must introduce a whitening paste into the cavity and to prevent micropermeability, the tooth must be covered with a thick layer (at least 2 mm) of a temporary filling such as Cavit.

The mixture should be left in the cavity of the tooth for up to one week. The patient is warned that when the tooth becomes lighter, he should immediately visit a doctor. This procedure may be repeated several times.

The bleaching agent has short period action and its effectiveness is reduced by 50% after 6 months.

The tactics of setting the final restoration was described above.

Note that increasing the amount of bleaching agent increases the risk of cervical root resorption, which can be minimized with a well-placed insulating pad. It has been noted that teeth after whitening are less resistant to fractures.

Repeated visits to the doctor

The manifestation of signs of resorption of the tooth root is not always detected in the next 6 months after the whitening procedure. Teeth that show damage after 2 years can, in principle, be preserved. Early definition and elimination pathological changes significantly improves the prognosis.

Repair of resorptive lesions in the cervical region

Sometimes the use of calcium hydroxide helps to stop resorption on initial stage. In most complex cases, orthodontic traction or coronal lengthening may be required to access the lesion and prevent biological width disturbance.

Often in cases where aesthetics is not a primary concern, silver amalgam is the simplest and preferred material. Composite materials are used to perform the most esthetic restorations. When the quality of the restoration depends solely on adhesion to dentin, the long-term prognosis is poorer.

Dumfahrt and Moschen described a technique for repairing a resorptive lesion in the cervical region of a tooth using an indirect ceramic inlay after a crown lengthening procedure. The disadvantage of this technique is also due to the dependence of the degree of fixation of the material to the dentin. A prudent approach to the choice of restorative material in the area of the upper third of the canal will help prevent resorption of the tooth neck.

Vital teeth whitening

This category includes home whitening (day and night) and office whitening products. The decrease in interest in this technique lies in the fact that before the bleaching procedure, it is necessary to carry out clinical examination and prophylactic treatment of the patient. First, it is necessary to treat the soft tissues of the oral cavity, as well as replace low-quality restorations and fill teeth with carious lesions. Before the treatment, it is desirable to take a photograph of the patient's teeth with a sample of the color chart.

Patients with visible ceramic or composite restorations should be informed that these restorations cannot be bleached and may therefore become more visible. Patients should also be encouraged to continue treatment and need replacement. existing restorations only after bleaching. Patients who are planning to have veneers or full ceramic restorations, external bleaching should be recommended in order to reduce the layer of opaque that masks the underlying tooth tissue, allowing the dental technician to produce a more transparent and natural restoration. Tooth preparation should be delayed for 2-3 weeks after the whitening procedure, which will allow rehydration and full recovery of the teeth, and also allow the release of residual oxygen, which has a negative effect on the fixation of structures.

Whitening agents

Being represented in various options gels and pastes, hydrogen peroxide remains, as before, the most effective bleaching agent. The concentration of hydrogen peroxide is from 30% to 50%. Overnight whitening gels are available in 5% to 22% sodium perborate (sodium tetraborate peroxide), which is more effective than 2-5% hydrogen peroxide solution (but only for a short period of time). This shows that the oxidative efficiency of hydrogen peroxide in alkaline solution much higher than in acid.

Preliminary preparation of the patient:

The patient should be covered with a special protective cape to prevent contact of the bleaching agent on hands, skin or clothing.

The patient is wearing goggles.

If pain or any discomfort occurs, it is necessary to maintain feedback with the patient, so local anesthesia does not apply.

To protect the tissues from the side of the lip and tongue, before fixing the rubber dam, a light-curing material - Oraseal or Orabase paste should be freely applied.

Next clinical stage is the imposition of a rubber dam fixed to certain teeth with the help of dental floss. Oraseal can also be applied to existing amalgam restorations to reduce heat from the light source. The holes made by the perforator should be smaller than usual and placed more anteriorly in order to adequately cover the proximal gingiva.

Before applying the rubber dam frame, Vaseline is applied to the patient's lips. A wet wipe is placed over the patient's lips to prevent thermal injury from the heat lamp. During the procedure, it is very important to re-moisturize it.

Pre-treatment of teeth

Most authors agree that enamel etching before bleaching does not practically enhance its effect and leads to irregularities, tissue loss from the enamel surface (namely, 10 µm when treated with pumice and 20 µm after etching). In order to restore the lost gloss to the enamel, after bleaching it is polished with diamond paste. During this procedure, a 20 to 30 micron layer enriched with enamel fluorine is removed. In practice, there are unsuccessful cases of whitening without preliminary etching of the enamel. Before applying a whitening agent, the doctor must ensure that all foreign matter, such as Orabase, petroleum jelly, or varnish, is removed from the surface of the teeth. The next clinical step is cleaning the teeth with a pumice stone and thoroughly rinsing the mouth. Areas of cervical erosion, chipping or abrasion within the dentin can be protected with adhesive.

In most cases, practitioners need to follow the instructions for use, and freely apply the gel or paste to the surface of the teeth with a thickness of 3-4 mm without excessive pressure. In the case of hypoplasia or fluorosis, where spots or streaks occur, the doctor will modify the application method accordingly. Some teeth may be darker than others. As a rule, yellow-brown staining responds better to bleaching than blue-gray, the translucent incisal edge brightens faster than the cervical region of the tooth crown. This is due to the different thickness of the dentin.

Traditional vital whitening

The traditional whitening protocol requires the use of a special whitening lamp. After applying the hydrogen peroxide solution to the surface of the teeth, the lamp is set at a distance of 12-14 inches (corresponding to 30-35 cm) from the patient's face for 20-30 minutes. Most importantly, this does not require the doctor or assistant to move the light source from tooth to tooth.

Despite the fact that the heating source has a fixed temperature that does not cause thermal injury dental pulp, many patients complain of discomfort from radiant heat on the skin surface. After the teeth are isolated with a rubber dam, a single-layer disposable gauze pad is applied to the surface of the teeth, since Superoxol is a liquid and the gauze acts as a tampon and reservoir to keep this solution in close proximity to the teeth. A two-layer gauze pad, respectively, is placed over the rubber dam, covering lower lip and preventing the solution from entering the oral mucosa. Other devices that control the heating temperature are used with special metal tips. various forms and sizes for whitening in the area of various grooves and recesses.