INTERNATIONAL JOURNAL OF RESEARCH IN DENTISTRY

Lt Col Vikas Dhir / IJRID Volume 4 Issue 5 Sep.-Oct. 2014
Available online at www.ordoneardentistrylibrary.org
ISSN 2249-488X
Case – report
INTERNATIONAL JOURNAL OF RESEARCH IN DENTISTRY
POWER BLEACHING OF TEETH FOR AESTHETICS USING DIODE LASERS: A CASE SERIES
Lt Col Vikas Dhir
Military Dental Centre BEG, BEG & Centre, East Kirkee, Pune -411003
Received: 14 Aug. 2014; Revised: 15 Sep. 2014; Accepted: 27 Oct. 2014; Available online: 5 Nov 2014
ABSTRACT
The pursuit of whiter teeth and use of bleaching techniques have been well documented since the nineteenth century.
Bleaching improves the colour of the teeth and is one of the least expensive aesthetic treatment options. Various modalities
have been used for bleaching vital teeth. Power bleaching may cause bleaching of teeth in a single visit in-office procedure to
produce quick results, safe and more reliable. Laser assisted power bleach is one of the effective latest options for treatment of
discoloured teeth.
Two cases of Powered bleaching of teeth for aesthetics has been described.
Key words- Power bleaching, Diode laser, Aesthetics
INTRODUCTION
The pursuit of whiter teeth and use of bleaching techniques have been well documented since the
nineteenth century. Bleaching improves the colour of the teeth and is one of the least expensive aesthetic
treatment options. Chemical used for bleaching vital teeth have included oxalic acid, ether peroxide, hydrogen
dioxide, hydrogen peroxide. In early twentieth century, 35% H2O2, was used as effective bleaching agent.
Later, 10% carbamide peroxide solution in nightguard became popular by 1990s.
Now, Power bleaching originated by Abbot is becoming popular as it may cause bleaching of teeth in a single
visit in-office procedure to produce quick results, safe and more reliable. Laser assisted power bleach is one of
the effective latest options for treatment of discoloured teeth.
Two cases of Powered bleaching of teeth for aesthetics has been described.
Clinical case -1:
A 25 years old female patient came to Dept with chief complaint of discoloured teeth and desired
treatment for the same at the earliest as she was getting married within 25 days. On history she revealed that her
teeth were discoloured since childhood. Further, revealed she was given strong medication while she sick
during childhood. She was non-smoker, non-alcoholic and occasionally takes 1 -2 cups of tea per day. She was
systemically healthy. On examination, there was generalized yellowish discolouration of teeth with some
whitish and brownish stains. Gingiva was healthy. Few extrinsic stains were present. There were no restorations
on anterior teeth. Teeth were vital. IOPA x-ray in anterior teeth did not reveal any pathology.
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Diagnosis- Generalized moderate discolouration of teeth due to tetracycline staining.
Treatment plan- Oral prophylaxis and polishing in Phase-I. Laser bleaching using Diode Lasers 810nm in
Phase-II followed by re-evaluation at 1, 2 weeks and 1, 6 months.
Method /Procedure:
Treatment Protocol followed was as described1. Patient was explained the procedure and informed consent was taken.
2. Prophylaxis and polishing with pumice and water was done prior to any bleaching procedure.
3. The cheek and tongue retractor were positioned and the field was kept dry.
4. Gingival protection material/dam along with the margin of gingiva covering approximately covering 1mm
of the tooth surface in the cervical region was applied and polymerized using light cure gun.
5. POLA-OFFICE H2O2 bleaching agent was prepared and carefully placed on the enamel using applicator
tips.
6. Diode laser 810nm (Smile doctor, Italy) was used for the procedure. Laser safety protocol was established
and monitored. The patient and staff wore the special glass goggles for protection. High volume suction was
used during the procedure. 810 nm Diode laser was used as per instructions given by manufacturer. Special
Laser handpiece for bleaching was used.
7. First maxillary anterior six teeth were done. Then mandibular anterior six were done. We started from
maxillary central incisors and moved laterally towards premolar 1st. Irradiated every tooth for30sec at
average power settings of 1W. Anterior six teeth can also be done together using 5W power for 5 minutes.
Constantly moved laser tipso that laser energy is not concentrated /directed at one place. If sensitivity is
increased reduce the power settings.
8. We Wiped off the used bleaching agent with wet gauze/cotton and reapply fresh material and reactivate the
laser. You can try 2-3 times till there is desirable appropriate shade. Apply non staining Fluoride solution.
And used Laser again.
9. We confirmed new shade with Vita shade guide and took a photograph for record. There was difference of 3
shades in one sitting.
10. After 1 week, one repeat sitting was carried out.
Instructions to patient1.
To avoid tea, coffee, red wine, mouthwash and excessive colouration in food.
2.
To report back if sensitivity was present.
3.
To follow up regularly and was advised that one sitting for bleaching may be required after 1 year.
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ResultsPatient was reviewed after 1 week, 2 weeks and then after 45 days. There was no pain, sensitivity or
rebound staining. Prognosis was good. Patient was very satisfied with the procedure and the results.
Clinical case-2
A 25 years old male patient with generalized physiological hyperpigmentation and discoloured teeth due
to fluorosis was managed by Depigmentation of gingival using Diode lasers at 1W,CW, 300um, contact mode.
Powered bleaching using same technique as described above for 14-24 and 34-44 region using 5W power.
Results were very satisfactory.
Discussion:
Bleaching of intrinsic or extrinsic teeth stains has continued to increase in popularity as an effective,
non-invasive method to alter the shade of discoloured teeth [1]. To accelerate the bleaching process, heat
activation can be used and several safe techniques have been improved. One accepted procedure is to use a
peroxide compound placed on the tooth surface that bleaches the intrinsic tooth pigments to a lighter hue.
Adding heat, light, or laser energy to the peroxide compound may accelerate this process [2].Office bleaching
procedures use different types of energy sources to increase the rate of chemical release of bleaching radicals
[3].
The objective of laser bleaching is to achieve ultimate power bleaching using the most efficient energy
source while avoiding any adverse effect. Argon, CO2, and 980 nm GaAlAs diode laser wavelengths are cleared
by the FDA for tooth whitening, and other laser radiation systems have been tested.
Laser assisted bleaching produces the whitening results quickly in a single visit and can be used in
patients requiring bleaching but which cannot complete the home bleaching process for various reasons, such as
time required, discomfort or irritation from wearing the trays, or unpleasant taste and gingival or stomach
irritations from the bleaching gel.
Various authors have shown varied results with Lasers for bleaching. Wetter in a study comparing
bleaching agents using no light source, a light emitting diode and diode laser, showed best overall results with
laser activation of the bleaching agent.[4]
In office bleaching, KTP, Argon, and Diode laser have been preferred. KTP and the Argon laser are also
completely safe at these wavelengths for both vital and non-vital tooth structures, and are feasible for photobleaching [5-7].
Walsh and Liu demonstrated that the whitening effect of photochemical KTP laser bleaching is more
effective than diode laser photo-thermal bleaching[8]. Zhang et al. [9] studied the whitening efficacy of LightEmitting Diode (LED), diode laser, and KTP laser irradiation in dental bleaching and the author suggests that
the KTP laser is effective in brightening teeth. LED and the KTP laser induced a safer pulpal temperature
increase when assisted with Hi-Lite bleaching gel.
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Diode laser absorption in water, tooth mineral, and pigments is low but in dental hard tissue is high,
indicating that pulp damage from a temperature increase can occur. Most of the studies on diode lasers show
that the bactericidal effect of this laser is perfect, and that it is commonly used for in-office bleaching
treatments. Study by Dostalovaalso suggests that selective diode laser radiations can reduce the time for
bleaching without surface modification. [10]
Various advantages of laser bleaching include increased resistance to tooth structure to mineral loss
from organic acids involved in caries, reduced toxic effects of hydrogen peroxide and its derivatives. Diode
laser can be used for powered bleaching keeping in mind its limitation of temperature rise during procedure if
used in high power and for increased time continuously. In the present case, Diode laser assisted bleaching has
given the desired aesthetic result.
ConclusionDental lasers contribute to the field of tooth bleaching. Currently, the lasers has been proven to be a safe
method and the most valuable energy source for power bleaching with simple and short application in the
office.
References –
1.
Sulieman M, Addy M, Rees JS (2005) Surface and intra-pulpal temperature rises during tooth bleaching:
an in vitro study. Br Dent J 199: 37-40.
2.
Buchalla W, Attin T (2007) External bleaching therapy with activation by heat, light or laser--a
systematic review. Dent Mater 23: 586-596.
3.
Hein DK, Ploeger BJ, Hartup JK, Wagstaff RS, Palmer TM,Hansen LD. In-office vital tooth
bleaching—what do lightsadd? Compendium of Continuing Education in Dentistry2003;24:340–52
4.
Wetter NU, Barroso MC, Pelino JE (2004) Dental bleaching efficacy with diode laser and LED
irradiation: An in vitro study. Lasers Surg Med 35:254-258.
5.
Garber DA (1997) Dentist-monitored bleaching: a discussion of combination and laser bleaching. J Am
Dent Assoc 128: 26S-30S.
6.
Vanderstricht K, Nammour S, De Moor R (2009) [“Power bleaching” with the KTP laser]. Rev Belge
Med Dent(1984) 64: 129-139.
7.
Baygin O, Korkmaz FM, Arslan I (2012) Comparison of Activated Bleaching Effects of Various Laser
Systems: An In vitro Study. Dentistry 2:139:2-6.
8.
Walsh LJ, Liu JY, Verheyen P (2004) Tooth Discoloration and Its Treatment Using KTP Laser-assisted
Tooth Whitening. J Oral Laser Applications 4: 7-21.
9.
Zhang C, Wang X, Kinoshita J, Zhao B, Toko T, et al. (2007) Effects of KTP laser irradiation, diode
laser, and LED on tooth bleaching: a comparative study. Photomed Laser Surg 25: 91-95.
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10.
Dostalova T, Jelinkova H, Housova D, Sulc J, Nemec M, et al (2004) Diode laser-activated bleaching.
Braz Dent J 15: SI3–S18.
Case-1: Powered bleaching using Diode lasers
Fig: 1. Pre - op photograph
Fig.3: Bleaching of Maxillary anterior teeth
Fig. 5: Post-op photograph close up
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Fig: 2. Gingival dam application
Fig.4:Bleaching of Mandibular anterior
Fig. 6: Post-op photograph
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Lt Col Vikas Dhir / IJRID Volume 4 Issue 5 Sep.-Oct. 2014
Case-2 Depigmentation & Powered Bleaching using Diode lasers
Fig 7: Preop photograph
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Fig 8: Post-op photograph
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