Bleaching
Etiologi
Pewarnaan Instrinsik
Pre Eruptive
- Penyakit
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Alkaptonuria
- Dark brown pigmentation
- Gigi sulung
- Gangguan autosomal recessive
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Hematological disorder
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Erythroblastic fetalis
green, brown discoloration
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Congenital poryphyria
red, brownish dicoloration
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Sickle cell anemia
hampir sama erythro namun lebih parah
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Gangguan enamel dan dentin
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Gangguan Enamel
Gangguan yang terjadi pada tahapan histodiferensiasi, aposisi, dan kalsifikasi selama tahapan pertumbuhan gigi
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Amelogenesis imperfecta
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sensitivity
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no dark brown
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high risk caries
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enamel loss
enamel hypokalsifikasi
enamel hypoplasia
enamel hypomaturasi
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Fluorosis
bercak warna
- No sensitivity
- Dark brown
- Low risk caries
- No email loss
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Mineral and vitamin deficiency
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Chromosomal abnormalities
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Gangguan Dentin
- Dentinogenesis imperfecta
- gangguan perkembangan autosomal dominan
- gigi berwarna biru keabuan atau kuning kecoklatan dan tembus cahaya
- shiny, bright
- Erythropoietic porphyria
- Hyperbirulinemia
- Dentinogenesis imperfecta
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- Obat-obatan
- Tetracycline and Minocycline (Antibiotics)
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Klasifikasi
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First degree/ Mild
Yellow to gray
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Second degree/ Moderate
Yellow brown to gray dark
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Third degree
Blue gray/ black
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Fourth degree
So dark, perawatan bleaching sudah tidak efektive
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Faktor pewarnaan
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Waktu pemberian
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Rentang lamanya pemberian
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Type dari teracycline
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Dosis
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Mekanismenya adalah tetrasiklin akan terikat dengan kalsium dan membentuk senyawa kompleks berupa tetrasiklin kalsium ortofosfat. Jaringan gigi yang ...
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- Tetracycline
- Fluorosis
- Tetracycline and Minocycline (Antibiotics)
Post eruptive
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perubahan pulpa
- bakteri
- mekanik
- kimia yang mengiritasi pulpa
→ nekrosis pulpa → diskolorasi
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trauma
pendarahan pulpa → RBC/ Sel darah merah lisis dan pembebasan iron sulphide → masuk ke dalam tubuli dentin → Gray discoloration (Abu2)
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hiperkalsifikasi dentin
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karies gigi
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material restorasi
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usia
Pewarnaan ekstrinsik
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Faktor luar
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Plaque
Yellowish appearance
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Makanan
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Minuman
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Tobacco
Black appearance
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OH buruk
Green, brown, orange stain
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Kimia
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Chlorhexidine
yellowish to brownish natural
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Pewarnaan metal
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Copper
green stain
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Iron
brown stain
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Mercury
greenish black stain
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Nickel
green stain
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Silver
black stain
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Bleaching
- Bahan Bleaching
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Carbamide Peroxide (CH6N2O3)
Home bleaching 5-20%
In office 35-40%
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Hidrogen peroksida
- yang biasa digunakan 30-35% (superoxol, perhydrol)
- dipakai hati2 karena tidak stabil, kehilangan oksigen cepat dan bisa meledak (oksidator)
- kaustik dan dapat membakar jaringan
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Natrium perborat
- Stabil dalam keadaan kering
- tetapi jika ada asam, air hangat atau air akan berubah menjadi natrium metaborat, hydrogen peroksida dan oksigen dalam bentuk onasen
- Preparat natrium perborat yang tersedia adalah monohidrat, trihidrat dan tetrahidrat
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Karbamid peroksida
Hidrogen proksida urea dengan konsentrasi antara 3%-15%
- mempengaruhi kekuatan ikatan resin komposit serta penutupan tepinya
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Piroson
- Merupakan cairan hidrogen proksida 25% dalam eter
- Mudah menguap, bau merangsang, rasa mual
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Bleaching Technique
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Vital Teeth (Bleaching Externa)
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Home bleaching/ Nightguard Vital Bleaching
- Bahan
- Carbamide peroxide 10%
- Carbamide peroxide 15%
- Hydrogen peroxide 1-10%
- Side effect
- Gingival irritation
- Soft tissue irritation
- Metallic taste
- Tooth sensitivity
- Bahan
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In-Office Bleaching
- Indication
- Superficial stain
- Moderate to mild stain
- Contraindications
- Tetracycline stain
- Severe discoloration
- Extensive restoration
- Extensive caries
- Patient sensitive
- Advantages
- Patient preference
- Less time
- patient motivation
- protection of soft tissue
- Disadvantages
- More expensive
- Dehydration teeth
- More chair time
- Discomfort
1 cycle 10-15 mnt→ dilight cure → membuat porositas
- Indication
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Microabrasion
- Procedure
- Clinically evaluate the teeth
- Clean teeth with rubber cup and prophylaxis paste
- Apply petroleum jelly to the tissue and isolate the area with rubber dam
- Apply microabrasion compound to area in 60 seconds interval with appropriate rinsing
- Repeat the procedure if necessary. Check the teeth when wet
- Rinse teeth for 30 second and dry
- Apply topical fluoride to the teeth for 4 minutes
- Re-evaluate the color of the teeth. More than one visit may be necessary sometimes
- Procedure
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Non Vital Teeth (Bleaching interna)
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Thermocatalytic Bleaching
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Procedure
potong 1-22 dibawha gingica crest
- Isolate the tooth to be bleached using rubber dam
- Place bleaching agent (superoxol and sodium perborate separately or in combination) in the tooth chambar
- Heat the bleaching solution using bleaching stick/ light curing unit
- Repeat the procedure till the desired tooth color is achieved
- Wash the tooth with water and seal the chamber using dry cotton and temporary restoration
- Recall patient after 1-3 weeks
- Do the permanent restoration of tooth using suitable composite resin afterward
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Side effect
- external cervical root resorp
- irritation to cementum and the periodon
tal ligament, possibly from the oxidizing agent incombination with heat.25
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Walking Bleach/ Intracoronal Bleaching
harus dirawat PSA, kasi GIC (cegah bocor)
- indication
- dicoloration of pulp chamber origin
- moderate to severe tetracyctline staining
- dentin discoloration
- discoloration not agreeable to extracoronal bleaching
- contraindication
- superficial enamel discoloration
- defective enamel formation
- presence of caries
- unpredictable prognosis of tooth
- procedure
- removal of coronal gutta-percha using rotary instrumetn
- placement of guttapercha barrier over gutta percha
- Placement of bleaching mixture into pulp chamber sealing a cavity using temporary restoration
- sodium perborate with increasing concentrations of hydrogen peroxide (3% to 30%) instead of water.
- indication
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Inside/ Outside Bleaching
- advantages
- more surface area for bleach to penetrate
- treatment time in days rather than weeks
- decreases the incidence of cervical resorption
- uses lower concentration of ccarbamide peroxide
- disadvantages
- noncompliant patients
- over-bleaching by overzealous application
- chances for cervical resorption is reduced but still exist
- procedure
- asses the obturation by taking radiographs
- isolate the tooth and prepare the access cavity by removing gutta-percha 2-3mm below in cementoenamel junctuin
- place the mechanical barries, clean the access cavity and place a cotton pellet in the chamber to avoid food packing into it
- Evaluate the shade of tooth
- Check the fitting or bleaching tray and advise the patient to remove the cotton pellet before bleaching
- Intruction for home bleaching. Bleaching syringe can be directly placed into chamber before seating the tray or extrableaching material can be placed into the ray space corresponding to tooth with open chambaer
- After bleaching, tooth is irrigated with water, cleaned and again a cotton pellet is placed in the empty space
- Re-assesment of shade is done after 4-7 days
- When the desired shaide is achieved, seal the access cavity initially with temporary restoration and finally with composite restoration after atleast two weeks
- advantages
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Closed chamber bleaching/ extracoronal bleaching
In this technique, insted of removing the existing restoration, the bleaching paste is applied to the tooth via bleaching rray
- Indication
- Totally calcified canals in a traumatized tooth
- As a maintenance bleaching treatment several years after initial intracoronal bleaching
- Treatment for adolescents with incomplete gingival maturation
- A single dark nonvital tooth where the surrounding teeth are suffieciently light where other vital teeth are also to be blached
- Indication
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Laser assisted bleaching
- Argon Laser
- CO2 laer
- diode laser
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Effect of bleaching
- Toxicity
- carcinogenity
- cervical resorption
- mucossal iritation
- tooth hypersensitiviy
- effect on material restorastion
- effect of
- pulp
- dentin
- cementum
- enamel → Carbamide Peroxide 10%→ decreased of enamel hardness→ fluoride→ remineralization
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