Presented here are three In-Office options with summarized instructions for each. Included are:
- Waiting Room Directions – 44% Carbamide Peroxide
- Vital Directions – 35% Hydrogen Peroxide
- Non-Vital Direction – 35% Hydrogen Peroxide
Waiting Room Directions
Use in a stent for the UPPER ARCH ONLY. It is used in situations where a patient needs a psychological boost to help him/her to follow through on the total bleaching program, or needs an immediate reduction in staining as a prelude to at-home bleaching.
- Form a stent on vacuum-former and carefully trim it off the soft tissue.
- Express evenly about 1/4 cc of material into the tooth indentations.
- OPTIONAL: Evenly disperse two drops of #9 ACCELERATOR over 44% bleaching material in stent.
- Place stent. A small amount of material may foam out. Wipe excess from labial vestibule with a dry 2X2. Wait about 30 seconds and wipe mucosa again with slightly moist 2X2. Place dry 2X2 in labial vestibule to further prevent gel from contacting soft tissue. Leave passively in patient’s mouth (in dental chair or waiting room) for up to 30 minutes.
Vital Directions – 35% Hydrogen Peroxide
- Use appropriate protection:
- Patient: eye wear, rubber dam muco protectant, and ligation
- Staff: Gloves, eyewear, gown
- Clean the teeth: Pumice or prophy paste, wash and dry.
- Lightly paint teeth with #9 Enhancer.
- Bleach teeth (3 min. 5 times is considered one treatment).
- Express approximately 1/2 cc into dappen dish.
- Use fine brush to cover:
- incisal – lingual surfaces.
- EXCEPTION – With paint-on dam – cover facial surfaces only.
- NOTE – do not etch prior to bleaching.
- Remove bleach:
- Suction – use small surgical tip.
- Alt. – Wipe incisally w/dry 2×2.
- Remove soft tissue protection.
- Recall; 4 – 5 days post treatment, evaluate for potential additional treatment.
Non-Vital Direction-35% Hydrogen Peroxide
I. Check endodontics –
B. Do not bleach if negative signs or symptoms
II. Protect soft tissue
III. Open tooth:
A. Remove discolored dentin
B. Reduce gutta-percha 2-3 mm below gingival margin.
IV. Clean the tooth (OPTIONAL – Chlorhexidine soap with or without pumice)
V. Seal gutta percha to prevent micro-leakage with glass ionomer or bonded composite (white).
VI. Bleach the tooth (internal and external)
A. Bleaching Gel
- Thin coat of #9 Enhancer inside and outside (optional)
- Fill chamber, cover external surface
- Repeat every 3 minutes for 5-10 applications (20-40 minutes total treatment time)
- Temporize or seal permanently.
B. “Walking” Bleach (optional) Place equal mixture 35% Hydrogen Peroxide gel and sodium perborate, or 35% Hydrogen Peroxide2 gel only. Seal with composite. Reappoint in 2-5 days.
C. Optional combine — A, then B
VII. Place final restoration after etching prepared surfaces (both internal and external).