Syringe-delivered carbamide peroxide (cp) in concentrations of 10%cp to 16%cp have been in use by dental professionals since 1990. It has been established that the efficacy of a bleaching treatment is a product of time (the length of time the bleaching material remains in contact with the teeth), concentration (the percent of active ingredient), and to a certain extent viscosity (determines the rate at which bleaching material leaches out of the tray or is broken down by saliva). It has been found that the higher the concentration of active ingredient, all other factors remaining the same, the faster the bleaching process will be and the deeper the lightening realized.
Life-Like Cosmetic Solutions offers at-home, carbamide peroxide concentrations of 10%, 15%, 20%, and 30%. The 30% will allow many bleaching treatments to be complete within about seven days of treatment per arch, as opposed to the more typical ten to twelve days for the 10% and 15% solutions. The higher the percentage of carbamide peroxide will reduce the bleaching process time for normal staining. This will provide a more satisfying result for those patients with particularly heavy staining.
With 30% use a .040 clear, soft, Ethyl Vinyl Acitate (EVA) material. While the stent is still on the model, draw a line with a ball point pen at the junction of the soft tissue and the teeth – facially and lingually. Take the stent off, then trim- using this line as the cutting guide. Make sure that the bleaching tray is scalloped so the tray does not overlap the soft tissue.
Demonstrate the calibrations of the Seal-Syringe to patients in the office and be sure to instruct them to place no more than 1/4 cc of bleach material in the tray. Have patients apply 1/4 cc of bleaching material into the tray and keep the tray in their mouth for 20 to 30 minutes with 30% cp bleach. Lower concentrations may require longer application times. Suggested applications are twice per day bleaching upper and lower arches simultaneously.
With 30%cp, it is expected that this material’s rate of sensitivity will remain in step with the general sensitivity rate found with lesser concentration bleaching. Should the patient experience pulpal sensitivity have them discontinue treatment for 24 to 48 hours, then have them resume treatment with one half the original treatment application time. Then if no sensitivity one can incrementally increase treatment times.
With lower concentration gels (10%cp and 15%cp) one can overlap the soft tissue. With these lower concentrations gels one generally does not have to worry about irritating the soft tissue. If fact holding low concentrations of carbamide peroxide gels at the gingival sulcas has a positive bio-oxidation effect.
On older patients with exposed dentin the peroxide can penetrate into the pulp too quickly, causing sensitivity. Should this occur one could trim the trays so to not hold the bleaching gel onto the dentin.
For best results, keep all peroxide gels refrigerated for longest shelf-life (more than a year if refrigerated).