Dalia Jibreel

Dr. Awni

24 part 1

28/4/2015

Conservative 3

Lecture No.

Date:

Doctor:

Done by:

Sheet Slides

Hand Out

University of JordanFaculty of Dentistry

Fourth year – 2nd semester 2014-2015

Dalia JibreelCons III Sheet No24 part 1 Date:28/4/2015

Designed by: Hind Alabbadi

Dalia JibreelCons III Sheet No24 part 1 Date:28/4/2015

Bleaching

The doctor showed us a picture for a patient with badly discolored and destructed teeth due to caries.

Usually patients come to our clinics to know the causes for the discolorations , way of treatment , how much time it takes and the final result of treatment.

Discoloration either happen during odontogenesis or at last of odontogenesis . During odontogensis >>> disturbances in tooth formation and deposition of matrix and

calcification that leads to change in quality and quantity of tooth structure : Amelogensis imperfecta : form of enamel hypoplasia Dentiongenesis imperfecta Enamel hypoplasia : caused by defective enamel matrix formation with a deficiency in the cementing substance.

amelogensis imperfecta

Dalia JibreelCons III Sheet No24 part 1 Date:28/4/2015

dentinogensis imperfecta

o During odontogenesis >>> discolorations here are stains like florosis , tetracycline >>> Intrinsic discolouration.

o After odontogenesis >>> those discolorations either from pulp cavity due to trauma (white spots ) or necrosis.

florosis tetracycline . staining

So we have two types of discolorations : intrinsic and extrinsic discoloration.

Aetiology of tooth discolouration:

a)Extrinsic discolouration:

Plaque and Calculus

Chromogenic bacteria

Dietary origin (tea, coffee, coloured food… etc)

Smoking : it depends on the local factors not the prevalence and incidence >>> it leads to black discoloration on the cervical and lingual areas.

Chlorhexidine MW

b) Intrinsic discolouration: Amelogenesis and dentinogenesis imperfecta

Dalia JibreelCons III Sheet No24 part 1 Date:28/4/2015Tetracycline staining

Fluorosis

Trauma

Ageing

Restorative materials (amalgam)

Caries

Toothwear

Systemic disease: Haematological, porphyria, alkaptonuria

The doctor showed us a picture for patient with severe discoloration due to highly exposure the metal and acids (he works at battery factory).

Cofactors that help in the prevalence and incidence of stains and discoloration:

1. Roughness of enamel surface : the more roughess more stains and discolorations.2. Dental plaque : more plaque more discolorations3. Overlapping 4. Oral hygiene5. Composition of the saliva : some people take chemotherapy and drugs that affect the amount of

saliva and its viscosity.

Treatment of extrinsic discolorations:

1. Cleaning and polishing2. restore carious teeth and failure restorations3. bleaching

florosis causes multiple floride white spots opacities on enamel but there’s opacities and white spots related to non-floride white opacities

The criteria for differention is :Non-floride enamel opacities : appears when light is perpendicular to the enamel surface , well defined margins (commonly introduced with hay fever in children during deposition and formation of enamel >>> hay fever stops enamel matrix deposition >>> leading to enamel opacities with clear margin )Florosis :thin irregular opaque streaks or fleks >>> no clear margins on enamel.

amelogensis imperfect (type of enamel hypoplasia) and dentienogensis imperfectaCauses of enamel hypoplasia : Hereditry factors causing malfunction of the proteins in the enamel leading to amelogenesis imperfect

(Hypocalcification).

Dalia JibreelCons III Sheet No24 part 1 Date:28/4/2015

tetracycline staining :It affects patients at 2nd month of pregnancy till 8 years old .Tetracycline affects the tooth structure , affect anteriors and 1st molarsStaining on molars lighter in color but on anteriors its darker.

fluorosis : mottling of tooth enamel, is a developmental disturbance of dental enamel caused by the

consumption of excess fluoride during tooth development. This happens when the floride level is above the ideal concentration in water (ideal 0.7 - 1.2 mg /L )

1. when the fluoride is above ideal >>> Fluorosis.2. when below the ideal level >>> increase incidence of caries.

appears as white spots , brown color , in severe cases associated with pitting surface. Patients with fluorosis as a treatment we don’t go for composite veneers because its

translucent >>> the best choice is bleaching (fluorosis responds well to bleaching more than tetracycline stains) , we also can do combined treatment (bleaching and veneers) .

non-fluoride enamel opacities :Disturbances in deposition of enamel matrix during tooth formation appears like white spots and yellow color In central incisors very clear margin when light is perpendicular to the tooth.

# how it can be corrected ??First we look for the cause then we look for the way of treatment .#treatment options :1. Removal of external stains , finishing and polishing.2. Bleaching technique.3. Operative technique >>> crowns and veneers.4. Combined treatment : bleaching and veneers.

Bleaching is the conservative and alternative for crowns.

# veneers : a layer of a tooth covering material covers the defected area.Either direct or indirectEither subgingival or eqigingival or slightly above gingiva (depends on caries and discoloration).Either shorter than incisal edge or on the incisal edge or overlapping the incisal edge (Dr.Awni prefer the overlapping one because it gives more retention , also esthetic and appearance also is more).

Dalia JibreelCons III Sheet No24 part 1 Date:28/4/2015

Bleaching

Bleaching : is the whitening and lightening of the teeth by using :

1. high concentration material (hydrogen peroxide) or

2. low concentration material (carbamide peroxide) that we use as home bleaching or

3. sodium perforate that we use in non-vital bleaching (walking bleaching).

Non-vital bleaching >>>used internally to non-vital tooth/endo treated tooth.

Most requested procedure to treat discoloration , more than 100 million person in America whiten their teeth either at office or home bleaching .

96% of these people use home bleaching , 98% are very satisfied. Research in 2010 showed that it cost 15 billion dollar for all the treatment so manufacturers

start to take care of this thing >> they start selling it in the market (bleaching kit). Some people use the home laser bleaching technique The doctor prefer the office and home bleaching , and recommend sometimes the laser one

but without using the disposable ring. The night guard that we use for the home bleaching must be comfortable and fit to the

patient. Anything we use must be fit with the teeth because we use materials that can do irritations

and burn to the gingiva. Bleaching either external or internal bleaching .

BEST REGARDS

DALIA JIBREEL