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a report by
D r Va n B. H ay wo o d , D M D
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Nightguard Vital Bleaching: Indications and Limitations
may reduce sensitivity. However, more material is used Figure 1: Cast trimmed such that no vestibule is
per application, and more time is required to fabricate present and a hole in the center allows for better
the tray. Scalloped trays are not as important now that adaptation of the soft tray material in the vacuum-
the softer tray materials are available, and non-scalloped forming machine.
trays provide a better seal and are more comfortable, as
well as being easier to fabricate. However, higher
concentrations of peroxide can cause gingival irritation.
A single tooth tray consists of a non-scalloped, no
reservoir tray design with the tooth mold removed on
either side of the tooth desired to be bleached. If a
sticky bleaching material is used, a ‘temporomandibular
disorder’ or ‘TMD’ tray design will only cover the facial
surfaces of the teeth and not involve the occlusal
contacts of the mouth. Although there are many tray
designs, this author prefers the non-scalloped tray with
no reservoirs or spacers as first tray of choice.
Indications
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Figures 3: Prior to bleaching, the patient is informed of primary deterrent to bleaching, and occurs with all
the defects on the central incisor. products. There is a greater rebound after bleaching
with higher concentrations, and there is very little
research on the safety and effects on the tooth.
Generally, higher concentrations should only be used at
the request of the patient, when they have been
informed of the side effects and cautions. Regardless of
the concentration or product, all bleaching will
eventually reach the same color outcome.
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Nightguard Vital Bleaching: Indications and Limitations
inherited. If the teeth remain translucent after Figure 5: Prior to bleaching, the color of the teeth is
bleaching, treatment options include bonding darker than the sclera of the eye.
composite to the lingual to block the light if the
occlusion allows, or facial composites or veneers.
Patients should be fully informed of the cost of the
potential additional restorations prior to bleaching.
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Figure 6: After bleaching, there is a better color match a time constraint for an upcoming event, since some
between the teeth and the sclera of the eye. patients cannot remember or easily see an obvious color
change. Digital photographs are essential to esthetic
dental treatment.
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Nightguard Vital Bleaching: Indications and Limitations
margins. Bleaching can also be used to remove these Figure 8: Before bleaching, the patient has an
stains prior to resealing the margins with a dentin unattractive smile, but does not see the problems.
bonding agent.
Sensitivity
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