Hereaus 360 Newsletter
Lee Ann Brady DMD
Recently following a presentation I gave on Esthetic preparation design a new graduate approached me with a question. “Isn’t there a material that will let me prep conservatively and still get the esthetic results I want? I hate cutting off all that tooth structure?” I knew he was hoping to hear about some great new restorative material. I had an answer he wasn’t expecting, “Absolutely, 38% Hydrogen Peroxide”.
That young dentist was asking the same question I had asked myself a few years ago before I incorporated in office bleaching, sometimes followed by trays at home, as part of my restorative treatment plans. My goal is to satisfy the esthetic needs of my patients as conservatively as possible. The ideal clinical situation to meet these goals is when the teeth to be prepared are no more then two shades darker then the final restorations.
We utilize in office bleaching as a restorative adjunct routinely, one of the first ways it brings beautiful esthetic results and being conservative together is by minimizing the number of teeth we have to prepare. A key piece of an esthetic evaluation is looking at smile zone, what teeth are visible during a full smile or natural laugh. Many patients show their premolars, and even molars in a full smile, and want to make changes to their front teeth. If one of the patient’s goals is to brighten their smile and go lighter, and not all of the teeth need alterations in size, shape or contour, in office bleaching goes on the treatment plan as a first step.
More complex restorative cases begin with in office bleaching, to move the existing shade of the teeth, ultimately the prep shade, as close as I can to the final restorative shade. This allows me the freedom to choose from a range of restorative materials, without being limited by their ability to mask underlying color. Additionally it allows me to prepare the teeth conservatively with less reduction, as opaquing underlying color is often accomplished through thickness of restorative material. Lastly, it gives the ceramist immense freedom, to meet our esthetic outcomes.
When I first started playing with bleaching, as an adjunct to my restorative therapy, in office, was not my first line of defense. What I have found over the years is it let’s us jump in and get started and the patient sees immediate movement towards their esthetic goals. That first appointment with the clinical assistant allows us to build our relationship and deepen the patients understanding of the treatment they have chosen. Also, with needing to allow 4 weeks minimum for rebound and re-hydration following bleaching before we can do shade selection it streamlines the process and let’s us get to the restorations efficiently.
Finally, in office bleaching has become an incredible tool for extending the lifetime of existing conservative anterior restorations. Patient’s request to have their veneers done again due to the alteration of color over time. This change is coming from the natural deepening of the dentin chroma with aging. When we can continue to lighten that underlying color, we extend the lifespan of the dentistry and apply conservative principles over the patient’s lifetime.