“I would like to have really white teeth!” – A case report from Dr. Clarissa Jänig

In the practice I hear this sentence very often, because in our society a bright white smile plays an increasingly important role for both men and women, regardless of age. Hollywood and social media convey this ideal of beauty, which is why more and more patients are expressing their desire for bright white teeth.

As a dentist, I have responded to this patient demand and have added suitable products to the repertoire of our dental practice. For me, the top priorities when whitening teeth are ensuring patient safety, achieving the desired success and being able to offer it at an affordable price.

Opalescence GoTM tooth whitening from Ultradent Products offers an excellent method for achieving an optimal whitening result in a short time, especially for those on a tight budget. The prefabricated UltraFitTM trays filled with 6% hydrogen peroxide gel are worn for 60-90 minutes a day.

Fig.1_Opalescence Go packaging_©Dr. JänigFor patients with regular dental arches, Dr. Jänig likes to recommend Opalescence GoTM whitening from Ultradent Products, Inc. with 6% hydrogen peroxide for cosmetic tooth whitening.

This is not a system with custom trays individually made for the patient, but a universally applicable tray that adapts to the dental arch. Depending on the width and shape of the dental arch, it usually extends to the first molars.

Because of these prefabricated trays, I can shorten the time in the dentist’s chair and don’t require any dental laboratory work. After instruction and the first treatment in the practice, the patient takes the trays home and wears them there, e.g. in front of the TV or while reading, 60-90 minutes a day for usually 5 to 10 days. How often the trays need to be worn can vary from patient to patient, depending on the initial tooth color and tooth structure.

Fig.2_Opalescence Go UltraFit tray_©Dr. JänigThe universal Opalescence GoTM whitening tray consists of two components: The outer tray is removed after placement on the dental arch, the inner UltraFitTM tray remains in the mouth. After only a few minutes the tray adapts to the individual dental arch.

Practical application using the example of a patient case

The 28-year-old male patient first presented in our practice for a routine check-up and professional tooth cleaning. When we asked the patient during the tooth cleaning treatment whether he was satisfied with his current tooth color, he immediately expressed the wish for “really bright teeth”.

We first discussed the two types of cosmetic tooth whitening that we offer in our practice: tooth whitening via custom-made trays using OpalescenceTM PF whitening gel and Opalescence Go whitening with universal ready-to-use trays. The patient chose the Opalescence Go whitening option primarily to try it out for the first time and for reasons of cost.

External stains and any tartar were removed during the previous tooth cleaning, which is why there was nothing to delay subsequent tooth whitening. In addition, the patient has an almost ideally shaped dental arch, so that the prefabricated trays can be used without any problems. (For cases with irregular dental arches, I prefer using tooth whitening with custom-made trays to ensure that the tray fits correctly.)

In this case, following a previous dental examination, there was no contraindication to tooth whitening. Pregnancy and breastfeeding are a contraindication to tooth whitening and the patient must be over 18—although I am often asked about tooth whitening by teenagers. In addition, the tooth structure should be examined to determine whether there is exposed cervical dentin, which may cause possible sensitivity. Existing restorations and prosthetics will not whiten—this should be taken into account when the tooth whitening treatment is planned. It is vital to inform the patient of all possible complications.

The determination of the initial tooth shade is essential before each tooth whitening. Often the patient no longer clearly sees the effect of the whitening treatment, which is why photographic documentation can be helpful.

In our patient case, we started with tooth shade A3. The teeth all had a yellow tinge, which tends to be easier to lighten compared with grey shades. In addition the patient had neither fillings nor crowns in the area to be whitened; so that no subsequent treatment measures had to be discussed. If a patient needs adhesive procedures to replace a restoration following tooth whitening, a delay of around two weeks should be scheduled in order to not risk a weakened adhesive bond.

Fig.3_Determination of tooth shade_©Dr. JänigBefore the treatment Dr. Jänig determines the tooth shade (A3).

If no further measures are required, treatment can begin immediately thanks to the Opalescence GoTM ready-to-use, pre-filled whitening trays. I demonstrate the product to the patient and how to use it, which is straightforward: Place – Fix – Remove outer tray – Wear.

The trays are packed in individual packages. Each of them containing a tray for the upper and lower arch.

Fig.4_Opalescence Go single packaging_©Dr. JänigSingle packaging with trays for the upper and lower arch.

The patient now places the tray for the upper and lower arch. Both arches can be, if wished, whitened at the same time.

Now the patient is instructed to firmly suck down or swallow and ideally to form a “kiss mouth” —pressing it down with the fingers is generally not necessary. The inner UltraFit tray is held onto the dental arch by suction. The outer tray can then be removed. In this case, after 60 minutes, the patient removes the UltraFit tray and cleans any whitening gel residues from the teeth using a toothbrush.

Step 1: The patient places the tray on the dental arch.

Step 2: By forming a kiss mouth, the patient gently sucks in the tray.

Fig.7_Fixation of tray_©Dr. Jänig

Step 3: The patient removes the outer tray, which serves as an application aid.

Fig.8_Removement of outer tray_©Dr. Jänig

Step 4: The patient wears the UltraFitTM tray for 60 minutes.

Fig.9_Wearing of tray_©Dr. Jänig

Step 5: The patient removes the tray and removes possible gel residues with a toothbrush.

Fig.10_Removement of tray_©Dr. Jänig

Occasionally, the tooth may appear spotty and marbled after treatment. This is because the gel does not touch every part of the tooth, since an adequate distance from the gingiva must be maintained. However, it is not necessary to have contact with all of the tooth surface because the active ingredient gradually penetrates the tooth and the tooth whitens evenly during the next 24 hours.

After successful instruction on how to use Opalescence Go whitening, the patient initially receives six packages from me and is discharged with a check-up six days later. It is important to me that tooth whitening remains under the control of the dentist and the check-up is essential to ensure the necessary patient compliance. If, during this time, the patient notices any sensitivity they are instructed to take a day off between each application. In this case, the control date would be postponed accordingly.

Fig.11_Dr. Jänig_©Dr. JänigDr. Jänig initially gives the patient six packages for the upper and lower arch for further treatment at home.

After six days, the patient came back for a check-up. He was enthusiastic. After only six treatments with Opalescence Go whitening, a great result was achieved: his teeth “shone” and he was very satisfied. He said that the handling was easy and that the treatment could easily be integrated into everyday life. He had no sensitivity and the result is impressive. The patient went home satisfied with beautiful teeth—shade A1!

Fig.3_Determination of tooth shade_©Dr. Jänig

Fig.13_Determination of tooth shade after the treatment(2)_©Dr. JänigAfter 6 days of treatment, both the clinician and the patient are more than satisfied with the A1 tooth color as a result.

How soon we need to refresh the results is primarily in the hands of the patient: avoiding factors like coffee, wine, and smoking play the greatest role in maintaining the newly achieved tooth shade. Thanks to products like Opalescence Go whitening, however, it is not necessary to give up all these delights; because touch-ups are easy and affordable.

Text / pictures: © Dr. Clarissa Jänig


About the author

Dr. Clarissa Jänig has been a practicing dentist in the dental practice “Zahnarztpraxis Rodenkirchen” in Cologne, Germany, since 2012. In 2015 she specialized in orthodontics. In 2019 she received her doctorate (PhD) at the Rheinische Friedrich-Wilhelms-Universität Bonn, Germany, on the topic “Fixation o CAD-CAM restorations”.

Dr. Clarissa Jänig has been a practicing dentist in the dental practice “Zahnarztpraxis Rodenkirchen” in Cologne, Germany, since 2012. In 2015 she specialized in orthodontics. In 2019 she received her doctorate (PhD) at the Rheinische Friedrich-Wilhelms-Universität Bonn, Germany, on the topic “Fixation o CAD-CAM restorations”.

 

Dr. Clarissa Jänig, Dentist from Cologne, Germany


 

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