At a recent American Academy of Esthetic Dentistry meeting Van Haywood did a beautiful presentation on bleaching. Van has been at the forefront of Nightguard vital bleaching research since its inception over 30 years ago.

One of the things he presented, which I had forgotten, was that 10% Carbamide Peroxide penetrates through the enamel and dentin, meaning even if you had a patient with veneers who wanted them whiter you can do Nightguard vital bleaching and the Carbamide Peroxide will penetrate from the lingual all the way to the facial enamel.

He showed some great cases using that approach on patients with veneers whose teeth had darkened over time, and he was able to lighten them with Nightguard vital bleaching, even though the veneers covered the entire facial surface.

It also has significance for bleaching calcified teeth. There was a period years ago where some speakers used to show performing an endo access on a calcified tooth to bleach it internally, even though the teeth didn’t need endo. Van’s presentation reminded me that because the Carbamide Peroxide penetrates the entire tooth, you can bleach calcified teeth using Nightguard vital bleaching.

I’m attaching images of a patient I treated in 2003 who had a calcified maxillary left lateral and a calcified mandibular left canine. The approach I used was to press my bleaching trays for both arches, then I removed the facial part of the tray on the maxillary left central and left canine, and on the mandibular left lateral incisor and premolar. This allowed my patient to isolate the bleach just over the two calcified teeth.

After 3 weeks the calcified teeth matched the unbleached teeth quite well. We then made new trays and she bleached all the teeth for another 3 weeks.

Her maxillary and mandibular central incisors were hypocalcified, and someone had done composite to try and hide the discoloration, but since the Carbamide Peroxide penetrates the entire crown, the portion of the tooth covered by the composite bleached as well.

I did let her sit for another 6 weeks before restoring the hypocalcified central in both arches with direct composite.

The beauty of this approach is, since she has both sets of trays, if the calcified teeth darken over time she can just bleach them, or if she wants to touch up the whitening everywhere she can use the trays without the facial cut outs.

Next time you have a patient with a dark calcified tooth, or one who thinks their veneers may have darkened over time, don’t be afraid to give Nightguard vital bleaching a try.

[image:64f7ab5a5dc3d_Bridget_1.jpg]

[image:64f7ab67c1480_Bridget_2.jpg]

[image:64f7ab76a74b5_Bridget_3.jpg]

[image:64f7ab877c10a_Bridget_4.jpg]

[image:64f7abf543ff2_Bridget_5.jpg]

[image:64f7ac18c3761_Bridget_6.jpg]

[image:64f7ac31e1abf_Bridget_7.jpg]

[image:64f7ac41ec06e_Bridget_8.jpg]

[image:64f7ac5204729_Bridget_9.jpg]