Mouthguard Bleaching : procedure
Numerous products are available, mostly containing either 1.5 to 10% hydrogen peroxide or 10 to 15% carbamide peroxide that degrades slowly to release hydrogen peroxide. The carbamide peroxide products are more commonly used. Higher concentrations of the active ingredient are also available and may reach up to 50%.
Treatment techniques may vary according to manufacturers’ instructions. The following step-by-step instructions should be used only as a general guideline.
The procedure is as follows:
1. Familiarize the patient with the probable causes of discoloration, procedure to be followed, and expected outcome.
2. Carry out prophylaxis and assess tooth color with a shade guide. Take clinical photographs before and throughout the procedure.
3. Make an alginate impression of the arch to be treated. Cast the impression and outline the guard on the model. It should completely cover the teeth, although second molars need not be covered unless required for retention. Place two layers of die relief on the buccal aspects of the cast teeth to form a small reservoir for the bleaching agent. Fabricate a vacuum-form soft plastic matrix, approximately 2 mm thick, trim with crown and bridge scissors to 1 mm past the gingival margins, and adjust with an acrylic trimming bur.
4. Insert the mouthguard to ensure a proper fit. Remove the guard and apply the bleaching agent in the space of each tooth to be bleached. Reinsert the mouthguard over the teeth and remove excess bleaching agent.
5. Familiarize the patient with the use of the bleaching agent and wearing of the guard. The procedure is usually performed 3 to 4 hours a day, and the bleaching agent is replenished every 30 to 60 minutes. Some clinicians recommend wearing the guard during sleep for better long-term esthetic results.
6. Instruct patients to brush and rinse their teeth after meals. The guard should not be worn while eating. Inform the patient about thermal sensitivity and minor irritation of soft tissues and to discontinue use of the guard if uncomfortable.
7. Treatment should be for between 4 and 24 weeks. Recall the patient every 2 weeks to monitor stain lightening. Check for tissue irritation, oral lesions, enamel etching, and leaky restorations. If complications occur, stop treatment and re-evaluate the feasibility of continuation at a later date. Note that frequently the incisal edges are bleached more readily than the remainder of the crown.