Restorative teeth whitening: what is it and what is the peculiarity of the procedure?

Author of the article:

Soldatova Lyudmila Nikolaevna

Candidate of Medical Sciences, Professor of the Department of Clinical Dentistry of the St. Petersburg Medical and Social Institute, Chief Physician of the Alfa-Dent Dental Clinic, St. Petersburg

Drinking coffee and tea, smoking are the reasons for the formation of areas of enamel staining. The love of sweets, juices, fruits, combined with improper oral care, also leads to the fact that the enamel suffers: areas of demineralization, sensitivity, and caries appear. How to get rid of such unpleasant phenomena as dark pigment on teeth and sensitive enamel?

For this purpose, many different preparations are produced in the form of special toothpastes, gels, and varnishes. Let's talk about dental varnishes and alternative products. Some solve cosmetic problems and are intended for home use, others are used for therapeutic purposes and are applied by a doctor.

The essence of the method

The peculiarity of restorative whitening is that the method allows you to give your teeth not only the desired shade, but also correct minor flaws (chips, cracks, stains, gaps between teeth). Please note that restoration methods do not affect the original color of the patient’s enamel and do not contribute to the destruction of unsightly pigment, as classical methods do, namely, they hide the defect. In this case, the patient has the opportunity to choose the color and degree of whiteness of the enamel, that is, he receives a predictable result, which is usually difficult to achieve with traditional lightening methods.

It is impossible to whiten chips and cracks in enamel using the usual method.

The purpose of restorative whitening is to improve the appearance and even correct the shape of row elements located in the smile area. The procedure is not carried out in the chewing area, since the materials used for it are not designed to withstand heavy loads.

The essence of the procedure for restorative teeth whitening comes down to the fact that the doctor applies artificial material to the frontal (front) surface of hard tissues or glues thin but very durable overlays that exactly imitate the color and shine of natural enamel. If the patient wishes, the specialist will always be able to remove, refresh or adjust the restorations, or select a new color.

Example No. 3

A young aspiring singer needs a snow-white smile, but there is no time or money for a serious smile change. Composite teeth whitening helped her continue her career.

Indications for the procedure

inability to achieve the desired effect using classical methods of enamel lightening: for example, if the patient has stains caused by severe forms of fluorosis and hypoplasia, yellow “tetracycline” teeth,
sensitivity and increased abrasion of hard tissues: restorative bleaching performs not only an aesthetic, but also a protective function,
in addition to the unsightly shade, the patient needs to eliminate a number of other defects: restore the anatomical shape of a chipped tooth, hide interdental gaps and cracks, hide old fillings, correct the position and shape of a crooked unit,
age up to 18 years: some methods of restorative bleaching (for example, using composite materials) are suitable for young patients who are not yet allowed to use traditional methods of enamel lightening.

Indications for the use of the method are chips and defects of the teeth.
Restorative bleaching is not suitable for those who have severely damaged crown parts of the teeth and have periodontal diseases, leading to loosening and displacement of the roots. The procedures are also contraindicated in patients with serious occlusion pathologies. In these cases, doctors recommend other ways to solve the problem: prosthetics with crowns, treatment with braces and other orthodontic devices (alignments, trainers, arches, plates).

Methods for carrying out the procedure in a dental office

Restorative teeth whitening can be performed in several ways. Let's list them.

Direct method, when the doctor corrects defects directly in the patient’s mouth

In this case, restorative bleaching is carried out in just one visit to the clinic. In the process, the specialist removes plaque and grinds down the enamel a little (to level the surface and better adhesion of fabrics to artificial materials), and then applies layer-by-layer layers of composite (there can be 10 or more of them), which are then polymerized with a special lamp. The doctor achieves the required shade, forms the desired shape, position and size of the crown, and then carefully grinds and polishes the material.

The photo shows artistic restoration of teeth using composites.

This method appeals to a large number of patients, as it does not require serious financial investments. Moreover, the result of such restorative bleaching can be corrected at any time. But the direct method also has certain disadvantages:

it is necessary that such exquisite work be performed by a professional doctor, otherwise you may be disappointed in the result obtained,
The composite material is stained by food and drinks, and plaque deposits on it. In addition, the composite does not have the shine of natural enamel, so over time it becomes dull and needs to be polished. To maintain the restoration in good condition, you need to visit the dentist at least once every 3-4 months.

“I really hoped to whiten my front teeth, because there are dark spots on them, but the doctor categorically forbade it. He said that the spots are caused by a disease, and bleaching not only will not help me, but will further deteriorate the condition of the enamel, making it thinner and more sensitive. I was very upset and was going to get crowns, but the specialist suggested a less radical and more affordable measure, namely restorative bleaching with a composite. Without thinking twice, she agreed. Yes, the method has disadvantages, but it’s better than walking around with spots like mine. I can say that it’s definitely worth doing the procedure if you have a similar hopeless situation.”

Karine, review from otzovik.com

Indirect method, when the restoration is pre-created in the laboratory

In this case, it will not be possible to get by with just one visit to the doctor.

At the first stage, the specialist prepares the teeth that need restorative bleaching and takes impressions of the jaws. During the preparation process, it is necessary to cut down the enamel layer (usually 0.3 to 0.8 mm of tissue is removed, which depends on the thickness of the onlay chosen by the patient). During the production of restorations, the doctor covers the prepared tissues with caps that protect them from destruction, bacteria, temperature and hardness of food.

At the initial stage, dental impressions should be taken

At the second stage, the resulting impressions are sent to the laboratory, where technicians create thin onlays from materials such as composite, ceramic, ceramic composite, and zirconium dioxide. The waiting process for restoration overlays usually takes about 2-3 weeks.

Direct restorative teeth whitening is usually carried out by a dentist-therapist, but indirect restorations are carried out by an orthopedic surgeon.

At the third stage, in fact, restorative bleaching takes place, but in this case it would be more correct to call it microprosthetics. The specialist processes, disinfects and thoroughly dries hard tissues, after which he places the thinnest snow-white overlays on their surface, which are securely and permanently fixed with dental cement.

Installing veneers will help change the color, shape and size of teeth

Among the advantages of this method: durability (7-15 years or more), high level of aesthetics, preservation of the original color of the restoration throughout its entire service life, resistance to dyes from food and drinks, protection of sensitive enamel from bacteria, caries and destructive processes. But there is one significant drawback - the high price.

Fluoridation of teeth at home

Currently, preparations for fluoridation of teeth can be purchased in pharmacies or specialized clinics. Fluoride varnish is an effective remedy for strengthening teeth at home, but it should be used carefully and only after consultation with your dentist.

In order for fluoridation to bring visible results, it is necessary to take care of the cleanliness of your teeth. Next, you need to strictly follow the instructions included with the drug. Fluoride varnish should be used in courses - 3-4 procedures.

The most common way to strengthen tooth enamel is to use toothpastes containing fluoride. However, it is worth remembering that you cannot use these products for a long time - you need to alternate them from time to time with other drugs that do not contain fluoride.

Standard whitening and restoration methods: what's the difference?

Dentists carry out laser, chemical, lamp and cosmetic whitening, where hydrogen or carbamide peroxide in different concentrations is used as the main active ingredient that corrodes the color pigment. But there are patients for whom the service is not suitable due to contraindications, and for them an excellent alternative is restorative teeth whitening, which allows not only to hide unsightly shades and stains, but also to correct a number of other minor defects (chips, cracks, slight curvature and tilt of teeth , cracks).

The main differences between classic and restorative bleaching are presented in the table below.

Classic methods	Restoration
Mechanism of action	The enamel brightens by 5-12 tones (depending on the method) under the influence of a gel with peroxide applied to the teeth and activated in various ways (lamp light, chemical components, laser)	The teeth are covered with a thin layer of composite and other materials, which the doctor skillfully applies or glues to the surface of the enamel, resulting in a snow-white smile
Possibilities	Changing the shade of enamel, removing persistent stubborn pigment from food and after smoking. The ability to remove stains from mild forms of fluorosis and hypoplasia	Comprehensive concealment of all minor defects: stains, chips, cracks, curvature. Getting not only the desired color, but also correcting the shape and position of the tooth
Contraindications	Thin and sensitive enamel, multiple caries, wedge-shaped defect and erosion, severe forms of non-carious lesions	Suitable for patients for whom traditional enamel lightening methods are contraindicated
Preparation for the procedure	It is important to treat tooth decay and other dental diseases. It is necessary to clean the fabrics from soft and hard deposits in order to obtain an even lightening effect. Also, the enamel is pre-strengthened with fluoride or remineralizing compounds with calcium	Traditionally, diseased teeth are treated, plaque is removed, and tissue is fluoridated. Before applying materials or installing onlays, be sure to grind off a small layer of enamel so that the smile looks natural
Condition of teeth after the procedure	Immediately after the procedures, tissue sensitivity increases. There is a reaction to cold, hard and hot foods	A layer of restoration materials protects hard tissues from any external influence
Durability	2-4 years, provided that the patient diligently maintains the result, follows a “white” diet, carefully carries out oral hygiene, and gives up smoking	A smile can maintain its beauty for 5-10 years or more. However, some artificial materials cannot be stained by food.
Price	From 8,000 to 30,000 rubles for both rows of front teeth. The most inexpensive method is chemical. Expensive – laser and lamp technologies (for example, ZOOM).	from 5000 rubles for direct restoration of 1 unit, from 25,000 rubles for 1 onlay made from jaw casts in the laboratory.

Fluoridation of teeth during pregnancy

During the period of bearing a child, most of all nutrients and minerals from a woman’s body go to the formation of the skeleton and muscle tissue of the unborn baby. Due to calcium deficiency during pregnancy, tooth enamel is destroyed, so fluoridation during this period is very useful. However, before applying fluoride to your teeth, you should have your mouth examined and consult an experienced dentist.

It is important to remember that severe toxicosis is the main contraindication to the procedure, so it is best to plan a trip to the dentist for the 2-3 trimester, when the pregnant woman’s health improves. During breastfeeding, the fluoridation procedure will also not be superfluous.

Nuances you need to know before the procedure

It is often written on the Internet that restorative whitening is a non-invasive procedure during which the original structure and condition of the tooth are not disturbed, and the composite or onlays are simply glued to the patient’s enamel on top. But this statement is nothing more than a publicity stunt.

Imagine what the restoration will look like if you simply glue an artificial material on top of your teeth, which also has some thickness? Let's list the consequences:

the tooth made will protrude forward and stand out from the rest, it will increase in volume,
without preparing hard tissues, it will not be possible to hide existing defects, stains, irregular shape and curvature of the crown,
the area at the border of the material with the mucous membrane, if you do not make a smooth transition or ledge, will generally look unnatural, will become constantly injured and inflamed, since food debris and bacterial plaque will constantly clog into the resulting gap.

Before installing microprostheses, the specialist grinds the teeth.
Before carrying out restorative bleaching, the doctor carries out, albeit minor, grinding of hard tissues from the vestibular (anterior), cervical and lateral sides. This procedure is also necessary to level the relief and surface of the tooth and ensure a tight fit of the materials, as well as their high-quality and durable fixation. Only patients who choose original lumineers1 can avoid preparation - in this case, the doctor only slightly grinds the enamel and treats it with glue before installing the onlays.

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whitening

Fleisher G.M. Lumineers - a new alternative to teeth whitening // Review. Dentistry. – 2014.

What makes Enamel Plus special

Enamel Plus is the first nanocomposite material with optical characteristics similar to natural teeth. This gives the dentist the opportunity to make restorations that are absolutely indistinguishable from natural tooth tissue.

The transition boundary from the restored part of the tooth to natural tissues is not visible in any light

The unique properties of the material were achieved through the inclusion of zirconium dioxide nanoparticles (12%) and glass filler, which has a high refractive index (68%) in the filler composition.

The total proportion of inorganic filler is about 80%, making Enamel Plus durable, abrasion-resistant and suitable even for volumetric restorations.

When light hits a tooth, part of it is reflected, and part is absorbed, part is scattered within the tissue, and part passes through. Moreover, this happens differently in enamel and dentin, since their optical properties are not the same.