Case Study: Brightening Smiles with Laser

By: Dr. Sunitha Gadudasu and Dr. J. Gnanaraj

INTRODUCTION

Everyone loves a smile with milk white teeth. Unfortunately our teeth do get stained and a variety of commercial agents are available for teeth whitening as it is a sought after cosmetic activity. The whitening procedures could be carried out by mechanically activated/ chemically activated /light activated/laser activated devices.

Commercially available toothpastes help with mechanical removal of the stains. The use of gels that are applied and activated either chemically or by light is more effective than mechanical devices.

However they are not used regularly as they cause tooth sensitivity and damage. The procedure is also time-consuming sometimes taking as much as one hour. The laser tooth whitening is a simple and safe procedure that takes less than 20 minutes.

ADVANTAGES OF LASER TEETH WHITENING

  • Less time for procedure
  • Patient comfort
  • Reduces anxiety of patient
  • Can be used for extrinsic and intrinsic types of stains.
  • Less or No sensitivity

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CASE REPORT

The 22 year old patient had yellow discoloration as shown in Figure 1. The patient had no significant medical problems. The patient had scaling 6 months prior to the procedure and had developed mild calculus. The patient was placed as A 3 in the shade guide prior to the procedure.

Figure 1. Before teeth whitening

The Biolase diode laser was used for the procedure. Vaseline was applied to the lips and cheek retractors were placed. Cotton balls were used for additional retraction and moisture protection. The laser whitening kit-biolase teeth whitening-20 kit contained the following:

  1. Teeth whitening gel – base
  2. Teeth whitening gel – activator
  3. Liquid dam
  4. Desensitizer

The teeth were air dried and the liquid dam was applied on to the gingival margin 0.5 mm onto the enamel as shown in the Figure. 2. The apical margin was 4-6mm high and 1.5 to 2mm thick. Any small or minute opening pores were checked for and filled with the liquid dam. The liquid dam was light cured for 20 seconds per arch. The whitening gel base and activator were mixed and a brush applicator tip was used for dispensing the whitening gel. The teeth were air dried and a thin layer of whitening gel is applied on all four quadrants. The gel thickness was 1mm thick and of uniform consistency.

Figure 2. Application of Desensitizer

The Laser teeth whitening hand-piece was attached and the mode was set to 7 W in the Biolase 940 NM Diode Laser for 30 seconds which is a setting time. The protective eyewear was worn by patient, assistant and the doctor. The hand piece was placed with the protective covering close to the teeth 4-5 teeth at a time. Each quadrant was laser treated for 30 seconds and the procedure was repeated for second time. The whitening gel was kept on for 5 minutes after the second cycle to allow the teeth to absorb the laser activated hydrogen peroxide. The gels were removed with high suction and the Laser-20 desensitizer containing potassium nitrate and sodium fluoride was applied on to the teeth and kept undisturbed for 15 minutes and then the liquid dam was also removed.

The total procedure time was short and the patient was at ease and went back with a confident smile.The teeth shade was A1 after the laser teeth whitening as shown in Figure.3. The patient was given instructions on not to take products like coffee, tomato, tea, sauces etc., that stain the teeth for the next 48 hrs.

Figure 3. Post LASER teeth whitening

DISCUSSION

Patients who receive laser treatment has less sensitivity as compared to other modes of treatments as the contact time of gels on teeth are less and activation time short. Several studies show that teeth whitening with diode laser have less teeth and gingival sensitivity3.There are concerns about the safety of the hydrogen peroxide contacting conventional gels. Studies using scanning electron microscope have shown changes in surface texture of enamel [like shallow depressions, increased porosity2]. However, with the gels activated by diode laser such changes have not been demonstrated1. Hence laser teeth whitening is a safe, quick, and better method for making people smile with white teeth.

sunitha gadudasu 64 Dr. Sunitha Gadudasu is currently working as a Dental Surgeon at Seesha Karunya community Hospital, Coimbatore, Tamil Nadu. She graduated from TN MGR University, Chennai ‐Tamilnadu. She is also certified in rotary endodontics from International Academy of Rotary Endodontics, USA. She also completed her M.B.A. (Hospital Administration).
Gnanaraj-64 Dr. J. Gnanaraj MS, MCh [Urology], FICS, FARSI, FIAGES is a urologist and laparoscopic surgeon trained at CMC Vellore. He has been appointed as a Professor in the Electronics and Instrumentation Engineering Department of Karunya University and is the Director of Medical Services of the charitable organization SEESHA. He has a special interest in rural surgery and has trained many surgeons in remote rural areas while working in the mission hospitals in rural India. He has helped 21 rural hospitals start minimally invasive surgeries. He has more than 150 publications in national and international journals, most of which are related to modifications necessary for rural surgical practice. He received the Barker Memorial award from the Tropical Doctor for the work regarding surgical camps in rural areas. He is also the recipient of the Innovations award of Emmanuel Hospital Association for health insurance programs in remote areas and the Antia Finseth innovation award for Single incision Gas less laparoscopic surgeries. During the past year, he has been training surgeons in innovative gas less single incision laparoscopic surgeries.

References (click to show/hide)

  1. Meghana Dang, Omkar Shetty, “Nine shade change by laser assisted teeth whitening”, 10.5005/jp-journals –10022-1041.
  2. Josey AL, Meyers JA, Romanuik K, Symons AL. “The effect of a vital bleaching technique on enamel surface morphology and the bonding of composite resin to enamel”, Journal of oral rehabilitation, 1996, April, 23(4) pp. 244-250.
  3. Gurugan S, Cakir F Y,Yazici E. Different, “Light-activated in-office bleaching systems: a clinical evaluation”, Lasers med sci 2010 NOV;25(6), pp. 817-822.


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