Bleaching is one of the most popular esthetic procedures in modern dentistry, aiming to give patients a more perfect appearance and esthetic smile. Vital teeth are usually whitened by one of the two techniques including in-office bleaching and night-guard or home bleaching. In-office bleaching employs relatively high concentrations of bleaching agents for short durations, whereas in home bleaching procedure, lower concentrated bleaching gels are applied over a longer period of time for example 4-8 hours a day for 2 or more weeks.
Although the use of home bleaching technique is remarkably increased in recent years, the long period of treatment, the discomfort from wearing the trays, the unpleasant taste of the bleaching gel and the lack of compliance in some patients encouraged the clinicians to continue in-office bleaching and even use supplementary modalities to enhance the whitening process. In-office bleaching is also preferred in cases of severe discoloration in one or more teeth as the treatment can be localized in the target area. The in-office bleaching process can be accelerated by the application of high-intensity light sources such as halogen curing lamps, plasma arc lamps, light-emitting diodes (LEDs) or lasers. Tooth whitening has been considered as a treatment measure for improving the esthetic appearance of white spot lesions. unresponsive to remineralization treatments. A great number of patients undergoing orthodontic therapy are affected with extensive discolorations around their attachments for which tooth whitening may be recommended at the end of the treatment. Regarding the high incidence of white spot lesions in these subjects, bleaching can be employed to not only eliminate the discolorations, but also to improve the appearance of the dentition by masking the demineralized enamel thus enhancing the esthetic outcome of orthodontic therapy. The diode laser was used in this study to accelerate the in-office bleaching process. It is believed that the thermal effect of laser increases the decomposition rate of peroxide and the formation of bleaching active radicals, thus providing the whitening effect in a shorter period of time. The diode laser may also be effective in reducing tooth sensitivity usually observed following the bleaching therapies.
Single Tooth Anesthesia
Although Cook invented the modern dental syringe nearly 150 years ago it is only recently that anesthetic delivery systems have seen major innovations. Although the traditional aspirating syringe still is the most common method by which local anesthetics are administered, newer technologies have been developed that can assist the dentist in providing enhanced pain relief with reduced injection pain and minimum adverse effects.
Another system that uses vibration diversion based on the pain gate theory is recently introduced DentalVibe (BING Innovations LLC, Crystal Lake, IL, USA). It is a cordless, rechargeable, hand held device that delivers soothing, pulsed, percussive micro-oscillations to the site where an injection is being administered. Its U-shaped vibrating tip attached to a microprocessor-controlled Vibra-Pulse motor gently stimulates the sensory receptors at the injection site, effectively closing the neural pain gate, blocking the painful sensation of injections. It also lights the injection area and has an attachment to retract the lip or cheek. In 2006, the manufacturers of the original CCLAD, the Wand, introduced a new device, Single Tooth Anesthesia (STA™). STA incorporates dynamic pressure-sensing (DPS) technology that provides a constant monitoring of the exit pressure of the local anesthetic solution in real time during all phases of the drug’s administration. Originally designed for use in medicine in epidural regional anesthesia, STA utilizes an adaptation of DPS to dentistry as a means of overcoming the problems associated with PDL injection, and simplifies AMSA and P-ASA injections. The system can be utilized for all traditional intraoral injection techniques. Unlike earlier variants, the STA includes a training mode that verbally explains how to use the device, and multi-cartridge and auto-cartridge retraction features. Since the pressure of the LA is strictly regulated by the STA system, a greater volume of LA can be administered with increased comfort and less tissue damage than seen with traditional syringes or PDL pressure devices.