Bleaching Materials - REALITY Publishing Company

Transcription

Bleaching Materials
REALITY’S CHOICES
Power
1.
Zoom!
Discus
2a.
Opalescence Xtra Boost
Ultradent
2b.
Opalescence Xtra
Ultradent
3.
Niveous
Shofu
Assisted
1a.
Opalescence Quick
Ultradent
1b.
White Speed
Discus
2.
Polazing
SDI
Home
1.
Opalescence/Opalescence PF
Ultradent
2a.
Day White Excel 3
Discus
2b.
Nite White Excel 3 Turbo
Discus
2c.
Zoom Take Home
Discus
3.
Nupro White Gold
Dentsply Professional
4a.
Poladay
SDI
4b.
treswhite
Ultradent
©2005 REALITY Publishing Co. Vol. 19
The Ratings
53
Bleaching Materials
Power
Price
Product
Per
Session
Activation
Unit/Mode
$1,495.00 $85.00
Ultraviolet
System
Zoom!
Discus
Opalescence
Xtra Boost
pH
Flow1
Separate,
$150
25
8.9
5.0
Automix
Syringe
60 min
105 min
Radiometer
N/A
$67.90
Chemical
N/A
38
7.6
5.0
Gel/gel:
syringemixed
60–90 min
90–120 min
N/A
$63.00
Light
Optional
N/A
35
4.3
5.0
Premixed
45 min
75 min
$96.97
Chemical,
Light
Optional
Ultradent
Niveous
N/A
Shofu
Approx.
Appt.
Length
%
H2O2
Ultradent
Opalescence
Xtra
Manufacturerrecommended
Total Bleach
Type of Mix
Time/Appt
N/A
27
5.0
3.9
Gel/impreg- 30 min with
light
nated
microbrush 45 min without light
60–75 min
Assisted
Cost/ml
% of Carbamide
Peroxide
pH
Flow1
Opalescence
Quick
$5.00
35
6.1
5.0
None Provided or
Recommended
$6.94
35 equivalent
5.6
4.5
None Provided or
Recommended
$4.81
35
5.5
5.0
None Provided or
Recommended
Ultradent
White Speed
Discus
Polazing
SDI
1
0
MOST FLOW
54
Soft Tissue
Protection
Product
The Ratings
1
2
3
4
5
LEAST FLOW
Bleaching Materials
Power
Average Shade Changes
Product
Zoom!
Discus
Opalescence
Xtra Boost
Sensitivity
(% of patients)
During
Post
Appt.
Appt.
Desensitizer
included?
Home Bleach
included/
suggested?
Initial Clinical Evaluation
1 month
3 months
0
30
Yes
Yes
5.5
5.1
0
100
No
Yes
3.0
2.7
0
N/A
No
Yes
N/A
N/A
0
N/A
No
No
N/A
N/A
Ultradent
Opalescence
Xtra
Ultradent
Niveous
Shofu
Home
Cost/ml
Product
Opalescence/
Opalescence PF
Kit
Refills
Dentsply
Professional
Poladay
SDI
treswhite
Ultradent
Flavors
5.0
6.3–
6.6
3:
Regular, Mint,
Melon
0.5mm
Reservoir
Material
Marketing Materials
Marketing Manual
(Blueprints for success),
Postcards, Counter
Displays, Posters,
Statement Stuffers
$2.50
$2.15
Hydrogen
7.5%, 9.5%
5.0
8.6–
9.5
1:
Cool Mint
0.4mm
Not
Nothing specific, just on
Recommended
bleaching in general
$5.65
$6.09
Hydrogen
6%
5.0
6.0
1: Mint
0.4mm
Not
Recommended
$5.36
$5.87
Hydrogen
4%, 6%
5.0
6.5–
6.6
1:
Mint
0.4mm
Not
Recommended
$2.92
$1.96
Carbamide
10%, 15%
5.0
5.7–
6.1
1:
Mint
0.4mm
Triad Gel VLC
Block Out Resin
Brochures, Postcards,
Statement Stuffers
$2.24
$1.52
Hydrogen
3%, 7.5%, 9.5%
5.0
6.0–
6.4
1:
Spearmint
0.4mm
Spacer resin
Postcards, Brochures,
Patient assessment
worksheet
$4.00/
patient
N/A
Hydrogen
9%
5.0
6.6
2:
Mint, Melon
N/A
N/A
Large cards and posters
Discus
Nupro White
Gold
pH
$2.17
Discus
Zoom!
Take-Home
Flow1
$2.50
Discus
Nite White Excel
3 Turbo
Thickness
of Tray
Material After
Fabrication
Carbamide
10%, 15%, 20%
Ultradent
Day White
Excel 3
Type of
Peroxide and
Concentrations
LC Block-Out
The Ratings
55
Bleaching Materials
Bleaching is dentistry’s only purely cosmetic procedure. In
other words, there is no functional component to bleaching.
Lighter or whiter teeth are not any healthier than dark teeth,
nor do they allow more effective chewing or more distinctive
speech. Nevertheless, it is the rare individual who does not
desire whiter teeth.
There are essentially two main types of bleach: power and
home. A third type, assisted, has been used as a booster for home
bleach. However, since several home bleaches are virtually the
same concentration as those targeted for assisted procedures, the
line between these subcategories is fuzzy at best.
Power Bleaches
With glitzy practice modes such as the dental spa movement,
power bleaching continues to be heavily promoted. Nevertheless,
the list of products in this subcategory is still relatively short.
Criteria for Choosing a Power Bleach
There are certain aspects of bleaching that all these systems share,
but dissimilarities do exist. And many of the details of these protocols seem to be based more on empirical voodoo than solid
clinical evidence.
Do you need to use a light? This is, by far, the most controversial of all issues facing power bleaching. In our most recent clinical
evaluation of each system, we placed black opaque tape over the
left side of the bleaching light so we could effectively bleach one
side of the arch with the light and one side without the light.
Regardless of the manufacturer’s instructions, all patients in our
evaluation were bleached for one hour. The results showed bleaching effectiveness was not influenced by the bleaching light.
Before
After
Zoom! Discus
Opalescence Xtra Boost Ultradent
Opalescence Xtra Ultradent
Niveous Shofu
56
The Ratings
Bleaching Materials
Lights do not seem to boost bleaching effectiveness. Nevertheless, since lights have no apparent
untoward effects, they still may be utilized IF you
don’t make unsubstantiated claims to the patient.
How important is application time? Of the five products in this
subcategory, the total, per appointment application times (as
opposed to total appointment times) range from 30-90 minutes.
We suggest longer is better, although patients tend to become
uncomfortable after 60 minutes. It is also uncertain whether reapplying the bleach every 15 minutes or so is better than one
application for the entire bleaching session, although intuitively,
the former seems to be more effective than the latter.
Does concentration of peroxide matter? The products we tested
ranged from 25%-38%. But, if “more is better”, why would some
manufacturers choose a concentration lower than others? There
are two possible reasons: sensitivity and enamel damage. As the
percentage of peroxide increases, the probability of sensitivity goes
up proportionally. It follows, then, that lower concentrations
should result in less sensitivity.
The same applies to enamel damage, the incidence of which
has been reported periodically in the scientific literature. Even
though the evidence for this damage is anything but definitive,
using a potentially less destructive product (lower concentration)
could help to silence the naysayers.
Does the pH matter? Along with concentration of peroxide, pH
has been implicated in causing sensitivity. It follows, therefore, that
a more neutral pH bleach would be less likely to cause sensitivity.
How thick does the layer of bleach need to be? A general guideline would be a fairly thick layer, about 1.5-2.0mm. However, we
believe the most important factor is to cover the facial surfaces of
the teeth completely and keep the gel from drying out.
Is sensitivity inevitable? Most patients will accept minor discomfort (no pain, no gain), but few will endure any level beyond
slight sensitivity. Even though sensitivity did occur in our evaluation at various levels in the first 24 hours, it was virtually
nonexistent after 24 hours, except for one patient. This means it
will be short-term and should not be a factor for any patients.
Nevertheless, several systems have companion products for desensitization to be on the safe side.
The patient with sensitivity used MI Paste (GC) in
bleaching trays overnight. The sensitivity was
completely resolved when the patient awakened
the next morning.
Should you encourage home bleaching to enhance the efficacy?
If a patient was willing to wear a tray, why even bother with the
power technique? With the leading candidates for power bleaching being those patients who don’t want to be bothered using a
tray, it would seem that combining these two approaches would be
an exercise in futility. That is, unless you realize superior results
when both methods are utilized. It’s no surprise, then, that home
bleach and tray material are either standard or optional in most
power bleach kits.
Does it require mixing? Of our CHOICES, three are automix,
one is hand-mixed, and one is premixed. Obviously, no mixing is
easier, less messy, less labor-intensive, and preferred, but auto-mixing is the next best alternative.
Does it need to be stored in the refrigerator? All of our
CHOICES recommend cold storage. However, just like most
materials, you should bring the bleach back to room temperature
prior to using it. The safest routine would be to take enough
bleach out of the refrigerator to whiten all the patients that are
scheduled the next day. If the next practice day occurs after a
weekend or holiday, then the first staffer to arrive at the office in
the morning should take the bleach out of the refrigerator. In this
instance, it may be prudent to place the syringe of bleach in warm
water if the first patient of the day is scheduled for bleaching. Cold
bleach will probably not be as effective as room temperature or
warm bleach. And, with at least one product, cold bleach was very
runny—it needed to be warmed so it would not flow completely
off the teeth.
What is the cost/patient/appointment? This is the cost of the
materials you would typically use during a power bleaching session assuming you bleach both arches for one hour, changing the
bleach every 15 minutes (four applications).
How do you protect the soft tissue? Due to their caustic nature,
power bleaching materials have the potential to cause significant
soft tissue injuries (that tend to heal uneventfully in 1-2 weeks).
Even though power bleaching can be performed using several different types of gingival protection, the safest and most reliable is
still a properly placed and sealed rubber dam. A well-sealed rubber dam allows the placement of the bleaching gel on the lingual
as well as the facial of the teeth to be bleached. While we have no
definitive proof that this total coverage hastens the bleaching
effect, our clinical impression suggests this protocol is most effective. In addition, you can retract the gingiva around each tooth by
ligating with waxed floss. This retraction allows you to bleach the
entire tooth.
However, most patients (and staff members) view the rubber
dam as cumbersome to apply and uncomfortable. Therefore, a
resin shield is the more popular method to protect the tissue and
material for this shield is usually included in power bleach kits.
Most, if not all of these materials are dispensed directly on the
tissue from its syringe. If the material is runny, you need to cure
for a few seconds as you place it around each tooth. If you try to
apply to more than one tooth before curing, it will flow over the
tooth, requiring you to chip off the excess using a #15 scalpel. This
The Ratings
57
Bleaching Materials
is time-consuming and a nuisance, since some of these materials
set very hard.
Unlike a rubber dam that is ligated around each tooth, there is
no gingival retraction with a resin shield. As a matter of fact, you
need to cover at least a narrow band of cervical tooth structure to
ensure the gingiva is well protected. This area that is covered with
the resin shield will not be bleached.
Once you finish the arch, cure for an additional 20 seconds,
although the heat produced by curing some of these products can
cause discomfort. When you are finished bleaching, merely dislodge one end with an explorer or other instrument and the entire
resin shield usually will peel off the gingiva in one piece.
What protection is necessary for dental team members?
Gloves, masks, and safety glasses will usually suffice when handling these caustic materials.
It is very important that the peroxide be fresh when used.
Otherwise, its ability to bleach teeth is reduced. All peroxides tend
to oxidize when the bottle or syringe is opened or uncapped. The
important message is to keep all bottles and syringes of peroxide
tightly capped and refrigerated. Most products, however, should
be brought back to room temperature before using.
For our CHOICES in this category, we have broken down the
costs to a common denominator: how much a two-arch bleaching
session costs, assuming you are reapplying new bleach four times
during the appointment (for a total of one hour of bleaching).
Clinical Evaluation
Initial evaluation 20 patients were randomly divided into four
groups of five patients for each product. The products were used
exactly as directed by the manufacturers. While this protocol precluded comparing the products using the same parameters (e.g.,
bleaching times were not all the same), it did allow us to gauge
their relative effectiveness if you follow the manufacturer’s directions, which is, of course, what most of us are inclined to do, at
least initially when we receive this type of product. Only one arch
was bleached for each patient, allowing their opposing arch to act
as the control.
The average shade change produced by all the systems has been
noted, but there is a built-in error in this calculation, since this
number is highly dependent on the patient’s initial shade. Even
though we randomized the use of the four systems, the beginning
shades of the patients were not equal across the board. For example, if a patient starts out at A1, only one shade change (to B1) is
possible. However, if a patient starts out at A3 and goes to B1,
that’s eight shade changes. So the systems with the patients with
darker teeth at baseline are more likely to have a higher score,
regardless of whether they are more effective or not.
All of these systems were, indeed, able to lighten most patients’
teeth to a reasonable degree, with the exception of two specific
patients with tetracycline staining, where the results were
mediocre at best. Any of them would be a viable alternative to
BriteSmile, should you be so inclined not to sign any contracts.
But, since the protocols were so varied, it is impossible at this time
to say which is the best system based on these results.
Follow-up evaluation Due to time constraints, only 10 patients
were treated. Because of this limited number of patients, we could
not come to any definitive conclusions, but the trends were fairly
obvious. These observations are noted in the commentaries of
each product.
58
The Ratings
Bleaching Materials
Zoom!
(4.5)
Cost: $1,495.00
Lip & Tongue Retractors: $9.50
Includes:
• 1 Zoom! Chairside Lamp
• 3 safety glasses
• Assorted Marketing Materials
• 1 video
• In-office training
Includes:
• 1 bag of retractors (2 large & 4
medium)
Procedure Kit: $85.00
Warranty: 1 year for lamphead,
the power supply, the floor stand,
and the power cord. The bulb has
a 90-day warranty, but should last
for 500 hours.
Includes:
• 3 retractor bibs
• 2 light guides
• 1 applicator brush
• 1 dual barrel syringe of Zoom!
Chairside Whitening Gel
(4.6g/4.0ml)
• 1 packet of vitamin E Soothing
Oil (0.43g), with brush
• 1 Packet of Protective Lip
Cream (0.61g), with swab
• 1 dual barrel syringe of Zoom!
Take-Home (4% or 6%) or
Day White (7.5%) Gel (2.4g)
• 1 tray case
• 1 pkg of gauze
• 2 sheets of tray material
• 1 syringe of Fluoridex 1.1%
Neutral Sodium Fluoride
Gel (1.3g)
• 2 syringes of Liquidam
(1.3g ea)
• 1 cardboard holder for before
& after photos
REALITY’S
CHOICES
1
Radiometer: $150.00
Lamphead: $480.00
What if it needs repairs?
Contact Discus at
888-427-9279.
Is there a loaner program?
Yes. Will send a replacement
immediately. No charge for
units under warranty. Shipping
charge may apply to units no
longer under warranty.
Shelf Life: 1 year refrigerated
Best marketing program by far
Coolest looking unit
Most time-consuming
Each patient kit is most expensive
MSDS: Not included
Cost/patient/appt = $85.00
(1 Procedure Kit)
Composition of Bleach
25% hydrogen peroxide gel. Zoom! Take-Home Gel is available in
4% or 6% hydrogen peroxide. Day White is 7.5% hydrogen peroxide.
Activation Unit/Mode
Light activation. The light consists of a five-legged base, a stationary vertical arm that supports the control box, and an adjustable
horizontal arm, the end of which holds the lamp. The predominant color of the entire unit is white, giving it a clean, contemporary look. Since there are no casters on the base, the size (vertical
arm is 45.0in/114.3cm in length, the horizontal arm attachment
measures 29.0in/73.7cm in length) and weight (21.0lb/9.5kg)
makes transporting this light quite cumbersome.
The cylinder-like control box, measuring 12.5in/31.8cm in
length x 5.25in/13.3cm in width x 4.25in/10.8cm in depth,
Discus
www.discusdental.com
includes a small LCD screen plus soft-touch switches, one for
turning the unit on-off (begins the warm-up), while the other
actually activates the timer and allows you to pause the timer
(although the light stays on). The bleaching time has a default
interval of 20 minutes.
The actual lamp, also cylinder-like with a silver oval accent
design on top, has the name of the product embossed in a classy
touch. The front of the lamp (facing the patient) also has the
name of the product embossed in white, the aperture for the
beam of light itself, and round receptacles on either side of the
aperture. The overall appearance is very sleek and futuristiclooking, sort of reminiscent of the Jetson’s type of décor. The lamp
measures 13.0in/33.0cm in length.
Utilizing a short-arc metal halide bulb, the lamp emits ultraviolet light (UVA) through the rectangular aperture, which measures 0.75in/1.9cm x 2.15in/5.5cm. The round receptacles stabilize the rod-like guides, which establish the correct position of the
light in relation to the mouth.
In order to use the light, the fuse, which comes in a
separated envelope, must be installed. To do this,
you open the small receptacle on the bottom surface
of the control box and insert the fuse. This is an easy
and quick operation.
The Ratings
59
Bleaching Materials
Radiometer
Solarmeter. Digital ultraviolet radiometer that resembles a garage
door opener. Measuring approximately 4.0in/10.2cm x
2.4in/6.0cm x 0.8in/2.1cm and weighing 4.0oz/113.4g, you
merely activate the light for a few minutes, hold the radiometer
against the light aperture, hold the small button on top of the
radiometer, and read the light’s power on the radiometer’s LCD
screen. Originally, any reading over 50 was supposed to be adequate. However, while one of our one-year-old units tested at 84,
a new unit tested only at 48, while another one-year-old unit only
scored 33. Discus now states that its tests show even readings as
low as 20 will not affect bleaching efficacy.
Changing the Bulb
Entire lamphead must be replaced by Discus representative.
ture. Be sure to wait for five minutes after taking the syringe out
of the water before extruding the gel.
After placing the retractor, secure the bib (looks like a rubber
dam napkin), which further protects the surrounding tissue from
the bleach and ultraviolet light. Activate the light, which requires
a three minute warm-up cycle before the actual whitening cycle
can begin. The unit will beep once as the timer approaches the
final three seconds of the three minute warm-up cycle.
Once the light is turned on, do not attempt to
turn it off or disconnect the power for a minimum of 60 seconds. Doing so will harm the bulb
and void the warranty.
Recommended Total Bleaching Time
(Per Appointment)
60 minutes.
Approximate Length of Appointment
(includes actual bleaching time, isolation procedures, polishing before bleaching, light warm-up and cooldown times,
removal of isolation at end, etc.)
105 minutes.
Initial Clinical Evaluation Shade Changes
One Month
5.5
Three Months 5.1
Consistency and Handling
5.0 Mixing tip automatically incorporates the ingredients in the
dual-barrel syringe to produce a viscosity that has just enough flow
to apply easily to teeth, but is not runny. Be sure to dispense initially on a pad, since the beginning of each syringe tends to be on
the watery side. Once the viscosity turns more gel-like, it is ready
for application on the teeth.
0
1
2
3
MOST FLOW
4
5
LEAST FLOW
pH
8.9
Soft Tissue Protection
Liquidam. Blue, light-cured resin. Dispensed directly on the tissue
from its syringe. Liquidam is a viscous liquid and can be applied
one quadrant at a time for greater control.
Use
Swab the lips with a coat of the 30 SPF protective lip cream,
which shields the patient from the ultraviolet light. Remove the
syringe from the refrigerator at least six hours before use or preferably the previous evening. If you forget and the syringe is removed
immediately prior to the appointment, place it in a cup of hot tap
water (120°F/49°C) for 10 minutes to bring it to room tempera-
60
The Ratings
During the light warm-up period, apply the whitening gel
directly from the syringe, using a disposable brush to spread the
gel completely over the facial surfaces of the teeth. Then place the
light guides, which have rectangular foam bite blocks for positioning interocclusally in the molar area and plastic posts, into the
receptacles in the face of the light. Posts should extend out along
the edge of the cheek retractor. When assembled properly, the
light should rest 1.5in/3.8cm from the facial surfaces of the maxillary central incisors, although our measurements were closer to
2.0in/4.4cm.
While this positioning doesn’t sound complicated, it is not as straightforward as it may seem.
Having four hands definitely helps.
By now, the warming time has expired and you can activate the
light for 20 minutes. When the 20 minutes has expired (you are
alerted with a beep three minutes before the end of the 20 minutes and then again by three beeps starting three seconds before
the end of the 20 minutes), move the light away from the patient
and wipe off the gel. The light will automatically turn off and go
into the cooldown period, which lasts for two minutes. At the end
of cooldown, the fan cooling the light goes off, but there is no
beep, alerting you to manually begin the warm-up period again.
Repeat the bleaching procedure two more times.
Sensitivity (as determined during our clinical evaluation)
During the Procedure None.
Post-Operative Two patients in the initial evaluation and one
patient in the follow-up evaluation reported slight sensitivity within the first 24 hours of treatment, while the others had none.
Desensitization
1.1% neutral sodium fluoride for five minutes.
Bleaching Materials
Packaging
The Procedure Kits come in a clear plastic tray with a cardboard
insert acting as a lid. The tray contains all materials except for
retractors and the bleach itself, the latter of which is in a separate
cardboard box that needs to be refrigerated. Expiration sticker is
on the bottom of the Procedure Kit tray and side of the cardboard
box holding the bleach.
Directions
Coated paper booklet with step-by-step instructions accompanied
by color clinical photos. Easy to understand and follow. PostWhitening Care Instructions are on a separate card. There are also
two professionally-made instructional videos (also available on
CD) that are very well done. One of them is very comprehensive
and even covers assembling the light, while the other is truncated
and gets more quickly into the technique.
Marketing Materials
Most of the new approach leverages on Zoom! being used on the
Extreme Makeover TV show and feature Dr. William Dorfman,
the founder of Discus. Among the various materials available are
appointment/postcards, statement stuffers, brochures, brochure
holder, posters, counter cards, buttons, baseball caps, window
stickers, etc. Brochures are well-done with Q&A format, but states
the process takes “just over an hour” when there is no way you’ll
be finished in less than 1.5 hours.
Opalescence Xtra Boost
Ultradent
(4.0)
www.ultradent.com
2a
Intro Kit
Cost: $99.99 ($20.82/ml)
Includes:
• 4 syringes of Opalescence Xtra Boost (0.96ml ea)
• 4 syringes of Activator (0.24ml ea)
• 2 syringes of OpalDam (1.2ml ea)
• 10 Micro 20 delivery tips
• 10 Micro 22 FX delivery tips
• 2 IsoBlocks
• Total bleaching material = 4.8ml
(4 dual syringes and 1 syringe of OpalDam)
Refills:
Cost: $29.99
Includes:
• 2 syringes of Opalescence Xtra Boost (0.96ml)
• 2 syringes of Activator (0.24ml)
Shelf Life: 1.5 years (refrigerated)
MSDS: Included
Composition of Bleach
38% hydrogen peroxide gel.
Chemical activation. The syringe of regular Opalescence Xtra is
“boosted” by mixing with a proprietary chemical activator. This
mixing is done by linking the two syringes via a Luer-lock-type of
connection.
(Per Appointment)
60-90 minutes.
Does not require a light
Color makes applying even layer easy
No retractors in kit
Mixing is tricky
(includes actual bleaching time, isolation procedures, polishing before bleaching, removal of isolation at end, etc.)
90-120 minutes.
One Month
3.0
Three Months 2.7
The Ratings
61
Bleaching Materials
5.0 Remove the syringe tips and attach the ends of the syringes via
the Luer-lock connectors. Then push the contents of one syringe
into the other, followed by the reverse motion 10-12 times to
thoroughly mix the two materials. The mixture will end up in the
red Boost syringe, which is used to deliver the material to the
teeth. Viscosity has just enough flow to apply easily to teeth, but
is not runny.
0
1
2
3
MOST FLOW
4
5
LEAST FLOW
During the Procedure None in the initial evaluation. In the follow-up evaluation, one patient was slightly sensitive, while
another described the discomfort as “throbbing”.
Post-Operative In the initial evaluation, three patients had slight
sensitivity, one patient had moderate sensitivity, and one patient,
the only one having mandibular bleaching, had severe sensitivity
and had to take pain medication. In the follow-up evaluation, one
patient had slight sensitivity, while two patients had severe sensitivity and had to take pain medication. One of these latter patients
had mandibular bleaching.
pH
7.6
Desensitization
UltraEZ (not included in kit) used in a tray at home.
OpalDam. White, light-cured resin, with filler that sparkles.
Dispensed directly on the tissue from its syringe. Due to its runny
consistency, you need to cure for a few seconds as you place it
around each tooth. If you try to apply to more than one tooth
before curing, it will flow over the tooth, requiring you to chip off
the excess using a #15 scalpel. This is time-consuming and a nuisance, since it sets very hard.
Packaging
Clear, plastic box with an attached, side-opening lid. Removable,
clear plastic tray secures and organizes the contents. Nice, neat,
and convenient. Xtra Boost syringes are clear red plastic, while the
Activator is in a clear plastic syringe with a red plunger and cap.
OpalDam syringes are blue with white plungers. Expiration date
is embossed on the syringes, but you need the secret code to decipher it.
Use
After mixing, apply the material directly from the syringe for 1015 minutes, agitating the mixture every five minutes. At the end
of the 10-15 minutes, suction the excess with a surgical aspirator
tip. Do not rinse. Then re-apply up to five more times in 10-15
minute intervals for a maximum total of six applications. Make
sure you use a new syringe tip with each newly mixed syringe.
Directions
Plain paper, two-sided fold-out. On one side, there is a summary
of the technique in 19 languages with seven small, black and white
photos. On the other side, there is a more detailed version with
larger photos. Good advice, easy to follow. A note in bold states
that the activator and the bleach must never be used separately.
Always mix. On the backside, instructions also state that after
mixing, the product is good for 10 days.
Marketing Materials
Only one poster and one statement stuffer. See Opalescence
(Home Bleach) for other, more generic marketing materials.
62
The Ratings
Bleaching Materials
Opalescence Xtra
Ultradent
(4.0)
2b
Cost: $79.99 ($16.66/ml)
Includes:
• 4 syringes of Opalescence Xtra (1.2ml ea)
$55.99/4 ($11.46/ml)
• 2 syringes of OpalDam (1.2ml ea)
Shelf life:
$32.99/4 ($6.87/ml)
1 year refrigerated
• 20 Micro 20 Tips
• 20 Black Mini Tips
MSDS: Included
• 2 IsoBlocks
(4 syringes and 1 syringe of OpalDam)
Composition
35% hydrogen peroxide premixed gel containing carotene, which
gives it the bright orange color.
None supplied but use of a light is optional. If you choose to use
a light, you should use the largest tip, at least 11mm, and keep it
as close to each tooth as possible. Carotene presumably absorbs
light to activate the peroxide.
(Per Appointment)
45 minutes.
75 minutes.
One Month
N/A
Three Months N/A
5.0 Easy to dispense gel, slightly runny.
0
MOST FLOW
1
2
3
4
5
Carrots for bleaching
Easy to apply
More sensitivity than others
Why not broccoli?
the excess using a #15 scalpel. This is time-consuming and a nuisance, since it sets very hard. Adding some flexibility into the resin
may be an improvement. Once you finish the arch, cure for an
additional 20 seconds, although the heat produced by curing can
cause discomfort.
Use
Apply directly from the syringe, cover the teeth with at least a
1.0mm thick layer of gel, and light activate each tooth 20-30 seconds with a halogen light or 3-5 seconds with a plasma arc light.
However, this is only valid if your plasma arc light has a large tip
and it provides the full power of the light. From our tests (see
CURING LIGHTS), no plasma arc can achieve this feat.
Therefore, if you hold the light away from the tooth to expose the
entire facial surface, you probably want to increase the exposure
time to 10 seconds. After 10-15 minutes, suction the gel and rinse
well. If no sensitivity, repeat the process.
Sensitivity
Minimal when no-heat is used. There was slight sensitivity with
the light-activated side.
Desensitization
UltraEZ (not included in kit) used in a tray at home.
Packaging
Cardboard box with an attached, side-opening lid. Removable,
white plastic tray secures and organizes the contents. Nice, neat,
and convenient. Xtra syringes are clear red plastic while OpalDam
has blue syringes with white plungers. The expiration date is on a
sticker on the bottom of the box and is also engraved into the individual syringes near the finger rest, but it is very difficult to read.
LEAST FLOW
pH
4.3
OpalDam. White, light-cured resin, with filler that sparkles.
Dispensed directly on the tissue from its syringe. Due to its runny
consistency, you need to cure for a few seconds as you place it
around each tooth. If you try to apply to more than one tooth
before curing, it will flow over the tooth, requiring you to chip off
Directions
Six-page, newsletter-like pamphlet on coated paper with clinical
photos. Good detail, including the technique with both OpalDam
and the rubber dam. In addition, there is a single sheet of coated
paper in 13 languages. Features color illustrations showing the
application steps.
Marketing Materials
Only with Xtra Boost. See Opalescence (Home Bleach) for other,
more generic marketing materials.
The Ratings
63
Bleaching Materials
3
Niveous
Shofu
(3.6)
www.shofu.com
NEW
Cost: $184.95 ($18.50/ml/ampule)
Includes:
• 10 ampules of Niveous (1.0ml ea)
$269.95/25 ($10.80/ml/ampule)
• 1 syringe of Liquid Dam (3g/3ml)
$25.95/2 ($4.33/ml)
• 10 Liquid Dam Tips
• 30 Booster Brushes
$38.95/100 ($0.39 ea)
(8 ampules, 16 Booster Brushes, and 1/3 syringe of Liquid Dam)
Shelf life: 1 year refrigerated
MSDS: Not included
Ampules dispensing
Easy to apply
Booster Brushes don’t activate gel equally
Not as effective as others
0.0-5.0 Depends on its temperature. When the gel is warm and
the treatment room is not overly cooled by air conditioning, it is
not runny. But if either the gel and/or the room is very cool, it can
be very runny.
0
1
2
3
4
5
MOST FLOW
Composition
27% hydrogen peroxide premixed gel containing orange pigment.
Booster Brushes, which are impregnated with a proprietary oxidizing chemical. A light is not part of the system, but you may still
choose to use one.
(Per Appointment)
30 minutes with light.
45 minutes without light.
60-75 minutes.
Clinical Evaluation Shade Changes
One Month
N/A
Three Months N/A
64
The Ratings
pH
Before activation
After activation
LEAST FLOW
3.6
3.6
Liquid Dam. Blue, light-cured resin. Dispensed directly on the tissue from its syringe. Good consistency—allows application to the
tissue around a quadrant without flowing over the teeth, yet it has
good affinity for the tissue for sealing purposes. Light cure for 20
seconds—the mild heat produced should cause only slight discomfort. Even though Liquid Dam is supplied, the rubber dam is
also recommended.
Use
Make sure the ampule has been removed from the refrigerator several hours before using. Even then, it is prudent to put the ampule
in warm water for 30 seconds before dispensing. If the material is
cold, it can be very runny.
Cut the sealed end of an ampule and apply the bleach directly
onto the teeth, covering them with at least a 1.0mm thick layer of
gel. Then activate the bleach by agitating it on each tooth for 15
seconds with a Booster Brush. The material will start bubbling on
the teeth, presumably indicating that the oxidation program has
begun. Alternatively, you can dispense the bleaching gel into a
Bleaching Materials
dappen dish (the dish that comes with the kit is too small), stir the
bleach with 2-3 Booster Brushes for activation, and apply to the
teeth. One ampule is necessary for each arch. Note that, even
though the warmed gel is very thick when initially dispensed, it
tends to become runny duration the activation process, which
requires stirring the gel with the brushes.
If you choose to use a halogen light, each tooth should be
exposed to the light for two minutes. With a plasma arc light,
exposure time is supposed to be only five seconds per tooth.
However, this is only valid if your plasma arc light has a large tip
and it provides the full power of the light. From our tests (see
CURING LIGHTS), no plasma arc can achieve this feat.
Therefore, if you hold the light away from the tooth to expose the
entire facial surface, you probably want to increase the exposure
time to 10 seconds. After 15 minutes, suction the gel and rinse
well. If no sensitivity, repeat the process 2-3 times, using a newly
activated mix of bleach for each application.
During the Procedure None.
Post-Operative One patient had slight sensitivity, which was
resolved using Sensodyne toothpaste.
Desensitization
Not provided or recommended.
Packaging
Cardboard box with a rear-attached lid. Removable, white plastic
tray secures and nicely organizes the contents. Ampules are clear
soft plastic while Liquid Dam is in a conventional black, pushtype syringe. There is a space on the side of the box for the expiration date, but the date was missing.
Directions
10-page, coated paper booklet with seven drawings to aid with
application specifics. There is also a quick reference guide inside
the lid of the box. Information is straightforward and easy to
understand. However, the booklet tells you to remove the bleach
from the refrigerator at least 15 minutes before use, while the
instructions inside the lid states 2-3 minutes is sufficient. In addition, the instructions inside the lid tell you to apply twice for 15
minutes each, but then it is stated that “optimal results may be
achieved with less applications”. If the standard is two applications,
then the only less option is one application. We find it difficult to
believe that one application will give you “optimal results”.
Marketing Materials
Only a brochure, although it is well-done and should appeal to a
wide variety of patients. Features a head and shoulders shot of a
young woman on the cover and a before and after smile shot
inside. Only flaw is the copy on the cover that states “Just smile,
baby!”, which smacks of Austin Powers slang. A more sophisticated message would be better.
REALITY
Zoom! gives you the biggest bang for your buck when it
comes to the light, not to mention its ultracool appearance.
Its marketing support is also unrivaled. However, it’s the most
difficult of the lights to position properly, the lack of casters
makes moving it from room to room a chore, and tissue protection is most critical due to its ultraviolet lamp.
Nevertheless, its procedure kits are the most complete in this
category. In the initial evaluation, it produced an average
three-month clinical shade change of 5.1 (the most), which
was confirmed in the follow-up evaluation.
Opalescence Xtra Boost uses a unique twin-syringe system
for activation, but be sure to mix it thoroughly using the conjoined syringes and apply it sparingly or your price per application will rise. All of the patients had post-treatment sensitivity of some sort and it produced an average three-month
clinical shade change of 2.7 (the lowest) in the initial evaluation. The follow-up evaluation had slightly better results.
Opalescence Xtra is the least expensive and the only product in this group with conveniently premixed gel, which is
dispensed directly from its syringes onto the teeth. While it
was not included in the initial evaluation, the follow-up evaluation found about the same results as its stablemate, Xtra
Boost. It seemed to be more likely to cause sensitivity than
the other products.
Niveous is, perhaps, the most innovative product in this
group, with its bleach activation being impregnated into the
fibers of the applicators that come with the kit. Its unidose
ampules also make the packaging and dispensing more calibrated.
However, the bleaching times and technique recommended are not effective and are hard to decipher. The bleaching
time of 30 minutes or less is just not realistic. To get any kind
of results with this product, we strongly recommend a full 60
minutes of bleaching.
Then you need to consider the kit and calculating how
much bleach and how many Booster Brushes to use. It comes
with 10 ampules of bleach and 30 Booster Brushes. This presumably means that you are supposed to use three brushes
to activate each ampule. But the instructions state that you
should use one brush for six teeth and, since it appears you
The Ratings
65
Bleaching Materials
should use three brushes for each ampule, then each ampule
should bleach 18 teeth.
However, we found one ampule only has enough bleach
to cover 10 teeth in a typical maxillary arch, with virtually no
gel available for the mandibular arch. Since you are supposed to use one brush for six teeth and we were bleaching
10 teeth, we settled on using two brushes to activate each
ampule. (Our activation test did not show any greater “bubbling” effect using three as compared to two brushes.)
Note: We chose to activate the bleach in a dappen dish as
opposed to applying it to the teeth and then activating it,
since we reasoned that in the latter method, the teeth
exposed to the brushes first would get a high concentration
of the activation material embedded in the fibers, while the
end of the line teeth would be shortchanged. By activating
the bleach in a dappen dish, we assumed each tooth would
get the same activation level of bleach.
The clinical evaluation showed results similar to the Xtra
twins.
Assisted Bleaches
Although there are several home bleaching products at the 30%
carbamide peroxide level, these products continue to be marketed,
despite the fact that they typically contain 35% carbamide peroxide or its equivalent, which, of course, is only slightly higher than
the at-home products.
Originally used as a first-appointment booster for a home
bleaching program, these products were not necessarily promoted
as a stand-alone office bleach. This is due to the fact that carbamide peroxide is not as strong as hydrogen peroxide. Therefore,
you would not expect to get the same results from these products
as compared to the hydrogen peroxide gels.
We found these materials were able to produce a slight change
in shade after one 30-minute bleaching session, with their efficacy virtually the same. It is clear their real contribution could be as
high-powered home bleaches for patients who do not have any
pretreatment sensitivity and want the absolutely fastest results.
With this impending dispensing change, direct application
without a tray would seem to be a time-consuming, labor-intensive, unnecessary option. A more logical approach would have the
patient fill and wear the tray for the first session in the office.
Assuming the patient does not experience any untoward effects,
the patient would then take the bleach with him or her and continue an abbreviated home bleaching schedule. Be careful not to
overlap the gingiva with the bleaching tray to keep these products
off the soft tissue. Even though they are not as caustic as high concentration hydrogen peroxide gels, these products do have the
capability to irritate the gingiva.
Opalescence Quick
1a
Ultradent
(3.9)
Cost: $23.99 ($5.00/ml)
Includes:
• 4 syringes of gel (1.2ml ea)
$103.99/20 ($4.33/ml)
• 4 White Mac tips
Shelf life:
2 years refrigerated
MSDS: Included
Easy dispensing
Good viscosity
Is it really necessary to warm before using?
Can cause soft tissue soreness quickly if excess is
not removed immediately after seating tray
Concentration
35% carbamide peroxide.
5.0 Thick viscosity gel, easy to control and wipe off gingiva.
0
1
2
3
MOST FLOW
66
4
5
LEAST FLOW
The Ratings
Flavor
One: Neutral—no specific flvaor.
pH
6.1
Bleaching Materials
Use
Only bleaching tray method recommended. It is suggested to
hold syringe under hot water for 2-3 minutes to warm bleach,
which seemed to slightly enhance bleaching effect and did not
cause any pain.
Sensitivity
None reported, although it can cause gingival soreness fairly rapidly if excess is not removed from soft tissue.
Packaging
Small, clear plastic tray with clear plastic lid. Clear syringes with
gold plungers, and includes Straight Mac tips. Depending on the
size of the bleaching tray, each syringe contains enough bleach for
one or two arches. The expiration date is on a sticker on the label
of the box, and is also chiseled on the syringe itself near the finger
rest (very difficult to read). Certified Kosher-Pareve by Rabbi Benny
Zippel of the Chabad Lubavitch of Utah. So, you can now feel free
to bleach regardless of whether you have eaten meat or dairy!
Directions
Small coated paper foldout with nine color photos and one color illustration. Easy to understand and follow. Also has the Kosher seal!
White Speed
Discus
(3.9)
1b
Cost: $50.00 ($6.94/ml)
Includes:
• 2 dual-barrel syringes (4g/3.6ml ea)
• 12 syringe tips
• Total bleaching material = 8g/7.2ml
Shelf life: 2 years
Why mix the two peroxides?
Tends to foam inside tray and run down
the throat
MSDS: Not included
Concentration
19% hydrogen peroxide and 20% carbamide peroxide. After mixing, is the equivalent of 35% carbamide peroxide.
4.5 Medium-thick viscosity gel, slightly runny, but easy to control
and wipe off gingiva.
0
MOST FLOW
1
2
3
Great name
Cool syringe
4
4.5
5
LEAST FLOW
Flavor
One: Peppermint Cream. Described as “delicious”, but more like
tolerable.
Sensitivity
Very minimal.
Packaging
Clear plastic tray with flip-up, cardboard lid holding the two dualbarrel syringes, translucent purple barrels and gray/green plungers.
Barrels have 12 calibrations, which are supposed to correspond
with an equal number of applications, but our test found you will
probably only be able to fill 3-4 trays with one syringe. And
mounting the tips on the syringes can be tricky.
Directions
Inside lid of plastic tray. Short, to the point.
pH
5.6
Use
Only bleaching tray method recommended.
The Ratings
67
Bleaching Materials
Polazing
2
SDI
(3.8)
Cost: $25.00 ($4.81/ml)
Includes:
• 4 syringes of gel (1.3g/1.3ml ea)
• 4 tips
Shelf life: 2 years, 3 years refrigerated
MSDS: Not included
Concentration
35% carbamide peroxide. Also includes fluoride, proprietary
desensitizing agent, and Chitosan, which is a polysaccharide found
in the exoskeleton of shrimp and crabs and is chemically similar to
cellulose. If your patient is allergic to shellfish, you may want to
use another product. It presumably acts as a natural soother and
conditioner that inhibits plaque formation and aids in calcium
absorption to further reduce sensitivity and ion loss from enamel.
5.0 Thick viscosity gel, easy to control and wipe off gingiva.
0
1
2
3
4
MOST FLOW
5
LEAST FLOW
Flavor
One: Mint, but it is very subtle.
Easy dispensing
Good viscosity
Wrong instructions in kit
Do you really want a bleach with “zing”
in its name?
Sensitivity
None reported.
Packaging
Small, cardboard box with removable white plastic tray securing
the syringes. Clear syringes with clear plungers need you to install
tips. Depending on the size of the bleaching tray, each syringe
contains enough bleach for 2-3 arches. The expiration date is on a
sticker on the bottom of the box and is also imprinted on the
syringe itself.
Directions
Plain paper foldout in seven languages. Composition listed doesn’t
correlate with marketing materials, since there is no mention of a
desensitizer or Chitosan. No photos. There is also the same plastic-laminated card that is found in the Poladay kit, but the card is
for patients, who are not supposed to be self-bleaching with this
product.
pH
5.5
Use
Only bleaching tray method recommended.
REALITY
Opalescence Quick has those terrific Ultradent syringes,
which makes it the easiest to dispense the gel into a tray.
However, be sure to remove the excess from the soft tissue
immediately after seating the tray—it can cause discomfort
quite quickly otherwise.
White Speed, mixing two different peroxides to arrive at
the same concentration of carbamide peroxide and its dualbarrel syringe with miniature mixing tip, at least creates
some intrigue. However, the mixture tends to foam up intraorally and can run down the patient’s throat.
Polazing is easy to dispense and does not seem to cause sensitivity, but who wants to “zing” a patient during bleaching?
68
The Ratings
Bleaching Materials
Home Bleaches
These products contain various concentrations of carbamide peroxide or hydrogen peroxide. While most versions keep the
concentration at 22% carbamide or lower, home bleaches with
30% carbamide peroxide are now being sold, although this concentration is still considered quite high by most dentists.
Nevertheless, the trend is to use stronger bleaches for shorter periods of time. Even Crest Whitestrips, which Proctor & Gamble has
chosen not to submit for evaluation, has a “supreme” version that
contains 14% hydrogen peroxide (equal to about 42% carbamide), although the marketing adds “some people may
experience sensitivity”!
Other differences between the products are based on viscosity,
flavor, packaging, and marketing. And all of them have the potential to cause gingival inflammation and/or tooth sensitivity if not
used properly.
Composition
Carbamide peroxide is the main ingredient for most home bleaches, but hydrogen peroxide is thought to be more active. While we
have indicated which form of peroxide each product contains,
most of the independent research plus our evaluator ratings have
failed to find any significant differences between them.
Concentration
For carbamide peroxide products, the range is from 10% to 30%.
It would seem the higher the percentage, the more effective the
material. However, there are other factors such as the viscosity,
which seem to be just as important as concentration. For hydrogen peroxide products, 3.0% to 9.5% is the range.
pH
Has been implicated in causing sensitivity. It follows, therefore, that
a more neutral pH bleach would be less likely to cause sensitivity.
Viscosity
Thicker and stickier is usually better. The more adherent the
bleach is to teeth, the more effective it probably is and the easier
it is to keep it off the soft tissue and from flowing down the throat.
On the other hand, those extra sticky bleaches are sometimes difficult to remove, especially from embrasures.
Packaging
Convenience is a major item in this category, since patients will
only use the bleach if it is easy and not a hassle. All of our
CHOICES are offered in individual syringes, which can be given
to patients a few at a time. This effectively forces patients to return
to the office on a regular basis (as often as you feel necessary) to
have their teeth and tissues checked. Several of the manufacturers
also include their toothpastes and mouthrinses in these kits. One
evaluator felt toothpaste and mouthrinse do not belong in this
type of kit while other evaluators reported that patients appreciated these extra components.
Bleaching Tray Material
Most of the bleaches come with material for bleaching trays. All of
these tray materials are very flexible and comfortable. We tested
each manufacturer’s tray material for ease of fabrication and thickness.
There are also different names given for bleaching trays, ranging from nightguards, mouthguards, whitening trays, application
trays, and mouth splints. The only one from that group that really describes its purpose is whitening tray. We continue to favor
bleaching tray, since most of the public refers to tooth whitening
as bleaching.
Reservoir Material
These are applied to the facial surfaces of teeth on the patient’s
model prior to making the tray. It provides a narrow space (about
1.0mm) between the teeth and the bleaching tray. This space presumably allows more bleaching gel to stay in contact with the teeth.
Our own clinical study showed there were no differences in bleaching, regardless of whether a
reservoir was used or not. Therefore, we do not
recommend reservoirs in bleaching trays.
We have left this information in each product’s commentary, just
in case you choose to continue using reservoirs. Some of these
products also have other uses. Please see BLOCK-OUT RESINS
for more information.
Storage
Most manufacturers of peroxide products, regardless of
whether they are destined for office or home use, recommend
refrigeration until they are dispensed. This means you should tell
your patients to keep their bleach in the refrigerator when they are
home and not to leave the bleach or their bleaching tray in their
car when the weather is warm or hot. They should be active for
one year if refrigerated. In addition, none of these home bleaches
require an MSDS.
The Ratings
69
Bleaching Materials
Opalescence/Opalescence PF
1
REALITY’S
Ultradent
CHOICES
www.ultradent.com (4.5)
Cost: $35.99 ($2.50/ml)
Doctor Kit Includes:
• 12 syringes of gel (1.2ml ea)
• 2 Sof-Tray sheets
• 1 tray case
• 1 syringe of LC Block-Out (1.2ml)
• 1 tube of Opalescence toothpaste (1oz)
• Shade Guide Card
Refills:
Cost: $103.99 ($2.17/ml)
Includes:
• 10 kits (4 syringes/kit)
• 2 Shade Guide Cards
• Total bleaching material = 48ml
Shelf life: 2 years refrigerated
Single dose syringes are still the easiest
Very good marketing support
Stronger than 20% would be nice
Sharp edges on plastic boxes are not friendly
Composition
Opalescence
carbamide peroxide.
Opalescence PF carbamide peroxide, 0.11% fluoride ion, and
3% potassium nitrate.
Concentrations
Opalescence
10%.
Opalescence PF 10%, 15%, and 20%.
Color
Clear.
5.0 Very thick, sticky viscosity, helps to keep gel in contact with
the teeth.
0
1
2
3
4
MOST FLOW
pH
6.3-6.6
Flavors
Three: regular, mint, and melon.
70
5
LEAST FLOW
The Ratings
Packaging
The kit is a translucent plastic box with a removable plastic tray
securing the contents. The color accent on the plastic instantly
identifies the flavor: purple is regular, green is mint, and
pink/peach is melon. However, if you are not familiar with the
color-coding, there is no other flavor identification on the box.
This box has a contemporary look, but the sharp corners of the
plastic are uncomfortable during opening. Inside, there is a clear
plastic insert securing the tray case and the tube of Opalescence
toothpaste.
The syringes of bleach are secured in translucent plastic trays,
four syringes to a tray. A slide-off sleeve serves as a cover for the
syringes. The refill boxes contain 10 of these 4-syringe trays (also
available as 2-syringe trays). A box can be quickly retrieved
through a cutout on the side. However, the sleeve also has no flavor designation other than the color-coding.
The tray case has a very low profile and can fit into a pocket or
purse without much bulk. Attractively embossed with the
Ultradent logo, it is made out of translucent plastic that is colorcoded with the rest of the kit.
The syringes have the tips already attached. The direct imprinting on the syringes prominently indicates the concentration and
flavor of the gel. In addition, the syringes for each flavor and concentration have different color imprinting, plastic barrels, and/or
plungers.
These syringes are smaller than those of the other materials in
this category, with each syringe containing enough material to fill
the bleaching tray once if you are bleaching the entire arch (first
molar to first molar) or twice if you are bleaching less teeth and
the teeth are small. This smaller syringe has both advantages and
disadvantages.
Its advantages include very easy dispensing for patients and
you. Patients do not have to worry about looking at lines on the
Bleaching Materials
syringe to make sure they are using the appropriate amount —
they just fill the tray with the syringe and throw it away. For you,
there is less calculating how many syringes to give the patient. If
you want them to fill and wear the bleaching tray twice a day, you
give them two syringes for each day. You don’t even need a calculator! The main disadvantage is adding more plastic to our
landfills and you need to give the patient more syringes.
The expiration date is on a label on the side of the main box,
and is also chiseled into the syringe itself (although very difficult
to read).
Brand name: Sof-Tray. Before fabrication: 0.7mm thick. After vacuum-forming, was 0.5mm thick in the middle of the facial surface
of the maxillary left central incisor. Slightly larger dimensions
compared to the other tray materials tend to keep it more secure
in the vacuum-forming machine when it is brought down over the
model. It also does not shrink when heated in a vacuum-forming
machine.
Reservoir Material
Brand name: LC Block-Out. Blue, easy to apply.
Directions
Dentist Plain paper foldout in 19 languages with b & w photos.
Fairly comprehensive in English, covering pre-treatment procedures, tray fabrication, and general information.
Patient Plain paper foldout in 19 languages with b & w photos.
But there is a General Precautions areas that is written more for
the dentist than the patient. Wisely advises following the dentist’s
recommended bleaching protocol.
Marketing Materials
BluePrints for Success is a comprehensive marketing program that
fits into a three-ring binder (not provided). It covers advertising,
public relations, and a media kit. Excellent information and easy
to follow. There are also postcards, counter displays, statement
stuffers, and posters, with several different themes including season-specific.
Day White Excel 3
Discus
(4.3)
2a
Cost: $36.00 ($2.50/ml)
Standard Kit Includes:
• 6 dual-barrel syringes of gel (2.6g/2.4ml ea)
• Bleaching tray case
• 6 automix syringe tips
Cost: $15.50 ($2.15/ml)
Mini Kit Includes:
• 3 dual-barrel syringes
• 3 automixing tips
Shelf life: 2 years
Concentrations
7.5% and 9.5%.
Gives daytime bleaching an identity
Using the real stuff makes sense
Can’t you use any bleach during the day?
Is there really an advantage of hydrogen
over carbamide?
Composition
Hydrogen peroxide. Activator contains eugenol, xylitol, and aloe
vera.
Color
Clear.
5.0 Very thick. Very easy and precise dispensing into tray,
although one evaluator thought it was too foamy.
0
MOST FLOW
1
2
3
4
5
LEAST FLOW
The Ratings
71
Bleaching Materials
pH
8.6-9.5
All the kits and syringes are prominently marked as to their
concentration of hydrogen peroxide. The syringes are all identified
as DAY WHITE Excel 3, with fuchsia printing for 7.5% and gold
printing for 9.5%. The expiration date is on a label on the bottom
or side of each box.
Flavor
One: Cool mint.
Packaging
Standard kit has a contemporary white cardboard with removable
lid that opens to reveal a translucent turquoise plastic tray securing six dual-barrel syringes of material, automix tips, and a case for
the bleaching trays. There is an opening in the middle of the lid
that exposes the two-syringe cases that are placed on top of one
another inside a recess in the box. The tray case is a sleek, expensive-looking, semi-translucent turquoise retainer-like box with an
unusual surface finish and Discus Dental embossed on the bottom. The six dual-barrel syringes are arranged in groups of three
in separate plastic translucent turquoise cases that are stacked on
top of each other. There are recesses inside each of the plastic cases
that secure three syringes and three tips. The inside of the box lid
contains some general instructions for the patient.
The syringes have been imprinted with six calibrations, guiding the patient as to the amount of bleaching gel to be dispensed
into the bleaching tray. This means each syringe should be able to
fill a bleaching tray six times, although on the average, most
patients were able to get only four doses per syringe.
The Mini kit comes in a thin white cardboard box with a sideopening flap. The three syringes come in the same translucent
turquoise plastic case that is in the standard kit, and an opening in
the top of the box showcases the cover of the plastic case. Patient
instructions are printed on the bottom of the cardboard box. This
Mini kit gives you a convenient and attractive package to give to
patients when they want to do a touchup, although there is also a
kit called the Single Kit that just contains one syringe.
2b
Before fabrication: 1.0mm thick. After vacuum-forming, was
0.4mm thick in the middle of the facial surface of the maxillary
left central incisor.
Reservoir Material
Not recommended.
Directions
Dentist None in the kit, but there is a double-sided postcard with
four color illustrations on how to fabricate a bleaching tray in the
bag holding the tray material. Straightforward and easy to understand. However, it is suggested to use Splash Lite Body for the
bleaching tray impression, even though this low viscosity material
has excessive flow for placement in an impression tray and is not
as effective as a higher viscosity material.
Patient Small glossy booklet with two photos, placed under the
stacked two-syringe packages. It is generic in that it applies to both
Day White and Nite White. Gives good advice on handling sensitivity, but recommends wearing the tray for a maximum of one
hour at a time. However, we prefer that manufacturers leave the
bleaching protocol to each dentist’s discretion.
Marketing Materials
Nothing specific for this product. Multitude of materials for
bleaching in general and other products.
Nite White Excel 3 Turbo
Discus
(4.3)
NEW
Cost: $39.00 ($5.65/ml)
3-syringe Kit Includes:
• 3 dual-barrel syringes of gel (2.4g/2.3ml ea)
• Bleaching tray case
• 3 automixing syringe tips
Cost: $28.00 ($6.09/ml)
2-syringe Kit Includes:
• 2 dual-barrel syringes (2.4g/2.3ml ea)
• 2 automixing tips
Shelf Life: 1 year
72
The Ratings
Bleaching Materials
If you want thick, this is it
Could this be the first sensitivity-free bleach?
Difficult to remove from embrasures
White color does not permit discrete bleaching
Composition
Hydrogen peroxide and potassium nitrate.
Concentration
6%.
left central incisor.
Color
White.
5.0 Very thick. Very easy and precise dispensing into tray. Adheres
exceedingly well to teeth. When a tray is removed, half of the
bleach remains on the teeth. And, if your patients have open gingival embrasures, this material will not rinse off even with
aggressive rinsing—they must use a toothbrush and/or floss. In
addition, mixed material was not always homogeneous.
0
MOST FLOW
a minimum of excess. This means each syringe should be able to
fill a bleaching tray eight times, although on the average, most
patients will be able to get only 2-3 doses per syringe. One of the
reasons is the barrel with the potassium nitrate, where two calibrations out of eight were not even filled in one of our sample
syringes. If a patient is using a syringe such as this one, he or she
would have to waste 25% of the peroxide just to get to point
where it could be mixed with the potassium nitrate. The printing
color on the syringes is black.
While the kit is prominently marked Nite White Excel 3
Turbo, the syringe itself only is imprinted with Turbo 6% Z (for
zero sensitivity). The expiration date is on a label on the bottom
of the box.
1
2
3
4
5
LEAST FLOW
pH
6.0
Flavors
One: mint, that is more neutral than minty.
Packaging
2-syringe kit has a contemporary black cardboard, rear-attached
lid that opens to reveal a charcoal grey plastic tray securing the two
syringes of material, syringe tips, and a case for the bleaching trays.
There is an opening in the middle of the lid that exposes the
syringe case that is placed in a recess in the box. The tray case is a
sleek, expensive-looking, translucent charcoal grey retainer-like
box with an unusual surface finish and Discus Dental embossed
on the bottom. The two syringes are secured in a separate translucent grey plastic case. The Discus symbol is placed in the center
on top of each plastic case. There are grooves inside each of the
plastic cases that secure two or three syringes and 2 or 3 tips. The
inside of the box lid contains some general instructions for the
patient.
The syringes are all the dual-barrel design and have been
imprinted with eight calibrations, guiding the patient to dispense
the correct amount of bleaching gel into the bleaching tray, with
Reservoir Material
Not recommended.
Directions
Patient Small glossy booklet with two photos, placed under the
syringe case. Gives good advice on handling sensitivity.
Marketing Materials
Auxiliary Materials
Speed Stone. This is a fast-set stone, which can be used for same
appointment models. Even though you can separate the model
from the impression after the package-indicated time of five minutes, our models were still not rock-hard. We suggest waiting 10
minutes just to be on the safe side. Speed Spray surfactant is used
to reduce bubbles when pouring models. It worked well. Speed
Release is a silicone spray used for model lubricant. Doublecurved scissors to trim trays are particularly effective and make
scalloping a cinch.
The Ratings
73
Bleaching Materials
Zoom! Take-Home
2c
Discus
(4.3)
Cost: $222.00/6 kits ($5.36/ml)
3
•
•
•
•
Syringe Weekender Kit Includes:
3 dual-barrel syringes of gel (2.4g/2.3ml ea)
Bleaching tray case
3 automix syringe tips
Total bleaching material = 6.9ml
Cost: $81.00 ($5.87/ml)
Touch-Up Kit Includes:
• 1 dual-barrel syringe
• 1 automixing tip
Shelf life: 1 year
If you want thick, this is it
Could this be the first sensitivity-free bleach?
Difficult to remove from embrasures
White color does not permit discrete bleaching
Composition
Hydrogen peroxide. Available with potassium nitrate (Z formula)
and without it (regular formula).
Concentrations
4% and 6%.
Color
White.
5.0 Very thick. Very easy and precise dispensing into tray. Adheres
exceedingly well to teeth. When a tray is removed, half of the
bleach remains on the teeth. And, if your patients have open gingival embrasures, this material will not rinse off even with aggressive rinsing—they must use a toothbrush and/or floss. In addition,
mixed material was not always homogeneous.
0
1
2
3
4
MOST FLOW
5
LEAST FLOW
Packaging
Weekender kits have a clean, clamshell-like design, with hard,
clear plastic lids hinged at the rear and bases in either silver (regular formula) or metallic blue (Z formula) plastic. These plastic
cases plus a single syringe in a conventional cardboard box come
in a clear plastic box that opens on each end. The syringes are standard dual-barrel design with the silver plungers. The imprinting
on the syringes indicates the peroxide concentration and includes
the Z designation when appropriate. This imprinting is also colorcoded: blue for 4% and silver for 6%. The silver tray case is a
unique half-moon design.
There are eight calibrations to guide the patient when dispensing the bleach into the tray, with each calibration supposedly containing enough bleach to fill a tray. We found, however, that most
patients with average-sized teeth were only able to get only 2-3
doses per syringe even if they were careful when dispensing.
The Touch-Up kits hold one syringe and come in a thin white
cardboard box with a side-opening lid. Patient instructions are
printed on the back of the cardboard box.
The expiration date is on a label on the bottom of the clamshell
case or side of the box.
left central incisor. It is supplied separately from the kit in proportion to the amount of kits you buy at no additional cost.
Reservoir Material
Not recommended.
pH
6.5-6.6
Flavor
One: Mint, but it is very subtle.
74
The Ratings
Bleaching Materials
Directions
Patient Small glossy foldout with two photos, placed in a slot
under the base of the case. Good advice, attractively presented.
Marketing Materials
Nupro White Gold
(3.7)
3
Intro Kit
Cost: $52.50 ($2.92/ml)
Includes:
Patient Take Home Portion
• 6 syringes with break-off dispensing tips attached (3ml ea)
• 1 tray case
• 1 patient shade guide
Lab Material for Tray Fabrication
• 1 syringe of Triad Gel VLC Block Out Resin (1.5g)
Touch-Up Kit
Cost: $11.75 ($1.96/ml)
Includes:
• 2 syringes with break-off dispensing tips attached (3ml ea)
Shelf life: 2 years
Composition
Carbamide peroxide. 15% contains fluoride.
Concentrations
10% & 15%.
Color
Clear.
5.0 Very thick, sticky viscosity, easy to dispense.
0
MOST FLOW
1
2
3
4
5
LEAST FLOW
pH
5.7-6.1
Flavors
One: mint, but more neutral than minty.
Least expensive
Attractive packaging
Nothing stronger than 15%
Not much marketing support
Packaging
The kit comes in a silver and blue cardboard box, with two panels
in the front that overlap and Velcro together. Inside, the syringes
are in plastic carrying cases with recesses to secure the syringes in
place. A cardboard insert holds the dark blue round tray case in
place. The case has turquoise blue sparkles intermingled with the
darker blue, and has the Nupro White Gold emblem in silver on
top of the case.
To complement the tray case, the 10% syringe plungers and
caps are the same dark blue color while the 15% with fluoride
syringes have turquoise blue as the accent. The direct imprinting
on the syringes prominently indicates the concentration of the gel
as well as the product name. The expiration date is on the individual syringes as well as on a sticker on the side of the box.
The lab materials come in a thin silver and blue cardboard box
that is shrink-wrapped with the intro kit. The block-out resin is
kept in place by a square cardboard insert attached to the inside of
the box. The tray sheets and instructions are loosely packed inside,
next to the cardboard insert holding the block-out resin.
Brand name: none. Before fabrication: 0.9mm thick. After vacuum-forming, was 0.4mm thick in the middle of the facial surface
of the maxillary left central incisor. It shrinks when heated in a
vacuum-forming machine.
Reservoir Material
Triad Gel VLC Block Out Resin. Somewhat thick — needs to be
aggressively manipulated to cover the facial surfaces of the teeth in
a relatively thin layer.
The Ratings
75
Bleaching Materials
Directions
Dentist Glossy paper booklet with no photos. Relatively brief,
but more than adequate for anyone other than a novice. Patient
instructions are on the last page of the booklet.
Patient Printed on a glossy small foldout enclosed with the twopack syringe set. On one side, there are six color photos. Advises
that you should follow “your dentist’s instructions”, and then
states each syringe contains approximately three-to-five treatments. They do make the recommendation of wearing the trays for
4a
NEW
a minimum of two hours. Also has a small note to refrigerate the
gel when not in use for more than two weeks. The patient instruction foldout is also inside the cover of the two-syringe travel kit.
Marketing Materials
Brochures, postcards, statement stuffers. Fairly middle-of-theroad. Won’t dazzle anyone, but also won’t offend.
Poladay
SDI
(3.6)
www.sdi.com.au
SAMPLING
Cost: $29.10 ($2.24/ml)
10 Syringe Kit Includes:
• 10 syringes of gel (1.3g/1.3ml ea)
• 10 tips
• 1 tray case
• Shade Guide Card
Refills: Cost: $99.00 ($1.52/ml)
Includes:
• 50 syringes
• 50 tips
• Total bleaching material = 65ml
Shelf life: 2 years at room temperature, 3 years refrigerated
Concentrations
3%, 7.5%, and 9.5%.
Excellent selection of concentrations
Least expensive
Lackluster packaging
Mediocre directions
Composition
Hydrogen peroxide. Also includes fluoride, proprietary desensitizing agent, and Chitosan, which is a polysaccharide found in the
exoskeleton of shrimp and crabs and is chemically similar to cellulose. If your patient is allergic to shellfish, you may want to dispense another product. It presumably acts as a natural soother and
conditioner that inhibits plaque formation and aids in calcium
absorption to further reduce sensitivity and ion loss from enamel.
Color
Clear.
5.0 Very thick, sticky viscosity, helps to keep gel in contact with
the teeth.
0
1
MOST FLOW
2
3
4
5
LEAST FLOW
pH
6.0-6.4
Flavors
One: spearmint.
76
The Ratings
Bleaching Materials
Packaging
The kit is a conventional cardboard box with a removable white
plastic tray securing the contents. There is no other identification
on the box among the peroxide versions other than a label on the
top of the lid.
The top five syringes of bleach are secured in a removable
translucent plastic tray, while the other five syringes reside in
cutouts in the main white tray. The tray case is white plastic with
a conventional shape and SDI embossed on the top. The tips for
the syringes need to be attached. The direct imprinting on the
syringes indicates the concentration of the gel. These syringes are
clear plastic and contain enough material to fill the bleaching tray
twice if you are bleaching the entire arch (first molar to first
molar). There are no calibrations on the syringe for dispensing
guidance.
The expiration date is on a label on the side of the lid and is
also imprinted onto the syringe itself.
left central incisor, but it “feels” much thinner, even flimsy. While
it has slightly larger dimensions compared to the other tray materials, this sheet literally melts in the vacuum-forming machine
before it can be brought down over the model. There is a real steep
learning curve when making a tray with this material. You also
have to wait until the material completely cools off to remove it
from the vacuum-forming machine because it becomes very sticky.
In addition, the material that comes with the kit is smooth on
both sides, while the material in refill bags has one smooth and
one textured side.
Reservoir Material
Brand name: Spacer Resin. Very light blue, somewhat thick—do
not apply evenly without extra manipulation.
Directions
Dentist Plain paper foldout in eight languages. More appropriate
for patients than dentist. Somewhat outdated, since it does not
mention the 9.5% version. Composition listed also doesn’t correlate with marketing materials, since there is no mention of a
desensitizer or Chitosan. No photos.
Patient Plastic-laminated card with five color illustrations but no
words whatsoever.
Marketing Materials
Postcards, brochures, and patient assessment worksheet, which is
basically an esthetic screening form. The brochure features a pretty young woman on the cover and covers all versions of the Pola
line of bleaches in a Q&A format.
treswhite
Ultradent
(3.6)
www.ultradent.com
4b
NEW
Patient Kit
Cost: $39.99 ($4.00/pack or $2.00/tray)
Includes:
• 10 packs (two trays/pack)
Shelf Life: 1 year refrigerated
Better coverage than White Strips
Keeps bleaching in the dental office, where it
really belongs
Trays not as comfortable as strips or paint-on
products
No single arch packaging
Composition
Hydrogen peroxide.
Color
Clear.
Concentration
9%.
The Ratings
77
Bleaching Materials
5.0 Very thick, very sticky viscosity, keeps gel in contact with the
teeth but also makes it difficult to rinse off.
0
1
2
3
4
MOST FLOW
5
LEAST FLOW
pH
6.6
Flavors
Two: mint and melon.
Packaging
The kit is a vertical translucent plastic box with a removable, pulloff cardboard top. Inside are 10 plastic trays with foil-lined, paper
lids. Both the trays and lids are disposable. Inside you will find a
thin plastic membrane-like tray that is stabilized and carried to the
mouth in a stiff plastic secondary tray that is immediately discarded after the thin tray is secured over the teeth. Color-coding
according to the flavor is found on the kit’s top, on paper lid of the
plastic trays, and on the stiff secondary tray. Green is mint and
peach is melon. However, if you are not familiar with the colorcoding, there is a sticker on the side of each kit with the flavor.
This box has a contemporary look, but the sharp corners of the
plastic are uncomfortable during opening.
The expiration date is on a label on the bottom of the main
box.
Prefabricated.
Reservoir Material
N/A.
Use
Once the membrane-like tray is in place, the patient needs to distribute the gel evenly over the facial surfaces of the teeth by
adapting or pressing on the outside of the tray with his or her fingers. This moves the gel cervically from its incisal resting position.
There is also a secondary gel at the gingival crest position that presumably prevents any overflow of bleach onto the tissue, where it
could cause irritation. However, some early adopters have complained about tissue irritation despite the presence of the gel
meant to prevent it. This irritation can probably be minimized by
not extending the wearing time beyond the aforementioned recommendations.
Directions
Dentist None.
Patient Foldout card with six color photos. Advises bleaching for
30-60 minutes per day.
Marketing Materials
Large cardboard cards and posters featuring a variety of models
that project a very natural appearance.
REALITY
Opalescence, the original thick bleach, has the best, most
convenient, single use syringes, and slick packaging. With the
demise of the “F” version, you now only have to choose
between regular and PF. We suggest PF, although don’t expect
a total absence of sensitivity.
Day White Excel 3, with its easy dispensing and reasonably
pleasant taste, is the strongest hydrogen peroxide-based product in this category. Its 9.5% concentration translates into the
equivalent of 28.5% carbamide, which is virtually the same as
the 30% carbamide products. For patients who can only tolerate short bleaching sessions, this would be a good choice.
Zoom! Take-Home and Nite White Excel 3 Turbo are identical products, except that the former also comes in a 4%
version, while both products come in 6% hydrogen peroxide.
Both products piggy-back off strong brethren and can leverage off their brand equity. Bleaching efficacy with these
products is presumably faster than other home bleaches due to
“revolutionary surfactant technology helps to improve gel
penetration.” In addition, the activation matrix supposedly
78
The Ratings
helps “regulate the release of free radicals” over an eight hour
period. These types of claims are difficult to validate, but most
evaluators reported excellent results, with only one finding
only slight whitening. Nevertheless, with all evaluators reporting virtually no sensitivity, this product appears to be a good
choice for patients who have bleached before but quit due to
hypersensitive teeth.
The gel itself is quite thick, which permits precise dispensing into the tray and keeps it in intimate contact with the
teeth. If your patient has ever used a runnier bleach and still
fears about getting a sore throat, this is the product to use —
it will definitely not run down anyone’s throat.
But it is pure white, not clear. Since you are supposed to
wear the tray for 4-6 hours, this is certainly not the product to
use if you don’t want people around you to know you are
bleaching. Excess gel is reasonably easy to remove from the soft
tissue with a wet finger, but this material is very adherent and
somewhat difficult to extricate from gingival embrasures, especially if the papillae are recessed. It is available in one neutral
flavor — not particularly offensive, but not overly pleasant
either.
Bleaching Materials
Note: In one syringe of the Turbo version, the white barrel
was not completely filled at the tip of the syringe—it was short
two calibrations. If you find syringes such as these, you should
return them to Discus for full syringes. In another syringe of
Turbo, the bleach literally dissolved and was largely washed
out of the tray after about two hours of bleaching. This is also
not typical and should be returned to Discus for new kits.
Nupro White Gold has attractive packaging and the lowest
price, but its top strength is just 15%, it only has one flavor,
and its marketing materials are not in the same league as the
other products.
Poladay has an excellent selection of concentrations and the
lowest price, but it only has one flavor, and its packaging and
marketing materials are not in the same league as the other
products. Its tray material tends to “melt” when heated—you
would be better using Sof-Tray. In addition, sensitivity still
occurred with the 9.5%--best to use the lower concentrations
for patients who have had sensitivity to bleaching in the past.
treswhite is obviously targeted at the White Strips/OTC market.
This along the lines of “If you can’t beat them, join them” philosophy. And it does its job in this regard reasonably well, at least
as good as the OTC competition and probably better. Just don’t
expect the comfort, control, and efficacy of a professionally
made, custom tray system. Many people are willing to forsake
those refinements for price and convenience. Patients liked the
packaging and flavors and, due to the basic design of the membrane-like trays, there is coverage back to the first molars unless
the patient has a very large arch. This leapfrogs White Strips,
which only cover canine to canine.
However, the trays do not adapt very well to the teeth,
especially if they are malpositioned, and are not as comfortable or invisible as strips or paint-on products. In addition, this
gel takes stickiness to a whole other level. Even very vigorous
rinsing has a problem dislodging it from teeth and embrasures.
On the other hand, in our clinical evaluation, sensitivity
occurred only occasionally along with gingival irritation for
most patients, although there were some patients that could
not adapt to this system at all.
OTHER PRODUCTS IN THIS CATEGORY
POWER
AcquaBrite
AcquaMed
ArcBrite
Biotrol
BriteSmile
BriteSmile
Excel 3 Power Bleach
Discus
GentleBright
Lumalite
Rembrandt Lightning
Plus
Oral-B
Super-Oxal
Life-Like
Superoxol
Sultan Chemist
35% Hydrogen Peroxide
Life-Like
ASSISTED
Karisma
C-Dent
Life-Like At-Home
Life-Like
Lustredent 30%
Murphy
Nite White Excel 3Z-CP
Discus
Nu Radiance Duet
Nu Radiance
Gel-White
Temrex
Oxyfresh ToothWhitening System
Oxyfresh
44% Carbamide Peroxide
Life-Like
Perfecta
Premier
white & brite 30
OMNII Products
Perfecta Bravo
Premier
HOME
Perfecta Ultra
Premier
Opalescence Endo
Ultradent
Aspire-Teeth Whitening
System
Dent Zar
Platinum
Colgate Oral
Pharmaceuticals
OpusWhite Laser
Whitening System
OpusDent
At-Home 30% Fast
Whitening
Life-Like
Platinum Overnight
Colgate Oral
Pharmaceuticals
Pola Office
SDI
Forte
Nu Radiance
Pola Night
SDI
High Concentration
At-Home
Life-Like
Rembrandt Smile
Oral-B
Hi Lite
Shofu
Illumine
Laser Smile
Biolase
LumaWhite
Lumalite
Rembrandt Whitening
Strips
Oral-B
Star*White
Temrex
Stark White
Tru-Tain
StayBright Take-Home
Whitening Enhancer
Lumalite
Vari-Shade
Lochemco
VivaStyle
Ivoclar Vivadent
White & Brite
Omnii
Whitestrips
Proctor & Gamble
Xantia
Dexcel Pharma
Zaris
3M ESPE
The Ratings
79
Everything summed up
on one sheet of paper.
(You can thank us later.)
Bleaching Consent Pads
Your patients will be well-informed and your practice protected against
potential lawsuits.
No other consent form explains bleaching in this detail.
To order call 800.544.4999 or 281.558.9101 or order online at
www.realityesthetics.com or look for the order form in this edition.

Bleaching Materials - REALITY Publishing Company

Transcription

Similar documents

christmas brochure

PROFESSIONAL TOOTH WHITENING SYSTEM

Party Trays Relax. Eat. Enjoy.

Whitening Instructions - Michigan Beautiful Smiles

MARQ Comparison Sheet - Marq Packaging Systems

information flyer - Penwell

Vivastyle Plus - Ivoclar Vivadent

Opalescence - Opal Orthodontics

introducing empress food trays!