Opalescence Quick is a unique in-office bleaching system. It is a clear, high-viscosity, sticky, 45% carbamide peroxide gel (pH ~6.5). The fluoride and potassium nitrate in Opalescence Quick 45% PF have been proven to reduce caries susceptibility, lower sensitivity, improve the microhardness of the enamel and improve enamel health.
All Opalescence products have unique qualities including sustained release, adhesive properties, and a custom designed application tray.
Opalescence Quick 45% PF is for in office use only. Opalescence Quick 45% PF provides an alternative, more conservative modality of treating dark, discolored teeth (compared to crowns, veneers, etc.) caused by congenital, systemic, metabolic, pharmacological, traumatic, or iatrogenic factors such as dental fluorosis, tetracycline and adult minocycline stains, trauma, erythroblastosis fetalis, jaundice, and porphyria.
Because restorative materials will not whiten, we recommend whitening teeth before esthetic restorative placement (wait two weeks after bleaching procedures before placing adhesive restorations). Bleaching problematic teeth to a more natural shade will optimize shade matching.
More attention must be given to tray design because of the sticky, viscous, sustained release features in comparison to early bleaching products! To avoid or reduce irritation, it is advised to limit peroxide contact to tooth surfaces rather than spilling onto soft tissues.
If instructions are followed, more predictable results are obtained in days rather than weeks. Results occur more rapidly, which reduces the chronic long-term exposure to peroxide. Our experience has shown that a soft, thin tray material is best (Sof-Tray 0.035), since it is more comfortable.
With a thin tray, awareness of the tray is minimized, since it occupies less of the patient’s interocclusal space. In addition, scalloping and reservoirs further reduce pressure on the teeth and gums.
- Before bleaching treatment, a diagnosis must be performed. Ensure the presence of soft tissue health to minimize tissue trauma. Failed restorations and/or areas of caries should be restored. Exposed root surfaces may experience sensitivity. If large areas are exposed, or if restorations are inadequate, patients can develop mild to moderately severe pain. Sometimes this can be addressed by simply trimming the tray back, or areas can be covered with a bonding agent.
- Remove calculus and external stains. If tissue is traumatized, wait one to two weeks before beginning bleaching treatment to minimize possible gingival sensitivity.
- Wait two weeks following the bleaching procedure before matching and placing resin-bonded restorations because time is required for color stabilization. This is important before placing definitive tooth-colored restorations.
- Occasionally a slight purple discoloration may appear in the tray following bleaching adjacent to amalgam fillings. This discoloration has proven inconsequential in our years of bleaching experience.
- When bleaching teeth with large amalgam restorations or cores, the teeth may appear darker. This is because the internal restoration becomes more visible through the bleached enamel. The patient should be made aware that a more extensive esthetic restoration may be required following bleaching.
- Some teeth do not respond to bleaching, and occasionally the colors return shortly after completion of treatment. This is often the result of a temporary color shift caused by dehydration (and then rehydration) of the teeth. With difficult intrinsic stains, the thicker portions of the tooth usually lighten less (i.e., gingival third lightens less than the body and incisal thirds).
- When tray is not in service, it should always be stored in an appliance case.
Opalescence Quick – Procedure:
- Fabricate the custom tray using laboratory instructions, or send the working cast/model, and prescription order form (enclosed in kit) to Ultradent.
- Load tray by expressing one continuous bead of gel approximately half way up (or slightly lower) from the incisal edge on the facial side of the tray from molar to molar. This should use no more than 1/3 to 1/2 of a syringe.
- Treatment times vary from patient to patient. A session should last no longer than thirty minutes and depends on patient comfort. If used as a starter treatment, only one in-office session is needed. The patient is then sent home with 10%, 15%, 20% or 35% carbamide peroxide Opalescence for prescribed home bleaching regime. Patient should not start home bleaching until 24 hours after in-office treatment. Patients should be evaluated every 5-7 days of home treatment. The clinician may schedule checkups more or less frequently, depending on patients’ needs and degree of progress. The number of days required for complete treatment mainly depends on the type of stains present and their severity. For example, tetracycline stains will require more treatment time than other types of disfiguring stains.
- Occasionally tooth sensitivity and/or gingival irritation may require treatment. First treatment of choice is application of UltraEZ, a potassium nitrate, sticky, viscous gel that may be worn in the Opalescence bleaching tray from 1-2 hours to overnight as needed.
Alternative treatments include the following:
a.Patient may wear tray with a near-neutral, sticky, viscous, bland fluoride gel (Flor-Opal). Daytime use insulates teeth from cold, allowing sensitivity to subside.
b.Appropriate administration of mild anti-inflammatory analgesics (e.g., ibuprofen or aspirin).
- Read and understand all instructions. Use recommended tray design and administer appropriate treatment regime to maintain optimal patient comfort.
- Opalescence Quick 45% PF is NOT a take home bleach.
- Gingival and general oral health should be good prior to initiating treatment.
- As a safety precaution, Opalescence should NOT be used during pregnancy.
- If patient has a known allergy or chemical sensitivity to peroxides, carbopol, glycerin, etc., Opalescence Quick 45% PF is NOT to be used. Mint flavor can be irritating to some patients. If patient has a known sensitivity to mint, do not use.
- Restorations should be adequately sealed and all exposed sensitive dentin should be covered. If a history of sensitivity exists, treat with appropriate restoration, dentin bonding agent, etc., or temporarily with dentin sealant.
- Areas of hypocalcification can exist which may not be visible to the naked eye. Hypocalcified areas will whiten faster, thereby becoming more obvious during bleaching. Continue bleaching treatment until the unaffected tooth surface blends. Re-evaluate two weeks after bleaching treatment when tooth color has stabilized.
- If gingival or tooth discomfort persists (such as excessive temperature sensitivity), inform patient to remove tray, discontinue treatment, and make an appointment to re-treat at another time. Patient may also be sent home with take-home Opalescence bleaching.
- Maintain control of all Opalescence whitening agents, dispensing only what is needed to reach the next evaluation appointment (approximately 3 to 5 days). Monitor patients’ bleaching progress to prevent bleaching beyond the desired level of whitening or degree of translucency.
- Understand each patient’s expectations before beginning treatment. Inform patients that existing crowns, tooth colored fillings, etc., do not whiten, even though natural teeth potentially will.
- All Opalescence whitening agents are supplied in preloaded 1.2ml unit-dose syringes. Material is NOT to be injected. Dispose of syringes when empty.
- Material should be refrigerated to maintain shelf life. Keep Opalescence Quick 45% PF out of heat and/or direct sunlight. When Opalescence Quick 45% PF is refrigerated, the syringe may take on a frosted appearance. When the syringe warms up to room temperature, it will return to its original appearance. This is normal and does not affect the overall performance of the product.
- Patients with heavy occlusion or bruxers may require a thicker tray. We recommend 0.60” tray material. Avoid treatment if patient may swallow or aspirate tray.
- Pour impression with fast set plaster or dental stone. Alginate must be poured shortly after making impression to ensure accuracy. Trimming is less work if quantity of stone is kept to a minimum. However, have enough mass to ensure removal of model from impression without fracture. Trim base of cast parallel to the occlusal table on model trimmer to within a few millimeters of gingival margin for ease of manipulation. Note palate and tongue areas are removed. Allow model to dry two hours.
- Ultradent LC Block-Out quickly provides reservoir spaces in tray. Apply ~0.5mm thickness of material onto desired labial surfaces. Stay about 1.5mm from gingival line. DO NOT extend onto incisal edges and occlusal surfaces. This prevents margin of tray from opening upon biting and/or impinging on soft tissues. Patients may experience less tooth discomfort from tray pressures with reservoirs because of reduced orthodontic pressures. Cure LC Block-Out for approximately 2 minutes (Ultra-Lume). A hand-held intraoral light can be used (~20-40 seconds per tooth). Wipe off oxygen inhibition layer.
- With vacuum former (UltraVac or use Econo Vacuum Former), heat tray material until it sags approximately 1 inch. Activate vacuum and adapt softened plastic onto model. Cool and remove model.
- Cut excess bulk of material away with serrated plastic trimmers (Ultradent Utility Cutters).
- With small tactile scissors (Ultra-Trim Scalloping Scissors), carefully and precisely trim tray 0.25 to 0.33mm occlusal from gingival margin. Scallop the gingival embrasures to prevent covering the gingival papillae with the tray. The papillae may become sore and irritated if tray covers them!
- Return tray to model; check tray extensions. Gently flame polish edges, one quadrant at a time (Blazer Micro Torch).
- While still warm, hold periphery of each segment firmly against model for three seconds with water-moistened finger. If an area is short of the desired length, gently heat and push the tray material to the desired location. If this over thins the tray material, a new tray should be fabricated.
- Once tray is fabricated clean with a soft brush and cool tap water. Store tray in appliance case when not in use.
- 4 x 1.2ml Opalescence Quick PF syringes with tips
- 20 x 1.2ml Opalescence Quick PF syringes with tips
OPALDAM AND OPALDAM GREEN – UNIQUE, LIGHT-REFLECTIVE, PASSIVELY ADHESIVE (SEALING) LIGHT CURED RESINS
SEEK AND SABLE SEEK – CARIES INDICATOR
ULTRACAL – 30%–35% CALCIUM HYDROXIDE PASTE