Opalescence PF – Tooth Whitening Systems

opalescence pf
Opalescence is a dentist-controlled, dentist-supervised, take-home bleaching system, dispensed in unit dose syringes. It is a clear, flavored, high-viscosity, sticky, 10, 15, 20, or 35% carbamide peroxide gel (pH -6.5).

Opalescence PF carbamide peroxide gel contains potassium nitrate and 0.11% weight to weight (1100 ppm) fluorideion.

Opalescence PF contains potassium nitrate and fluoride. Potassium nitrate has been shown to help reduce sensitivity and fluoride has been shown to help reduce caries and strengthen enamel. Together, they help improve the overall health of teeth. Opalescence gels have 20% water content to lessen tooth dehydration, which minimizes tooth shade relapse.

All Opalescence products have unique qualities, including sustained release, adhesive properties and a custom designed application tray. All Opalescence products are gluten-free and kosher.

Indications:

Opalescence has been shown to effectively remove the internal colors from teeth, from the time of tooth eruption through the stains of aging. In cases of tetracycline and brown fluorosis discoloration, Opalescence has obtained success of varying degrees. Opalescence is also used on non-vital teeth for intracoronal bleaching, and provides a more conservative modality for treating dark, discolored teeth (compared to crowns, veneers, etc.).

This includes discolorations 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. Peroxide is a strong oxidizing agent. Bleaching occurs when the peroxide penetrates the enamel and dentin, oxidizing the offending stains within the tooth.

Whitening occurs first and more rapidly with the enamel. For example, most of the disfiguring stains for tetracycline occur within the dentin and require more time to oxidize (whiten)

Because restorative materials will not whiten, we recommend whitening dark teeth before restorative placement, and matching restorations to the new lighter shades (wait two weeks following bleaching procedures before placing restorations).

Opalescence

General Information:

Pay attention to tray design, because the sticky, viscous, sustained-release gel behaves differently than other bleaching products. To avoid or reduce irritation, limit peroxide contact to tooth surfaces and avoid contact with soft tissues.

Following instructions yields predictable results in days rather than weeks. Although the gel stays active 8-10 hours in the mouth, advise your patients on the following recommended wear times:

  • Opalescence 10% for 8-10 hours or overnight;
  • Opalescence 15% for 4-6 hours;
  • Opalescence 20% for 2-4 hours;
  • Opalescence 35% for 30 minutes.

Observing wear times and properly using Opalescence can speed results and reduce long-term exposure to peroxide. A soft, thin tray material is best for fabrication of custom trays (Sof-Tray 0.035’) because it is more comfortable, and thin material minimizes awareness of the tray because it occupies less of the patient’s interocclusal space. Scalloping and reservoirs further reduce pressure on the teeth and gums.

Pre-Treatment Procedure:

  1. A diagnosis to ensure soft tissue health must precede a bleaching treatment. Address failed restorations and/or areas of caries. Exposed root surfaces may experience sensitivity, and if large areas are exposed, or if restorations are inadequate, patients may develop mild to moderately severe pain. Sometimes this can be addressed by simply trimming the tray back or covering exposed root surfaces with a bonding agent.
  2. Remove calculus and external stains. If tissue is traumatized, wait one to two weeks before beginning bleaching treatment to minimize possible gingival sensitivity.
  3. Wait two weeks following the bleaching procedure before matching and placing resin-bonded restorations, because color stabilization requires time. This is important before placing definitive tooth-colored restorations.
  4. Occasionally, a slight purple discoloration may appear in the tray following bleaching adjacent to amalgam fillings. This discoloration is normal.
  5. Teeth with large amalgam restorations or cores may appear darker than other bleached teeth, because the internal restoration becomes more visible through the bleached enamel. The patient should be made aware that these teeth may require a more extensive esthetic restoration following bleaching.
  6. Some teeth do not respond to bleaching, and occasionally the original tooth colors return shortly after completion of treatment. This is often caused by a temporary color shift from 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).
  7. When not in use, trays should be stored in the appliance cases provided in each Opalescence kit.
  8. Dark, nonvital, endodontically treated teeth are rapidly whitened by opening lingual access of tooth. The patient is given an Ultradent syringe with a Black Micro tip and instructed to irrigate lingual opening with water, then fill opening with Opalescence. The tray is then loaded and inserted. Evaluate periodically, as nonvital teeth can whiten significantly in 1-4 days.
  9. If the dentist anticipates the patient may swallow or aspirate the tray(s), treatment should be avoided.

Opalescence PF – Procedure:

  1. Fabricate the tray using laboratory instructions, or send the working cast/model and prescription order form to Ultradent.
  2. Use the provided patient instructions to instruct patient on the bleaching procedure, application of Opalescence, cleaning technique and tray care. Explain treatment regimes to patient:
    a. Most dentists prefer nighttime bleaching regimes for their patients, because they offer maximum results with less bleaching material use, due to decreased salivary flow during sleep. The lowered mouth activity prevents “pumping” of material from tray. Wear Opalescence 10% 8-10 hours or overnight, Opalescence 15% 4-6 hours, Opalescence 20% 2-4 hours, and Opalescence 35% for 30 minutes. Note: Only Opalescence 10% (PF and non-PF) should be worn overnight
    b. Alternative, customized treatments can be used from 30 minutes to several hours per day, depending on the patient’s needs, level of sensitivity and day-to-day activities.
    c. Stopping for multiple nights does not jeopardize continued bleaching when reinitiated.
  3. Show patient how to 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. Instruct patient to clean tray with soft brush and cool tap water after each use.
  4. Occasionally tooth sensitivity and/or gingival irritation may require treatment. The treatment of choice is UltraEZ, a sticky, viscous gel that contains potassium nitrate and may be worn in the Opalescence bleaching tray for up to one hour.
    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).
  5. Evaluate patients every 3-5 days of treatment. The clinician may schedule checkups more or less frequently, depending on patients’ needs and degrees of progress. The number of days required for complete treatment depends on the type of stains present and their severity. For example, tetracycline stains require more treatment time than other types of disfiguring stains.

Precautions:

  1. Read and understand all instructions. Use recommended tray design and administer appropriate treatment regime to maintain optimal patient comfort.
  2. Ensure gingival and general oral health prior to initiating treatment.
  3. As a safety precaution, Opalescence should NOT be used during pregnancy.
  4. If patient has a known allergy or chemical sensitivity to peroxides, carbopol, glycerin, etc., Opalescence is NOT to be used. Mint flavor can be irritating to come patients. If patient has a known sensitivity to mint, us alternate flavors.
  5. 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.
  6. Hypocalcified areas, which may not be visible to the naked eye, 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.
  7. Monitor patient’s progress every few days, depending on severity of tooth discoloration. If only a mirror change is desired, evaluate the patient’s progress within 1-3 days. Since some teeth become more translucent with bleaching, observe teeth with large metallic fillings closely to detect and prevent show-through.
  8. If gingival or tooth discomfort persists (such as excessive temperature sensitivity), inform patient to remove tray, discontinue treatment and make an appointment for evaluation.
  9. Maintain control of Opalescence whitening agent, dispensing only what is needed to reach the next evaluation appointment (approximately 3 to 5 days).
  10. Monitor patients’ bleaching progress to prevent bleaching beyond the desired level of whitening or degree of translucency.
  11. 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.
  12. Opalescence whitening agent is supplied in preloaded 1.2ml unit-dose syringes. Material is NOT to be injected, and patients should be instructed to dispose of syringes when empty.
  13. Material should be refrigerated to maintain shelf life. Instruct patients to keep Opalescence out of heat and/or direct sunlight.
  14. Patients with heavy occlusion or bruxers may require a thicker tray. We recommend 0.60” tray material.
  15. Avoid treatment if patient may swallow or aspirate tray.
  16. Instruct patients to be careful not to swallow gel or rinsed gel. Opalescence tooth whitening products contain peroxide and may contain fluoride; swallowing large amounts can be harmful.

Laboratory Instructions:

  1. Pour impression with fast set plaster or dental stone. Pour alginate 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.
  2. 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-Lumes). A hand-held intraoral light can be used (-20-40 seconds per tooth). Wipe off oxygen inhibition layer.
  3. 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.
  4. Cut excess bulk of material away with serrated plastic trimmers (Ultradent Utility Cutters).
  5. 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!
  6. Return tray to model; check tray extensions. Gently flame polish edges, one quadrant at a time, with a butane torch.
  7. 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 hear and push the tray material to the desired location. If this over thins the tray material, fabricate a new tray.
  8. Once tray is fabricated, clean with a soft brush and cool tap water. Store tray in applicance case when not in use.

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