Dr Johnson's Blog

CERAMIC DENTAL IMPLANTS – NEWTON, WELLESELY, MA

Joseph Coupal - Wednesday, November 30, 2016

Are dental implants made from ceramics ready to consider as a viable alternative to metal?

Since their introduction over 40 years ago, dental implants have become an established treatment modality that had revolutionized the concept of replacing missing teeth. Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners has been considered a pioneer in computer-assisted implant dentistry. His first implant case was in 1988. According to Dr. Johnson, “The recent material of choice for manufacturing dental implants is commercially pure titanium, because of its excellent biocompatibilty and mechanical properties However, the gray colour of the titanium may be disadvantageous and give rise to esthetic problems, especially if the soft tissue situation is not optimal and the dark colour shines through the thin peri-implant mucosa. The profession has been looking for options to address this concern. Some implant companies are wrapping a pink material along the collar of the implant while others are developing ceramic implants.”

Zirconia ceramics (yttrium-stabilized tetragonal poly-crystals) seem to be a suitable material for dental implants because of their tooth-like colour, their excellent mechanical properties and their good biocompatibility. They have extensively been used as ball heads in total hip replacements with remarkable clinical outcomes. Recent animal studies have also shown successful bone healing of dental zirconia implants under both unloaded and loaded conditions. Dr. Johnson has been using zirconia to fabricate his dental crowns for many years without outstanding success. As the conventional fabrication of zirconia rods usually results in realtively smooth surfaces, only few studies have investigated rough surface modifications of zirconia implants. This is a critical aspect, since it has been already demonstrated that surface roughness and topography also influence osseointegration of zirconia implants.

A recent study by Rita Depprich, et al, in Head and Face Medicine, looks at the comparison of titanium and zirconia implants on pigs and concludes that, “zirconia implants with modified surfaces display features of osseointegration similar to those of titanium implants. These results are promising for using zirconia implants for dental applications in the future”.

“It’s still early in the game” according to Dr. Johnson, “but it may be available in the next few years after clinical trials are complete. Until then, titanium implants are sill the gold standard. ”

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Original article: https://head-face-med.biomedcentral.com
Artwork: www.southerdentalimplant.com

E-CIGARETTES AS BAD THE REAL ONES? – NEWTON, WELLESELY, MA

Joseph Coupal - Friday, November 18, 2016

Former and would-be smokers who opt for electronic cigarettes may not be doing their teeth a whole lot of good, according to a new study. Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners has been educating his patients on the harmful effects of smoking on dental tissues for 30 years. “Many have shifted toward the e-cigarettes thinking that they are a ‘safe’ alternative but new evidence suggests that both may increase the likelihood of gum disease”.

However, research published in the journal Oncotarget, which focuses on cancer-related issues, suggests that electronic cigarette smoke may wreak the same type of havoc on teeth and gums that conventional tobacco does. A team of scientists from the University of Rochester and Stony Brook University found that the vapors released in e-cigarettes can cause tissue inflammation and damage comparable to that produces by regular ones.

Furthermore, chemicals used to flavor some e-cigs may cause even more harm to mouth tissue, the researchers say.

Some caveats: This particular experiment was conducted on gum tissue, not live human participants. It’s possible that there are other confounding factors that may contribute to gum disease and in e-cig and regular cigarette users alike.

But it’s the latest example of scientific skepticism surrounding the health benefits of e-cigarettes. Manufacturers claim that they are an obviously superior alternative to conventional products that contain known carcinogens; but the overall public health ramifications of the products remain unclear, including whether or not they may actually be encouraging more kids to smoke.

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Original article: http://fortune.com/2016/11/17/e-cigarettes-yellow-teeth-study/
Artwork: www.motherjones.com

DR. JOHNSON DISCUSSES COMPUTERS IN DENTISTRY

Joseph Coupal - Friday, November 04, 2016

Watch as Dr. Ryne Johnson, prosthodontist at Newton Wellesley Dental Partners discusses the increased use of computers in dentistry…click on the link below to download the video:

Comcast Ryne Computer

ALL-ON-FOUR DENTAL IMPLANTS – NEWTON, WELLESLEY, MA

Joseph Coupal - Thursday, November 03, 2016

Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners recently participated in the American College of Prosthodontics annual meeting in San Diego where he discussed the All-on-4® treatment concept. It provides edentulous and soon-to-be edentulous patients with an efficient and effective restoration using four dental implants to support an immediately-delivered full-arch prosthesis. Dr. Johnson has been called a pioneer in the synergistic use of computers in implant dentistry. His first case, using a CT scan generated model was performed in 1988.

After the first dental implant patient was treated in the 1980s, a discussion began around the optimal number of implants needed to anchor a fixed dental prosthesis in edentulous patients. Some clinicians tended to install as many implants as possible, often one per tooth. Others argued that biomechanically, only four or even three were needed. Only long-term clinical data could provide answers.

At the forefront

The records of the early patients of P-I Brånemark allowed for an early retrospective study. After a 10-year observation period, the survival rates were demonstrated to be the same for restorations with four and six implants assuming that the bone levels and distribution of implants were ideal. The challenge of advanced resorption remained, however. Because it is not possible in many cases to insert distal implants without grafting and/or nerve lateralization, the concept of tilting the two distal implants was introduced.

Immediate results

In 2003, the concept of immediate loading (placing a dental prosthesis on implants the same day the implants are placed) of four implants in edentulous lower—and soon after also upper—jaws with two tilted distal implants. This one-stage procedure substantially reduced the costly and time-consuming bone grafting procedures, number of surgeries and healing time.

The success continues

In an early reported a cumulative survival rate of 96.7% for implants and 100% for prostheses at up to 3-year follow up.2 Since then, he and others have repeatedly reproduced high survival rates for both upper and lower jaws. Today, the All-on-4® treatment concept is used around the world with similar high survival rates and patient satisfaction that is enhanced by limited costs.

Dr. Johnson, with his in-office periodontist, has done hundreds of implant cases with outstanding results. To arrange a consultation with Dr. Johnson, contact Newton Wellesley Dental Partners.

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Original article and artwork: www.nobelbiocare.com

DENTAL IMPLANTS & MEDICATIONS – NEWTON, WELLESLEY, MA

Joseph Coupal - Thursday, October 27, 2016

Each year, about 500,000 North Americans get dental implants. Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners, considered by many as a pioneer in the synergistic use of computers in implant dentistry says, “If you are one of them, and are preparing to have a dental implant, it might be a good idea to start taking beta blockers, medication that controls high blood pressure, for a while. And to stop taking heartburn pills”.

A body of research indicates that in order to raise the odds that dental implants will attach properly, there are clear benefits to taking certain common medications and avoiding others.

Bone cell growth, healing and death

“The success of procedures like dental implants depends mainly on how the existing bone accepts the implants to create a connection between the living bone and the surface of the implant,” says Dr. Johnson, who has been involved in implant dentistry since 1988. “Because some medications affect bone metabolism and the way that bone cells heal and multiply or die, they can have an important effect on the success of implants.”

A McGill research team reviewed data about the integration of dental implants gathered from over 700 patients. They then confirmed the results they saw in human patients through studies in rats.

Implications for hip and knee replacements

“We believe that this research may have implications for orthopedic interventions such as hip and knee replacements, because the same mechanisms of bone cell growth break down, and healing take place in all the bones in the body,” says one of the researchers. “Our work with implants in rats suggest that this is indeed the case, but further research will be needed to confirm it.”

Drugs that aid integration of implants – Beta blockers

  • Conclusions are based on 1499 dental implants in 728 patients between Jan. 2007 — Sept. 2013 at the East Coast Oral Surgery in Moncton, New Brunswick
  • 327 implants were in 142 people who took beta blockers for hypertension
  • 1172 implants were in 586 people who didn’t take beta blockers
  • Failure rates of implants for people using beta blockers was 0.6%
  • Failure rates of implants in people who don’t take beta blockers was 4.1%
  • More than 640 million patients around the world take beta blockers to control hypertension.

“We carried out this study because we knew that beta blockers have been reported to increase bone formation,” says Prof. Tamimi from McGill’s Faculty of Dentistry. “So we thought it was possible that they would also decrease the risk of failure of dental implants. However we didn’t expect that there would be such a clear difference in the failure rates for implants between users and non-users of beta blockers. Randomized clinical trials will need to be carried out as well as other studies of large numbers of patients to investigate this phenomenon in more depth.”

Drugs that impede integration of dental implants – Heartburn treatment

  • Conclusions are based on 1773 dental implants in 799 patients between Jan. 2007 — Sept. 2015 at the East Coast Oral Surgery in Moncton, New Brunswick
  • 133 implants were in 58 people who took heartburn medication
  • 1640 implants were in 741 people who don’t take heartburn medication
  • Failure rates of implants for people using heartburn medication were 6.8%
  • Failure rates of implants for people not taking heartburn medication were 3.2%
  • More than 20 million Americans, about one in 14 people, take heartburn medication.
  • Heartburn medication is rapidly becoming the third most prescribed pharmaceutical product worldwide, especially for elderly people, who take it either on an occasional or long-term basis.

“Scientists already knew that drugs for heartburn reduce calcium absorption in bones and generally increase the risk of bone fractures,” says Dr. Tamimi, of McGill’s Faculty of Dentistry. “That is why we wanted to look at how it affects the integration of implants and bone healing after this type of surgery. But we didn’t expect to find that the negative effects of these type of drugs would be as great as they are. Further work will need to be done to find the appropriate dosages and time periods that people should take or avoid these medications.”

For additional blogs by Dr. Johnson, click here

To learn more about Dental Implants, contact Newton Wellesley Dental Partners.

Original article: www.eurekalert.org

Artwork: www.medicalxpress.com

DENTAL IMPLANTS FAILURES – NEWTON, WELLESLEY, MA

Joseph Coupal - Wednesday, October 19, 2016

Dental implants are now used widely around the globe. However, questions about patient risk assessment prior to placing the implants still abound. Dr. Ryne Johnson, prosthodontist and managing partner at Newton Wellesley Dental Partners asks, “What causes implants to fail in some patients but not others?

There are several factors which negatively influence implant predictability:

1. Gum and Bone Disease: The placement of implants in a patient with periodontal disease would be one relevant concern. Researchers from Sweden performed a systematic review to determine if persons with periodontitis are more susceptible to peri-implantitis. The conclusion was that an increased susceptibility for periodontitis may also confer an increased risk for implant loss, loss of supporting bone, and postoperative infection.
2. Smoking: A recently published study discussed the effectiveness of implant treatment in a large patient population nine years after treatment. They used a large and randomly selected patient sample, and concluded that patient characteristics and implant features affect results. They discovered that smokers and patients with an initial diagnosis of periodontitis were at higher risk of implant loss. A 2014 study confirmed that placement of implants in smokers pointedly affected implant failure rates, the risk of postoperative infections, and marginal bone loss.
3. Short Implants: Those with implants shorter than 6 mm and implants using particular brands of products also showed increased risk.
4. Teeth Grinding: Several studies have clearly demonstrated an increased failure rate on patient with nocturnal bruxism. The off-axis forces delivered to implants in people who grind their teeth can be significant and will over-stress the bone.

Dr. Johnson is considered a pioneer in the synergistic use of computers in dental implant dentistry and performed his first implant reconstruction in 1988.

For additional blogs by Dr. Johnson, click here
For more information on dental implants, Contact Newton Wellesley Dental Partners.

Original article in www.dentistryiq.com,
Artwork: www.pintrest.com, www.implantninja.com, www.slideshare.com, www.ceraroot.com

DENTAL IMPLANTS, A PATIENT’S PRIMER – NEWTON, WELLESLEY, MA

Joseph Coupal - Friday, October 14, 2016

Dental implants have become ‘mainstream’ as a treatment option for many patients. Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners has been doing implant supported reconstructions since 1988 and has been regarded as a pioneer in the synergistic use of CT Scans, CAD/CAMs and state of the art dental material science to deliver outstanding results. He wants people to have some perspective on the process:

Before the procedure

Dental implants require a strong jaw bone. Patients who have lost a lot of jawbone may need to have a bone graft procedure performed before this procedure. Dr. Johnson will identify the available bone…sometimes with a CT Scan if necessary. In some instances, this can be done BEFORE any teeth are removed (implants may be placed the same day) or AFTER the area has healed from tooth removal (with adequate bone preservation techniques employed at the time of extraction).

You will receive instructions about how to prepare for the day of the procedure. It is highly recommended you quit smoking several months before the procedure as smoking can cause poor osseointegration (poor bone and implant integration), which is the leading cause of implant failure.

Anesthetic

The procedure starts with a local anesthetic. This will make the implant site and the area around it completely numb. You will be awake, but you won’t be able to feel any pain in that area. You might still feel pressure, vibrations, or some other sensations that might be uncomfortable, but no pain. Some offices offer conscious sedation or partial sedation where you are awake and numb, but “out of it” and mostly unaware of what is going on. Some people describe the feeling as similar to being drunk. Partial sedation is usually more expensive than local anesthetic and is not available at every office.

A dentist applies local anesthetic to a patient’s lower jaw. A numbing gel is usually applied so that the patient will not feel the injection.

Preparing the implant site

After the anesthetic has taken effect, the implant site will be prepared and the gums will be retracted so the dentist can access the jawbone and evaluate the implant site. The bone needs to be relatively flat and smooth, and the dentist might use a drill to reshape it.

Drilling the pilot hole

The dentist will then use a series of drills to make a hole in the jawbone for the implant (s)…sometimes a “placement jig” will be fabricated from the CT Scan work up. They will first create a divot using a small round bur, and then a pilot drill to create a pilot hole. They may use a plastic jig prepared from plaster casts to help guide the pilot drill, but this is mostly up to the dentist if they need one. They may also use an alignment pin to make sure the pilot hole is on target. If no adjustments are needed, the pilot hole will be drilled deeper. As the hole is being created, the dentist may flush the area with water or saline to keep the bone cool and prevent overheating caused by drilling. Once the pilot hole is finished they will check its alignment again using the alignment pin. If the positioning of the implant is close to other anatomical structures, such as nerves or blood vessels, they may take an x-ray with the alignment pin in place to check its position.

Finishing the hole

When the pilot hole is finished, the dentist will use a series of increasingly larger drill bits until it’s the correct diameter for the implant. The size of the implant will have been chosen ahead of time based on the condition of the bone.Usually, your dentist will want to select the largest implant that your bone can sustain because larger implants distribute their load to the bone better than smaller implants do. Most are about 4 mm in diameter.

After the hole for the implant is finished, the alignment will be checked again using the pin. Then the whole will be threaded using a screw tap to match the threads on the implant. Some implants are self-tapping and don’t require this step. Dental implants are roughly the size of the root of a normal tooth.

Placing the implant

Finally, the implant will be placed. This can be done using a special head for the dental drill or using a small hand wrench. Sometimes it is actually done using a small torque wrench. This can cause some unpleasant sensations but skilled surgeons are able to minimize the discomfort. The surgical site will be closed using an implant cap and stitches.

Healing and osseointegration

The stitches will be left in place for 7 to 10 days, after which they will be removed. In some cases, the gum flaps may be stitched so that they cover the implant cap as the site heals and the gum tissue will later be trimmed back when the abutment is placed. The implant will be given 3 to 6 months to osseointegrate (fuse with the bone) before the restoration (consisting of the abutment and crown) is placed.

Note: It is extremely important that you keep the implant area and surrounding teeth clean. Peri-implantitis is a condition that is caused by bacteria infecting the area surrounding an implant and can cause bone loss and implant failure due to poor osseointegration. Some clinics offer “immediate load” implants where a temporary restoration is placed the same day as the implant. This restoration will be removed in the future and a permanent one placed. Not every patient is a candidate for immediate load implants; this is an option you should discuss with your dentist. The treatment will be completed on a second trip, after osseointegration is complete and the abutment and prosthesis is custom-made. Dental implants are made up of three parts; the implant (screw), the abutment (stump), and the crown (tooth).

Final/Definitive restoration

After the implant has healed and is stable, the definitive restoration can be placed. This can consist of a crown, bridge, or denture. The implant cap (think ‘manhole cover’) is removed and replaced with an abutment and the dental prosthesis is placed on top of it. For most conventional implants, this is a crown that either screws on to the abutment or is cemented in place. Removable restorations like dentures may have clips or snaps of some kind.

After the procedure

Most patients are extremely satisfied after dental implants. After the implant is placed, your dentist will advise you to stick to chewing soft foods while the implant osseointegrates. Immediate load implants will also need time to osseointegrate, and your dentist will tell you when the temporary parts of the implant need to be replaced with a permanent restoration. Patients who have had dental implant surgery say that the pain is mostly a dull ache in their jaw after the anesthetic wears off and it is gone completely within a week. After the final restoration is complete, though, patients are able to treat the prosthetic like a normal tooth and can hardly tell the difference. They look, feel, and can be used just like normal teeth.

For more blogs by Dr. Johnson, click here
For more information on dental implants or to arrange a consultation, contact Newton Wellesely Dental Partners.

Original article: www.medigo.com

DENTAL IMPLANTS: YOU HAVE OPTIONS – NEWTON, WELLESLEY, MA

Joseph Coupal - Thursday, October 13, 2016

If you’re missing a tooth, Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners wants you to know, “you’ve got several options. The least advisable is to do nothing! It’s not just about aesthetics…Replacing a lost tooth is important to restoring maximum function, maintaining the alignment of surrounding teeth, and preserving facial contours”. Dr. Johnson has been involved in implant dentistry since 1988 and is regarded as a pioneer in the synergistic use of CT Scans, CAD/CAM and placement ‘jigs’ to create implant supported reconstructions with stunning results.

Your pearly whites don’t just look pretty, they are important place holders for each other. Over time, those adjacent to a toothless gap can drift to fill the space and move out of alignment. Additionally, tooth roots below the gums provide stimulation that the underlying jawbone needs to maintain its form and density.

Following are common approaches to replacing a lost tooth. The most appropriate for you will depend on a variety of factors that you should discuss with your dentist.

Dental Implants

Today’s gold standard for tooth replacement is the dental implant. This is actually a tooth root replacement to which a separately fashioned crown is attached. For successful implantation, there must be a sufficient amount of healthy jawbone to anchor the implant and the adjacent gums and teeth must be healthy. Certain systemic health conditions may preclude implantation as well.

PROS: Aesthetic, functional, reliable Stimulates the jaw bone to remodel and rebuild Does not compromise the integrity of adjacent teeth Decreased risk of periodontal (gum) disease compared with a bridge

CONS More expensive than a bridge (but more durable so it could be more cost effective long term) Requires minor surgery and healing time before placement of a permanent crown

Bridges

Prior to implants, the three-unit fixed partial denture (FPD), or fixed bridge, was the standard approach for tooth replacement. In this scenario, the two teeth on either side of the gap (the “abutment” teeth) are crowned and the crowns support a “pontic” — a false tooth — between them like pickets in a fence.

PROS: Provides normal function and aesthetics Less wait time than with implants Less expensive than implants

CONS: Damage to abutting teeth (must be shaped to accommodate the crown) Greater susceptibility to tooth decay Jawbone beneath the ‘fake tooth’ may deteriorate over time

Removable Partial Denture (RPD)

A removable denture is made of an artificial tooth anchored in plastic that mimics gum tissue. It is attached to metal clasps that hook onto adjacent natural teeth. It can be removed for cleaning.

PROS: Aesthetic, functional Least expensive option

CONS: Greater susceptibility for periodontal (gum) disease and tooth decay Usually results in teeth becoming loose May have stability and comfort issues May not fit right over time Jawbone underneath may deteriorate over time

For more information on your options for replacing missing teeth, contact Newton Wellesely Dental Partners.

For more information and access to additional blogs by Dr. Johnson, click here

original article: www.deardoctor.com
artwork: www.samdental.com, www.dentalcrest.com

DENTAL IMPLANTS – ALL ON FOUR – WELLESLEY, NEWTON, MA

Joseph Coupal - Tuesday, October 11, 2016

Those who have missing teeth — or are soon to have their last, failing teeth removed — have several options for tooth replacement. One of the most advanced and reliable techniques is to permanently attach lifelike prosthetic (new replacement) teeth to dental implants that are anchored in the jawbone.

Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners, is recognized as a pioneer in dental implants and placed his first implant prosthesis in 1989. Since that time, he has honed his approach to develop a computerized technique, incorporating CT scan coupled with CAD/CAM technology. This synergistic effort offers immediate results with incredible precision.

Implant-supported teeth look and function just like real teeth, and are maintained with the same oral hygiene practices, such as brushing and flossing. They provide important health benefits (described is this article). And while dental implants are relatively expensive, a newer procedure that also provides functional teeth on the same day implant surgery is performed has brought the cost down and put this beneficial technology within the reach of many.

Implant-supported teeth allow normal function of the whole stomatognathic system (“stomato” – mouth; “gnathic” – jaws) including the nerves, muscles and jaw joints. By permanently replacing missing teeth — and lost gum tissues — dental implants restore the support of the facial structures (cheeks and lips), thereby creating a more youthful appearance as well as the ability to function normally. This includes chewing tough foods, eating fresh fruits and vegetables, laughing, kissing, speaking confidently, and smiling with joy.

Dental Implants: State-of-the-art Tooth Replacement Systems

It is not an overstatement to say that permanent tooth replacement with implants has revolutionized dentistry. Implants have particularly transformed the lives of people who are edentulous (completely toothless) by giving them a solution that is a lot more comfortable, secure, and reliable than removable dentures. They also prevent the loss of jawbone density and volume that is inevitable when teeth are lost. Dental implants stabilize and stimulate the bone around them, maintaining bone dimension and strength. This is something removable dentures can’t do. In fact, wearing dentures actually accelerates bone loss.

A dental implant is a small, screw-shaped post that replaces the root of a missing tooth — the part that is housed in the bone beneath the gum. Implants are made of titanium, which has a unique ability to fuse to bone in a process called osseo-integration (“osseo” – bone; “integration” – to join with or fuse to). That’s what makes them so sturdy and reliable.

After implants are inserted into the jawbone during a well-tolerated surgical procedure, fixed bridges can be attached to them immediately that look and function like real teeth. This can be accomplished in one or both jaws in the same day.

All For One — And One “Four” All

Today’s state-of-the-art implant systems enable a minimum number of implants to support a maximum number of teeth. That means as few as four implants can be used to support a full arch (upper or lower jaw) of fixed, non-removable replacement teeth. And this remarkable life-changing event can be accomplished in a single day!

Success will depend on some crucial steps:

This person had no upper teeth and wore an old denture that fit poorly.
An implant-supported fixed denture replaced the upper teeth, re-establishing the smile as well as the ability to eat.
  • When the implants are placed in the jawbone, they must remain completely immobile to allow the process of osseo-integration to occur. Any force that causes even minute movement of the implants in the early healing phase can ruin the integration process, resulting in implant failure. That’s why a soft diet (no hard, crunchy or tough foods) during the first 6-8 weeks is essential.
  • The implants themselves must be strategically placed to offer the most effective support. By rigidly connecting the new teeth to the implants, they stabilize each other. Think of this arrangement like a tabletop or chair supported by four legs — which are sometimes angled outward for maximum support.

This process is not only the most efficient way to replace all the teeth, but also the most cost-effective strategy for implant-supported tooth replacement. Individual implants to replace each tooth are impractical and not recommended. Given that there are usually 28 functional teeth (excluding wisdom teeth), replacing teeth individually can be vastly more expensive and may not offer any better results.

For more information on dental implants in Newton and Wellesely, MA, contact Newton Wellesley Dental Partners.

For additional blogs by Dr. Johnson, click here

Original article: http://www.deardoctor.com/

THE LATEST ON TEETH WHITENING

Joseph Coupal - Wednesday, September 28, 2016

Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners was recently interviewed for a national magazine that was developing a synopsis of cosmetic dental procedures. According to Dr. Johnson, “Tooth whitening has become one of the most frequently requested dental procedures in his office. The public has come to demand whiter, more perfect smiles and in response many choices for tooth whitening have been made available. These include home-based products such as toothpastes, gels, and films, as well as in-office based systems where products containing highly concentrated bleaching agents are applied under professional supervision”. The profession and public have been aware of certain risks related to tooth whitening such as increased tooth sensitivity and gingival irritation. New research has shown that there are other risks such as tooth surface roughening and softening, increased potential for demineralization, degradation of dental restorations, and unacceptable color change of dental restorations. The new research is also focused on optimizing whitening procedures to reduce tooth sensitivity and to increase the persistence of the whitening.

Types of Teeth Whitening Systems

Whitening systems can be variously categorized. The following approach is in accordance with the American Academy of Cosmetic Dentistry.

Whitening Toothpastes

Whitening toothpastes typically contain higher amounts of abrasives and detergents than standard toothpastes, to remove tougher stains. Whitening toothpastes do not contain bleach (sodium hypochlorite) but some contain low concentrations of carbamide peroxide or hydrogen peroxide that help lighten tooth color. Whitening toothpastes typically can lighten tooth color by about one or two shades.

OTC Whitening Strips and Gels

Whitening strips were introduced into the market in the late 1980’s. They deliver a thin layer of peroxide gel on plastic strips shaped to fit onto the buccal surfaces of the teeth. There are a variety of white strip products on the market with varying instructions. A typical set of instructions are to apply the strips twice daily for 30 minutes for 14 days. Tooth lightening can be seen in several days and this method can lighten the teeth by 1 or 2 shades. There are some newer whitening strip products that require only one 30-minute application per day that have the same whitening end point as the two-a-day products.

Whitening gels are peroxide-based gels applied with a small brush directly to the surface of the teeth. Manufacturer’s instructions are usually twice a day applications for 14 days. Like the whitening strips, the teeth can usually be lightened by 1 or 2 shades.

Whitening Rinses

Whitening rinses contain oxygen sources such as hydrogen peroxide to react with the chromogens. Manufacturer’s instructions are for twice a day rinsing for 60 seconds each. It takes up to 3 months to see a 1 or 2 shade improvement in tooth color.

Tray-Based Tooth Whiteners

Tray-based tooth whitening systems are available both professionally and OTC. This method involves use of a fitted tray containing carbamide peroxide-bleaching gel worn for 2 to 4 hours a day or overnight. Usually by following the manufacturer instructions tooth whitening is noticeable in a few days, lightening the teeth by 1 or 2 shades.

In-Office Whitening

Quicker tooth lightening can be achieved through in-office whitening because the products deliver higher concentrations of peroxide than OTC. Consequently, gingival tissues are usually protected before the agent is applied. Some products claim to increase the oxidation of chromogens by exposure to heat or an intense blue light with a wave length between 480 nm and 520 nm to activate the product while on the tooth, causing the chemical reactions to proceed faster. Some professionals use laser systems to increase the rate of the chemical reactions. This use of lasers is considered to be an ‘off-label’ use of laser systems in dentistry by the US Food and Drug Administration. In a systematic review by Buchalla and Attin no added benefit from light-activated systems was found and thus the American Dental Association does not endorse such whitening systems.project5 Tooth lightening results are seen after one 30- to 60-minute treatment. More dramatic results can be obtained with several applications.

Risks associated with Tooth Whitening

Risks commonly reported with tooth whitening include increased tooth sensitivity and mild gingival irritation. The degree of these side effects is directly related to the concentration of the peroxide bleach component, duration of the treatment, and the non-bleach composition of the product used. Tooth sensitivity usually occurs at the time of treatment and can last several days; gingival irritation begins within a day of the treatment and can also last several days. There are additional risks that have been reported from in vitro studies which include tooth erosion, tooth mineral degradation, increased susceptibility to demineralization, and pulpal damage.4 The ultimate endpoint for tooth whitening is dependent upon the tooth itself, with common wisdom telling us that all treatment regimens will eventually arrive at the same whitening endpoint. This is not exactly true as some very aggressive regimens can damage the tooth through dehydration and demineralization such that the tooth temporarily appears whiter.

Dr. Ryne Johnson, who first lectured on tooth whitening procedures in 1989, has helped thousands of patients achieve a more beautiful smile, often incorporating this proven technique.

For other blogs on important dental topics, click here

To contact Dr. Johnson, click here.

Original article: https://www.ncbi.nlm.nih.gov

Artwork: www.dentalguideaustralia.com , www.askthedentist.com , www.webmd.com , www.parasomnia.tk , www.denmat.com