Vital tooth bleaching with Nightguard vital bleaching.

Between July 1994 and May 1996, several landmark articles were published concerning the safety and efficacy of vital tooth bleaching with 10% carbamide peroxide in a customfitted tray. The American Dental Association (ADA) published guidelines for ADA acceptance, and three products received approval. Long-term clinical trials on 38 patients indicated 92% successful bleaching after 6 weeks of treatment. Results were stable in 74% of the patients at 1.5 years, and in 62% of the patients at 3-year follow-up with no further treatment. Clinical pulpal studies and periodontal studies indicated no detrimental safety problems, although some laboratory cell studies suggested concerns. The noncarcinogenic potential of 10% carbamide peroxide was established in animal studies. Successful bleaching of tetracycline-stained teeth was achieved after 6 months of treatment, with no tooth problems detected clinically or by scanning electron micrograph. Extended treatment times are effective on other stains from dentinogenesis imperfecta or nicotine. On insertion in the mouth, 10% carbamide peroxide elevated the pH in the tray and saliva. After 4 hours of clinical wear, over 60% of the newer, thicker materials (Opalescence [Ultraclent Products, South Jordon, UT] and Platinum [Colgate Oral Pharmaceuticals, Canton, MA]) was present and active in the tray. Nightguard vital bleaching seems to be the most cost-efficient, user-friendly, patient-accepted method of bleaching teeth available to the profession and is safe and effective. Over-the-counter products can have harmful effects on tooth structure and may not lighten teeth.