This technique isolates and protects soft tissues and exposed dentine by applying paint-on dam- a modified form of flowable composite.  After the paint-on dam is light-cured, a high concentration bleaching gel is painted onto the enamel surfaces.  A lamp is then positioned to shine on the gel assisting activation.  With this technique, it is important to build a fail-safe barrier between the gel and the sensitive parts of the oral cavity.  This is time-consuming and requires much practice to make perfect.  If the lamp emits a spectrum containing UV, as in the case of the Zoom!® lamp, a good isolation (and, obviously eye protection for all) is doubly important.   The manufacturers’ recommended contact time varies from 30 to 60 minutes depending on the system you choose.

Fig 1. All the soft tissues and dentine are protected

This technique is basically the combination of ‘jump-start’ (The initial acceleration of teeth whitening with a stronger gel) with home bleaching using customised trays.  Paint-on dam and bleaching lamp are not required.  However, a total of three appointments are needed with this technique.
Impressions are taken at the first appointment resulting in a set of customised bleaching trays.  The patient is recalled for a second appointment when the trays are ready and a ‘jump-start’ treatment using the customised trays is carried out.  The patient is then instructed to carry out a 14 day/night home bleaching.  After the home treatment, a third appointment is arranged, during which a final jump-start /booster session is carried out. 
It is ultimately important that the patient completes the home treatment because, with its very long contact time, it is the fourteen days of treatment that does the core bleaching and makes the teeth white.  The final ‘booster’ appointment is the key to ensuring that patients comply with the home whitening regime.  The jump-start and the final booster contribute very little to the overall result as the gel used is only slightly stronger than the home gel.  Their main role however, is to make the DB treatment different from a simple home bleaching treatment.  The hero here is the home bleaching, and the real innovation here is the management of the patient’s psyche.  The Enlighten system at the high end of the market uses this technique, but the same technique can be employed successfully using quality gel and tray products available from other suppliers.

Fig 2. A typical customised bleaching tray

This technique is an improved version of Rod Kurthy’s DB using two key components - the wy10 Proactiv Diffusion (PD) lamp and the trays with a patented design.  Similar to DB, three appointments are required.  During the first appointment, impressions are taken of the patient’s teeth to make a set of wy10 bleaching trays. Each set of these trays have patented internal seals and loading points for bleaching gel.   These internal seals and loading points are important to ‘lock’ the gel safely within active areas on the teeth surfaces. 
During the second appointment, a 30 minute Proactiv jump-start procedure is carried out with these trays, loaded with your preferred chairside bleaching gel.  After positioning the wy10 trays comfortably over the teeth, a wy10 lip and cheek retractor is positioned, followed by a wy10 PD lamp – mounted onto the custom retractor.  A ten minute cycle of the lamp warms the bleaching gel and creates a temperature gradient sufficient to enhance the diffusion rate of gel into the enamel.   The wy10 PD lamp and retractor are removed after 10 minutes but the trays with gel remain in contact with the teeth for another 20 minutes. 
After the Proactiv jump-start, the patient continues with 14 days of home bleaching using the wy10 trays.
After this period, a final booster treatment is given – a repeat of the initial Proactiv treatment.

Fig 3. The wy10 Proactiv Diffusion lamp


In Summary

Using good quality gels, all the above three power whitening techniques give good results. The ‘paint-on’ dam system is technique sensitive and the operator must be trained properly to understand the science of power whitening in order to produce predictable results and avoid embarrassment, of having to explain to an unhappy patient, or even to refund money .   On the plus side, it has the “laser” effect and offers the “instant” result which a lot of patients demand!
Both Dr Kurthy’s DB and the wy10 Proactiv are very easy to carry out and produce better results than the paint-on dam systems due to the prolonged contact time between the bleaching gel and teeth.  The wy10 Proactiv produces consistently better results due to the enhanced diffusion effect generated by the lamp - which also has a “laser” effect on the patients, satisfying their demand AND their expectations, leaving you a confident dentist!

Dentists offering teeth whitening treatments should be familiar with these techniques and ideally have them at their disposal when choosing the best treatment options for their patients based on the patients’ requirements, the efficacy and cost-effectiveness of the treatment.

Wyman Chan is the founder of smilestudio – the first dedicated centre for teeth whitening.  A founder member of the British Dental Bleaching Society, he is a researcher and regular speaker on bleaching techniques and materials.  He runs monthly bleaching courses and can be contacted at wyman@smile-studio.co.uk