One Size Does Not Fit All
How successful is your in-office whitening system? Are you seeing the results that you expect or that your patients want to see? Believe it or not, whitening trays are not all the same. We’ve been taught the same thing for years, leaving us with the same result – sometimes our patients have great whitening results, sometimes not. Why is that? Have you ever whitened the teeth of a teenager and had a great result, and then tried the same thing with a more mature patient where the end result left much to be desired? We feel your frustration – we’ve all been there! It turns out that the focus should not only be on the type of whitening system that you’re using, but also on the fabrication of the whitening trays themselves.
In-Office Whitening = Revenue
In-office whitening is a great way to bring revenue into your practice with little or no “doctor time.” It’s a simple way to cosmetically improve a patient’s smile and instantly boost their self- esteem. Think about how many whitening cases your practice averages each month. As a dental assistant, you are skilled and capable of performing your practice’s in-office whitening sessions. Don’t wait for your patients to ask about whitening – take the initiative! With the right verbal skills and tact, you can present whitening to your patients in a way that won’t offend even the most sensitive person.
The steps we take to fabricate our whitening trays may seem like overkill, but it’s worth your time. Your efforts will result in whitening trays with no distortion, which will lead to a better whitening result for your patients. We suggest practicing by making whitening trays for yourself and other staff members until you perfect the technique. Your own smile can be your best advertisement.
Take maxillary and mandibular alginate impressions using a metal, perforated tray. Wrap your impressions with a wet paper towel to keep the alginate moist.
Immediately pour your impressions in yellow dental stone. When pouring your models, do not make a base, and do not flip your impressions over. Instead, place the impressions upright on a slab. Be sure that all excess stone is removed from the edge of the tray so you do not “lock in” your model. You also want to be sure your impression is level – if it isn’t, place a folded paper towel under one side.
After the stone is set, separate the model from the impression. Trim the models as close as possible to the teeth, then level and thin the bottom. Rinse the models and let them dry completely.
Use a scaler to “scallop” the gingival margins of the facial and lingual surfaces of all teeth. Defining the margins with a scaler will allow the tray material to form tightly to the cervical areas. This will help seal the whitening trays to the teeth, decreasing the loss of whitening gel.
Soak the models in a bowl of water until thoroughly soaked through the stone.
Mix a “slurry” of stone and water in a small dappen dish. Using a paint brush, place a thin layer of stone on the facial surface of each tooth. Do not let the stone slurry get too thick, or flow into the interproximal areas or gingival margins. The stone is used to create a reservoir for the whitening gel to be placed in the tray. (You may currently use a block-out resin to create a reservoir, but using the stone slurry achieves the desired reservoir depth.)
Let the models dry completely. Spray them with a silicone spray and again, allow them to dry. (You may want to do this outside if your dental lab does not have an exhaust fan.) The silicone spray allows the tray material to separate easily from the model after you’ve used the vacu-form or Drufomat scan. The Drufomat scan is a pressure thermoforming unit that can be used to fabricate dental appliances like retainers, night guards, sport guards, and whitening trays.
Take two paper sheets that separate the tray material in the tray material box, and place the models on top of each sheet. Trace the outline of each model with a pencil. Remove the models and cut just inside the traced line using sharp cuticle scissors or vinyl scalloping scissors. This step can be skipped if using the Drufomat scan machine.
Place the tray material in the vacu-form machine and tighten. Place the paper with cut-out on the platform and place the corresponding model on top. Make sure the platform is totally covered and that there are no air holes exposed.
Heat the tray material until the “bubble” is drooping half-way down and lower the tray material over the model and turn on the vacuum.
Turn off the vacuum and remove the model from the machine. Place the model in a bowl of cold water and let it soak for 5 minutes.
Proceed with steps 9-11 for the next model.
Remove the models from the water bath and take the tray material off each model.
Trim the trays with sharp cuticle or vinyl scalloping scissors. Be careful that you do not “over -trim” into the gingival margins. Trim the models just above the visible clear line. Scallop the gingival margins on the facial, but not on the linguals, as this will add retention.
Try the trays on each model to check your margins and to be sure they are tight against the teeth and are not flared out.
Remove the trays and store them loosely in a case. Do not store the trays on the models.
If you try this out yourself, please let us know what you think of the results in a comment below. Also, are there any modifications you’d make to the process? Don’t forget to tell us why. Thanks!