20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Shop
Events and Master Courses
Submit your case

Subscribe
Account

Explore content
More

Search
what is StyleItaliano
Founders& Members
Our Events& Courses
Cases
Shadeguides
Endodontics
Digital

“Welcome to our world of feasible, teachable and repeatable dentistry”

Founded in 2008 by Prof. Angelo Putignano and Dr.

Walter Devoto, Style Italiano quickly developed into what it is today: A rapidly
growing community of skilled dental practitioners who contribute their ideas to
bring more simplicity and predictability into everyday dental procedures.

We would like to invite you to meet our founders and members, dig into our
wealth of articles illustrating feasible, teachable and repeatable techniques and
share your own knowledge! Those who would like to improve their practical
skills will also be given the opportunity to register for one of our popular
seminars.

Read the StyleItaliano Philosophy >>>

ENDODONTIC APPETIZER: DAILY SBIANCA CON STYLE

Dr. CHIODERA, D.ssa SALAT – 4 Dec 2017
LASER A DIODI NELLA PRATICA RECIPES
Dr. PAOLO GENERALI, Dr. CALOGERO BUGEA – 27
ODONTOIATRICA QUOTIDIANA Nov 2017
Dr. GIUSEPPE CHIODERA – 20 Nov 2017

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 1/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

THE DAILY MENU 27TH EDITION THE DAILY MENU 29TH EDITION THE DAILY MENU 28TH EDITION
Dr. DEVOTO – Prof. PUTIGNANO – Dr. MANAUTA – MARCHETTI, CHIODERA, MANAUTA – 22-24 Jan DEVOTO – PUTIGNANO – MANAUTA – 29 Jan-01 Feb
11-14 Dec 2017 2018 2018

View All
SHADEGUIDE

Ajay Juneja

Angie Segatto

WALTER DEVOTO & ANGELO Anna Salat

PUTIGNANO

Carlos Fernández Villares

Styleitaliano founders
Caroline Werkhoven

Dan Lazar

Dimitar Filtchev

Engin Taviloglu

Giulio Pavolucci

Giuseppe Chiodera

Giuseppe Marchetti

Gregory Camaleonte

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 2/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Janos Grosz

Jordi Manauta

Louis Hardan

Maciej Zarow

Marcos Vargas

Monaldo Saracinelli

Murad Akhundov

Paulo Monteiro

Simone Grandini

Stefan Koubi

Sulivan Leite

Vincenzo Musella
ENDO

Fabio Gorni

Pio Bertani

Calogero Bugea

Clifford Ruddle

Enrico Cassai
https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 3/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Filippo Cardinali

Marino Sutedjo

Massimo Giovarruscio

Paolo Generali

Pierre Machtou

Riccardo Tonini

Zaher Al-Taqi

ACTIVE CARE

Giuseppe Chiodera
PERIO

Giano Ricci
ORTHO & KIDS

Patrizia Lucchi
DIGITAL

Franco Brenna

Roberto Sprea co
LABORATORY

Daniele Rondoni

Menu
More
More


https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 4/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano
Search

SHOP

ARTICLES ARCHIVE

EVENTS AND MASTER COURSES

FOUNDERS & MEMBERS

STYLEITALIANO PHILOSOPHY

YOUR COMMUNITY CASE

LOGIN

REGISTER

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 5/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Styleitaliano Dental Bleaching Protocol, Part I:

Say hello and take color
ACTIVE CARE - BLEACHING
20 Nov 2017

Do you need a protocol to document dental bleaching? Read the following tips
that will probably help you getting to a better clinical practice work ow.

Tip 1: We say that the rst thing to do when a patient arrives is to take color. In
your right hand you should shake the one of your patient, while in your left hand
you should be already holding your chosen shadeguide: say hello and take color.

Tip 2: It would be logical to dispose the shadeguide depending on brightness as

dental whitening increases the luminosity of the teeth. 

Tip 3: Start with the upper arch for phycological reasons; the patient will
appreciate the difference in color after a few days of treatment which is
encouraging and motivating.

Tip 4: Obtain photographic documentation of the initial and nal situation with
a shade guide; you’ll see this has many reasons.

Fig. 1

Tip 1 – Say Hello and take color

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 6/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

One of the effects of teeth dehydration is that it makes teeth appear whiter than
they really are. With the lip retractors we should take color as soon as possible
because dehydration start from the rst moment we place the lip retractor and
dry saliva with our air-water syringe. “Say hello and take color” means that color
has to be taken at the very beginning, before dehydration takes place.

Fig. 2

We get angry when we forget to take color at the beginning of an appointment

because dehydration of teeth can alter their shade and may lead to errors in
shade matching (1). The air replaces the water between the enamel rods ,
changing the refractive index that makes the enamel appear opaque and white.
Teeth dehydrates and color changes. Rehydration takes time, usually longer
than 2 hours (3)

Fig. 3

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 7/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Tip 2 – Dispose the shadeguide depending on luminosity

Our favorite shadeguide is VITA Bleachedguide 3D-MASTER® . Human eye is

very sensitive to slight changes in luminosity thats why exist in the market
speci c shadeguides made only for color taking in bleaching procedures. These
scales have many samples, more that the usual shadeguides made for prosthesis
or conservative dentistry, with very light changes in value or luminosity.
Remember that dental bleaching increases luminosity, has a little effect on
chromaticity and almost no effect on tonality.

A SHORT REVIEW OF HUE, CHROMA, AND VALUE

Hue is the attribute of color that allows to classify it as red, yellow, green, blue,
or an intermediate between any contiguous pair of these colors. In the Vita
shadeguide hue is de ned as A, B, C, D. Dental bleaching doesn’t affect the hue.

Fig. 4

Chroma or saturation describes how intense is a speci c color is. In the Vita
Shade Guide chroma is indicated with numbers, being 1 the less chromatic color
and 4 the more intense. Bleaching slightly affects the chromaticity, while it
reduces the yellowness. (4)

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 8/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Fig. 5

Value is the level of brightness from black to white and is typically not
represented at all in the shade selection process. However, value is the most
important component when performing bleaching, but also in restorative
dentistry. Dental bleaching specially affects the value increasing it, making teeth
look brighter.

Fig. 6

Classical Vita Shade guide is classi ed by hue or tonality.

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 9/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Fig. 7

Classical Vita Shade guide classi ed by value. It is strongly suggested to classify

one of your Classical Vita Shade guides for bleaching purposes but it is also
convenient for restorative and prosthetic dentistry.

Fig. 8

The VITA Bleachedguide 3D-MASTER is the best way to plan and monitor tooth
whitening processes.

Features/Bene ts:

– It determines the level of luminosity during bleaching in only one step.

– The clear organization supports communication between dentist and patient.

– Realistic representation of the bleaching procedure and simplicity thanks to

an easy and comprehensible structure.
https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 10/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

In the above picture you can see the Vita 3D-MASTER Bleached guide (5) with
tabs based on the brightness levels de ned by the American Dental Association;
this facilitates an accurate recording of grades in the bleaching process. When it
comes to documenting shade changes, the VITA Bleached guide 3D-Master is
the only linearly-aligned shade guide that has the ability to properly document
the changes systematically. Due to the equal-distanced shade tabs, it is easy to
perceive color shifts and accurately depict equal shade shifts between each
shade tab. Shade guides are typically not scienti cally fabricated to have each of
their shade tabs the same distance away from each other in 3-D color space.
Some shade tabs look very similar to their neighboring shade tab, while others
look drastically different. This deviation of color can be a drastic difference, or a
very minor (almost undetectable) change between shade tabs. This can make
the shade analysis and selection process very dif cult. (6)

Fig. 9

Even if for a more detailed and precise color project and control over the
bleaching procedure, we advise you use the dedicated VITA Bleached guide 3D-
MASTER shades. 3 Bleached shades are available as a supplement for the VITA
Classical guide, for those who would like to stick to that system for dental
bleaching. These VITA Bleached Shades include shades 0M1, 0M2 e 0M3,
which are integrated into the VITA SYSTEM 3D-MASTER

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 11/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Fig. 10

Tip 3 – The upper arch rst

We always want to bleach the upper arch rst, as a protocol, during the rst
week. For tooth whitening it is a fact that, for a patient, it is fundamental to be
able to notice a difference induced by our treatment; this is only possible by
comparing the colour of the teeth after the treatment with the colour before
the treatment. If we take into account the imperfection of human colour
memory we should better bleach the upper arch rst. If you perform bleaching
in you daily practice probably happened to you that patients don’t remember
the initial color and think that bleaching doesn’t work and you have to show the
initial picture.

In our experience, if we bleach the upper arch rst, we are helping the patient to
appreciate the difference in color and we encourage and motivate him/her to
continue with the bleaching.
In this picture you can appreciate the difference after 1 week with bleaching
trays and 10% carbamide peroxide (White Dental Beauty, Optident), used only
on the upper arch.

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 12/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Fig. 11

After 1 week with 6% HP (hydrogen peroxide) (WDB White Dental Beauty,

Optident) used only on the upper arch.

Fig. 12

Tip 4 – Let photography come to your rescue

Need accuracy of color? We don’t always obtain consistent pictures for some
difference in some of the parameters, for example ash position. To evaluate
results in bleaching cases we need consistent pictures. We need it for the initial
and nal pictures:

1.To use the same camera

2. Same ash power

3. Same ash position

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 13/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

4. Same magni cation ratio

5. Same exposition

6. Same ISO Protocol

1 – When using DSLR camera to document bleaching, there are some variables
to take into account: aperture, focal distance, ash power, ISO, speed, ash
position, ash power, exposition. You cannot change any of these parameters,
and it is better if you have a precise protocol that you use all the time and that
you can write down into you patient record because, for example, I usually use
camera brackets with point ashes R1C1 and the position of my ashes can vary
some degrees very easily, and alter our color accuracy which makes it dif cult to
evaluate results.

Fig. 13

Before and after bleaching pictures. Images took with a DSLR camera. Nikon
7200 with Nikkor 105mm micro lens f22 EV+/- 0,  1/125, iso 100, 1,8:1,  point
ash R1C1 45 degrees, manual ash 1/2 power, shadeguide: Vita Classical+
Bleach colors. It is important to use the same settings for the initial and the nal
picture  to be able to compare color. How we do the picture and what do we
need? We need black Flexipalettes, retractors and the most similar sample from
https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 14/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

the shadeguide. With one hand we hold the camera and with the other the tab.
Assistant shows the patient how to hold the retractors and blow air to remove
saliva and with the other hand holds the black background as far as possible
from the teeth to obtain a pure black.

We should always use the same settings with the DSRL which are the following:

1. The same camera (I use Nikon 7200 with a macro Nikor 105mm)

2. Same ash power (with a Nikon point ash R1C1 power 1/2 and full power
with a polarized lter)

3. Same ash position (45 degrees with my point ashes R1C1)

4. Same magni cation ratio (1,8:1)

5. Same exposition (f22, +/- 0) 6. Same ISO (100)

Fig. 14

Protocol 2: Simpli ed protocol with Smile Lite MDP (Mobile Dental

Photography): a device that allows you to adapt your smartphone to a light
system equipped with three groups of LEDs (light emitting diodes). The pictures
from your camera will drastically improve. The parameters to set in this case
would be the ash power (4 different steps of power) and camera zoom. It

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 15/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

allows you to have consistent pictures in a much easier way. It gives you the
possibility to take pictures with a polarizing lter which is ideal in color
comparison. Even though it is not scienti cal ,the preprocessing and the
postprocessing of the images in the phone sensor are amazingly precise. They
give an outstanding exposure and white balance. We strongly suggest this tool
to three kind of people: rst, to people who lack knowledge in photography and
are not interested in learning, then to those who rely on the assistant or
hygienist to document, and those who are not willing to spend or can not afford
an expensive DSRL camera and lenses.

Fig. 15

Pictures taken with Smile Lite MDP. Flash power:2 Without Polirizing lter

We recommend the following type of photography to document bleaching:

– Polarized: the ideal because it eliminates all the re exes and let us appreciate
color.

– Twin Flash 45 0 45: a good picture because it creates re ects only in

transitional angles.

– Ring ash: not ideal because it gives a lot of glare in the buccal surface.

– Diffusors: not ideal because re ections are too white and kill the color.
https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 16/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

– Studio portrait: the least ideal to appreciate color differences.

Fig. 16

Accessories to document: to document bleaching we need good cheek

retractors, the chosen shadeguide, black photography contrastor, gray
contrastor, a good light temperature and a camera. We use Flexipalettes as
black contrastors for intra oral photography and gray Flexipalette for color
match.

Fig. 17

Smile Lite allows us to choose the right color of our shadeguide thanks to the
ideal lighting conditions  (5500K).

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 17/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Fig. 18

To choose the right color tab we usually use Smile Lite with gray exipalette for
shade matching in the best conditions. 5500K light is the ideal color
temperature with neutral gray.
 

Conclusions

Taking and documenting color is strongly suggested especially to better

comunicate with your patient. With this article I want to summarize the tips that
I have learnt with experience, the tips that helped me to be consistent and
ef cient when taking and documenting bleaching cases. Remember to take
color before teeth dehydration, an important thing also in conservative and
prosthetic dentistry. I would strongly suggest to use a shadeguide specially
designed for bleaching because it has more tabs (bleaching tabs) not existent in
“normal” shadeguides and besides it is classi ed by value, the color dimension
that changes with bleaching (3D Master Bleachguide, Vita) and not by hue as
the other shadeguides. We prefer to bleach the upper arch rst with an “at
home” bleaching with the bleaching trays because in this way, when he/she see
the difference the patient is highly motivated. If you need a simple protocol to
document bleaching use the Smile Lite MDP with your telephone in order to
have few parameters to take into account before shooting. If you like

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 18/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

photography and you already use a DSRL camera you should only be consistent
with camera and ash settings to compare color in bleaching pictures. 

Bibliography

1. Burki Z., Watkins S., Wilson R., Fenlon M. A randomised controlled trial to
investigate the effects of dehydration on tooth colour. J Dent. 2013
Mar;41(3):250-7. doi: 10.1016/j.jdent.2012.11.009. Epub 2012 Nov 14.
2. Rusell MD., Gulfraz M., Moss VW.In vivo measurement of colour changes in
natural teeth.J Oral Rehabil. 2000 Sep;27(9):786-92.
3. Du RX., Li YM., Ma JF. Effect of dehydration time on tooth colour
measurement in vitro. Chin J Dent Res. 2012;15(1):37-9.
4. Westland S., Luo W., Ellwood R., Brunton P., Pretty I. Colour assessment in
dentistry. Annals of the BMVA Vol. 2007, No. 4, pp 1?10 (2007)
5. https://www.vita-zahnfabrik.com/es/VITA-Bleachedguide-3D-MASTER-
26263,27568.html
6. http://www.dentistrytoday.com/aesthetics/136–sp-440471052
https://www.smileline-by-styleitaliano.com/es/toma-de-color-fotogra a/75-
smile-lite-mdp.html
https://www.smileline-by-styleitaliano.com/es/toma-de-color-fotogra a/5-
smile-lite-style-lense.htmlhttps://www.smileline-by-styleitaliano.com/es/toma-
de-color-fotogra a/10- exipalette-color-match.html

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 19/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

0 comentarios Ordenar por Más recientes

Agregar un comentario...

Plugin de comentarios de Facebook

Author: Anna Salat

Dr Anna
Salat graduated with a degree in dentistry from the International University of
Catalonia…

DOWNLOAD PDF

RELATED ARTICLES

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 20/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

DIRECT POSTERIORS
Single body shade posteriors
Angie Segatto - 20 Jan 2014

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 21/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

COMMUNITY - INDIRECT ANTERIORS

Nazariy Mykhaylyuk
- 14 Jan 2013

COMMUNITY - DIRECT POSTERIORS

Georgios Dimitrakopoulos
- 21 Oct 2013

RELATED COURSES

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 22/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

Endodontic Appetizer: Daily Recipes

2017-11-27

Sbianca con Style

2017-12-04

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 23/24
20/11/2017 Styleitaliano Dental Bleaching Protocol, Part I: Say hello and take color - Styleitaliano

The Daily Menu 27th Edition

2017-12-11

 Our Social

           

© 2017 Styleitaliano - All right reserved | Contact Us | Privacy Policy

https://www.styleitaliano.org/styleitaliano-dental-bleaching-protocol-part-say-hello-take-color/ 24/24