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A Novel Technique
for In-Office Bleaching with a 6%
Hydrogen Peroxide Paint-On Varnish
Antonio Duarte Sola Pereira da Mata, DDS, PhD
Associate Professor
Oral Biology Research Group, Instituto Superior de Ciências da Saúde Egas Moniz
Monte Caparica, Portugal

Duarte Nuno da Silva Marques, DDS

Assistant Lecturer
Oral Biology Research Group, Instituto Superior de Ciências da Saúde Egas Moniz
Monte Caparica, Portugal

Correspondence to: Prof Antonio Duarte Sola Pereira da Mata

Instituto Superior de Ciências da Saúde Egas Moniz, Oral Biology Research Group, Campus Universitário – Quinta da Granja,
2825-511 Monte Caparica, Portugal; phone: 351 91920 6396; fax: 351 28970 7564; e-mail: [email protected].

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Abstract
In-office techniques for bleaching vital teeth study. Ten-minute applications of the paint-
are effective and expedient, but because on whitening varnish were performed re-
they require the use of elevated concentra- peatedly with each patient for up to 1 hour
tions of hydrogen peroxide–based agents, and then repeated 1 week later. Initial
which are caustic and potentially toxic, they shades were recorded with a Vita scale
are found to be less appealing by practi- guide, and photographs were taken at the
tioners compared with home whitening beginning and end of the study. A ques-
procedures. In this article we propose a tionnaire assessing clinical parameters
new technique for in-office whitening of vi- and patient satisfaction was performed.
tal teeth using a 6% hydrogen peroxide A change of 7 to 13 values on the Vita
paint-on whitening varnish, which enables scale was observed in all cases. There
the whitening procedure to be more eco- were no reports of tooth sensitivity, and
nomic and user-friendly, as well as less overall patient satisfaction was achieved.
toxic and time consuming, compared with In-office bleaching with the use of paint-on
traditional in-office bleaching. varnishes seems to be effective, safe, and
A total of six patients with no caries or well accepted by patients, offering a viable
restorations in the maxillary and mandibu- alternative to high-peroxide-concentration
lar anterior teeth were selected for this in-office procedures.
(Eur J Dent 2006;1:70–77.)

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Over the last two decades, patient demand sion up to 30 minutes. Effective bleaching
for esthetic dentistry has increased dra- is expected in 2 weeks following a twice-a-
matically. Having a beautiful smile has be- day regimen.
come an important part of a successful so- The low peroxide content, elevated per-
cial and professional life for most people.1 oxide kinetic release, and short application
When tooth integrity is acceptable, dental time associated with these products sug-
whitening procedures represent an easy gest that they may be a viable and effective
and viable option for attaining a patient’s alternative for in-office use with far lower
desired smile. toxicity potential compared with traditional
In-office bleaching has the longest his- in-office procedures.
tory of all the tooth whitening procedures;
the process can be traced back as early as
1877.2 Since 1989, when the nightguard vi- Method and materials
tal bleaching technique was introduced,
home whitening procedures have become A new 10-minute in-office multi-application
3,4
extremely popular. Nevertheless, the use technique employing a 6% hydrogen per-
of several in-office techniques is still wide- oxide paint-on varnish (Paint On Plus,
5
spread. The convenience of the in-office Ivoclar-Vivadent) was used to treat six pa-
techniques lies in how quickly the desired tients in two 1-hour visits.
results can be obtained. Thus, they are in- Patients selected for this study were
dicated for situations in which immediate screened using the following exclusion
whitening is required.6 However, in-office criteria:
bleaching requires the use of highly con-
centrated (usually 35%) hydrogen perox- ■ Age less than 18 years old
ide, which is caustic. Isolation procedures, ■ Known allergy to ingredients
such as the use of rubber dam to prevent ■ Patient is pregnant or nursing
hydrogen peroxide contact with soft tis- ■ Severe systemic illness
2
sues, are mandatory. Moreover, 35% hy- ■ Restorations in the anterior teeth
drogen peroxide has been reported to ■ Untreated periodontitis or caries
cause roughening and etching of tooth sur- ■ Fixed orthodontic appliances
faces.7 This toxicity potential and the ■ Gingival index score greater than 1.0
amount of time involved requires the den-
tist to increase the fee for the treatment. All patients received and signed an in-
Recently, a new generation of whiten- formed consent form. This study received
ing products has been introduced. This ethical clearance from the ethical commit-
new class of products consists of low- tee at the Instituto Superior de Ciências da
concentration hydrogen peroxide or car- Saúde Egas Moniz.
bamide peroxide paint-on varnishes or
gels to be used by the patients at home.
Based on the high kinetic release of hydro-
gen peroxide, manufacturers recommend
short application times, ranging from 10
minutes in the most recently marketed ver-

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Clinical procedure

1. An Optragate retractor (Ivoclar-Viva-

dent) was placed in the patient’s mouth,
and the initial shade was recorded with
the use of a Vita shade guide. Digital
color photographs were taken with the
shade guide positioned in the view field
for documentation purposes (Fig 1).
2. Vaseline gel (Unilever) was applied to
the gingival margin to prevent contact
with the peroxide varnish (Fig 2).
3. One thin and uniform layer of the paint-
Fig 1 Initial shade recording.
on varnish was applied to the buccal
surface of maxillary and mandibular
anterior teeth (canine to canine), as rec-
ommended by the manufacturer for at-
home use of this product (see Fig 2).
4. After 10 minutes, the varnish was eas-
ily removed using an ultrasonic scaling
device (Fig 3).
5. Steps 2 to 4 were repeated five addi-
tional times to give a total whitening
procedure time of 60 minutes.
6. A final photograph was taken with the
shade guides in place.

The procedure was repeated after 1

week. A questionnaire was handed to the
patient to assess tooth sensitivity, soft tis- Fig 2 Application of the Vaseline gel and paint-on
sue irritation, perception of whitening, and whitening varnish.

overall degree of satisfaction. Gingival tis-

sue was inspected for the presence of
whitening-induced lesions, and these were
classified as absent nonerosive (lesion
without loss of surface integrity) or erosive
(lesion with loss of surface integrity).

Fig 3 Ultrasonic varnish removal.

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Results
To date, the authors have treated a total of Tooth pain or sensitivity was not report-
six patients using this in-office whitening ed by any of the patients. All six patients
technique. The results of these cases are noted that they experienced mild discom-
depicted in Figs 4 and 5. After the second fort of the gingival tissue. In three of the six
session, the color change in the maxillary patients, nonerosive lesions (Fig 6) were
right canine ranged from 7 to 13 values on observed, but lasted no more than 20 min-
the Vita shade guide (Table 1). utes following treatment.

a b

Fig 4 Tooth shades for patient 2 before (a) and after (b) two sessions of in-office whitening.

a b

Fig 5 Tooth shades for patient 3 before (a) and after (b) two sessions of in-office whitening.

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Table 1 Vita shade guide values for the maxillary right canine before and after in-
office whitening treatment
Patient Vita shade before Vita shade after Change in shade value
1 B4 A2 8
2 A4 A1 13
3 A3.5 A1 10
4 A3.5 B1 11
5 A3.5 A2 7
6 A3.5 B1 11

Discussion
The paint-on whitening varnish with a con-
centration of 6% hydrogen peroxide used
in this study is designed for at-home self-
application for 10 minutes twice a day for
14 days. The manufacturer-recommended
short duration application time is based on
the rapid hydrogen peroxide kinetic re-
lease. A previous in vitro study conducted
by the authors confirmed that after 10 min-
utes more than 95% of the hydrogen per- Fig 6 Nonerosive lesion on gingival tissues following
whitening treatment. All such lesions resolved within 20
oxide was released from the varnish to a
minutes of treatment.
surrounding medium.8 This fact led to the
hypothesis that repeated application of this
product could induce a fast rate of bleach-
ing compatible with in-office use require-
ments. It has been stated that for in-office
bleaching with the use of high-concentra-
tion hydrogen peroxide, two to six appoint-
ments lasting 45 to 60 minutes are usually duration of the whitening effect is unknown
9
required. The results obtained show that at the present time. However, vital bleach-
with two sessions of six 10-minute applica- ing techniques have proved to be quite
tions, effective whitening can be attained. predictable, with color stability reported for
Color changes obtained range from 7 to 13 up to several years, and there are no rea-
shade values in the Vita shade guide, sons found to expect a different result from
which is comparable to the results present- this technique.9,11 Other whitening products
ed by others with the use of in-office high- may also be effective, provided they have
concentration hydrogen peroxide.10 The rapid peroxide kinetic release.

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Tooth sensitivity, a common side effect provides a good field of vision, which facil-
associated with the use of in-office prod- itates precise product application. More-
ucts with high peroxide concentrations, over, in the absence of rubber dam isola-
was not experienced by any of the patients, tion, the use of a lip retractor enables
which is a promising advantage for this bleaching of both dental arches simultane-
12
technique. Patient reports of soft tissue ously.
discomfort are minimal. Manufacturer rec- Patients evaluated the overall procedure
ommendations for at-home use of this as “good” to “very good” and all patients in
product do not include protection of the the study would recommend this proce-
soft tissue. However, in the first patient we dure to a friend.
treated, after several applications we de-
tected the presence of white nonerosive
surface lesions on the gingival tissue that Conclusion
were asymptomatic and resolved within 20
minutes following treatment. Similar tissue In-office bleaching with the use of paint-on
burns have been reported with the use of varnishes seems to be effective, safe, and
highly concentrated hydrogen peroxide well accepted by patients, offering a viable
13
during in-office techniques. To avoid this alternative to high-peroxide-concentration
situation, the use of rubber dam to prevent in-office procedures. Long-term results are
soft tissue contact with the hydrogen per- not available at this time. However, a clini-
oxide is highly recommended.2,9,13 In the cal study is presently being conducted by
subsequent cases, the authors applied the authors to collect more data, which will
Vaseline gel to the soft tissues, which help to assess short- and long-term clini-
served as effective protection of the gingi- cal effects of this technique.
va, as shown by the fact that the number
of lesions observed decreased. Therefore,
it is reasonable to assume that for this Acknowledgments
technique, the use of rubber dam, which is
The authors would like to thank the Oral Biology
uncomfortable to the patient and time con- Research Group colaborators, João Silveira, Joana
suming to apply, can be avoided, and pro- Marques, Joana Cabrita, Nuno Guilherme, and João
tection of the soft tissues can be safely and Amaral for their contribution to this work; the Clinical
Director Doctor Maria Armanda Amorim at the Institu-
easily accomplished with the use of an iso- to Superior de Ciências da Saúde Egas Moniz for the
lating medium such as Vaseline. The use logistic support; and the Administration Board at Egas
Moniz for funding and support.
of a lip retractor is also recommended be-
cause it is easy to apply, comfortable, and

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