Whiteness HP Maxx is a 35% hydrogen peroxide whitening gel for the whitening of vital and non-vital teeth.
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Description

The product contains a combination of special tints that acts as an absorbing barrier (changes from intense carmine color to green). When irradiated with light it converts the light into thermal energy, which accelerates the peroxide process penetration in the dental structure. This accelerates the whitening process. Additionally to the tints, the product contains an inorganic load that acts as a barrier and collector of heat waves. This barrier allows the heat waves been used into the gel for the whitening process acceleration and consequently avoiding that they hit directly the pulp increasing its temperature and generating sensitiveness.

Presentation

• 1 bottle with 10g of concentrated hydrogen peroxide
• 1 bottle with 5g of thickener
• 1 bottle with 2g of peroxide neutralizing solution – Neutralize (FGM).
• 1 spatula.
• 1 plaque for gel preparation.
• Instructions for Use
• 1 syringe of Top dam with 2g.
• 6 applicator tips.

• 1 bottle with 4g of concentrated hydrogen peroxide
• 1 bottle with 2g of thickener
• 1 bottle with 2g of peroxide neutralizing solution – Neutralize (FGM).
• 1 spatula.
• 1 plaque for gel preparation.
• Instructions for Use
• 1 syringe of Top dam with 2g.
• 6 applicator tips.

Characteristics and Advantages

• Presented in two phases, peroxide and thickener, which allows for the manipulation of the just necessary quantity of the product. As examples, for a single tooth or a region of the tooth and whitening retouches, avoiding waste of material.
• The two phase’s presentation allows for a better product shelf life (2 years).
• Versatility in the combination with the domestic use technique.
• The complete kit allows for 18 applications.
• It has heat blocker in the composition to minimize the sensitiveness that can be caused by accelerating sources.
• It comes with an enzymatic solution (Neutralize) container which is used when an accidental contact of the peroxide with the patient´s mucosa happens.
• It can be used on the whole arcades or on individual tooth.
• Excellent viscosity.
• Indicated for vital and non-vital teeth.
• Neutral PH.
• Quicker.
• More efficient in the reduction of sensitiveness to the treatment.
• Better cost/benefit ratio.
• Selection of tints that compose a wider spectrum of visible light.
• Mixing system at the preparation moment, without losses due to excess or lack of material.
• It can be used with or without source of acceleration.

Indications

It has a unique formula with a combination of special tints and an inorganic load, which allows for a bigger heat wave retention coming from the light sources preventing, this way, heat waves to hit the dental pulp.
• As its predecessor, Whiteness HP (FGM), the Whiteness HP Maxx also has color transition that ends in a light green tone, facilitating its visualization for the moment of removal presenting no risks of pigmentation.
• The product preparation system is identical to its predecessor, where two phases are mixed together at the very moment of application.
• Its content normally is sufficient for the whitening of 6 arcades (3 applications in each arch).
• It can be used with or without sources of acceleration
• For having a wider spectrum for light absorption, Whiteness HP Maxx accelerates the whitening process, which makes it more agile and economical, both for the dentist and the patient.
• It was developed to allow reduced sensitiveness to the treatment, a very important factor to guarantee the comfort and safety for the patient.

Step by Step

Step 1

Prepare the patient according to the whitening case (see instructions for vital and non-vital teeth: Step by Step).

Step 2

Remove the whitener from the packaging observing the safety instructions.

Step 3

Hold the peroxide bottle in a vertical position and carefully open the lid.

Step 4

Prepare the recipient for the mix and the spatula to mix the product.

Step 5

Shake vigorously the thickener bottle in order to homogenize the content. Fail in the homogenization of the thickener can result in a low viscosity gel (insufficient viscosity).

Note: In cases when the whitener is kept under refrigeration, take it from the fridge at least 30 minutes before the beginning of the treatment to allow its temperature to get closer to room temperature.

Whitening of vital teeth

Perform a good evaluation of the buccal cavity of the patient; look for cavities, deficient restoration, enamel fissures, recession of the gum, gingivitis or other characteristics that you think must be checked and treated before the procedure. Put in place your and the patient´s protection equipment.

Step 1

Select and take the color of the patient´s teeth via a shade guide and/or taking a picture before start the whitening process.

Step 2

Perform relative isolation with Top dam – light-curing gingival protector (FGM) covering the marginal gum and the buds with a 3 to 5mm wide and 1mm max thickness. The barrier must cover approximately 0.5 to 1.0mm of the dental surface. Use a clinic mirror looking from the incisal to the cervical and observe if there is gingival tissue uncovered. If there is, make the correction. This step is crucial to avoid the contact of the peroxide with the gum. Use a labial retractor to facilitate the barrier and the whitener application.

Step 3

Cure the Top dam resin (FGM) using a 20 to 30 seconds light-curing for each group of three teeth. The gingival protector that is formed is rigid and insoluble, avoiding the occasional irritation by aggressive products.

Step 4

Using the mixture plaque provided in the kit, mix the Peroxide phase (phase 1) with the thickener phase (phase 2) in the following proportion: 3 drops of peroxide to 1 drop of thickener. This mix quantity is sufficient for one tooth application. For the smile line (10 teeth), normally 21 drops of peroxide and 7 drops of thickener are sufficient. Shake vigorously the thickener bottle before using it.

Step 5

With the help of a brush or spatula, thoroughly cover the vestibular surface of the teeth to be whitened, including the interproximal surfaces and extend a little on the incisal and occlusal surfaces. The gel layer should be between 0.5mm and 1mm thick. In case of choosing to use equipment to accelerate the process, start the application of light right after the application of the gel. For each equipment, there is a specific protocol for light exposure times. Follow the instructions of the manufacturer. Considering a photopolymerizer, it is recommended to apply light for 20 seconds on each teeth alternately (generally from pre-molar to pre-molar), maintaining a distance of 5 to 10mm from the surface of the gel. For each gel application, try to apply light twice.

Step 6

Leave the gel on the dental surface for at least 15 minutes from the beginning of the application through the end. With the help of a brush or micro applicator, move the gel over the teeth three or four times to eliminate possible oxygen bubbles that might have formed and renew the best contact possible of the gel with the teeth. At the end of the recommended time, clean the gel from the teeth with a suction cannula (for example, an endodontics one) and clean the teeth with a piece of gauze to have them ready for the new portion of gel. Repeat steps 4 through 6 up to twice more (maximum) on the same session, if necessary, depending on the evolution of the results and always monitoring the patient’s sensitivity.

Step 7

At the end of treatment, clean the gel through suction and wash the teeth. Remove the gingival protector detaching it with a probe.

Step 8

Apply the Desensibilize KF 2% (FGM) for 10 minutes and, right after that, polish the teeth with polishing paste Diamond Excel (FGM) and felt disks Diamond (FGM) or Diamond Flex (FGM).
Check the final aspect after the treatment. Compare before and after photographs.

NOTES:

1 – Monitor the patient throughout the whole whitening process for dental sensitivity and possible peroxide irritation areas. In case any of those is noted, interrupt the process and verify and intervene (see comments in the section Precautions and Side Effects).

2 – If the results obtained do not correspond to the expectations and the patient does not show sensitivity or any other contraindication, the reapplication of the product may be done for a maximum of two more sessions. In the case of an extra session, an interval of at least 7 days between sessions has to be obeyed.

Whitening of non-vital teeth

Before beginning whitening, take an X-ray of the tooth to be whitenend for the verification of its conditions. The treatment has to be in accordance to acceptable endodontic standards.

Step 1

Select and take the color of the teeth of the patient by means of a shade guide or photograph before beginning the treatment.

Step 2

Perform a good opening for exposing the crown removing restorations, cavity-affected dentine, etc. With the pulpal chamber cleaned, deepen the entrance of the conduct removing approximately 3mm of filling for the making of the sealing of the canal (the sealing prevents the diffusion of the whitening agent to the region of the cement and periodontium. It is recommended that the sealing of the canal be carried out with a glass ionomer with a minimum thickness of 2mm for a better sealing).

Step 3

Isolate the teeth with Top dam (FGM) and mix the phases of the whitener Whiteness HP Maxx in the proportion of 3 drops of phase 1 (peroxide) for 1 drop of phase 2 (thickener). Generally, 6 drops of peroxide for 2 drops of thickener are enough for one application. Vigorously shake the bottle of the thickener before using it.

Step 4

Apply Whiteness HP Maxx on the vestibular face and inside the pulpar chamber with the help of a micro applicator. A layer of approximately 1mm-thick is enough.

Step 5

In case of choosing to use equipment to accelerate the process, start the application of light right after the application of the gel. For each equipment, there is a specific protocol for light exposure times. Follow the instructions of the manufacturer. Considering a light-curing source, it is recommended to apply light for 40 seconds on each teeth per vestibule and 40 seconds per palatine or lingual. Wait 5 minutes and apply the light again. Leave the gel to act for the necessary time to complete 15 minutes from the beginning of the application.

Step 6

Remove the gel using suction (endodontics cannula) before reapplying the product. Up to three gel applications may be performed in the same session. After finishing the applications of the whitening gel, wash and dry the tooth. Restore temporarily the cavity and follow up the results of the whitening for, at least, a week. If necessary, repeat the application for a maximum of 4 times.

NOTES:

1 – The non-vital tooth restored temporarily, presents a fragile crown and absence of dental structure in its interior. Instruct the patient for the right care for not fracturing the crown of the fragile tooth.

2 – As an alternative, after the removal of the Whiteness HP Maxx, the professional may use the whitener Whiteness Super-Endo (FGM) – carbamide peroxide at 37% for internal use and continue the whitening of the teeth during the interval between sessions with Whiteness HP Maxx (for the use of the whitener Whiteness Super-endo refer to the specific use instructions).

Step 7

At the end of the whole whitening process, restore permanently the cavity on the whitened tooth. It is recommended to wait at least 7 days before restoring the tooth (time for the stabilization of the color of the tooth and the elimination of residual oxygen). Check the final aspect of the tooth after treatment.

FAQ

How does teeth whitening work?

Teeth whitening can be performed thanks to the teeth permeability, which allows for the molecules of the whitening gel to penetrate inside the enamel and the dentine. The hydrogen peroxide in the whitening gel “breaks” the molecules of the stain-inducing pigments, which are removed through diffusion.

How can I treat dental sensitivity caused by in-office whitening?

The professional can space applications, apply a potassion nitrate and fluor based desensitizing gel like the Desensibilize KF 2% (FGM), at the office for 10 minutes.

During whitening, white stains may appear. What can be done?

Dental whitening does not cause stains. In areas of hypoplasia, most times imperceptible, they are evidenced during whitening, but usually disappear by the end of the treatment.

Is it necessary to make reservoirs in the plaster models before making the trays?

No, it is not a necessity, however, some authors defend reservoirs because they help the perfect adjustment of the tray, allow for a greater amount of gel to be applied and reduce the pressure on the teeth. The reservoirs can be made with Top dam.

In case a retouch is needed, how should it be done?

Whitening retouches can be done with the take-home or in-office versions of the whitener. Usually this “re-whitening” is faster than the regular process.

Can patients under tetracycline treatment undergo dental whitening?

The best procedure is to assess the degree of staining caused by the tetracycline and talk to the patient about possible results. There are reports in the literature of home dental whitening during tetracycline treatment for up to six months with satisfactory results. Both Whiteness HP (FGM) and Whiteness HP Maxx can be used, presenting the advantage of allowing for the use along the stained areas. A good option is the combination of the office and the home use techniques.

Can pregnant or breast-feeding women undergo dental whitening?

We do not recommend whitening during those periods. In scientific literature there are no reports that dental whitening may cause damage to the baby, however, we recommend waiting for those phases to end and start with safety after that.

Why is dental whitening not recommended before age 15?

We do not recommend whitening before age 15 because the pulpar chamber is too wide and hypersensitivity may occur.

Why is the cervical sealing recommended for the whitening of non-vital teeth?

Cervical sealing should be done because it prevents the diffusion of the whitening gel to the periodontium through dentine canaliculi, avoiding the radicular reabsorption.

May I combine in-office and take-home whitening?

Yes, that is a great option in several cases of very dark teeth, pigmentation that is hard to remove and cases of patients with stains caused by tetracycline.

What are the precautions patients should take concerning eating habits during treatment?

Patients should avoid the excess intake of tinting foods like carrots, beets, coffee, tea, red wine. Citric and cola-based drinks should also be avoided because they can increase sensitivity.

What are the cases that suggest the best indication for whitening?

The cases that had better responded to whitening are younger patients with naturally darkened teeth, cases of darkening from age and yellowish tones.

How long does the whitening last?

The longevity of a whitening treatment may vary from patient to patient. A work published by Leonard J. R. RH in 1998 found the maintenance of the color in 82% of the cases after 4 years.

Can any person undergo dental whitening?

Yes. Any person may have their teeth whitened if the teeth are in good condition and without too many restorations. The professional dentist will perform a thorough evaluation of the patient. As from age 15, a person can undergo teeth whitening.

When to choose a take-home or in-office whitening treatment?

There is no rule; most cases can be resolved with the take-home technique, with the in-office one or a combined strategy. We have to analyze the degree of discoloration, the life style of the patient, his/her discipline and the urgency needed for the whitening treatment.

When is a whitening treatment not recommended?

Whitening is not recommended in cases of teeth with extensive restorations, patients with allergies to the components of the product, pregnant and breast-feeding women.

How long after whitening, can restorations be done with composite resins?

An interval of 7 to 14 days should be waited for adhesive restorations due to the fact that there is a decrease in the adhesive capacity when restorations are done right after whitening.

Information for the Professional

Precautions and Contraindications

• There are cases in which sensitivity is noted only after the treatment (1 or 2 hours later). In those cases, if sensitivity is too high, a pain reliever is recommended and the application of Desensibilize KF 0.2% (FGM) in a whitening mold for 10 minutes. The application of Desensibilize should not exceed once a day.
• Whitening can reveal or emphasize hypo-calcification areas due to the differentiated whitening (more intense) in those areas. In certain cases, those stains disappear due to the dehydration of the enamel after the end of the whitening treatment. The treatment with fluoride on those areas can also help them disappear.
• Prolonged product exposure to temperatures above 40°C (104°F) can result in alterations or product leakage.
• The product is not recommended for patients who have undergone recent periodontal surgery, with gingivitis or periodontitis, with active cavity lesions, defective restorations and enamel hypoplasia or allergic reactions to the components of the products.
• Use during pregnancy and lactation is not recommended either.
• It is normal to experience dental sensitivity during the procedure or even afterwards. If the patient shows sensitivity during the treatment, interrupt whitening and treat the teeth with the desensitizing gel Desensibilize KF 2% (FGM). If sensitivity persists, and whitening cannot be continued, schedule a new session a minimum of 7 days apart. Evaluate if there are no anomalies on the teeth that can be fixed to eliminate the sensitivity.

Preservation and Storage

• Store product under temperatures between 5°C and 25°C (41°F and 77°F) for better conservation of the product.
• Do not freeze it.
• Protect it from direct sun.

General

• Most dental stains can be removed with one single whitening session. However, depending on the origin and age of the staining, there are cases in which more than one whitening session may be necessary.
• If the whitening result obtained in one session does not correspond to the expectations and the patient does not show senstivity or any other contraindication, the reapplication of the product may be done for up to two more sessions. In the case of more than one session, a minimum interval of 7 days between sessions must be respected.
• In case the patient develops sensitivity that cannot be controled, the duration of the whitening session may be reduced and distributed over three sessions. In that case, it is suggested to verify the presence of possible anomalies that can be causing the sensitivity (fissures, exposure of the dentine, etc.). When sensitivity is hard to control or, else, for another reason the whitening session is not possible or not recommended, the whitening process can be complemented by the home use procedure with the carbamide peroxide based Whiteness Perfect (FGM) and hydrogen peroxide based White Class (FGM), for example.
• Like with all other whitening techniques, the recording of the color of the teeth before whitening, the clarification to the patient about the real perspectives of his/her case (limitations in the case of tetracycline caused stains, grey coloring, etc.), warnings about potential sensitivity, need to replace restorations, are recommended. There are cases in which, due to particular characteristics of the teeth (enamel, pigmentation, etc.), the level of desired whitening cannot be obtained.