Does whitening have a role in orthodontics? A popular cosmetic procedure which 1 in 4 adults partake in, and was proposed recently at a conference as part of finishing in orthodontics. So this podcast reviews whitening as a topic and the latest evidence in combining whitening with aligners.

Reminder the podcast is an opinion piece and is the independent work of myself and the orthodontics in summary team.

24% of adults have whitening their teeth (dentalhealth.org)

How does it work:

Bleaching is the chemical changing of darker staining on teeth termed chromogens, with the active ingredient hydrogen peroxide. 

Hydrogen peroxide reacts to oxidize the chromogen, which becomes a lighter colored compound. 

Hydrogen Peroxide is not a stable chemical, so Carbamide peroxide  is used, which roughly breaks down to 1/3 H2O2 when mixed with water. 

Hydrogen Peroxide UK limit 6%, or Carbamide peroxide 16% is used, USA, greater concentrations are used with 10% hydrogen peroxide for at home whitening, and 35% hydrogen peroxide for in office bleaching. 

Children

UK guidelines GDC 2014 – no bleaching until 18, unless purpose of treating or preventing disease.’

USA: The AAPD 2023 s Safe and effective for whitening discolored teeth of children and adolescents. Avoid full-arch bleaching mixed dentition and primary dentitions

Risks

Sensitivity -

about 80% of patient’s experience sensitivity 

Gingival irritation

Susceptibility to demineralisation

How long does the whitening last

Duration of correction, depends on lifestyle, with smoking and coffee reducing the correction. Expected 6-12 months of stable colour change. Wiegand 2008

Aligners

Retainers as bleaching trays?

Use of 0.8mm Zendura, no resivoir, effective bleaching with marked or extremely marked improvement in 78% of cases with 10% Carbamide peroxide, however but this changed the VFRs’ biomechanical properties, decrease in tensile strength and an increase in hardness and internal roughness, unclear what the medium and long term effects are .Jin 2024 

Bond strength

Join me for a summary

Limitations of

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Advantages of direct

·       Select thickness, 0.5-0.7mm, conventional

·       Gingival margin

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Manufacturing steps

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Characteristics of

·       Greater accuracy: (Zendura, Essix

·       Less with DTP (Hertan 2022)

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Shape memory effect

·       DTP Polymer chains crosslinked, not case in conventional aligners

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Unknowns

·       How effective shape memory is remains unclear

·       Cytotoxicity – not enough data, although manufacturer

·       Changing thickness, unclear how much of a

Clinical points

Teeth extrusion

Lateral incisors

·       Difficult to do with conventional aligners,

·       Create ‘wedging’ gingival pressure columns to

Elastic Hooks

·       Hook printed into aligner with DTP, instead of cut

·       Tip aligners and elastics: Still add attachment

Mandibular advancement

·       Problem of mandibular advancement with aligners

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·       DTP choice of thickness of block

Bite ramps

Conventional bite

DTP no limit to size

In the Transverse

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Concluding statement

Enjoy the variability

Contributions

Contents:

Edited

Join me for a summary looking at gingival recession in orthodontics, and whether it is detrimental or beneficial. This lecture was given by James Andrews, he explored the effect of orthodontics on the periodontium, an area under increasing interest within aesthetics to achieve the ideal ‘pink aesthetics’ with the increasing adult population receiving orthodontic treatment. His lecture was based on, is orthodontics good or bad for the gingiva?

What is the starting point ?

Facial type and bone morphology Tunis 2021

Tooth movement: 

What happens when teeth move buccally?

What type of movement

How to decide what to do?

WALA line – Will Andrews Larry Andrews ridge Andrews 2000

Aligners any different?

What do we do to correct extra-alveolar teeth?

If teeth pushed outside of cortical plate then retracted, what happens

Intrusion

Gingival graft when to move teeth

“Diagnose and treat each tooth no miracles shortcuts for good orthodontics” Peck 2017 

Join me for a summary looking at miniscrews, looking at

Is torque a factor in TAD success?

Torque study – compression during insertion Motoyoshi 2006

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Understanding

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Ideal

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Rules:

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What is the best site for TAD insertion?

Keratinised gingiva

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o   zone

Target zones and site

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Is there ideal bone?

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Ideal site:

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Evidence of site selection success

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Does root proximity influence TAD success?

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Understanding

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What happens if TADs fail and we try again?

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For more education see Sebastian’s TAD course:

https://tadchallenge.com/tad-certification-course

I have no financial interest

Join me for a summary of Tommaso’s lecture on aligner treatment, exploring questions on the use of aligners. Tommaso described how compliant patients are with the use of aligners, who is more likely to wear aligners well and methods to increase compliance. He critically reviewed the use of attachments, and revealed aligner deformation and staging as key areas of treatment. This podcast is a summary of the WFO online webinar from November patient compliance, biomechanics , rotation, distalisation and intrusion

Patient Compliance

Sample of over 200 patients treated with aligners under remote monitoring, Thirumoorthy 2021:

Patient factors which vary compliance of removable appliances Fleming 2019

The study came with some recommendations:

Join me for a podcast summary looking at the grey topic of

Flavia Artese began with asking the clincal question we

Difference in international practice

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What factors in decision making

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Orthodontic influence 

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Prediction method

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Prediction of orthodontists and surgeons Bastos 2016

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Surveillance protocol

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Fully erupted

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Review of guidelines Gadiwalla 2021

            Only 2

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Conclusion

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Please join Flavia Artese at the 2025 International

Contributions

Contents: AbdAllah Sharafeldin

Contents edited and

Join me for a podcast exploring the limits of

Anatomical boundary

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boundary for lower molar distalization.

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Side effects of lower molar distalisation

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Horizontal movement: atrophic ridge

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Vertical:

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Periodontal boundaries

Carlos Flores Mir started the topic with a thought proving

The difference between the gingival biotype and phylotype,

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Thin gingival biotypes are likely to have more chances

Factors to consider

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CBCT

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Lower incisor proclination and recession:

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Understanding

Recession = Thin gingiva + proclination +

Contents– Shanya Kapoor

Editing and Production – Farooq Ahmed

Orthodontics In Interview: RICHARD COUSLEY

Join me for a summary of two lectures from this year’s international orthodontic symposium (IOF), looking at mouth breathing and paediatric obstructive sleep apnoea, by Hong He and Carlos Flores Mir. The lectures explore this controversial area in both medicine and orthodontics and review the current understanding of the topic, the relationship with facial features and current recommendations for orthodontists.

OSA is defined disruption to breathing American Academy of Sleep Medicine

Defining mouth breathing at airflow over 25% through the mouth

Evidence of craniofacial effects

Treatment

Conclusions

Contributions 

Contents and video editing – Shanya Kapoor

Editing and Production – Farooq Ahmed

Orthodontics In Interview GUEST HOST Björn Ludwig with Ralf Radlanski

Guest podcast hosted by Dr Björn Ludwig, he interviews the anatomist and

The two questions close to Bjorn’s heart are explored: do you drink

YouTube

https://youtu.be/vcAzjWa507Y

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