Considering biomodification and remineralization techniques as adjuncts to vital tooth-bleaching regimens.

Although in-office and dentist-monitored vital night-guard bleaching have proved successful for whitening teeth, in some cases involving stark white spots, additional efforts may be required. This clinical case demonstrates the use of a combination in-office and take-home whitening regimen, followed by the in-office and home application of a paste containing casein phosphopeptide and amorphous calcium phosphate, both of which are believed to help replace lost minerals in teeth, make teeth stronger, and help protect them from decay and erosion. The patient's teeth successfully lightened from an initial shade of A2 to a uniform shade of B1. The white spots that were still visible after the bleaching process had disappeared into the tooth structure after the 3-week at-home use of the remineralizing paste. However, at the 3-month recall appointment, some relapse in the appearance of the white spots was noted. Although more research is needed to assess the broader implications of the technique, the author concludes that this individualized result suggests that products with the potential to remineralize tooth structure might be useful adjuncts to traditional tooth-bleaching processes to achieve a uniform appearance when white spots are present.