Dr. Koronczay László
Ultrasonic White teeth whitening system – enhancing the
effectiveness of teeth whitening by ultrasonic treatment
Teeth whitening is the area of cosmetic dentistry that the public is most interested in, and as such
it's one of the fastest developing field. Being a cosmetic treatment, it involves extra profits, however,
the expectations are often unrealistic. As fast as possible, blindingly white teeth, without pain these are the basic requirements.
There are many teeth whitening system in the world, but nearby all use the whitening effect of oxygen
evolving at the decomposition of various peroxides. Look after what are peroxides ant what should be known
about teeth whitening. The hydrogen peroxide is a clear, colorless and odorless liquid miscible with water
unrestrictedly. Its chemical formulae is H-O-O-H as H2O2. As from the formulae could be seen two oxygen
atoms are directly connected (-O-O-). This combination of two oxygen atoms is denominated as a peroxide
group. The feature of this peroxide group that the oxygen atoms connect easily to other molecules or groups
The formula shows it unambiguously that the two oxygen atoms are directly bond to each other (-O-O-).
Such a combination of two oxygen atoms is called a peroxide group. A characteristic of this peroxide group
is that the oxygen atoms easily bond to other molecules or groups through intermediary reactions. This
reaction is called oxidation, and the oxygen given up is called the active oxygen. Out of the active oxygen
compounds, hydrogen peroxide is the simplest. H2O2. has a wide variety of uses: it's a disinfectant, oxidizer,
reducing agent and oxygen supply.
When brought into contact with certain enzymes, pollutants, certain metals and their salts (Fenton reaction
2), alkaline compounds and UV radiation, hydrogen peroxide is activated and it rapidly decays. During this
activation or accelerated decay, a large amount of disinfectant oxygen is released. At the end of the reaction
the hydrogen peroxide perfectly decomposes into water and oxygen. This is the most interesting
characteristic of hydrogen peroxide.1 The production and decomposition of hydrogen peroxide is also related
to ultrasound.
If we want the whitening material to act not only on the surface of the teeth, we have to know about the
permeability of the enamel and the dentin against hydrogen peroxide. According to the literature, this value
is extremely varying, much more than the concentration of peroxide can be varied in commercial whitening
systems. (10-38%) (Probably this is the reason, why every whitening system can be successful - just not for
everyone, according to my and my colleagues' experience)
In-office whitening systems can be classified into 3 groups:
1. The material is applied to the teeth and then we simply wait
2. The material is activated by light (including laser and UV lamp variations)
3. Ultrasound is used for activation.
The efficiency of the whitening depends on how much material reaches how deep into the tooth. Different
solutions have been developed to increase the effect, but none of them have been perfect yet.
The apply-and-wait method can have two drawbacks:
Either the system uses a syringe, in which case the material should be slightly acidic in order to stabilize the
peroxide, and the material decays slowly after the application as well.
Systems with 2 or more components likely contain Fe+3 or alkaline constituents, which accelerates the
decomposition of the peroxide, but we cannot control the direction in which the active oxygen is released
from the gel applied to the surface.
Photoactivated materials can release the oxygen rapidly, but have the same problem as the chemically
activated materials: they cross the enamel with difficulty.
The ultrasound drives out the peroxide from the gel rapidly, and decomposes it, and the vibration brings the
material deeper into the tooth, but it is difficult to control the gel containing the peroxide in commercially
available systems, and so until now only concentrations similar to that of domestic teeth whitening systems
could be used.
That's where it came up how the process could be made more efficient
Photoactivation was rejected, because on one hand, working with light has a lot of drawbacks: only UV light
decomposes directly the hydrogen peroxide (10), but UV light is dangerous and the mucous membrane,
face, etc. have to be protected; in other systems the heat is the activator (which can be damaging to the
pulpa), or some photoactivated peroxide activator is used; while on the other hand, activation can be done
chemically in a very simple way. (11)
Using ultrasound to accelerate chemical processes, such as bleaching with peroxide, is known in the art
(567), so we studied the ultrasound system.
How can ultrasound be used in a way that doesn't result in the gel spilling from the spoon , and so higher
concentration is possible during the treatment.
Ultrasound is conducted well by water and unclosed cell materials saturated with water, which led to the idea
of using the micro brush, well known in the art, as an ultrasound transducer.
This led to the development of a system that has numerous advantages compared to other commercially
available systems. It improves the efficiency of any system that uses chemically activated agents, no large
investment is needed, etc. The system is called Ultrasonic White, and is under patent protection.
What is the “UltraSonic White®” whitening system?
The Ultrasonic White whitening system is a apparatus based on the characteristic of ultrasound that it
can accelerate chemical processes, and is under patent protection in Hungary.
What does the “UltraSonic White®” system consist of?
It consists of a handpiece which vibrates at a certain frequency, a head that conducts the vibration
onto the teeth without damaging them, and a chemically active gel.
EXPERIMENT:
We conducted an experiment to prove the effectiveness of the apparatus. After talking to several companies
distributing teeth whitening materials, Heller Hungary provided us with an appropriate amount of teeth
whitening material, called Hellerdent Supreme White 40®.
After several preliminary experiments, we developed an adequate photographic method and laid down the
steps of the experiment
We were looking for answers to the following questions:
1. The result of the ultrasonic whitening isn't just a placebo effect from the dehydration of the teeth.
2. We can improve the effect of a given commercially available material. (Hellerdent Supreme White
40®)
Description of the experiment
The aim of the experiment is to observe and evaluate the effectiveness of the ultrasonic whitening treatment.
Steps of the experiment:
1. Adjusting the camera:
- setting date imprinting on
- manual settings: focus
5,6 shutter speed: 1/100
- white balance set on a test sheet
- macro zoom is set on
2. taking a test photograph on a black and white test sheet
3. the patient signs a declaration of assent
4. taking an initial picture of the patient with a mouth straddle
5. teeth whitening:

surface anaesthesia of the mucous membrane

gingiva barrier lege artis

apply the whitening material lege artis

a 10 second ultrasonic stimulation per teeth on the right side with the Ultrasonic White¤
apparatus

whitening for 3x 20 minutes

washing the material completely off, remove the gingivabarrier
6. Taking a picture with the mouth straddle on.
7. The patient fills out the test form.
8. The patient is asked to return after at least 2 days.
9. Taking a picture according to the settings detailed above.
10. The other side is whitened following the directions of the manufacturer.
11. Taking a picture of the result.
12. Taking a picture after 2 days.
The first picture was taken at the beginning of the experiment, the second immediately after the ultrasonic whitening treatment, the third 2 days later,
the fourth after normal whitening, the last 4 days later.
The experiment may seem a little complicated, but it was the only way the difference between the 2 sides
could be evaluated, and also the whitening from the dehydration of the teeth, and the redarkening, which is
often mentioned on internet forums as a drawback of the concurrent ultrasonic treatment.
12 persons took part in the experiment. There were 2 unusable results (imperfect photography, the patient
didn't return), 7 partially usable results (didn't return, filling of crown on the front surface) and 3 valuable
results.
Evaluation:
We evaluated the resulting pictures in the HSB colorspace (47), which is based on the human color
perception, and which is the best for teeth whitening. A typical area of the front teeth were averaged, and the
color could be expressed using 3 numbers.
HSB colorspace is based on human color perception. It uses 3 basic properties of colors:
Hue (H): the frequency of the light that the object emits or absorbs. Hue is expressed as an angle between 0
and 360 degrees, according to its position on the standard color circle. In general it is referred to by the name
of a color, such as red, orange, green.
Saturation (S): the strength or clarity of a color. Saturation is measured as a percent – from 0% (gray) to
100% (full saturation). Gray, white and black, that can appear on a grayscale image, have 0% value. A
saturation value of 100% means the clearest variation of a color.
Brightness (B): the brightness or darkness of a color which is also expressed as a percent between 0%
(black) and 100% (white).
At the end of the experiment, we asked the participants to fill out a form:
1. Did you notice a difference between the right and left sides during the treatment? If yes, what was
it?
2. Please give an estimation, how much discomfort did you feel during the 3 cycles . (1 none at all, 5
terrible)
First 20 minutes:... Second 20 minutes:...
Third 20 minutes:...
3. What was the most uncomfortable during the whitening treatment?
4. Are you satisfied by the result? (1 no - 5 very much)
5. How much money would you spend on such a whitening procedure if the effect lasted for 5 years?
Due to the small number of cases no statistical assessment was done, but the evaluating graphs are also
revealing. The graphs show that both the peroxide and the dehydration had the effect of increasing the
saturation of the teeth, with almost no effect on its brightness or color.
These measurements can be used in practice as well to predict the colors expected after the whitening
treatment already at the time of the restoration necessary before the treatment. (table x)
Color saturation decreased by 5.92 points on average (from 24.69% to 18.77%), which corresponds to a 34%
„whitening”. This corresponds to a A3-B2 color change on VITA color scale.
Following the directions of Hellerdent Hungary, the whitening was 4.6% on average – 28.76% less than
when using ultrasound.
The „whitening” effect of dehydration was also studied, it changed from 22.17 to 17.67, but after a few days,
it returned to 21.33. The fact that it didn't exactly return to its original value is explained either by the
uncertainties of the measurement or by that the patient received instructions to wash their teeth, what to eat,
etc. and the positive effects of these could be observed in the measurements.
The graph above shows that after the whitening treatment of the right side, the left side also whitened due to
dehydration, but by the time of the next treatment, this already returned to its original value.
The „whitening” effect of dehydration was also studied, it changed from 22.17 to 17.67, but after a few days,
it returned to 21.33. The fact that it didn't exactly return to its original value is explained either by the
uncertainties of the measurement or by that the patient received instructions to wash their teeth, what to eat,
etc. and the positive effects of these could be observed in the measurements.
Case 1
22.5
20
saturation
17.5
15
12.5
10
jobb oldal
bal oldal
7.5
5
2.5
0
Alapáll Jobb
Kontro
apot
old UH ll
Bal
sima
feh.
Eredm
ény
event
The graph above shows that after the whitening treatment of the right side, the left side also whitened due to
dehydration, but by the time of the next treatment, this already returned to its original value.
Chance so ordained it that one of our patients had a ceramic fused on metal crown on teeth #11. We did not
exclude him from the experiment (it was very hard to find patients) – according to the literature peroxide has
no effect on ceramic, so it could be used as a reference. However, after evaluating the pictures, it turned out
that some sort of „dehydration” effect is indeed in place, color saturation was definitely level lower by a
point on pictures taken after the whitening procedure. Of course at the end the crown didn't become whiter, it
had the same value as initially.
Eset 2
25
22.5
színtelítettség
20
17.5
15
12.5
jobb oldal
bal oldal
10
7.5
5
2.5
0
Alapáll Jobb
Kontro
apot
old UH ll
Bal
sima
feh.
Eredm
ény
esemény
The evaluation of the forms was also revealing.
For patients explained that the ultrasonic treatments were more sensitive (which was expected), but they
found the aspirator and the mouth straddle more discomfortable than the pain.
It is surprising that 4 patients found the mouth straddle the most discomfortable, 3 the aspirator and only 2
said that it was the pain. In these cases it turned out that the gingivabarrier was leaking and the peroxide was
burning the gum. (It's unpleasant, but disappears within a few hours spontaneously.)
The average satisfaction was 3.71, most participants gave 4 on a scale of 5. Those who had previous
experience with teeth whitening gave better grades.
At the evaluation of pain it turned out clearly that discomfort doesn't increase linearly by time, but this could
have multiple reasons. It is possible that the pain really increases, but it is also possible that the same
physical stimulation is felt more acutely after some time.
Sensitivity
25
22.5
relative pain
20
Eset 9
Eset 8
Eset 7
Eset 6
Eset 5
Eset 4
Eset 3
Eset 2
Eset 1
17.5
15
12.5
10
7.5
5
2.5
0
20. perc
40 perc
60 perc
minutes
It is also edifying to see how much the patients would spend on such a treatment.
Those who were aware of the prices of whitening procedures in Budapest almost uniformly said 50,000 Ft.
These participants were typically women between 25 and 35. Men were less interested in cosmetic questions,
they would typically spend an amount between 0-10,000 Ft on teeth whitening.
Young adults gave an amount in between.
How much would you spend on whitening
0-10000 Ft
10001-20000 Ft
20001-30000 Ft
30001 Ft <
In summary , the effect of teeth whitening agents, such as the Supreme40® sold by Hellerdent Hungary, can
be improved by ultrasound. Whitening is not just a result of dehydration, a real and lasting change is
observed.
The experiment raises some problems worthy of further reflections. After the ultrasonic treatments, the teeth
kept whitening until next morning. This is logical, the peroxide penetrated the teeth and slowly oxidized the
coloring compounds therein. If we aid the decomposition of peroxide e.g. by creating alkaline pH value, does
this effect become more rapid, and can we reach the maximal whiteness already at the and of the treatment?
Materials with alkaline pH decrease the sensitivity of teeth. (zz) Can this effect be utilized during the
whitening treatment?
References
http://www.huwa-san.hu/hidrogen.php
Introduction into the feature of hydrogen-peroxide (Bevezetés a hidrogén-peroxid tulajdonságaiba)
http://www.hazipatika.com/topics/fogapolas/articles/Feherebb_a_fehernel?aid=20071017122648
http://www.trojanuv.com/en/business/ECTadditionalinfo.aspx
http://garfield.chem.elte.hu/Zador/zador_PhD.pdf :
J. Zádor: Uncertainty analysis of reaction kinetics model (Reakciókinetikai modellek bizonytalanságanalízise)
http://www.hik.hu/tankonyvtar/site/books/b133/ch17s01s03.html
http://pubs.acs.org/cgi-bin/abstract.cgi/esthag/1997/31/i08/abs/es960717f.html:
Environ. Sci. Technol., 31 (8), 2237 -2243 es960717f S0013-936X(96)00717-1
Copyright © 1997 by the American Chemical Society
Optimization of Ultrasonic Irradiation as an Advanced Oxidation Technology Inez Hua and Michael R. Hoffmann*
W. M. Keck Laboratories, California Institute of Technology, Pasadena, California 91125
Z. Galbács, G. Galbács, Zs. Gyarmati: Bleaching of dyes in a solution of hydrogen-peroxide activated by
ultrasound,
Ultrasonic International 2001, 2001, Delft, The Netherlands
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TFY-4D8VHXS4&_user=10&_coverDate=05%2F01%2F2005&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c
&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=719597a965af19c673cc50b
791cc8ca0
Ultrasound in textile dyeing and the decolouration/mineralization of textile dyes
Simona Vajnhandl and Alenka Majcen Le Marechal
http://www.freepatentsonline.com/20050074723.html:
Systems and methods for utilizing ultrasonic energy to activate tooth whitening substances
United States Patent 20050074723
http://www.blackwell-synergy.com/doi/abs/10.1111/j.1708-8240.2003.tb00185.x:
Journal of Esthetic and Restorative Dentistry
Volume 15 Issue 3 Page 154-165, May 2003
Scanning Electron Microscopy Study of Dental Enamel Surface Exposed to 35% Hydrogen Peroxide: Alone, With Saliva, and With 10%
Carbamide Peroxide
http://www.peroxidefree.org
http://www.cda-adc.ca/jcda/vol-65/issue-8/453.html:
The Safety of Home Bleaching Techniques
Laura Tam, DDS, M.Sc.
http://www.blackwell-synergy.com/doi/abs/10.1111/j.0143-2885.2004.00761.x?prevSearch=%28%28keyword%3A%28peroxide%29%29%29
International Endodontic Journal
Volume 37 Issue 2 Page 120-124, February 2004
In vitro penetration of bleaching agents into the pulp chamber

A. R. Benetti11Restorative

M. C. Valera11Restorative



Dentistry, ,
Dentistry, ,
M. N. G. Mancini22Physiological Sciences and ,
C. B. Miranda11Restorative Dentistry, &
I. Balducci
http://www.blackwell-synergy.com/doi/abs/10.1046/j.1365-2842.2002.00856.x?prevSearch=%28%28keyword%3A%28peroxide%29%29%29
Journal of Oral Rehabilitation
Volume 29 Issue 5 Page 473-477, May 2002
Effects of hydrogen peroxide on the light reflectance and morphology of bovine enamel





Y. H. Kwon**Department
of Dental Biomaterials, College of Dentistry, Kyungpook
University, Taegu, Korea, ,
M. S. Huo**Department of Dental Biomaterials, College of Dentistry, Kyungpook
University, Taegu, Korea, ,
K. H. Kim**Department of Dental Biomaterials, College of Dentistry, Kyungpook
University, Taegu, Korea, ,
S. K. Kim††Department of Conservative Dentistry, College of Dentistry, Kyungpook
University, Taegu, Korea, &
Y. J. Kim‡
National
National
National
National