Tooth whitening through the combined technique using Whiteness HP AutoMixx 6% and Whiteness Perfect 16%: an effective and safe technique with excellent clinical results

Authors: Prof. Dr. João Cardoso Ferreira, Prof. Dr. Patrícia Teixeira Pires. Dr. Nuno Ribeiro Santos, Dr. Liliana Dias, Dr. Fabiana Almeida

Gender and patiant age: 34-year-old female patient

CHIEF COMPLAINT: Very darkened teeth.

Initial Evaluation: The patient came to the clinic to undergo a tooth whitening procedure because she was dissatisfied with the color of her teeth. No caries or dentin hypersensitivity were found in the clinical examination. Oral hygiene was good and the periodontium was clinically healthy.

Treatment performed

The proposed treatment plan was, after hygiene prophylaxis, tooth whitening – combined technique (one in-office session + at-home whitening). In a first consultation, the initial shade was taken (Figs. 1a and 1b) and molding was carried out with alginate for the manufacture of whitening trays. In the next appointment, the teeth were previously polished with a toothpaste and brush, and Desensibilize KF 2% was applied preventively for 10 minutes.
Then, to protect the soft tissues (lips, cheeks and tongue), the Arcflex retractor (FGM) was used and the gingival tissues were protected by applying a gingival barrier (Top dam – FGM) – Fig.2 . The 6% hydrogen-peroxide whitening gel (Whiteness HP Automixx 6% – FGM) was applied – maximum percentage allowed in Europe by directive 2011/84/EU – on all buccal surfaces from 2nd premolar to 2nd premolar in both arches – Fig. 3a and 3b.
The application time was 45 minutes in a single session, with the gel being activated for 5-5 minutes. After the action time, the gel was removed. Then, the teeth were polished with Diamond Flex disks (FGM) and Diamond felt disks (FGM) associated with Diamond Excel diamond paste (FGM). After polishing, FluorCare fluoride foam (FGM) was applied. Immediately after the office session, the final shade was taken and desaturation was observed for A2 (Fig. 4).

The upper and lower whitening trays were then tested in the mouth. The carbamide peroxide gel Whiteness Perfect 16% (FGM) and the whitening trays were supplied to the patient with the following instructions for use: place one drop of gel per tooth in the molding tray in the deepest and most vestibular incisal area, position the molding tray and adapt it by pressing gently. Wear it overnight (about 8 hours/night) for a period of 2 weeks.

In the end, results were improved from A3.5 and A3 to A1 (fig. 5) without any complaints of dentin hypersensitivity or other undesirable effects, making the patient clearly satisfied.

Step by step

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Fig. 1a, 1b – INITIAL – Before whiteing. A3 – central incisives; A3,5 – canines (Vita shade guide).

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Fig. 2 – Application of the Top dam gingival barrier (FGM) in all papillae and cervical contour of teeth up to 1st molar.

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Fig. 3 –Application of Whiteness HP Automixx 6% hydrogen peroxide whitening gel on the buccal surface of the teeth.

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Fig. 4 –Result after the removal of Whiteness HP Automixx 6% whitening gel (FGM) with a change in color saturation.

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Fig. 5 – Final aspect– After 2 weeks – A1 (Vita shade guide).


The combined whitening technique using Whiteness HP AutoMixx 6 % and Whiteness Perfect 16% (FGM) provided excellent esthetic results and absence of dentin hypersensitivity, demonstrating efficacy and safety.


• Marshall K, Berry TG, Woolum J. Tooth whitening: current status. Compend Contin Educ Dent. 2010 Sep;31(7):486-92, 494-5; quiz 496, 508.
• Pretty IA, Brunton P, Aminian A, Davies RM, Ellwood RP. Vital tooth bleaching in dental practice: 3. Biological, dental and legal issues. Dent Update. 2006 Sep;33(7):422-4, 427-8, 431-2.
• Marshall K, Berry TG, Woolum J. Tooth whitening: current status. Compend Contin Educ Dent. 2010 Sep;31(7):486-92, 494-5; quiz 496, 508.

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