Abstract

Introduction: Severe hyperbilirubinemia in biliary atresia affects bones, teeth and mucous membranes causing greenish stains. If bilirubin levels are normalized following liver trans- plantation, the pigment effects disappear in tissues but persist in teeth, causing stains of multiple magnitudes depending on stage formation and dental mineralization. Case reports: 11‐year‐old female patient with a history of hepatic cirrhosis due to biliary atresia, liver transplant at 2 years. Mixed dentition, generalized greenish intrinsic stains on primary teeth and partially on permanent teeth. She suffers from bullying and self‐esteem problems at school. Selective teeth whitening is performed with 6% and 15% hydrogen peroxide, DMC equipment, lase peroxide lite kit 6% - lase peroxide flex kit 15/35. Following manufacturer`s instructions, each session was 12–20 min; application on teeth 1.1 ‐ 2.1 ‐ 3.2 ‐ 4.2, gradually decreasing intrinsic staining intensity until a total of 120 min of contact was completed. Color was measured with a subjective visual scale (Vita 3D Master Bleaching Guide) while procedure effectiveness was corroborated with objective change of 5 SGU units and color stability is maintained at 6 months follow‐up. Comments: Teeth were subjected to selective whitening via gels with low HP concentration, initially at 6% and due to good tolerance and an effort to accelerate procedure speed to 15%; without light clinical guideline, changes were measured subjectively from session 1 with good effectiveness, improv- ing color unity. While not obtaining optimal whitening, patient perception was positive, observing favorable changes socially and to her quality of life. There was no record of sensitivity during practice or at immediate and later follow‐ups. Color stability and longevity was measured 6 months later and was evaluated without significant clinical changes ac- cording to the Vita Bleaching Guide scale. This report shows significant whitening obtained in teeth with bilirubin stains following 120 min of low‐concentration application with color stability at 6 months follow‐up. Minimally invasive whitening performed by a dentist represents a safe alternative for resolving severe color alterations in adolescent patients.