Published on March 9, 2014
Bleaching of Nonvital Teeth DR. HAKAN ÇOLAK DDS, PHD ISHIK UNIVERSITY SCHOOL OF DENTISTRY DEPARTMENT OF RESTORATIVE DENTISTRY
Thermocatalytic Technique of Bleaching for Nonvital Teeth Isolate the tooth to be bleached using rubber dam Place bleaching agent (superoxol and sodium perborate separately or in combination) in the tooth chamber Heat the bleaching solution using bleaching stick/light curing unit Repeat the procedure till the desired tooth color is achieved Wash the tooth with water and seal the chamber using dry cotton and temporary restorations Recall the patient after 1 to 3 weeks Do the permanent restoration of tooth using composite resins afterwards. suitable
Intracoronal Bleaching/Walking Bleach of Nonvital Teeth It involves use of chemical agents within the coronal portion of an endodontically treated tooth to remove tooth discoloration. Indications of Intracoronal Bleaching Discolorationsof pulp chamber origin Moderate to severe tetracycline staining Dentin discoloration Discolorations not agreeable to extracoronal bleaching.
Intracoronal Bleaching/Walking Bleach of Nonvital Teeth Contraindications of Intracoronal Bleaching Superficial enamel discoloration Defective enamel formation Presence ofcaries Unpredictable prognosis of tooth.
Intracoronal Bleaching/Walking Bleach of Nonvital Teeth Steps Take the radiographs to assess the quality of obturation. If found unsatisfactory, retreatment should be done Isolate the tooth with rubber dam Prepare the access cavity, remove the coronal gutta percha, expose the dentin and refine the cavity Place mechanical barriers of 2 mm thick, preferably of glass ionomer cement, zinc phosphate, IRM, polycarboxylate cement on root canal filling material The coronal height of barrier should protect the dentinal tubules and conform to the external epithelial attachment
Intracoronal Bleaching/Walking Bleach of Nonvital Teeth Steps (Con’t) Now mix sodium perborate with an inert liquid (local anaesthetic, saline or water) and place this paste into pulp chamber After removing the excess bleaching paste, place a temporary restoration over it Recall the patient after 1 to 2 weeks, repeat the treatment until desired shade is achieved Restore access cavity with composite after 2 weeks.
Walking bleach, A, Internal staining of dentin caused by remnants of obturating materials (OM) in the chamber as well as by materials and tissue debris in pulp horns (PH). B, Coronal restoration is removed completely. C, A protective cement base (B) is placed over the guttapecha. A paste (P) of sodium perborate and hydrogen peroxide is placed. D, A thick mix of temporay cement (Z) seals access. E, At a subsequent appointment when the desired shade reached, a permanent cement is placed (TS) at the pulp chamber and composite resin (C) to seal of the access
Complications of Intracoronal Bleaching External root resorption Chemical burns if using 30 to 35 percent H2 O2 Decrease bond strength of composite.
Laser Assisted Bleaching Technique This technique achieves power bleaching process with the help of efficient energy source with minimum side effects. Laser whitening gel contains thermally absorbed crystals, fumed silica and 35 percent H2O2 In this, gel is applied and is activated by light source which further activates the crystals present in gel, allowing dissociation of oxygen and therefore better penetration into enamel matrix. Following laser have been approved by FDA for tooth bleaching: Argon laser CO2 laser
EFFECTS OF BLEACHING AGENTS ON TOOTH AND ITS SUPPORTING STRUCTURES
Tooth Hypersensitivity Common side effect of external tooth bleaching. Higher incidences of tooth sensitivity (67% - 78%) are seen after in office bleaching with hydrogen peroxide in combination with heat. The mechanism responsible for external tooth bleaching though is not fully established, but it has been shown that peroxide penetrated enamel, dentin and pulp. This penetration was more in restored teeth than that of intact teeth.
Effects on Enamel Studies have shown that 10 percent carbamide peroxide significantly decreased enamel hardness. But application of fluoride showed improved remineralization after bleaching
Effects on Pulp Penetration of bleaching agent into pulp through enamel and dentin occur resulting in tooth sensitivity. Studies have shown that 3 can cause: percent solution of H2O2 Transientreduction in pulpal blood flow Occlusion of pulpal blood vessels.
Effects on Restorative Materials Increased surface hardness Surface roughening and etching Decrease in tensile strength Increased microleakage No significant color change of composite material itself other than the removal of extrinsic stains around existing restoration
Toxicity The acute effects of hydrogen peroxide ingestion are dependent on the amount and the concentration of hydrogen peroxide solution ingested. The effects are more severe, when higher concentrations are used. Signs and symptoms usually seen are ulceration of the buccal mucosa, esophagus and stomach, nausea, vomiting, abdominal distention and sore throat. It is therefore important to keep syringes with bleaching agents out of reach of children to prevent any possible accident.
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