A Step By Step Guide To Internal Whitening / Internal Bleaching On A Discoloured, Non-Vital, Anterior Tooth

The discolouration of a non-vital, anterior tooth is often due to the presence of pulpal haemorrhagic products as a result of trauma. Discoloration can also be seen after endodontic intervention due to inappropriate management, poor technique or the placement of inadequate materials.

Please note: The Internal Whitening protocol should only be carried out if the tooth has already undergone root canal treatment and adequate informed consent has been gained by the patient.


Internal Whitening / Internal Bleaching – Full Protocol:

1. Carry out a full patient assessment and take a preoperative periapical radiograph of the discoloured tooth.
2. Confirm preoperative tooth shade by using a shade guide and take clinical photos.
3. Take an impression/digital scan of the arch with the discoloured tooth. This is required in order to construct a special LUMIWHITE Internal Whitening Tray.
4. Isolate the discoloured tooth using rubber dam.
5. Remove Gutta Percha from the coronal portion of the pulp chamber to ~3mm below the cemento-enamel junction. Ultrasonic should also be used to ensure all material has been removed and the cavity is clean.
6. Place RMGIC over the Gutta Percha and ensure a good seal as there is a risk of external root resorption if the whitening gel seeps into the root canal space.
7. Remove the rubber dam.
8. Provide your patient with instructions on how to place LUMIWHITE BY NIGHT 10% or 16% Carbamide Peroxide inside the access cavity and to renew the gel every two hours for four days.
9. Review your patient after four days – evaluate postoperative tooth shade by using a shade guide and take clinical photos. If the desired tooth shade has not been achieved, repeat step 8 and review the patient daily.
10. Once the desired tooth shade has been achieved, isolate the tooth once again with rubber dam. You should then clean the access cavity thoroughly before sealing it with composite.

For severe cases, you can use the inside/outside technique. This involves applying LUMIWHITE BY NIGHT 10% or 16% Carbamide Peroxide onto the internal and external aspects of the discoloured root-filled tooth. The technique is essentially the same as the internal whitening protocol described above except that it also requires placement of LUMIWHITE BY NIGHT 10% or 16% Carbamide Peroxide into palatal and labial reservoirs that have been incorporated into the tray design.

References

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Chauhan C (2018) Non-vital bleaching of a dark tooth in the aesthetic zone. Available at: https://www.dentistry.co.uk/2018/06/26/non-vital-bleaching-dark-tooth-aesthetic-zone/ [Accessed 10 March. 2020]

Dunn JR (1998) Dentist prescribed home bleaching: current status.Compend Contin Educ Dent 9(8):760-764

Marin PD, Bartold PM, Heithersay GS (1997) Tooth discolouration by blood: an in vitro histochemical study.Endod Dent Traumatol 13:132-138

Matis BA, Gaiao U, Blackman D, Schultz FA, Eckert GJ (1999) In vivo degradation of bleaching gelused in whitening teeth.J Am Dent Assoc130:227–235

Poyser NJ, Kelleher MG, Briggs PF (2004) Managing discoloured non-vital teeth: the inside/outside bleaching technique.Dent Update 31(4):204-214

Settembrini L, Gultz J, Kaim J, Scherer W (1997) A technique for bleaching non-vital teeth: inside/outside bleaching.J Am Dent Assoc 128:1283-1284

Spasser HF (1961) A simple bleaching technique using sodium perborate.NY Dent J 27:332-334

Sulieman M (2005) An overview of bleaching techniques: 2. Night guard vital bleaching and non-vital bleaching.Dent Update 32(1):39-46