BCHD IV Non Vital Bleaching

ODO470
Endodontics
Non-vital bleaching
BChD IV
Dr. Glynn D Buchanan

BChD(Pret), PDD Endo(UWC), MSc(Dent)
Non-vital bleaching
Today, we will talk a bit about non-vital bleaching in endodontic treatment
This topic is covered in dental materials, this lecture is a re-cap/revision pertinent to endodontics
Endodontics: Principles and practice 6th ed. Chapter 17 (Bleaching discoloured nonvital teeth):
368-382
Non-vital bleaching
Why consider non-vital bleaching?
 As an alternative to the fabrication of full crowns, composite

resin or ceramic veneers as an esthetic treatment.
 Non-vital bleaching can only be done on teeth that had
proper and successful root canal treatment done.
 It is very important to obtain informed consent from the
patient, with emphasis on the associated risk/complications
of non-vital bleaching Image: Dr GD Buchanan
Non-vital bleaching
What causes tooth discolouration?
 Intrinsic or extrinsic causes. In endodontics, mostly local intrinsic

causes responsible.
 Traumatically induced internal bleeding of the pulp, leads to diffusion of
blood products into the dentinal tubules.
 Breakdown products of proteins from a necrotic pulp. When pulp tissue
remnants remain within the pulp chamber, usually in the region of the
pulp horns.
 Root canal filling materials (e.g. Sealers, MTA, Endomethasone),
medicaments (e.g. Ledermix) and restorative materials (e.g. Amalgam). Image: Dr GD Buchanan
Non-vital bleaching
Aim
 Restore colour consistency of the bleached tooth

with that of the neighbouring teeth.
 Relapse is however possible
Image: Dr GD Buchanan
Non-vital bleaching
Where do we start?
 Clinical and radiographic examination of the tooth. Check the

following:
 Restorability
 Periodontal status/involvement
 Peri-apical pathology
 Quality of the root canal treatment
 History of trauma (advise increased resorption risk) Image: Dr GD Buchanan
Non-vital bleaching
Contraindications for bleaching

 Vital teeth
 Root canal treated teeth with severely damaged clinical crowns
or multiple large restorations (rather do a crown in these
cases).
 Root canal teeth with inadequately obturated root canal
systems.
 Root resorption
 Previous attempts at bleaching that were unsuccessful.
Non-vital bleaching
Complications
 External resorption, which can occur 1-12 years after treatment. It is

important to monitor treated teeth closely. The gutta-percha obturating
material must be sealed properly at the cement-enamel junction (CEJ) to
prevent the bleaching agent from reaching the external root surface via the
dentinal tubules.
 The bleaching agents can burn the patient’s lips and gingiva. Always work
with rubberdam!
 Recurrence of discoloration with time.
 Internally bleached teeth could be predisposed to fracture. Image: Dr GD Buchanan
Non-vital bleaching
Materials
 Today, preparations containing hydrogen peroxide are the most commonly used bleaching
agent.
 This is because these materials release various free radicals and reactive oxygen molecules
which are responsible for oxidation and therefore removal of chromogenic stains
Non-vital bleaching
Materials
 Mixture of Sodium perborate with 30-35% Hydrogen peroxide.

 30% Hydrogen peroxide.
 35% Opalescence Endo. 35% Hydrogen peroxide whitening gel used in the “walking bleach”
technique or in-office bleach technique.
 38% Opalescence Xtra Boost. 38% hydrogen peroxide power bleaching gel. Used for in-office
non-vital bleaching.
 10% Opalescence Carbamide gels. Used for modified walking bleach technique.
 35% Carbamide peroxide gels.
Non-vital bleaching
Techniques
 Thermo-catalytic technique.
 In-office bleach technique.
 Walking bleach technique.
 Modified walking bleach technique.
Non-vital bleaching
Thermo-Catalytic technique
 30% Hydrogen peroxide is place in pulp chamber after gutta-percha has been sealed with
RMGI (e.g. Vitrebond).
 The bleach is activated by a heated instrument.
 Repeat 2-3 times or leave for 30 minutes.
 Increased risk of external root resorption.
 Not considered to be a safe technique anymore – for historical perspective only
Non-vital bleaching
In-office bleach technique
 One visit.
 35% Opalescence Endo or 38% Opalescence Xtra Boost is used.
 Cover palatal and labial aspects of the tooth, as well as pulp chamber with the bleaching
agent. (outside and inside the tooth)
 Agitate (mix) with instrument every 5 minutes.
 Refresh solution every 15 minutes.
 Rinse with sodium hypochlorite and water.
 Seal with composite.
Non-vital bleaching
Walking bleach technique steps
1. Open access cavity.

2. Place rubberdam.
3. Refine access cavity preparation to include entire pulp chamber.
4. Remove 1-1,5mm existing gutta-percha.
5. Ensure removal of filling materials from walls with caries bur.
6. Place +/- 1,5mm of Vitrebond over the GP at the cement-enamel
junction (CEJ).
Non-vital bleaching
Walking bleach technique
7. Etch 37% phosphoric acid remove smear layer & increase

internal diffusion of oxygen.
8. Place bleaching material.
9. Cover with cotton pellet.
10. Seal with Glass Ionomer (Ketac Molar) or Polycarboxylate
(Poly F) cement.
Non-vital bleaching
Walking bleach technique
 Sodium perborate and Hydrogen peroxide is used, it is left in the tooth for 7 days and the treatment
can be repeated 3 times.
 Opalescence Endo - left in the tooth for 3-5 days.
 Delay final restoration placement to avoid reduction in bond strength because of residual hydrogen
peroxide, the changed enamel surface chemistry and residual oxygen. Rather place a temporary
restoration.
 Schedule a follow-up appointment to remove the temporary restoration and replace with composite.
Non-vital bleaching
Modified walking bleach technique:
 Initial preparation as for walking bleach technique.

 Leave access cavity open. (GP still sealed off with RMGI!)
 Supply patient with custom tray and 10% Carbamide peroxide gel.
 The patient fills the pulp chamber with the gel themselves.
 Change the bleach every 2 hours. A 10-ml syringe is used to flush the pulp
chamber with warm water prior to replenishment of the carbamide peroxide gel.
 Progress in bleaching must be reported by the patient on a daily basis,
maximum of 3 days.
Non-vital bleaching
 Recurrence rate
 Bleaching does work well, but not in every patient

 Recurrence relatively low.
 Tooth will darken if exposed to chromogens.
 The tooth should not revert to the initial shade if the permanent
restoration remains sealed and intact.
 In general, if done properly, the recurrence is 10% in 2 years, 25%
in 5 years and 49% in 8 years Image: Dr GD Buchanan
Thank You

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ODO470

Dr. Glynn D Buchanan

Today, we will talk a bit about non-vital bleaching in endodontic treatment

Why consider non-vital bleaching?

 As an alternative to the fabrication of full crowns, composite

What causes tooth discolouration?

 Intrinsic or extrinsic causes. In endodontics, mostly local intrinsic

 Restore colour consistency of the bleached tooth

 Clinical and radiographic examination of the tooth. Check the

Contraindications for bleaching

 External resorption, which can occur 1-12 years after treatment. It is

 Mixture of Sodium perborate with 30-35% Hydrogen peroxide.

In-office bleach technique

Walking bleach technique steps

1. Open access cavity.

Walking bleach technique

7. Etch 37% phosphoric acid remove smear layer & increase

Walking bleach technique

 Opalescence Endo - left in the tooth for 3-5 days.

Modified walking bleach technique:

 Initial preparation as for walking bleach technique.

 Bleaching does work well, but not in every patient

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