Bleaching Of non vital teeth Methods case presentations lazer techniques Side effects

1. Shahzad Hussain
Final year BDS
Nishtar Institute of Dentisty Multan

2.  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 suitable
composite resins afterwards

3.  It involves use of chemical agents within
the coronal portion of an endodontically
treated tooth to remove tooth discoloration.
 Indications of Intracoronal Bleaching
• Discolorations of pulp chamber origin
• Moderate to severe tetracycline staining
• Dentin discoloration
• Discolorations not agreeable to extracoronal
bleaching.

4. Contraindications:
• Superficial enamel discoloration
• Defective enamel formation
• Presence of caries
• Unpredictable prognosis of tooth.

7. 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 gutta-pecha. 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

13. External root resorption
• Chemical burns if using 30 to 35
percent H2 O2
Decrease bond strength of
composite.

14.  This technique achieves power bleaching process with
the help of efficient energy source with minimum side
effects.
 Laser whitening gel contains thermally absorbed
crystals, fumes silica and 35 percent hydrogen
peroxide.
 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

15. Tooth hypersensitivity
Effects on Enamel
Effects on pulp
Effects on restorative materials
Toxicity

16.  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.

17. Studies have shown that 10 percent
carbamide peroxide significantly
decreased enamel hardness. But
application of fluoride showed improved
remineralization after bleaching

18.  Penetration of bleaching agent into pulp through
enamel and dentin occur resulting in tooth
sensitivity.
 Studies have shown that 3 percent solution of
H2O2 can cause:
• Transient reduction in pulpal blood flow
• Occlusion of pulpal blood vessels.

19. 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.

20.  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.