Aesthetic Management of Nonvital Discolored Teeth with Internal Bleaching

Stephen J. Chu, DMD

Learning Objectives:

Upon reviewing this case study, the reader should:

• Gain an increased visualization of the process of bleaching nonvital discolored teeth
• Understand the aesthetic advantages and see the aesthetic results of nonvital tooth bleaching

Aesthetic considerations have a significant role in defining the direction of treatment in contemporary restorative dentistry. Present trends have established the "preceptual need" for whiter teeth, since whiteness is associated with cleanliness and health. Natural teeth display a variety of shades. Color correction or whitening of vital and, more specifically, nonvital teeth has become an increasing challenge. Among the many options available, internal or intracoronal bleaching provides one of the best methodologies to predictably treat nonvital discolored teeth. The benefits of this include conservation of remaining coronal tooth structures, nonrestorative intervention, maintenance of original occlusal contacts and relationships, color-matching adjacent teeth with natural color and translucency, and color correction of the tooth preparation or "stump" shade prior to restoration.

The purpose of this case study is to delineate the history, diagnosis, rationale, techniques, methods, outcomes, and possible complications utilized in the predictable treatment of nonvital discolored teeth. Emphasis is placed on the diagnosis and etiology of discoloration, which has significant bearing on the predictability of treatment outcomes that can be expected. This is particularly valid when treating stump shades, which require foundation restorations and subsequent full-coverage restorations.

*Clinical Associate Professor and Director, Advanced Program in Aesthetic Dentistry, Department of Periodontology & Implant Dentistry, New York University College of Dentistry, New York, NY; private practice, New York, NY

Related Reading:

1. Pearson HH. Bleaching of the discolored pulpless tooth. J Am Dent Assoc 1958;56:64-68.
2. Spasser BA. A simple bleaching technique using sodium perborate. NY State Dent J 1961;27:332-334.
3. Poe N. A new combination for bleaching teeth. JSCSDA 1963;31:289-291.
4. van der Burgt TP, Mullaney TP, Plasschaert AJ. Tooth discoloration induced by endodontic sealers. Oral Surg Oral Med Oral Pathol 1986;61:84-89.
5. Rotstein I, Walton RE. Bleaching discolored teeth: Internal and external. In: Walton RE, Torabinejab M, eds. Principles and Practice of Endodontics. 3rd ed. Philadelphia, PA: WB Saunders; 2002:405-423.
6. Parsons JR, Walton RE, Rick-Williamson L. In vitro longitudinal assessment of coronal discoloration from endodontic sealers. J Endodont 2001;11:699-702.
7. Abbott PV. Aesthetic considerations in endodontics: Internal bleaching. Pract Periodont Aesthet Dent 1997;9:833-840.
8. Frysh H, Bowles WH, Baker F, et al. Effect of pH on hydrogen peroxide bleaching agents. J Esthet Dent 1995;9:130-133.
9. Rotstein I, Lehr Z, Gedalia I. Effect of bleaching agents on inorganic components of human dentin and cementum. J Endod 1992;18:290-293.
10. Lewinstein I, Hirschfeld Z, Stabholz A, Rotstein I. Effect of hydrogen peroxide and sodium perborate on the microhardness of human enamel and dentin. J Endod 1994;20:61-63.