CASE REPORT
Combined Approach for Tooth Whitening: A Case Report
Chethana S. Murthy,1 Sudhanva M.E,2 Raghavendra Rao,3 Vishwas B.V 4
ABOUT THE AUTHORS
1. Dr. Chethana S.Murthy,
MDS
Designation: Senior Lecturer
Department of Conservative
Dentistry and Endodontics,
V.S Dental College and
Hospital,
Bangalore- 560004
chethanasmurthy@gmail.com
2. Dr. Sudhanva M.E,
MDS
Designation: Senior Lecturer
Department of Conservative
Dentistry and Endodontics,
V.S Dental College and Hospital,
Bangalore- 560004
sudhanva_gowda@hotmail.com
3. Dr. Raghavendra Rao,
MDS
Designation: Professor
Department of Conservative
Dentistry and Endodontics,
V.S Dental College and
Hospital,
Bangalore- 560004
bkrster@gmail.com
4. Dr. Vishwas B.V
Designation: Post Graduate
Department of Conservative
Dentistry and Endodontics,
V.S Dental College and
Hospital,
Bangalore- 560004
drvish611@gmail.com
Corresponding Author:
Dr. Chethana.S.Murthy,
Senior Lecturer, Department of
Conservative Dentistry and
Endodontics,
V.S Dental College and
Hospital,
Bangalore- 560004
chethanasmurthy@gmail.com
69
Abstract
The discolored, non-vital anterior tooth is a common aesthetic concern for many patients.
Discolored non-vital teeth are frequently compromised owing to previous trauma, caries,
endodontic therapy and failed restorations. Destructive invasive treatment options are likely to
weaken the remaining tooth structure. This can reduce the prognosis and challenge the long-
term viability of the tooth, thereby initiating further prosthetic predicaments. This paper
discusses modern approaches to the treatment of discolored teeth. The paper presents a case
on inside/outside bleaching technique.
KEYWORDS: Bleaching, discoloration, in-office bleaching, root filled teeth, inside/outside
bleaching.
Introduction
Tooth color is determined by a combination of phenomena associated with optical
2 3
Properties and light . Essentially, tooth color is determined by the color of dentin and
1
by intrinsic and extrinsic colorations . Intrinsic color is determined by the optical
3
properties of enamel and dentin and their interaction with light . Extrinsic color
4
depends on material absorption on the enamel surface . Any change in enamel,
dentin, or coronal pulp structure can cause a change of the light-transmitting
5
properties of the tooth
Tooth discoloration can be defined as being extrinsic or intrinsic on the basis of
localization and etiology. It varies in etiology, appearance, localization, severity, and
adhesion to tooth structure. When the discoloration of a tooth comes from within the
pulp chamber itself, whether from necrotic pulp tissue or from staining agents that
are placed in the chamber as part of the dental treatment, the bleaching treatment
may also need to take place within the chamber. Some types of stains can be treated
with surface bleaching, but if previous endodontic work has been done, it may afford
6
the opportunity to bleach within the pulp chamber .
CASE REPORT:
A female patient aged 37 years reported to the Department of Conservative Dentistry
And Endodontics, complaining of discolored tooth in the upper left canine, which she
said prevented her from smiling. Patient gave a history of trauma 15 years back and
noticed the discoloration few years back. Intra oral periapical radiograph(Fig.1) was
taken of the tooth in question and pulp vitality test was done, which revealed upper
left canine was non vital. Treatment options like root canal treatment followed by
crown/veneer/bleaching were explained to the patient. Patient opted for root canal
treatment followed by bleaching. Root canal treatment was started immediately with
access opening and working length determined, calcium hydroxide dressing was given
and patient was recalled after a week, after which obturation was done. The bleaching
agent used in this case is a 38% hydrogen peroxide power bleaching gel.
IJCDS • NOVEMBER, 2011 • 2(4) © 2011 Int. Journal of Clinical Dental Science
 Opal dam was placed as a barrier for protection of the
Gingiva from the bleaching agent (Fig.4).

Fig.4 Application of Opal Dam

Fig.1 Pre-operative intraoral radiograph

The bleaching agent was applied extracoronally on the
labial surface of the tooth and intracoronally in the
Coronal debridement was established,the gutta-percha
prepared pulp space (Fig.5)
in the root canal was sealed off from the pulp chamber
with conventional glass ionomer cement. Pre-operative
photograph of the tooth was taken to verify the same.
(Fig.2 & Fig.3)

Fig.2 Coronal seal with GIC

Fig.5 Extracoronal/Intracoronal bleaching

The bleaching agent was applied for 15 minutes and

Fig.3 Pre-operative with the shade tab agitated every 5 minutes to activate the agent. This
was continued for two more cycles. The patient was
recalled after a week (Fig.6)

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IJCDS • NOVEMBER, 2011 • 2(4) © 2011 Int. Journal of Clinical Dental Science
 The bleaching of unsightly non vital discolored
teeth has been documented for over 100 years. The
bleaching agents used for root filled teeth are
hydrogen peroxide, carbamide peroxide, and sodium
perborate. Hydrogen peroxide is the active ingredient
in currently used tooth bleaching materials. It can be
applied directly or can be produced by chemical
reaction from carbamide peroxide or sodium
perborate.
Some investigators have reported that hydrogen
peroxide and urea molecules are small enough to pass
8
freely through enamel and dentin . Inside and outside
technique works quickly because the nascent oxygen
released from the hydrogen peroxide can move freely
inside and outside the tooth to achieve whitening.

Fig.6 Post-operative (1 week) Conclusion

This article presents an alternative to the traditional

walking bleach and thermocatalytic techniques. The
active bleaching material interacts with a non vital
tooth both intracoronally through a syringed bleaching
system and extracoronally by way of in office bleaching
system.

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Discussion
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6
esthetic results .

71 IJCDS • NOVEMBER, 2011 • 2(4) © 2011 Int. Journal of Clinical Dental Science
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.