[Bleaching of anterior pulpless teeth].
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Intracoronal bleaching has emerged as a popular technique to bleach discoloured, endodontically treated anterior teeth. Although hydrogen peroxide and sodium perborate have traditionally been used in intracoronal bleaching, some concern has been expressed regarding the use of hydrogen peroxide, mainly because of the suspected "cause and effect" relationship between hydrogen peroxide and invasive cervical root resorption. Other complications associated with use of hydrogen peroxide alone or in combination with sodium perborate include increased dentine permeability, alteration in the chemical structure of dentine, and general weakening of physical properties of dental hard tissues. This has prompted researchers to look for alternative bleaching agents as effective as the traditional bleaching agents but unassociated with such complications. Some of these alternatives have been shown to be as effective as sodium perborate in lightening tooth colour under in vitro conditions and may represent a useful alternative to the traditional materials that are currently in use.
This report suggests a treatment alternative for replacing a maxillary lateral incisor, and identifies the complication of cervical resorption after bleaching.
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Current dental diagnostic methods can detect caries but cannot quantify the mineral status of a lesion. Quantitative light-induced fluorescence (QLF) measures the percentage of fluorescence change of demineralized enamel with respect to surrounding sound enamel, and relates it directly to the amount of mineral lost during demineralization. Development of caries-like lesions and subsequent remineralization of the lesions were monitored by QLF. The results showed that the percentage of fluorescence change (Delta Q) increased linearly with the demineralization time and decreased with increased remineralization time. Stained teeth were whitened with a bleaching agent and the change in stain intensity (Delta E) was quantified using QLF. The results showed that Delta E decreased linearly as the tooth regained its natural color. Factors that might affect the use of QLF to detect and quantify caries were also examined. It was concluded that QLF could be used to detect and longitudinally monitor the progression or remineralization of incipient caries, however lesion detection may be limited by the presence of saliva or plaque and enhanced by staining. The change in shade of discolored teeth by whitening agents could be quantitatively measured by QLF.
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Internal bleaching can be a simple, economic and effective method for improving the appearance of discoloured non-vital teeth. The authors give a step-by-step guide to the 'walking bleach' technique, and describe how to avoid the most common potential complications of bleaching.
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