Fig. 1

Clinically the patient chief complain suffering from grayish discoloration of the upper right central incisor with no signs and symptoms of any pain and tenderness, Vitality test was done to the tooth with ethyl chloride and the result showed negative response (the tooth is non vital).

Fig. 2

Pre-op X-Ray showed upper right central incisor with normal periapical status

The patient’s dental history revealed a previous traumatic incident involving the affected tooth approximately seven years earlier, which likely contributed to the subsequent discoloration. 

Fig. 3

Rubber dam isolation.

Access opening from the palatal surface 

Removing of the necrotic tissue and dentin even from  the pulp horn 

copious amount of NaOCl 5.25% to decrease the amount of bacterial load from the pulp chamber to reduce the possibility of flare up

Fig. 4

Clean cavity

Straight line access to the canal chemomechanical shaping and cleaning

  • Rotary file 17/04
  • Rotary file 25//04
  • Rotary file 30/04
  • Rotary file 35/04

with copious amount of NaOCl 5.25% with ultrasonic activation for 1 minutes, then EDTA to remove the smear layer and followed again with NaOCl to disinfect again.

Fig. 5

Apical gauge to the master apical cone confirmed. 

Fig. 6

Obturation of the canals by single cone with bioceramic sealer and down back of the cones with obturation pen.

Fig. 7

Final obturation and the gutta-percha condensed 1mm below the orifice. 

Fig. 8

Resin modified glass ionomer was applied above the gutta-percha to provide sealing to prevent the leakage of the internal bleaching material thus avoiding the possibility of external cervical resorption of the tooth.

Fig. 9

Internal bleaching (35% hydrogen peroxide) gel was introduced into the pulp chamber cavity for 5 days and the cavity sealed with glass ionomer filling material

After 5 days the bleaching material was washed with normal saline and the cavity sealed again with glass ionomer for two weeks to prevent any effect from the residual bleaching material on the bonding of the final composite restoration.

Fig. 10

Post-op X-Ray with final restoration.

Fig. 11

Follow up after one month showing excellent transformation from gray to natural shade.

Fig. 12

Before and after treatment.

Conclusions

Regardless of the technique used, internal bleaching is a conservative, simple, effective, and low-cost procedure, with good esthetic results, in the treatment of non-vital tooth discolorations. The cervical barrier is a standard of care in internal bleaching techniques and should be used.

Bibliography

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