The use of internal bleaching in a non-vital tooth as a conservative approach

Fig. 1

Female 35 years old

This patient was referred to me, due to the discoloration of the tooth 3.3

Diagnosis was necrotic pulp do to trauma in the past.

Calcification in the middle third of the root.

Fig. 2

Initial clinical situation

Fig. 3

Patient wants to improve the color on tooth 3.3 after the endo-treatment

Fig. 4

Discoloration of tooth 3.3

Fig. 5

A3 color on tooth 4.3

Fig. 6

Dark color on tooth 3.3

Fig. 7

Isolation with the rubber dam and B6 clamp is perform for the endo-treatment

Fig. 8

Correct clamp position to avoid damaging the soft tissue.

Fig. 9

After the endo-treatment, internal bleaching is the next step.

In the literature several options in materials for internal bleaching are reported:

-30% sodium perborate.

-35% hydrogen peroxide.

-5%-10%-16% carbamide peroxide

Fig. 10

After the endodontic treatment, it is very important to block out the gutta-percha and the cervical area with a glass ionomer to avoid any external resorption. 

In this case, 20% perborate was placed for 5 days.

Fig. 11

After 5 days, with only one application, the tooth color improved, becoming A3.

Fig. 12

Before initial treatment

Fig. 13

After

Fig. 14

Final result of the Endo-treatment. 

2 years follow up.

Fig. 15

Final result with 2 years follow up