University of Kirkuk

College of Dentistry
Operative Dentistry
Treatment of Vital and Non-vital Teeth Discolorations

Name:-‫محمد عبدالهادي إسماعيل‬

Stage:-4th
Group-E-
Introduction

Defined as any change in the hue , colour or translucency of the tooth due to
any cause Discoloration of the tooth results from trauma, loss of vitality,
endodontic treatment, and restorative procedures The remnants of the blood
stain consequent to trauma or incomplete removal of pulp during endodontic
treatment lead to hemolysis. 

Classification of tooth discoloration

Intrinsic discoloration

The intrinsic discoloration occurs when the chromogens are deposited within
the bulk of the tooth, which maybe of local or systemic origin.

Extrinsic discoloration

Extrinsic discoloration is defined as discoloration located on the outer surface of

the tooth structure and is caused by topical or extrinsic agents.

Causes

 Diet
 Oral hygiene problems(dental plaque &calculus)
 Medications such as minocycline , iron containing oral solutions ,
stannous fluoride
 Habits such as tobacco smocking
 Occupation and environment such as exposure to iron, silver
 Genetic disorders such as Amelogenesis imperfecta , dentin
dysplasia
 Pulpal causes such as pulpal trauma with hemorrhage , internal
resorption
 Dental material such as amalgam, composite/GIC
 Calcific metamorphosis - it is a condition characterized by rapid
deposition of hard tissue within the root canal. Usually seen in the
anterior teeth following trauma
 Root canal medicaments– certain medicaments cause
discoloration. Some stain the tooth diretly Other stain only on
decomposing or combining with other agents used in endodontic
treatment. Example- essential oils from resinous substance.
 Aging

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Diagnosis

History The patient's history of tooth discoloration provides useful information

regarding the etiology . The history should include the following:

Prevention

Brushing your teeth after every meal will help to prevent some stains. Dentists
recommend that you rinse your mouth with water after having wine, coffee or
other drinks or foods that can stain your teeth. Regular cleanings by a dental
hygienist also will help to prevent surface stains

Treatment

Treatment options can vary depending on the cause of the discoloration. They
include:
• Proper brushing and flossing techniques
• Avoidance of the foods and beverages that cause stains
• Microabrasion
• Bonding
• Veneers
• Vital bleaching, using over-the-counter whitening agents or in-office
whitening procedures
• Non-vital bleaching

Tooth bleaching

Tooth whitening or tooth bleaching is the process of lightning the color of

human teeth. Bleaching is often desirable when teeth become yellowed over
time for a number of reasons, and can be achieved by changing the intrinsic
or extrinsic color of the tooth enamel. The chemical degradation of
the chromogens within or on the tooth is termed as bleaching Hydrogen
peroxide is the active ingredient most commonly used in whitening products
and is delivered as either hydrogen peroxide or carbamide peroxide

Bleaching Types

 Vital bleaching
 Non vital bleaching
 Home bleaching
Vital bleaching.

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Indications :
 Developmental or acquired stains
 Stains in enamel and dentin
 Yellow-brown stains
 Age-yellowed smiles
Contraindications
 should be avoided for teeth with large pulp chambers or those
that have exhibited sensitivity.
 . Patients with erosions, whether chemical, abrasive, or caused
by recession, may experience more bleaching sensitivity through
and after treatment.

Bleaching agents :
either 30%-35% hydrogen peroxide or carbamide peroxide concentrations that
yield high concentrations of hydrogen peroxide) in liquid or gel form

Non vital bleaching

Agents
sodium perborate and 30% to 35% hydrogen peroxide used alone or in
combination.The most commonly used agent has been reported to be
30% hydrogen peroxide
Techniques
 . Walking bleaching .
 . Thermocatalytic technique

Walking Technique
 . Evaluate the high smile line.
 . If the gingival portion of the clinical crown is not visible during
function or maximum smiling, the incisal termination of the
base should be appropriately positioned to further reduce the
chance of external cervical root resorption .
 isolate the tooth with rubber dam
 remove access preparation or any remain pulp tissue from the crown
 . Remove excess gutta-percha and endodontic sealer. Remove

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 gutta-percha to 2 to 2.5 mm gingival to the gingival-most
point on the coronal extension of the planned base .
 . Place a 2- to 2.5-mm thick protective base that conforms to
the predetermined design and location
 Mix a thick paste of sodium perborate and sterile water on
a glass slab and place the mixture into the tooth.
 . Tamp the mixture into place with a moist cotton pellet so
that appropriate space is provided for the temporary restorative
material .
 . Seal the access with temporary restorative material .
 . Schedule the next appointment for the patient for 3 days later.
 . If a successful result is achieved after 3 days , Isolate the tooth
with rubber dam, remove the temporary filling, and carefully wash
the internal tooth chamber with water. Mix a thick paste of calcium
hydroxide powder and sterile water and place the mixture into the
tooth .
 tamp the paste into place with moist cotton pellet
 seal the access with temporary restorative material
 schedule for next appointment for 7-14days later
 After 7 to 14 days, remove the calcium hydroxide paste
 restore the tooth .

Home Bleaching
Patient self-application of bleaching agents performed at home is perhaps the
most popular method of bleaching vital teeth. It is alternately referred to as
“home bleaching” or “matrix bleaching.”
Technique
 The material options for at-home bleaching include bleaching trays
.
 . In most cases a custom-made tray is fabricated by the dental
office or
laboratory and given to the patient .
 . The patient injects the bleaching agent into the tray during the
day,
overnight, or both .
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  . typically requires about 2 to 4 weeks .

Microabrasion
is a procedure in which a microscopic layer of enamel is simultaneously
abraded and eroded with special compound , leaving a perfect enamel surface
behind , it`s used for treatment of dysmineralization cases.

Advantages
 Easily performed
 Fast acting
 It’s conservative treatment

Disadvantages
 It remove the enamel
 Hydrochloric acid compounds are coustic
 Can’t be delegated and must be carried out with dentist
Indications
 White spots
 Some irregular surface textures
 Superficial hypoplastic enamel
 Multicoloured stains (yellow, grey, brown)
Contraindications
 Age related staining
 Tetracycline staining
 Area of deep enamel and dentin stains
 Most Amelogenesis imperfecta
Microabrasion results
enamel appears smooth , lustrous , normally about 200μm of enamel
is removed or less . Remineralisation can occur , enamel appears not
to retain plaque , stains .

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Veneer
A veneer is a thin layer of porcelain made to fit over the front surface of a tooth,
like a false fingernail fits over a nail. Sometimes a natural-colour ‘composite'
material is used instead of porcelain. Veneers can improve the colour, shape and
position of your teeth. A precise shade of porcelain can be chosen to give the
right colour

References
https://www.healthhub.sg/a-z/diseases-and-conditions/88/teeth_discoloration

https://www.slideshare.net/SupritPawar/discoloration

https://www.slideshare.net/AhmedAbbas45/teeth-discoloration-61520135?from_action=save

http://www.medicinaoral.com/odo/volumenes/v3i2/jcedv3i2p180.pdf

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