Instructions for Bleaching of Non-vital Teeth.

1. Confirm that the root canal treatment is correctly done and that there is no periradicular disease. If necessary, retreat the canal. 2. Isolate the tooth, preferably with rubber dam. 3. Remove GP for 4-5 mm below alveolar crest. 4. Fill this root canal space with polycarboxylate cement eg Durelon. 5. Remove and replace any existing decay, leaking or discoloured restorations. 6. Remove excess cement and cut deep, well defined undercuts underneath the entire circumference of the access cavity. This is extremely important. The procedure is totally dependant upon the seal and retention of the temporary restoration. 7. Using a cotton wool pledget and chloroform clean the access cavity. The chloroform removes debris and fatty deposits. 8. Mix 20-30% hydrogen peroxide with sodium perborate into a creamy mixture. Use fresh hydrogen peroxide, preferably a brand new bottle. 9. Introduce the mixture into the access cavity with a flat plastic instrument. 10. At this stage, the chairside assistant should start mixing the renforced zinc oxide eugenol (IRM) temporary restoration. Simultaneously, the dentist removes all of the bleaching material (peroxide/ sodium perborate) from the undercuts, using a spoon excavator. This is the difficult part, because the mixture is runny, but it has to be done correctly. If the mixture is present inside a section of the undercut it will cause the temporary restoration to leak and there will be no bleaching. 11. Place the IRM into the access cavity,ensuring that it goes into the prepared, clean, dry undercuts. Use the fingers to maintain pressure until the IRM has set completely. Do not neglect this step. 12. Remove excess IRM. Check occlusion. 13. Dismiss patient. Recall at two weeks. Repeat procedure every two weeks until desired shade is achieved. Bleach a shade too white to allow for relapse. 14. Restore access cavity with resin composite.

CASE REPORT A patient reported with a main complaint of unsightly front teeth(Figure 1). Examination confirmed the discoloured teeth (11,21 and 22) with leaking restorations (Figure 2).

Radiographic examination showed peri-apical radiolucencies and inadequate root canal treatment. The patient insisted that she did not want to have her teeth crowned, under any circumstances. The root canals were re-treated, (Figure 3) non-vital bleaching carried out and the teeth restored with resin composite. The final result is shown in Figure 4. In certain respects (cost, periodontal, conservation of tooth structure) this represents a better treatment than prosthetic crowns. Koos Marais

Fig.1

Fig.4

Fig.2

Fig. 3