TOOTH DISCOLORATION

(Causes)
INTERNAL BLEACHING
(indications & procedures)
 Types of Stains / Discolorations

Extrinsic Stains:

- Poor oral hygiene

- Ingestion of chromatogenic foods and
drinks
- Tobacco use
INTRINSIC STAINS:

- Aging
- Ingestion of chromatogenic foods and drinks
- Tobacco use
- Microcracks in the enamel
- Tetracycline medication
- Excessive fluoride ingestion
- Severe jaundice in infancy
- Porphyria
- Dental caries
- Restorations
- Thinning of the enamel
BLEACHING:

The lightening of the color of tooth through

the application of a chemical agent to oxidize
the organic pigmentation in the tooth.
 INDICATIONS

Dissatisfaction with tooth color;

- light enamel discoloration
- mild tetracycline discoloration
- endemic fluorosis discoloration
- Age related discoloration

- Extending the esthetic life of the existing crowns

- Whitening a single dark tooth to the desired shade

 CONTRAINDICATIONS

• Hypersensitive teeth
• Severe enamel loss
• Teeth with extremely large pulps
• Teeth exhibiting gross or microscopic
enamel cracking
• Teeth with composite restorations
PROCEDURES:

 Based upon the tooth involved

- Vital
- Non- vital

 Basedupon where the procedure is

performed
In-office
At-home bleaching
 Based on techniques;

Internal External
bleaching bleaching

Thermocatalytic Mouth Guard

technique Bleaching

Chairside
Walking Bleach
Bleaching
Bleaching Agents:

Hydrogen
Peroxide 35% • Nascent Oxygen
(Superoxol)

• Sodium metaborate
Sodium • Hydrogen peroxide
Perborate • Nascent oxygen

• Urea
Carbamide • Carbon dioxide
peroxide 10% • Hydrogen peroxide
Mode of Action:

 Interfereswith the bonding process

 Very high oxygen concentration in the enamel and
dentin which hinders the polymerization of the
resin composite.

 A delay of 7-10 days

 1-2 weeks required for the shade of the bleached
teeth to stabilize
MODE OF ACTION

 Hydrogen Peroxide:
- low molecular weight
- Free radicals attack organic molecules to
achieve stability  releases other radicals
- Carbon double bonds [yellow] converted to
hydroxyl groups[colorless]

PLATEAU
 Carbamide Peroxide:

Urea Hydrogen Peroxide

Factors affecting both the In-Office
and At-Home Bleaching Processes:

 Surface Cleanliness

 Concentration of Peroxide

 Temperature [In-office bleaching]

 pH
 Time

 Sealed environment

 Additives
Internal Bleaching Procedure:

 The surface of the tooth should be cleaned thoroughly

to determine the degree of external discoloration.

 Radiograph should be made to check the quality of the

root filling.

 An inadequate root filling should be replaced before

bleaching, and the new filling material should be
allowed to set for at least 7 days after obturation
before starting the bleaching procedures
WALKING BLEACH TECHNIQUE

 Preparation of the pulp cavity

 Cervical Seal
 Application of the bleaching agent
 Temporary filling
 Restoration of the access cavity and
post-operative radiograph
Young patient after anterior tooth trauma and endodontic treatment
of tooth 11 - five years ago
The root filling material is shortened
2–3 mm subgingivally. The depth of
the access cavity is checked with a
periodontal probe.
 Where treatment is Basic procedure Time taken to
completed complete treatment

Walking bleach The procedure is - The bleaching - Depending on each

technique completed agent is placed in clinician, the time
exclusively in the the tooth. required is minimal.
surgery. - A temporary filling - Approximately 30-
is placed into the 40 mins is required
tooth, which allows per treatment.
the bleach to be
sealed.
- Regular
appointments are
arranged to assess
success, and to re-
apply bleach.
THERMOCATALYTIC TECHNIQUE

 Placement of 30% – 35% hydrogen peroxide in the pulp

chamber followed by heat application by electric heating
devices or specially designed lamps.
 Heat application is repeated 3 or 4 times at every
appointment, changing the pellet with “fresh”
bleaching agent at each visit.
 When heat is applied, a reaction produces foam and
releases the oxygen present in the preparation.
 At the end of each appointment the bleaching agent
is sealed into the pulp chamber for additional
bleaching between appointments as in the walking
bleach technique.
10% CP
 Where treatment Basic procedure Time taken to
is completed complete
treatment
Thermo-catalytic The procedure is -The bleaching - Depending on
technique completed agent is placed in each clinician the
exclusively in the the tooth. time required is
surgery. - A temporary minimal.
filling is placed - Approximately
into the tooth, 30-40 mins is
which allows the required per
bleach to be treatment.
sealed. Heat is
then applied to
the tooth.
- Regular
appointments are
arranged to assess
success, and to re-
apply bleach.
Advantages:

 Better Esthetics
 Antibacterial potential of carbamide peroxidase
 Lower risk of damage to gingival tissues
 Ability to do vital and non vital bleaching
simultaneously via inside out technique.
DISADVANTAGES:

 Possibilityof crown fracture

 Re-discoloration
 Over bleaching
 External root resorption  tooth loss

 High concentration of hydrogen peroxide

 High heat
 Lack of a seal over the gutta percha
 Injury to the periodontal ligament
 Deficiency in the cementum exposing the cervical dentin
Inside-Outside bleaching

 10% Carbamide Peroxide placed inside

the chamber and at the same time apply
it externally with the tray.
Non vital bleaching:

 Non vital bleaching is mainly applied by dentist

 Requires from 2 days upto 2-4 weeks of treatment
 Applied mainly inside the pulp chamber
 Endodontically treated tooth is prevented by GI or RMGI
to prevent leakage.
VITAL BLEACHING

 This technique involves the external application of

hydrogen peroxide to the surface of tooth followed by
its activation with a heat source.

 INDICATIONS:

¨ Very mild tetracycline staining without obvious banding.

¨ Mild fluorosis
¨ Yellowing due to ageing
¨ Single teeth with sclerosed pulp chamber and canals.
In-Office Technique

 35% Hydrogen Peroxide

 Application of light/ heat
 Soft tissues must be well protected
 Cost
 1 to 2 weeks to allow rehydration of the
teeth to the stable shade
VITAL BLEACHING – custom
trays
 This technique involves the daily placement
of carbamide peroxide gel into a custom
fitted tray of either the upper or lower arch.

 INDICATIONS:

1. Mild fluorosis

2. Yellowing due to ageing.

 10% Carbamide Peroxide
 Safe
 Active upto 10 hours – 50% agent used
in the first
2 hours
 Less expensive
ADVANTAGES DISADVANTAGES

• Comfort and personal • Not recommended for

satisfaction children
• Reduces plaque
• Peroxide allergy
dentobacterial
• Reducing the yellow color of • Sensitive teeth, decayed
teeth between 5 and 14 teeth
shades
• The clinical whitening lasts
• Dental trauma
only 1 hour
• procedure is not painful or • Duration time
invasive
THANKYOU
!