Internal Bleaching

[dc-10]

If you were going to have this done, would you let a GP do it or would you go to an endo (the tooth already has RCT). Are there many risks or complications associated with internal bleaching?

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[12YearOldKid]

GP has a LOT more experience with esthetics. I would be surprised if you could even find an endo who does any kind of bleaching.

 

[DcS]

GP has a LOT more experience with esthetics. I would be surprised if you could even find an endo who does any kind of bleaching.

That statement is very, very wrong. In fact, internal bleaching was taught to us by the head of our Endo Dept and is done by almost all Endos. With that said, going to a GP would be fine. It's not the most difficult thing and doesn't have much risk besides unpredictable results (they will be hard to predict regardless of who does the procedure.) I would go to a GP because frankly they probably will charge less.

 

[Fullosseousflap]

I have worked with endodontists in both capacities. Some wish to do the bleaching.... others had no desire and deferred.

When you have a good professional working relationship you generally share the responsibility and do what is best for the patient.

 

[DrTacoElf]

What substance would be used for internal bleaching (Carbamide peroxide) beacuse aren't canals usually irrigated with common bleach (NaOCl)?

 

[DcS]

What substance would be used for internal bleaching (Carbamide peroxide) beacuse aren't canals usually irrigated with common bleach (NaOCl)?

Sodium perborate is used, the canal fill is removed 2mm apical to the CEJ, sodium perborate is placed and sealed with IRM. Leave in 5-7 days, repeat as necessary. Usually overbleached because will darken a little. It is also known as "walking bleach".

 

[SPBest]

Sodium perborate is used, the canal fill is removed 2mm apical to the CEJ, sodium perborate is placed and sealed with IRM. Leave in 5-7 days, repeat as necessary. Usually overbleached because will darken a little. It is also known as "walking bleach".

Will this remove the discoloration that gray gutta percha left behind? How effective is it? Are there contraindications?

 

[DcS]

Will this remove the discoloration that gray gutta percha left behind? How effective is it? Are there contraindications?

It should remove the discoloration from gutta percha, yes. Its effectiveness is variable, it is very unpredictable. You have to over bleach because it tends to darken a little bit. Certain stains are easier to get out than others. Staining due to pulpal necrosis responds well to non-vital bleaching, whereas something like tetracycline might not respond as well. Either way, there is a good chance in time for the need for retreatment.

Contraindications:

Inadequate root canal fill
cracks
extensively restored teeth
impatient patients
patients with unrealistic expectations
metallic salt discolorations

 

[JesseBrad3]

if you overbleach too much, is there anyway to counteract that (even after its darkened all it will darken)? May seem like a dumb question, but I wasn't sure if there was an alternative besides bleaching the rest of the teeth to match the brighter shade of one tooth.

 

[DcS]

if you overbleach too much, is there anyway to counteract that (even after its darkened all it will darken)? May seem like a dumb question, but I wasn't sure if there was an alternative besides bleaching the rest of the teeth to match the brighter shade of one tooth.

Not really, so when you do this walking bleach technique (patient comes in every 2 weeks to have more put in until they get the desired results) you have to inform them that if it starts getting too light it's important they come in to have the sodium perborate removed. Of course, with time, if it were overbleached it would darken as all natural teeth do.