INTRA CORONAL LIGHTENING OF DISCOLORED PULPLESS TEETH: A MODIFIED WALKING BLEACH TECHNIQUE

Introduction: Discolored anterior teeth is of serious esthetic concern to the patient. Various treatment options are available for discolored anterior teeth which includes bleaching, composite laminates, porcelain laminates etc. Although bleaching of teeth has a long history it was disregarded for some time due to certain disadvantages. But bleaching is back again as one of the treatment modalities for anterior discoloration. Various bleaching techniques exists for vital and non vital teeth. or non vital teeth walking bleach technique was previously used. !his however has certain disadvantages such as long duration of treatment and cervical resorption. !o overcome these disadvantages modified walking bleach technique was developed. !his technique employs "#$ carbamide peroxide. %odified walking bleach technique minimi&es the risks, because treatment time is reduced to days rather than weeks as required in the original walking bleach technique. 'ere is a case presentation of the modified walking bleach technique.

C !" !"#"ction: A discolored anterior tooth that has been endodontically treated is selected. !he tooth should be asymptomatic. (ercussion and radiographic examination should indicate a successful endodontic treatment without any periapical or periodontal lesions. M t"ri #! nd M"t$od: !his includes )upro gold tooth whitening gel which is specially formulated with the active ingredient of "#$ carbamide peroxide a proven and extremely effective tooth whitener. !he gel has a high viscosity and exceptional adhesive properties to extend contact time with the patients enamel surface. Dycal *lass ionomer cement +lear custom made splint to retain and seal the intra coronal medicament. !his photograph shows the discolored central incisor prior to bleaching. "#$ carbamide peroxide breaks down to ,.-$ hydrogen peroxide therefore the intra coronal technique is a little harmful due to the potential risk of cervical root resorption. !hus obtaining an adequate

cervical seal that will prevent hydrogen peroxide from penetrating the root at the cements enamel function is important. !he coronal restoration is removal carefully. !he coronal gutta.percha is then removed using gates glidden drill. Approximately ,mm of root canal gutta.percha are removed apical to the cements enamel function. !he ob/ective of removing root canal gutta.percha is to create space for the restorative cervical seal and to expose dentinal tubules directed toward the cervical region of the tooth. A calcium hydroxide plug approximately "mm in thickness is applied to the freshly exposed gutta.percha. !his prophylactic step aims to maintain an alkaline medium because cervical resorption has been associated with a drop in p' at the cervical level. !he remaining 0mm depth of the cervical root canal access is sealed with glass ionomer cement. !his is crucial as to seal the root canal from bacterial ingress during bleaching and to prevent contamination of the gutta.percha fillings. An impression is made of the patients arch and a cast is prepared. A soft splint is fabricated on the working cast and trimmed to the dimensions of a custom sports mouth guard. !he patient is given a tube of neutral p', "#$ carbamide peroxide and instructed to fill the pulp chamber every 0 hours until the desired tooth lightening is reached. A syringe is used to flush the pulp

chamber with warm water each time prior to placement of the carbamide peroxide gel. !he splint is used to retain the bleaching agent and to prevent ingress of debris into the access cavity. (atients are encouraged to limit applications to daylight hours when reliable assessment of color can be made. !his photograph shows the whitened central incisor after bleaching using the modified walking bleach technique. 1n achieving the desired tooth lightening the access cavity is restored with the tooth colored resin composite. R"!u#t: !wo cases were selected for this study. !he result obtained was good following the application of "#$ carbamide peroxide containing bleaching agent. !he technique developed by 2illiam '. 3iebenberg focuses on obtaining an adequate cervical seal. !he resorptive potential of hydrogen peroxide has highlighted the importance of preventing hydrogen peroxide from penetrating the root through the attachment apparatus. Conc#u!ion: Advantages: Are as follows

 +oncentration of the bleaching agent used is low 'eat is not required for this technique. !he bleaching agent used is safe for both the patient and dental staff. Duration of treatment is short compared to traditional walking bleach technique. Disadvantage: !he only disadvantage of this technique is patient compliance as it requires the patient to fill the pulp chamber with the bleaching agent every 0 hours.