Internal Bleaching

Question 1

what are the different types of discoloration that are related to endo txt

Answer 1

• pulpal necrosis
• intrapulpal hemorrhage
• calcific metamorphosis
• iatrogenic etiologies
• -obturating materials
• -pulp tissue remnants
• -intracanal medicaments
• -coronal resorations

Question 2

what is intra-pulpal hemorrhage?

Answer 2

• traumatic injury disrupts coronal blood vessels –> hemorrhage
• penetration of dentinal tubules by RBCs–> RBC disintegration byproducts (hemosiderin/Iron sulfides) leads to discoloration (grey-black-brown)
• if pulp survives the discoloration may resolve naturally
• RCT
• internal bleaching

Question 3

what is calcific metamorphosis

Answer 3

• traumatic injury WITHOUT pulpal necrosis –> extensive formation of tertiary (irregular) dentin within the root canal –> yellow or yellow/brown discoloration
• AKA: “pulp canal obliteration”
• common in luxation injuries and horizontal root fractures
• more common in open apex cases
• occurs gradually
• no RCT indicated
• do external bleaching first

Question 4

when is calcific metamorphosis most common?

Answer 4

in luxation injuries and horizontal root fractures

-more common in open apex cases

Question 5

types of iatrogenic discolorations

Answer 5

• obturation materials

- remnants of pulpal tissue

Question 6

discoloration due to obturation materials…

Answer 6

• incomplete removal of GP/sealer from chamber (adjacent to tubules)
• dark discoloration

Question 7

discoloration due to remnants of pulpal tissue

Answer 7

• unaccessed pulp horns (young patients) - tissue degradation byproducts penetrate dentinal tubules
• gradual discoloration

Question 8

what bleaching materials are used for internal bleaching?

Answer 8

• hydrogen peroxide (superoxol)
• sodium perborate
• carbamide peroxide
• -SP?CP are gradually degraded to lower levels of H2O2

Question 9

what bleaching agent is used for internal bleaching at vcu?

Answer 9

hydrogen peroxide and sodium perborate

Question 10

components of hydrogen peroxide (superoxol)

Answer 10

• 30% hydrogen peroxide, powerful oxidizer
• store in refrigerator, caustic will burn tissue
• not used alone for internal bleaching acidic pH can increase risk of external cervical root resoption

Question 11

what is the material of choice for internal bleaching?

Answer 11

-sodium perborate

Question 12

sodium perborate

Answer 12

• material of choice for internal bleaching

- dry powder, addition of water or H2O2 -> active form (H2O2, O2