3. Causes of Discoloration
Extrinsic Intrinsic
Discoloration Discoloration
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4. Extrinsic Discoloration
Due to deposition of pigments or calculus
Causative factors
Coffee
Tea
Smoking
Doesn’t Need Bleaching – Needs Polishing
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5. Intrinsic Discoloration
Color changes of the internal tissues of the
teeth
• Discoloration after
Local tooth formation
• Discoloration during
Systemic tooth formation
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6. Intrinsic Discoloration
(Local Causes)
Patient related Dentist related
Pulp necrosis Endodontic related
• Remnants of pulp tissues left
• Root canal sealers
Intra-pulpal Hemorrhage • Intral canal medicaments
Calcific metamorphosis Restoration related
• Amalgam
• Pins & posts
Age
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15. Internal Bleaching (Thermocatalytic Bleaching)
• Done after root canal treatment
• Tooth is polished
• Temporary filling is removed
• Cavity is irrigated and dried
• Remove coronal gutta-percha
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16. Internal Bleaching (Thermocatalytic Bleaching)
• Place cement in the chamber
• Flush pulp chamber
• Apply vaseline to protect gum tissues
• Place the rubber dam
• Record the tooth shade
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18. Internal Bleaching (Thermocatalytic Bleaching)
• Place cotton pellet with bleaching agent
• Apply bleaching lamp or heat
• Check shade
• Process is repeated until appropriate
shade is reached
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22. Internal Bleaching (Walking bleaching)
• Same procedure as for thermocatalytic
technique
• Mix sodium perborate with inert liquid or
anesthetic solution
• Place in the cavity and cover with
cement
• Repeat every 1-2 weeks till desired
shade is reached
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23. Adverse Effects of Bleaching
External Resorption
Damage to Restorations
Chemical Burn
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24. Adverse Effects of Bleaching
• Cervical resorption may occur
• 2 Theories:
– Diffusion through dentinal tubules
– Combination of heat with chemical may
cause cementum necrosis with
inflammation of the periodontal ligament
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26. Adverse Effects of Bleaching
External Resorption
Damage to Restorations
Chemical Burn
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27. External vs Internal Bleaching
• Use for vital teeth
• Used on the labial surface of the teeth
• Less effective than internal bleaching
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29. Mouth Guard Bleaching
• Used for mild cases
• Active ingredient is 10%-15%
carbamide peroxide
• Decomposes in hydrogen peroxide
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30. Mouth Guard Bleaching
• 1st visit
– Polish the teeth
– Alginate impressions are taken
– A stone cast is poured
– Die relief is done
– Fabrication of the plastic mouthgaurd
(Vaccum formed)
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31. Mouth Guard Bleaching
• 2nd visit
– Take shade
– Fill mouth guard with bleaching gel
– Train the patient to use the system
– Used for 3-4 hours a day
– Explain possible side effects
– Treatment time up to a few weeks
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32. Different Bleaching Agents
Natural White
Karisma
Opalescence
White Brite
White & Brite Nite White
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34. Chair Side Bleaching
• Photo activated or Laser activated
• Higher concentrations of peroxides
• Used for short periods of time
• Activated with light
• Zoom bleaching
• Side effects
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