Internal bleaching


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Presentation about Internal, or non-vital bleaching, will updated more in the future hopefully.
This presentation aims to introduce basic principles, agents, and other details of internal bleaching, as it is one of the ways to achieve the conservative approach in modern dental care.

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Internal bleaching

  1. 1. Internal Bleaching Presented to you By Hossam Faisal
  2. 2. Definition and Historical Review
  3. 3. “The lightening of the color of a tooth through the application of a chemical agent to oxidize the organic pigmentation in the tooth is referred to as Bleaching”
  4. 4. Causes of intrinsic local stains, indicating non-vital bleaching
  5. 5. Pulp Necrosis
  6. 6. Intrapulpal haemorrhage
  7. 7. Endodontic materials
  8. 8. Coronal Filling Materials
  9. 9. Root resorption
  10. 10. Contraindications
  11. 11. Superficial enamel discoloration
  12. 12. Defective Enamel Formation
  13. 13. Severe Dentin Loss
  14. 14. Presence of Caries
  15. 15. Discolored Composites
  16. 16. Differences Between Vital and Non-Vital Bleaching
  17. 17. Vital bleaching could either be applied by the dentist, or by the patient at home using the home bleaching techniques, while non-vital bleaching is mainly applied by the dentist.
  18. 18. In-office bleaching could yield satisfactory results from just a single visit, while modern and recommended(described later) nonvital bleaching requires at least 2 days of treatment, which could also last up two four weeks.
  19. 19. Vital bleaching are applied on the external tooth structure only, while nonvital bleach is applied mainly inside the pulp chamber.
  20. 20. In vital bleaching, protection of the gingival tissues is of main importance, while in non-vital bleaching, the endodontically treated root canal must be protected using GI or RMGI to prevent leakage of the bleaching material.
  21. 21. There is also a notable price difference between vital and non-vital bleach, with the latter being cheaper.
  22. 22. Techniques for Non-Vital Bleaching
  23. 23. Walking Bleach Technique Most common technique  Sealing of the endodontically treated root canal with RMGI or GI  Placement of the bleaching material in the pulp chamber  Access cavity sealed with temporary restoration and recall after 2-7 days 
  24. 24. Walking Bleach Technique  The process should not be repeated four more than four weeks, to avoid weakening of the crown and potential spontaneous fracture
  25. 25. Agents used for Walking Bleach Technique
  26. 26. 1-Sodium Perborate
  27. 27. 1-Sodium Perborate Available as powder that is stable when dry  It is an oxidizing agent  It is mixed with water, or with hydrogen peroxide (330%)  Breaks down to sodium metaborate, hydrogen peroxide and nascent oxygen  Easier to control and safer than H2O2 
  28. 28. 2-Carbamide Peroxide 37%
  29. 29. 2-Carbamide Peroxide     Breaks up to H2O2 and Urea Urea elevates the pH, increasing the effect of and stabilizing the H2O2 Currently contains glycerin to make it more chemically stable than H2O2 Shows antibacterial potential
  30. 30. Thermocatalytic technique
  31. 31. Thermocatalytic Technique Same as the walking bleach technique, but heat is applied using different instruments  Due to the heat and the high concentration of the bleaching agent, cervical root resorption could occur  Not proven more effective, yet more dangerous  Not recommended for routine use 
  32. 32. Agents used for Thermocatalytic Technique
  33. 33. Hydrogen Peroxide(30-35%)
  34. 34. Hydrogen Peroxide(30-35%) Caustic at high concentrations and cause chemical burns  Thermodynamically unstable, could explode so stored in dark and cool containers 
  35. 35. Inside Outside Technique
  36. 36. Inside Outside technique In addition to the intracoronal bleaching, the agent is also applied to external tooth structure using specially designed bleaching tray  10% carbamide peroxide is used 
  37. 37. Inside Outside technique Useful when simultaneous vital and non-vital bleaching is used  Could compromise the endodontic treatment, as the the access cavity is left open 
  38. 38. Advantages Allows better esthetics of tooth structure, and better esthetics of overlying fixed prosthesis  Antibacterial potential of carbamide peroxide  Lower risk of damage to gingival tissues  Ability to do simultaneous vital and non-vital bleaching via inside outside technique 
  39. 39. Disadvantages and possible complications
  40. 40. Possibility of crown fracture
  41. 41. Internal or External Root Resorption
  42. 42. Rediscoloration
  43. 43. Overbleaching
  44. 44. Compromising the endodontic ttt in inside outside technique
  45. 45. References 1- Sturdevant’s Art and Science of Operative Dentistry, 6th edition 2, 4- Textbook of Endodontics By Nisha Garg, Amit Garg, 2nd edition, pg 448 3- Aesthetic dentistry, Color atlas of dental medicine, Josef Schmidseder, Thieme,2000 5- Ingle's Endodontics 6. John Ide Ingle, Leif K. Bakland, J. Craig Baumgartner 6- Endodontics: Principles and Practice, Mahmoud Torabinejad, Richard E. Walton, Elsevier Health Sciences, 2009.
  46. 46. References 7- Essentials of Operative Dentistry, I. Anand Sherwoo, JP Medical Ltd, 2010 8- Endodontics, Volume 1, John Ide Ingle, Leif K. Bakland, PMPH-USA, 2002 9- uuid=B37966DCDD3FDE41D6DDAAAC6A1B57D7 10 3.pdf 11 JOE2008.pdf