Bleaching of a discoloured non-vital tooth: use of a sodium perborate/water paste as the bleaching agent

Study of the Intra-Coronal Pressure Generated by Internal Bleaching Agents and Its Influence on Temporary Restoration

Intra-coronal bleaching is a treatment that whitens non-vital teeth from within the pulp chamber, a procedure by which oxygen and free radicals are released. This in vitro study analyzed and compares the oxygen expansion produced when different bleaching agents encounter dental tissues during this type of bleaching. Here, 120 lower incisors were included and prepared to achieve conditions as close as practicable to internal bleaching with the walking bleach technique. The access cavity of the lingual surface was prepared to seal glass tubes with oil inside them by adhesive restoration once the bleach was placed inside the pulp chamber. The following bleaching groups were used: hydrogen peroxide (HP) 30% (n = 30), sodium Perborate (SP) with distilled water (n = 30), a mixture of HP 30% with SP (n = 30) and a control group (n = 30). After 10 days, the oil displacement that took place through the tube due to oxygen release was measured daily. Displacement of the oil was observed in all groups except the control group. The final mean expansion at 10 days was 335.24 ± 76.85 mm for the HP 30% group, 8.40 ± 1.74 mm for the SP group and 183.07 ± 49.93 mm for the HP30% + SP mixture. Significant statistical differences were observed between the three groups using the Games–Howell post hoc test, where HP30% caused the greatest expansion and SP the least expansion. These results suggest that the higher the amount of HP in the sample, the more oxygen expansion is observed, so that temporary restoration must be performed more carefully to avoid displacement.

Effect of calcium hydroxide on ph changes of the external medium after intracoronal bleaching

AIM

This in vitro study evaluated the effect of calcium hydroxide on pH changes of the external medium after intracoronal bleaching.

MATERIALS AND METHODS

A total of 50 extracted human premolars were prepared and filled with gutta-percha and endodontic sealer. The teeth were randomly divided into five groups according to the bleaching agents employed: (a) Sterile cotton pellet with distilled water (control group); (b) sodium perborate and distilled water; (c) sodium perborate and 10% carbamide peroxide; (d) sodium perborate and 35% hydrogen peroxide; (e) 35% hydrogen peroxide. The teeth were stored in vials containing distilled water and the pH values of the medium surrounding the teeth were analyzed. After 7-day storage, the bleaching agent was removed and replaced by calcium hydroxide, and the distilled water was changed, in which the teeth were kept stored for further 14 days. Measurement of pH of the external medium (distilled water) was performed 7 days after insertion of the bleaching agents, immediately, 7 and 14 days after insertion of the calcium hydroxide. Data were submitted to statistical analysis by the two-way ANOVA and Tukey,s test.

RESULTS

There were pH changes of the external medium at 7- day period after bleaching procedures. These results confirmed the diffusion of bleaching agents to the external medium.

CONCLUSION

Calcium hydroxide increased the external medium pH and was effective for pH alkalinization after intracoronal bleaching.

CLINICAL SIGNIFICANCE

Intracoronal bleaching of endodontically treated teeth may cause cervical root resorption. A possible explanation for this process is the passage of bleaching agents to the periodontal tissues yielding an inflammatory process. In an attempt to keep the neutrality of the periodontal pH, the calcium hydroxide has been recommended.Results of this study showed that this material should be always used after intracoronal bleaching.

Effect of internal bleaching agents on dentinal permeability of non-vital teeth: quantitative assessment

The aim of this in vitro study was to assess quantitatively dentin permeability of pulpless teeth after intracoronal bleaching therapy with three different agents. Twenty-four maxillary central incisors were randomly assigned to four groups according to the bleaching agent used: I--non-bleached control; II--37% carbamide peroxide; III--sodium perborate/20% hydrogen peroxide paste; IV--27% carbamide peroxide. After standard access and root-canal preparation the access opening, biomechanical preparation and root-canal filling, a cervical glass ionomer plug was prepared and intracoronal bleaching procedures were carried out in a standardized fashion. The access cavities were opened and the teeth were externally sealed and immersed in a 10% copper sulfate aqueous solution for 30 min, in vacuum for the first 5 min. Then, samples were removed, dried with absorbing paper and immersed in a 1% rubianic acid alcohol solution, for the same above-mentioned period in solution and in vacuum. Copper ion penetration was indicated by the rubianic acid staining. Mean values and SD for the experimental groups were: I--7.88% (+/-1.33), II--16.94% (+/-5.72); III--11.45% (+/-3.90) and IV--8.98% (+/-4.19). Data were submitted to one-way anova. The results showed that the 37% carbamide peroxide provided the highest increase in dentin permeability, followed by sodium perborate with 20% hydrogen peroxide. The 27% carbamide peroxide provided the lowest results and showed statistical similarity to the control group. On basis of these findings, it may be concluded that, among the tested intracoronal bleaching agents, 37% carbamide peroxide presented an optimized overall performance in increasing dentinal permeability.