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    Pingyuan Chen
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    This patient presented with yellowish discoloration of tooth #2.1 due to past trauma. After accessing and cleaning the canal, bleeding was encountered indicating a possible resorption defect. The canal was dressed with calcium hydroxide and later obturated with gutta percha. Internal bleaching using sodium perborate was performed over multiple appointments. References discuss how bleaching can compromise bonding strength, but this can be reversed by applying sodium ascorbate or waiting periods before restoration. The treatment was successful in eliminating the tooth discoloration.

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    This patient presented with yellowish discoloration of tooth #2.1 due to past trauma. After accessing and cleaning the canal, bleeding was encountered indicating a possible resorption defect. The canal was dressed with calcium hydroxide and later obturated with gutta percha. Internal bleaching using sodium perborate was performed over multiple appointments. References discuss how bleaching can compromise bonding strength, but this can be reversed by applying sodium ascorbate or waiting periods before restoration. The treatment was successful in eliminating the tooth discoloration.

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    18 views4 pages

    Bleaching 1

    Uploaded by

    Pingyuan Chen
    This patient presented with yellowish discoloration of tooth #2.1 due to past trauma. After accessing and cleaning the canal, bleeding was encountered indicating a possible resorption defect. The canal was dressed with calcium hydroxide and later obturated with gutta percha. Internal bleaching using sodium perborate was performed over multiple appointments. References discuss how bleaching can compromise bonding strength, but this can be reversed by applying sodium ascorbate or waiting periods before restoration. The treatment was successful in eliminating the tooth discoloration.

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    of 4

    KENNETH S.

    SEROTA, DDS, MMSC


    [email protected]
    WWW.ENDOSOLNS.COM
    VOLUME 6; ISSUE 2

    I N T E R N A L B L E AC H I N G
    FEBRUARY 2006

    ENDOESTHETICS

    This patient presented wishing to elimi- At the followup appointment, an apical plug of MTA was
    nate the yellowish discolouration of placed, the canal sealed and the MTA allowed to set. At the
    tooth #2.1. She recalled sustaining a final appointment, the root canal procedure was completed.
    trauma roughly twenty years prior, after Sodium perborate alone was used (Superoxyl is NOT recom-
    which the tooth continued to discolour. mened for bleaching procedures due to the prevalent inci-
    No other signs or symptoms were re- dence of cervical resorption). The material was changed on
    ported. (sequence of treatment images
    on pages 3 and 4). Looking at the
    radiograph, partial calcification in the
    coronal part of the canal is noted. At
    mid-root level, a canal space is clearly
    visible, although of an irregular shape.
    Access preparation and ultrasonic
    troughing identified the original canal,
    which was diametrally quite narrow to
    begin with, but which became very
    wide at mid-root level. There
    was profound bleeding upon entering
    this region of the canal space. The
    sensation was similar to what one
    experiences with a resorption defect.
    The apical foramen was gauged with three occasions during the next two weeks. The access open-
    ProsystemGT #70, and a dressing of ing was soaked with 10% sodium ascorbate for five minutes
    calcium hydroxide placed for a period (see below) as it acts as a scavenger for any residual oxygen
    of two weeks (Ultracal/NaviTip, UPI, S. which may affect the polymerization of the resin used to close
    Jordan, Utah) the preparation

    SODIUM ASCORBATE

    Sodium Ascorbate is a buffered form of Vitamin C


    that consists of 90% ascorbic acid bound to 10%
    sodium. A powerful anti-oxidant, it is available in
    many holistic food stores in liquid form.
    INTERNAL BLEACHING Page 2

    REFERENCE ARTICLES

    1: Oper Dent. 2003 Nov-Dec;28(6):825-9.


    Reversal of dentin bonding to bleached teeth.
    Kaya AD, Turkun M.

    Many studies have shown a considerable reduction in enamel bond strength of resin com-
    posite restorations when the bonding procedure is carried out immediately after bleaching.
    These studies claim that a certain waiting period is needed prior to restoration to reach the
    original bond strength values prior to bleaching. This study determined the effect of anti-
    oxidant applications on the bond strength values of resin composites to bleached dentin.
    Ninety human teeth extracted for orthodontic purposes were used in this study. The labial
    surface of each tooth was ground and flattened until dentin appeared. The polished sur-
    faces were subjected to nine different treatments: 1) bleaching with gel (35% Rembrandt
    Virtuoso); 2) bleaching with gel + 10% sodium ascorbate (SA); 3) bleaching with gel + 10%
    butylhydroxyanisole (BHA); 4) bleaching with sol (35% hydrogen peroxide); 5) bleaching
    with sol + 10% sodium ascorbate; 6) bleaching with sol + 10% BHA; 7) bleaching with gel +
    immersed in artificial saliva for seven days; 8) bleaching with sol + immersed in artificial
    saliva for seven days; 9) no treatment. After bonding application, the resin composite in
    standard dimensions was applied to all specimens. The teeth were stored in distilled water
    at 37 degrees C for 24 hours and a universal testing machine determined their resistance
    to shear bond strength. The data was evaluated using ANOVA and Duncan tests. Bond
    strength in the bleached dentin group significantly decreased compared to the control
    group. On the other hand, the antioxidant treatment had a reversal effect on the bond
    strength to dentin. After the bleaching treatment, the 10% sodium ascorbate application
    was effective in reversing bond strength. In the samples where antioxidant was ap-
    plied after the bleaching process, bonding strength in dentin tissue was at the same
    level as those teeth kept in artificial saliva for seven days.

    2: J Dent Res. 2002 Jul;81(7):477-81.


    Reversal of compromised bonding in bleached enamel.
    Lai SC, Tay FR, Cheung GS, Mak YF, Carvalho RM, Wei SH, Toledano M, Osorio R,
    Pashley DH.

    Oxygen inhibits polymerization of resin-based materials. We hypothesized that


    compromised bonding to bleached enamel can be reversed with sodium ascorbate, an
    anti-oxidant. Sandblasted human enamel specimens were treated with distilled water
    (control) and 10% carbamide peroxide gel with or without further treatment with 10% so-
    dium ascorbate. They were bonded with Single Bond (3M-ESPE) or Prime&Bond NT
    (Dentsply DeTrey) and restored with a composite. Specimens were prepared for microten-
    sile bond testing and transmission electron microscopy after immersion in ammoniacal sil-
    ver nitrate for nanoleakage evaluation. Bond strengths of both adhesives were reduced
    after bleaching but were reversed following sodium ascorbate treatment (P < 0.001).
    Resin-enamel interfaces in bleached enamel exhibited more extensive nanoleakage in the
    form of isolated silver grains and bubble-like silver deposits. Reduction of resin-enamel
    bond strength in bleached etched enamel is likely to be caused by a delayed release
    of oxygen that affects the polymerization of resin components.
    VOLUME 6; ISSUE 2

    REFERENCE ARTICLES

    3. Effect of 10% sodium ascorbate on the shear bond strength of composite resin to
    bleached bovine enamel.

    Turkun M, Kaya AD.

    Department of Restorative Dentistry and Endodontics, School of Dentistry, Ege University,


    Izmir, Turkey.

    The purpose of this study was to comparatively investigate the effect of antioxidant treatment
    and delayed bonding after bleaching with three different concentrations of carbamide
    peroxide (CP) on the shear bond strength of composite resin to enamel. One hundred flat
    buccal enamel surfaces obtained from bovine incisors were divided into three bleaching
    groups of 10, 16 and 22% CP (n = 30) and a control group. Each bleaching group was then
    divided into three subgroups (n = 10). Group 1 consisted of specimens bonded immediately
    after bleaching. Group 2 specimens were treated with antioxidant agent, 10% sodium ascor-
    bate, while Group 3 specimens were immersed in artificial saliva for 1 week after bleaching.
    Specimens in the control group were not bleached. After the specimens were bonded with
    Clearfil SE Bond and Clearfil AP-X, they were thermocycled and tested in shear until failure.
    Fracture analysis of the bonded enamel surface was performed using scanning electron mi-
    croscope. The shear bond strength data was subjected to one-way analysis of variance fol-
    lowed by Duncan's multiple range test at a significance level of P < 0.05. Shear bond
    strength of composite resin to enamel that was bonded immediately after bleaching with 10,
    16 and 22% CP was significantly lower than that of unbleached enamel (P < 0.05). For all
    three bleaching groups, when the antioxidant-treated and delayed bonding (1 week)
    subgroups were compared with the control group, no statistically significant differences in
    shear bond strength were noted (P < 0.05).

    Preoperative radiograph Working Length Determination


    Ca(OH)2 insertion Canal preparation completed

    MTA Apical plug/Obturation/Access Sealed

    Postoperative clinical appearance

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