Dental Education Lecture: Home & Office Bleaching

We discuss what you should do to finish internal bleaching at home in last lecture.  We need to pay attention to detail, making sure to remove temporary filling so that we apply bleaching material inside the tooth for internal bleaching.  In this lecture, we show you two cases and demonstrate how important each step of internal bleaching at home.  If at-home bleaching turns out not satisfied, we do bleaching in office.

Teeth in these two cases turn dark due to trauma long time ago.  There is abscess (arrow in Fig.1 and 5).  After root canal treatment, the abscess disappears (Fig.3,4,6). In the first case, the affected tooth is whitened immediately after root canal therapy (compare Fig.1 and 2).  We ask the patient to do external and internal bleaching, but he is unable to remove the temporary filling at home.  In fact what he has done is external bleaching.  The affected tooth does not improve as much as the neighboring teeth (compare Fig.1 and 3).  As a matter of fact, the discoloration rebounds (compare Fig.2 and 3).  You can see how important the internal bleaching is and bleaching by root canal therapy itself is not enough.  We do in office external and internal bleaching for two central incisors.  Final result is shown in Fig.4.  We use very high concentration of bleaching material, which is caustic to the gums.  We need to do very good job of isolation.  Unfortunately adjacent gums are also bleached due to incomplete isolation. We will talk more about in office bleaching in next lecture.

The affected tooth in the second case is a lower incisor (Fig.5).  At home external and internal bleaching brings satisfactory results (Fig.6) and remains so for 2.5 years.  

Xin Wei, DDS, PhD, MS 1st edition 02/01/2009, last revision 08/30/2009