How to Correct Discoloration after Luxation

A 16-year-old boy had bicycle accident.  The teeth #8 and 9 were luxated.  They were placed back in the sockets in a timely manner and splinted.  One month later, the tooth #8 had percussion, while #9 discolored (Fig.1).  Although there is periapical radiolucency associated with #7 (Fig.2), RCT was initiated for #8,9 (Fig.3 *: CaOH paste).  The shade of #9 improved post initial RCT (Fig.4,5). 

The patient returned to finish RCT 1.5 months later (Fig.6).  Gutta percha was removed as much (high) as possible (Fig.7 >).  In order to prevent butterfly rubber dam clamp interference in access and GP removal, smaller clamps should be placed in the neighboring teeth (Fig.8). When RCT was done, the tooth #9 was still the darkest (Fig.9).  Thermoplastic tab was used to make local external bleaching tray (Fig.10 *).  The patient and his mother were instructed to do external and internal bleaching daily. 

Two weeks later, the shade of #9 was similar to that of #10 (Fig.11).  Composite with the lightest shades were used to finish build up (Fig.12 *).  The tooth #9 was prepared for veneer; the dentine looks pretty light (Fig.13).  Proper shade was chosen (Fig.14).  Veneer at the site of #9 is bonded (Fig.15).  The patient returns for excess cement removal 1 week post cementation (Fig.16).

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Xin Wei, DDS, PhD, MS 1st edition 10/29/2014, last revision 11/12/2014