Bleaching Discolored Endodontically Treated Teeth by Dr. Terry Shaw

Lighten Up! 

One of our most-followed Townies explains how to treat endodontically treated discolored teeth


by Dr. Terry Shaw


Case 1

This 60-year-old patient tripped over her cat and whacked her left central. The luxated tooth moved 2 mm palatally, and although the patient could “straighten it” by closing her teeth together to move it back into place, after a few weeks the tooth also was obviously discoloured (Figs. 1 and 2), which finally inspired her to come in. I performed a root canal treatment, then placed some Opalescence Endo whitening gel (Ultradent) inside the tooth to help whiten it.

Before injecting the 35% hydrogen peroxide gel, I placed a plug of Ketac-Cem glass ionomer cement (3M) using an endodontic orifice locator, and let the GI cement harden in the tooth at the crestal bone level. This is important to prevent the bleach from migrating out the canal and irritating the apical tissues—even if you think it’s well sealed, the bleach will still get past the cemented gutta-percha!

Discolored Endo cases
Fig. 1
Discolored Endo cases
Fig. 2
Discolored Endo cases
Fig. 3: One week after treatment, the tooth was bleached whiter than the adjacent teeth.
Discolored Endo cases
Figs. 4 and 5: The tooth will probably regress slightly over time.
Discolored Endo cases
Fig. 6: Access opening.
Discolored Endo cases
Fig. 7: Tooth with first increment in place.
Discolored Endo cases
Fig. 8: Composite added.
Discolored Endo cases
Fig. 9: Finished.
Discolored Endo cases
Fig. 10: On the X-ray, you can see the glass ionomer plug between the gutta-percha and the composite restoration.

The patient told me she thought her tooth had been moved down out of the socket slightly—because this appeared to be the truth, I shaved a bit off the tooth when I finished adjusting it after placing the restoration.


Case 2

Discolored Endo cases
Fig. 11: An old RCT with lots of discoloration.
Discolored Endo cases
Figs. 12–14: Cleaning out the old composite and stained material.
Discolored Endo cases
Fig. 15: After removing the old stain and placing glass ionomer over the gutta-percha at the crestal level. Looking better already!
Discolored Endo cases
Fig. 16: X-rays at the start.
Discolored Endo cases
Fig. 17: The patient lives more than 200 miles away, so they returned after nearly one month so I could continue the restoration work.
Discolored Endo cases
Fig. 18: Old restoration and decay removed from adjacent tooth.
Discolored Endo cases
Fig. 19: Incisal view.
Discolored Endo cases
Fig. 20: Pulp chamber with first increment added.
Discolored Endo cases
Fig. 21: Larger increment added to distal, lingual and buccal surfaces.
Discolored Endo cases
Figs. 22 and 23: Adding composite. I included a little over the buccal incisal enamel, which I will finish to a featheredge margin.
Discolored Endo cases
Figs. 24–26: Finished restoration.

Case 3

Discolored Endo cases
Fig. 27: Three root canals staining badly. For what it’s worth, I always clean out the gutta-percha after I do my root canal treatment to the crestal bone level, and place composite in the canal from the crestal bone level to the palatal or occlusal surface. I strongly believe doing so reinforces the tooth, and they very seldom break. I find these last for many years, rather than placing a post and doing a crown prep and crown. Much less tooth structure is removed—and I have many that are 40 years old and have never been touched.
Discolored Endo cases
Fig. 28: Canals cleaned out. Lateral had a lot of black material in it
Discolored Endo cases
Fig. 29: The centrals were nonvital and had no pulps visible on the X-ray. I tried to access them but couldn’t find any canal.
Discolored Endo cases
Fig. 30: Teeth with glass ionomer over access area and bleach in canals, plus etch composite temps in lingual.
Discolored Endo cases
Fig. 31: Etched composite restorations in the lingual.
Discolored Endo cases
Fig. 32: Four weeks went by because this fellow works in the west of Canada for three to four weeks at a time.
Discolored Endo cases
Fig. 33: Most teeth became much whiter. The lateral had some labial composite I hadn’t seen, so I decided to rebleach it and also restore the centrals with composite.
Discolored Endo cases
Figs. 34 and 35: All cleaned out.
Discolored Endo cases
Fig. 36: The lateral is still dark.
Discolored Endo cases
Fig. 37: Centrals restored.
Discolored Endo cases
Fig. 38: Lateral being rebleached for one more week.
Discolored Endo cases
Fig. 39: After one week, restoring the distal of the patient’s left central before doing his lateral.
Discolored Endo cases
Fig. 40: You’ll notice that his lateral is palatal to the central, so I decided to add composite to the lateral and move the labial surface forward, so it looks more even and blends better with his other teeth. (Plus, I could get the color whiter because the tooth didn’t bleach as well as his centrals.)
Discolored Endo cases
Figs. 41 and 42: The lateral was also quite round, so I flattened it as well.
 
Discolored Endo cases
Fig. 43: Before we started.
Discolored Endo cases
Fig. 44: Definitely looking better!


Check out Dr. Terry Shaw’s 3 CE courses!
Hundreds of dentists have taken Dr. Terry Shaw’s three CE courses on Dentaltown about using composite for full-mouth rehabilitations, bridges and more. Click here to check them out and earn up to 5 CE credits.  
Author Bio
Dr Terry Shaw Dr. Terry Shaw practices in Perth-Andover, New Brunswick. He graduated from Dalhousie Dental School in 1976 and has a chronic affection for composite dentistry. Shaw is the continuing education chairperson for the Atlantic Canada Academy of General Dentistry.

Sponsors
Townie Perks
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2024 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450