NON-VITAL

BLEACHING

WHAT IS BLEACHING:-

Bleaching is a procedure which involves

lightening of the color of a tooth
through the application of a chemical
agent to oxidize the organic
pigmentation in the tooth.

HISTORY OF TOOTH BLEACHING

BLEACHING WAS FIRST DESCRIBED IN 1864
AND A VARIETY OF MEDICAMENTS SUCH AS
CHLORIDE, SODIUM HYPOCHLORITE, SODIUM
PERBORATE AND HYDROGEN PEROXIDE HAS
BEEN USED, ALONE OR IN COMBINATION,
WITH OR WITHOUT HEAT ACTIVATION.

INDICATIONS: Discolouration of anterior teeth after R.C.T.

Tetracycline stains (mild).
Fluorosis.
Discolouration due to ageing.

CONSTITUENTS OF BLEACHING GELS

Carbamide peroxide.
Hydrogen peroxide and sodium
hydroxide.
Sodium perborate.
Thickening agent-carbopol or carboxy
polymethylene.
Urea.
Surfactant and pigment dispersants.
Preservatives.
Vehicle-glycerine and dentifrice.
Fluoride and 3 percent potassium nitrate

MECHANISM OF BLEACHING
The mechanism is oxidation/reduction
process called as Redox process.
The active ingredient is hydrogen
peroxide, an oxidizing agent
It diffuses through the organic
matrix of enamel and dentin
produces free radicals, which are
responsible for the bleaching
process (oxidation)
These free radicals open the highly
pigmented carbon rings and converting
them into chains, which are lighter in color

BLEACHING TECHNIQUE :1. FORNONVITAL TEETH

(A). THERMOCATALYTIC IN-OFFICE BLEACHING.

(B). WALKING BLEACH/INTRACORONAL BLEACHING.
(C). INSIDE/OUTSIDE BLEACHING.

2. FOR VITAL TEETH

(A). HOME BLEACHING TECHNIQUE

(B). IN-OFFICE BLEACHING.

 BLEACHING OF NONVITAL TEETH

1. THERMOCATALYTIC TECHNIQUE OF BLEACHING
1. Isolate the tooth to be bleached using rubber dam.

2. Prepare the access cavity

3. Place bleaching agent (30% to 35% superoxol and
sodium perborate separately or in combination) in
the tooth chamber.
4. Heat the bleaching solution using light curing unit.
5. Repeat the procedure till the desired tooth colour
is achieved.
6. Wash the tooth with water and seal the chamber
using dry cotton and temporary restorations.
7. Recall the patient after 1-3 weeks and do the
permanent restoration of tooth.

THERMOCATALYTIC IN-OFFICE BLEACHING

2. INTRACORONAL BLEACHING/WALKING BLEACH OF

NONVITAL TEETH

1. Take the radiographs to assess the quality of

obturation. If found unsatisfactory, retreatment
should be done.
2. Evaluate tooth color with shade guide.
3. Isolate the tooth with rubber dam.
4. Prepare the access cavity, remove the coronal
guttapercha, expose the dentin and clean the cavity.
5. Place mechanical barriers of 2 mm thick, preferably
of glass ionomer cement, zinc phosphate, IRM,
polycarboxylate cement on root canal filling
material. The coronal height of barrier should
protect the dentinal tubules.

6. Now mix sodium perborate with an inert liquid (saline or

water) and place this paste into pulp chamber.
7. After removing the excess bleaching paste, place a
temporary restoration over it.
8. Recall the patient after 1-2 weeks, repeat the
treatment until desired shade is achieved.
9. Restore access cavity with composite after 2 weeks.

Walking bleach

RECENT ADVANCEMENT:3. INSIDE/OUTSIDE BLEACHING TECHNIQUE

Synonyms:- Internal/External Bleaching, Modified Walking
Bleach Technique
This technique involves intracoronal bleaching technique along
with home bleaching technique.
This combination of bleaching treatment is helpful in treating
difficult stains.
PROCEDURES
1. Isolate the tooth and prepare the access cavity by removing
gutta-percha 2-3 mm below the cementoenamel junction.
2. Place the mechanical barrier, clean the access cavity and place
a cotton pellet in the chamber to avoid food packing into it.

3. Evaluate the shade of tooth.

4. Check the fitting of bleaching tray and advise the patient to
remove the cotton pellet before bleaching.
5. After bleaching, tooth is irrigated with water, cleaned and
again a cotton pellet is placed in the empty space.
6. Re-assessment of shade is done after 4-7 days.
7. When the desired shade is achieved, seal the access cavity
initially with temporary restoration and finally with composite
restoration after at least two weeks.

INSIDE/OUTSIDE BLEACHING

Precautions should be taken for

Nonvital Bleaching

1.
2.
3.
4.
5.
6.
7.
8.

Safer

Isolate tooth effectively.

Protect oral mucosa.
Verify adequate endodontic obturation.
Use protective barriers.
Avoid acid etching.
Avoid strong oxidizers.
Avoid heat.
Recall periodically.

NONVITAL BLEACHING ADVANTAGES

Low cost
High success rate
No tooth alternation
NONVITAL BLEACHING DISADVANTAGES

Unpredictable results
Need Re-treatment
Possible side effects

Bleaching is safe, economical, conservative

and effective method of discoloring the
stained teeth. It should always be given a
thought before going for more invasive
procedure like veneering or full ceramic
coverage, depending upon specific case.

THANK YOU