Whitening of vital and non-vital teeth

Changed teeth color, especially of the front ones, can be a serious aesthetic problem. Change in color can occur on vital and non-vital teeth.

On vital teeth it appears a consequence of:
Secondary mineralization (after trauma and subluxation teeth injuries),
Tooth enamel defects (hypoplasia, hypocalcification),
Systemic medications (tetracycline coloration).

It is caused on non-vital teeth because of:
Pulp necrosis,
Endodontic drugs, materials,
Repair materials.

Vital teeth whitening
Whitening of vital teeth is much more uncertain and less predictable than non-vital. In general, it can be said that only the changed color of the enamel can be improved by whitening.

One of the methods is the application of 30% carbamide peroxide in the form of gel. It is applied to foils that are made on the basis of the taken imprint and model for each patient separately. The gel applied on the foil is filled in and applied over the teeth for 30 minutes. The procedure is repeated until the desired shade of the teeth color.

Whitening on Endodontically treated teeth
Preparation
It is necessary to make a control X-ray footage of tooth to determine the periapical state of the tooth and the quality of the root canal filling. If the canal is not adequately filled, it is absolutely necessary to be re-treated.

If filling is correct, all restorations on the crown are removed as well as areas of highly changed dentine. The root canal filling is removed to the level of 1 to 2 mm more apical from the entrance to the canal (below the marginal gingiva level) and the filling is covered by a layer of zinc oxide – eugenol- cement strengthen by resin.

Vaseline is then placed on the gingival tissue of the tooth that is treated as well as on the adjacent teeth. This will protect soft tissues from bleaching agents. Then a cofferdam is placed. This is followed by teeth acidification for 60 seconds with a gel of 37% phosphoric acid, basic rinse and air drying. Tooth whitening is performed with oxidizing agents 3% hydrogen peroxide and paste 30% carbamide peroxide and Na perborate.

Hydrogen peroxide is rapidly destabilizing by heat and light and it releases oxygen. There are special devices for heating hydrogen peroxide (up to 40 degrees) as well as heat lamps.

Hydrogen peroxide is applied to the prepared tooth using cotton balls, and then is applied light or heat. Cotton balls are constantly maintained by wet continuous addition of hydrogen peroxide.

The warming is applied lightly, controlled by a heated instrument that is leaned over the cotton ball 4 to 5 times, the procedure is repeated several times. In most cases whitening in one visit is not enough to achieve the desired results.

Therefore, the Sodium perborate paste and 30% carbamide peroxide are placed in the entrant cavity of the tooth until the next visit after a week. After that, if the color of the tooth is satisfactory, the tooth is restored.

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Word of doctor

PhD Milica Čelebić

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