Internal whitening on lower molar. Patient came to the clinic complaining of pain and swelling in the lower right gingival region and darkening of the crown of tooth 46.
On clinical examination, gingival edema in the region of tooth 46, with buccal periodontal pocket, pain on percussion and palpation. Radiographic examination revealed a periapical radiolucent image in tooth 46 and endodontic treatment apparently well performed, however, the patient reported not using absolute isolation during treatment, which reinforces the hypothesis of contamination, more specifically of the pulp chamber, causing the darkening. On tomography, an image was observed in the furcation, which could be compatible with a caved canal, connected to a hypodense half-moon area, suggesting contamination of this canal.
On access, contaminated dentin was observed. Initial sanitization was performed, followed by a crack search with methylene blue. The image of a caved canal was then observed near the distal canal. The canals were then emptied, decontaminated, and medicated with Bio C Temp.
On return, 15 days later, there were no signs or symptoms and the tooth returned to its original color. The canals were then filled.
In: Rocha et al. Endodontic reintervention and endogenous bleaching of darkened anterior teeth: a case report. Arch Health Invest (2020) 9(2):112-118
The fundamental objective of endodontic treatment is to allow the permanence of functioning teeth in the oral cavity without compromising the patient's health. The remarkable emergence of new materials, new techniques and new technologies in endodontics lead to high rates of success in endodontic therapy, although it is not uncommon to come across patients in the clinic whose treatment has failed, verified through signs and symptoms.
Despite the efforts to achieve clinical success, failures may occur and it is possible to resort to endodontic intervention to maintain teeth in function. Endodontic failure may be related to the persistence of bacteria in the root canal, lack of technical mastery by the professional, such as errors in bioromechanical preparation procedures, unsatisfactory fillings, untreated canals, canals filled but exposed to salivary water, inadequate restorations, microleakage, iatrogenic perforations and instrument fractures.
Some endodontic treatments or inappropriate techniques may cause esthetic complications, specifically tooth darkening.
Among the main darkening etiologies in devitalized teeth are the presence of filling materials in the pulp chamber, pulp tissue remnants after endodontic treatment, pulp necrosis and some intracanal medications, such as iodoform. In anterior elements, changes in staining can trigger psychological implications, impairing the aesthetics of the smile and leading to low self-esteem in the patient.
In cases of endodontic failure, a new intervention in the canal is necessary to reverse the failure of the previous therapy and make the tooth functional again. Conventional reintervention, whenever possible, is selected as the first treatment alternative, because it is considered a less invasive procedure when compared to parendodontic surgery, with low cost and good prognosis.
Essentially, non-surgical retreatment consists of root canal desobturation, reinstrumentation, disinfection, and reobturation of the canal systems to allow repair of the supporting structures and tissues.
Internal whitening on lower molar
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