Spectrophotometric analysis of internal bleaching of traumatized teeth with coronal discoloration following regenerative endodontic procedures

Jaqueline Lazzari,Brenda Paula Figueiredo De Almeida Gomes,Vanessa Pecorari,José Flávio Affonso De Almeida,Walbert Vieira,Adriana De-Jesus-Soares

doi:10.20396/bjos.v21i00.8665232

Jaqueline Lazzari, Brenda Paula Figueiredo De Almeida Gomes + Show 4 more

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https://doi.org/10.20396/bjos.v21i00.8665232

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Abstract

Aim: The objective of this study was to describe a case series concerning internal bleaching of anterior traumatized teeth that underwent regenerative endodontic procedures (REP). Methods: Seven non-vital maxillary anterior teeth discolored after regenerative endodontic procedures were included and divided into two groups according to the medication protocol used in the REP: (1) Triple antibiotic paste (TAP) group (n=4); (2) Calcium hydroxide and 2% chlorhexidine gel (HC+CHX) (n=3). The bleaching technique used was walking bleach, where sodium perborate associated with distilled water was used. Bleaching agent was replaced weekly until the darkened tooth was slightly lighter than the adjacent tooth. The color was recorded with the aid of a digital spectrophotometer in two moments (T1: prior the first session of bleaching, T2: fourteen days after the last session of bleaching). The change in color after the procedure (ΔE) was calculated and reported in a descriptive analysis. Results: The ΔE for all teeth showed color differences exceeding the perceptibility threshold (ΔE > 3.7). Both groups showed similar ΔE (TAP: 18.3 ± 11.5; HC+CHX: 14 ± 11.2) at the end of the treatment. The average number of sessions needed to achieve satisfactory results was 1.7 ± 0.6 for HC+CHX group and 2.3 ± 0.5 for TAP group. Conclusion: Internal bleaching with sodium perborate associated with distilled water is effective in treating discolored teeth after regenerative endodontic procedures.

Highlights

Traumatic injuries in young patients are the major cause of pulp necrosis in immature permanent teeth[1]
This intracanal medication has a great antibacterial spectrum, it is hypothesized that the minocycline is the responsible for this discoloration, since this substance has the property of binding calcium ions, forming an insoluble complex, which when incorporated into the dentin matrix, leads to darkening[2]
Of the 23 upper incisors subjected to regenerative endodontic procedures in the study by Nagata et al.[8], thirteen presented coronal discoloration during follow-up, of which only seven teeth were included in the sample (Figure 2)

Summary

Introduction

Traumatic injuries in young patients are the major cause of pulp necrosis in immature permanent teeth[1]. The main cause of this discoloration has been attributed to the use of the triple antibiotic pastes (TAP) used as intra-canal medication[8,10,11]. A clinical trial by Nagata et al.[8] (2014) observed that 83% of the teeth subjected to this medication protocol had some degree of coronary discoloration. This intracanal medication has a great antibacterial spectrum, it is hypothesized that the minocycline (a component of TAP) is the responsible for this discoloration, since this substance has the property of binding calcium ions, forming an insoluble complex, which when incorporated into the dentin matrix, leads to darkening[2]

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