Nonvital Bleaching Research Articles

Evaluation of peroxide release during nonvital bleaching using three different coronal barriers: An in vitro study.

Peroxide from bleaching agents can cause external cervical resorption. An intracoronal barrier is used to prevent leakage of bleaching agents into the periradicular space. This study aims to determine and compare the amount of peroxide released, during non vital bleaching at the end of 1st and 3rd day using Glass ionomer cement (GIC), Mineral Trioxide aggregate (ProRoot MTA) and Biodentine as intracoronal barriers. Forty-five single-rooted teeth were selected for the study and root canal therapy was performed. Three millimeters of the coronal gutta-percha were removed and according to the coronal barrier placed, samples were divided into Group A: GIC, Group B: ProRoot MTA, and Group C: Biodentine. Nonvital bleaching was done using sodium perborate and 30% H2O2. Peroxide released at the end of the 1st and 3rd day was analyzed using potassium iodide and ultraviolet spectrophotometer. This was done using the Wilcoxon matched pair test and the Kruskal-Wallis test. No significant difference in intergroup comparison at the end of 1st and 3rd day, respectively (P > 0.05), a significant difference was found in the MTA group at follow-up dates (P < 0.05). All the three tested materials (GIC, MTA, and Biodentine) may be preferred as intracoronal barrier for nonvital bleaching.

Effectiveness of Three Bleaching Techniques for Endodontically Treated Teeth: A Randomized Clinical Trial.

Various techniques, products, and protocols are used for the bleaching of non-vital teeth. The walking bleach technique involves sealing the bleaching agent in the pulp chamber. In the inside/outside technique, a low-concentration bleaching agent is applied at home using a custom tray. In the in-office technique, a high-concentration bleaching agent is applied by a dental professional. Limited research has compared the effectiveness of these techniques. This clinical trial aimed to evaluate the effectiveness of the walking bleach, the inside/outside, and the in-office bleaching techniques. Fifty-four discolored teeth were selected according to eligibility criteria, randomized, and assigned to three treatment groups (n=18): walking bleach (sodium perborate - SP), inside/outside bleaching (7.5% hydrogen peroxide -HP7.5), and in-office bleaching (35% hydrogen peroxide - HP35). A cervical seal was placed in all the teeth, and nonvital bleaching was performed according to each technique. The CIELab color coordinates were measured using a clinical spectrophotometer at baseline, weekly, and at the 1-week follow-up. ΔE00 and ΔWID were calculated between the baseline and each evaluation time point. The ANOVA, Fisher exact, and Kruskal-Wallis tests were used to compare the quantitative variables, and the Fisher exact test, to determine the association among categorical variables. Bleaching effectiveness was interpreted by 50:50% perceptibility and acceptability thresholds. As the treatment progressed, all techniques presented a significant increase in L* and WID (p<0.001), and a significant decrease in a* and b* (p<0.001). HP7.5 and HP35 presented greater increases in WID mean values, in comparison with SP (p=0.006). No significant differences were observed among the techniques for ΔE00 after treatment completion (p=0.383). There were no statistical differences in bleaching effectiveness among the techniques after treatment completion (p=0.098). All techniques presented excellent effectiveness after treatment completion. However, HP7.5 and HP35 techniques provided a more rapid whitening response.

An In Vitro Exploration of Interaction Mechanisms of Intracoronal Bleaching on the Compressive Strength of Conventional and Calcium Silicate-Based Self-Adhesive Resins and Their Bonding to Composite Resin Restorative Material.

Objectives: The cervical resorption following intracoronal bleaching necessitates the application of impermeable cervical barriers. This study aimed to evaluate the effect of two bleaching agents on the compressive strength (CS) and shear bond strength (SBS) of two self-adhesive resins, TheraCem and Vertise Flow, to composite resin restorative material. Materials and Methods: Two hundred sixteen specimens from TheraCem and Vertise Flow were prepared in special molds and treated in three groups: nonbleached (control); sodium perborate-hydrogen peroxide (SP-HP) (sodium perborate +3% hydrogen peroxide); and HP gel (35% hydrogen peroxide gel). The CS of 72 specimens in the three groups was tested using a universal testing machine. For SBS test, 144 specimens from TheraCem and Vertise Flow in the three groups were bonded to Z250 composite using Single Bond Universal adhesive in self-etch and etch-and-rinse modes. SBS was measured using universal testing machine. Data were analyzed using two-way ANOVA and Tukey tests for CS and three-way ANOVA and Tukey tests for SBS. Results: Vertise Flow showed higher CS than TheraCem (p < 0.001), while none of the bleaching agents deteriorated its CS. HP gel significantly lowered the CS of TheraCem (p = 0.001). Bleaching agents increased the SBS of Vertise Flow while the SBS of TheraCem was not significantly affected. For both resin barriers, SBS was higher in the etch-and-rinse mode (p < 0.05), except in nonbleached Vertise Flow (p = 0.091). Conclusions: HP gel deleteriously affected the CS of only TheraCem during nonvital bleaching. The etch-and-rinse mode was preferred in terms of SBS for resin barriers.

Treatment of Teeth with Root Resorptions: A Case Report and Systematic Review

Aim. This article presents an evaluation of different multidisciplinary treatment approaches to managing teeth with external and internal root resorptions.&#x0D; Methods. This study presents a clinical case of a 35-year-old female patient referred to Akdeniz University for dental issues. A comprehensive review of the literature was conducted, encompassing 21 articles sourced from PubMed and Web of Science over the past decade, including case reports and case series.&#x0D; Results. Case Report. A clinical case of a 35-year-old female patient seeking treatment for dental aesthetic concerns was reported and discussed. Intraoral examination revealed discoloration of maxillary anterior teeth and a sinus tract in the apical region of tooth #11. The resorption area was sealed with mineral trioxide aggregate. Afterward, the coronal part of the root was filled using the warm-vertical compaction method. During the final visit, non-vital bleaching was applied to teeth #11 and #21. After all these procedures, aesthetic coronal restorations were completed. Systematic Review. In the context of this clinical case, a literature review was conducted, encompassing an assessment of a total of 25 cases of external and internal resorptions. Among these cases, a combination of surgical and endodontic treatments was applied in 12 cases, while non-surgical endodontic treatment was performed in 13 cases.&#x0D; Conclusions. In the present case report, a patient who had both external and internal root resorptions was treated with mineral trioxide aggregate and flap operation, with no subsequent complications during the follow-up sessions. Among the 21 reports included in our review, 24 out of 25 treated teeth demonstrated successful outcomes, while only one tooth necessitated extraction.

Effect of green tea extract antioxidant on dentin shear bond strength and resin-tag penetration depth after non-vital bleaching.

Background: 35% Hydrogen peroxide (H 2O 2) as an active material for internal bleaching can produce free radicals that can affect resin tag penetration into the dentinal tubules. Application of 10% and 35% green tea (GT) extract as an antioxidant after 2 minutes are expected to remove free radical residues and increase dentin shear bond strength and resin tags penetration depth after non-vital bleaching. Methods: 30 extracted healthy human premolars were cut horizontally 2 mm from the Cemento Enamel Junction margin to the crown part, then cut in a mesio-distal direction into two parts. The specimens were divided into five groups: normal dentin, post bleaching dentin, delayed 2 weeks, 10% GT, and 35% GT group. Non-vital walking bleach with 35% H 2O 2 gel was done to all groups except control group. Soon after, 10% and 35% GT extract gel were applied on dentin for 2 minutes, then the specimens were rinsed-off with aquabidest for 2 minutes and dried. All specimens were etched and bonded with an etch-and-rinse adhesive system and filled with resin composite. The shear bond strength assessment was carried out using a Universal Testing Machine (UTM) with a cross-head speed of 0.5 mm/minute. Confocal laser scanning microscopy (CLSM) with a wavelength of 560 nm and a lens magnification of 40x was used to analyze the resin tag penetration. Data were analyzed by one way ANOVA and t-test. Results: There was a significant difference in resin tag penetration depth and shear bond strength between applying 10% and 35% GT extract (p < 0.05). The 35% GT extract group resulted in a significantly longer resin tag penetration than the 10% GT extract group. Conclusions: The application of 35% GT extract is more effective than 10% GT extract as an antioxidant for increasing the shear bond strength of composite resin after internal bleaching.

Effect of Internal Bleaching on the Microshear Bond Strength of Composite Resin to Dentin in Recently Restored Teeth

Background: This study aimed to assess the effect of internal bleaching on the microshear bond strength of composite resin to dentin in recently restored teeth.&#x0D; Methods: This in vitro, experimental study evaluated 40 sound human premolars. The teeth were sectioned below their cementoenamel junction. Access cavity was prepared, pulpal tissue was removed and filled with glass ionomer. The teeth were then randomly divided into 4 groups. In the control group, no internal bleaching was performed and dentin surface was restored with composite. In group 2, internal bleaching with 35% hydrogen peroxide (Opalescence, ultradent) was performed 4 weeks after composite restoration. Bleaching was performed immediately after restoration of teeth in groups 3 and 4. Teeth were etched with 35% phosphoric acid for 15 seconds, rinsed, dried, and primer and adhesive (Adper Scotchbond Multipurpose) were applied. The teeth were then restored with Z250 (3M ESPE) microhybrid resin composite. Teeth were sectioned into 1 mm2 sections and underwent micro-shear bond strength test. In groups 1 to 3, bond strength was measured after 24 hours while in group 4, it was measured after 1 month. Data were analyzed using one-way ANOVA.&#x0D; Results: The mean micro-shear bond strength of composite to dentin was maximum in group 2 and minimum in group 3. However, the difference in this respect was not significant among the groups (p&gt;0.05).&#x0D; Conclusion: In teeth requiring immediate esthetic restorations, treatments can be performed after non-vital bleaching with no time restriction and adequately high bond strength comparable to non-bleached teeth.

Fracture resistance and bonding performance after antioxidants pre-treatment in non-vital and bleached teeth.

This study aimed to evaluate the effect of antioxidant solutions on fracture strength and bonding performance in non-vital and bleached (38% hydrogen peroxide) teeth. One hundred and eighty dentin specimens were obtained, 60 for each test: fracture strength, hybrid layer thickness, and bond strength. The groups (n=10) were randomly composed according to post-bleaching protocol: REST - restoration, without bleaching; BL - bleaching + restoration; SA - bleaching, 10% sodium ascorbate solution, and restoration; AT - bleaching, 10% α-tocopherol solution, and restoration; CRAN - bleaching, 5% cranberry solution, and restoration; CAP - bleaching, 0.0025% capsaicin solution, and restoration. Data were analyzed with ANOVA, Kruskal-Wallis, Dunn, and Qui-Square tests (α=0.05). The highest fracture strength values were observed in REST (1508.96 ±148.15 N), without significant difference for the bleached groups (p>0.05), regardless of the antioxidant use. The hybrid layer thickness in the group that was not subjected to bleaching (REST) was significantly higher than in any other group. The bond strength in the bleached and antioxidants-treated groups (SA, AT, CRAN, CAP) has no differences with the bleached group without antioxidants (BL). Adhesive failures were predominant in the groups that did not receive the antioxidant application. In conclusion, the evaluated antioxidants did not show an effect on the fracture strength, hybrid layer thickness, or bond strength of dentin bleached after endodontic treatment. The application of 10% sodium ascorbate, 10% alpha-tocopherol, 5% cranberry, or 0.0025% capsaicin solutions is not an effective step and should not be considered for the restorative protocols after non-vital bleaching.

Effect of green tea extract antioxidant on dentin shear bond strength and resin-tag penetration depth after non-vital bleaching

Background: 35% Hydrogen peroxide (H2O2) as an active material for internal bleaching can produce free radicals that can affect resin tag penetration into the dentinal tubules. Application of 10% and 35% green tea (GT) extract as an antioxidant after 2 minutes are expected to remove free radical residues and increase dentin shear bond strength and resin tags penetration depth after non-vital bleaching. Methods: 30 extracted healthy human premolars were cut horizontally 2 mm from the Cemento Enamel Junction margin to the crown part, then cut in a mesio-distal direction into two parts. The specimens were divided into five groups: normal dentin, post bleaching dentin, delayed 2 weeks, 10% GT, and 35% GT group. Non-vital walking bleach with 35% H2O2 gel was done to all groups except control group. Soon after, 10% and 35% GT extract gel were applied on dentin for 2 minutes, then the specimens were rinsed-off with aquabidest for 2 minutes and dried. All specimens were etched and bonded with an etch-and-rinse adhesive system and filled with resin composite. The shear bond strength assessment was carried out using a Universal Testing Machine (UTM) with a cross-head speed of 0.5 mm/minute. Confocal laser scanning microscopy (CLSM) with a wavelength of 560 nm and a lens magnification of 40x was used to analyze the resin tag penetration. Data were analyzed by one way ANOVA and t-test. Results: There was a significant difference in resin tag penetration depth and shear bond strength between applying 10% and 35% GT extract (p &lt; 0.05). The 35% GT extract group resulted in a significantly longer resin tag penetration than the 10% GT extract group. Conclusions: The application of 35% GT extract is more effective than 10% GT extract as an antioxidant for increasing the shear bond strength of composite resin after internal bleaching.

Current Status and Future Prospects In Managing Discoloured Teeth – A Review And Case Report

Tooth discoloration involves a wide range of treatment protocols for clinicians and patients in order to achieve an aesthetic result. Management of tooth discoloration may be interdisciplinary and involves both vital and nonvital teeth. Prosthodontic treatments are more invasive and involve loss of tooth structure as well as a life cycle of further treatment in the future.Vital teeth can be easily treated with low-concentration hydrogen peroxide products safely and effectively using an external approach and trays. For endodontically treated teeth, the walking bleach technique with hydrogen-releasing peroxide products is widespread. However, there is an association between external cervical root resorption with higher concentrations of hydrogen peroxide of 30%–35%. In this article, a brief reviewof managing tooth discoloration and a case report of nonvital bleaching will be discussed.

INVASIVE CERVICAL RESORPTION DUE TO IONTOPHORETIC INTERNAL BLEACHING WITH HYDROGEN PEROXIDE: TWO CASE REPORTS

Background: Invasive cervical resorption is a localised inflammatory-mediated aggressive form of an external root resorptive process of the tooth. One of the predisposing factors associated with ICR is the internal bleaching of non-vital teeth. The maxillary anterior teeth are highly affected among all tooth types. Case reports: The clinical management and one-year follow-up results of two cases with invasive cervical resorption in maxillary central incisors due to iontophoretic internal whitening with 30% hydrogen peroxide are presented in this study. The complications associated with post-bleaching ICR as well the prevalence and underlying mechanism of this phenomenon and treatment planning, are discussed. Conclusion: Clinicians should be alert to the possibility of ICR, especially following iontophoretic non-vital bleaching. A combined multidisciplinary treatment approach can be applied based on thorough clinical, radiographical and CBCT evaluation.

Attitude of Clinical Dental Students to Bleaching of Vital and Non-Vital Teeth

Background: Bleaching is considered the most conservative and cost-effective aesthetic procedure. Vital and non-vital bleaching techniques commonly involve at-home, in-office, and over-the-counter techniques and can be internal (within the pulp chamber) or external (on the enamel surface). Aim: To assess the attitudes of clinical dental students towards the various aspects of tooth bleaching in Saudi Arabia Design and settings: This is an observational cross-sectional study that was carried out across different universities in Saudi Arabia. The study’s questionnaire consisted of questions regarding the demographics and knowledge of dental bleaching procedures, techniques, and materials. Results: A total of 674 dental students and interns from 14 different governmental and private dental colleges in Saudi Arabia completed the survey. The majority of participants were females, 461 (68.4%), attended governmental universities, 396 (58.8%), and did not use any bleaching techniques (62.8%). Dental interns had a higher level of knowledge (42%) followed by 5th-year students (33.7%), and 6th-year students (22.9%). Furthermore, participants who practiced tooth bleaching during clinical training and private universities’ students showed a significantly better bleaching knowledge Conclusion: Overall, dental schools should be encouraging their students to be involved in bleaching application. Additionally, there is a pressing need to focus more on dental bleaching material and procedures in dental school. Keywords: Tooth Bleaching, Dental Students, Bleaching Techniques.

Management of non-vital maxillary central incisor with intrinsic discoloration using walking bleach technique

Non-vital bleaching is a non-invasive technique for the treatment of intrinsic discoloration of teeth. Hydrogen peroxide and sodium perborate are commonly used bleaching agents. The aim of this case report is to demonstrate the non-vital bleaching technique in maxillary anterior teeth. Maxillary central incisors were isolated and root canal treatment was performed. Barrier space preparation was done using a heated instrument. Glass ionomer cement was used a barrier material. Mixture of hydrogen peroxide was placed in the canal and sealed with intermediate restorative material. After 1 week, the procedure was repeated to achieve the desired results. Non-vital bleaching is a minimally invasive procedure to restore the esthetics of a discoloured non-vital tooth. However, care should be taken to prevent any post-operative complications.

Dentists’ preference for Vital and Non-vital Tooth Bleaching Material in Teaching Institutions of Multan

Objective: The objective of this study was three fold; to investigate the preference of dentists regarding the technique for vital and non-vital tooth bleaching, to find out the materials used for vital and non-vital tooth bleaching and to evaluate the influence of post-graduate training, working place and clinical experience on techniques and material used. Methodology: A cross sectional study was carried out using a questionnaire with dentists working in three teaching institutes of Multan, Nishtar Institute of Dentistry (NID), Bakhtawar Amin Medical &amp; Dental College (BAMDC) and Multan Medical &amp; Dental College (MMDC). A total of 170 questionnaires were distributed and 154 recovered, at a response rate of 90.5%. Information about post-graduate training, working place and clinical experience was obtained. The information regarding technique and material used for vital and non-vital tooth bleaching was also collected. Data were analyzed using SPSS version 22 and frequencies and percentages were calculated along with association between the treatment options and other variables. Results: Majority of the dentists 81.8% and 75.3% preferred in-office technique for vital and non-vital tooth bleaching respectively. For vital tooth bleaching, 31.8% selected HP 6% and 28.4% opted CP10-22%. For non-vital tooth bleaching, 34.8% selected SP mixed with water/HP and 26.6% opted HP37%. Conclusion: Clinical experience and working place significantly influenced the bleaching technique for vital teeth not for the non-vital. No significant influence of post-graduation, clinical experience and working place was found on material used for vital or non-vital bleaching. Key Words: Vital tooth bleaching, Non-vital tooth bleaching, Hydrogen peroxide, Carbamide peroxide, Sodium perborate

Dentist’s preferences on vital and nonvital tooth bleaching

Aim: The present study aimed to investigate if the Guatemalan dentist’s options on tooth bleaching could be influenced by their time in clinical practice, the level of specialization or their working place. Methods: A representative sample of dentists working in clinical practice in Guatemala was selected. Data were collected using a self-administered questionnaire with information related to gender, professional characteristics (time since graduation in years and working place) and preferences regarding vital (at-home or in-office; type and concentration of bleaching agent) and the nonvital tooth bleaching (bleaching agent used). The analysis was performed and the association between preference for bleaching technique and independent variables were investigated using Fisher’s exact test. Results: 200 dentists were interviewed. More than half of dentists were male (57.0%) with time since graduation between 11 and 20 years (n= 64; 32.3%). Dentists mostly (60.5%) preferred in-office technique for vital bleaching, with 10-20% Carbamide peroxide (CP) as the preferred agent (50%). For nonvital teeth, the preferred agent (46.8%) was 37% Hydrogen Peroxide (HP). About the associations, younger dentists (&lt; 20 years of graduation) selected mostly in-office technique, while those with more than 20 years indicated more the at-home technique. Also, the dentists working in private practice chose more frequently in-office technique. Thus, the in-office technique was more popular among Guatemalan dentists, with 10-20% CP and 37% HP selected as favorite bleaching agents for vital and nonvital techniques, respectively. Conclusion: The time of clinical practice and working place influenced some choices.

TwoTechniques for BleachingofDiscolouredEndodontically Treated Teeth– A Case Series

Discoloration of anterior teeth can cause aesthetic impairment after an endodontic treatment. Use of in-office non vitalbleaching is an effective method to overcome such an aesthetichinderance whichis a conservative alternative to more invasive esthetic treatments like full-coverage crowns or veneers. Bleaching agents like sodium perborate and hydrogen peroxide can be used for such procedure. This case series presents two cases with anterior discoloration treated with in-office non vital bleaching procedure to gain the desired results. In case 1,walking bleach (non-vital bleaching) was decided for the discoloured central incisor (11) where after placement glassionomer cement as an intraorifice barrier, the mixture of sodium perborate and 3% hydrogen peroxide was placed in the chamber and temporization using cavit was performed; the desired results were obtained in one week. In case 2 after the required endodontic treatment and placement of glass ionomer cement as an intraorifice barrier,in-office non vital bleaching was performed with upper central incisor (11) using Opalesence Boost (40% Hydrogen Peroxide), where 2 cycles of freshly mixed pastes were applied on labial, palatal surface and in the chamber for 20 minutes. The same cycle was repeated after one week, and the desired shade was achieved. In both the cases definitive restoration using composite resin was performed after a week. Keywords: Non-vital bleaching; bleaching case series; tooth discolouration; tooth bleaching; bleaching techniques

Conservative management of discolored maxillary central incisor with open apex using Mineral Trioxide Aggregate (MTA) apical plug and walking bleach Method: A case report.

Esthetics enhancement is a better treatment option for a non-fracture discolored traumatic maxillary central incisor (Max CI). The traumatic injury occurred in Max CI teeth because it was present in the most anterior region of the jaw. Necrosis (pulpal) in Max CI is the second commonest complication after fracture due to trauma. Open apex, incomplete root development, root shortening, roots with a poor remaining dentinal thickness (RDT), and a compromised crown root ratio all these factors affect the survival prognosis of traumatized teeth. Nowadays MTA based bio regenerative material helps in treatment strategies like apexification that was a popular treatment of open apex cases. Necrosis associated discoloration is managed with a conservative approach non-vital bleaching, less time consuming, and satisfy the economical and esthetic aspect for the patient.

Management of Traumatic Maxillary Anterior Teeth for Esthetic : A case report

Objectives: The crown fracture of anterior teeth is most frequent dental trauma, and maxillary central incisor is most common tooth to be broken. This report presents combined treatment procedure of fractured maxillary anterior teeth with alveolar bone fracture. Two right maxillary incisors were treated with resin-wire splint and endodontic treatment. Right maxillary lateral incisors were treated with root coverage with connective tissue graft. Right maxillary central incisor was treated with non-vital bleaching and direct composite restoration. After one year of follow-up, the resin restoration of the maxillary incisor was well maintained and showed good periodontal condition even after root canal treatment.

Optical changes of human dentin after non-vital bleaching and effect of Er,Cr:YSGG laser on micro-shear bond strength of a self-etch and an etch-and-rinse adhesive system.

The aim was to evaluate the optical changes of bleached human dentin and the efficacy of Er,Cr:YSGG laser on micro-shear bond strength (μSBS) of two adhesive systems for immediate and delayed applications. Seventy-two human dentin specimens (1mm) were obtained. Colour measurements of 30 specimens (control and bleaching groups) were made at baseline, after bleaching and a 7-day delay. Differences at colour (ΔE00), translucency (ΔTP00) and whiteness (ΔWID) were calculated by recorded data. Forty-two specimens were used to compare μSBS of a self-etch (Clearfil SE Bond [SE]) and an etch-and-rinse (Prime&Bond NT [PBNT]) adhesive to bleached dentin. Additional to a negative group, six groups were contemplated for each adhesive, considering the time of composite application (immediate, delayed) and whether additional surface treatment by laser (1W, 2W) or not. Colour and μSBS data were statistically analysed. For optical analysis, only ΔE00 and ΔWID calculated for the difference between baseline and bleaching were found significantly different for control and bleaching groups. Whiteness of bleached specimens was remarkably decreased after a 7-day delay. Despite immediate applications of SE showing lower μSBS than negative control, delayed applications showed no significant differences except that of the 2W laser etching. For PBNT, laser etching increased μSBS for both of the immediate and delayed applications, and no significant difference was observed from negative control. Related with the preferred adhesive system, Er,Cr:YSGG laser etching can be an alternative for optimal bond strength of immediate restorations, but the clinicians should always keep in mind that perceived colour and whiteness will change by the passing time which can affect the shade match.

Management of discolored nonvital tooth by walking bleach technique: A conservative approach

Discoloration of teeth in the anterior region can cause considerable cosmetic impairment. One of the techniques which is commonly used for bleaching of endodontically treated teeth is “walking” bleach techniques, and it provides satisfactory results. Based on the clinical reports with nonvital tooth bleaching, it is a viable, esthetic treatment for the discolored tooth. Its conservative nature makes it an important part of an esthetic dentistry treatment. This case report presents two cases, in which nonvital bleaching was done by walking bleach technique. Regular follow-up after a period of 4 weeks showed a significant reduction in the discoloration of teeth.

Management of a nonvital discolored tooth associated with radicular cyst: A multidisciplinary approach

The radicular cyst arises from proliferated epithelial cell rests of malassez when they get stimulated by an inflammatory process originating from pulpal necrosis of a nonvital tooth. The associated tooth is usually asymptomatic and may result in swelling of the soft tissues and mobility of the teeth involved. The typical radiographic description of the lesion is a round or oval, well-circumscribed radiolucency involving the apex of the tooth. Radicular cysts can be managed either surgically or nonsurgically. The nonvital, discolored anterior tooth associated with the lesion is a common esthetic concern for patients. It can effect their self-confidence and employability. Discolored nonvital teeth are frequently compromised due to root canal treatment, previous trauma, or caries. Invasive treatment options like crowns or veneers further weaken the tooth structure. This case report presents the successful surgical management of a radicular cyst associated with a nonvital discolored anterior tooth. This will also include the technicalities involved in the inside/outside nonvital bleaching technique.