Authors: Nutting EB, Poe GS.
Title: A new combination for bleaching teeth.
Journal: J So Calif Dent Assoc
Date: Sep 1963
Citation: 31(9): 289-291
Category: Bleaching/Tooth Whitening
Evidence-based Ranking: 5
Purpose/Objectives: To present a new technique for the bleaching of discolored endodontically treated teeth, the cause of discoloration of pulpless teeth, considerations in case selection, and currently popular bleaching agents and methods.

Etiology: Most responsible etiologic factor is the necrotic pulp. Pulpal hemorrhage is often responsible. Hemoglobin releases iron which forms a black compound when in combination with hydrogen sulfide. Necrotic tissue contains various protein degradation products which may also create the grayish-black discoloration. The length of time between death of the pulp and inception of treatment will directly relate to the degree of discoloration (longer – more discoloration). Poorly executed RCT can also discolor teeth. Missed tissue, filling material excess and medicaments have discoloration potential.

Case Selection: An adequate root canal filling should precede treatment. The crown to be treated must also be questioned. If excessive restorations exist, bleaching may not work.

Bleaching Agents: Aqueous solution of 30% H2O2 (Superoxol) and 25% H2O2 in 75% ether (Pyrozone – no longer used b/c of associated hazards) .

Bleaching Methods: 1) seal a C.P. saturated with Superoxol into the pulp chamber (Walking Bleach technique) 2) Adding sodium perborate with Superoxol to form a paste 3) technique – access, take start shade, isolate, clean, place bleaching material, seal with Cavit, monitor q 3-5 days and compare shade, replace bleach prn, remove bleach, restore

Summary: An approach to bleaching endodontically treated teeth without the use of a lamp using a paste of Sodium Perborate and Superoxol has been presented.

Reviewer’s Comments: 1963!