One of our most-followed Townies explains how
to treat endodontically treated discolored teeth
by Dr. Terry Shaw
Case 1
This 60-year-old patient tripped over her cat and whacked her left central. The luxated tooth moved 2 mm
palatally, and although the patient could “straighten it” by closing her teeth together to move it back into
place, after a few weeks the tooth also was obviously discoloured (Figs. 1 and 2), which finally inspired her to
come in. I performed a root canal treatment, then placed some Opalescence Endo whitening gel (Ultradent)
inside the tooth to help whiten it.
Before injecting the 35% hydrogen peroxide gel, I placed a plug of Ketac-Cem glass ionomer cement (3M)
using an endodontic orifice locator, and let the GI cement harden in the tooth at the crestal bone level. This
is important to prevent the bleach from migrating out the canal and irritating the apical tissues—even if you
think it’s well sealed, the bleach will still get past the cemented gutta-percha!
Fig. 1
Fig. 2
Fig. 3: One week after treatment, the tooth was bleached whiter than the adjacent teeth.
Figs. 4 and 5: The tooth will probably regress slightly over time.
Fig. 6: Access opening.
Fig. 7: Tooth with first increment in place.
Fig. 8: Composite added.
Fig. 9: Finished.
Fig. 10: On the X-ray, you can see the glass ionomer plug between the gutta-percha and the composite restoration.
The patient told me she thought her tooth had been moved down out of the socket
slightly—because this appeared to be the truth, I shaved a bit off the tooth when I finished
adjusting it after placing the restoration.
Case 2
Fig. 11: An old RCT with lots of discoloration.
Figs. 12–14: Cleaning out the old composite and stained material.
Fig. 15: After removing the old stain and placing glass ionomer over the gutta-percha at the crestal level. Looking better already!
Fig. 16: X-rays at the start.
Fig. 17: The patient lives more than
200 miles away, so they returned after
nearly one month so I could continue
the restoration work.
Fig. 18: Old restoration and decay
removed from adjacent tooth.
Fig. 19: Incisal view.
Fig. 20: Pulp chamber with
first increment added.
Fig. 21: Larger increment added to
distal, lingual and buccal surfaces.
Figs. 22 and 23: Adding composite.
I included a little over the buccal incisal
enamel, which I will finish to a featheredge
margin.
Figs. 24–26: Finished restoration.
Case 3
Fig. 27: Three root canals staining
badly. For what it’s worth, I always
clean out the gutta-percha after I do
my root canal treatment to the crestal
bone level, and place composite in the
canal from the crestal bone level to the
palatal or occlusal surface. I strongly
believe doing so reinforces the tooth,
and they very seldom break. I find
these last for many years, rather than
placing a post and doing a crown prep
and crown. Much less tooth structure
is removed—and I have many that
are 40 years old and have never been
touched.
Fig. 28: Canals cleaned out. Lateral
had a lot of black material in it
Fig. 29: The centrals were nonvital
and had no pulps visible on the
X-ray. I tried to access them but
couldn’t find any canal.
Fig. 30: Teeth with glass ionomer over
access area and bleach in canals, plus
etch composite temps in lingual.
Fig. 31: Etched composite restorations in the lingual.
Fig. 32: Four weeks went by because
this fellow works in the west of Canada
for three to four weeks at a time.
Fig. 33: Most teeth became much
whiter. The lateral had some labial
composite I hadn’t seen, so I decided
to rebleach it and also restore the
centrals with composite.
Figs. 34 and 35: All cleaned out.
Fig. 36: The lateral is still dark.
Fig. 37: Centrals restored.
Fig. 38: Lateral being rebleached
for one more week.
Fig. 39: After one week, restoring
the distal of the patient’s left central
before doing his lateral.
Fig. 40: You’ll notice that his lateral is
palatal to the central, so I decided to
add composite to the lateral and move
the labial surface forward, so it looks
more even and blends better with his
other teeth. (Plus, I could get the color
whiter because the tooth didn’t bleach
as well as his centrals.)
Figs. 41 and 42: The lateral was also quite round, so I flattened it as well.
Fig. 43: Before we started.
Fig. 44: Definitely looking better!