endodontically treated tooth has been described. Known as the inside/outside
bleaching technique, it is essentially a combination of the walking and vital bleaching
techniques. Tooth preparation is the same as described for the walking bleach
technique (section 10.2.2) with particular attention being paid to removal of the gutta
percha below the cemento-enamel junction followed by the placement of a barrier
(usually a glass ionomer cement or zinc oxide eugenol cement) to seal the root canal
from the oral cavity. A custom made tray (see 529HFig. 10.5 (b)) is constructed as a
vehicle for the bleaching gel. However, rather than creating space labially as in the
vital bleaching technique a small reservoir is created palatal to the affected tooth only.
The gel, 10% carbamide peroxide, is placed by the patient into both the access cavity
of the non-vital tooth and the tray. The tray is then worn full time for up to 4 days, the
gel being replaced every 2-4 h. Once an aesthetically acceptable result is achieved the
access cavity is refilled appropriately. Long-term results are not yet available for this
approach with relapse being as likely as any of the other bleaching techniques.
530H
Fig. 10.5 (a) Model of upper arch with
wax relief for construction of a night
guard. (b) Mouthguard being loaded with
carbamide peroxide gel.10.2.4 Vital bleaching⎯chairside
This technique involves the external application of hydrogen peroxide to the surface
of the tooth followed by its activation with a heat source. The technique has achieved
considerable success in the United States, but it is a lengthy and time-consuming
procedure that requires a high degree of patient compliance and motivation.
Indications
(1) very mild tetracycline staining without obvious banding;