Teeth whitening in a patient with a severely darkened upper central incisor

Whitening in a patient with a severely darkened upper central incisor

Every day we see cases of adult patients with darkened teeth caused by trauma suffered in childhood that was not treated properly. That is why, in most cases, we tend to propose teeth whitening as a solution to that darkening.

However, before making any decision and starting treatment, it is essential to know exactly what is causing the tooth to darken, and for that a number of things have to be taken into account.

TREATMENT:
Teeth whitening

DURATION:
A year and a half

1. We have to take an X-ray of the tooth to assess the state of the nerve
2. If the nerve has not been treated before and the tooth is dark, we have to carry out the tests needed to confirm the state of health of the nerve in the affected tooth.
3. If the nerve was treated in the past, we have to be 100% sure of its current state and, if it is inadequate, carry out re-treatment
4. Once we have the results, we have to act on them. If the nerve has a problem, we have to solve it before we can carry out whitening.

As with any dental procedure, diagnosis is the basis for
solving the case successfully.

Teeth whitening is a treatment that requires very specific preparation for each individual case, and even more so when the patient has an incisor with a dark discoloration that seriously affects the way their smile looks.

The case we are presenting here is that of a patient who came to us asking for 2 things: overall whitening of all her teeth and, in particular, of the upper right central incisor which, as you can see, had an unattractive gray mark in the area near the gum. 

After a thorough dental examination, we concluded that this was a tooth whose nerve had been treated in childhood and which, gradually and over the years, had taken on a very unattractive gray color. Much of the discoloration could be down to the materials used to treat the tooth in the past. 

The treatment we determined should be carried out was:

1. Re-doing the nerve treatment with modern materials and making sure the root canal would be completely clean.
2. Once that treatment was done, we could start whitening the darkened tooth by placing 35% carbamide peroxide inside it.
3. Just a week later the tooth looked completely different, since the unattractive gray mark had started to disappear.
4. The next and final step was to start whitening the rest of the teeth, using a combined technique of in-practice whitening with high concentration hydrogen peroxide and at-home whitening with 16% carbamide peroxide.

After the whitening treatment, we achieved:

1. A match between the color of the affected tooth and the rest of the teeth
2. The complete disappearance of the gray mark on the incisor
3. A full lightening of the color of every tooth
4. A bright, white smile

And, most importantly, meeting the patient’s objectives and giving her a happy smile.