Internal bleaching

internal bleaching

Interested in internal bleaching after a root canal?

Internal bleaching or internal whitening is a procedure your dentist does to whiten a dark tooth after doing a root canal. The root canal may have been years ago or may be done at the same time as the bleaching. To see more images of before and after examples click this link.

Internal bleaching or internal whitening results seen here.

What are the internal bleaching steps?

Internal whitening is a two visit dental procedure. First of all we access the inside of the tooth and place the whitening agent. Finally, we remove the whitening agent and place a post or filling.

Step 1 of the internal whitening procedure

  1. We take a photo to document pre-op shade of tooth.
  2. Next we remove any filling and or any post in the tooth.
  3. If the tooth has not had a root canal then one is done.
  4. Remove some gutta percha to several mm below the crestal bone.
  5. Mix a solution of EDTA with an endoactivator.
  6. Place small layer of Vitrebond base over the gutta percha with a small syringe and a blue tip.
  7. Place the bleaching agent.
  8. Next place the bond and red flowable over the acess.
  9. Check bite and smooth

Step 2 of the internal bleaching protocol

  1. Check with he patient on the level of “whiteness”.
  2. Post op photo if everyone is happy.
  3. Remove filling covering the bleach and rinse it all out.
  4. See step 1 above if not white enough.
  5. Prepare post space
  6. Seat post with Rely x unicem 2 or parapost cement
  7. Cure
  8. Etch
  9. Bisco All Bond
  10. Bleach Filtek composite
  11. Check bite and smooth

What happens if the tooth whitening procedure does not work?

It will work. It may not work the first time though and there are several reasons this may be. The main reason I see for this is either we, the dentist, left some bonding inside the tooth OR the filling holding the bleaching agent inside the tooth comes off and the bleaching agent is lost. Below is an example of the filling on the back side of the tooth coming off too early. So instead of us finishing after one day, we finish up after day two. We do this by simply adding more bleach and trying again. You can see the second time was a success.

2 steps used to whiten this brown front tooth via internal bleaching.
As you can see the tooth did get lighter after the first day but the bleach was not in long enough. By the third day, after we add more bleach, the tooth is white again!

What does internal bleaching cost?

The fee will vary depending on where you live and who you see, therefore the answer depends! Our internal bleaching cost in 2018 is $576 and that number does not include the filling or post that we place after we are done. A fair fee for your zip code can be found by typing in the dental code below in the fee site fair health consumer. org, the number will probably be close to ours though.

Some internal bleaching before and after photos.

Below is a normal example of a before and after result. There are more dramatic examples that you can see by clicking our before and after link as well.

Before and after photo of internal bleaching
From dark tooth to white tooth!

What are the internal bleaching side effects?

A whiter tooth is a major side effect of this procedure, obviously! Real side effects are pain, and if you have ever whitened your teeth and gotten this pain then expect more. Another serious potential side effect is internal resorption. This is a possible but debatable side effect. Resorption comes from trauma, and teeth that need internal bleaching have always had trauma as well so may be a case of correlation and not causation.

A side note on side effects is that your tooth will get very white the first day. Sometimes far whiter than your other natural teeth. This is due to 2 factors. Number one if your natural teeth are not very white and in need of whitening then there will be a mismatch. The internal bleaching will make your tooth as white as you can get and if your others are not then you’ll notice. The second reason is the whitening gel we use will dehydrate the tooth and this leaves a tooth looking highly opaque. So your tooth will not stay as white as it first looks. It will rehydrate and some of the opaqueness will be lost.

Does internal bleaching hurt?

There will be some zingers the first day or night. If you use whitening gel, then you know what a zinger is.

What is the internal whitening dental code?

The dental code to use is D9974 and the code is a per tooth dental code. Therefore, if you have two teeth next to each other that need this then you code for both teeth individually.

Internal bleaching products and materials.

Probably one of the biggest debates is what material to whiten with and many people prefer sodium perborate to hydrogen peroxide. I have no strong feelings on the issue. I really do not have any strong opinions on products to use other than be sure to use a glass ionomer liner at the base.

What if the internal whitening works too well?

Tooth too white from internal bleaching
An example of a tooth with dehydration. This tooth was perfect after another couple days. The extra white color is mostly from the tooth dehydrating.

You may need to whiten your other teeth some. The fist few days the tooth will be much whiter than the surrounding teeth but this is due to dehydration and it will not stay this white. Typically the tooth will go from dark to super white and opaque to near perfect in just a few days.