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1. INTRA CORONAL LIGHTENING OF DISCOLORED PULPLESS
TEETH: A MODIFIED WALKING BLEACH TECHNIQUE
Introduction:
Discolored anterior teeth is of serious esthetic concern to the
patient. Various treatment options are available for discolored anterior
teeth which includes bleaching, composite laminates, porcelain
laminates etc.
Although bleaching of teeth has a long history it was disregarded
for some time due to certain disadvantages. But bleaching is back again
as one of the treatment modalities for anterior discoloration.
Various bleaching techniques exists for vital and non vital teeth.
For non vital teeth walking bleach technique was previously used. This
however has certain disadvantages such as long duration of treatment
and cervical resorption. To overcome these disadvantages modified
walking bleach technique was developed. This technique employs 10%
carbamide peroxide.
Modified walking bleach technique minimizes the risks, because
treatment time is reduced to days rather than weeks as required in the
original walking bleach technique.
Here is a case presentation of the modified walking bleach
technique.

2. Case selection:
A discolored anterior tooth that has been endodontically treated is
selected. The tooth should be asymptomatic. Percussion and
radiographic examination should indicate a successful endodontic
treatment without any periapical or periodontal lesions.
Materials and Method:
This includes
• Nupro gold tooth whitening gel which is specially formulated with the
active ingredient of 10% carbamide peroxide a proven and extremely
effective tooth whitener. The gel has a high viscosity and exceptional
adhesive properties to extend contact time with the patients enamel
surface.
• Dycal
• Glass ionomer cement
• Clear custom made splint to retain and seal the intra coronal
medicament.
This photograph shows the discolored central incisor prior to
bleaching.
10% carbamide peroxide breaks down to 3.6% hydrogen
peroxide therefore the intra coronal technique is a little harmful due to
the potential risk of cervical root resorption. Thus obtaining an adequate

3. cervical seal that will prevent hydrogen peroxide from penetrating the
root at the cements enamel function is important.
- The coronal restoration is removal carefully.
- The coronal gutta-percha is then removed using gates glidden drill.
Approximately 3mm of root canal gutta-percha are removed apical to
the cements enamel function. The objective of removing root canal
gutta-percha is to create space for the restorative cervical seal and
to expose dentinal tubules directed toward the cervical region of the
tooth.
- A calcium hydroxide plug approximately 1mm in thickness is applied
to the freshly exposed gutta-percha. This prophylactic step aims to
maintain an alkaline medium because cervical resorption has been
associated with a drop in pH at the cervical level.
- The remaining 2mm depth of the cervical root canal access is sealed
with glass ionomer cement. This is crucial as to seal the root canal
from bacterial ingress during bleaching and to prevent contamination
of the gutta-percha fillings.
- An impression is made of the patients arch and a cast is prepared.
- A soft splint is fabricated on the working cast and trimmed to the
dimensions of a custom sports mouth guard.
- The patient is given a tube of neutral pH, 10% carbamide peroxide
and instructed to fill the pulp chamber every 2 hours until the desired
tooth lightening is reached. A syringe is used to flush the pulp

4. chamber with warm water each time prior to placement of the
carbamide peroxide gel.
- The splint is used to retain the bleaching agent and to prevent
ingress of debris into the access cavity. Patients are encouraged to
limit applications to daylight hours when reliable assessment of color
can be made.
- This photograph shows the whitened central incisor after bleaching
using the modified walking bleach technique.
On achieving the desired tooth lightening the access cavity is
restored with the tooth colored resin composite.
Result:
Two cases were selected for this study. The result obtained was
good following the application of 10% carbamide peroxide containing
bleaching agent.
The technique developed by William H. Riebenberg focuses on
obtaining an adequate cervical seal. The resorptive potential of
hydrogen peroxide has highlighted the importance of preventing
hydrogen peroxide from penetrating the root through the attachment
apparatus.
Conclusion:
Advantages: Are as follows

5. • Concentration of the bleaching agent used is low
• Heat is not required for this technique.
• The bleaching agent used is safe for both the patient and dental
staff.
• Duration of treatment is short compared to traditional walking bleach
technique.
Disadvantage:
The only disadvantage of this technique is patient compliance as
it requires the patient to fill the pulp chamber with the bleaching agent
every 2 hours.

6. • Concentration of the bleaching agent used is low
• Heat is not required for this technique.
• The bleaching agent used is safe for both the patient and dental
staff.
• Duration of treatment is short compared to traditional walking bleach
technique.
Disadvantage:
The only disadvantage of this technique is patient compliance as
it requires the patient to fill the pulp chamber with the bleaching agent
every 2 hours.