Intracoronal bleaching: concerns and considerations

The history of intracoronal bleaching and the development of the walking bleach technique are reviewed. External cervical resorption associated with intracoronal bleaching is a serious sequela that has been reported in the literature. One explanation given for this phenomenon is that it results from an inflammatory process initiated by the presence of bleaching agents in the attachment apparatus. The basis for this conclusion is discussed. A review of published case reports on external cervical resorption associated with intracoronal bleaching revealed that: 100 per cent of the affected teeth had no intermediate dental base placed, 84 per cent were treated with a thermocatalytic technique, 80 per cent were bleached after the root canal sealer was fully set and 72 per cent had a history of trauma before bleaching. Based on these observations, it should be possible to safely bleach teeth intracoronally provided specific concerns and considerations are taken into account. These are: 1) the use of heat should be avoided; 2) an intermediate dental base should be placed with due respect to the attachment level; and 3) a base should be selected with due respect to its effectiveness in sealing tooth structure.