Internal Whitening Protocols Pt1 (Non Vital Bleaching) – PDP146

Non-vital bleaching or internal whitening comes in many forms, but it's often confusing which exact protocol to adopt. When you learn this technique you can make a HUGE difference to a patient's smile in a minimally invasive manner. Restorative Specialist Dr. AJ Ray-Chaudhuri covered the all-important diagnoses and indications of internal bleaching as well as how to treat tooth calcific metamorphosis (the obliterated pulp). We answer the key question: do you always need to have a root canal treatment present? https://youtu.be/mEHIypt-WW4 Watch PDP146 on Youtube The Protrusive Dental Pearl: When carrying out internal bleaching make sure to clean out the entire pulp chamber especially the necrotic pulp horns - clean the necrotic tissue inside using ultrasonics. Ensure the entire chamber is de-roofed - remember that these are mostly trauma cases and the pulp went necrotic in youth - hence large pulp chambers. No role for Ninja access here! Need to Read it? Check out the Full Episode Transcript below! Download Protrusive App on iOS and Android and Claim your Verifiable CPD/CE by answering a few questions + You can get EARLY ACCESS to the episode + EXCLUSIVE content Highlights of this episode: 3:03 The Protrusive Dental Pearl 5:55 Dr. AJ Ray-Chaudhuri’s journey into restorative dentistry13:02 Internal Bleaching Protocol15:45 Whitening obliterated pulp (Calcific Metamorphosis)21:22 No prep veneer/Composite veneer VS Tooth Whitening22:50 Q: Best time for Internal bleaching after Endodontics? STAY TUNED for Part 2 Next week when it gets really spicy - we have a PDF infographic to follow! If you enjoyed this episode, check out Post Operative Pain after Endodontics – Prevention and Management Click below for full episode transcript: Jaz's Introduction: Non-vital bleaching or internal bleaching is something that you don't really learn or get to practice at dental school. It's something that you don't really often get to do, but when you get to do it, you get to make a huge difference to a patient smile. Jaz's Introduction:But there's lots of different ways to do it. It can get very confusing and the first time you come across a case, you end up going online and searching for all the different papers and different techniques out. And you just end up getting confused, which is why I've got this killer two-part series with Dr. AJ Ray-Chaudhuri, restorative consultant. We both discuss the indications, the diagnoses, so basically it's two parts. This first part you listen to right now is going to cover his journey as a restorative consultant. The diagnoses that you can make, like when you have a yellow tooth, and you take a peri-apical radiograph and you observe that, 'Hey, where's the pulp gone? There is no canal anymore.' That's a calcific metamorphosis, right? That's a sclerosed canal, and that can be a discolored tooth. Now, how do you whiten that, and how is that different to an actual non-vital tooth where you actually drill an access cavity if there isn't one already and you whiten the tooth from within the tooth? So your diagnosis is really important. And some of the big questions that we cover are things like, do you always need to have a root canal treatment present? Does that root canal treatment need to be perfect quality, even if the patient is asymptomatic? And then we go on to discuss about which barrier material. Barrier material is something that you put over the gutter percha before you put the whitening gel to whiten the tooth. So these are all the nitty gritty things that we build up to. And in part two next week, wow. That's really going to go into the full protocol for non-vital or internal bleaching. Hello, Protruserati. I'm Jaz Gulati. Those of you who are listening, I probably sound a bit different. And those of you who are watching, yeah, I look in a different place. So, I'm actually in between Reading where I work and live and West London at the moment because my wife is heavily pregnant. And so we have a lot more family support in West London. So kind of between two places at the moment. But the show must go on, right? Protrusive must go on. And I owe you a killer episode because I've been so busy with OBAB, so happy it's been launched. As you'll know, it's been a really tough ride for me to actually put this occlusion course together, and I had to do it now before baby number two comes. But I'm just so happy I'm going to read to you the first bit of feedback that I've got. So at the end of every module we have a video like, 'Hey, congrats to finishing the module. What did you learn?' And so at the end of module one, so well done to the guys who already finished module one, remember this is a 30 hour course. So it's pretty killer. So, Aysha Dhanani, thanks so much. You wrote, 'I found myself wanting to click on the next video rather than fall asleep (what's happening to me?)' And then Aysha goes on to write all the things that she learned from module one so far. So that kind of feedback just means so much and there's loads more at the end of that lesson. I'm not going to bore you with. So it's been such a graph and so busy doing that, that it's about time I release an episode like this. This is like my Trump card. I've just kept this episode on the DL for you because I knew that you'd be a little bit upset with me, that 'Jaz, you haven't been dropping the pearls as regularly as you used to', but now I'm back. Okay? I know baby number two's coming, but I've got loads of content for you and you'll love this two-part series. Very comprehensive series with Dr. AJ Ray-Chaudhuri. Protrusive Dental PearlThe Protrusive Dental Pearl for this episode is very relevant for internal bleaching or inside outside bleaching or non-vital bleaching. Lots of different terms for it. And the pearl is that if you ever attempt to do this treatment, I'm hoping that this, by the end of the two part series, going to give you lots of confidence to take on cases like this. Like I said, these cases can be extremely rewarding and they can really lift up a smile, and it's a lot more intricate and more fun than just regular whitening. So a lot more to it, a lot more hands on. But when you get to do this, you have to make sure of one thing that you clean out the entire pulp chamber. Now, usually it's incisors that need this kind of treatment, right? Internal bleaching, and therefore the places where you might miss in terms of cleaning or your access cavity is the horns of an incisor. So make sure those necrotic horns are completely cleared out with ultrasonics and there's no necrotic tissue inside, which is not going to help your whitening. And also why would you want to have necrotic tissue, right? Like you don't want that, obviously in your root canal system. Now, for those of you watching, there's some images on the screen right now showing you how I've done a few cases before where when I've inherited it. The root canal was good, but the access cavity was insufficient. It was too small. So all you have to do is actually remove all the old material and really assess, have we gain full access to these pulp horns? Because remember these people with dark incisors, black and yellow, and various colors, even purple I've seen before. It's usually due to trauma at a young age, right? Maybe, 12, 13, that kind of stuff. And therefore the pulp chamber of these centrals and laterals and pulp horns are very large. So it's well worth cleaning out. There's no place for ninja access cavity. When you're doing this kind of treatment, ask me how I know. I've had a failure before many years ago, and that's where I learned that actually you can't do these tiny access cavities. You need to make them big enough for a reservoir, for your whitening gel. And also just to make sure you removed all the necrotic material. So lots of pearls where that came from. From this episode and the next one. I hope you enjoy these two parts. A full protocol guide to non-vital bleaching. Main Episode:AJ Ray-Chaudhuri, welcome to the Protrusive Dental Podcast. How are you, my friend? [AJ]I'm very well, thank you. Thank you for the very kind invite. [Jaz]This is going to be a really huge topic because I find that internal bleaching, I don’t know how you learned it, and it'd be great to hear about not only your journey into restorative dentistry and your a little bit about your career ladder and that kind of stuff. But in terms of specifically internal bleaching, How you get into it and how your GDP friends got into it because it's something that we don't really learn or do very unlikely to do at Dental School. Because it's more postgrad kind of stuff. And then when you get to DF1, you might see someone with a dark tooth and then you ask your principal, or you ask your trainer, how'd you do this? And then they have their own version that they do it. And then you might be brave enough to try it and you try to search some literature. So it'd be cool to learn about how you got into that. And then I've got some cases and failures to share and I know you do as well. And we could talk about your protocol and my protocol and just discuss a few things. So it'll be great to learn from you. But first, AJ, just tell me your journey into restorative dentistry. [AJ]Into restorative dentistry. So- [Jaz]And tell us also about where you work and what kind of stuff that you do. [AJ]Well, okay. I'll give you brief, I'll won't go back too far. So, born in India, move to England in 1986. Couldn't speak a word of English and I moved to Luton where it's not really necessary to speak English anyway. And then, secondary education. I went to King's College London and then kind of came out in VT went, it was in the Northampton Ski, which was just brilliant and probably quite important to know. I was got into dental school through clearing when it,