Internal Whitening Protocols Pt2 (Non Vital Bleaching) – PDP147
27.04.2023
0:00
NaN:NaN:NaN
Following the cliffhanger from Part 1 where the theme was Diagnosis - we now discuss the two main protocols of internal bleaching: the Inside-Outside Bleaching technique and Walking Bleach Technique for non-vital teeth whitening.
In this episode Dr. AJ Ray-Chaudhuri discussed how to prevent peroxide gel from entering the root canal system while performing non-vital bleaching. We cover every detail of the procedure and offer step-by-step guidance on how to make a tray, how much to charge patients, which gels to use and much more.
https://youtu.be/5Pl238679j4
Watch PDP147 on Youtube
Protrusive Dental Pearl: The full protocol workflow - summarised PDF of Part 1 and 2 of this Internal Bleaching Series plus the patient advice sheet AND lab instruction sheet by Dr. AJ Ray-Chaudhuri
Click Here to Request the PDFs
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
Need to Read it? Check out the Full Episode Transcript below!
Highlights of this episode:
2:28 Protrusive Dental Pearl3:40 Tips and Advice for Internal Bleaching in Practice7:21 The Inside-Outside Whitening Technique17:45 Internal Bleaching Protocol23:21 Getting the proper access cavity27:21 Dealing with patients who do not follow instructions well31:47 Considerations and Tips to maximize success or to avoid mistakes33:08 Internal resorption and relapse
If you enjoyed this episode, check out the first part of this episode: Internal Whitening Protocols Pt1 (Non-Vital Bleaching)
Click below for full episode transcript:
Jaz's Introduction: Hello, Protruserati. I'm Jaz Gulati, and you are listening to this episode because you've just finished part one and you are pumped to get into the full protocols for internal bleaching where Dr. AJ Ray-Chaudhuri, or you just clicked on.
Jaz's Introduction:Because you've got a patient next week who's got a black tooth and you want to follow all the protrusive pearls shared in this full guide on how to actually carry out internal beach treatment, or you are in luck because we cover all those things today.
In the previous episode, so part one of internal bleaching we covered about getting your diagnosis right, making sure you've got a really good root canal treatment, and also the difference between a yellow tooth, which is more likely be like a calcific metamorphosis versus an actual non vital tooth. Now, why one will not need a root canal treatment?
So if you haven't listened to that one yet, please go back one episode and check that one out. Now towards the end of that episode, I left you on a cliffhanger because you got really saucy. We started talking about barrier materials. Like what material, what restorative materials should you put over your gutta percha before you put your whitening gel, right?
Because the logic says that we need to put a barrier to prevent our peroxide gel from actually going into the root canal system. But you know what? I'm going to give you a spoiler now, right? What AJ actually practices is no barrier material, providing you don't have a scope because the problem is like, imagine you don't have a scope and you're going to provide some sort of a barrier.
Like have you ever tried placing GIC deep down three millimeters below the CEJ? And how difficult it is not to smear that glass ionomer material all the way up the tubules. Because if you smear them, then how is that whitening gel? How is the proxide gel going to enter the tubules? And that's when you get ineffective whitening.
That's when most of the tooth whitenings, but you get a neck that's still discolored. So his argument actually is really good. So we'll listen to that first thing up. But we also talk about my protocol and what I've done as well. We go through every single detail and step-by-step protocol of non-vital bleaching, including tray design, how much to charge your patient, which gel to use, what do you put over the gel, but before the restorative material, yada, yada, yada.
There's a lot of ground we cover when it comes to internal bleaching. There's the ultimate guide you always wished you had. Hello, Protruserati. I'm Jaz Gulati and if you didn't hear from the previous episode, I'm not in my usual recording studio. So sorry if I sound a bit different. I'm also a little bit ill at the moment, so probably sound a bit nasal, but I look different because I'm in West London where my parents and my in-laws are.
So we got a lot of family support as my wife's heavily pregnant, expecting baby number two any day now. So that's why I'm in a different place. But the show must go on. You're going to love the Protrusive Dental Pearl. Not only did we summarize the both those episodes and easy to follow diagram with a flow chart just like we did for the icon one also, which is the best ceramic episode, and you can download that.
Plus AJ is very kindly donated his patient advice sheet and his lab sheet, so you get. Three PDFs. Now, if you're Protrusive Premium, head over to the app or the web app, which is protrusive.app, and then you can actually just download it. It's there in the Protrusive Vault section. Go ahead, download it right away.
But if you're not Protrusive Premium, and if you want to gain from this pearl, head over to protrusive.co.uk/blacktooth, or one word that's /blacktooth and you'll get all three PDFs. So thanks AJ for donating yours and the protrusive team have put together this fantastic little diagram inspired by these two episodes.
There's loads of facets to this part two is very, very clinical, it's very geeky. But we also talk about communication, like patients often use the word 'perfect'. They want things to be perfect and there's lots of connotations and things to be careful when we're talking about perfect. Because remember, beauty is in the eye of the beholder.
So AJ actually talks a lot about communication when it comes to doing this kind of treatment, which I think is absolutely golden. So please enjoy this episode, I'll catch you in the outro. Main Episode:Any tips and advice you can give to the humble GDP try and do this in practice?
[AJ]For the humble GDP who does the vast majority of the dentistry in the UK. I'll tell you what I do. I don't put a seal on that. And I was taught this technique by Martin Kelleher and he published that paper, the original paper, one of the original UK papers with Poiser. Peter Briggs and Martin Kelleher and he said, 'AJ, why are you sealing it?' Firstly, you can't do it well.
And for the exactly the reasons you described, because this is when I was a first year registrar, I couldn't use a microscope. I couldn't use that microscope until much later. So he goes, 'AJ, you're just going to smear all of this up the walls. It's going to look like a bird poo in there'. And the second thing is, he goes, 'and also what you're filling it with, we are filling this with carbamide peroxide, which is dissociating into hydrogen peroxide'.
' What is hydrogen peroxide, AJ? What's Its job?' Obviously as a 28 year registrar, I not the first idea, and Martin Kelleher is just in many ways a polymath, and we say, 'well, AJ, let me give you a history lesson and it would be a long one', but cycle forward, he goes, 'well, have you heard of Vincent Angina?'
No, ANUG. We just about heard about it. Trench mouth, maybe heard about it. He goes, 'well, actually, one of the reasons we used hydrogen peroxide was actually because it releases lots of oxygen, is very good for killing anaerobic bacteria. And that's all they kind of had a hundred years ago to stop ANUG and ANUP occurring in the trenches'.
So one of its primary jobs as we discovered it is to kill bacteria. So you're filling this entire chamber with a enormously hostile oxidizing product. You're not going to get any bacteria in there, AJ. And actually-
[Jaz]Especially for the short while that you're working and doing this procedure, it may not be worth without a scope to make it so messy with the glass enema.
So I really respect that you said that actually, if you're in that scenario and you haven't got access to a scope and you haven't done this before, then maybe just to have a really good root filling root seal with the GP at the correct level, three to four millimeters below the CEJ. And then allow the proxide to get in there. Right?
[AJ]Absolutely. And except that's a niche, that may be a niche opinion. And if I'm doing my own whitening, which I almost always do, but if I'm returning it to a colleague, right? The colleagues that I work with in private cloud, they're just brilliant. I've got no problems that they're going to drop the ball.
I worry about the patient in between who goes floating off, and that's when I want to seal something. So under those circumstances, I will see it. If I'm doing the endodontics of somebody else. I don't have any strong views on what should be in there, really. I think it can be GIC. Or it can be something like IRM or kalzinol, so something zinc oxide eugenol based.
But I'll be placing it using a microscope if you're going to do it. It doesn't have to be a microscope, but I think you need magnification. And the trick is not to go runny. The trick is to the opposite. You get your nurse to get it, let's say GIC or whatever. And so it's almost crumbly. And then you pick it up and you pack it in there.
So it should be rollable into a sausage and you pack it into and go for the tiniest amount you can. Pack it into there and as long as soon as you've got a seal of a millimeter or two, you're fine. But the important thing is not to smear it up the walls, and that's one of the reasons I quite like. Something like radio-opaque ketac chem which is a white GIC, old-fashioned GIC.
Or IRM because it's white. So if I have submitted up the walls which you will still do,
Więcej odcinków z kanału "Protrusive Dental Podcast"
Nie przegap odcinka z kanału “Protrusive Dental Podcast”! Subskrybuj bezpłatnie w aplikacji GetPodcast.
