Endo and Internal Bleaching - Dental Minute with Steven T. Cutbirth, DDS

CLICK HERE NOW to find out how to take your practice to the highest level of technique and productivity by joining Dr. Cutbirth’s: www.DentistryMasterClasses.com.
In this Dental Minute video, Dr. Cutbirth discusses endo and internal bleaching.
Dr. Cutbirth is the Founding Director of the Center for Aesthetic Restorative Dentistry (CARD) (www.CenterforARD.com) and maintains a full-time restorative and cosmetic practice (www.WacoSedationDentist.com).
Edited by Bo Ellis.

[@joshalum732]

Great stuff. We don't do much internal bleaching in dental school, simply because there is not enough cases. I am glad i found this video to see how the procedure works. Thanks doc

[@centerforard]

You are welcome.

[@dudiqashmar5609]

Thank you professor. Wow, how much I enjoy watching your super useful videos, especially as student that can take your tips and perform it in workshops at clinic..

[@kalyanitarejoshi3530]

I learned a lot from your detailed video.. I am always hesitant about internal bleaching procedure.. but seeing it now seems much easier.. loved your in depth n precise clinical tips.. thanks a ton..

[@centerforard]

Glad you liked he video. Subscribe to DentistryMasterClasses.com for an organized library of all the DM videos plus many complete comprehensive cases. Only $20/month.

[@truthmode6704]

This was the dental 21 minutes. Dr. C you are always fantastic. I am a new practitioner and love all your videos.

[@centerforard]

Subscribe to DentistryMasterClasses.com. An organized library of all DM videos plus many complete comprehensive cases not seen in DM videos.

[@drtusharjaipuria2107]

Really neat and complete work done sir. Thanks for sharing your wisdom... Please keep doing it..

[@centerforard]

Subscribe to DentistryMasterClasses.com. There is a library of all Dental Minute and DentistryMasterClasses.com cases. DMC.com is comprehensive, complex cases in addition to the basics. Very inexpensive! $15/month. I want everyone interested in becoming an excellent dentist to be able to afford to subscribe!

[@mahmoudsayed9602]

Thanks Dr.Steven for such great video .

[@centerforard]

You are welcome. Subscribe to DentistryMasterClasses.com if you like this!

[@despinatouratzidou8327]

I am a new practitioner myself! I love how you share tips that dental schools just havent taught us! Thank you!

[@centerforard]

You are welcome. Glad the videos are helpful. I have a lot of excellent training, great mentors and many years of experience with basic and complicated cases. My objective is to provide practical teaching videos that anyone can understand and use. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@laipubamfabinasharma8959]

Great tip on the bleach. Wish I had seen this earlier. I struggled with putting it in the canal few days back. Thank you Doc! 😊

[@centerforard]

Glad you liked the procedure. All the procedures I am teaching in The Dental Minute and DentistryMasterClasses.com work well. I have been doing this work at the highest level on very discriminating patients for 37 years. The procedures have to work!

[@herminioamuniz]

Great job. Really captivated my your explanation.

[@centerforard]

Great. Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@tahaciltas8022]

Thank you very much for subtitle and your sharing sir.

[@centerforard]

You are welcome.

[@shajalkarmakar4612]

Excellent presentation doctor.

[@centerforard]

Thank you. Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@yellowinspirit2673]

Your video is very helpful , Thank you Doctor 😊

[@centerforard]

Glad it was helpful!

[@hasansaleh6232]

As usual great video

[@centerforard]

You are welcome.

[@impact7113]

Very informative thank you so much Dr

[@centerforard]

You are welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@garrettbuck512]

Awesome. Enjoy your vids. Keep it up!

[@centerforard]

OK! Subscribe to DentistryMasterClasses.com. That is the best. Complex and basic comprehensive cases plus a library of all Dental Minute and DentistryMasterClasses.com cases. Cheap! $15/month. Cancel at any time ..... but you will never cancel because the information/cases are so good!

[@rubasarkez9917]

Very informative 👏🏻 thank you for your effort 👌🏻

[@centerforard]

You are welcome. Glad the video was helpful.

[@rajitharanvijayasekaram5862]

Your patients will laaaaaw you and Wham!. I love your expressions

[@centerforard]

Thank you. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@mahmoudmarzouk7507]

Thank you Dr Steven

[@centerforard]

Welcome. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@siddhanthiwale5325]

Hi doc !! Being a dentist myself...I admire your work. The way you present your cases, it is so precise and well detailed. I would love it if you present a case of vital tooth bleaching. It would be really helpful.

[@centerforard]

Are you referring to bleaching with take home trays or something in-office, like "Zoom?" I am not a fan of "in office" bleaching with systems like Zoom be cause of the hypersensitivity patients experience post op if there is any gingival recession. If you use the "in office systems," be sure the patient does not have any gingival recession or teeth that are sensitive to cold (ice) at the gumline. Also, do not place the bleach/light on the teeth for more than about 10 minutes at a time. I prefer at home bleaching with trays because the bleach is not as concentrated and does not produce much sensitivity, especially if you instruct the patient not to wear the trays more than 30 minutes daily, especially during the first days. The same result is achieved with at home bleaching, it just takes 4-5 days. Remember, the degree of tooth whitening achieved has more to do with where the yellow/darkness is present in the teeth. If the yellow comes from the enamel, you will look like a genius because the teeth will probably bleach well. If, however, the yellow shade is from the dentin, those teeth will not bleach as well and if the patient desires a whiter tooth, veneers will be required.

[@siddhanthiwale5325]

@@centerforard Even I prefer the home bleaching over the in-office way. Good to know that we share the same view. Thank you for the reply. Stay safe !

[@sivawilson]

Love his teaching

[@centerforard]

Thank you. I hope you subscribe to DentistryMasterClasses.com. That is the best material.

[@sharadpradhan3655]

Best channel

[@centerforard]

Thank you. Glad you like the videos. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@daptomycinabd541]

Great video !thank you

[@centerforard]

You are welcome.

[@dr.adityasharma7332]

Thankyou alot!! Dr steven sir

[@centerforard]

You are welcome!

[@asmahafizi736]

i wished that i had an amazing instructor like you i have learnt many new tips from your great speach love and respect from afghanistan ,could you please make more educational video?

[@centerforard]

I narrate over the recorded videos almost every Friday and Saturday morning. Subscribe to DentistryMasterClasses.com. There is an organized library of all the Dental Minute videos plus many other comprehensive complete cases. We are adding to the library weekly.

[@Lily-gi8uy]

Thank you so much for sharing your technique and tips on this Dr. Cutbirth! Quick question, would internal bleaching not be as effective if tooth was already obturated?

[@centerforard]

If the endo were already completed prior to internal bleaching, it will be difficult to internally bleach if the pulp chamber were filled with composite. You would have to try and remove the bonded composite and also remove additional dentin to have a chance of the internal bleach reaching the stained area. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.

[@TubesWidener]

Excellent result as always. Thank you for good info. One question please, why Na-perborate and superoxal? Are they better in internal bleaching than bleaching gel, in terms of effect and durability of the bleached color?

[@centerforard]

I have not heard of using external tray bleaching gel for internal bleaching. I think there is something about the effervescence of the Na perborate and supernal that pushes the peroxide into the stained dentinal tubules under pressure.

[@samaa8354]

Up

[@jtapia92]

I would love to work under you, I would learn so much honestly, wouldn't expect pay. You spew so much knowledge. Thank you for the diferent perspective

[@centerforard]

Attend the CARD classes in Dallas. There are 5 - 2 day, Friday, Saturday courses annually, spaced about 2-3 months apart. Also subscribe to DentistryMasterClasses.com. Only $15/month. There is an organized library of all the Dental Minute videos plus many complete comprehensive cases and important articles.

[@rtyankeedoodle]

Very informative Mr Stevens. Can't we use light cure GIC instead of IRM for a better seal ?

[@centerforard]

If you wish. I am teaching only one method, that works effectively, for each procedure. There are probably other ways to do many of the procedures. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@sunnindawg]

Key point 7:24 about reabsorption. Fantastic bleaching technique.

[@centerforard]

Thank you. Glad the video was helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@AkashSingh-fw5zf]

Same accident happened with me but my dentist suggested me a crown after RCT. Now, I will share this technique to him.

[@centerforard]

Terrific.

[@colinkanobe]

Amazing!!

[@centerforard]

Thank you. Glad you like it. DentistryMasterClasses.com. Check it out!

[@Fatdogchannel]

Thank you sirr for sharing

[@centerforard]

You are welcome.

[@informaldentist]

thanku 😃😃😃😃

[@dineshkdinu4213]

Thank you so much sir for such a beautiful video.

[@centerforard]

You are welcome.

[@neharoxx1]

Thank you sir

[@centerforard]

Welcome.

[@hoburton]

Dr. Cutbirth, may I ask about the reason behind rinsing the canal with anesthetics? Thank you very much!

[@centerforard]

The 30 gauge needle is small enough to fit loosely into the canal without causing apical pressure when the liquid is gently injected. It is the 30 gauge needle, not the anesthetic, that is important. I am rinsing out the dilute sodium hypochlorite and any loose debris prior to drying the canal.

[@IndigoBass]

I’m not even a dentist I’m a musician, why am I enjoying this?!

[@centerforard]

Ha, ha, glad you enjoyed the video!

[@derekwang6023]

great share, Doc. what's the purpose of using local anesthetic to rinse the canal? I mean, you have already taken out the pulp. thank you

[@centerforard]

I anesthetize if I am doing any filing. Part of it is for the psychological comfort of the patient. They don't have to worry about any unexpected discomfort.

[@centerforard]

I am using local anesthesia to rinse the canal only because the solution is delivered in the small 30 gauge syringe. The main irrigant is water mixed with NaOCl. The 30 gauge syringe/local anesthesia is just used to rinse out the NaOCl and any remaining debris. Water through the 30 gauge syringe would be just as effective. Be sure not to apply pressure with the syringe. Just "float" the liquid/debris to the top of the canal.

[@laurenchen1478]

Hello Doctor. If a tooth is dead, would you recommend root canal and internal bleaching immediately or wait until tooth becomes noticeably discolored?

[@sarahshehab2525]

great video, I just have a question , why you choose to put zinc oxyde eugenol under the composite knowing that the wugenol inhebit composite polymerization ? or this IRM does not contain eugenol ? thanks

[@centerforard]

The IRM is mixed very dry and packed hard. If there is any composite polymerization inhibition, I feel it is minimal. I have never had any problems with this method in almost 40 years of practice. Be sure to mix the IRM as dry as possible.

[@sarahshehab2525]

@@centerforard i will finish my exams and register in your site .... THANK YOU FOR YOUR TIME AND EFFORT .... APPRECIATED .

[@ahmedelhossain8833]

I am a dentist, and i am telling you," you are awesome. "

[@centerforard]

Thank you. Subscribe to DentistryMasterClasses.com. There is an organized library of all the Dental Minute videos plus many complete comprehensive cases.

[@marydannelle9914]

This is amazing! How many hours did you work with the patient in each appointment Doc? I'm currently a dental student, and I'm quite slow in procedures but I never want to rush. How long does it usually take to do RCT on a monorooted tooth?

[@centerforard]

I normally schedule 1 hour for an endo procedure if that is all I am doing. Normally, the patient is sedated with an IV and I am performing additional procedures along with the endo.

[@marydannelle9914]

@@centerforard Thanks for the info Doc :) love your videos. Hope to apply them when I start working. God bless!

[@centerforard]

Take your practice to the Top Tier. Subscribe to www.DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases. New cases added weekly. Do this now while you are in dental school.

[@vinhduong398]

I don't know if you mentioned this but how many cases have you had that came back with external cervical resorption?

[@centerforard]

I do not remember any cases. I occasionally see internal resorption in teeth that have been previously traumatized. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month.

[@kikaresendez8273]

My 13 year old son had a root canal on tooth #8 and internal bleaching 3 times. His tooth never lightened up and is still gray. The endodontist’s technique was very different from yours. Instead he mixed the peroxide with the pellets and used an instrument to push the pellets in the hole. I’m not saying he did it wrong. Just curious if you think we should seek out a different endodontist and continue trying internal bleaching?

[@centerforard]

Unfortunately, I have also had the occasionally internally bleached tooth lighten well, then darken a bit some months later. I do not know what causes the darkening to return. I always tell my patients receiving internal bleaching that any bleaching procedure is abstract, i.e., you never know what the exact outcome will be, so veneers may also be necessary. I have never had an internally bleached tooth that did not bleach somewhat lighter, but you cannot predict the exact amount of shade lightening.

[@camilapoblete526]

Hii Doctor, i want to know wich software or application do you use for mesure the lenght of the radiography thanks Greetings from Chile

[@centerforard]

I use Dentrix software. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@khalidahmed5903]

Hi sir! So my question is did u leave the hydrogen peroxide cotten inside the canal or you just wiped it and then removed.

[@centerforard]

Don't leave the cotton pellet in the chamber. Fill the chamber with the sodium perborate crystals soaked in the 30% hydrogen peroxide then seal the chamber on the palatal side with a thick, dense paste of IRM.

[@nikolacurcic4967]

Dear doctor ,why should we finish our irrigation with local anesthetic ? What do we get from it ? Is it better solution than saline ?

[@centerforard]

No, the local anesthetic is of no significance. The 30 gauge needle used to deliver the anesthetic is the important part. The needle is an ideal size to irrigate the canals. It just so happens the anesthetic is easily delivered by the needle. If there was water being delivered by the 30 gauge syringe, it would work just as well.

[@Prime72]

Good video! I would suggest to use a base that does not contain eugenol as to not inhibit the curing of the the composite resin, like GIC.

[@centerforard]

I have used IRM for 40 years as a base under composite fillings without any composite curing issues. You have to be sure the IRM has hardened so the eugenol does not affect the composite. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@Prime72]

@@centerforard I still find GIC much more time efficient.

[@centerforard]

Thanks for your comment and suggestion.

[@centerforard]

I want to be able to remove the material in the pulp chamber if necessary for some reason. IRM can be completely removed if needed. I do not think Glass Ionomer Cement could be completely removed from the pulp chamber/dentinal tubules if you needed to remove it. It would be more like trying to remove composite primer adhesive from the dentinal tubules. Do you agree?

[@calvinth6568]

Hey doc. How do you feel about about using household bleach? Would you use the same 3:1 water to bleach ratio?

[@centerforard]

Yes. I do not like to use undiluted NaOCl.

[@user-un5bc1ln8t]

I have a question : in endodontic treatment at any conditions or what is the cases that require to leave the tooth open for drainage ? need your opinion doctor plz every thing you do is great , awesome

[@centerforard]

I cannot remember the last time I left a canal open and did not complete the endodontics in one appointment. There is normally no reason to leave a canal open so long as you file and irrigate effectively. If there is infection, I premedicate the patient with antibiotics (normally 1000 mg Kellex or Amoxicillin), file 1 mm past the apical foramen with a #10 Hedstrom file, irrigate well and let the infection drain out the coronal part of the canal for 5-10 minutes until there is no drainage. If you filed and irrigated the canal well, the source of the infection (necrotic pulp) is gone and there will be no post operative problem. Be sure to put the patient on 500 mg Keflex, Amoxicillin or another appropriate antibiotic tid for 5 days post op.

[@user-un5bc1ln8t]

I asked this question because this issue is controversial in Libya , as most of dentists leave the canal open . Thank you very much . Dr. Steven , for all the information really you are great man

[@user-un5bc1ln8t]

When should I premedicate the patient ??

[@centerforard]

Premedication is not recommended as often as it used to be in the US. I would pre medicate and post medicate my patient if there was infection in a maxillary anterior tooth because of the possibility of a brain abscess. I would also premeditate a patient just prior to the endodontic procedure if there was significant periapical infection in any tooth (2000mg Keflex or Amoxicillin pre-med) normally followed by 5 days of 500mg Keflex, Amoxicillin or another antibiotic tid if the patient is allergic to K or A. We do not pre-med with antibiotics for heart murmurs, heart valves, joint replacements, previous rheumatic fever or other things like these like we used to. Look up the recommendations for dental antibiotic premedication on Google.

[@BD-ez3ky]

I have a yellow upper front tooth from past trauma. Xray shows the pulp has filled with calcium. My dentist recommends I do not do vaneer, crown, or internal bleaching because I have bruxism. But the yellow tooth bothers me and I want to fix it. My dentist said bleaching will make the tooth more frail and prone to cracking/breaking, and says a vaneer or crown is not a good idea because I will easily break it with my bruxism. I wear a dental mouth splint every night for my bruxism. Do I have any options to fix my tooth while also considering my bruxism condition?

[@centerforard]

Absolutely. You do not have to live with a dark tooth. I cannot diagnose you without examining you, but there are several options to significantly improve the cosmetics of your condition.

[@willwyatt7023]

Have you ever used the EndoVac system for NaOCl irrigation? And, I've had trouble with internally bleached teeth darkening again after a few years.

[@CousinHubertRetrogaming]

Will Wyatt it's perfectly normal, even with a perfectly waterproof seal of the final filling. Because the tooth is dead, there is no positive pressure inside the dentinal tubules to prevent outside contamination, so the pigments from the outside come in again in a few years. I've done many endo bleachings. Using only sodium perborate crystals works equally well with full original tooth color retrieval possible.

[@centerforard]

I am not sure why they darken again. I have not experienced that problem with this method. I have not used the EndoVac system. I like simple when possible.

[@willwyatt7023]

The Endovac system, while effective is NOT simple.

[@rdraj535]

Which is the best way endo bleaching or ceramic crown, I have same problem.

[@centerforard]

It depends. Internal bleaching is the most conservative approach for treating a tooth that has darkened following endodontic treatment, but the final shade is not as predictable as with a crown or veneer.

[@blotzkrog]

is there a specific reason why you'd use LA to irrigate the canal doc? 16:26 i assume water cant be used here but idk why 6:42

[@centerforard]

I only use local anesthetic because it happens to be the liquid in the carpule that is connected with the 30 gauge needle. It's the small, 30 gauge needle that is the key. The small needle fits into the coronal part of the canal, without being constricted, so minimum apical pressure is applied within the canal, to flush out the remaining dilute sodium hypochlorite and any tooth debris from the canal prior to drying the canal with paper points. An endodontist taught me this method many years ago. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@okokok3600]

DOctor tell me pleas i have this problem in my front teeth .. why the technology loser to now not solving this problem and let the root go white as first time without this all i mean just using liser ?? and did this your way let the teeth always white or it back agine black ?

[@centerforard]

This is the only technique I know. The tooth stays white with the method I describe.

[@rubybaybay2854]

Hi! I thought IRM should no be placed as a base when using composites. Because the composite covering the IRM will not cure. Is this true doc?

[@centerforard]

I have also heard that for a long time. I was taught to place IRM as an intermediate build up prior to placement of the overlay composite build-up. In many years of practice, I have never had a composite build-up placed over an intermediate IRM build-up not cure or come out. I like the IRM because it is a good "larger space" filler and, if for any reason one had to access the filled canal to remove the gutta for a post or some other reason, it would be easier because the IRM is white and could be tracked directly to the filled canal orafice. I allow the IRM to cure completely for about 15 minutes before placing the composite overlay. Bottom line, it is not a problem placing straight composite in the orafice. I have just always used a combination of IRM and composite with 100% success.. Personal preference.

[@rubybaybay2854]

Thanks for sharing your knowledge. God bless !

[@krishnakrish5487]

Thank you sir .Iam happy to see this video. Sir question to you I have black death tooth is it possible to make as white for long run ? When I seen my teeth iam disappointed but I got hurt while was playing the mach. What should do sir to my tooth? Is death tooth comes for life? Please help me out.

[@centerforard]

You can definitely internally bleach a dark, necrotic tooth, which means the nerve of the tooth is dead, and make the tooth whiter.

[@krishnakrish5487]

Thank you Dr. I will do that.

[@maneldali6458]

@@krishnakrish5487 u do it ?

[@aprilroman7371]

I’m sadly one of these cases. Matter of fact they are my 3 front teeth 😭😭 they were filled with dark fillings as well. One of my root canals has failed 2x and basically has to be extracted. I wish I was in Waco instead of San Diego, dentists here only care about making money and not their patients 😭

[@centerforard]

Sorry.

[@TheBasselious]

How does the composite cure properly over the IRM? Doesn't the Eugenol in the IRM inhibit that?

[@centerforard]

No problem. Let the IRM set completely, then cure the unfilled resin (primer/adhesive) placed over the IRM. There will be no problem.

[@nonakareem5092]

Hi dr Does it hurt? How many sessions (appointments) needing in general ?

[@centerforard]

No pain. 1 session.

[@yulianasglam317]

Hi, I would love to get this procedure done by you!.. where are you located? Please and thank you. 😊

[@centerforard]

Waco, Texas.

[@yulianasglam317]

Dental Minute with Steven T. Cutbirth, DDS thank you so much for your response. 😊 and do you have a contact number or an office number?, thank you

[@StrollwithSobia]

Great video... Love from Pakistan 🇵🇰❤️

[@centerforard]

Thank you.

[@breezymac9070]

Would the patient or doctor know immediately if there was a sodium hypochlorite leak past the apex? I had a root canal 3 weeks ago and have had some mild swelling, skin redness and heat along with some nerve pain. I am not sure what caused this

[@centerforard]

The NaOCl should not be injected into the pulp canal under any pressure at all. It is just gently flowed into the pulp chamber to fill the pulp chamber. It is taken into the canals by the files as they are moved up and down. If you have questions, contact your dentist or an endodontist (root canal specialist) and have him/her check it out.

[@breezymac9070]

Dental Minute with Steven T. Cutbirth, DDS thank you for your response. I’ve been having this pain and pressure for weeks and I’m search of answers. I appreciate your reply

[@breezymac9070]

Dental Minute with Steven T. Cutbirth, DDS could Endodontic treatment cause Trigeminal Neuralgia? And could it increase chances of you have a very abscessed tooth?

[@Nehakumari-in9wh]

Also sir,can irm is placed Permanent ly beneath composite core in RCT treated mandibular molar for crown preparation?

[@centerforard]

Yes you can. Let the IRM set completely prior to composite placement. An Endodontist showed me this method many years ago and I have used it successfully for many years without a problem. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@Nehakumari-in9wh]

@@centerforardsir,can I use freshly mixed znoe instead of irm beneath composite ?

[@eggtart7214]

can i replace the CaOH with GIC?

[@centerforard]

I am not using CaOH. I am using glass ionomer or some other permanent C & B cement inside the pulp chamber, coronal to the gutta percha in the canal, to prevent the bleach from going into the gp filled canal. I am using IRM in a viscous mix to cover the palatal opening of the pulp chamber and contain the bleach in the pulp chamber.

[@MurtyCZ]

Why the ice test and not cognoscin instead?

[@centerforard]

It is simpler and quite accurate, in addition to percussion.

[@nickcolagiovanni6572]

This is now day 3 of being in unbearable pain after tooth internal bleaching.... worst pain of my life. Called my dentist on sunday and he removed the bleach and put peroxide in. Said my gums may be irritated from the potent bleach. I have now been gone from that visit for 3 hours and ZERO relief. Ive taken the prednisone he gave me and ive taken 4 oxycodone today... zero relief 10/10 pain. Havnt slept in two days.. please help!

[@centerforard]

Sorry, without examining you I cannot diagnose the problem. The bleach actually is 1/2 peroxide, so I am not sure what he replaced the initial bleach with. It would seem the dentist would want to remove the initial bleach, thoroughly rinse out the pulp chamber and not put anything else into the chamber. He might want to take a radiograph of the tooth and see if a problem appeared on the radiograph.

[@zanboorasali2022]

Great job. But I thought IRM having Eugenol should not be used in any tooth that will be restored with composite.

[@centerforard]

That's what some say, but I have used IRM as a build up under composite for 40 years without it affecting the set of composite. Be sure the IRM is mixed thickly and has set completely before placing the composite.

[@zanboorasali2022]

@@centerforard Thanks for your prompt response and clarification.

[@skooterdumar565]

Hello sir does this work for dark dead tooth

[@centerforard]

Yes. Those are the teeth this technique is mainly used on.

[@bryanacevedo4724]

the whitening of a tooth with endodontics fades and becomes darker again? After internal and external whitening, is any other procedure such as veneer or crown necessary? Can I slightly improve the discoloration of my tooth with root canal with external whitening, emphasizing that tooth?

[@centerforard]

Normally external bleaching does not lighten the shade of a dark tooth caused by a dead nerve. Normally endodontics and internal bleaching is needed, and sometimes a veneer is also needed to get the shade as light as needed.

[@samaa8354]

Where I could find sodium perborate , please?

[@centerforard]

A pharmacy should have it or know where you can get it. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@Aya-vs7qv]

Please sir , Why do you use local anasthesia as irrigation ?

[@centerforard]

Because the syringe is connected to a 30 gauge needle, which is small enough to irrigate the canal. It could just as well be water. I irrigate out the dilute NaOCl before I place the gutta percha cones.

[@centerforard]

It has nothing to do with local anesthesia, it is the 30 gauge syringe that fits into the canal without pressure. The irrigant could be water. The local anesthesia is just convenient since it is already available and fits into the syringe attached to the 30 gauge needle. Remember, the true irrigating solution is NaOCl mixed 2 parts water to 1 part NaOCl. The local anesthesia is just used to rinse out the NaOCl.

[@catia6114]

Hello doctor, i just had internal bleaching. After 3 days the tooth is white like the others. It is amazing ! I have to keep the product for 2 more weeks. I am just wondering how long does it last ? Will i have to do it every year ? I paid 800 euros for it ! Are the effects long term? Thanks

[@centerforard]

Normally, long term. You really cannot redo internal bleaching because once the bleaching is complete, a bonded composite is placed in the orafice (hole), and that plugs up the dentinal tubules.

[@catia6114]

Dental Minute with Steven T. Cutbirth, DDS thanks docteur ! I had it 5 days ago. Since 2 days i feel like electricity in my teeth every hour. I am a bit worried. I called the dentist. He said it is the product inside the teeth because the teeth is dead so he said it is the product that causes this feeling Do you think it is normal to feel this? The teeth is white now which is great but i feel electricity inside every hour. It is not confortable to feel this.

[@carloszuniga1911]

I wish I had seen this video 5 years ago, my wife had exactly the same case, I made her a porcelain crown which failed, then a metal porcelain crown which failed too, so the tooth was fixed by removing the remaing crown tissue and rebuilding the crown with stratification of composites, I feel bad for that.

[@centerforard]

Sorry. I am sure you are not a bad person! Subscribe to DMC.com and watch all the videos. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@user-nn2cq3kh2d]

First sorry for my englich How long this result last After bleching

[@centerforard]

It could last indefinitely.

[@candidlychar]

What happens if the temporary seal keeps dissolving

[@centerforard]

I do not place a temporary seal. I complete the endo and build in one appointment 99.9% of the time. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@PeterRudesindus]

I didn't see any caries from the outside, how did it get in there?

[@centerforard]

The tooth was necrotic, which means the nerve was dead, probably from some type of trauma, possible years ago. There was no caries.

[@PeterRudesindus]

@@centerforard Thank you for explaining.

[@hitendrarana2103]

Hi doctor, i have 8th tooth decoloured and doctor said nerves are blocked due to calcified and needs to go for CT then perform bleach procedure? Can I go for that? Will it works? And will create any problems after age? Please suggest calcified i am 27 now.

[@centerforard]

Sorry, I cannot diagnose your condition without examining you. If you question the recommendation, you might want to get an opinion from a good Endodontist.

[@hitendrarana2103]

I am having same 1 tooth with dull colour. Can i go for the same procedure which you done in video? I will create lifetime sensitivity in that tooth?

[@Dr.aryan_mhedin]

Why using anesthetic to irrigate after NAOCL dear doc?

[@centerforard]

Because the 30 gauge needle is the ideal width to fit the coronal opening. As I state in the video, it has nothing to do with the local anesthetic, it's only the 30 gauge needle that is important. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@andragaillacara932]

Can i have braces if i have root cannal???

[@centerforard]

yes.

[@RegisteredNurseL.A.]

Can the pt feel this?

[@centerforard]

No, they are anesthetized.

[@Nehakumari-in9wh]

Good morning sir.why u do irrigation with local anesthetia.what is the role of this?

[@centerforard]

To clean out the dilute NaOCl prior to filling the canal with the sealer and gutta purchase. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@Nehakumari-in9wh]

@@centerforard thank u sir for ur reply.sir,which property of la makes it an irrigant ?why it is used in irrigation instead of saline?please guide me sir.

[@centerforard]

Saline is perfectly fine.

[@nickcolagiovanni6572]

is the bleaching permanent? Or will the tooth discolor back to grey over time?

[@centerforard]

Normally permanent. Occasionally the tooth will reverse a little bit, but should not change much, if at all.

[@nickcolagiovanni6572]

I am just confused on this whole tooth changing color issue... A year ago while doing a routine cleaning, my dentist spotted an "issue" above my #7... a circular formation above my root in the xray. He asked me if I was in any pain and I said no. So he shrugged it off and I forgot about it because my dentist said no biggy. Now, fast forward a year, my tooth is changing color and i went to see a specialist who told me my tooth is dead and a root canal is needed. I am very upset that my dentist didnt communicate the possible outcomes of what he saw a year ago... like my tooth could die and could even change color! Now, I am 31 years old, brush twice a day, floss regularly and use mouthwash but somehow have a dead, changed color tooth in the front of my smile. Noone even told me why this happened in the first place. I am just very nervous that after the bleaching, my dentist isnt going to get the color right... I am also very nervous about the tooth being brittle now post root canal and I know that i will always worry about it not only looking different in color but breaking as well while im eating one day and il need an implant. Is there any specific special filling i can request that can make my tooth as strong as possible following the root canal?

[@centerforard]

The nerve in teeth can "die" just like trees die. You probably were hit in that tooth, fell on that tooth or somehow traumatized the tooth, possibly many years ago. It sometimes takes years for a necrotic nerve to show up and be symptomatic. The treatment would not have been any different if it had been performed when your dentist first noticed it. I would probably have done just what he/she did, i.e., informed you about the potential problem but probably not suggested treatment at that time because you would probably not been agreeable to treatment then because the tooth was asymptomatic. Generally, when endodontics is performed on an anterior tooth, only a composite filling is placed in the endo. access hole in the tooth unless the tooth is badly broken down. The main thing is to preserve as much tooth structure as possible. Normally, one does not want to place a crown on the anterior tooth because that would remove considerable tooth structure. A veneer is normally better. Crown placement on posterior teeth that have been endodontically treated is, on the other hand, recommended because those teeth are larger and have more tooth structure. Posterior teeth are also under more biting pressure than anterior teeth, so they are more likely to fracture from biting something hard. I would also suggest a nightguard so you do not place ungoverned stress on that tooth through bruxism (teeth clinching) while you are sleeping.

[@dpetersontube]

Great results...How would you set up the patient for payment for this entire procedure? RCT ~1200, internal bleaching ~400, final restoration ~400... So how do you justify (only) charging ~2000 for a case where you're basically going in and doing the RCT procedure twice (because of the calcium hydroxide step) and all the time, etc? Chair time and procedures alone I would need ~4-5000 for this process but it's tough to justify with patients and insurances. Thanks for sharing!

[@centerforard]

Sorry, I do not discuss cost and payment because it varies so much depending on many factors. I do not base costs on insurance coverage. I charge a fair fee the patient is responsible for, regardless of insurance coverage. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@dpetersontube]

@@centerforard Thanks for the reply. I understand about not discussing fees. I was more curious about you putting so much time into that case and hoping you charge accordingly - but I honestly don't know how I would handle the treatment planning of that case. Thanks again doc.

[@centerforard]

You would enjoy watching the comprehensive cases in the library of DMC.com. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@ninja_dentist]

RM stands for ?

[@centerforard]

I'm not sure. Could you be referring to RD (rubber dam)? Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@1stMikeWhite]

What's the cost of this procedure?

[@centerforard]

Depends on many things, including where you live and the training of the doctor..

[@hitendrarana2103]

Also dental scaling will remove anamle? And my teeth will become yellowish after some months?

[@centerforard]

No, that should not happen, especially if it is done primarily with ultrasonic scaling.

[@hitendrarana2103]

@@centerforard thank you for your reply doctor you are great

[@supipek]

Sir, like 15 years ago when I was 9 years old I fell and both front teeth were damaged but they fixed it. Now years later one of my teeth is coloured way darker then the other teeth. So I went to my dentist and he did the cold ice test and said that it was necrotic. So wednesday I have my appointment but I’m a bit scared since I have a needle phobia. My dentist also said he would leave it open to bleach some days after the first appointment and I’m a bit concerned about that too. What’s your opinion on this? Thank you for your video, it’s really informative.

[@centerforard]

Maybe he has a different technique.

[@esthermaina8053]

How long will it last white?

[@centerforard]

Indefinitely.

[@esthermaina8053]

@@centerforard you are a Genius

[@ralphylad]

Just had mine completed, but please go and see a proper endo for this procedure. It will cost you more but if something goes wrong at least you have that specialist who can prevent infection.

[@centerforard]

You definitely want to have the endo. done properly. Many general dentists are well trained and perform excellent endo. If you are uncertain about the training of your dentist, an endodontist is definitely a good choice.

[@asignul2009]

Is this procedure painful

[@centerforard]

No.

[@asignul2009]

@@centerforard thank you. I have appointment tomorrow. Have a non front tooth. Not sure how it happened, i didnt suffer trauma on itt

[@centerforard]

I am sure things will go well.

[@dessk.6327]

May I ask what does RM actually mean ?

[@centerforard]

I am not sure what you are referring to.

[@lougrob]

I think it's referring to IRM. IRM is a Zinc Eugenol paste strengthened with some kind of composite used as a temporary filling.

[@lougrob]

Zinc oxide eugenol paste

[@lougrob]

Zinc oxide eugenol paste

[@ottifantiwaalkes9289]

Why do teeth turn dark after root canal procedure

[@centerforard]

It is from blood in the dentinal tubules. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@ottifantiwaalkes9289]

@@centerforard seems this can only happen when root canal procedure was not 100% successful? I thought all gets sealed in the opened shaft to prevent this from happening after rootcanal.

[@centerforard]

I have discussed this "dark tooth following endo" issue with several endodontists over the years. None of them seem to have a clear answer why the darkness sometimes occurs following seemingly thorough, complete endodontic treatment. I agree with you, it seems all the bleeding possibility would be eliminated following a good endodontic procedure. Bottom line: I do not know the answer. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $39.95/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513

[@user-im9yd3rn8h]

❤️❤️❤️❤️

[@centerforard]

Glad you like the videos. Subscribe to DentistryMasterClasses.com.

[@maxmad988]

In the European Union, sodium perborate, like most borates, was classified as carcinogenic, mutagenic or toxic for reproduction. Their use has been banned in cosmetic products and in tooth whitening since 1 December 2010.

[@centerforard]

Interesting! Is that also true with a very small amount of sodium perborate tetra hydrate, mixed with 30% hydrogen peroxide in this technique, completely contained within the pulp chamber? I do not know of another internal teeth bleaching material.

[@vishalsehgal1105]

I recently read an article stating that the genotoxicity and carcinogenicity properties of sodium perborate resembles those of hydrogen peroxide, lessened when mixed. The article concluded that there is no concern for humans with regard to a possible genotoxicity or carcinogenicity of the products*. *The products they mentioned ranged from laundry bleaching agents to those used in dental work.

[@asignul2009]

Gosh i wish you were in RSA

[@centerforard]

What is RSA, Russia?

[@asignul2009]

@@centerforard Republic of South Africa

[@centerforard]

Thanks for your comments.

[@Zim-lee3]

Sir why irrigate with LA...

[@centerforard]

What is LA?

[@Zim-lee3]

Local anesthetic sir

[@centerforard]

The irrigation has nothing to do with the local anesthesia. It has to do with the 30 gauge needle being small enough to optimally rinse the canals following NaOCl irrigation and the ease of delivery with the anesthetic carpal and the syringe.

[@Zim-lee3]

Ok sir

[@Zim-lee3]

Sir wat is the advantage of open end needle over the side vent needle

[@bitechabitechabitecha9015]

Is there anyway to whiten a dead yellow tooth, with out insurance?

[@centerforard]

Internal bleaching. Unfortunately, insurance will normally not pay for any cosmetic treatments.

[@Dentistresponds]

Awesome video when do I get my CE certificate in the mail 😂

[@centerforard]

Sorry, you will have to attend a CARD course in Dallas for that! Subscribe to DentistryMasterClasses.com.

[@faribashafaei6420]

Like 🙏

[@centerforard]

Glad the videos are helpful. Take your practice to the Top Tier. Subscribe to DentistryMasterClasses.com for an organized library of all the Dental Minute videos plus many complete comprehensive cases and many very important articles. New cases are added weekly. Only $20/month. Click here to subscribe: membership.dentistrymasterclasses.com/purchase/?plan=513