FIGURE 2. Preclinical retracted view. FIGURE 1. Preclinical evaluation. in less than 1% of cases, while Oginni et al8 found this occurrence to be higher in teeth with total PCO (43%) compared to partial PCO (14%). Some studies have identified reduced transparency or yellowish discoloration of the tooth crown, regardless of the degree of oblitera- tion.4,6 AB In the clinical experience of the authors, the degree of oblitera- tion of the pulp chamber has a direct correlation to the intensity of color change, which can range from mild yellowish to dark yellow/brown. The purpose of this clinical report is to present a simple and conser- vative treatment approach for the esthetic management of dark teeth with different etiologies in the same patient. CLINICAL REPORT A 40-year-old Hispanic female with unremarkable medical history presented with a concern that her left maxillary central incisor (#9) and right maxillary lateral incisor (#7) were discolored (Figure 1 and Figure 2). Her dental history revealed previous orthodontic treatment in her teenage years, and she attributed her tooth discoloration to the orthodontic treatment. A clinical examination of the area of concern revealed a composite restoration on the lingual fossa (access for the canal) and Class III composite restorations on the mesiolingual and distolingual surfaces of the central incisor (#9), while the lateral incisor (#7) was intact. The patient was caries-free and maintained good oral hygiene and regular prophylaxes. Periapical radiographs revealed root MARIO F. ROMERO, DDS, is an assistant professor in the Department of Restorative Sciences at The Dental College of Georgia at Augusta University. Romero maintained a private practice for 15 years prior to joining Augusta University in 2013. He can be reached at [email protected]. DAVID URBANAWIZ, DMD, is an instructor in the Department of Restorative Sciences at The Dental College of Georgia at Augusta University. His teaching and research interests include restorative dentistry, esthetics and photography. COURTNEY S. BABB, DMD, is an instructor in the Department of General Dentistry at The Dental College of Georgia at Augusta University. She was an associate in private practice for 5 years before pursuing an academic career. The authors have no commercial conflicts of interest to disclose. DecisionsInDentistry.com FIGURE 4. Bleaching tray with a modified design to be used to treat a discolored tooth or teeth. December 2017 • Decisions IN DENTISTRY 23 canal treatment, with a 10-plus-year history on the central incisor (#9), and PCO on the lateral incisor (#7). The patient had no recollection of trauma to this area. In addition, no periapical lesions or widening of the periodontal ligament space were found (Figures 3A and 3B). The patient had an endodontic consultation, which included an intraoral exam, shifted periapical radiographs, and a cone beam com- puted tomographic image to assess the presence and type of calcifica- tion. Electrical pulp testing of the right maxillary lateral incisor (#7) was within normal limits, but the tooth exhibited a delayed response to cold. A diagnosis of partial PCO with a normal periapex was estab- lished, with no treatment indicated at this time. Due to the patient’s desire to conserve tooth structure, a minimally invasive treatment option was presented that consisted of nightguard bleaching. FIGURES 3A and 3B. Periapical radiograph of the maxillary right lateral incisor that presented partial pulp canal obliteration and no periapical lesion (A), and periapical radiograph of the maxillary left central incisor to evaluate root canal treatment (B).
