The walking bleach technique is the technique of choice used for internal (intracoronal) whitening of non-vital teeth.

✔️ First, the quality of endodontic treatment is radiologically evaluated; if this is inadequate, retreatment has to be performed before the initiation of the whitening procedures.

- The tooth color is first assessed, and a photograph of the tooth and the shade guide element corresponding to the initial situation is taken.

- A rubber dam is placed, the restoration that has filled the cavity access is removed, any restorative materials present in the pulp chamber are also removed ( restorations , liners , sealers , or root canal filling remnants ), and 2 mm of the root canal filling apical of the CEJ is removed.

- A glass-ionomer cement layer at least 2 mm thick is placed at this level, covering the root

⛔️ The coronal height of this barrier must be sufficient to avoid the infiltration of bleaching material along the dentinal tubules, preventing the possibility of cervical (root) resorption.

 This method consists of using a 35% to 40% hydrogen peroxide gel which is applied under isolation in the pulp chamber . e.g. Opalescence endo ( Ultradent )

- The gel is forced into all the interstices of the pulp chamber. The excess is removed using a dry pellet and a space of at least 2 mm is reserved for the temporary coronal restoration.

- A temporary coronal restoration is performed, which is applied in direct contact with the gel, by using a material that allows sealing, preferably glass ionomer cement, in a sufficiently thick layer (minimum 2 mm).

- The patient is recalled for an evaluation of the result after 7 days, a time period considered to be optimal.

➡️ If the result obtained is satisfactory 😃 the temporary coronal filling and the gel placed in the pulp chamber during the first session are completely removed, and a long-term restoration is placed.

➡️ If the bleaching effect is insufficient 🙁 all the procedures performed in the previous session can be repeated, the patient being recalled after another 7 days.

⛔️ This therapeutic procedure should not be repeated more than three times, otherwise the risk of root resorption increases significantly.

✔️ Finally, under isolation conditions, the coronal restoration and the bleaching material are removed from the pulp chamber, and the long-term coronal restoration is made from composite material, overlying the glass ionomer cement layer applied during the first treatment session.

- Following the application of this therapeutic method, the patient’s evolution should be
examined, including a radiograph examination, every 6 to 12 months.

⛔️ Most cervical resorptions occur within a time period ranging between 6 months and 1 year, implying a follow-up of the clinical condition for at least 2 years after the completion of treatment.
The mechanism of cervical resorption is not perfectly understood. ‼️ It is supposed that
oxidants permeate the dentinal tubules of the cervical region, inducing root cement necrosis, periodontal ligament inflammation, and, finally, cervical resorption.

Advantages :

• The technique may yield rapid results, with only one or two treatment sessions being
• Comfort for the patient, who will have normal mastication because between the treatment sessions the cavity is sealed with a long-term restoration material.
• The wearing of a tray is unnecessary.

Disadvantages :

• There is always a risk of cervical resorption.
• Sometimes, whitening is obtained to a smaller extent at the cervical level, where
discoloration usually manifests most prominently, due to the glass-ionomer cement barrier placed at this level in order to prevent cervical resorption.


Regards ..

Clinical case presentation in this link:
Internal Bleaching Case Presentation