Treatment of Tooth Discoloration after the Use of White Mineral Trioxide Aggregate

Introduction: A number of vital pulp therapy techniques have been recommended to preserve pulp vitality in teeth with complicated crown fractures, especially in young patients. Calcium hydroxide has been the gold standard as a pulp capping material, but recently mineral trioxide aggregate (MTA) has been recommended. This case report describes the treatment of tooth discoloration caused by white MTA (WMTA) used for the management of a complicated crown fracture. Methods: A partial pulpotomy was performed with the use of WMTA after a complicated crown fracture of the upper right central incisor. Seventeen months later, the WMTA was removed because of tooth discoloration, and internal bleaching was performed. Results: Upon access, the WMTA was completely discolored. After it was removed, a significant color change was observed in the tooth crown, which was further improved with internal bleaching. The tooth remained vital, and a dentin bridge was confirmed clinically and radiographically. Conclusions: The recommendation to use WMTA for vital pulp therapy in the esthetic zone may need to be reconsidered. Should discoloration occur with the use of WMTA, the technique described may be used to improve the esthetics. (J Endod 2011;37:1017-1020)