A Aesthetic and Conservative Management of a Discoloured Maxillary Central Incisor with Pulp Necrosis: A Case Report

Abstract

Background: Pulpal necrosis may present with discolouration of the affected tooth, often following trauma or extensive carious lesions. Although sometimes asymptomatic, advanced cases may be accompanied by persistent pain. Minimally invasive endodontic treatment combined with internal bleaching allows for functional and aesthetic rehabilitation without excessive removal of sound tooth structure. Objective: To report a conservative approach for the endodontic and aesthetic treatment of a discoloured maxillary central incisor. Case Report: A 25-year-old female presented with discolouration of tooth #21, which had progressively darkened over several years. The tooth had previously been restored with composite before sustaining multiple episodes of minor trauma. In recent months, the patient reported of continuous pain radiating to the head. Clinical examination revealed shade A3.5 discolouration, and radiographic evaluation showed tertiary dentine deposition partially obliterating the pulp chamber. The diagnosis was pulp necrosis with symptomatic apical periodontitis. Single-visit root canal treatment was performed using Reciproc Blue R25 in reciprocating motion. Internal bleaching was carried out for seven days using hydrogen peroxide, resulting in a shade improvement to A1. Calcium hydroxide was placed in the chamber for 14 days to neutralise pH prior to final restoration. The access cavity was restored using direct resin composite. Conclusion: A conservative endodontic approach combined with internal bleaching and direct adhesive restoration can effectively restore both aesthetics and function in discoloured anterior teeth with pulpal necrosis.