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J Endod. 2013 Dec;39(12):1598-602. doi: 10.1016/j.joen.2013.08.035. Epub 2013 Oct 6.

Tooth discoloration after the use of new pozzolan cement (Endocem) and mineral trioxide aggregate and the effects of internal bleaching.

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Microscope Center, Department of Conservative Dentistry and Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea.



The aim of this study was to evaluate tooth discoloration after the use of mineral trioxide aggregate (MTA) and to examine the effect of internal bleaching on discoloration associated with MTA.


Thirty-two teeth were endodontically treated. Three-millimeter plugs of MTA, ProRoot, Angelus, or Endocem were placed on the access cavities of 24 teeth. Eight teeth served as the control group. After 24 hours, the access cavities were restored, and the tooth color was recorded at baseline and at 1, 2, 4, 8, and 12 weeks. After 12 weeks, the MTA materials were removed under a microscope, and an internal bleaching treatment was performed. After removal of the MTA materials and after a 1-week bleaching treatment, the color changes were measured, and the MTA-dentin interfaces were observed under a microscope.


The ProRoot and Angelus groups displayed increasing discoloration during a period of 12 weeks. The discoloration associated with ProRoot and Angelus was observed at the MTA-dentin interface and on the interior surface of the dentin. However, the Endocem groups demonstrated no significant discoloration (P < .05). No marginal discoloration was observed around the material in the Endocem group. Removal of the discolored MTA was effective for resolving the discoloration in all of the experimental groups (P < .05). However, a subsequent internal bleaching treatment was not significantly effective compared with the removal of MTA.


ProRoot and Angelus caused tooth discoloration. However, Endocem did not affect the contacting dentin surface. Removing the discolored MTA materials contributed more to resolving the tooth discoloration than post-treatment internal bleaching.


Internal bleaching; mineral trioxide aggregate; pozzolan cement; tooth discoloration

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