Abstract
This case report describes the successful management of severe dental discoloration using a combined minimally invasive approach involving internal and external bleaching techniques, followed by conservative restorative treatment. A 52-year-old female presented with a chief complaint of spontaneous pain and severe discoloration of #11. Clinical and radiographic examinations revealed pulpal necrosis of #11. In addition to treating the affected tooth, the patient desired comprehensive esthetic improvement and shade optimization of the entire dentition. Following successful non-surgical root canal treatment of #11, a comprehensive whitening protocol was initiated. This consisted of two sessions of internal bleaching (walking bleach) on #11, followed by a dual-whitening regimen (combined in-office and at-home bleaching) for the complete maxillary and mandibular arches. This protocol successfully harmonized the shade of #11 with the rest of the dentition, achieving significant objective brightness improvement. At the 30-month follow-up, the esthetic outcomes remained stable with minimal shade relapse. Furthermore, to address an associated esthetic concern regarding a discolored and microdontic #12, a minimally invasive lithium disilicate laminate veneer was fabricated and bonded. This combined approach successfully resolved complex anterior discoloration and structural disharmony without aggressive enamel reduction, demonstrating that a synergy of advanced whitening protocols and conservative prosthodontics can provide highly predictable, stable, and minimally invasive esthetic outcomes.
