Tooth Discoloration After Endodontic Treatment: Causes, Management, and Prevention: A Scoping Review

Abstract

Background: Tooth discolouration is a common dental problem that deteriorates the aesthetic appearance of a patient’s smile. Tooth discolouration can be classified as internal or external discoloration. The internal discolouration subdivided into systematic or local internal discolouration. The later could be caused by many reasons. One of these reasons is internal discolouration after RCT. In the literature, there are a variety of studies that discuss internal discolouration however, there is a lack of studies that consider internal discolouration involving causes, management, and prevention of tooth discolouration after root canal treatment (RCT). Thus, this scoping review was conducted to fill that knowledge gap. Aims and Objectives: Aim: A scoping review of causes, management, and prevention of discolouration after root canal treatment to explore the current knowledge from existing literature. Objectives: To explore causes, management, and prevention of discolouration after RCT and evaluate if this review could be a precursor to a systematic review. Methodology: This scoping review (SR) has been conducted based on the guidelines of the PRISMA Extension for Scoping Reviews (PRISMA-ScR) (Tricco et al., 2018) and the Joanna Briggs Institute – JBI (Peters et al., 2015) for scoping reviews using the framework that was proposed by Arksey and O’Malley in the updated version(Levac, Colquhoun, and O'Brien, 2010). The electronic databases used were Scopus, Medline, Embase, and Cochrane. The relevant information was gained and screened based on the following eligibility criteria: articles published in English, permanent or immature permanent discoloured teeth because of previous RCT, trauma, endodontic regenerative procedures (ERPs), primary studies that include human clinical trials (RCT), case series, case reports, longitudinal, observational, or cross-sectional studies. Secondary studies that involved reviews or systematic reviews were included, as were all the eligible articles that were published from January 2013 to March 2023. Results: A total of 1409 articles, including duplicates, have been retrieved from all four databases. After the removal of duplicate papers, around 615 set, 794 articles were chosen for screening. Then, these articles were subjected to assessment based on the title and abstract according to eligibility criteria. As a result of the first stage of screening, 724 were excluded, and 70 articles related to the topic that had been published in the period between January 2013 and March 2023 were retained. After that, a full text screening of the related articles was performed; 15 articles were excluded due to being irrelevant to the topic, and 55 of them were included in this study. Conclusion: To conclude, previously root canal-treated teeth, trauma, triple antibiotic, and mineral trioxide aggregate in ERPs are the main causes of discolouration. Internal dental bleaching is the first treatment option chosen by dental professionals if it is indicated as a simple and conservative procedure. For preventive protocols, the endodontic material should be within the limit below the cemento-enamel junction and ensure the removal of any pulp remnants from the pulp chamber. Also, use materials that do not induce discolouration especially in interior teeth.