Bleaching of simulated stained-remineralized caries lesions in vitro

Red biofluorescence revealed by dental bleaching in discolored pits and fissures of occlusal caries

OBJECTIVE

Distinguishing between cariogenic and noncariogenic discoloration is crucial to avoid unnecessary removal of dental tissue. This study aimed to investigate the efficacy of biofluorescence bleaching (BF-bleaching) for identifying cariogenic discoloration in human teeth with naturally discolored pits and fissures.

METHODS

Sixty-nine extracted human permanent teeth with discolored pits and fissures associated with suspected occlusal caries were included. A dental bleaching agent (15% H2O2, BeauTis 15 whitening gel, Osstempharma, Seoul, Republic of Korea) was applied in 5-minute intervals for 20 mins. Pit and fissure sites (n = 197) were classified as noncariogenic discoloration (NCD) or cariogenic discoloration (CD) based on histological findings. CD was further divided by the presence of red biofluorescence before bleaching as masked and exposed CD. Biofluorescence was quantified using red biofluorescence intensity (ΔR) and hue angle (h°). Their diagnostic performance was also assessed, including sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC).

RESULTS

Prebleaching ΔR values were significantly lower in the NCD and masked CD groups (p < 0.001). ΔR in masked CD increased by 15% after 5 mins (p < 0.001), becoming similar to those in exposed CD. ΔR in NCD and exposed CD showed no significant changes at any time point. The h° value of masked CD decreased by 2.05°, shifting from orange to red after 20 mins. In contrast, the h° of NCD group remained stable within the orange hue range. After 5 mins, ΔR sensitivity increased from 0.79 to 0.90, and h° AUC improved from 0.69 to 0.93.

CONCLUSION

Bleaching of pits and fissures exhibiting caries-related discoloration effectively removes the overlying stains, revealing the lesion's underlying red biofluorescence. Thus, BF-bleaching can be a useful method for the objective diagnosis and monitoring of cariogenic discoloration.

CLINICAL SIGNIFICANCE

Using BF-bleaching for accurate evaluation of CD will help provide minimally invasive preventive and treatment options.

Effects of microabrasion and bleaching on color and shear bond strength of simulated stained-remineralized caries lesions

Purpose

This study investigated the effects of bleaching and microabrasion on the color and shear bond strength (SBS) of stained-remineralized caries-like lesions (s-RCLs).

Methods

Human enamel specimens were demineralized, stained (coffee/tea), then remineralized (2% NaF and artificial saliva [AS]) to create s-RCLs. Specimens were randomly divided into five groups (n = 18): G1, demineralized/AS; G2, s-RCLs/AS; G3, s-RCLs/at-home bleaching (15% carbamide peroxide [CP)], 6 h/d×7)/AS; G4, s-RCLs/microabrasion (6.6% hydrochloric acid, [1min/3cycles]/AS; and G5, s-RCLs/microabrasion and at-home bleaching/AS. Color was spectrophotometrically measured at baseline, after demineralization, after staining, and after treatment. After two weeks, the SBS was tested using a universal testing machine. Outcomes were analyzed using ANOVA models followed by Tukey's test (α = 0.05).

Results

The mean colors (ΔE) for demineralization and staining were significant (ΔE ≤ 5.9 and ≤14.4, respectively). G3 (ΔE 23.9) and G5 (ΔE 25.2) were significantly improved compared to G4 (ΔE 12.3). The SBS in G5 had the highest significant value (25.2 MPa), followed by G4 and G3 (21.5-20.6 MPa), which were significantly higher than G2 (16.8 MPa). G2, in turn, was more significant than G1 (10.9 MPa).

Conclusion

At-home bleaching (15% CP) for seven days eliminated and improved organic stains on RCLs. Faster results were achieved when combined with microabrasion. All surface treatments resulted in high SBS.

Effect of Bleaching Agents on Healthy Enamel, White Spots, and Carious Lesions: A Systematic Review and Meta-Analysis

This systematic review examines studies focusing on tooth bleaching and its effects on healthy enamel or incipient caries and bacterial adhesion. The aim is to explore the impact of different bleaching agents on incipient caries lesions and healthy enamel. Clinical studies, in vitro studies, and observational studies that compared at least two groups were included. A search strategy was used to select studies from the MEDLINE via Pubmed and Scopus databases. Two evaluators performed data extraction, screening, and quality assessment independently. Only studies written in English were included. From 968 initial records, 28 studies were selected for a full-text evaluation. Of these, 7 studies were classified as cluster 1 (bacterial adherence on teeth), 12 studies as cluster 2 (no bacteria involved), 4 studies as cluster 3 (no teeth deployment), and 5 clinical studies were cluster 4. Of the selected studies, 6 (21.4%) supported increased bacterial attachment capacity and cariogenic dynamics, 4 (14.3%) decreased adhesion and cariogenic activity, 7 (25%) showed no difference, and 11 (39.3%) followed a different methodological approach and could not be categorized. The risk of bias appeared to be high, mainly because of the different methodologies in the studies, so we cannot reach a confident conclusion. Nevertheless, as far as carbamide peroxide bleaching is concerned, there does not seem to be a clinically significant alteration, neither in microorganism counts nor in enamel microstructure.

Effect of Three Chemical Agents on Stain Removal from Dentin Caries Lesions Treated with Silver Diamine Fluoride

INTRODUCTION

This in vitro study aimed to evaluate the effect of three different chemical agents on stain removal and mineral uptake of artificial dentin caries (ADC) lesions treated with silver diamine fluoride (SDF).

METHODS

Baseline L*a*b* values were determined in polished human permanent dentin blocks, and ADC lesions were induced with an acid gel for 1 week. Samples were assigned to four groups; in three groups, half of each sample received SDF (30% SDF for 3 min), while the other half received SDF followed by a bleaching treatment protocol (garlic extract, bentonite, or 35% hydrogen peroxide). The fourth group had one SDF-treated half and one half without SDF. Color changes (ΔE) were measured by spectrometry, and transversal microradiography was used to quantify integrated mineral loss (ΔZ) 24 h after treatment (SDF or SDF + bleaching). A two-way mixed ANOVA was applied to thirty percent.

RESULTS

SDF application increased mineral uptake by ADC (p = 0.001). The type of chemical agent evaluated (p < 0.0001), time (p = 0.01), and their interaction (p < 0.0001) bleached the ADC treated with SDF. However, 35% hydrogen peroxide was the only compound with a bleaching effect (p < 0.001), without returning to baseline color. None of the compounds altered the mineral uptake effect of SDF (p = 0.30).

CONCLUSION

This in vitro study showed mineral uptake effect in ACD within 24 h after SDF application and the ability of hydrogen peroxide to partially remove (reduction of 24%) the staining caused by SDF without affecting its mineral uptake effect.

Influence of salivary acquired pellicle on colour changes and minerals content of dentine after application of silver diamine fluoride followed by potassium iodide

PURPOSE

This study evaluated whether the presence of the salivary acquired pellicle (AP) had any effect on the dentin's darkening and on the caries arresting effect after the use of SDF + KI, in a cariogenic challenge.

METHODS

Human dentin specimens were standardised, submitted to artificial caries lesion formation, and divided into five groups (n = 20): C: control group-no treatment, SDF: 38% SDF, APSDF: SDF 38% and AP, KISDF: 38% SDF and KI, and APKISDF: 38% SDF, KI and AP, that were submitted to pH cycling. Colour evaluation (CIE L*a*b* system) and surface hardness were performed before and after the treatments/pH cycling.

RESULTS

SDF and APSDF groups showed no difference in colour. KISDF and APKISDF groups showed significantly different colours than the groups without KI. SDF, APSDF, and APKISDF groups had less mineral loss than C and KISDF. SDF, APSDF, and APKISDF revealed significantly greater mineral recovery, compared to KISDF and C.

CONCLUSION

The AP did not influence the dentin´s colour after SDF + KI, but had a protective role in modulating the dentin´s mineral gain/loss. KI used after SDF decreased the dentin´s darkening, and did not interfere with the dentin de/remineralization process.

Evaluation of bleaching agent effects on color and microhardness change of silver diamine fluoride-treated demineralized primary tooth enamel: An in vitro study

BACKGROUND

The present study aimed to assess the impact of application of fluoridated- 10% carbamide peroxide (CP) with or without potassium iodide (KI) on silver diamine fluoride (SDF)-treated enamel surface in the primary teeth.

METHODS

After stained-remineralized caries lesions (s-RCLs) creation, 96 teeth were randomly allocated to four experimental groups: Group 1:SDF-treated enamel followed by 8-h/day application of 10% CP for 2 weeks; Group 2: SDF-treated enamel followed by 15-min/day application of 10% CP for 3 weeks; Group 3: SDF + KI-treated enamel followed by 8-h/day application of 10% CP for 2 weeks; and Group 4: SDF + KI-treated enamel followed by 15-min/day application of 10% CP for 3 weeks. Enamel microhardness (EMH) test (n = 12) and spectrophotometric color assessment (n = 12) was performed at four stages: baseline (intact enamel), demineralized enamel, aged remineralized-stained enamel, and after final intervention. Sixteen samples were used for SEM evaluation. Data were analyzed with the paired t-test, one-way ANOVA, and Tukey's post-hoc test (p < 0.05).

RESULTS

EMH values in all groups showed significant decrease after demineralization (all, p < 0.00001). All samples showed complete recovery of EMH values (%REMH) after SDF application compared to demineralization (%REMHSDF) (p = 0.971). Bleaching caused a slight decrease in %REMH for all groups. However, the differences were not statistically significant (p = 0.979). SEM findings revealed no changes in enamel porosity after bleaching. Bleaching application ameliorated the discoloration in all groups (all, p < 0.00001). All samples in Groups 2 and 4 had significantly lighter color after 21 days as compared to 14-day exposure to the bleaching material (both, p < 0.00001).

CONCLUSIONS

SDF application on demineralized primary tooth enamel completely recovered enamel microhardness. 10% carbamide peroxide effectively bleached SDF stain without causing significant decrease in EMH values. Color improvement was more evident with the use of KI immediately after SDF application. Both 15-min and 8-h application of fluoridated CP resulted in statistically similar color enhancement in primary teeth.

Bleaching Stained Arrested Caries Lesions: In vivo Clinical Study

Objective  Conservative approaches to esthetically treat stained arrested caries lesions (s-ACLs) have not been explored in clinical studies. This study aims to investigate the efficacy of in-office dental bleaching agent, as a conservative approach, to esthetically treat s-ACLs.

Materials and Methods  Twelve patients ( n = 46) presented with s-ACLs were treated with 40% hydrogen peroxide (in-office bleaching protocol; 20 minutes × 3). Color values were measured using a spectrophotometer (CIE L*a*b*), aided with digital photography to assess visual color change clinically. Measurements were taken for each specimen at baseline and immediately after bleaching.

Statistical Analysis  The color change calculated before and after bleaching for each dental substrate was analyzed using paired t -test (α = 0.05).

Results  The bleached s-ACLs had a significant increase in L * values ( p < 0.001), and a significant decrease in both a * ( p = 0.001) and b * ( p = 0.007) values, indicating lighter color improvement (bleaching efficacy). The baseline mean of L *, a *, and b * values were 61.5, 2, and 15.4, respectively, and after bleaching were 67.7, 1.4, and 13.3, respectively, with a mean increase in ∆ E of >7.9, which resulted in a visible clinical stain improvement as orange/light brown stains were removed completely, while gray/black stains improved to a lesser extent.

Conclusion  Significant color improvement was observed when the in-office bleaching protocol (40% hydrogen peroxide) was used in orange/brown s-ACLs. However, it showed lesser improvement in gray/black s-ACLs.

The ability of dual whitening anti-caries mouthrinses to remove extrinsic staining and enhance caries lesion remineralization - An in vitro study

OBJECTIVES

This laboratory study investigated the ability of dual whitening anti-caries mouthrinses to remove extrinsic staining from artificially stained caries lesions and to enhance their remineralization and fluoridation.

MATERIALS AND METHODS

Early caries lesions were created in bovine enamel specimens. The lesions were artificially stained and pH cycled for 10 days with the daily cycling regimen consisting of twice daily 60s-treatments with one of 11 mouthrinses, a 4-h demineralization period and artificial saliva treatments in between. Mouthrinses were eight commercially available products, all containing 100ppm fluoride but utilizing hydrogen peroxide, pyro-, tri- or hexametaphosphate salts and/or sodium bicarbonate. The three control mouthrinses were 100ppm fluoride, 30 % hydrogen peroxide and deionized water. Enamel color changes (ΔE) were determined spectrophotometrically. Vickers surface microhardness (VHN) was used to determine lesion remineralization. Enamel fluoride content (EFC) was determined using the microbiopsy technique. Data were analyzed using ANOVA.

RESULTS

ΔE was significantly different among groups (p=0.0045). Thirty percent hydrogen peroxide was superior to all other mouthrinses, while there were no differences between commercial mouthrinses and deionized water. There were small, directional but non-significant differences between commercial mouthrinses with those containing hydrogen peroxide providing better whitening. There were no significant differences between mouthrinses in their ability to remineralize caries lesions (p=0.2898). EFC differed among groups (p<0.0001), with the two mouthrinses containing pyrophosphate salts having lower EFC than all but the deionized water group.

CONCLUSIONS

Artificially stained caries lesions show reduced susceptibility to fluoride remineralization and whitening effects of commercial whitening and anti-caries mouthrinses.

CLINICAL RELEVANCE

Artificially stained caries lesions appear to require stronger than over-the-counter interventions to successfully whiten and remineralizing them.

Evaluation of the effect of tooth polishing on color stability after in-office bleaching treatment

Abstract Introduction One of the most commonly used corrective methods for staining teeth is tooth bleaching. However, subclinical alterations may occur in the micromorphology of dental tissues during the bleaching procedure, such as increases in porosity and surface roughness. Consequently, dental enamel may become more permeable and susceptible to staining. Objective To evaluate the influence of tooth polishing after in-office bleaching treatment on color stability. Material and method Thirty-three extracted human molars were used. The teeth were cut in the mesiodistal direction to obtain two samples per tooth (total of 66). The samples were randomly divided into six groups (n=11). Before and after the bleaching treatment, the lightness of the samples and change in lightness (∆L) were determined with a digital spectrophotometer (Easy Shade). The samples were bleached with 35% hydrogen peroxide (three sessions weekly). Three groups were submitted to polishing with felt discs and polishing paste after each session. To simulate the oral conditions during the consumption of colored beverages, the samples were submitted to alternating cycles of immersion in staining solutions (coffee, red wine, and Coca Cola). Result Polishing resulted in an increase of mean lightness of 4.49 in the red wine group, 2.73 in the coffee group, and 4.08 in the cola group. The difference was significant in the red wine group (p<0.022), but not in the coffee or cola group. Conclusion Polishing after in-office bleaching using felt discs and polishing paste can reduce the degree of pigment impregnation in patient with red wine rich diet.