Laser-assisted in-office bleaching using a neodymium:yttrium–aluminum–garnet laser: an in vivo study

Evaluation of tooth color change after a bleaching process with different lasers

The aim of this in vitro study was to evaluate the efficiency of diode laser-activated bleaching systems for color change of teeth. 75 extracted teeth were studied in five different bleaching protocols. Group 1: diode laser 445 nm, 320 µm fiber, 0.5W, continuous wave mode, dose 53 J/cm2. Group 2: diode laser 970 nm, 320 µm fiber, 1W, continuous wave mode, dose 106.10 J/cm2. Group 3: diode laser 940 nm, bleaching handpiece, 7W, continuous wave mode, dose 105 J/cm2. Group 4: diode laser 940 nm, 300 µm fiber, 2W, continuous wave mode, dose 47.16 J/cm2. Group 5: bleaching process without laser activation. In groups 1, 2 and 5, teeth were bleached with Perfect Bleach Office + and in groups 3 and 4, LaserWhite20 bleaching gel was used. Tooth color was determined immediately after the bleaching process using a spectrophotometer. Color change data on the CIE L * a * b* system was analyzed statistically by the one-way ANOVA and Tukey's HSD test. All bleaching procedures resulted in a change of color. All laser groups (∆E * ab > 3) have statistically larger ∆E * ab values than the control group (∆E * ab = 0.73) (p < 0.05). The diode laser 445 nm has the largest ∆E * ab value (∆E * ab = 4.65) and results in a significantly higher color difference than all other groups. In terms of color score difference in VITA Shades, all laser-activated groups lead to a lightening effect while the control group leads to only a slight lightening effect. The diode laser 445 nm produced the greatest color difference. Laser-activated bleaching is more effective than conventional bleaching without light activation. The diode laser 445 nm performs best in this in vitro study.

Feasibility and Safety of Adopting a New Approach in Delivering a 450 nm Blue Laser with a Flattop Beam Profile in Vital Tooth Whitening. A Clinical Case Series with an 8-Month Follow-Up

A prospective observational case series included six patients who presented with discoloured upper and lower teeth extending from the right second premolar to the left second premolar. The photoactivation dosimetry and treatment protocol were as follows: λ 450 nm, 1 W, CW; flattop beam profile; 1 cm2; 15 J/spot; 10 irradiated spots; an irradiation time of 15 s/spot; three whitening cycles in a single session. Blanc One ULTRA+ was the bleaching agent. A visual analogue scale (VAS) was utilised to evaluate the pain intensity and dental hypersensitivity during treatment immediately after complete treatment (T1), 24 h (T2), and 8 h (T3) postoperatively, and at an 8-month follow-up timepoint (T4), whereas the dental colour shade change was assessed using the VITA colour shade guide pre-treatment (T0), T1, and T4. The Gingival index and modified Wong Baker faces scale were utilised to evaluate gingival inflammation and patients' treatment satisfaction, respectively. Our findings revealed a reduction in the dental colour shade of the six cases between 2 and 10- fold (average of 3.5-fold) at T1 and maintained at T4, indicating significant improvement in the colour shade change with optimal outcomes. The percentage of this improvement for all the patients was ranged between 16.6% and 33.3%. At all timepoints, a "0" score was provided for pain intensity, dental hypersensitivity, and gingival inflammation. Our study demonstrates the feasibility and safety of a λ 450 nm laser delivered with a flattop handpiece to achieve optimal whitening outcomes without adverse effects. This offers a useful guide for dental clinicians for vital in-office tooth whitening. Extensive clinical studies with large data are warranted to validate our study protocol.

LASER as a tool for surface modification of dental biomaterials: A review

In recent years, the application of lasers for modifying the surface topography of dental biomaterials has received increased attention. This review paper aims to provide an overview of the current status on the utilization of lasers as a potential tool for surface modification of dental biomaterials such as implants, ceramics, and other materials used for restorative purposes. A literature search was done for articles related to the use of lasers for surface modification of dental biomaterials in English language published between October 2000 and March 2023 in Scopus, Pubmed and web of science, and relevant articles were reviewed. Lasers have been mainly used for surface modification of implant materials (71%), especially titanium and its alloys, to promote osseointegration. In recent years, laser texturing has also emerged as a promising technique to reduce bacterial adhesion on titanium implant surfaces. Currently, lasers are being widely used for surface modifications to improve osseointegration and reduce peri-implant inflammation of ceramic implants and to enhance the retention of ceramic restorations to the tooth. The studies considered in this review seem to suggest laser texturing to be more proficient than the conventional methods of surface modification. Lasers can alter the surface characteristics of dental biomaterials by creating innovative surface patterns without significantly affecting their bulk properties. With advances in laser technology and availability of newer wavelengths and modes, laser as a tool for surface modification of dental biomaterials is a promising field, with excellent potential for future research.

The effect of two different prophylaxis paste applying processes on color stability in-office bleaching: 24-month clinical follow-up

OBJECTIVE

The purpose of this study was to examine the effect of applying two different prophylaxis pastes with various protocols on the degree of bleaching and color stability in the office bleaching process with a bleaching agent containing 40% hydrogen peroxide.

MATERIAL AND METHOD

The 300 teeth of 15 (9 female, 6 male) patients were included in our study, and 5 different study groups were randomly formed. The bleaching process with Ultradent Opalescence Boost (Ultradent, South Jordan, USA) was performed according to the manufacturer's instructions. Two different prophylaxis pastes, Ultrapro (Ultradent, Cologne, Germany) and Cleanic (Kerr, Rastatt, Germany), were applied with protocols determined according to the groups. The effect on color stability at 6-, 12-, and 24-month follow-up was determined using the CIE L* a* b* color system. The changes in the parameters were analyzed using the one-way ANOVA, chi-square, and Tukey test (p > 0.05).

RESULTS

The evaluation rate of the treatments was 100% at the end of 24 months. Control group 6-month ΔE (0-6) and 12-month ΔE (0-12) values were higher than 24-month ΔE (0-12) values. UU + UU, KC + KC, and UU group 6-month ΔE (0-6) values were higher than 12-month ΔE (0-12) values. In addition, 6-month ΔE (0-6) and 12-month ΔE (0-12) values were higher than 24-month ΔE (0-24) values. KC group 6-month ΔE (0-6) and 12-month ΔE (0-12) values were higher than 24-month ΔE (0-24) values. Control, UU + UU, KC + KC, UU, and KC group ΔE (1-6) values at 6 months were lower than 12-month ΔE (1-12) and 24-month ΔE (1-12) values in all groups. In addition, 12-month ΔE (1-12) values were lower than 24-month ΔE (1-24) values. According to the study data, there was no statistically significant difference between the groups according to the prophylaxis paste and prophylaxis procedure (p > 0.05). However, it was observed that whiteness decreased in all groups over time.

CONCLUSIONS

Discoloration was observed at 6 months, 12 months, and 24 months after bleaching. However, at the end of 24 months, the tooth color was significantly whiter than the initial color.

CLINICAL RELEVANCE

Pre-bleaching prophylaxis application and pre-bleaching and post-bleaching prophylaxis application have no effect on color stability.

Effects of Bleaching Associated with Er:YAG and Nd:YAG Laser on Enamel Structure and Bacterial Biofilm Formation

OBJECTIVE

To compare the effects of bleaching associated with Er:YAG and Nd:YAG laser on enamel structure and mixed biofilm formation on teeth surfaces.

MATERIALS AND METHODS

Sixty-eight enamel samples were randomly divided into four groups (n = 17), control, Opalescence Boost only, Opalescence Boost plus Er: YAG laser, and Opalescence Boost plus Nd:YAG laser. The structure was observed using SEM after bleaching. Subsequently, the treated enamel samples were also cultured in suspensions of Streptococcus mutans, Streptococcus sanguis, Actinomyces viscosus, and Fusobacterium nucleatum (Fn) for 24 and 48 h. Biofilm formation was quantified by crystal violet staining, and the structure was visualized by confocal laser scanning microscopy. The data were analyzed using the Kruskal-Wallis method.

RESULTS

The enamel structure significantly changed after bleaching. There was no obvious difference in the biofilm formation after 24 h; however, after 48 hours, the amount of biofilm increased significantly. Remarkably, the amount was significantly higher on enamel bleached only, however, there was no significant difference between samples bleached with Er:YAG or Nd:YAG laser compared to the control.

CONCLUSIONS

Bleaching only appeared to markedly promote biofilm formation after 48 h, and the biofilms on samples bleached with Er:YAG or Nd:YAG laser did not change significantly, showing that bleaching with Er:YAG or Nd:YAG laser can be safely applied in clinical practice.

Evaluation of Tooth Sensitivity of In-office Bleaching with Different Light Activation Sources: A Systematic Review and a Network Meta-analysis

OBJECTIVES

A systematic review and network meta-analysis were performed to answer the following research question: Are there differences in the risk and the intensity of tooth sensitivity (TS) among eight light activation systems for in-office bleaching in adults?

METHODS

Randomized controlled trials (RCTs) that compared at least two different in-office bleaching light activations were included. The risk of bias (RoB) was evaluated with the RoB tool version 1.0 from the Cochrane Collaboration tool. A random-effects Bayesian mixed treatment comparison (MTC) model was used independently for high- and low-concentration hydrogen peroxide. The certainty of the evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach. A comprehensive search was performed in PubMed, Bridge Base Online (BBO), Latin American and Caribbean Health Sciences Literature database (LILACS), Cochrane Library, Scopus, Web of Science, and grey literature without date and language restrictions on April 23, 2017 (updated on September 26, 2019). Dissertations and theses, unpublished and ongoing trials registries, and IADR (International Association for Dental Research) abstracts (2001-2019) were also searched.

RESULTS

After title and abstract screening and the removal of duplicates, 32 studies remained. Six were considered to be at low RoB, three had high RoB, and the remaining had an unclear RoB. The MTC analysis showed no significant differences among the treatments in each network. In general, the certainty of the evidence was graded as low due to unclear RoB and imprecision.

CONCLUSION

There is no evidence that the risk and intensity of TS are affected by light activation during in-office bleaching.

Different light-activation systems associated with dental bleaching: a systematic review and a network meta-analysis

OBJECTIVES

A systematic review and a network meta-analysis were performed to answer the following research question: "Is there any light-activation protocol capable of improving color change efficacy when associated with an in-office bleaching gel in adults?"

MATERIAL AND METHODS

A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE without date and/or language restrictions in April 23, 2017 (updated on March 30, 2018). IADR abstracts (1990-2018), unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials conducted in adults that included at least one group treated with in-office dental bleaching with light activation were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A random-effects Bayesian-mixed treatment comparison (MTC) model was used to combine light-activated versus light-free in-office bleaching with direct light-free comparison trials. A meta-analysis with independent analysis (high- and low-concentrate hydrogen peroxide [HP]) was conducted for color change (∆E*, ∆SGU).

RESULTS

After the removal of duplicates, title, and abstract screening, 28 studies remained. Nine were considered to be at a low RoB, five were at a high RoB, and the remaining were at an unclear RoB. The MTC analysis showed no significant difference in color change (ΔE* and ΔSGU) between light-activation protocols and light-free in-office bleaching, regardless of the HP concentration in the efficacy of the bleaching.

CONCLUSION

No type of light-activated in-office bleaching was superior to light-free in-office bleaching for both high- and low-concentrate in-office bleaching gels (PROSPERO-CRD42017078743).

CLINICAL RELEVANCE

Although many times dental professionals use "laser whitening" as a form of marketing, this study confirmed that no type of light-activation for in-office bleaching can improve the bleaching efficacy.

Effectiveness of Light Sources on In-Office Dental Bleaching: A Systematic Review and Meta-Analyses

OBJECTIVE

A systematic review and meta-analyses were performed to evaluate the efficacy of tooth color change and sensitivity of teeth following in-office bleaching with and without light gel activation in adult patients.

METHODS

This review was registered at PROSPERO (CRD 42017060574) and is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Electronic systematic searches of PubMed/MEDLINE, Web of Science, and the Cochrane Library were conducted for published articles. Only randomized clinical trials among adults that compared in-office bleaching with and without light activation with the same bleaching gel concentrations were selected. The outcomes were tooth color change and tooth sensitivity prevalence and intensity.

RESULTS

Twenty-three articles from 1054 data sources met the eligibility criteria. After title and abstract screening, 39 studies remained. Sixteen studies were further excluded. Twenty-three studies remained for qualitative analyses and 20 for meta-analyses of primary and secondary outcomes. No significant differences in tooth color change or tooth sensitivity incidence were found between the compared groups; however, tooth sensitivity intensity decreased when light sources were applied.

CONCLUSION

The use of light sources for in-office bleaching is not imperative to achieve esthetic clinical results.

Comparison of Tooth Color Change After Bleaching With Conventional and Different Light-Activated Methods

Introduction: The demand for esthetic dental treatments is increasing in recent years mainly due to improved oral hygiene and better maintenance of oral health and teeth in older individuals. Bleaching of discolored anterior teeth is the most popular among esthetic dental treatments. Even individuals with sound teeth and adequate esthetics seek to have whiter teeth in the anterior region. The aim of this study was to evaluate tooth color changes following conventional in-office bleaching techniques compared to light-activated methods using different light sources. Methods: Seventy sound anterior teeth (devoided of caries and/or fracture), extracted for periodontal and orthodontic reasons were selected and allocated to 7 groups: (A) control, (B) conventional bleaching (C) LED-activated bleaching, (D) KTP laser-activated bleaching, (E) diode laser-activated bleaching, (F) Nd:YAG laser-activated bleaching and (G) CO2 laser-activated bleaching. Colorimetric evaluation was carried out before and after treatment using a spectrophotoradiometer. Data were analyzed by one- and two-way analysis of variance (ANOVA) as well as multiple comparison methods. Results: The results showed that all bleaching procedures were effective in reducing the yellowness index. However, the KTP laser-activated bleaching was significantly more effective than the other techniques in 95% confidence level. It was also seen that CO2 laser activated method has outperformed groups E, F and G and the conventional bleaching without light activation was not effective at all and represented similar results with the control group. Furthermore, the groups E and G had almost the same results in decreasing the yellowness index. Conclusion: The results showed that all bleaching techniques were effective however, the KTP laser-activated bleaching was significantly more efficient, closely followed by the CO2 laser-activated bleaching technique.

In-office dental bleaching with light vs. without light: A systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis were performed to answer the following research question: Does light-activated in-office vital bleaching have a greater whitening efficacy and higher tooth sensitivity (TS) in comparison with in-office vital bleaching without light when used in adults?

DATA AND SOURCE

Only randomized clinical trials (RCTs) involving adults who had in-office bleaching with and without light activation were included. Controlled vocabulary and keywords were used in a comprehensive search for titles and abstracts in PubMed, and this search was adapted for Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE without restrictions in May 2016 and was updated in August 2017. IADR abstracts (1990-2016), unpublished- and ongoing-trial registries, dissertations, and theses were also searched. The risk-of-bias tool of the Cochrane Collaboration was used for quality assessment. The quality of the evidence was rated using the Grading of Recommendations: Assessment, Development, and Evaluation approach. Through the use of the random effects model, a meta-analysis with a subgroup analysis (low and high hydrogen peroxide concentration) was conducted for color change (ΔE*, ΔSGU) as well as the risk and intensity of TS.

STUDY SELECTION

We retrieved 6663 articles, but after removing duplicates and non-relevant articles, only 21 RCTs remained. No significant difference in ΔE*, ΔSGU, and risk and intensity of TS was observed (p > .05). For ΔE and risk of TS, the quality of the evidence was graded as moderate whereas the evidence for ΔSGU and intensity of TS was graded as very low and low, respectively.

CONCLUSION

Without considering variations in the protocols, the activation of in-office bleaching gel with light does not seem to improve color change or affect tooth sensitivity, regardless of the hydrogen peroxide concentration. (PROSPERO - CRD42016037630).

CLINICAL RELEVANCE

Although it is commercially claimed that in-office bleaching associated with light improves and accelerates color change, this study did not confirm this belief for in-office bleaching gels with either high or low levels of hydrogen peroxide.

Randomized clinical trials of dental bleaching - Compliance with the CONSORT Statement: a systematic review

We reviewed the literature to evaluate: a) The compliance of randomized clinical trials (RCTs) on bleaching with the CONSORT; and b) the risk of bias of these studies using the Cochrane Collaboration risk of bias tool (CCRT). We searched the Cochrane Library, PubMed and other electronic databases, to find RCTs focused on bleaching (or whitening). The articles were evaluated in compliance with CONSORT in a scale: 0 = no description, 1 = poor description and 2 = adequate description. Descriptive analyses of the number of studies by journal, follow-up period, country and quality assessments were performed with CCRT for assessing risk of bias in RCTs. 185 RCTs were included for assessment. More than 30% of the studies received score 0 or 1. Protocol, flow chart, allocation concealment and sample size were more critical items, as 80% of the studies scored 0. The overall CONSORT score for the included studies was 16.7 ± 5.4 points, which represents 52.2% of the maximum CONSORT score. A significant difference among journal, country and period of time was observed (p < 0.02). Only 7.6% of the studies were judged at "low" risk; 62.1% were classified as "unclear"; and 30.3% as "high" risk of bias. The adherence of RCTs evaluating bleaching materials and techniques to the CONSORT is still low with unclear/high risk of bias.

Comparison of laser and power bleaching techniques in tooth color change

Background

Laser-assisted bleaching uses laser beam to accelerate release of free radicals within the bleaching gel to decrease time of whitening procedure. The aim of this study was to compare the efficacy of power bleaching using Opalescence Xtra Boost® and laser bleaching technique using LaserSmile gel and diode laser as an activator in their tooth whitening capacity.

Material and Methods

Student t test showed that the laser bleaching group significantly outperformed the power bleaching group in changing ∆E (p=0.977).

Results

Similarly, while comparing the groups in changing ∆L, the laser bleaching group indicated significantly superior results (p=0.953). Statistical data from student t test while comparing the groups in changing the parameter of yellowness indicated that samples in laser bleaching group underwent a more significant reduction than power-bleached samples (p=0.85). Correspondingly, changes in whiteness were statistically tested through student t test, showing that laser bleaching technique increased whiteness of the samples significantly more than those treated by power bleaching (p=0.965). The digital color evaluation data was in accordance with spectrophotometry and showed that laser bleaching outperformed power bleaching technique. Both techniques were able to increase whiteness and decrease yellowness ratio of the samples. ΔE decrease for laser bleaching and power bleaching groups were 3.05 and 1.67, respectively. Tooth color change in laser bleaching group was 1.88 times more than that of power bleaching group (p<0.001).

Conclusions

It could be concluded that under the conditions of this study, both laser-assisted and power bleaching techniques were capable of altering tooth color change, but laser bleaching was deemed a more efficient technique in this regard.

Key words:Laser, power bleaching, tooth color introduction.

The efficacy of laser-assisted in-office bleaching and home bleaching on sound and demineralized enamel

AIMS

This study investigated the effectiveness of laser-assisted in-office bleaching and home-bleaching in sound and demineralized enamel.

MATERIALS AND METHODS

The sample consisted of 120 freshly-extracted bovine incisors. Half of the specimens were stored in a demineralizing solution to induce white spot lesions. Following exposure to a tea solution for 7.5 days, the specimens were randomly assigned to 4 groups of 30 according to the type of enamel and the bleaching procedure employed. Groups 1 and 2 consisted of demineralized teeth subjected to in-office bleaching and home bleaching, whereas in groups 3 and 4, sound teeth were subjected to in-office and home bleaching, respectively. A diode laser (810 nm, 2 W, continuous wave, four times for 15 seconds each) was employed for assisting the in-office process. The color of the specimens was measured before (T1) and after (T2) staining and during (T3) and after (T4) the bleaching procedures using a spectrophotometer. The color change (ΔE) between different treatments stages was compared among the groups.

RESULTS

There were significant differences in the color change between T2 and T3 (ΔE T2-T3) and T2 and T4 (ΔE T2-T4) stages among the study groups (p<0.05). Pairwise comparison by Duncan test revealed that both ΔET2-T3 and ΔET2-T4 were significantly greater in demineralized teeth submitted to laser-assisted in-office bleaching (group 1) as compared to the other groups (P< 0.05).

CONCLUSION

Laser-assisted in-office bleaching could provide faster and greater whitening effect than home bleaching on stained demineralized enamel, but both procedures produced comparable results on sound teeth.

Effects of the bleaching procedures on enamel micro-hardness: Plasma Arc and diode laser comparison

BACKGROUND AND AIMS

One of the major side effects of vital bleaching is the reduction of enamel micro-hardness. The purpose of this study was to evaluate the influence of two different bleaching systems, Plasma Arc and GaAlAs laser, on the enamel micro-hardness.

MATERIALS AND METHODS

15 freshly extracted human third molars were sectioned to prepare 30 enamel blocks (5×5 mm). These samples were then randomly divided into 2 groups of 15 each (n=15): a plasma arc bleaching group (: 350-700 nm) + 35% Hydrogen Peroxide whitening gel and a laser bleaching group (GaAlAs laser, λ: 810 nm, P: 10 W, CW, Special Tip) + 35% Hydrogen Peroxide whitening gel. Samples were subjected to the Vickers micro-hardness test (VHN) at a load of 50 g for 15s before and after treatment. Data were statistically analyzed by a Mann-Whitney test (p≤0.05).

RESULTS

In the GaAlAs laser group, the enamel micro-hardness was 618.2 before and was reduced to 544.6 after bleaching procedures. In the plasma arc group, the enamel micro-hardness was 644.8 before and 498.9 after bleaching. Although both techniques significantly reduced VHN, plasma arc bleaching resulted in a 22.62% reduction in VHN for enamel micro-hardness, whereas an 11.89% reduction in VHN was observed for laser bleaching; this difference is statistically significant (p<0.001).

CONCLUSION

Both bleaching techniques reduced enamel micro-hardness, although the reduction is much less significant with the GaAlAs laser than with the plasma arc. Therefore GaAlAs laser bleaching has fewer harmful effects than plasma arc in respect to enamel micro-hardness reduction.

Microhardness of demineralized enamel following home bleaching and laser-assisted in office bleaching

BACKGROUND

There is little data regarding the effect of tooth whitening on microhardness of white spot lesions. This study was conducted to investigate the effect of home-bleaching and laser-assisted in-office bleaching on microhardness of demineralized enamel.

MATERIAL AND METHODS

Forty bovine incisors were selected and immersed in a demineralizing solution for 12 weeks to induce white spot lesions. Enamel blocks were prepared and randomly assigned to two groups of 20 each. The first group underwent home bleaching with 15% carbamide peroxide which was applied for 8 hours a day over a period of 15 days. In the second group, in-office bleaching was performed by 40% hydrogen peroxide and powered by irradiation from an 810 nm gallium-aluminum-arsenide (GaAlAs) diode laser (CW, 2W). This process was performed for 3 sessions every seven days, in 15 days. The specimens were stored in Fusayama Meyer artificial saliva during the experiment. Surface microhardness was assessed before and after the bleaching therapies in both groups.

RESULTS

Microhardness decreased significantly following both home bleaching and laser-assisted in-office bleaching (p<0.05). There were no significant differences in hardness values among the two groups either before (p=0.131) or after (p=0.182) the bleaching procedures.

CONCLUSIONS

Tooth whitening through home bleaching or laser-assisted in-office bleaching can result in a significant reduction in microhardness of white spot lesions. Therefore, it is suggested to take protective measures on bleached demineralized enamel. Key words:White spot lesion, bleaching, laser, microhardness, demineralized enamel, home bleaching, in-office bleaching.

Laser teeth bleaching: evaluation of eventual side effects on enamel and the pulp and the efficiency in vitro and in vivo

Light and heat increase the reactivity of hydrogen peroxide. There is no evidence that light activation (power bleaching with high-intensity light) results in a more effective bleaching with a longer lasting effect with high concentrated hydrogen peroxide bleaching gels. Laser light differs from conventional light as it requires a laser-target interaction. The interaction takes place in the first instance in the bleaching gel. The second interaction has to be induced in the tooth, more specifically in the dentine. There is evidence that interaction exists with the bleaching gel: photothermal, photocatalytical, and photochemical interactions are described. The reactivity of the gel is increased by adding photocatalyst of photosensitizers. Direct and effective photobleaching, that is, a direct interaction with the colour molecules in the dentine, however, is only possible with the argon (488 and 415 nm) and KTP laser (532 nm). A number of risks have been described such as heat generation. Nd:YAG and especially high power diode lasers present a risk with intrapulpal temperature elevation up to 22°C. Hypersensitivity is regularly encountered, being it of temporary occurrence except for a number of diode wavelengths and the Nd:YAG. The tooth surface remains intact after laser bleaching. At present, KTP laser is the most efficient dental bleaching wavelength.

Laser welding and syncristallization techniques comparison: "Ex vivo" study

BACKGROUND AND AIMS

Stabilization of implant abutments through electric impulses at high voltage for a very short time (electrowelding) was developed in the Eighties. In 2009, the same procedure was performed through the use of laser (laser welding) The aim of this study is to compare electrowelding and laser welding for intra-oral implant abutments stabilization on "ex vivo models" (pig jaws).

MATERIALS AND METHODS

Six bars were welded with two different devices (Nd:YAG laser and Electrowelder) to eighteen titanium implant abutment inserted in three pig jaws. During the welding process, thermal increase was recorded, through the use of k-thermocouples, in the bone close to the implants. The strength of the welded joints was evaluated by a traction test after the removal of the implants. For temperature measurements a descriptive analysis and for traction test "values unpaired t test with Welch's correction" were performed: the significance level was set at P<0.05.

RESULTS

Laser welding gives a lower thermal increase than Electrowelding at the bone close to implants (Mean: 1.97 and 5.27); the strength of laser welded joints was higher than that of Electrowelding even if nor statistically significant. (Mean: 184.75 and 168.29) CONCLUSION: Electrowelding seems to have no advantages, in term of thermal elevation and strength, while laser welding may be employed to connect titanium implants for immediate load without risks of thermal damage at surrounding tissues.

Evaluation of the effects of conventional versus laser bleaching techniques on enamel microroughness

Nowadays, bleaching of the teeth within the dental office is one of the most widespread techniques to correct tooth discoloration. Variability of the materials and techniques accompanied with the trend toward esthetic restorations with minimally invasive approaches are increasing. The use of laser in this regard has also been taken into consideration. The aim of this study was to evaluate the effects of in-office versus laser bleaching on surface roughness of enamel. Fifteen freshly extracted human molars were sectioned mesiodistally to produce 30 lingual and buccal enamel blocks. Samples were mounted in transparent acrylic resin blocks and polished before treatment. Samples were randomly assigned to laser bleaching (LB) and office bleaching (OB) groups (n = 15 each). Pretreatment evaluation of microroughness was carried out for all samples using profilometer. Samples were treated twice in the OB group with Opalescent Xtra Boost and in the LB group using a laser-activated gel. Microroughness was evaluated after bleaching in both groups. Data were analyzed using repeated measure ANOVA. Both methods increased enamel surface roughness. Microroughness changes were significantly different between the two groups (p < 0.05). Microroughness significantly increased in the OB group (p > 0.05), but there was no significant difference in pre- and post-treatment roughness evaluation in the LB group (p < 0.05). Laser was considered a safer technique because it demonstrated a less surface roughness increase in comparison with the conventional office bleaching procedure.

Efficacy of and effect on tooth sensitivity of in-office bleaching gel concentrations: a randomized clinical trial

With the aim of reducing the side effects of in-office bleaching agents, less-concentrated hydrogen peroxide (HP) gels have been released by manufacturers. We evaluated the tooth sensitivity (TS) and bleaching efficacy (BE) of two HP concentrations in this study. Gels containing 35% and 20% HP (HP35 and HP20, respectively) were applied on teeth of 60 caries-free patients. Color was recorded at baseline and one week after the first and second bleaching sessions using the Vita Classical shade guide. TS was recorded on a 0-4 scale. BE at each weekly recall was evaluated by Kruskall-Wallis and Mann-Whitney tests (α=0.05). Absolute risk of TS and its intensity was evaluated by Fisher exact and Mann-Whitney tests, respectively (α=0.05). After two bleaching sessions, color change of approximately eight tabs was obtained with HP35; whereas, with HP20 it was six tabs (p<0.05). Only 26.7% (HP35) and 16.7% (HP20) of the participants reported TS, and no statistical differences were detected among them. Both in-office bleaching gels showed similar TS intensity, but the 35% HP agent produced faster bleaching.

The effects of light on bleaching and tooth sensitivity during in-office vital bleaching: a systematic review and meta-analysis

OBJECTIVE

To evaluate the influence of light on bleaching efficacy and tooth sensitivity during in-office vital bleaching.

DATA SOURCES

We performed a literature search using Medline, EMBASE and Cochrane Central up to September 2011.

STUDY SELECTION

All randomised controlled trials (RCTs) or quasi-RCTs comparing the light-activated bleaching system with non-activation bleaching system were included. Reports without clinical data concerning bleaching efficacy or tooth sensitivity were excluded.

RESULTS

Eleven studies were included in the meta-analysis. A light-activated system produced better immediate bleaching effects than a non-light system when lower concentrations of hydrogen peroxide (15-20% HP) were used (mean difference [MD], -1.78; 95% confidence interval [CI]: [-2.30, -1.26]; P<0.00001). When high concentrations of HP (25-35%) were employed, there was no difference in the immediate bleaching effect (MD, -0.39; 95% CI: [-1.15, 0.37]; P=0.32) or short-term bleaching effect (MD, 0.25; 95% CI: [-0.47, 0.96]; P=0.50) between the light-activated system and the non-light system. However, the light-activated system produced a higher percentage of tooth sensitivity (odds ratio [OR], 3.53; 95% CI: [1.37, 9.10]; P=0.009) than the non-light system during in-office bleaching.

CONCLUSIONS

Light increases the risk of tooth sensitivity during in-office bleaching, and light may not improve the bleaching effect when high concentrations of HP (25-35%) are employed. Therefore, dentists should use the light-activated system with great caution or avoid its use altogether. Further rigorous studies are, however, needed to explore the advantages of this light-activated system when lower concentrations of HP (15-20%) are used.

Analysis of shade, temperature and hydrogen peroxide concentration during dental bleaching: in vitro study with the KTP and diode lasers

Many dental bleaching techniques are now available, several of them using a laser source. However, the literature on the exact role of coherent light in the biochemical reaction of the whitening process is very discordant. The aims of this in vitro study were: (1) to compare two different laser sources, a KTP laser with a wavelength of 532 nm and a diode laser with a wavelength of 808 nm, during dental bleaching, and (2) to investigate the relationships among changes in gel temperature, tooth shade and hydrogen peroxide (HP) concentration during laser irradiation. Altogether, 116 bovine teeth were bleached using a 30% HP gel, some of them with gel only and others with gel plus one of the two lasers (532 or 808 nm) at two different powers (2 and 4 W). The KTP laser produced a significant shade variation with a minimal temperature increase. The diode laser led to a higher temperature increase with a greater reduction in HP concentration, but the change in shade was only statistically significant with a power of 4 W. At a power of 2 W, the KTP laser caused a greater change in shade than the diode laser. No significant correlations were found among temperature, HP concentration and shade variation. The KTP laser appears to provide better results with less dangerous thermal increases than the diode laser. This might call into question most of the literature affirming that the action of laser bleaching is by increasing the gel temperature and, consequently, the speed of the redox reaction. Further study is required to investigate the correlations between the parameters investigated and efficacy of the bleaching process.

Effect of light activation on tooth sensitivity after in-office bleaching

This clinical study evaluated the effects of light-emitting diode (LED)/laser activation on bleaching effectiveness (BE) and tooth sensitivity (TS) during in-office bleaching. Thirty caries-free patients were divided into two groups: light-activated (LA) and non-activated (NA) groups. A 35% hydrogen peroxide gel (Whiteness HP Maxx, FGM Dental Products, Joinville SC, Brazil) was used in three 15-minute applications for both groups. For the LA group, LED/laser energy (Whitening Lase Light Plus, DMC Odontológica, São Carlos SP, Brazil) was used, in accordance with the manufacturer's directions. Two sessions of bleaching were performed at one-week intervals. Color was registered at baseline and after the first and second bleaching sessions using a Vita shade guide. Patients recorded TS on a 0 to 4 scale during bleaching and within the next 24 and 48 hours of each session. BE at recall each week and intensity of TS were evaluated by repeated measures analysis of variance (ANOVA) and Tukey tests (α=0.05). Tooth sensitivity was compared using the Friedman repeated measures analysis of variance by rank and the Wilcoxon sign-ranked test. Faster bleaching was observed for the LA group than for the NA group after the first session (4.8 and 3.8 shade guide units [SGUs]; p=0.0001). However, both techniques were capable of bleaching the same number of SGUs after the second bleaching session (p=0.52). Most of the LA group (53.3%) had sensitivity even 24 hours after each bleaching session, but only 26.6% from the NA group reported TS. The intensity of TS was similar for both groups immediately after bleaching but significantly higher for the LA group 24 hours after each bleaching session (p=0.001). After two bleaching sessions, the use of LED/laser light activation did not improve bleaching speed. Persistent tooth sensitivity and higher tooth sensitivity after 24 hours of bleaching were observed when light activation was used.