The influence of violet LED application time on the esthetic efficacy and cytotoxicity of a 35% H2O2 bleaching gel

Co-doped titanium dioxide nanoparticles decrease the cytotoxicity of experimental hydrogen peroxide gels for in-office tooth bleaching

OBJECTIVE

To evaluate the efficacy and cytotoxicity of experimental 6% and 35% hydrogen peroxide gels (HP6 or HP35) incorporated with titanium dioxide nanoparticles (NP) co-doped with nitrogen and fluorine and irradiated with a violet LED light (LT).

METHODS

Bovine enamel-dentin disks adapted to artificial pulp chambers were randomly assigned to bleaching (n = 8/group): NC (negative control), NP, HP6, HP6 + LT, HP6 + NP, HP6 + NP + LT, HP35, HP35 + LT, HP35 + NP, HP35 + NP + LT, and commercial HP35 (COM). Color (ΔE00) and whiteness index (ΔWID) changes were measured before and 14 days after bleaching. The extracts (culture medium + diffused gel components) collected after the first session were applied to odontoblast-like MDPC-23 cells, which were assessed concerning their viability, oxidative stress, and morphology. The amount of HP diffused through the disks was determined. Data were analyzed by generalized linear models or Kruskal Wallis Tests (α = 5%).  RESULTS: HP6 + NP + LT exhibited ΔE00 and ΔWID higher than HP6 (p < 0.05) and similar to all HP35 groups. HP6 + NP + LT showed the lowest HP diffusion, and the highest cell viability (%) among bleached groups, preserving cell morphology and number of living cells similar to NC and NP. HP6 + LT, HP6 + NP, and HP6 + NP + LT exhibited the lowest cell oxidative stress among bleached groups (p < 0.05). HP35, HP35 + LT, and HP35 (COM) displayed the lowest cell viability.

CONCLUSION

HP6 achieved significantly higher color and whiteness index changes when incorporated with nanoparticles and light-irradiated and caused lower cytotoxicity than HP35 gels. The nanoparticles significantly increased cell viability and reduced the hydrogen peroxide diffusion and oxidative stress, regardless of HP concentration.

CLINICAL SIGNIFICANCE

Incorporation of co-doped titanium dioxide nanoparticles combined with violet irradiation within the HP6 gel could promote a higher perceivable and acceptable efficacy than HP6 alone, potentially reaching the optimal esthetic outcomes rendered by HP35. This approach also holds the promise of reducing cytotoxic damages and, consequently, tooth sensitivity.

In-office Bleaching Activated With Violet LED: Effect on Pulpal and Tooth Temperature and Pulp Viability

OBJECTIVES

This study evaluated the influence of hydrogen peroxide (HP) with or without titanium dioxide nanotubes (TiO2) associated with violet LED (VL) regarding: a) the temperature change in the pulp chamber and facial surface; b) the decomposition of HP; and c) the cytotoxicity of the gels on pulp cells.

METHODS AND MATERIALS

The experimental groups were: HP35 (35% HP/Whiteness HP, FGM); HP35+VL; HP35T (HP35+TiO2); HP35T+VL; HP7 (7.5% HP/White Class 7.5%, FGM); HP7+VL; HP7T (HP7+TiO2); and HP7T+VL. TiO2 was incorporated into the bleaching gels at 1%. Eighty bovine incisors were evaluated to determine temperature change in 8 experimental groups (n=10/group). A k-type thermocouple was used to evaluate the temperatures of the facial surface and in the pulp chamber, achieved by enabling endodontic access to the palatal surface, throughout the 30-minute session. HP decomposition (n=3) of gels was evaluated by using an automatic potentiometric titrator at the initial and 30-minute time points. Trans-enamel and trans-dentinal cell viability were assessed with a pulp chamber device as well as enamel and dentin discs (n=6), and the treatment extracts (culture medium + diffused components) were collected and applied to MDPC-23 odontoblast cells to evaluate cell viability according to the MTT test.

RESULTS

A temperature increase in the pulp chamber was observed in the presence of VL at 30 minutes (p<0.05) (Mann-Whitney test). Also at 30 minutes, HP35 showed greater decomposition in the presence of VL rather than in its absence (p<0.05) (mixed linear models and the Tukey-Kramer test). HP7 provided greater cell viability than the groups treated with HP35 (p<0.05) (generalized linear models test). Cell viability was significantly lower for HP7 in the presence of VL (p<0.05).

CONCLUSION

Pulpal temperature increased with VL (maximum of 1.9°C), but did not exceed the critical limit to cause pulp damage. Less concentrated HP resulted in higher cell viability, even when associated with VL.

Low and high hydrogen peroxide concentrations of in-office dental bleaching associated with violet light: an in vitro study

OBJECTIVES

This study aims to assess hydrogen peroxide (HP) penetration within the pulp chamber, color change (CC), physical-chemical properties, and temperature using in-office different concentration bleaching gels with or without violet light.

MATERIALS AND METHODS

Fifty teeth were divided into five groups (n = 10) based on the HP concentration bleaching gels used (6% and 35%) and the used violet light (with or without). HP penetration within the pulp chamber was measured using UV-Vis. The CC was evaluated with a digital spectrophotometer. Initial and final concentration, and pH were measured through titration, and a Digital pHmeter, respectively. Temperature analyses were measured through a thermocouple. Statistical analysis included two-way ANOVA, Tukey's, and Dunnett's test (α = 0.05).

RESULTS

The presence of violet light did not affect the amount of HP within the pulp chamber, or the CC (p > 0.05). Greater penetration of HP was observed within the pulp chamber, as well as CC when using 35% HP (p < 0.05). The final concentration of both gels was lower than the initial concentration, regardless of the use of violet light (p < 0.05). The initial and final pH levels remained neutral and stable (p > 0.05). The pulp temperature increased when the gels were used in conjunction with violet light (p < 0.05).

CONCLUSIONS

Using violet light in conjunction with 6% or 35% HP does not alter the physical properties of the bleaching agents, the penetration of HP or enhance color change. However, an increase in temperature was observed when violet light was applied associated with bleaching gels.

CLINICAL RELEVANCE

While the simultaneous use of violet light with hydrogen peroxide 6% or 35% does not alter the material's properties, it also does not bring benefits in reducing hydrogen peroxide penetration and improving color change. Furthermore, the use of violet light increases pulp temperature.

Catalysis-based approaches with biopolymers and violet LED to improve in-office dental bleaching

This in vitro experimental investigation aimed to evaluate the impact of the combined application of a nanofiber scaffold (NS), a polymeric catalyst primer (PCP) containing 10 mg/mL of heme peroxidase enzyme, and violet LED (LEDv) on the esthetic efficacy (EE), trans-amelodentinal cytotoxicity (TC), and procedural duration of conventional in-office bleaching therapy. To achieve this, 96 standardized enamel/dentin discs were individually placed in artificial pulp chambers. A 35% hydrogen peroxide (H2O2) bleaching gel was administered for 45, 30, or 15 min to the enamel, either previously coated with NS + PCP or left uncoated, followed by irradiation with LEDv for 15 min or no irradiation. The established groups were as follows: G1, negative control (no treatment); G2, 35% H2O2/45 min; G3, NS + PCP + LEDv; G4, NS + PCP + 35%H2O2/45 min + LEDv; G5, NS + PCP + 35%H2O2/30 min + LEDv; and G6, NS + PCP + 35%H2O2/15 min + LEDv. Extracts (culture medium + gel components diffused through the discs) were collected and applied to odontoblast-like MDPC-23 cells. EE (ΔE00 and ΔWI) and TC were assessed using ANOVA/Tukey analysis (p < 0.05). The EE analysis revealed no statistical differences between G6 and G2 (p > 0.05). Cells in G6 exhibited higher viability and lower oxidative stress compared to other bleached groups (p < 0.05). In conclusion, employing NS + PCP + LEDv to catalyze a 35%H2O2 bleaching gel applied for 15 min to the enamel resulted in successful esthetic improvements and reduced the cytotoxicity commonly linked with traditional in-office bleaching procedures.

Fracture strength and hybrid layer formation of endodontically-treated teeth after dental bleaching photoactivated with violet LED

OBJECTIVE

To evaluate in vitro the effect of dental bleaching using high concentration hydrogen peroxide (HP) photoactivated with violet LED on fracture strength and hybrid layer formation.

METHODS

forty endodontically-treated bovine teeth were randomized into four groups (n = 10): C - Control, HP - 35% hydrogen peroxide, HP-BL - 35% hydrogen peroxide photoactivated with blue LED, HP-VL - 35% hydrogen peroxide photoactivated with violet LED. Three bleaching sessions with an interval of 7 days between them were performed. After 10 days of the last bleaching session, the dental crowns were restored and submitted to the fracture strength test. Five specimens from each group were used to evaluate the hybrid layer formation by scanning electron microscope (SEM) images. One-way ANOVA and Kruskal-Wallis test were used for parametric and non-parametric data, respectively. Significance level of 5% was adopted to all the tests.

RESULTS

No differences on fracture strength among the groups were observed (p > 0.05). HP and HP-BL showed alterations on hybrid layer formation compared to C group (p < 0.05), but not for HP-VL (p > 0.05). No differences on hybrid layer formation were observed among HP, HP-VL and HP-BL groups (p > 0.05).

CONCLUSION

Dental bleaching, photoactivated or not, did not affect the fracture strength of endodontically-treated teeth. Regardless of the protocol used, hydrogen peroxide altered the hybrid layer formation at some level when the restoration was placed after 10 days of the last bleaching session.

Influence of violet LED and fluoride-containing carbamide peroxide bleaching gels on early-stage eroded/abraded teeth

PURPOSE

This study evaluated enamel with early-stage erosion/abrasion following bleaching with 20% and 45% carbamide peroxide (CP) gels containing fluoride (F) and irradiated with violet LED (LED).

METHODS

Enamel blocks were immersed in 1% citric acid (5 min) and artificial saliva (120 min) three times to produce early-stage enamel erosion. Simulated toothbrushing was performed only after the first saliva immersion, to provoke enamel abrasion. The erosive/abraded enamel samples were submitted to (n=10): LED/CP20, CP20, LED/CP20_F, CP20_F, LED/CP45, CP45, LED/CP45_F, CP45_F, LED, and control (without treatment). The pH of the gels was assessed, and color (ΔE₀₀) and whiteness index (ΔWI_D) changes were calculated after cycling (T₁), and 7 days from bleaching (T₂). Enamel surface roughness average (Ra) and Knoop microhardness (kg/mm², %SHR) were evaluated at baseline (T₀) at T₁ and T_2. Scanning electron microscopy evaluated the enamel surface morphology at T₂.

RESULTS

The gels' pH was neutral and CP20 and CP45 exhibited no differences in ΔE₀₀ and ΔWI_D (p>0.05) but LED increased these parameters for CP20_F and CP45. Erosion/abrasion significantly decreased mean kg/mm², and the LED group was the only one not increasing microhardness after bleaching (p>0.05). None of the groups fully recovered the initial microhardness. All groups exhibited %SHR similar to the control (p>0.05) and the increase in Ra was detected only after erosion/abrasion. CP20_F groups exhibited a more preserved enamel morphology.

CONCLUSION

Light irradiation combined with low-concentrated CP gel promoted a bleaching effect comparable to the high-concentrated CP. The bleaching protocols did not adversely impact the surface of early-stage eroded/abraded enamel.

Effectiveness and color stability of non-vital dental bleaching photoactivated by violet LED on blood-stained teeth

BACKGROUND

Few studies have investigated the effect of violet LED irradiation associated or not with bleaching agents on blood-stained teeth. This in vitro study aimed to evaluate the whitening efficacy and color stability of non-vital dental bleaching using 35% hydrogen peroxide (HP) photoactivated with violet LED (VL) compared to 35% HP alone and 35% HP photoactivated with blue LED (BL).

METHODS

Fifty bovine dental crowns were used to obtain specimens of 5 × 5 × 2 mm. After selection based on a previous colorimetric analysis, the specimens were blood-stained and randomly assigned into five groups (n = 10): control (no treatment); 35% HP, 35% HP/BL; 35% HP/VL; and VL. Three bleaching sessions were performed and the colorimetric analysis (∆E_ab, ∆L, and ∆WI_D) was recorded after 7 days, 30 days, and 9 months of the last bleaching session. Two-way repeated measures ANOVA followed by Bonferroni post-hoc test was used at a significance level of 5%.

RESULTS

35% HP, 35% HP/BL, and 35% HP/VL showed higher values of ∆E_ab, ∆L, e ∆WI_D (P < 0.05), without intra- and intergroup differences (P > 0.05). C and VL were similar in all the evaluation times (P > 0.05), showing lower values of ∆E_ab, ∆L, and ∆WI_D (P < 0.05).

CONCLUSIONS

35% HP/VL can be a viable alternative for dental bleaching in endodontically-treated teeth, showing bleaching efficacy similar to 35% HP solely used, even after a 9-month follow-up. VL used alone was not effective to bleach blood-stained teeth.

Direct dentin bleaching: Would it be possible?

This study aims to evaluate in vitro the effect of violet LED when applied directly to dentin tissue pigmented by different substances. We analyzed the chromatic alteration, the bleaching effect and the temperature variation. Hence, 60 bovine dentin tissue discs were divided into five groups: NNatural Pigmentation; T-Black Tea; C-Soluble Coffee; W-Red Wine; B-Equine Blood. Individualized pigmentation protocols were performed and all groups reached the same chromatic change value. Subsequently, we simultaneously performed a bleaching session and measured temperature variation using a K-type thermocouple device. Data on chromatic change (∆E, ∆E00, ∆a, ∆b and ∆L), whitening effect (WID) and temperature variation were subjected to one-way Anova and Tukey's post-test at a 5% significance level. The C group showed the most relevant chromatic change values, similar to the N group, responding positively to the treatment. However, the B group differed from the control group, which showed difficulty to respond to the treatment. Regarding the whitening index, only the W group showed lower results than the others. The B group showed the greatest temperature changes. We conclude that the violet LED offered chromatic change, which generated a bleaching effect. Pigmentations with red wine and blood showed the greatest difficulty to respond to treatment, also promoting a higher temperature rise in teeth pigmented with blood.