Effect of non-vital tooth bleaching on microleakage of coronal access restorations

Intracoronal tooth bleaching - A review and treatment guidelines

Intracoronal bleaching is a minimally invasive procedure that was introduced into dentistry in the 19th century. The role of that procedure in enhancing the colour of teeth subjected to internal discolouration while being conservative made it extremely popular amongst dental professionals. Different materials and techniques have been utilized over the years attempting to obtain predictable long-term results while minimizing any associated risks. Contemporarily, bleaching agents are mainly based on peroxide-releasing compounds in different formulations and delivery systems. Different theories have been formulated on the bleaching mechanism of such agents, but the exact mechanism is yet to be proven. The effect of hydrogen peroxide-based bleaching agents on the organic structure of enamel and dentine has been extensively investigated to address the effects of bonding of resin-based restorative materials to hard tooth structure. Multiple case reports raised a concern about the contribution of intracoronal bleaching in developing invasive root resorption. Modification of intracoronal bleaching techniques was thus necessary to address such concerns. This review will provide a summary of the important aspects of intracoronal bleaching, focusing on how it applies to the contemporary clinical setting. © 2023 Australian Dental Association.

Study of the Intra-Coronal Pressure Generated by Internal Bleaching Agents and Its Influence on Temporary Restoration

Intra-coronal bleaching is a treatment that whitens non-vital teeth from within the pulp chamber, a procedure by which oxygen and free radicals are released. This in vitro study analyzed and compares the oxygen expansion produced when different bleaching agents encounter dental tissues during this type of bleaching. Here, 120 lower incisors were included and prepared to achieve conditions as close as practicable to internal bleaching with the walking bleach technique. The access cavity of the lingual surface was prepared to seal glass tubes with oil inside them by adhesive restoration once the bleach was placed inside the pulp chamber. The following bleaching groups were used: hydrogen peroxide (HP) 30% (n = 30), sodium Perborate (SP) with distilled water (n = 30), a mixture of HP 30% with SP (n = 30) and a control group (n = 30). After 10 days, the oil displacement that took place through the tube due to oxygen release was measured daily. Displacement of the oil was observed in all groups except the control group. The final mean expansion at 10 days was 335.24 ± 76.85 mm for the HP 30% group, 8.40 ± 1.74 mm for the SP group and 183.07 ± 49.93 mm for the HP30% + SP mixture. Significant statistical differences were observed between the three groups using the Games–Howell post hoc test, where HP30% caused the greatest expansion and SP the least expansion. These results suggest that the higher the amount of HP in the sample, the more oxygen expansion is observed, so that temporary restoration must be performed more carefully to avoid displacement.

Assessment of Oxygen Expansion during Internal Bleaching with Enamel and Dentin: A Comparative In Vitro Study

Internal bleaching is a conservative, non-invasive, and simple treatment that is frequently performed in daily clinical practice. The present in vitro study analyzes the oxygen expansion of different bleaching agents resulting from the oxidation reaction when interacting with enamel and dentin. Enamel and dentin were crushed separately until obtaining a fine powder with particles of an approximate size between 0.06 and 0.2 mm. Each enamel and dentin sample were mixed with 37% carbamide peroxide (CP 37%), 30% hydrogen peroxide (HP 30%), sodium perborate (SP) combined with HP 30% (HP 30% + SP) and SP with distilled water (SP). A total of 280 1 mm diameter glass tubes were used with 70 for each bleaching agent (30 for powdered enamel evaluation, 30 for powdered dentin evaluation, and 10 controls). The bleaching agents were placed in the prepared tubes immediately after mixing the components. As expansion occurred, the oil inside the tube was displaced, through which the resulting expansion was evaluated and measured for 10 days. A significant expansion was observed that varied in magnitude according to the bleaching agent and the tooth structure used. Student's t test and Welch's ANOVA were used to analyze the data obtained. The highest mean expansion of both enamel and dentin was observed with 30% HP (66.6 mm for enamel, 94.5 mm for dentin) followed by HP 30% + SP (48.6 mm for enamel, 52.7 mm for dentin), CP 37% (38.4 mm for enamel, 52.6 mm for dentin) and finally SP with water (12.7 mm for enamel, 4.4 mm for dentin). It was observed that the expansion in the SP group with enamel was significantly lower than in the rest of the groups, while that registered for HP 30% was significantly higher. (p < 0.001). The results with dentin were similar, with a significantly lower expansion for SP and higher for HP 30% (p < 0.001). The oxygen expansion observed as a result of the interaction between bleaching agents and dental tissues could contribute to improving our understanding of bleaching and its results. These results suggest that bleaching agents react with the organic component of the tooth structure.

Marginal integrity of aesthetic restorations following intracoronal bleaching with sweet potato extract as an additive: An SEM study

The aim of this in vitro study was to evaluate the marginal integrity of an alkasite restoration in comparison to that of a conventional composite resin restoration following intra-coronal bleaching with 30% hydrogen peroxide (HP) containing sweet potato extract (SPE) as an additive. Access cavities were prepared in 60 extracted human incisors. The teeth were decoronated 2mm below the CEJ and the pulp chambers were sealed cervically. The samples were divided into two groups (n = 30) based on the type of restorative material - group I: Hybrid composite resin and group II: Alkasite restorative material. Both the groups were divided into three subgroups (n = 10) based on the intra-coronal bleaching agent used namely, subgroup A: no bleaching (NB); subgroup B: 30% hydrogen peroxide (HP) and subgroup C: 30% hydrogen peroxide containing SPE (HSP). The tooth-restorative interface was observed under a scanning electron microscope (SEM) to determine the marginal integrity. The results were tabulated and statistically analyzed using one-way ANOVA. Specimens bleached with HP alone showed higher marginal gaps, irrespective of the restorative material used. Subgroups A and C showed lesser marginal gaps under both the restorative materials. An improved marginal integrity was seen with the alkasite material. It can be concluded that the addition of SPE to HP improves the marginal integrity of the coronal restorative material placed immediately post-bleaching. The new alkasite material holds promise as a permanent coronal seal in cases of intra-coronal bleaching.

Effective application duration of sodium ascorbate antioxidant in reducing microleakage of bonded composite restoration in intracoronally-bleached teeth

OBJECTIVES

The aim of this study was to determine an appropriate application duration of sodium ascorbate (SA) antioxidant gel in reducing microleakage of bonded composite restoration in intracoronally-bleached teeth.

MATERIALS AND METHODS

Eighty endodontically-treated human incisors were randomly divided into eight groups: control, no bleaching; IB and DB, immediate and delayed bonding after bleaching, respectively; S10m, S60m, S24h, S3d and S7d, bleaching + SA gel for 10 min, 60 min, 24 hr, 3 day and 7 day, respectively. For bleaching, a mixture of 30% hydrogen peroxide and sodium perborate was applied for 7 day. All access cavities were restored using One-Step adhesive (Bisco Inc.) and then Aelite LS Packable composite (Bisco Inc.). The bonded specimens were subjected to 500 thermal cycles, immersed in 1% methylene blue for 8 hr, and longitudinally sectioned. Microleakage was assessed with a 0 - 4 scoring system and analyzed using nonparametric statistical methods (α = 0.05).

RESULTS

Group IB showed a significantly higher microleakge than the control group (p = 0.006) and group DB a statistically similar score to the control group (p > 0.999). Although groups S10m, S60m, and S24h exhibited significantly higher scores than group DB (p < 0.05), the microleakage in groups S3d and S7d was statistically similar to that in group DB (p = 0.771, p > 0.999).

CONCLUSIONS

Application of SA gel for 3 day after nonvital bleaching was effective in reducing microleakage of composite restoration in intracoronally-bleached teeth.

Protective Effect of Resin Coating on the Microleakage of Class V Restorations Following Treatment with Carbamide Peroxide In Vitro

Carbamide peroxide treatment increased the microleakage of Class V conventional glass-ionomer cement and resin modified glass-ionomer cement restorations. The resin coating is an effective method to avoid bleaching-induced microleakage without affecting the bleaching outcome.

Effect of bleaching on restorative materials and restorations—a systematic review

OBJECTIVE

Internal and external bleaching procedures utilizing 3-35% hydrogen peroxide solutions or hydrogen peroxide releasing agents, such as carbamide peroxide or sodium perborate, can be used for whitening of teeth. The purpose of the review article was to summarize and discuss the available information concerning the effects of peroxide releasing bleaching agents on dental restorative materials and restorations.

SOURCES

Information from all original scientific full papers or reviews listed in PubMed or ISI Web of Science (search term: bleaching AND (composite OR amalgam OR glass ionomer OR compomer OR resin OR alloy) were included in the review.

DATA

Existing literature reveals that bleaching therapies may have a negative effect on physical properties, marginal integrity, enamel and dentin bond strength, and color of restorative materials as investigated in numerous in vitro studies. However, there are no reports in literature indicating that bleaching may exert a negative impact on existing restorations requiring renewal of the restorations under clinical conditions.

CONCLUSION

Bleaching may exert a negative influence on restorations and restorative materials. Advice is provided based on the current literature to minimize the impact of bleaching therapies on restorative materials and restorations.