Tooth whitening with hydrogen/carbamide peroxides in association with a CPP-ACP paste at different proportions

The effect of photobiomodulation therapy associated with casein phosphopeptide-amorphous calcium phosphate fluoride paste on the treatment of posthome whitening tooth sensitivity and color change: A randomized clinical trial

OBJECTIVE

This study assessed whether combining photobiomodulation therapy (PBMT) with casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) paste can effectively reduce post-home whitening tooth sensitivity (TS) without compromising shade change.

METHODS

Fifty participants were selected and assigned to one of four groups: (1) PLACEBO group-received a placebo paste and PBMT simulation; (2) PBMT group-received a placebo paste + PBMT; (3) CPP-ACPF group-received CPP-ACPF paste and PBMT simulation; (4) CPP-ACPF + PBMT group-received both CPP-ACPF paste and PBMT. The participants used whitening trays containing 22% carbamide peroxide for 2 h a day for 21 days. TS was measured daily using a visual analog scale, while shade change was assessed using a spectrophotometer: before bleaching treatment (T0), after the first (T1), second (T2), and third (T3) weeks of treatment, and 30 days (T4) after completing the whitening treatment.

RESULTS

Intragroup analysis revealed that the PLACEBO group had the highest increase in sensitivity during the whitening treatment. The CPP-ACPF and PBMT groups showed no significant difference tooth whitening (TW) between weeks regarding aesthetic change. The CPP-ACPF and PBMT group exhibited a significant reduction in TS between the first and third and between the second and third weeks TW, but not between the first and second. Conversely, the PLACEBO group showed a higher sensitivity than the other groups (p < .05). The CPP-ACPF and PBMT groups did not differ from each other. Furthermore, the CPP-ACPF and PBMT group showed a greater decrease in sensitivity than the PLACEBO group at T1, T2, and T3 (p < .01), and was significantly differed from CPP-ACPF and PBMT groups only at T2 and T3. All groups confirmed TW effectiveness. Student's and paired t-test did not reveal any significant difference between groups (p > .05).

CONCLUSION

Therefore, PBMT associated with CPP-ACPF paste can reduce TS without compromising the efficacy of TW.

Effect of 1.5% potassium oxalate on sensitivity control, color change, and quality of life after at-home tooth whitening: A randomized, placebo-controlled clinical trial

OBJECTIVE

This clinical trial evaluated the effect of 1.5% potassium oxalate (PO) in controlling sensitivity and color change after at-home tooth whitening. It also evaluated the influence of PO on health-related quality of life (HRQoL) and the degree of patient satisfaction after bleaching treatment.

MATERIALS AND METHODS

Fifty volunteers were randomized into two groups (n = 25): At-home bleaching gel with 22% carbamide peroxide for 45 min + placebo gel (GP) or 1.5% PO (GPO) for 10 min. The intensity of tooth sensitivity was assessed daily through the visual analog scale. The color analysis was performed three times: baseline, 21 days, and 1 month after the last application of the whitening gel. The impact of the oral condition on the patient's quality of life (OIDP) was used to measure the impact caused by the whitening treatment in relation to the individuals' ability to carry out their daily activities and its influence on HRQOL.

RESULTS

No difference in tooth sensitivity was observed (p > 0.05). In addition, there was no difference in color change between groups (p > 0.05). However, there was an intragroup statistical difference throughout the evaluation period (p <0.05). The OIDP analysis showed a statistical difference between the groups (p > 0.05) and there was no difference between the groups regarding the degree of satisfaction with the bleaching (p > 0.05).

CONCLUSIONS

The 1.5% PO was effective in preventing sensitivity and did not interfere with tooth whitening. Desensitizing therapy had a positive impact on quality of life and patient satisfaction.

A review on dental whitening

OBJECTIVES

To provide a narrative review on vital dental whitening chemistry, toxicity and safety, vital dental whitening techniques, whitening systems, potential side effects of whitening and cyclic whitening using products with a range of concentrations and pH values. In addition, new developments and recommendations in the field of vital dental whitening will be presented to help clinicians understand the whitening process, its advantages, limitations, and the impact of whitening concentration and pH on enamel providing guidance in tailoring whitening treatments.

DATA

Data were gathered using the following keywords: dental whitening, roughness, hardness, sensitivity, hydrogen peroxide, whitening pH, whitening concentration, whitening chemistry, colour, and toxicity.

SOURCES

An electronic search was performed using PubMed and Scopus databases. Bibliographic material from papers reviewed was then used to find other relevant publications.

CONCLUSIONS

The effectiveness of vital dental whitening depends on many factors, such as the concentration/pH of the whitening agent, application duration, chemical additives, and re-mineralising agents used. Developing new whitening products and technologies such as nano-additives and alternative carrier systems is showing promising results, and might prove efficient in maximising whitening benefits by accelerating the whitening reaction and/or minimising expected reversible/irreversible enamel structural damage.

Preparation and Characterization of Natural Bleaching Gels Used in Cosmetic Dentistry

The novelty of this study consists of the formulation and characterization of three experimental bleaching gels with hydroxylapatite oxides and fluorine (G28®, G29®, G30®) based on natural fruit extracts compared to the commercial Opalescence 15% (GC, Ultradent, South Jordan, UT, USA). Studies have been conducted on the effect that the experimental bleaching gels have on the color and morphology of different restorative materials (Nanofill®-Schulzer, P.L. Superior Dental Materials GmbH, Hamburg, Germany, and experimental nanocomposites (P11®, P31®, P61®)), immersed in coffee and artificial saliva (for 10 days and 30 days). The study also includes a cytotoxicity test on the gels and nanocomposites after bleaching, with ISO 109993-5 protocols on human dental follicle stem cells. UV-VIS spectroscopy, computerized measurement, and fluorescence spectrometry were used in order to observe the color changes, while the microstructure of the surface was investigated by Scanning Electron Microscopy (SEM). All of the samples immersed in coffee showed the highest color shift in comparison to the baseline. The color difference ΔE values obtained using the two methods (UV-Vis, computerized based on digital images) both after coloring and bleaching, respectively, were different for all four types of nanocomposites stored in the coffee, while no difference was observed in those stored in artificial saliva. The studied experimental gels and nanocomposites had a low cytotoxic effect on cell cultures after bleaching.

Home-based chemically-induced whitening (bleaching) of teeth in adults

BACKGROUND

With the increased demand for whiter teeth, home-based bleaching products, either dentist-prescribed or over-the-counter products have been exponentially increasing in the past few decades. This is an update of a Cochrane Review first published in 2006.

OBJECTIVES

To evaluate the effects of home-based tooth whitening products with chemical bleaching action, dispensed by a dentist or over-the-counter.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 12 June 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 6) in the Cochrane Library (searched 12 June 2018), MEDLINE Ovid (1946 to 12 June 2018), and Embase Ovid (1980 to 12 June 2018). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (12 June 2018) and the World Health Organization International Clinical Trials Registry Platform (12 June 2018) were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases.

SELECTION CRITERIA

We included in our review randomised controlled trials (RCTs) which involved adults who were 18 years and above, and compared dentist-dispensed or over-the-counter tooth whitening (bleaching) products with placebo or other comparable products.Quasi-randomised trials, combination of in-office and home-based treatments, and home-based products having physical removal of stains were excluded.

DATA COLLECTION AND ANALYSIS

Two review authors independently selected trials. Two pairs of review authors independently extracted data and assessed risk of bias. We estimated risk ratios (RRs) for dichotomous data, and mean differences (MDs) or standardised mean difference (SMD) for continuous data, with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.

MAIN RESULTS

We included 71 trials in the review with 26 studies (1398 participants) comparing a bleaching agent to placebo and 51 studies (2382 participants) comparing a bleaching agent to another bleaching agent. Two studies were at low overall risk of bias; two at high overall risk of bias; and the remaining 67 at unclear overall risk of bias.The bleaching agents (carbamide peroxide (CP) gel in tray, hydrogen peroxide (HP) gel in tray, HP strips, CP paint-on gel, HP paint-on gel, sodium hexametaphosphate (SHMP) chewing gum, sodium tripolyphosphate (STPP) chewing gum, and HP mouthwash) at different concentrations with varying application times whitened teeth compared to placebo over a short time period (from 2 weeks to 6 months), however the certainty of the evidence is low to very low.In trials comparing one bleaching agent to another, concentrations, application method and application times, and duration of use varied widely. Most of the comparisons were reported in single trials with small sample sizes and event rates and certainty of the evidence was assessed as low to very low. Therefore the evidence currently available is insufficient to draw reliable conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use.Tooth sensitivity and oral irritation were the most common side effects which were more prevalent with higher concentrations of active agents though the effects were mild and transient. Tooth whitening did not have any effect on oral health-related quality of life.

AUTHORS' CONCLUSIONS

We found low to very low-certainty evidence over short time periods to support the effectiveness of home-based chemically-induced bleaching methods compared to placebo for all the outcomes tested.We were unable to draw any conclusions regarding the superiority of home-based bleaching compositions or any particular method of application or concentration or application time or duration of use, as the overall evidence generated was of very low certainty. Well-planned RCTs need to be conducted by standardising methods of application, concentrations, application times, and duration of treatment.

Effect of CPP-ACP on efficacy and postoperative sensitivity associated with at-home vital tooth bleaching using 20% carbamide peroxide

OBJECTIVES

To evaluate CPP-ACP effect on colour change and tooth sensitivity (TS) associated with at-home vital tooth bleaching using 20% carbamide peroxide (CP).

METHODS

A randomised double-blind placebo-controlled clinical trial was conducted to measure the TS and tooth colour change of 24 patients at 3-day, 7-day, 14-day and 30-day periods. The participants were instructed to apply 20% CP (7 days-04 h each) followed by the application of either CPP-ACP or non-active placebo paste, delivered by the bleaching custom tray (7 days-30 min each). Lightness (L*), redness (a*) and yellowness (b*) were measured using a digital spectrophotometer and the overall colour changes ∆E were calculated. ∆E and TS values were statistically analysed. The level of statistical significance was established at p = 0.05.

RESULTS

No significant differences were detected between CPP-ACP and placebo groups regarding the ∆E. The ∆E measurements presented significant differences within CPP-ACP groups between 3-day vs. 14-day and 30-day measurements. The CPP-ACP application reduced significantly the TS reported by the participants at 3-day when compared with the placebo group.

CONCLUSION

The application of CPP-ACP paste during at-home tooth bleaching with 20% CP was beneficial since its use reduced the TS and presented no deteriorating effect on the colour change.

CLINICAL RELEVANCE

The current findings are of importance for clinicians to manage TS reported by patients when a high CP bleaching agent is used.

In situ Effect of Nanohydroxyapatite Paste in Enamel Teeth Bleaching

AIM

Evaluate in situ the effect of nanohydroxyapatite paste (nano-HAP) before bleaching with hydrogen peroxide 35% (HP35%) by ion chromatography (IC) Knoop hardness number (KHN) and tristimulus colorimetry (TC).

MATERIALS AND METHODS

A total of 60 fragments were obtained from third molars included (3 mm × 3 mm × 3 mm) and the specimens were divided into three groups (n = 20): Gas chromatography (CG) (negative control group) = no bleaching; HP35% (positive control group) = HP35% whitening (whiteness HP35%); nano-HAP = application for 10 minutes before bleaching treatment + HP35%. The specimens were fixed to the volunteers' molars. The KHN and TC were measured before and after bleaching. For IC, the dentin layer was removed, leaving the enamel that was crushed, and autoclaved for chemical quantification (calcium, fluorine, and phosphorus). The results of KHN and TC were analyzed statistically by analysis of variance (ANOVA) followed by Tukey test (p < 0.05).

RESULTS

The HP35% group showed reduction of the Ca, F, and P ions. The initial and final KHN mean of the CG and nano-HAP did not differ statistically; however, the group of HP35% did differ statistically. The mean ΔE of the HP35% and nano-HAP groups did not differ statistically from each other. However, they differed from the CG.

CONCLUSION

The nano-HAP paste preserved the KHN, promoted the lower loss of Ca and P ions and an increase of F ions when compared with the CG, but did not influence the effectiveness of the bleaching treatment.

CLINICAL SIGNIFICANCE

Nano-HA is a biomaterial that has shown positive results in the prevention of deleterious effects on the enamel by the action of the office bleaching treatment.

Effectiveness of sodium bicarbonate combined with hydrogen peroxide and CPP-ACPF in whitening and microhardness of enamel

Background

This study investigated the effects of sodium bicarbonate (NaHCO3) combined with 1.5% hydrogen peroxide (H2O2) and casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) on color and microhardness of enamel.

Material and Methods

Seventy-five bovine incisors were immersed in a tea solution for 7.5 days. The specimens were randomly divided into five groups according to the whitening agent applied: 1) 94% NaHCO3, 2) a blend of 94% NaHCO3 and CPP-ACPF, 3) a blend of 94% NaHCO3 and 1.5% H2O2, 4) a blend of 94% NaHCO3, 1.5% H2O2 and CPP-ACPF, 5) control. The whitening procedure was performed for 10 times over 10 days. At each day, the buccal surfaces were covered with whitening agents for 5 minutes and then brushed for 30 seconds. After the 10 days, the teeth were again immersed in a tea solution for 10 minutes. Color assessment was performed at baseline (T1), after the first staining process (T2), after the whitening procedure (T3), and after the second staining process (T4). Finally, the specimens were subjected to microhardness test.

Results

There was a statistically significant difference in the color change between T2 and T3 stages among the study groups (p<0.05), with the greatest improvement observed in group 4. Microhardness was significantly greater in groups 2 and 4, as compared to the other groups (p<0.05).

Conclusions

The combination of 94% NaHCO3, 1.5% H2O2 and CPP-ACPF was effective in improving color and microhardness of teeth with extrinsic stains and could be recommended in the clinical situation.

A Study for Tooth Bleaching via Carbamide Peroxide-Loaded Hollow Calcium Phosphate Spheres

The objective of this study was to investigate if a prolonged bleaching effect of carbamide peroxide-loaded hollow calcium phosphate spheres (HCPS) can be achieved. HCPS was synthesized via a hydrothermal reaction method. Carbamide peroxide (CP) was-loaded into HCPS by mixing with distilled water as solvent. We developed two bleaching gels containing CP-loaded HCPS: one gel with low HP concentration as at-home bleaching gel, and one with high HP concentration as in-office gel. Their bleaching effects on stained human permanent posterior teeth were investigated by measuring the color difference before and after bleaching. The effect of gels on rhodamine B degradation was also studied. To investigate the potential effect of remineralization of using HCPS, bleached teeth were soaked in phosphate buffer solution (PBS) containing calcium and magnesium ions. Both bleaching gels had a prolonged whitening effect, and showed a strong ability to degrade rhodamine B. After soaking in PBS for 3 days, remineralization was observed at the sites where HCPS attached to the teeth surface. CP-loaded HCPS could prolong the HP release behavior and improve the bleaching effect. HCPS was effective in increasing the whitening effect of carbamide peroxide and improving remineralization after bleaching process.

Effect of three nanobiomaterials on microhardness of bleached enamel

OBJECTIVES

The aim of this in vitro study was to evaluate the effect of incorporating three different nanobiomaterials into bleaching material on microhardness of bleached enamel.

MATERIALS AND METHODS

The crowns of 24 extracted sound human molars were sectioned. Sixty enamel specimens (2 × 3 × 4 mm) were selected and divided into five groups (n = 12): Group 1 received no bleaching procedure (control); Group 2 underwent bleaching with a 40% hydrogen peroxide (HP) gel; Groups 3, 4, and 5 were bleached with a 40% HP gel modified by incorporation of bioactive glass (BAG), amorphous calcium phosphate (ACP) and hydroxyapatite (HA), respectively. The enamel microhardness was evaluated. The differences in Knoop microhardness data of each group were analyzed by one-way ANOVA, followed by post hoc Tukey tests.

RESULTS

Significant differences were observed between the study groups. The enamel microhardness changes in Groups 1, 3, 4, and 5 were significantly lower than that of Group 2 (p < 0.001).

CONCLUSIONS

Within the limitations of this study, it can be concluded that incorporation of each one of the three tested biomaterials as remineralizing agents might be effective in decreasing enamel microhardness changes subsequent to in-office bleaching.

Ultrastructural evaluation of enamel surface morphology after tooth bleaching followed by the application of protective pastes

The aim of the present in vitro study was to evaluate the morphology of bleached enamel surface followed by the application of different protective pastes. Specimens were prepared from 50 human incisors free of caries and defects. The bleaching procedure was performed with 35% hydrogen peroxide (Perfect Bleach Office+). For the remineralization treatment, different protective pastes (Tooth Mousse, MI Paste Plus, Remin Pro, and Profluorid Varnish) were evaluated. Specimens were randomly assigned to 10 groups of 5 specimens each. The specimens were analyzed under scanning electron microscopy. The superficial morphology of enamel was examined and scored as follows: 0, enamel with smooth surface morphology; 1, enamel with slight irregularities; 2, enamel with moderate irregularities; 3, enamel with accentuated irregularities. The photomicrographs were evaluated in a double-blind manner by three examiners, previously calibrated. Results were analyzed by a Kruskal-Wallis nonparametric test, at the significance level of 0.05. Dunn method posttest was applied for multiple comparisons. A different superficial morphology was observed among control group specimens and specimens treated with bleaching agent and protective pastes (p < 0.05). Enamel bleached showed pronounced surface changes and irregularities, significantly different from other groups except for groups 8 (enamel + Perfect Bleach Office+ + Remin Pro) and 10 (enamel + Perfect Bleach Office+ + Profluorid Varnish) (p > 0.05). The application of the tested pastes after bleaching is effective on repairing enamel surface morphology, demonstrating a higher efficacy for the CPP-ACP products compared to fluoridated ones. SCANNING 38:221-226, 2016. © 2015 Wiley Periodicals, Inc.

An in situ Evaluation of Bioactives on the Morphology of Bleached Enamel

AIM

The aim of this study was to use surface rugosity analysis (Ra) and scanning electron microscopy (SEM) comparing effects of nano-hydroxyapatite (NANO), casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and NovaMin (NOVA) on enamel's human morphology bleached with 37.5% hydrogen peroxide.

MATERIALS AND METHODS

Forty specimens (3 × 3 × 3 mm) were obtained from fully included third molars and four specimens were attached in the first molars of the volunteers. The POLA-positive control has only been bleached. Three experimental groups were bleached and treated with respective bioactive: NANO, CPP-ACP, and NovaMin. The Ra analyses were performed before and after the treatment using a rugosimeter. The obtained photomicrographs were analyzed using SEM (n = 3) by three examiners, and the study was double blind.

RESULTS

The Ra results were analyzed by one-way analysis of variance and Tukey's post hoc test (p < 0.05). All experimental groups showed significant differences of the others; however, the experimental groups were not significantly different from each other.

CONCLUSION

The enamel morphology of the bioactive-treated groups had more regular surfaces, than the others.

Effect of Nano-Tricalcium Phosphate and Nanohydroxyapatite on the Staining Susceptibility of Bleached Enamel

Objective. This study was designed to evaluate the effect of nano-tricalcium phosphate (n-TCP) and nanohydroxyapatite (n-HAP) on prevention of restaining of enamel after dental bleaching. Methods. Forty bovine incisors were bleached with 20% carbamide peroxide for two weeks. Afterward, they were divided into five groups based on remineralization solution: no treatment (control), 10% n-TCP, 5% n-TCP, 10% n-HAP, and 5% n-HAP. Each group was daily immersed for 10 minutes in the restaining solution (tea) and for 3 minutes in the remineralization agent, respectively. This protocol was repeated for five days. Subsequently, three digital photographs (baseline, after bleaching, and after restaining) were analyzed by Adobe Photoshop software. The obtained L^∗, a^∗, b^∗, and ΔE parameters were compared using ANOVA and Wilcoxon and Bonferroni tests. Results. After bleaching, there were significant changes in tooth colors (P < 0.001) while, after restaining and immersion in remineralization solutions, there were no significant differences in L^∗, a^∗, and b^∗ values of different groups (P > 0.05). However, ΔE of 10% TCP was significantly lower than the control (P = 0.02) while there were no significant differences between the other groups (P > 0.05). Conclusion. 10% n-TCP could significantly maintain the resultant color and reconstruct the enamel structure after bleaching.