Potassium-titanyl-phosphate (KTP) Laser and Dental Bleaching. Literature review

Enamel alteration following tooth bleaching and remineralization

The purpose of this study was to compare the effects of professional tooth whitening agents containing highly concentrated hydrogen peroxide (with and without laser activation), on the enamel surface; and the potential of four different toothpastes to remineralize any alterations. The study was performed on 50 human molars, divided in two groups: treated with Opalescence(®) Boost and Mirawhite(®) Laser Bleaching. Furthermore, each group was divided into five subgroups, a control one and 4 subgroups remineralized with: Mirasensitive(®) hap+, Mirawhite(®) Gelleѐ, GC Tooth Mousse™ and Mirafluor(®) C. The samples were analysed by SEM/3D-SEM-micrographs, SEM/EDX-qualitative analysis and SEM/EDX-semiquantitative analysis. The microphotographs show that both types of bleaching cause alterations: emphasized perikymata, erosions, loss of interprizmatic substance; the laser treatment is more aggressive and loss of integrity of the enamel is determined by shearing off the enamel rods. In all samples undergoing remineralization deposits were observed, those of toothpastes based on calcium phosphate technologies seem to merge with each other and cover almost the entire surface of the enamel. Loss of integrity and minerals were detected only in the line-scans of the sample remineralized with GC Tooth Mousse™. The semiquantitative EDX analysis of individual elements in the surface layer of the enamel indicates that during tooth-bleaching with HP statistically significant loss of Na and Mg occurs, whereas the bleaching in combination with a laser leads to statistically significant loss of Ca and P. The results undoubtedly confirm that teeth whitening procedures lead to enamel alterations. In this context, it must be noted that laser bleaching is more aggressive for dental substances. However, these changes are reversible and can be repaired by application of remineralization toothpastes.

KTP and Er:YAG laser dental bleaching comparison: a spectrophotometric, thermal and morphologic analysis

The aim of this study was to compare the results, in terms of temperature, colour change and morphology, of two different laser wavelengths with two different concentrations of hydrogen peroxide (HP). The lasers used were KTP (potassium-titanyl-phosphate) laser (λ = 532 nm (PD = 1.98 W/cm2)) and Er:YAG laser (λ = 2940 nm (PD = 2.54 W/cm2)). The bleaching gels used were PolaOffice 35% HP gel and PolaOffice+ 6% HP gel (SDI, Australia). Thirty-six extracted human teeth were selected and divided into two groups. For the 35% HP treatment, 18 teeth were randomly assigned to three subgroups: (1) HP gel without laser irradiation vs. HP gel + KTP laser irradiation; (2) HP gel without laser irradiation vs. HP gel + Er:YAG irradiation; and (3) HP gel + KTP laser irradiation vs. HP gel + Er:YAG irradiation. The same protocol was used for the 6% HP bleaching treatment. The bleaching results were analysed by a spectrophotometer, the thermal elevation by K thermocouples and the enamel surface by a scanning electron microscope (SEM). The Kruskal-Wallis test and the Mann-Whitney test were performed, and the data were analysed using the software StatView and the free Web statistics tool BiostaTGV. The thermal elevation of the Er:YAG groups was higher than KTP, while only the group 35% HP gel vs. 35% HP gel + Er:YAG showed significant colour differences (p < 0.05). SEM photographs showed slight enamel surface morphologic alterations after bleaching treatment. The Er:YAG laser may improve the bleaching results of 35% HP even if it increases the gel temperature, when compared to the KTP laser.