Clinical benefits of immediate dentin sealing: A systematic review and meta-analysis

STATEMENT OF PROBLEM

The clinical complications, success, and survival rates of indirect restorations delivered with the immediate dentin sealing protocol are unclear.

PURPOSE

The purpose of this systematic review and meta-analysis was to find and collect evidence on the clinical complication, success, and survival rates of indirect restorations delivered with immediate dentin sealing.

MATERIAL AND METHODS

Electronic databases were searched for clinical studies on immediate dentin sealing up to December 2023, without language or time limitations. The records were included if they were clinical trials evaluating the clinical complication and survival rates of indirect restorations bonded to tooth substrate sealed immediately after preparation with suitable resin bonding. The extracted data were analyzed via Review Manager 5.4 for meta-analysis (α=.05).

RESULTS

A total of 11 studies were included in this review. The clinical complication rate was lower for immediately sealed dentin than for protocols without dentin sealing. The survival rate of restorations luted with the immediate dentin sealing protocol was higher (96.4% to 100%) than that of immediate dentin sealing (81.8% to 96.7%), negatively correlated with the observation time. The intensity and incidence of postoperative sensitivity were statistically significantly lower for restorations with immediate dentin sealing than for those without dentin sealing or conventionally cemented (P<.05).

CONCLUSIONS

Immediate dentin-sealed indirect restorations had fewer clinical complications and higher success and survival rates than those delivered without dentin sealing. To avoid postoperative sensitivity or reduce its intensity, dentin surfaces should be sealed immediately after preparation. More long-term randomized clinical trials are recommended to confirm these evidence-based conclusions.

Color assessment of resin composite by using cellphone images compared with a spectrophotometer

Objectives

This study assessed the reliability of digital color measurements using images of resin composite specimens captured with a cellphone.

Materials and Methods

The reference color of cylindrical specimens built-up with the use of resin composite (shades A1, A2, A3, and A4) was measured with a portable spectrophotometer (CIELab). Images of the specimens were obtained individually or pairwise (compared shades in the same photograph) under standardized parameters. The color of the specimens was measured in the images using RGB system and converted to CIELab system using image processing software. Whiteness index (WI_D) and color differences (ΔE₀₀) were calculated for each color measurement method. For the cellphone, the ΔE₀₀ was calculated between the pairs of shades in separate images and in the same image. Data were analyzed using 2-way repeated-measures analysis of variance (α = 0.05). Linear regression models were used to predict the reference ΔE₀₀ values of those calculated using color measured in the images.

Results

Images captured with the cellphone resulted in different WI_D values from the spectrophotometer only for shades A3 and A4. No difference to the reference ΔE₀₀ was observed when individual images were used. In general, a similar ranking of ΔE₀₀ among resin composite shades was observed for all methods. Stronger correlation coefficients with the reference ΔE₀₀ were observed using individual than pairwise images.

Conclusions

This study showed that the use of cellphone images to measure the color difference seems to be a feasible alternative providing outcomes similar to those obtained with the spectrophotometer.

Impact of transparent tray-based application of bioactive glasses desensitizer on the permeability of enamel and dentin to hydrogen peroxide: an in vitro study

BACKGROUND

To investigate the effect of transparent tray-based application of bioactive glasses (BGs) desensitizer on the permeability of enamel and dentin to hydrogen peroxide (H₂O₂).

METHODS

Freshly extracted human first premolars were divided into 6 groups (n = 8). Group A and B: without pretreatments; Group C and E: treated with BGs desensitizer only; Group D and F: treated with BGs desensitizer dispensed with a transparent tray. After roots and pulp tissues of the treated tooth specimens were thoroughly removed, acetate buffer was added into pulp chambers and the treated specimens were immersed in distilled water (Groups A, E, and F) or 30% H₂O₂ (Groups B, C, and D) for 30 min at 37 °C. The amount of H₂O₂ in the pulp chamber of each group was measured using ultraviolet-visible spectrophotometry.

RESULTS

In control groups (Group A, E, and F), H₂O₂ was not detected. The amount of pulpal H₂O₂ in Group B, C, and D were 21.149 ± 0.489 μg, 9.813 ± 0.426 μg, and 4.065 ± 0.268 μg respectively. One-way ANOVA analysis indicated that significant differences existed in these groups (F = 459.748, p < 0.05).

CONCLUSIONS

The effect of BGs desensitizer in reducing the permeability of enamel and dentin to H₂O₂ could be enhanced when dispensed with a transparent tray.

Evaluation of In-office Vital Tooth Whitening Combined with Different Concentrations of At-home Peroxides: A Randomized Double-blind Clinical Trial

Background:

The clinical evidence relate the effect of associating the in-office and at home vital tooth whitening, describing positive effects on tooth color change and reduction of dental sensitivity.

Objective:

The purpose of this randomized double-blind clinical trial was to evaluate the effect on the shortened application of in-office vital tooth whitening combined with different concentrations of at-home peroxides in the final tooth color change and dental sensitivity.

Methods:

Randomized double-blind clinical trial with 120 participants between 18-65 years, allocated in four tooth whitening treatment groups: G1= Carbamide Peroxide 10% + Hydrogen Peroxide 40%, G2= Carbamide Peroxide 15% + Hydrogen Peroxide 40%, G3= Carbamide Peroxide 20% + Hydrogen Peroxide 40%, G4= Hydrogen Peroxide 10% + Hydrogen Peroxide 40% was conducted. Tooth color was measured at baseline and dental sensitivity and tooth color change during and after treatment.

Results:

No statistical significant differences were found in tooth color change (superior arch p= 0.183 / inferior arch p= 0.374), and in dental sensitivity (p=0.268).

Conclusion:

Reducing the application time of in-office whitening, combined with in-home products was effective in improving the color. All groups resulted in identical final color change and dental sensitivity.

Clinicaltrials.gov: NCT02682329 Available from: https://clinicaltrials.gov/ct2/show/NCT02682329?term=hydrogen+peroxide.

Is a Single Preliminary Session of In-office Bleaching Beneficial for the Effectiveness of At-home Tooth Bleaching? A Randomized Controlled Clinical Trial

OBJECTIVES

To evaluate the effect of combining in-office with at-home bleaching procedures in terms of the time required to obtain satisfactory tooth color, final color changes, and tooth sensitivity (TS) reported by patients.

METHODS AND MATERIALS

Twenty-six patients enrolled in this study used 10% carbamide peroxide in a bleaching tray for 1 h/d until satisfactory tooth color was obtained. One-half of the participants underwent a preliminary session of in-office tooth bleaching with 35% hydrogen peroxide for 45 minutes. The time in days for the patients to obtain satisfactory tooth color by at-home bleaching procedures was recorded. The color change of the maxillary canines was assessed using the Vita Bleachedguide 3D Master scale and a spectrophotometer at 1 week and after the end of bleaching procedures. Participants' satisfaction with their smile was recorded using a visual analog scale, and TS was determined throughout the entire treatment. Data were analyzed by t-test, Mann-Whitney test, or Fisher exact test (α=0.05).

RESULTS

The combined protocol reduced (by an average of 3.7 days) the time required to obtain satisfactory tooth color but increased the risk and level of TS. No difference in the final tooth color change (around 5.0 shade guide units; ΔE=11.6-14.9), or the level of patients' satisfaction with their smile, was observed.

CONCLUSIONS

A preliminary session of in-office bleaching reduced the time necessary to obtain satisfactory tooth color with at-home bleaching but increased the risk and level of TS.

Association Between In-Office And At-Home Tooth Bleaching: A Single Blind Randomized Clinical Trial

This controlled randomized clinical trial evaluated the effect of associating at-home and in-office bleaching procedures on tooth sensitivity (TS) and bleaching effectiveness. Forty patients subjected to on session of in-office bleaching with 38% peroxide hydrogen. Subsequently, the patients were randomly allocated to receive a second session of in-office bleaching or to use a tray containing 10% carbamide peroxide delivered during 7 consecutive days. The worst TS score reported during or after each bleaching procedure was recorded using a verbal rating scale and TS risk (score different from 0) was calculated. Color changes were measured 7 days after each in-office session (for patients receiving in-office procedures only) or after the end of at-home bleaching (for the combined protocol), and 6 months after the last procedure for both bleaching protocols. Color was assessed by a spectrophotometer and by color match with the Vita Classical and Bleach guide scales. Statistical analyses were carried out to assess possible differences between the protocols regarding the outcomes and to analyze the effect of time of assessment on color changes. The bleaching protocol did not affect the risk for and the maximum level of TS reported, irrespective of the time of assessment. In the color evaluation, the bleaching protocol also did not affect the ultimate tooth color. In conclusion, after one in-office bleaching session, there was no difference in bleaching effectiveness and TS between performing a second in-office session and associating it with 1-week at-home bleaching.

Effectiveness of and Dental Sensitivity to At-home Bleaching With 4% and 10% Hydrogen Peroxide: A Randomized, Triple-blind Clinical Trial

OBJECTIVES

To evaluate the risk for and intensity of tooth sensitivity and color change of at-home dental bleaching with 4% and 10% hydrogen peroxide (HP).

METHODS

For this study, 78 patients were selected according to the inclusion and exclusion criteria and randomized into two groups: HP 4 (White Class 4%, FGM) and HP 10 (White Class 10%, FGM). In both groups, the at-home bleaching was performed for a period of 30 minutes twice a day for two weeks. The color was assessed by Vita Classical, Vita Bleachedguide 3D-MASTER and spectrophotometer Vita Easyshade (Vita Zahnfabrik) at baseline, during bleaching (first and second weeks) and after bleaching (one month). Patients recorded their tooth sensitivity using a numeric rating scale (0-4) and visual analog scale (0-10). Data from color change (DeltaE data) was submitted to two-way analysis of variance. The color change data in Delta SGU from the two shade guide units were compared with the Mann Whitney test. The risk of tooth sensitivity was evaluated by χ² test and the intensity of tooth sensitivity from both scales was evaluated by a Mann-Whitney test (α=0.05).

RESULTS

The absolute risk and intensity of tooth sensitivity was higher in the group that used HP 10 than the one that used HP 4. Data from change in the number of shade guide units and color variation after one month of bleaching for both groups showed significant whitening, with no difference between groups.

CONCLUSIONS

At-home bleaching is effective with 4% and 10% HP concentrations, but 10% HP increased the absolute risk and intensity of tooth sensitivity during at-home bleaching.

Combination of Acetaminophen/Codeine Analgesics Does Not Avoid Bleaching-Induced Tooth Sensitivity: A Randomized, Triple-Blind Two-Center Clinical Trial

Bleaching-induced tooth sensitivity (TS) is highly prevalent.

OBJECTIVE

This study aimed to determine if the combination of opioids and nonopioids analgesics (Tylex) may provide a better analgesic effect.

METHOD

A triple-blind, parallel, randomized two-center clinical trial was conducted with 105 healthy patients who received either a placebo or a combination of acetaminophen/codeine. The first dose of Tylex 30 mg (acetaminophen 500 mg/codeine 30 mg) or placebo was administered one hour before the in-office bleaching (35% hydrogen peroxide), and extra doses were administered every six hours for 48 hours. The TS was recorded using a visual analog scale of 0 to 10 and a numeric rating scale of 0 to 4 in different periods: during bleaching, one hour up to 24 hours, and 24 hours up to 48 hours postbleaching. The color was measured before and one month after dental bleaching with a visual shade guide (Vita Classical), Vita Bleachedguide 3D-MASTER, and the spectrophotometer Vita Easyshade. The absolute risk of TS was evaluated using the Fisher exact test. Data of TS intensity with numeric rating scale of the two groups were compared with the Mann-Whitney U-test and the Friedman test, while data from the visual analog scale were evaluated by two-way repeated measures analysis of variance and the Tukey test for pairwise comparison. The color changes between groups were compared using the Student t-test (α=0.05).

RESULTS

No significant differences between the groups were observed in the risk and intensity of TS. The overall absolute risk of TS was approximately 96%. No significant differences between groups were observed in terms of color change ( p>0.05) for any scale.

CONCLUSION

The use of an acetaminophen/codeine combination prior to in-office bleaching does not reduce the risk and intensity of bleaching-induced TS.

Preemptive use of etodolac on tooth sensitivity after in-office bleaching: a randomized clinical trial

Purpose

This study determined the effectiveness of the preemptive administration of etodolac on risk and intensity of tooth sensitivity and the bleaching effect caused by in-office bleaching using 35% hydrogen peroxide.

Material and methods

Fifty patients were selected for this tripleblind, randomized, crossover, and placebo-controlled clinical trial. Etodolac (400 mg) or placebo was administrated in a single-dose 1 hour prior to the bleaching procedure. The whitening treatment with 35% hydrogen peroxide was carried out in two sessions with a 7-day interval. Tooth sensitivity was assessed before, during, and 24 hours after the procedure using the analog visual scale and the verbal rating scale. Color alteration was assessed by a bleach guide scale, 7 days after each session. Relative risk of sensitivity was calculated and adjusted by session, while overall risk was compared by the McNemar's test. Data on the sensitivity level of both scales and color shade were subjected to Friedman, Wilcoxon, and Mann-Whitney tests, respectively (α=0.05).

Results

The preemptive administration of etodolac did not affect the risk of tooth sensitivity and the level of sensitivity reported, regardless of the time of evaluation and scale used. The sequence of treatment allocation did not affect bleaching effectiveness, while the second session resulted in additional color modification. The preemptive administration of etodolac in a single dose 1 hour prior to in-office tooth bleaching did not alter tooth color, and the risk and intensity of tooth sensitivity reported by patients.

Conclusion

A single-dose preemptive administration of 400 mg of etodolac did not affect either risk of tooth sensitivity or level of sensitivity reported by patients, during or after the in-office tooth bleaching procedure.

Preemptive Use of Naproxen on Tooth Sensitivity Caused by In-Office Bleaching: A Triple-Blind, Crossover, Randomized Clinical Trial

Objectives:

A triple-blind, randomized, crossover clinical trial evaluated prior use of nonsteroidal anti-inflammatory naproxen on sensitivity reported by patients undergoing in-office tooth bleaching.

Methods and Materials:

Fifty patients were subjected to two sessions of in-office tooth bleaching with 35% hydrogen peroxide in a single application of 40 minutes for two sessions, with an interval of seven days between applications. One hour prior to the procedure, each patient randomly received a single dose of naproxen (500 mg) or placebo. The patient's sensitivity level was evaluated during and immediately after the bleaching using two scales (verbal and visual analog); the verbal scale only was repeated after 24 hours. The effectiveness of the bleaching procedures was evaluated with the Bleachedguide scale. Relative risk to sensitivity was calculated and adjusted by session, while comparison of overall risk was performed by the McNemar test. Data on the sensitivity level for both scales and shade were subjected to the Friedman, Wilcoxon, and Mann-Whitney tests (α=0.05).

Results:

The use of naproxen only decreased the absolute risk and intensity of tooth sensitivity reported immediately after the second session. On the other hand, no measurable effect was observed during or 24 hours after either session. The sequence of drug administration did not affect the bleaching effectiveness.

Conclusions:

Preemptive use of naproxen only reduced tooth sensitivity reported by patients immediately after the second session of bleaching.

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.