Microhardness change of enamel due to bleaching with in-office bleaching gels of different acidity

Feasibility and Safety of Adopting a New Approach in Delivering a 450 nm Blue Laser with a Flattop Beam Profile in Vital Tooth Whitening. A Clinical Case Series with an 8-Month Follow-Up

A prospective observational case series included six patients who presented with discoloured upper and lower teeth extending from the right second premolar to the left second premolar. The photoactivation dosimetry and treatment protocol were as follows: λ 450 nm, 1 W, CW; flattop beam profile; 1 cm2; 15 J/spot; 10 irradiated spots; an irradiation time of 15 s/spot; three whitening cycles in a single session. Blanc One ULTRA+ was the bleaching agent. A visual analogue scale (VAS) was utilised to evaluate the pain intensity and dental hypersensitivity during treatment immediately after complete treatment (T1), 24 h (T2), and 8 h (T3) postoperatively, and at an 8-month follow-up timepoint (T4), whereas the dental colour shade change was assessed using the VITA colour shade guide pre-treatment (T0), T1, and T4. The Gingival index and modified Wong Baker faces scale were utilised to evaluate gingival inflammation and patients' treatment satisfaction, respectively. Our findings revealed a reduction in the dental colour shade of the six cases between 2 and 10- fold (average of 3.5-fold) at T1 and maintained at T4, indicating significant improvement in the colour shade change with optimal outcomes. The percentage of this improvement for all the patients was ranged between 16.6% and 33.3%. At all timepoints, a "0" score was provided for pain intensity, dental hypersensitivity, and gingival inflammation. Our study demonstrates the feasibility and safety of a λ 450 nm laser delivered with a flattop handpiece to achieve optimal whitening outcomes without adverse effects. This offers a useful guide for dental clinicians for vital in-office tooth whitening. Extensive clinical studies with large data are warranted to validate our study protocol.

In vitro bleaching efficacy of violet LED associated with 10% hydrogen peroxide and 10% carbamide peroxide

BACKGROUND

This in vitro study evaluated the efficacy and the effect over the dental enamel surface of violet LED dental bleaching associated to different concentrations of carbamide and hydrogen peroxide.

METHODS

Human dental blocks (n = 100) were randomly distributed into 5 groups: 10% hydrogen peroxide (HP10), 10% carbamide peroxide (CP10), 10% hydrogen peroxide with violet LED (VHP10), 10% carbamide peroxide with violet LED (VCP10) and 35% hydrogen peroxide (HP35). The specimens were analyzed by Vickers microhardness test (n = 50) initially, immediately after and seven days after ending the bleaching protocol. For color analysis (n = 50), the specimens were evaluated for bleaching effectiveness (ΔE2000, ΔE1976) and whiteness index (ΔWID) with EasyShade spectrophotometer, before bleaching protocol and seven days after ending the bleaching protocol. The microhardness and color data were analyzed using one-way ANOVA with post-hoc Tukey test (α = 0.05).

RESULTS

The microhardness values showed difference among the investigated groups only immediately after the end of the dental bleaching (p < 0.05), with reduction for the groups HP35 (p < 0.01) and HP10 (p < 0.05), however the microhardness values were reestablished after seven days. Regarding the color changes, a difference between VHP10 and the others groups evaluated for ΔE2000 and ΔE1976 index was observed (p < 0.05). For ΔWID, there was no difference between the studied groups.

CONCLUSIONS

Violet LED associated with low concentration bleaching agents did not show a negative effect on dental enamel regarding the surface microhardness. All bleaching protocols were effective, therefore, perceptible to human eyes.

Effect of a Toothpaste for Sensitive Teeth on the Sensitivity and Effectiveness of In-office Dental Bleaching: A Randomized Clinical Trial

OBJECTIVES

The present study aimed to evaluate the desensitizing effect of toothpaste for sensitive teeth on patient tooth sensitivity and on bleaching efficacy of the 38% hydrogen peroxide bleaching agent used for in-office bleaching compared to a regular toothpaste in a randomized clinical trial.

METHODS AND MATERIALS

Forty-eight patients having maxillary right central incisors with darkness greater than A1 were selected for the present double-blind randomized clinical trial. Patients were randomly allocated into two groups: the placebo group, which used regular toothpaste, and the experimental group, which used sensitivity toothpaste. The intervention consisted of applying toothpaste with the aid of an individual tray for a period of 4 minutes daily, starting one week before the first bleaching session and interrupting use immediately after the second session. After allocation to one of the groups, individuals received in-office dental bleaching with a 40-minute application of 38% hydrogen peroxide for two sessions with an interval of one week. The incidence and intensity of sensitivity were assessed using a visual analogue scale and a numeric analogue scale. Sensitivity was measured immediately before each session, 1 hour, 24 hours, and 48 hours after each bleaching session and four weeks after the second bleaching session. Tooth shade was evaluated using a spectrophotometer and by comparison with the VITA Classical Shade Guide (Vita Zahnfabrik, Bad Säckingen, Germany). Tooth shade was evaluated before the first bleaching session, one week after the first bleaching session, one week after the second bleaching session and four weeks after the second bleaching session. Participants and professionals who performed the bleaching, shade, and sensitivity assessments were blinded to the group of patients they were treating or assessing. For the incidence of hypersensitivity, the results were evaluated by comparing the groups at different evaluation times with the Mann-Whitney test for comparison between groups, the Friedman test for repeated measures, and the Tukey test for comparison of times. Shade change on the guide was analyzed using the Mann-Whitney test for comparison between groups and the Wilcoxon test for comparison between times. Shade change by the spectrophotometer was analyzed using the t-test for comparison between groups and the paired t-test for comparison between times. All analyses were performed with a significance level of 5%.

RESULTS

There was no difference in the pattern of dental hypersensitivity between groups. For all shade measures, there was no difference between the bleaching results, and no statistically significant difference was observed between the study groups.

CONCLUSION

The use of arginine-based desensitizing toothpaste did not interfere with the bleaching ability of hydrogen peroxide and was not effective in reducing the sensitivity caused by in-office tooth bleaching.

Effect of pH of In-Office Bleaching Gels and Timing of Fluoride Gel Application on Microhardness and Surface Morphology of Enamel

Objective

To assess microhardness (VH) of enamel treated with two in-office bleaching agents with different pH and to study the effect of post- and prebleaching fluoride therapy.

Materials and Methods

Eighty bovine incisors were divided into eight groups: G1-Unbleached group; G2-2% NaF; G3-Pola Office (pH = 3.8); G4-Pola Office+ (pH = 7); G5-Pola Office followed by 2% NaF; G6-2% NaF followed by Pola Office; G7-Pola Office+ followed by 2% NaF; G8-2% NaF followed by Pola Office+. Bleaching was conducted 3x with 1-week intervals (T1/T7/T14). Specimens were kept in artificial saliva. VH was measured at T1, T7, and T14. Data were analyzed using repeated measure ANOVA. Surface morphology was assessed using scanning electron microscopy.

Result

There was no significant difference among the groups at T1. No significant difference was found between G3 and G4 at all intervals. 2% NaF (G5/G6 vs. G3) significantly prevented softening at T7 and T14. Some nonsignificant hardening was observed for 2% NaF for G7/G8 vs. G4. At T14, G3 showed the lowest VH values. G5 showed higher VH values compared to other groups apart from G6-G7. No relationship between bleaching protocols and surface morphology was observed.

Conclusion

Pola Office caused the most softening. 2% NaF gel application after Pola Office bleaching was effective in recovering enamel hardness. Fluoride application after Pola Office+ bleaching provided little benefit.

Bleaching Gels Used After 1 Week of Mixing: Efficacy, Hydrogen Peroxide Penetration, and Physical-chemical Properties

OBJECTIVES

This in vitro study aimed to evaluate the bleaching efficacy (BE), hydrogen peroxide penetration into the pulp chamber (HPP), and physical-chemical properties (concentration, pH, and viscosity) of in-office bleaching gels immediately and after 1 week of mixing.

METHODS AND MATERIALS

We randomly divided 49 premolars into seven groups: control (no bleaching) and the following in-office bleaching (Opalescence Boost 40%, Total Blanc One Step 35%, and Whiteness HP Blue 35%) applied at two storage times: immediately and after 1 week. We evaluated the BE using a digital spectrophotometer and the HPP through UV-Vis spectroscopy. We measured the initial concentration, pH, and viscosity using titration, a Digital pH meter and Rheometer, respectively. For statistical analysis, we used a twoway analysis of variance and Tukey and Dunnet tests (α=0.05).

RESULTS

We observed higher BE and HPP for Opalescence Boost and Total Blanc One Step after 1 week of mixing than for Whiteness HP Blue (p<0.001). We observed a significantly lower initial concentration for Whiteness HP Blue 1 week after mixing compared to immediately (p=0.00001). All bleaching gels showed a decrease in pH after 1 week of mixing (p=0.00003). However, Total Blanc One Step had a lower pH at both evaluation times (p<0.001). Only Opalescence Boost maintained viscosity 1 week after mixing.

CONCLUSIONS

Opalescence Boost was the only bleaching gel able to keep bleaching efficacy, with the same characteristics of permeability and physical- chemical properties after 1 week of mixing.

Impact of different intraorifice barriers on fracture resistance of non-vital bleached teeth

Background and Aim

This study aimed to evaluate the effects of bleaching agents on the fracture resistance of endodontically treated teeth using different intraorifice barrier (IOB) materials.

Materials and Methods

The endodontic treatment was performed for 160 mandibular premolars, and then, the teeth were divided into four groups according to the IOB: Ionoseal, Biodentine, ProRoot MTA, and TheraBase. Then, these teeth were subdivided into four subgroups (n = 10) based on the bleaching agents as distilled water (control), hydrogen peroxide 35% (HP), sodium perborate (SP), and carbamide peroxide 37% (CP). The access cavities were restored with composite resin after applying the bleaching agents for 7 days. The fracture resistance test was performed using a universal testing machine. Data were statistically analyzed, and the significance level was set at 5%. A scanning electron microscope was used to evaluate the effect of bleaching agents on the surfaces of IOBs.

Results

The highest fracture resistance values were observed in Biodentine groups with significant differences compared to Ionoseal and ProRoot MTA (P <.05). The distilled water groups showed significantly the highest fracture resistance compared to SP and HP groups (P <.05). There was no significant difference between SP, HP, and CP groups (P >.05). It was demonstrated that the morphological surface of the intact IOBs (control) was different from the surface of IOBs treated with bleaching agents.

Conclusion

The intracoronal bleaching procedures affected negatively the fracture resistance of the endodontically treated teeth.

Microhardness change of human dental enamel due to power bleaching with different gels

AIM

Since the introduction of bleaching treatments in the office, different lights have been suggested to accelerate the bleaching reaction. This study aimed to evaluate the microhardness of tooth enamel after office bleaching using different materials.

Effect of conventional and power office bleaching with diode laser and led light on enamel microhardness

Aim: The present study aimed to asses enamel microhardness after office bleaching with diode laser and LED light compared to the conventional bleaching procedure. Methods: Thirty-nine human premolar teeth were collected and randomly divided into three groups regarding of the bleaching technique. Group 1: Snow O bleaching gel with LED light-curing unit; Group 2: Snow L bleaching gel with diode laser irradiation; and Group 3: Opalescence Boost bleaching gel with no light source in group 3. Enamel surface changes were evaluated in one tooth in each study group and one intact tooth as a reference under a scanning electron microscope (SEM). In the remaining samples (n=12), enamel microhardness was determined by Vickers microhardness test before and after bleaching. Data were analyzed with repeated-measures ANOVA to compare microhardness changes, followed by post hoc Tukey tests at the 0.05 significance level. Results: Enamel microhardness decreased in all the groups after bleaching, with the maximum decrease in microhardness in the Snow O bleaching group with LED light, which was significantly higher than the other groups (P=0.002). The two other groups did not exhibit any significant difference in microhardness decrease (P>0.05). Conclusion: Based on the limitations of this study, it can be concluded power bleaching with 980nm diode laser was less time-consuming compare to conventional bleaching procedure and yielded better outcomes in terms of enamel surface microhardness compared to the use of an LED light-curing unit.  

VIOLET LED DENTAL WHITENING: EFFECTIVENESS AND BIOLOGICAL SAFETY: AN IN VITRO STUDY

INTRODUCTION

The light-emitting diode (Led) in the violet spectrum associated or not with hydrogen peroxide (HP) has been suggested as a promising technique for dental bleaching. Violet led has a wavelength of 405-410 nm, which is very close to that of ultraviolet (UV) radiation, and this has raised biological safety concerns.

AIM

To investigate the effectiveness of the violet led dental bleaching technique by evaluating color parameters, enamel surface microhardness, and biological safety analysis.

METHODS

One hundred bovine dental blocks were divided into groups according to the bleaching technique (G1 - only HP; G2 - HP associated with blue led; G3 - only blue led; G4 - HP associated with a violet led; and G5 - only violet led). The color analysis (ΔE, ΔL, and WID) and enamel surface microhardness were assessed before and after bleaching (immediately, 5, 14, and 30 days). The biological safety of the violet led irradiation was assessed by measuring the number of micronuclei formed in human cells in culture in response to irradiation. Data analysis included Kruskal-Wallis test, Friedman test, and Mann-Whitney test.

RESULTS

In groups G4 and G5 there was the formation of precipitates on the enamel surface. At the time of 14 days, it was observed that the G2 group had lower values of microhardness than G5. ΔL and ΔE showed differences between groups in experimental times. Mean percentages of micronuclei occurrence were similar in the control group and the violet led group.

CONCLUSION

The violet led irradiation can be applied for dental bleaching because this approach produces significant color changes preserving tooth enamel integrity and causes no genotoxic effects on vital cells.

Effect of a Self-Assembly Peptide on Surface Roughness and Hardness of Bleached Enamel

After bleaching, enamel surfaces are damaged, contributing to erosion and tooth sensitivity. Although fluoride is used after bleaching to try and revert alterations, it is not capable of repairing tooth structure. This study compared the effect of a self-assembly peptide (P11-4), with and without fluoride, and sodium fluoride (NaF 2%) on the Knoop microhardness (KHN) and surface roughness (Ra (μm)) of bleached enamel with an in-office bleaching regimen. Enamel blocks of bovine teeth (5 × 5 × 2 mm) with standardized surface hardness were bleached with 35% carbamide peroxide, following the manufacturer’s instructions. The teeth were randomly divided into the following groups (n = 7) according to post-bleaching treatment: no treatment (negative control) (C-); 2% NaF (NaF); Curodont™ Repair (Repair); and Curodont™ Protect (Protect). Specimens were stored in artificial saliva at 37 °C. To evaluate the effect of the post-bleaching treatments, KHN and Ra were measured before bleaching (baseline) and 24 h and 7 days after bleaching. Data were submitted to repeated measures ANOVA and Bonferroni tests (α = 0.05). There were significant interactions between the study factors (p = 0.001). After 7 days, Repair (572.50 ± 79.04) and Protect (583.00 ± 74.76) specimens showed increased surface KHN, with values higher than the NaF (465.50 ± 41.50) and C- (475.22 ± 58.95) baseline values. There was no significant difference in KHN at 24 h among groups (p = 0.587). At 24 h after bleaching, Repair was significantly different from all groups (p < 0.05). Repair showed the lowest Ra (μm) values (0.133 ± 0.035). After seven days, there was no significant difference in Ra values among groups when compared to the baseline. The use of P11-4-based materials after bleaching resulted in the fastest recovery to baseline enamel properties.

Influence of Viscosity and Thickener on the Effects of Bleaching Gels

OBJECTIVE

This study investigated the influence of the viscosity and kind of thickener of 35% hydrogen peroxide bleaching gels on the tooth (color change, demineralization of enamel, and permeation) and on the gel [reactive oxygen species (ROS), pH, and peroxide concentration].

METHODS AND MATERIALS

Two hundred forty specimens were divided into groups of bleaching gels with different thickeners (CAR, carbomer; ASE, alkali swellable emulsion; MSA, modified sulfonic acid polymer; SSP, semisynthetic polysaccharide; PAC, particulate colloids) in three viscosities (low: 50,000 cP; medium: 250,000 cP; high: 1,000,000 cP). Color change (ΔEab), demineralization of enamel by Knoop microhardness (KHN) reduction analysis, and peroxide permeation (PP) were analyzed in the specimens, while pH, peroxide concentration (PC), and ROS were evaluated in the gels. Data were analyzed by two-way ANOVA (α=0.05).

RESULTS

The higher viscosity gels reduced ΔEab, PP, enamel softening, and ROS in relation to the lower viscosity gels. However, the drop in pH and PC were higher in the more viscous gels. Gels with MSA produced higher ΔEab compared with SSP and ASE. The PP was higher for PAC, and smaller for SSP and CAR. The KHN reduction was higher for CAR and smaller for PAC. The higher pH reduction was seen for ASE and CAR, and the smaller for SSP. The PC reduction was higher for SSP and smaller for CAR. More ROS were observed for MSA and fewer for ASE.

CONCLUSIONS

Increased gel viscosity was associated with reduced color change, permeation, demineralization of enamel, and ROS, and led to increased peroxide decomposition and pH alteration during the treatment. The kind of thickener significantly interfered with the treatment effects.

Efficacy and Safety of Bleaching Gels According to Application Protocol

OBJECTIVES

This study evaluated bleaching efficacy, enamel microhardness, and roughness of highly concentrated hydrogen peroxide (HP) gels (35%-40%) using different application protocols. Gel decomposition and pH alteration were also analyzed.

METHODS AND MATERIALS

Bovine enamel/dentin specimens were divided into groups according to the bleaching gel-Pola Office Plus (POP-SDI, 37.5% HP), Opalescence Boost (OPB-Ultradent, 40% HP), Whiteness HP (WHP-FGM, 35% HP)- and application protocol-single application (SA) and multiple application (MA) during the in-office session. Deionized water was used in control group (no bleaching). Thus, seven final groups were obtained (n=15/group). Color (CIE L*a*b*), surface microhardness (SMH), and roughness (Ra) were assessed before/after treatments. The pH of gels was measured, and HP concentration was determined with potassium permanganate titration method in different times. Data were submitted to analysis of variance and Tukey tests (5%).

RESULTS

All gels presented similar and clinically acceptable bleaching efficacy (ΔE>2.7) for both SA and MA, as well as no significant differences for SMH and Ra comparing the two protocols in the same gel. Peroxide decomposition significantly increased with time, but final gel concentrations were still high after 45 minutes (32.29% POP; 38.45% OPB; and 32.74% WHP). The pH decreased over time (initial - after 45 min) for WHP (6.83±0.07 - 5.81±0.06), but minimal alterations were observed for POP (8.09±0.09 - 7.88±0.07) and OPB (7.82±0.11 - 7.87±0.07).

CONCLUSIONS

Peroxide decomposition was very low for all gels tested, and pH remained stable for POP and OPB gels. Bleaching protocol did not influence whitening efficacy and hazardous effects over enamel, thus potentially there was no clinical significance. Therefore, for the products tested, there is no evidence for recommending the gel change during the bleaching session.

Bleaching and microstructural effects of low concentration hydrogen peroxide photoactivated with LED/laser system on bovine enamel

BACKGROUND

Tooth whitening protocols with low concentration hydrogen peroxide (HP) appear to minimize the microstructural effect on teeth. In addition, light sources have been used to enhance bleaching efficiency. This study evaluated the color change and microhardness of a protocol with 6% HP photoactivated by LED/laser in comparison with 35% HP.

METHODS

Twenty bovine incisors were randomized in two groups: 6% HP + LED/laser and 35% HP (n=10). Teeth were submitted to staining using dark tea. Three whitening sessions were carried out according to the manufacturer's instructions. Enamel microhardness (VHN) and color change evaluation (∆L*, ∆a*, ∆b*, ∆E₀₀ [CIEDE2000], and WI_D) before 24 hours and 7 days after the last whitening session were performed. Two-way repeated ANOVA and Bonferroni post-test was used (α = 0.05).

RESULTS

Both groups showed perceptible color changes, being more pronounce for 35% HP. Differences were observed for ∆a*, ∆b* and ∆E₀₀ (p≤0.027), except for ∆L* (p>0.05). Differences were also found in the comparison among the evaluation times within the same group (p≤0.027), except for ∆a* results (p>0.05). WI_D showed that 35% HP exhibited high whiteness values. Regarding microhardness, the groups did not show significant differences (p>0.05). However, 35% HP showed decreased values after 7 days of the last whitening session compared to the baseline (p≤0.027).

CONCLUSIONS

6% HP + LED/laser promoted perceptible color change, but not comparable with 35% HP. No differences on enamel microhardness were observed between the whitening protocols. However, 35% HP showed decreased hardness after 7 days of whitening compared to baseline.

ATR-FTIR, EDS and SEM evaluations of enamel structure after treatment with hydrogen peroxide bleaching agents loaded with nano-hydroxyapatite particles

Background

Tooth whitening is one of the most requested dental treatments, but it still presents some side effects. Indeed, the bleaching agent can generate patients’ discomfort and dental hard tissue damages, not achieving an efficient and long-lasting treatment with optimum whitening effect. To overcome these limitations, the bleaching agents containing nano-hydroxyapatite can represent a reliable solution to avoid these detrimental effects.

Methods

In this study, human third molars were treated with commercial bleaching agents, containing nano-hydroxyapatite (nHA) and 6% (at-home treatment), 12% and 18% (in-office treatments) of hydrogen peroxide (HP), named respectively G1, G2 and G3. The results were evaluated descriptively and analytically using Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy (ATR-FTIR), Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray spectroscopy (EDS), comparing the treated groups with a commercial gel containing 10% carbamide peroxide (CONV) and with a non-treated control group (CTRL).

Results

ATR-FTIR analysis revealed a similar composition in carbonates and phosphates for CTRL, G1 and G2 groups, which showed no significant differences in their spectral profiles; an increased amount of organic matter was found in G3, while CONV displayed an intermediate behavior. SEM analysis did not highlight significant changes in the enamel microstructure of G1 and CONV when compared to CTRL; the pattern observed in G2 presented a slight increase of enamel irregularities, while G3 displayed a partial removal of the aprismatic layer and microporosities. No evident effects due to nHA were observed in the structure of the hydroxyapatite component of G1, G2 and CONV, if compared to CTRL, while G3 showed a slight loss of crystallinity. In all groups, EDS identified slight changes in the concentration of chemical elements O and Ca, while the Ca/P ratio was similar when compared to CTRL.

Conclusion

The obtained results suggest that the application of the tested commercial bleaching agents, with a concentration of HP up to 12%, does not alter the morphological and chemical composition of the enamel surface and maintains its crystallinity.

Effects of different bleaching application time on tooth color and mineral alteration

BACKGROUND

The effects of HP-based products upon dental enamel are inconclusive.

PURPOSE

The purpose of this study was to evaluate the colour and mineral changes caused by the bleaching agent applications at different durations on the enamel surface.

BASIC PROCEDURES

60 caries-free lower central incisor extracted for periodontal reasons were standardized for enamel and dentin thickness after cone-beam computed tomography (CBCT) measurements in terms of mineral (n = 24) and colour change (n = 36). All teeth were divided into 3 groups according to different bleaching durations for colour (n = 12) and mineral change (n = 8) measurements. The samples for mineral change were examined with the -energy scattering X-ray (EDX, JSM-6390 LV, Jeol Inc., Japan) device before and 2 weeks after the application. For colour change, the measurement of the samples was performed with spectrophotometer device (VITA EasyShade 4.0, Germany). Opalescence Boost PF 40% (Ultradent Products, USA) was applied for 20 min (min) in Group 1, 40 min in Group 2 and 60 min in Group 3. In order to determine the efficacy of bleaching, colour measurements were repeated at 24 h, 7 and 14 days after the application. In the intragroup comparison, Friedman and Wilcoxon tests were used for non-normally distributions, while repeated variance analysis and paired t test were used for normally distributions in dependent variables. In the intergroup comparison, ANOVA and LSD tests were used for normally distributions, while Kruskal-Wallis and Dunn tests were used for non-normally distributions in independent variables. p < 0.05 was considered significant.

MAIN FINDINGS

In the study, statistically significant difference was observed between all groups in terms of colour change at different measurement times (p < 0.05). The highest ΔE₀₀ values were observed in Group 3 (ΔE₀₀₃ = 8.37 ± 2.15); the lowest value was observed in Group 1 (ΔE₀₀₁ = 4.74 ± 1.26). Ca values were similar increase among all groups (p > 0.05). The highest Ca values were observed in Group 3 (69.91 ± 5.34); the lowest value was observed in Group 2 (66.08 ± 1.50). P values were similar increase among all groups (p > 0.05). The lowest P values were observed in Group 3 (26.54 ± 5.92); the highest value was observed in Group 2 (29.86 ± 2.26).

PRINCIPAL CONCLUSIONS

Effective whitening was achieved in all study groups. When the results are evaluated as versatile in terms of bleaching effectiveness and mineral change, the most ideal bleaching duration was determined as 40 min (Group 2).

Effects of bleaching gel containing TiO2 and chitosan on tooth surface roughness, microhardness and colour

BACKGROUND

This study aimed to evaluate the effects of an experimental bleaching gel made with TiO₂ and chitosan, along with the Opalescence Boost PF and Philips Zoom bleaching agents, on tooth surface roughness, microhardness and colour.

MATERIALS AND METHODS

The experimental gel, containing 6% hydrogen peroxide (HP), was evaluated against the two existing treatments, which incorporate 40% and 25% HP. For colour evaluation, 36 human premolar teeth were divided into three groups (n = 12). For surface roughness and microhardness evaluation, 72 bovine incisor samples were divided into six groups (n = 12). Data on colour alteration were analysed with the CIEDE2000 formula. Surface roughness was measured using a profilometer, and microhardness was measured with a Vickers hardness tester. ANOVA was used for statistical analysis.

RESULTS

There were no statistically significant differences among the groups for surface roughness, microhardness values or colour change after bleaching (P > 0.05). The lowest bleaching efficacy was observed for the 40% HP agent, and the highest efficacy was observed for the 25% HP agent (P < 0.05).

CONCLUSIONS

An experimental 6% HP gel containing TiO₂ and chitosan provided effective bleaching without adverse effects on tooth surface roughness or microhardness. The use of TiO₂ with chitosan can provide clinicians with positive results.

Effect of daily use of fluoridated dentifrice and bleaching gels containing calcium, fluoride, or trimetaphosphate on enamel hardness: an in vitro study

OBJECTIVE

This study evaluated the effects of calcium gluconate (CaGlu), sodium fluoride (NaF), sodium trimetaphosphate (TMP), and NaF/TMP added to a 35% hydrogen peroxide (HP) bleaching gel for the reduction in enamel demineralization in vitro, with and without the use of a fluoridated dentifrice.

DESIGN

Enamel blocks (n = 100) were obtained from bovine incisors (n = 200) after flattening and subjected to initial surface hardness (SH) analysis. The blocks were divided according to the bleaching gel (35% HP; 35% HP + 0.05% NaF; 35% HP + 0.25% TMP; 35% HP + 0.05% NaF + 0.25% TMP; 35% HP + 2% CaGlu) and were treated with ether non-fluoridated or fluoridated (1100 ppm) dentifrice. The bleaching gels were applied thrice (40 min/session) at the intervals of 7 days between each application. After 21 days, the final SH for the calculation of the percentage of SH loss (%SH) and cross-sectional hardness for the evaluation of the integrated hardness area (IH) were determined.

RESULTS

Bleaching containing HP + NaF + TMP presented lowest %SH (p < 0.001), regardless of the dentifrice used. HP + NaF + TMP bleaching gel led to lower subsurface enamel mineral loss (IH) compared to the other groups (p < 0.001), and these did not differ from each other (p > 0.05). Daily use of fluoride dentifrice led to higher IH values (p < 0.001), regardless of the bleaching gels.

CONCLUSION

The addition of NaF/TMP to a 35% HP bleaching gel remarkably reduced the mineral loss compared to the cases of the other bleaching gels, regardless of dentifrice.

CLINICAL RELEVANCE

The association of TMP/NaF can be used as a strategy for reducing mineral loss during the bleaching procedure, even without the daily use of fluoride dentifrice.

Influence of Erosion/Abrasion and the Dentifrice Abrasiveness Concomitant with Bleaching Procedures

Purpose

The aim of this study was to evaluate the effect of erosive/abrasive cycles and two different levels of abrasiveness of dentifrices over enamel and dentin subjected to bleaching.

Methods

Enamel and dentin bovine specimens were prepared and submitted to an at-home bleaching treatment using 9.5% hydrogen peroxide gel, which was applied daily (30 min/14 days). Concomitant with bleaching, an erosive cycle was performed using citric acid (0.3%, pH 3.8, 5 mins, 3×/day), followed by immersions in artificial saliva for remineralization (30 mins). Abrasion was done with two (high and low abrasiveness) dentifrices (2×/day, 120 seconds) after the first and third erosive immersion each day. Enamel and dentin softening were assessed by microhardness and erosive tooth wear by optical profilometry. Data were submitted to repeated measures ANOVA, followed by the Tukey’s test with a significance level of 5%.

Results

For the enamel and considering the erosive-abrasive cycle, significant differences were found between the groups tested, the bleaching, and the abrasiveness of the dentifrice tested; however, the final microhardness values were significantly lower than the initial ones. For dentin, differences were found between the eroded/abrasion and the non-eroded/abrasion groups, with the former presenting lower microhardness values compared with the latter. In addition, bleaching decreased the microhardness values only for the highly abrasive dentifrice, and the final values were lower than for the initial ones for all tested groups.

Conclusion

The use of high and low abrasiveness dentifrices during bleaching and concomitant with erosion/abrasion cycles is more harmful to dentin than to enamel.

Clinical Relevance

Although bleaching is considered a conservative treatment, it can cause deleterious effects to dental hard tissue. The association of an at-home bleaching technique with erosion and high- or low- abrasive dentifrices harms dentin more than enamel.

Influence of Different Time Intervals among the in-Office Bleaching Sessions on the Tooth Enamel Mass Variation

AbstractThis study evaluated the effect of different time intervals between tooth bleaching sessions on the variation of tooth enamel mass, using a 35% hydrogen peroxide (HP35) gel. Twenty bovine incisor teeth were collected and cross-sectioned twice, leaving only the middle coronal portion. The dentin layer was removed, leaving only the buccal dental enamel. The samples were randomly divided into 2 groups (n = 10): G1 (with a 7-day time interval between each bleaching session), and G2 (with a 2-day time interval between each bleaching session). Three bleaching sessions were performed for each group. Each specimen’s mass was measured using an electronic analytical scale, first at the beginning of the experiments (T0), and then immediately after each bleaching intervention (T1, T2 and T3, respectively). All samples were stored in artificial saliva and kept in a biological chamber during the time of the study. The data analysis was performed using ANOVA for the related samples (p = 0.05). The results showed a reduction in the enamel mass values in G2 after the 3rd session when comparing to enamel mass values presented at the beginning of the study. On the other hand, G1 presented an increase in the mass values at the end of the third session, and these intragroup differences were statistically significant (p <0.001). It was concluded that bleaching treatment with 7-day intervals between sessions leads to no tooth enamel mass loss, whereas the reduced 2–day time interval between sessions caused a significant tooth enamel mass loss. Keywords: Tooth. Tooth Bleaching. Tooth Enamel. Resumo                                                                 Este estudo avaliou a influência de diferentes intervalos de tempo entre as sessões de clareamento com peróxido de hidrogênio a 35% (PH35) sobre a variação de massa do esmalte dental. Foram utilizados 20 dentes incisivos bovinos hígidos, seccionados em duas porções transversais, com a camada de dentina vestibular toda removida, restando apenas o esmalte dental vestibular. As amostras foram distribuídas em 2 grupos (n=10): G1 - intervalo de tempo de 7 dias entre as sessões de clareamento, e G2 - Intervalo de 2 dias entre as sessões de clareamento. Foram realizadas 3 aplicações de gel clareador em cada grupo. A pesagem dos espécimes foi realizada antes do início do tratamento clareador e ao final de cada intervenção clareadora, em uma balança analítica eletrônica. Os espécimes foram armazenados em saliva artificial, e mantidos em estufa biológica. Os dados foram submetidos à ANOVA para amostras relacionadas (p=0.05). O G2 apresentou uma redução nos valores de massa do esmalte quando comparados os tempos antes do clareamento (T0 - 0.1650g) e após a 3° sessão (T3 - 0.1643g). Entretanto, o G1 apresentou um aumento nos valores de massa ao término da terceira sessão (T0 - 0.1615g e T3 - 0.1624g), sendo essas diferenças intragrupos estatisticamente significantes (p<0.001). Foi possível concluir que no clareamento com intervalo de 7 dias entre as sessões não houve perda de massa do esmalte dental, ao passo que quando reduzido o intervalo entre as sessões para 2 dias, uma perda significativa de massa foi observada. Palavras-chave: Dente. Clareamento Dental. Esmalte Dentário.

Effect of Calcium and Fluoride Addition to Hydrogen Peroxide Bleaching Gel On Tooth Diffusion, Color, and Microhardness

Objectives:

The aim of this study was to evaluate the effect of calcium and fluoride addition to a 35% hydrogen peroxide (HP) bleaching gel with regard to its diffusion through the tooth structure, enamel microhardness, and bleaching efficacy.

Methods and Materials:

Eighty specimens (6 mm in diameter and 2 mm in height; 1 mm/enamel and 1 mm/dentin) were obtained from bovine incisors that were polished and divided into four groups (n=20) according to the remineralizing agent added to the gel: Ca = 0.5% calcium gluconate; F = 0.2% sodium fluoride; Ca+F = 0.5% calcium gluconate and 0.2% sodium fluoride; and control = no agent. Initial microhardness and color were assessed. The samples were positioned over simulated pulpal chambers filled with acetate buffer solution to capture the HP. Gels were applied over enamel for 30 minutes, and HP diffusion was assessed by spectrophotometry two hours after bleaching. Microhardness was measured immediately after bleaching and then the specimens were immersed into artificial saliva for seven days for final color assessment. Data were analyzed by one-way analysis of variance followed by Tukey test.

Results:

Bleaching reduced microhardness for all groups (p=0.0001), but the Ca+F and F groups showed lower reductions after bleaching. The addition of Ca, F, and Ca+F decreased the peroxide penetration through the tooth structure (p=0.0001), but there were no differences in color change for ΔL (p=0.357), Δa (p=0.061), Δb (p=0.823), and ΔE (p=0.581).

Conclusion:

The addition of calcium and fluoride in the gel did not affect bleaching efficacy, but it was able to reduce both the peroxide diffusion and the bleached enamel microhardness loss.

Influence of Staining Solutions on Color Change and Enamel Surface Properties During At-home and In-office Dental Bleaching: An In Situ Study

The purpose of this in situ study was to evaluate the influence of staining solutions (coffee and cola) on the color change, microhardness, roughness, and micromorphology of the enamel surface during at-home and in-office dental bleaching. One hundred and thirty-five enamel bovine blocks were prepared to perform the evaluations. Fifteen volunteers used an intraoral appliance with nine enamel blocks for 15 days. The enamel blocks were randomly assigned among the different groups according to the three treatments: in-office bleaching with high hydrogen peroxide concentration (Opalescence Boost PF 40%, Ultradent) for 40 minutes in three sessions (first, eighth, and 15th days of treatment), at-home bleaching with low carbamide peroxide concentration (Opalescence PF 10%, Ultradent) for 60 minutes daily for 15 days, and a control group (no bleaching agent applied). The enamel blocks were immersed daily in different staining solutions (coffee or cola) for 30 minutes for 15 days or were not submitted to staining (control) to obtain a factorial scheme (3×3) of the dental bleaching treatment and staining solution (n=15). The microhardness analyses (Knoop), roughness evaluations (Ra), surface micromorphological observations, and color measurements (using the CIELAB system and the VITA Classical scale) were made before and after the bleaching treatments to assess immersion in staining solutions. Mixed model tests showed that there was a decrease in enamel microhardness after exposure to cola compared with coffee and the control group (p<0.0001) for both bleaching techniques. Roughness was higher for the cola groups (p<0.0001), and there was no significant difference between the coffee and the control groups. Generalized linear models showed that when no staining solution was applied, lighter color scores were found for the VITA Classical scale (p<0.0001). Without the staining solutions, there was an increase in luminosity (ΔL) (p=0.0444) for in-office bleaching. Lower values of Δa (p=0.0010) were observed when the staining solutions were not used. The Δb (p=0.3929) did not vary significantly between the bleaching agents, but when cola was applied, the values were significantly higher than for the control (p=0.0293). Higher values of ΔE (p=0.0089) were observed for in-office bleaching without staining solutions, while lower values of ΔE were observed for the in-office associated with coffee immersion. Regardless of whether being submitted to bleaching, the enamel stained with cola showed a decrease in microhardness, an increase in roughness, and changes in the micromorphology. The efficacy of the bleaching agents was greater when no staining solution (cola or coffee) was used, and in-office bleaching showed greater color change than the at-home bleaching technique.

Effect of Remineralizing Gels on Microhardness, Color and Wear Susceptibility of Bleached Enamel

Objectives:

To evaluate the effect of a remineralizing gel combining fluoride and calcium silicate/phosphate or a sodium fluoride gel on bleached enamel microhardness, color, and wear susceptibility.

Methods and Materials:

Two hundred forty bovine enamel-dentin samples were prepared. Baseline analysis of Knoop microhardness, color coordinates (L*a*b*), and surface profile were performed. According to the baseline microhardness values, specimens were stratified into six groups (n=40): NC (negative control)—no treatment; BL (positive control)—bleaching with 40% hydrogen peroxide gel (Opalescence Boost, Ultradent); BL/Rs—bleaching + application of calcium silicate/phosphate gel (Regenerate Serum, Unilever - Rs); Rs/BL—Rs + bleaching; Rs/BL/Rs—Rs + bleaching + Rs; and BL/F—bleaching + 2% sodium fluoride gel. After the treatment described for each group, color change (ΔE) and microhardness were evaluated again. To evaluate abrasion susceptibility, samples were randomly divided into two subgroups, according to the toothpaste used (Cp—Close Up or Rt—Regenerate), and underwent 100,000 brushing strokes. The profile of each sample was evaluated and the mean wear calculated. The data were analyzed by ANOVA and Tukey tests.

Results:

All bleached groups showed a significant reduction of microhardness in relation to the negative control. The groups treated with remineralizing gels showed a significantly higher microhardness and less wear than the positive control, although nonsignificant differences were observed among them. Nonsignificant differences in ΔE were found among bleached groups. The groups brushed with Regenerate toothpaste showed significantly less wear than those brushed with Close Up toothpaste.

Conclusions:

The remineralizing gels did not interfere with bleaching efficacy. However, all the treatments minimized the surface hardness reduction caused by the bleaching procedure and enamel loss after abrasion. Regenerate toothpaste resulted in less enamel abrasion.

Application of quantitative light-induced fluorescence technology for tooth bleaching treatment and its assessment: An in vitro study

OBJECTIVES

This study aimed to determine the efficacy of a combination of photocatalysts-hydrogen peroxide at a low concentration (3.5%) and titanium dioxide (TiO₂)-activated at a wavelength of 405 nm using quantitative light-induced fluorescence (QLF) technology, and to quantify their tooth-bleaching efficacy using fluorescence images obtained from QLF technology.

MATERIALS AND METHODS

Forty bovine incisors were extrinsically stained according to Stookey's method, and were randomly divided into four groups (n = 10 per group). Two bleaching solutions were prepared by mixing 3.5% H₂O₂ with 0.05% of anatase and rutile TiO₂ powders. These solutions were applied to the stained teeth using a microbrush and then irradiated for 15 min at either 306 or 405 nm to activate the bleaching agent. The color difference (ΔE^*) was assessed before and after every 5 min of treatment. The ΔE^* and the changes in the fluorescence loss (ΔΔF) were obtained from white-light and fluorescence images, respectively.

RESULTS

All of the low-H₂O₂/TiO₂ treatments caused significant tooth-bleaching efficacy after irradiation at 306 and 405 nm (p < 0.05). The results did not differ significantly between the two wavelengths (p > 0.05), but the bleaching efficacy was greater with anatase TiO₂ at 306 nm and rutile TiO₂ at 405 nm. Analysis of the fluorescence images revealed that the ΔF values increased significantly in all groups with the treatment time (p < 0.05). There was a statistically significant correlation between ΔE^* and the change in ΔΔF (r = 0.822, p < 0.001).

CONCLUSIONS

Combining low-H₂O₂/TiO₂ with QLF technology at 405 nm has an efficacy of tooth-bleaching as a less harmful and biofriendly method, while the fluorescence images obtained by QLF technology could be used to assess tooth-bleaching.

Effect of Different Intraorifice Barriers and Bleaching Agents on the Fracture Resistance of Endodontically Treated Anterior Teeth

INTRODUCTION

Intraorifice barriers (IOBs) are usually used before internal bleaching for coronal sealing and the prevention of cervical resorption. The aim of this study was to investigate the effect of different IOBs on the fracture resistance (FR) of endodontically treated anterior teeth bleached with various bleaching agents (BAs).

METHODS

After performing root canal treatment for 72 extracted bovine upper incisors, the coronal 3 mm of gutta-percha was removed, and samples were classified into 3 based on the type of IOB: calcium-enriched mixture, mineral trioxide aggregate, and resin-modified glass ionomer. After applying IOBs, samples of each group were subdivided into 4 based on the BA: carbamide peroxide 45% (CP), hydrogen peroxide 35% (HP), sodium perborate (PB), and distilled water as the control. At the end of bleaching, the access cavities were restored with composite resin. The FR was measured with a universal testing machine at a crosshead speed of 5 mm/min. The data were analyzed using 2-way analysis of variance and least significant difference post hoc tests (P < .05).

RESULTS

The effect of BAs on the FR was significant (P < .05); however, the effect of the IOB and the interactive effect of these variables were not significant (P > .05). The FR in the HP and PB groups was significantly different from the control (P < .05) but that of CP was not significantly different from the control (P > .05).

CONCLUSIONS

Mineral trioxide aggregate and calcium-enriched mixture act similarly to resin-modified glass ionomer as an IOB. CP, unlike HP and PB, did not significantly decrease the FR.

Enamel Mineral Content Changes After Bleaching With High and Low Hydrogen Peroxide Concentrations: Colorimetric Spectrophotometry and Total Reflection X-ray Fluorescence Analyses

The purpose of this study was to evaluate the calcium (Ca) and phosphorous (P) content in enamel bleached with high and low concentrations of hydrogen peroxide (HP) using Total Reflection X-Ray Fluorescence (TXRF) and colorimetric spectrophotometry (SPEC). Forty-eight sound human third molars were used. Their roots were embedded in polystyrene resin and immersed for seven days in an artificial saliva solution. Then they were distributed into six groups to receive the bleaching treatments. The agents of high HP concentration (for in-office use) evaluated were Whiteness HP Maxx/FGM (35% HP), Whiteness HP Blue/FGM (35% HP, 2% calcium gluconate), Pola Office+/SDI (37.5% HP, 5% potassium nitrate), and Opalescence Boost/Ultradent (38% HP, 1.1% ion fluoride, 3% potassium nitrate); these agents were applied to enamel in three sessions. The agents of low HP concentration (for home use) evaluated were Pola Day/SDI (9.5% HP) and White Class 10%/FGM (10% HP, potassium nitrate, calcium, fluoride), and these agents were applied for 14 days. Enamel microbiopsies were evaluated by TXRF and SPEC analysis before the bleaching treatment (baseline), during the treatment, and 14 days after the end of the treatment. For TXRF, the Kruskal-Wallis test showed that Ca and P were not influenced by agent (p>0.05). For SPEC, Pola Office+, Opalescence Boost, Pola Day, and White Class 10% caused a decrease of Ca over time; there was a significant decrease of P over time to Pola Office+ and White Class 10%. The Spearman test showed no correlation between the Ca (p=0.987; r²=-0.020) and P (p=0.728, r²=0.038) obtained by SPEC and TXRF. For TXRF and SPEC, changes in Ca and P during bleaching occurred independently of the HP concentration used.

Effects of in-office bleaching on human enamel and dentin. Morphological and mineral changes

BACKGROUND

The effects of HP-based products upon dental enamel and dentin are inconclusive.

AIM

To evaluate changes in micromorphology and composition of calcium (Ca) and phosphate (P) in enamel and dentin after the application of 37.5% hydrogen peroxide (HP) and 35% carbamide peroxide (CP) METHODS: Crowns of 20 human teeth were divided in two halves. One half was used as control specimen and the other as experimental specimen. The control specimens were kept in artificial saliva, and the experimental specimens were divided into four groups (n=5 each): group 1 (enamel HP for 45min); group 2 (dentin HP for 45min); group 3 (enamel CP for 90min); and group 4 (dentin CP for 90min). The morphological changes were evaluated using confocal laser scanning microscopy (CLSM), while the changes in the composition of Ca and P were assessed using environmental scanning electron microscopy combined with a microanalysis system (ESEM+EDX). The results within each group and between groups were compared using the Wilcoxon test and Mann-Whitney U-test, respectively (p<0.05).

RESULTS

Similar morphological changes in the enamel and no changes in dentin were assessed with both products. Ca and P decreased in enamel and dentin, without significant differences between them or with respect to their control specimens (p>0.05).

CONCLUSIONS

When bleaching products with a neutral pH are used in clinical practice, both, the concentration and the application time should be taken into account in order to avoid possible structural and mineral changes in enamel and dentin.

Effect of Hydrogen and Carbamide Peroxide in Bleaching, Enamel Morphology, and Mineral Composition: In vitro Study

AIM

The aim of the study was to evaluate the bleaching effect, morphological changes, and variations in calcium (Ca) and phosphate (P) in the enamel with hydrogen peroxide (HP) and carbamide peroxide (CP) after the use of different application regimens.

MATERIALS AND METHODS

Four groups of five teeth were randomly assigned, according to the treatment protocol: HP 37.5% applied for 30 or 60 minutes (HP30, HP60), CP 16% applied for 14 or 28 hours (CP14, CP28). Changes in dental color were evaluated, according to the following formula: ΔE = [(L_a-L_b)²+(a_a-a_b)² + (b_a-b_b)²]^1/2. Enamel morphology and Ca and P compositions were evaluated by confocal laser scanning microscope and environmental scanning electron microscopy.

RESULTS

ΔE HP30 was significantly greater than CP14 (10.37 ± 2.65/8.56 ± 1.40), but not between HP60 and CP28. HP60 shows greater morphological changes than HP30. No morphological changes were observed in the groups treated with CP. The reduction in Ca and P was significantly greater in HP60 than in CP28 (p < 0.05).

CONCLUSION

Both formulations improved tooth color; HP produced morphological changes and Ca and P a gradual decrease, while CP produced no morphological changes, and the decrease in mineral component was smaller.

CLINICAL SIGNIFICANCE

CP 16% applied during 2 weeks could be equally effective and safer for tooth whitening than to administer two treatment sessions with HP 37.5%.

The effect of long-term use of tooth bleaching products on the human enamel surface

The aim of this in vitro study was to evaluate the long-term effect of bleaching on human enamel. Four groups of enamel specimens were prepared (n = 20): group 1: bleaching with Opalescence Boost [40% hydrogen peroxide (H₂O₂), 3 × 20 min/week]; group 2: control group (the specimens were stored in human saliva); group 3: beaching with Vivastyle Paint on Plus (6% H₂O₂, 2 × 10 min/day), and group 4: bleaching with Opalescence PF 16% [16% carbamide peroxide (CP), 6 h/day]. After each bleaching session the specimens were stored in human saliva. Knoop microhardness and surface roughness were measured: before bleaching, after 2-week and after 8-week bleaching. After 2-week treatment, surface roughness was significantly increased in all experimental groups (p < 0.05), while among them no significant difference was found (p > 0.05). The roughness changes exerted after 8-week bleaching were not significantly higher than the ones after 2 weeks (p > 0.05). After 8-week treatment, the increase in roughness caused by 16% CP was significantly higher (p < 0.05) than the one caused by 40% H₂O₂. Microhardness increased in all groups including control; however, only 40% H₂O₂ increased the microhardness significantly (p < 0.05). The effect of bleaching on enamel was not shown to be dependent on the method or the H₂O₂ concentration. Bleaching with CP 16% resulted in higher roughness than bleaching with H₂O₂, while 40% H₂O₂ caused the higher microhardness increase. The present study showed that in-office bleaching with 40% H₂O₂ seems to be at least as safe as home bleaching as far as their effects on human enamel are concerned.

Impact of hydrogen peroxide activated by lighting-emitting diode/laser system on enamel color and microhardness: An in situ design

Background:

Hydrogen peroxide (HP) at lower concentration can provide less alteration on enamel surface and when combined with laser therapy, could decrease tooth sensitivity. This in situ study evaluated the influence of 15% and 35% HP gel activated by lighting-emitting diode (LED)/laser light for in-office tooth bleaching.

Materials and Methods:

Forty-four bovine enamel slabs were polished and subjected to surface microhardness (load of 25 g for 5 s). The specimens were placed in intraoral palatal devices of 11 volunteers (n = 11). Sample was randomly distributed into four groups according to the bleaching protocol: 15% HP, 15% HP activated by LED/laser, 35% HP, and 35% HP activated by LED/laser. The experimental phase comprised 15 days and bleaching protocols were performed on the 2^nd and 9^th days. Surface microhardness (KHN) and color changes were measured and data were analyzed by ANOVA (α = 0.05).

Results:

There were no significant differences in microhardness values neither in color alteration of enamel treated with 15% HP and 35% HP activated or not by LED/laser system (P > 0.05).

Conclusions:

Both concentrations of HP (15 or 35%), regardless of activated by an LED/laser light, did not affect the surface microhardness and had the same effectiveness in enamel bleaching.

The effect of two remineralizing agents and natural saliva on bleached enamel hardness

BACKGROUND

In order to compensate the adverse consequences of bleaching agents, the use of fluoride-containing remineralizing agents has been suggested by many researchers. The aim of this study was to compare the effect of applying two remineralizing materials on bleached enamel hardness and in comparison to natural saliva.

MATERIALS AND METHODS

In this experimental study, 30 enamel samples of sound human permanent molars were prepared for this study. Microhardness (MH) of all specimens was measured and 35% hydrogen peroxide was applied 3 times to the specimens. After completion of the bleaching process, MH of samples was measured and then enamel specimens were divided into three groups each of 10, specimens of groups 1 and 2 were subjected to daily application of hydroxyl apatite (Remin Pro) and casein phosphopeptide amorphous calcium phosphate fluoride (CPP-ACPF) (MI Paste Plus) pastes, respectively, for 15 days. In group 3, the specimens were stored in the operators' natural saliva at room temperature in this period of time. Final MH of all groups was measured. The data were analyzed using repeated measures ANOVA (α = 0.05).

RESULTS

The hardness significantly decreased in all groups following bleaching. Application of either Remin Pro, CPP-ACPF or natural saliva increased the hardness significantly. The hardness of the three test groups after 15 days were statistically similar to each other.

CONCLUSION

The hardness of enamel increases eventually after exposure to either MI Paste Plus, Remin Pro or natural saliva.

Nanotribological and Nanomechanical Properties Changes of Tooth After Bleaching and Remineralization in Wet Environment

Teeth bleaching cases had increased with people's desire for oral aesthetic; however, bleached teeth would still undertake chewing actions and remineralizing process in saliva. Nanotribological and nanomechanical properties are proper displays for dental performance of bleached teeth. The purpose of the research was to reveal the effect of bleaching and remineralization on the nanotribological and nanomechanical properties of teeth in wet environment. The specimens were divided into four groups according to the bleaching products used: 12 % hydrogen peroxide (HP) (12HP group); 15 % carbamide peroxide (CP) (15CP group); 35 % CP (35CP group); and artificial saliva (control group). The nanotribological and nanomechanical property changes of tooth enamel after bleaching and remineralization were evaluated respectively by nanoscratch and nanoindentation tests in wet environment, imitating the wet oral environment. The morphology changes were evaluated by statistical parametric mapping (SPM) and scanning electron microscopy (SEM). After bleaching, 12HP group and 15CP group showed increased scratch depth with more pile ups on the scratch edges, decreased nanohardness, and corroded surface appearance. While the 35CP group showed an increase in nanoscratch depth, no change in nanohardness and surface appearance was observed. The control group showed no change in these measurements. After remineralization, the three bleaching groups showed decreased nanoscratch depth and no change of nanohardness compared with the bleached teeth. And the control group showed no changes in nanotribological and nanomechanical properties. The nanotribological and nanomechanical properties of the 12HP group and 15CP group were affected by bleaching, but the nanotribological properties recovered partly and the nanomechanical properties got no change after 1 week of remineralization. As for the 35CP group, the nanotribological properties were influenced and the nanomechanical properties were not affected. These results remind us of taking actions to protect our teeth during bleaching.

Effects of acids used in the microabrasion technique: Microhardness and confocal microscopy analysis

Background

This study evaluated the effects of the acids used in the microabrasion on enamel.

Material and Methods

Seventy enamel/dentine blocks (25 mm2) of bovine incisors were divided into 7 groups (n=10). Experimental groups were treated by active/passive application of 35% H3PO4 (E1/E2) or 6.6% HCl (E3/E4). Control groups were treated by microabrasion with H3PO4+pumice (C5), HCl+silica (C6), or no treatment (C7). The superficial (SMH) and cross-sectional (CSMH; depths of 10, 25, 50, and 75 µm) microhardness of enamel were analyzed. Morphology was evaluated by confocal laser-scanning microscopy (CLSM). Data were analyzed by analysis of variance (Proc Mixed), Tukey, and Dunnet tests (α=5%).

Results

Active application (E1 and E3) resulted in higher microhardness than passive application (E2 and E4), with no difference between acids. For most groups, the CSMH decreased as the depth increased. All experimental groups and negative controls (C5 and C6) showed significantly reduced CSMH values compared to the control. A significantly higher mean CSMH result was obtained with the active application of H3PO4 (E1) compared to HCl (E3). Passive application did not result in CSMH differences between acids. CLSM revealed the conditioning pattern for each group.

Conclusions

Although the acids displayed an erosive action, use of microabrasive mixture led to less damage to the enamel layers.

Key words:Enamel microabrasion, enamel microhardness, confocal laser scanning microscopy.

Enamel and Dentin Microhardness and Chemical Composition After Experimental Light-activated Bleaching

OBJECTIVES

To evaluate 1) the influence of five bleaching agents (with additional light activation) on enamel and dentin surface microhardness and chemical composition and 2) the remineralizing potential of artificial saliva and amorphous calcium phosphate (ACP).

METHODS AND MATERIALS

The study was conducted on 125 human third molars dissected into quarters for separate enamel and dentin measurements. The bleaching process was performed with 38% and 25% hydrogen peroxide (HP) and 30%, 16%, and 10% carbamide peroxide (CP) gels two times for 15 minutes each time. All bleaching gels were tested alone and in combination with ZOOM2, light-emitting diode (LED), organic LED, and femtosecond laser. A total of 25 bleaching combinations (n=10) were evaluated. Microhardness was measured by a Vickers diamond. Chemical analysis was performed using energy-dispersive X-ray spectroscopy.

RESULTS

Bleaching agents used in the absence of light activation caused a significant reduction in enamel and dentin surface microhardness (p<0.001), ranging from 8% for 16% CP to 40% for 25% HP. The effects of different light activations were negligible. After two-week treatment with ACP and artificial saliva, maximum deviation from baseline microhardness was just 3%. Such treatment increased the concentrations of calcium, phosphorus, and fluorine.

CONCLUSIONS

An increase in peroxide concentration and gel acidity negatively affected microhardness and concentrations of calcium and phosphorus in enamel and dentin. ACP and artificial saliva stimulated the remineralization of hard tissues.

Effect of hydrogen peroxide concentration on enamel color and microhardness

OBJECTIVES

The aim of this study was to investigate the effect of hydrogen peroxide gels with different concentrations (20%, 25%, 30%, and 35%) on enamel Knoop microhardness (KNH) as well as on changes in dental color (C).

METHODS

Cylindrical specimens of enamel/dentin (3-mm diameter and 2-mm thickness) were obtained from bovine incisors and randomly divided into six groups (n=20), according to the concentration of the whitening gel (20%, 25%, 30%, 35%, control, thickener). After polishing, initial values of KNH0 and color measurement, assessed by spectrophotometry using the CIE L*a*b* system, were taken from the enamel surface. The gels were applied on the enamel surface for 30 minutes, and immediate values of KNHi were taken. After seven days of being stored in artificial saliva, new measures of KNH7 and color (L7* a7* b7*, for calculating ΔE, ΔL, and Δb) were made. Data were submitted to statistical analysis of variance, followed by Tukey test (p<0.05).

RESULTS

Differences in gel concentration and time did not influence the microhardness (p=0.54 and p=0.29, respectively). In relation to color changes, ΔE data showed that the 35% gel presented a higher color alteration than the 20% gel did (p=0.006).

CONCLUSION

Bleaching with 35% hydrogen peroxide gel was more effective than with the 20% gel, without promoting significant adverse effects on enamel surface microhardness.

Acid demineralization susceptibility of dental enamel submitted to different bleaching techniques and fluoridation regimens

The aim of the current study was to assess the acid demineralization susceptibility of bleached dental enamel submitted to different fluoride regimens. One hundred bovine enamel blocks (6×6×3 mm) were randomly divided into 10 groups (n=10). Groups 1 and 2 received no bleaching. Groups 3 to 6 were submitted to an at-home bleaching technique using 6% hydrogen peroxide (HP; G3 and G4) or 10% carbamide peroxide (CP; G5 and G6). Groups 7 to 10 were submitted to an in-office bleaching technique using 35% HP (G7 and G8) or 35% CP (G9 and G10). During bleaching, a daily fluoridation regimen of 0.05% sodium fluoride (NaF) solution was performed on groups 3, 5, 7, and 9, while weekly fluoridation with a 2% NaF gel was performed on groups 4, 6, 8, and 10. The samples in groups 2 to 10 were pH cycled for 14 consecutive days. The samples from all groups were then assessed by cross-sectional Knoop microhardness at different depths from the outer enamel surface. The average Knoop hardness numbers (KHNs) were compared using one-way analysis of variance and Tukey tests (α=0.05). The comparison between groups 1 and 2 showed that the demineralization method was effective. The comparison among groups 2 to 6 showed the same susceptibility to acid demineralization, regardless of the fluoridation method used. However, the samples from groups 8 and 10 showed more susceptibility to acid demineralization when compared with group 2 (p<0.05). Groups 7 and 9 provided similar results to group 2, but the results of those groups were different when compared with groups 8 and 10. The use of 6% HP and 10% CP associated with daily or weekly fluoridation regimens did not increase the susceptibility of enamel to acid demineralization. However, the use of 35% HP and 35% CP must be associated with a daily fluoridation regimen, otherwise the in-office bleaching makes the bleached enamel more susceptible to acid demineralization.

Optical effects of experimental light-activated bleaching procedures

OBJECTIVE

The purpose of this study was to evaluate the efficiency of experimental light-activated bleaching procedures.

BACKGROUND DATA

The improved color effect may be attributed to the potential photochemical effect of light-emitting diode (LED405), organic LED (OLED), and femtosecond laser rather than to the photothermal effect of conventional lights used for tooth bleaching.

MATERIALS AND METHODS

Specially made pastilles of hydroxylapatite were immersed in green tea for 8 h and randomly divided into four groups (n=50) specified by the type of light source applied during a 30 min bleaching treatment: LED405, OLED, and femtosecond laser, or its absence (control group). Each group was treated with five bleaching gels: 10%, 16%, and 30% carbamide peroxide (CP), and 25% and 38% hydrogen peroxide (HP). Changes in color were determined by red-green-blue (RGB) colorimeter and ultraviolet-visible-near-infrared (UV/Vis/NIR) spectroscopy.

RESULTS

Regardless of the applied bleaching gel, LED405 produced a larger increase in the value of RGB index than did OLED and bleaching without light activation (p<0.05). Femtosecond laser also produced significantly better results in combination with 16% CP and 38% HP. Furthermore, application of a bleaching agent with a higher concentration of peroxide boosted the value of the RGB index. Spectroscopic measurements revealed similar results, although treatments with OLED were rated relatively better than in RGB analysis.

CONCLUSIONS

The mechanisms of light-activated bleaching procedures had a significant effect on the color change. The bleaching activation with LED405 and higher concentrations of peroxide in bleaching agents promoted better whitening effect.

Toxic effects of daily applications of 10% carbamide peroxide on odontoblast-like MDPC-23 cells

BACKGROUND

bleaching has been widely studied, mainly due to the possible undesirable effects that can be caused by this esthetic procedure. The cytotoxicity of the bleaching agents and its components to pulp cells has been demonstrated in several researches. The aim of this study was to evaluate the toxic effects of successive applications of 10% carbamide peroxide (CP) gel on odontoblast-like cells.

MATERIALS AND METHODS

Enamel-dentin discs obtained from bovine incisors were adapted to artificial pulp chambers (APCs). The groups were formed as follows: G1: Without treatment (control group); G2: 10% carbamide peroxide, CP (five applications/one per day); G3: 10% CP (one unique application); and G4: 35% hydrogen peroxide, HP (three applications of 15 min each). After treatment, cell metabolism (MTT), alkaline phosphatase (ALP) activity and plasma membrane damage (flow cytometry) were analyzed.

RESULTS

Reductions in cell metabolism and alkaline phosphatase activity along with severe damage of the cytoplasmic membrane were noted in G2. In G3, no damage was observed, compared to the control group. Intermediary values of toxicity were obtained after 35% HP application.

CONCLUSION

It can be concluded that one application of 10% CP did not cause toxic effects in odontoblast-like cells, but the successive application of this product promoted severe cytotoxic effects. The daily application of the bleaching agents, such as used in the at-home bleaching technique, can increase the damages caused by this treatment to the dental pulp cells.

In vitro evaluation of halogen light-activated vs chemically activated in-office bleaching systems

OBJECTIVES

To compare the tooth whitening efficacy, temperature and HP concentration changes induced by halogen light-activated and chemically activated in-office bleaching systems.

MATERIALS AND METHODS

Twenty-four extracted premolars were randomly divided into two groups (n = 12): Group BL (35% HP with halogen light activation) and Group OP (38% HP with chemical activation). Tooth color was measured by a spectrophotometer according to the CIE L*a*b* color space system. Temperatures of bleaching gels and pulp chambers during the bleaching process were monitored and recorded by a digital multimeter with K-type thermocouple. HP concentrations were tested before and after treatments by iodometry. ANOVA and paired t-test were used for statistical analyses at the significance of p < 0.05.

RESULTS

Tooth whitening resulted in the increase of ΔL* and ΔE and reduction of Δb*. Paired t-tests revealed groups BL had greater ΔE than group OP, however, there was no statistically significant difference in ΔE between them after 3 weeks post-treatment. Maximal temperature rise (ΔT) was found only in group BL, showing the increment of 2.55 and 2.02°C for bleaching gels and pulp chambers, respectively. HP concentrations were higher than baseline values for group OP (p < 0.001) rather than group BL.

CONCLUSIONS

Halogen light and chemically activated in-office bleaching systems were both effective for tooth whitening, but halogen light activation could improve the immediate whitening effect. In contrast, chemical activation was a more conservative method due to the little temperature rise in pulp chambers.

Temperature rise during experimental light-activated bleaching

The purpose of this study was to evaluate the surface and intrapulpal temperatures after treatments with different bleaching gels subjected to different types of light activation. A K-type thermocouple and infrared thermometer were used to measure the temperature increase during the 15- or 30-min treatment period. Light-emitting diode with a center wavelength of 405 nm (LED405), organic light-emitting diode (OLED), and femtosecond laser were tested and compared to ZOOM2. The tooth surface was treated with five bleaching agents and Vaseline which served as a control.The generalized estimating equation (GEE) model was applied for testing the differences in temperature increase. The ZOOM2 light source led to the largest increase in mean pulpal and tooth surface temperatures of 21.1 and 22.8 °C, followed by focused femtosecond laser which increased the pulpal and surface temperatures by up to 15.7 and 16.8 °C. Treatments with unfocused femtosecond laser, LED405, and OLED induced significantly lower mean temperature increases (p < 0.001 for each comparison with ZOOM2 and focused femtosecond laser), both in the pulp chamber (up to 2.7, 2.5, and 1.4 °C) and at the tooth surface (up to 3.2, 3.4, and 1.8 °C). Significant differences between pulp chamber and tooth surface measurements were obtained for all types of bleaching gel, during treatments with ZOOM2 (p < 0.001), LED405 (p < 0.001), and unfocused (p < 0.001) and focused femtosecond laser (p ≤ 0.002). Different bleaching agents or Vaseline can serve as an isolating layer. Focused femtosecond laser and ZOOM2 produced large temperature increases in the pulp chamber and at the tooth surface. Caution is advised when using these types of light activation, while LED405, OLED, and unfocused femtosecond laser could be safely used.

Effect of bleaching agents and whitening dentifrices on the surface roughness of human teeth enamel

OBJECTIVE

The aim of this in vitro study was to evaluate the surface roughness of human enamel bleached with 10% carbamide peroxide or 10% hydrogen peroxide bleaching agents at different times and also subjected to different superficial cleaning treatments.

MATERIALS AND METHODS

One hundred and forty flat enamel samples were divided into 14 groups, Group 1-Group 14 (G1-G14). G1-G7 were treated with 10% carbamide peroxide and different dentifrices, G8-G14 were treated with 10% hydrogen peroxide and different dentifrices (G1 and G8: not brushed as control groups; G2 and G9: brushed with Ipana® toothpaste; G3 and G10: brushed with Clinomyn® toothpaste; G4 and G11: brushed with Moos Dent® toothpaste; G5 and G12: brushed with Signal® toothpaste; G6 and G13: brushed with Colgate® toothpaste; G7 and G14: brushed without dentifrice). A profilometer was used to measure average roughness values of the initial surface roughness and at each 7-day-interval. The bleaching was performed for 6 h a day and the surface cleaning treatment was performed 3-times a day, 2 min each time, for 4 weeks. The samples were stored in distilled water during the test period.

RESULTS

Statistical analysis revealed significant differences in surface roughness values over time for all groups except G1 and G8 (not brushed). The results of the surface roughness of all groups were nearly the same.

CONCLUSIONS

The bleaching with 10% hydrogen peroxide and 10% carbamide peroxide did not alter the enamel surface roughness, but when the bleaching treatment was performed combined with abrasive dentifrices, a significant increase in roughness values was observed.