Evaluation of hydrogen peroxide permeability, color change, and physical-chemical properties on the in-office dental bleaching with different mixing tip

OBJECTIVE

This study aims to assess hydrogen peroxide (HP) penetration into the pulp chamber, color change (CC), physical-chemical properties, and material wastage (MW) and material used (MU) in mixing tips when using in-office bleaching gels with two different mixing tips.

MATERIALS AND METHODS

Forty teeth were divided into five groups (n = 8) based on the bleaching gels used (Pola Office +37.5% [PO+] and Whiteness HP Automixx Plus 35% [AM+]) and the mixing tip types (T-Mixer and Helical). A negative control group was treated with ultra-purified water. HP concentration was measured using UV-Vis, and CC was evaluated with a digital spectrophotometer. Initial concentration, pH, and viscosity were measured through Titration, a Digital pH meter, and Rheometer, respectively. MW and MU were measured using a precise analytical balance. Statistical analysis included two-way ANOVA, Tukey's, and Dunnett's test (α = 0.05).

RESULTS

A higher HP concentration was observed with PO+ with the Helical mixing tip in comparison with AM+ (p = 0.01). No significant differences in CC or MU were found for different mixing tips (p = 0.001). The T-mixer mixing tip resulted in significantly less MW (p < 0.00001) and improved mixture homogeneity and viscosity.

CONCLUSIONS

Utilizing a T-mixer with self-mixing bleaching gels achieves comparable CC while reducing MW. Moreover, it decreases HP penetration when using PO+.

CLINICAL SIGNIFICANCE

For the application of a self-mixing in-office bleaching gel, a T-mixer mixing tip should be recommended, as it reduces the penetration of hydrogen peroxide into the pulp chamber when using PO+, while also minimizing gel wastage.

Prosthetic rehabilitation after hemimaxillectomy: a case report

Maxillofacial defects created by the surgical resection of a tumor negatively impact the mastication, phonation, swallowing, and psychological function of patients. A 68-year-old woman received a diagnosis of oral squamous cell carcinoma involving the hard palate. The hemimaxillectomy procedure for tumor resection created a defect on the left side of the palate. This case report describes the patient's cancer treatment from presurgical planning to final rehabilitation with a conventional obturator and subsequent follow-up care for 1 year. The rehabilitation strategy was satisfactory for the patient, reestablishing lost function and esthetics.

Effect of Prior Application of Desensitizing Agent on the Teeth Submitted to In-Office Bleaching

This study aimed to quantify the penetration of hydrogen peroxide, color change evaluation, surface morphology, and composition after application of desensitizing agents before in-office bleaching. Fifty premolars were sectioned, an acetate buffer was placed in the pulp chamber and divided into five groups (n=10). In the positive control group, only the in-office bleaching gel was used, and in the negative control group, no treatment was used. Three different desensitizing agents were applied: Desensibilize KF2%® group; Mi Paste® group, and Desensibilize Nano-P® group. The bleaching procedure was carried out with 35% HP. The absorbance of the resulting solution was determined in a spectrophotometer. Color change was assessed by using a digital spectrophotometer. Four additional premolars were assigned to the same groups above for analysis under scanning electron microscope, as well as to evaluate the elemental composition with X-ray dispersive energy spectrometry. Data were subjected to ANOVA and Tukey's test (α=0.05). All products reduced the penetration of HP in the pulp chamber. Mi Paste and Nano P were the products that yielded the lowest HP penetration, which was similar to the negative control group (p<0.001). No significant difference was detected in color change (p<0.001). Concerning enamel morphology, the groups that were analyzed after bleaching were observed a greater deposition of desensitizing agents on the surface. The use of desensitizing agents before tooth bleaching seems to be an alternative to reduce adverse effects of the tooth.

Initial and pulp chamber concentration of hydrogen peroxide using different bleaching products

Objective: This study’s aim was to quantify the hydrogen peroxide (HP) penetration into the pulp chamber of teeth submitted to different protocols of bleaching. Material and Methods: Ninety premolars were randomly divided into nine groups according to the bleaching agent protocol (n = 10): control (no bleaching), carbamide peroxide 10% [10% CP], carbamide peroxide 16% [16% CP], carbamide peroxide 22% [22% CP], hydrogen peroxide 4% [4% HP], hydrogen peroxide 6% [6% HP], hydrogen peroxide 7.5% [7.5% HP], hydrogen peroxide 10% [10% HP] and hydrogen peroxide 35% [35% HP]. The penetration of HP was measured via spectrophotometric analysis of the acetate buffer solution from the pulp chamber. The absorbance of the resulting solution was determined in a spectrophotometer and converted into equivalent concentration of HP (?g/ mL). To analyze the concentration of HP, the titration of bleaching agents with potassium permanganate was used. Data were subjected to ANOVA and Tukey’s test for pairwise comparison (? = 0.05). Results: Higher concentration of HP in the pulp chamber was found in the HP 35% group (p < 0.0001). No significant difference between at-home protocols were observed (p = 0.64). Titration values showed that the concentration of the products was similar to that claimed by the manufacturer. Conclusion: It follows that the amount of HP that reaches the pulp chamber is not proportional to the concentration of whitening gels, but depends on the application time recommended by the manufacturers.KEYWORDSAt-home bleaching; Dental enamel permeability; Inoffice bleaching; Tooth bleaching. 

Tailoring the physical and chemical properties of Sn1-xCoxO2 nanoparticles: an experimental and theoretical approach

In this work, we present a coupled experimental and theoretical first-principles investigation on one of the more promising oxide-diluted magnetic semiconductors, the Sn_1-xCo_xO₂ nanoparticle system, in order to see the effect of cobalt doping on the physical and chemical properties. Our findings suggest that progressive surface enrichment with dopant ions plays an essential role in the monotonous quenching of the surface disorder modes. That weakening is associated with the passivation of the oxygen vacancies as the Co excess at the surface becomes larger. Room-temperature ¹¹⁹Sn Mössbauer spectroscopy data analysis revealed the occurrence of a distribution of isomer shifts, related to the different non-equivalent surroundings of Sn⁴⁺ ions and the coexistence of Sn²⁺/Sn⁴⁺ at the particle surfaces provoked by the inhomogeneous distribution of Co ions, in agreement with the X-ray photoelectron spectroscopy measurements. Magnetic measurements revealed a paramagnetic behavior of the Co ions dispersed in the rutile-type matrix with antiferromagnetic correlations, which become stronger as the Co content is increased. Theoretical calculations show that a defect with two Co mediated by a nearby oxygen vacancy is the most likely defect. The predicted effects of this defect complex are in accordance with the experimental results.

Does the Use of Reservoirs Have Any Impact on the Efficacy of At-Home Bleaching? A Systematic Review

Abstract To answer the following focused question through a systematic review: “Are the risk and intensity of tooth sensitivity (TS) and bleaching efficacy different between adult patients who undergo at-home bleaching using trays with reservoirs and those who use trays without reservoirs?”. A comprehensive search was performed in the MEDLINE via PubMed, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database, Brazilian Library in Dentistry, Cochrane Library, and grey literature without restrictions. Abstracts from conferences; unpublished and ongoing trial registries, dissertations and theses (ProQuest Dissertations and Periódicos Capes Theses databases) were searched. Only randomized clinical trials (RCTs) were included. We used the Risk of Bias tool (RoB) from the Cochrane Collaboration for quality assessment. After the removal of duplicates, title and abstract screening and full-text examination, nine RCTs remained for qualitative analyses. The great majority of the studies did not report the method of randomization, allocation concealment, and examiner blinding during color assessment. From the nine studies, eight were at unclear risk of bias. In regard to color change, four studies reported no change and two reported improved color change with reservoirs. Only four studies recorded tooth sensitivity and they reported no significant differences. Only one study reported greater gingival irritation with reservoirs. Lack of data reporting prevented us from running a meta-analysis. Further well-designed RCT should be conducted to answer this research question. So far there is not evidence to support that reservoirs in bleaching trays improve color change. PROSPERO - CRD42016037628

Effect of an experimental desensitizing agent on reduction of bleaching-induced tooth sensitivity: A triple-blind randomized clinical trial

BACKGROUND

In this randomized study, split-mouth, triple-blind clinical trial, the authors evaluated the efficacy of a desensitizing gel that contained 5% potassium nitrate and 5% glutaraldehyde applied before in-office bleaching with 35% hydrogen peroxide (HP).

METHODS

Treatment with the desensitizing or placebo control gels was randomly assigned to one-half of the maxillary teeth of 42 patients in a split-mouth design. The desensitizing gels were applied and maintained in contact with the tooth enamel for 10 minutes, followed by 2 HP bleaching sessions separated by 1 week. The primary outcome variable was pain intensity assessed with a numeric rating scale and a visual analog scale. Color was evaluated by means of a digital spectrophotometer and a value-oriented shade guide.

RESULTS

The difference in risk of developing tooth sensitivity between the desensitizing gel group (31.7%, 95% confidence interval [CI], 19.6 to 46.9) and the control group (70.7%; 95% CI, 55.5 to 82.3%) was statistically significant (P < .0001), as well as the difference in pain intensity in the first 24 hours (P < .001). No statistically significant difference was found in color change between teeth that received the desensitizing gel and those that received the placebo gel.

CONCLUSIONS

Application of desensitizing gel that contained 5% potassium nitrate and 5% glutaraldehyde before HP whitening reduced the risk and severity of dental sensitivity, without altering the effectiveness of whitening.

PRACTICAL IMPLICATIONS

A single application of desensitizing gel that contained 5% potassium nitrate and 5% glutaraldehyde can reduce tooth sensitivity after dental bleaching systems.

Difusão do Peróxido de Hidrogênio em Dentes Submetidos a Diferentes Protocolos de Clareamento

Objetivos: avaliar a concentração de Peróxido de Hidrogênio (PH) que alcança a câmara pulpar, utilizando géis clareadores de mesma marca comercial. Métodos: 90 pré-molares foram divididos em 9 grupos de acordo com o tratamento: Controle (sem tratamento clareador) [C], Peróxido de Carbamida (PC) 10% [PC10%], PC 16% [PC16%], PC 22% [PC22%], Peróxido de Hidrogênio (PH) 4% [PH4%], PH 6% [PH6%], PH 7 ½% [PH7 ½%], PH 10% [PH10%] e PH 35% [PH35%]. Os dentes foram seccionados e inserido tampão de acetato na câmara pulpar. Os géis clareadores foram aplicados de acordo com as recomendações dos fabricantes. A solução de tampão foi removida e adicionada a esta, soluções de leucocristal violeta e enzima peroxidase. Os dados foram submetidos a ANOVA e teste de Tukey para contraste das médias (a 0,05). Resultados: Maior quantidade de PH foi observado em protocolo de consultório [PH 35%] quando comparado com clareamento caseiro (p 0,000). Não houve diferença estatisticamente significante   (p 0,649) entre os protocolos caseiros. O [PC 10%] libera aproximadamente 3,5% de PH, o qual se difunde na câmara pulpar em quantidades semelhantes ao grupo [PH 4%]. Os grupos [PC 22%] e [PH 10%] também foram similares. Conclusões: A quantidade de PH que alcança a câmara pulpar não é proporcional a concentração inicial de PH dos géis clareadores.Palavras-chave: Peróxido de Hidrogênio. Clareamento Dental. Permeabilidade do Esmalte Dentário.

Efeito de Restaurações que Apresentam Resina Composta Fluida em Lesões Cervicais não Cariosas: Revisão Sistemática e Metanálise

O objetivo foi avaliar se a resina composta fluida em lesões cervicais não cariosas (LCNCs) melhora as taxas de retenção, descoloração marginal e adaptação, em pacientes adultos, por meio de uma revisão sistemática e metanálise. Foram pesquisadas sem restrições as bibliotecas Medline, Scopus, Web  of Science, Lilacs, BBO, Cochrane Library e SIGLE (bases cinzentas), resumos do IADR     e registros de ensaios clínicos (REBEC). Dissertações e teses também foram pesquisadas através das bases de dados ProQuest Dissertações e Periódicos Capes Teses. Foram incluídos apenas ensaios clínicos randomizados que compararam as restaurações com resina composta fluida e resina composta de viscosidade regular em LCNCs. A ferramenta da Cochrane Collaboration foi utilizada para avaliar o risco de viés dos estudos elegíveis. A ferramenta GRADE foi usada para avaliar a qualidade da evidência para cada estudo, de acordo com seus resultados. Após a remoção de duplicatas e avaliação por títulos e abstracts, 8 estudos mantiveram-se para a análise qualitativa. Não foi observada diferença significativa entre os grupos quanto a retenção nem descoloração marginal em todos os períodos avaliados (1 a 3 anos). Observou-se melhor adaptação marginal para as restaurações que foram realizadas com resina fluida. A qualidade da evidência foi classificada como moderada para perda ou retenção aos 3 anos e baixa e/ou muito baixa para todos os outros desfechos. Concluiu-se que a viscosidade da resina composta não influencia as taxas de retenção e descoloração marginal das restaurações em LCNCs.Palavras-chave: Lesões Cervicais. Flow. Ensaio Clínico Randomizado. Revisão Sistemática.

Effect of Different Protocols in Preconditioning With EDTA in Sclerotic Dentin and Enamel Before Universal Adhesives Applied in Self-etch Mode

Objectives:

The aim of this study was to investigate the effect of different protocols of 17% ethylene diamine tetra-acetic acid (EDTA) conditioning on the etching pattern and immediate bond strength of universal adhesives to enamel and sclerotic dentin.

Methods and Materials:

Forty bovine teeth with sclerotic dentin and 20 human third molars were randomly divided into eight groups resulting from the combination of the main factors surface treatment (none, two-minute EDTA conditioning manual application, 30-second EDTA manual application, 30-second EDTA sonic application) and adhesives systems (Scotchbond Universal Adhesive [SBU] and Prime & Bond Elect [PBE]). Resin-dentin and enamel-dentin bond specimens were prepared and tested under the microtensile bond strength (μTBS) and microshear bond strength (μSBS) tests, respectively. The etching pattern produced on the unground enamel and the sclerotic dentin surfaces under the different protocols and adhesive systems was evaluated under scanning electron microscopy.

Results:

For enamel, only the main factor adhesive was significant (p&lt;0.0001), with SBU showing the highest μSBS. In sclerotic dentin, the lowest mean was observed for the group without EDTA application and the highest mean in the group with EDTA application with the sonic device for 30 seconds. Regardless of the EDTA protocol, the highest means of μTBS were observed for SBU (p&lt;0.05).

Conclusions:

EDTA conditioning improves the bonding performance of universal adhesives in the self-etch mode on sclerotic dentin, mainly when applied for 30 seconds with the aid of a sonic device. EDTA pretreatment also improves the retentive etching pattern of enamel, but it does not result in higher enamel bond strength.

Effects of the concentration and composition of in-office bleaching gels on hydrogen peroxide penetration into the pulp chamber

In tooth whitening, the hydrogen peroxide (HP) diffuses in the enamel and dentin, reaching the pulp. This in vitro study aimed to quantify the penetration of HP in the pulp chamber in teeth submitted to bleaching agents of different concentrations of HP without calcium (HP 20% [20CF], HP 35% [35CF]) and with calcium (HP 20% [20CC], HP 35% [35CC]).

METHOD

Fifty human premolars were sectioned 3 mm from the cemento-enamel junction and the pulp tissue was removed. The teeth were divided into five groups according to treatment and with a control group (n=10). An acetate buffer solution was placed in the pulp chamber of all teeth. The control group was exposed only to distilled water, while the other groups were treated with a bleaching procedure, according to the manufacturer's recommendations. After treatment, the acetate buffer solution was transferred to a glass tube in which leuco-crystal violet and peroxidase solutions were added, resulting in a blue solution. The optical density of this blue solution was determined spectrophotometrically and converted into micrograms equivalent to the HP. Data were analyzed using analysis of variance and Tukey tests (α=0.05).

RESULTS

The HP concentration did not affect the HP inside the pulp chamber, but the presence of calcium significantly reduced it (p<0.0001).

CONCLUSION

The amount of HP that reaches the pulp chamber depends on the bleaching protocol and the product employed, and it seems to be less affected by HP concentration.

Effects of light activated in-office bleaching on permeability, microhardness, and mineral content of enamel

The aim of this study was to evaluate the permeability (PE), microhardness (KHN), and mineral change in enamel after LED/laser activated in-office bleaching. For PE, the coronal portion of premolars (n=51) was subjected to bleaching with 35% hydrogen peroxide (Whiteness HP Maxx, FGM Dental Products, Joinville, SC, Brazil). The samples were stained via the histochemical method, which involves a copper sulphate solution and rubeanic acid. The penetration of dye into the enamel was measured. The KHN of enamel was assessed before treatment, immediately after the bleaching treatment, and again after one week. The calcium and phosphorus content were analyzed with a scanning electron microscope with energy-dispersive X-ray (JSM 6360LV, Jeol Ltd, Tokyo, Japan). The data set from each test was subjected to appropriate parametric statistical analysis (α=0.05). No significant differences were observed for PE in NLA and LA compared to the control group (p=0.98), as well as for calcium (p=0.16) and phosphorus (p=0.80) content. Significant reduction of KHN after bleaching occurred for both groups (p<0.001). After immersion in artificial saliva, the KHN of the enamel for all groups was similar to that seen before bleaching. Light activation during in-office bleaching does not produce significant changes in the enamel compared to a non-light-activated technique.