Dentin microhardness during and after whitening treatments

Objective: This in vitro study aimed to evaluate the effect of bleaching agents on dentin microhardness during and after bleaching. Method and materials: Specimens were randomly assigned to seven groups (n = 15): Nite White Excel 2 Z [NW] 10% and 22%; Rembrandt [REM] 10% and 22%; Opalescence [OPA] 10% and 20%; and a placebo agent. The 42-day whitening treatment consisted of daily application of the agents to the dentin surfaces for 8 hours, followed by immersion in artificial saliva for 16 hours. After the bleaching treatment, specimens were kept immersed in artificial saliva for 14 days. Microhardness was measured at baseline, 8 hours, and 7, 14, 21, 28, 35, and 42 days of bleaching and during the posttreatment period (7 and 14 days). Results: The analysis of variance for split-plot showed a significant effect on the interaction between bleaching agent and time. Tukey's test and regression analyses revealed that during the bleaching period, the agents NW 10%, NW 22%, and OPA 20%, which did not differ from each other, did not alter dentin microhardness, showing constant microhardness values. There were no differences among REM 10%, REM 22%, and OPA 10%, which showed significant reductions in microhardness after day 14 compared to other agents. After bleaching procedures, there was an increase in dentin microhardness for all groups. Conclusion: Throughout the bleaching treatment, depending on the agent applied, dentin showed a transitory decrease in microhardness values. In the posttreatment period, artificial saliva presented a remineralizing effect on the bleached surfaces.

Efeito da escovação utilizando dentifrícios com diferentes graus de abrasividade no desgaste do esmalte após o uso de agentes clareadores com e sem cálcio, em diferentes intervalos de tempo

Pós-graduação em Odontologia Restauradora - ICT

Eficácia e sensibilidade dental resultante do clareamento dental de consultório com 6¢ H2O2/TiO_N. Estudo clínico randomizado controlado

Pós-graduação em Ciências Odontológicas - FOAR

Efeitos de diferentes sistemas de clareamento dental sobre a rugosidade e morfologia superficial do esmalte e de uma resina composta restauradora

The aim of this study was to evaluate and compare the roughness and superficial morphology of enamel and a composite restorative resin after different bleaching techniques application. Material and Methods: Bovine incisors were selected and standardized cavities were prepared on the buccal surface, which were restored with composite resin. The teeth were distributed according to the following treatments: G1- bleaching with 10% carbamide peroxide (CP); G2 - bleaching with 38% hydrogen peroxide (HP); and G3 - bleaching with 38% of HP associated to light irradiation. For G1, the bleaching gel was applied for 8 hours daily during 21 days. For G2 and G3, 3 sessions were performed, consisting of 3 applications of 15 minutes each, with 7 days of intervals between the sessions. For G3, the LED (470nm) light was used to activate the bleaching agent for 6 minutes. The surface of enamel and composite resin were evaluated before and after the bleaching procedures using a roughness tester and an atomic force microscope. Results: The results showed significant differences in surface roughness of enamel after bleaching only for G1 (Wilcoxon, p<0.05). For composite resin, neither group showed a statistical difference compared to control (Mann-Whitney, p>0.05). Conclusion: It was concluded that the increase in the roughness of enamel occurred only after bleaching therapy using a gel with 10% of CP. The bleaching procedures evaluated in this investigation did not increase the roughness or cause changes in the superficial morphology of the composite resin.

Estudio descriptivo in vitro de dos agentes blanqueadores de distinta concentración sobre la micromorfología del esmalte bovino

Dental tooth bleaching is a conservative option for the treatment of tooth stains. It is based on the use of hydrogen peroxide as an active agent. Despite its effectiveness to lighten tooth colour, there is concern regarding its use due to the effects it could have over enamel surface. There is scarce evidence on the subject and contradictions exist between different authors. The aim of this study was to compare enamel surface micromorphology after bleaching teeth with different concentrations of hydrogen peroxide solutions. Method: 50 healthy bovine incisors sectioned horizontally at the cemento-enamel junction were prepared. Contents of pulp chamber and tooth surfaces were cleaned. The buccal surface of each tooth was divided vertically, assigning one half to the control group (CG) and the other randomly to: Group 1: 25 samples treated with 15% hydrogen peroxide with nitrogen doped titanium dioxide. Group 2: 25 samples treated with 35% hydrogen peroxide. Square samples (2x2 mm.) were obtained and observed by SEM (magnification of 5.000x and 10.000x). Results: All treated groups showed longitudinal depressions on the surface and increased surface roughness. Conclusions: Tooth bleaching with hydrogen peroxide produces subclinical alterations over bovine enamel surface. 15% hydrogen peroxide bleaching agent produced less micromorphology alteration over bovine enamel surface than the 35% hydrogen peroxide agent.

Penetration of 35% hydrogen peroxide into the pulp chamber in bovine teeth after LED or Nd:YAG laser activation

This aim of the present study was to evaluate the pulp chamber penetration of 35% hydrogen peroxide activated by LED (light-emitting diode) or Nd:YAG laser in bovine teeth, after an in-office bleaching technique. Forty-eight bovine lateral incisors were divided into four groups, acetate buffer was placed into the pulp chamber and bleaching agent was applied as follows: for group A (n = 12), activation was performed by LED; for group B (n = 12), activation was performed by Nd:YAG laser (60 mJ, 20 Hz); group C (n = 12) received no light or laser activation; and the control group (n = 12) received no bleaching gel application or light or laser activation. The acetate buffer solution was transferred to a glass tube and Leuco Crystal Violet and horseradish peroxidase were added, producing a blue solution. The optical density of this solution was determined spectrophotometrically and converted into microgram equivalents of hydrogen peroxide. The results were analysed using ANOVA and Tukey's test (5%). It was verified that the effect of activation was significant, as groups activated by LED or laser presented greater hydrogen peroxide penetration into the pulp chamber (0.499 +/- 0.622 microg) compared with groups that were not (0.198 +/- 0.218 microg). There was no statistically significant difference in the penetration of hydrogen peroxide into the pulp chamber between the two types of activation (LED or laser). The results suggest that activation by laser or LED caused an increase in hydrogen peroxide penetration into the pulp chamber.

Demineralization and hydrogen peroxide penetration in teeth with incipient lesions

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influência da clareação sobre a polpa dentária

Tooth bleaching is the most common treatment and more conservative to get a smile with white teeth. However, the tooth sensitivity has been a major adverse effects caused by this treatment, which raises questions about the effect of bleaching the pulp. Therefore, we performed a literature review in order to study the relationship between bleaching agents and their possible effects on the dental pulp. We review various articles showing that the peroxide compound used to whiten teeth, penetrates through enamel and dentin until the pulp chamber causing changes of variable intensity or induce pulp necrosis. Moreover, we found that the higher the concentration of peroxide in the bleaching agent, and the greater the contact time with this dental structure, the greater the damage caused in the pulp. Although several studies show that the bleaching agent hydrogen peroxide-based pulp can make changes, there are still many gaps to be filled.

Influence of the coloring agent concentration on bleaching gel and pulp chamber temperatures during dental bleaching

This study evaluated the Influence of the coloring agent concentration on the temperature of the gel layer and pulp chamber during dental bleaching with an LED/laser light source. Ten human incisors and a digital thermometer with K-type thermocouples were used. Using a high-speed spherical diamond bur, endodontic access was gained through openings on the lingual faces until pulp chamber was exposed. One end of the thermocouple was placed on the labial surface (immersed in bleaching gel) and the other end in the pulp chamber. The same 10 specimens were used in the 12 groups, according to the type and concentration of bleaching gel. Each bleaching gel was used in four different concentrations: manipulated without coloring, with normal quantity recommended by the manufacturer, with double the recommended amount of coloring, and with triple the recommended amount of coloring. The temperature rise was measured every 30 seconds for three minutes with a K-type thermocouple. The data were analyzed by ANOVA to examine the concentration and type of bleaching gel. This test was followed by Tukey's test, which was performed Independently for the gel at the labial surface and the pulp chamber (a = 5%). For both surfaces, values of p = 0.00 were obtained for all factors and for the Interaction between them. The varying concentrations of coloring agent produced statistically significant differences in terms of temperature increase for both the gel layer and the pulp chamber during activation.

Effects of Light Activation, Agent Concentration, and Tooth Thickness on Dental Sensitivity After Bleaching

Examining three bleaching systems, this in vivo clinical trial evaluated the relationship among tooth sensitivity, light activation, and agent concentration, and it correlated dental sensitivity with tooth thickness.Materials and Methods: Eighty-seven volunteer patients were included. Inclusion criteria were the presence of anterior teeth without restorations as well as the absence of a previous bleaching experience and absence of non-carious cervical lesions or dental pain. Exclusion criteria included pregnancy or breastfeeding, a maximum of TF3 hypoplasia, tetracycline-fluorosis stains, malpositioned teeth, orthodontic treatment, periodontal disease, and/or analgesic/anti-inflammatory intake. Patients were randomly assigned to three bleaching groups: Group A (n=25) was treated with 15% H2O2 and nitrogenous-titanium-dioxide and was light activated (Lase Peroxide Lite, DMC, SaoCarlos, Sao Paulo, Brazil); Group B (n=27) was treated with 35% H2O2 and was light activated (Lase Peroxide Sensy, DMC); and Group C (n=35) was treated with 35% H2O2 (White Gold Office, Dentsply, 38West Clark Ave., Milford, USA) without light activation. Tooth sensitivity (TS) was self-reported by the patients using the visual analog scale (VAS) at baseline (TSO), immediately after treatment (TSI), and at seven days after treatment (TS7). In 46 patients, tooth thickness was determined by computed tomography. TSO, TSI, and TS7 were compared between the A and B groups to determine the effect of concentration and between the B and C groups to determine the effect of light using analysis of covariance. The correlation between tooth thickness and TSI was determined by Spearman Rho test (SPSS 15).Results: Eighty-seven patients were evaluated at baseline, and 61 were evaluated at seven days. Separated by groups, tooth sensitivity, expressed as VAS value at the time points TS0, TS1, and TS7, respectively, were as follows: Group A: 13.76 +/- 13.53, 24.40 +/- 25.24, and 5.94 +/- 5.5; Group B: 15.07 +/- 18.14, 42.4 +/- 31.78, and 8.68 +/- 17.99; and Group C: 10.80 +/- 14.83, 31.51 +/- 29.34, and 7.24 +/- 9.2. Group A showed significantly lower tooth sensitivity than group B at TSI (p=0.032). No differences were observed in the tooth sensitivities between groups B and C. No correlation was encountered between tooth thickness and tooth sensitivity immediately after treatment (Rho=-0.088,p=0.563). The median tooth thickness was 2.78 +/- 0.21 mm.Conclusions: Increases in the concentration of bleaching agents directly affect tooth sensitivity, and LED/laser activation and tooth thickness are not correlated with tooth sensitivity after dental bleaching.

Influence of the quantity of coloring agent in bleaching gels activated with LED/laser appliances on bleaching efficiency

The aim of this study was to assess the influence of the quantity of coloring agent on the bleaching efficiency of gels containing 35% H2O2. Sixty human third molars were sectioned mesiodistally, darkened in a coffee solution and sectioned in the occlusal-cervical direction, resulting in mesial (not bleached) and distal halves (bleached). They were distributed into three groups: Whiteness HP, Total Bleach, and Whiteform Perox Red Gel; and subdivided into four sub-groups: no coloring agent, manufacturer's standard, double the standard, and triple the standard. The gels were activated with light-ermitting diode/laser appliances. The images were analyzed with the Adobe Photoshop program (deltaEL*a*b*). The variation was submitted to the ANOVA test (two factors: type of gel and quantity of coloring agent) and Tukey test. Differences were observed for the quantity of coloring agent. The mean (+/-SD) was determined for each quantity of coloring used: no coloring agent -6.85 (+/-2.26)a, manufacturer's standard -794 (+/-2.55)ab, double the standard -8.65 (+/-2.47)b, triple the standard -9.05 (+/-2.72)b. In conclusion, the standard quantity of coloring agent did not provide significantly more intense bleaching than when it was completely absent. The use of double and triple the amount provided greater bleaching than that observed for the gel without coloring agent. No significant differences were observed between the tested gels.

Effect of Sodium Ascorbate and the Time Lapse before Cementation after Internal Bleaching on Bond Strength between Dentin and Ceramic

Purpose: To evaluate the effects of the elapsed time (ET) after nonvital bleaching (NVB) and sodium ascorbate application (10%) (SAA) on the shear bond strength of dentin to ceramic.Materials and Methods: Bovine incisors were selected, internally bleached (35% carbamide peroxide) for 9 days and submitted to the following treatments (n = 10): G1, G2, G3-luting after 1, 7, and 14 days; G4, G5, and G6-luting after SAA, 1, 7, and 14 days, respectively. G7 and G8 were not bleached: G7-luting 24 hours after access cavity sealing; G8-luting 24 hours after access cavity sealing after SAA. After NVB, the vestibular dentin was exposed and flattened. The SAA was applied to the dentin (G4, G5, G6, G8) for 10 minutes, and it was then washed and dried. The dentin was etched (37% phosphoric acid), and an adhesive system (Single Bond 2) was applied. Feldspathic ceramic discs (VM7; 4-mm diameter, 3-mm thick) were luted with a dual-resin agent (RelyX ARC, 3M ESPE Dental Products, St. Paul, MN). After 24 hours, specimens were submitted to shear test on a universal testing machine. The data (MPa) were submitted to ANOVA and Dunnet's test (5%).Results: The means (+/- SD) obtained were (MPa): G1 (14 +/- 4.5), G2 (14.6 +/- 3.1), G3 (14 +/- 3.7), G4 (15.5 +/- 4.6), G5 (19.87 +/- 4.5), G6 (16.5 +/- 3.7), G7 (22.8 +/- 6.2), and G8 (18.9 +/- 5.4). SAA had a significant effect on bond strength (p = 0.0054). The effect of ET was not significant (p = 0.1519). G5 and G6 presented higher values than the other bleached groups (p < 0.05) and similar to G7 and G8 (p > 0.05).Conclusions: After NVB, adhesive luting to dentin is recommended after 7 days if sodium ascorbate has been applied prior to dentin hybridization.

Effects of 10% carbamide peroxide bleaching materials on enamel microhardness

Purpose: To evaluate the microhardness of enamel treated with two different 10% carbamide peroxide bleaching materials at different time intervals. Materials and Methods: Two bleaching agents were analyzed: Opalescence (OPA) and Rembrandt (REM). The control group (CON) consisted of dental fragments maintained in artificial saliva. Bleaching was accomplished for 8 hrs per day and stored during the remaining time in an individual recipient with artificial saliva. Enamel microhardness testing was performed before the initial exposure to the treatments and after 1, 7, 14, 21, 28, 35 and 42 days. Results: the ANOVA, followed by the Bartlet and Tukey tests, showed significant differences for treatments (P < 0.00001) from day 7-day 42. From the 7th to the 14th day, OPA presented an increase of enamel microhardness over time while REM presented a decrease of microhardness. Statistical differences were not found between REM and the control group (OPA > CON = REM). From the 21st-35th day, enamel fragments bleached with OPA and REM presented a decrease of microhardness. Statistical differences of microhardness were verified among all the treatments (OPA > CON > REM). on the day 42, statistical differences were not found between OPA and the control group, but they were found between REM and the control group (OPA = CON > REM). The polynomial regression showed an increase of microhardness for OPA until the 21st day, followed by a decrease of microhardness up to the 42nd day. A decrease of microhardness for REM was verified. There were alterations in enamel microhardness as a function of bleaching time when using the two different 10% carbamide peroxide whiteners. Over a 42-day treatment time, bleaching with REM agent caused a decrease in enamel microhardness. The OPA agent initially increased the microhardness, then returned to the control level. Different bleaching materials with the same concentration of carbamide peroxide have different effects on the enamel.

Study of DNA damage induced by dental bleaching agents in vitro

Dental bleaching is a simple and conservative procedure for aesthetic restoration of vital and non-vital discolored teeth. Nevertheless, a number of studies have demonstrated the risk of tissue damage from the contact of these agents with the oral mucosa. In the current study, the genotoxic potential associated with exposure to dental bleaching agents was assessed by the single cell gel (comet) assay in vitro. Chinese hamster ovary (CHO) cells in vitro were exposed to six commercial dental bleaching agents (Clarigel Gold - Dentsply; Whitespeed - Discus Dental; Nite White - Discus Dental; Magic Bleaching - Vigodent; Whiteness HP - FGM and Lase Peroxide - DMC). The results pointed out that all dental bleaching agents tested contributed to DNA damage as depicted by the mean tail moment, being the strongest effect observed with the highest dose of hydrogen peroxide (Whiteness HP and Lase peroxide, at a 35% concentration). On the other hand, Magic Bleaching (Vigodent) induced the lowest level of DNA breakage. Negative and positive controls displayed absence and presence of DNA-damaging, respectively. Taken together, these results suggest that dental bleaching agents may be a factor that increases the level of DNA damage. A higher concentration of hydrogen peroxide produced higher noxious activities in the genome as detected by single cell gel (comet) assay.

In vitro assessment of pulp chamber temperature of different teeth submitted to dental bleaching associated with LED/laser and halogen lamp appliances

This study sought to assess the pulp chamber temperature in different groups of human teeth that had been bleached using hydrogen peroxide gel activated with halogen lamps or hybrid LED/laser appliances. Four groups of ten teeth (maxillary central incisors, mandibular incisors, mandibular canines, and maxillary canines) were used. A digital thermometer with a K-type thermocouple was placed inside pulp chambers that had been filled with thermal paste. A 35% hydrogen peroxide-based red bleaching gel was applied to all teeth and photocured for a total of three minutes and 20 seconds (five activations of 40 seconds each), using light from an LED/laser device and a halogen lamp. The temperatures were gauged every 40 seconds and the data were analyzed by three-way ANOVA, followed by Tukey's test. Regardless of the light source, statistically significant differences were observed between the groups of teeth. The mean temperature values (±SD) were highest for maxillary central incisors and lowest for mandibular canines. The halogen lamp appliance produced more pulp chamber heating than the LED/laser appliance. The increase in irradiation time led to a significant increase in temperature.