Mineral Loss and Morphological Changes in Dental Enamel Induced by a 16% Carbamide Peroxide Bleaching Gel

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Responses of Dental Pulp Cells to a Less Invasive Bleaching Technique Applied to Adhesively Restored Teeth

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

Responses of human dental pulp cells after application of a low-concentration bleaching gel to enamel

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

Avaliação clínico visual de três técnicas de clareamento dental

O objetivo deste estudo in vivo foi avaliar comparativamente três técnicas de clareamento de dentes polpados quanto ao grau de cor final alcançado, sensibilidade dental e satisfação pessoal de operadores e pacientes. Indivíduos jovens de mesma faixa etária e padrão de higiene bucal foram selecionados e divididos aleatoriamente entre os grupos (G1; n=7) caseiro, com regime de uso de 8 h/dia/4 semanas; (G2; n=7) consultório, com regime de clareamento de 4 sessões semanais de 2 aplicações de 15 min cada e; (G3; n=6) associado, com caseiro e consultório combinados. Para as técnicas caseira e de consultório foram utilizados peróxido de carbamida a 16% (WhitegoldHome/Dentsply) e peróxido de hidrogênio a 35% (Whitegold Office/Dentsply), respectivamente. Os registros de cor foram obtidos por um único operador antes e após o emprego da cada técnica utilizando escala de cores Vita Bleachedguide 3D-Master e máquina fotográfica digital profissional (EOS Rebel XT Canon), com ajustes de iluminação, flash e distância focal padronizados. O nível de clareamento foi avaliado por unidades de mudança de cor (luminosidade) na escala de cores, além do número de tons alcançados nas imagens digitais e mudança de cor no sistema CIE L*a*b* por meio do software ScanWhite. Os dados foram tratados estatisticamente pelos testes não paramétricos de Kruskal Wallis e dos sinais (p≤0,05). Os registros de sensibilidade dental trans e pós operatória e da satisfação pessoal dos operadores e pacientes foram preenchidos individualmente em questionário unidimensional ao final de cada sessão. Foram atribuídos escores para a avaliação final da sensibilidade dental, conforme: 0=ausente; 1=leve; 2=moderada e; 3=severa. Os dados foram tratados estatisticamente pelo teste Kruskal Wallis. As médias das variações de unidades de mudança de cor da escala Vita e do software foram, respectivamente: G1) 4,57 (IC1,34), 27,14 (IC12,03); G2) 2,86 (IC0,99), 21,29 (IC14,27); G3) 4 (IC1,82), 25,33 (IC10,70). Na comparação entre os métodos de avaliação de cor, os p-valores do teste dos sinais foram 0,453, 0,453 e 0,687 para os grupos 1, 2 e 3, respectivamente. As médias da variação total de cor (∆E) foram, respectivamente: G1) 8,79(IC4,18), G2) 7,10(IC3,53) e G3) 9,74 (IC4,07). Não foi determinada diferença estatisticamente significante entre os grupos. Os postos médios do nível de sensibilidade foram: G1 = 9,64; G2 = 11,58; e G3 = 10,43, e o p-valor = 0,807. Não houve diferença estatisticamente significante entre grupos. Conclui-se que as técnicas caseiro, consultório e associada foram igualmente eficazes quanto ao nível de cor final, de acordo com os métodos objetivos e subjetivos utilizados. O nível de sensibilidade dental foi o mesmo independentemente da técnica utilizada. Todos os indivíduos registraram satisfação ao final do clareamento.

Influência da espessura do substrato dental sobre a eficácia clareadora e citotoxicidade de diferentes protocolos de clareamento

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Fracture strength of incisor crowns after intracoronal bleaching with sodium percarbonate

Objectives: To compare the fracture resistance of bovine teeth after intracoronal bleaching with sodium percarbonate (SPC) or sodium perborate (SP) mixed with water or 20% hydrogen peroxide (HP). Materials and methods: Fifty extracted bovine teeth were divided into four experimental groups (G1G4) and one control (n = 10) after endodontic treatment. Following root canal obturation, a glass ionomer barrier was placed at the cementoenamel junction. After that, the pulp chambers were filled with: G1 SP with water; G2 SP with 20% HP; G3 SPC with water; and G4 SPC with 20% HP. No bleaching agent was used in the control group. Coronal access cavities were sealed with glass ionomer and specimens were immersed in artificial saliva. The bleaching agents were replaced after 7 days, and teeth were kept in artificial saliva for an additional 7 days, after which the pastes were removed and the coronal access cavities were restored with glass ionomer. Crowns were subjected to compressive load at a cross head speed of 0.5 mm min-1 applied at 135 degrees to the long axis of the root by an EMIC DL2000 testing machine, until coronal fracture. Data were statistically analysed by anova and Tukey test. Results: No differences in fracture resistance were observed between the experimental groups (P > 0.05). However, all experimental groups presented lower fracture resistance than the control group (P < 0.05). Conclusion: SPC and SP led to equal reduction on fracture resistance of dental crowns, regardless of being mixed with water or 20% HP.

Ex vivo evaluation of the effectiveness of bleaching agents on the shade alteration of blood-stained teeth

Aim To evaluate ex vivo effectiveness of the three formulations of bleaching materials for intracoronal bleaching of root filled teeth using the walking bleach technique.Methodology Extracted premolar teeth were stained artificially with human blood. After biomechanical preparation, the root canals were filled and a 3-mm thick intermediate base of zinc phosphate cement was placed at the level of the cementoenamel junction. The teeth were divided into four groups (n = 12): C (control, without bleaching material), A1 (sodium perborate + distilled water), A2 (sodium perborate + 10% carbamide peroxide) and A3 (sodium perborate + 35% carbamide peroxide). The bleaching materials were changed at 7 and 14 days. Evaluation of shade was undertaken with aid of the VITA Easyshade (TM) (Delta E*ab) and was performed after tooth staining and at 7, 14 and 21 days after bleaching, based on the CIELAB system. Data were analysed by ANOVA for repeated measurements, Tukey and Dunnett tests (alpha = 0.05).Results The Tukey test revealed that group A1 (10.58 +/- 4.83 Delta E*ab) was statistically different from the others (A2, 19.57 +/- 4.72 Delta E*ab and A3, 17.58 +/- 3.33 Delta E*ab), which were not different from each other. At 7 days: A1 was significantly different from A2; at 14 and 21 days: A2 and A3 were significantly better than A1; the Dunnett test revealed that the control group was different from A1, A2 and A3 at all periods (P < 0.05).Conclusion Sodium perborate associated with both 10% and 35% carbamide peroxide was more effective than when associated with distilled water.

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.

Effect of dental surface treatment with Nd:YAG and Er:YAG lasers on bond strength of resin composite to recently bleached enamel

The aim of this work is to evaluate the effect of surface treatment with Er:YAG and Nd:YAG lasers on resin composite bond strength to recently bleached enamel. In this study, 120 bovine incisors were distributed into two groups: group C: without bleaching treatment; group B: bleached with 35% hydrogen peroxide. Each group was divided into three subgroups: subgroup N: without laser treatment; subgroup Nd: irradiation with Nd:YAG laser; subgroup Er: irradiation with Er:YAG laser. The adhesive system (Adper Single Bond 2) was then applied and composite buildups were constructed with Filtek Supreme composite. The teeth were sectioned to obtain enamel-resin sticks (1 x 1 mm) and submitted to microtensile bond testing. The data were statistically analyzed by the ANOVA and Tukey tests. The bond strength values in the bleached control group (5.57 MPa) presented a significant difference in comparison to the group bleached and irradiated with Er:YAG laser (13.18 MPa) or Nd:YAG (25.67 MPa). The non-bleached control group presented mean values of 30.92 MPa, with statistical difference of all the others groups. The use of Nd:YAG and Er:YAG lasers on bleached specimens was able to improve the bond strengths of them.

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.

Sealing evaluation of the cervical base in intracoronal bleaching

Discoloration of non-vital teeth is an esthetic deficiency frequently requiring bleaching treatment. The purpose of this study was to evaluate in vitro the cervical base efficacy in order to prevent or to minimize the leakage along the root canal filling and into the dentinal tubules. Thirty-eight extracted single-root human teeth were used, which were biomechanically prepared, filled, and divided into three experimental groups: G1, a cervical base was applied (3 mm of thickness) below the cemento-enamel junction, with resin-modified glass-ionomer cement (Vitremer); G2, the base was done with glass-ionomer cement (Vidrion R); and G3 (Control), did not receive any material as base. A mixture of sodium perborate and hydrogen peroxide 30% was placed inside the pulp chamber for 3 days, and the access opening was sealed with Cimpat. This procedure was repeated thrice. Soon after this, a paste of calcium hydroxide was inserted into the pulp chamber for 14 days. All teeth were covered with two layers of sticky wax, except the access opening, and immersed in blue India Ink for 5 days. The results did not show statistically significant differences between the three groups concerning the leakage inside the dentinal tubules. Regarding the apical direction, a statistical difference (ANOVA P < 0.05) was observed among the experimental group G1 and control group G3. No statistically significant difference was observed between G2 and G3 groups. Therefore, the placement of a cervical base before internal bleaching procedures is still recommended.