Dentin hypersensitivity after teeth bleaching with in-office systems. randomized clinical trial

Purpose: To comparatively and prospectively compare in a randomized clinical trial, dentin hypersensitivity after treatment with three in-office bleaching systems, based on hydrogen peroxide at different concentrations, with and without light source activation. Methods: 88 individuals were included according to inclusion and exclusion criteria. Subjects were randomly divided into the following three treatment groups: Group 1 was treated with three 15-minute applications of hydrogen peroxide at 15% with titanium dioxide (Lase Peroxide Lite) that was light-activated (Light Plus Whitening Lase) with five cycles of 1 minute and 30 seconds each cycle, giving a total treatment time of 45 minutes; Group 2 was treated with three 10-minute applications of hydrogen peroxide at 35% (Lase Peroxide Sensy), activated by light (LPWL) same activation cycles than Group 1, with a total treatment time of 30 minutes; Group 3 was treated with only one application for 45 minutes of hydrogen peroxide at 35% (Whitegold Office) without light activation. Each subject underwent one session of bleaching on the anterior teeth according to the manufacturers' instructions. Dentin sensitivity was recorded with a visual analogue scale (VAS) at baseline, immediately after, and at 7 and 30 days after treatment using a stimulus of an evaporative blowing triple syringe for 3 seconds on the upper central incisors from a distance of 1 cm. A Kruskal-Wallis test followed by Mann-Whitney test was performed for statistical analysis. Results: All groups showed increased sensitivity immediately after treatment. Group 1 displayed less changes relative to baseline with no significant differences (P= 0.104). At 7 and 30 days after treatment, a comparison of VAS values indicated no significant differences between all groups (P= 0.598 and 0.489, respectively).

Effect of fluoride-treated enamel on indirect cytotoxicity of a16% carbamide peroxide bleaching gel to pulp cells

The aim of this study was to evaluate the possibility of fluoride solutions applied to enamel to protect pulp cells against the trans-enamel and transdentinal cytotoxicity of a 16% carbamide peroxide (CP) bleaching gel. The CP gel was applied to enamel/ dentin discs adapted to artificial pulp chambers (8 h/day) during 1, 7 or 14 days, followed by fluoride (0.05% or 0.2%) application for 1 min. The extracts (culture medium in contact with dentin) were applied to MDPC-23 cells for 1 h, and cell metabolism (MTT assay), alkaline phosphatase (ALP) activity and cell membrane damage (flow cytometry) were analyzed. Knoop microhardness of enamel was also evaluated. Data were analyzed statistically by ANOVA and Kruskal-Wallis tests (a=0.05). For the MTT assay and ALP activity, significant reductions between the control and the bleached groups were observed (p<0.05). No statistically significant difference occurred among bleached groups (p>0.05), regardless of fluoride application or treatment days. Flow cytometry analysis demonstrated 30% of cell membrane damage in all bleached groups. After 14 days of treatment, the fluoride-treated enamel presented significantly higher microhardness values than the bleached-only group (p<0.05). It was concluded that, regardless of the increase in enamel hardness due to the application of fluoride solutions, the treated enamel surface did not prevent the toxic effects caused by the 16% CP gel to odontoblast-like cells.

Effect of low-level laser therapy on odontoblast-like cells exposed to bleaching agent

The aim of the present study was to evaluate the effect of low-level laser therapy (LLLT) on odontoblast-like MDPC-23 cells exposed to carbamide peroxide (CP 0.01 %-2.21 μg/mL of H2O2). The cells were seeded in sterile 24-well plates for 72 h. Eight groups were established according to the exposure or not to the bleaching agents and the laser energy doses tested (0, 4, 10, and 15 J/cm2). After exposing the cells to 0.01 % CP for 1 h, this bleaching solution was replaced by fresh culture medium. The cells were then irradiated (three sections) with a near-infrared diode laser (InGaAsP-780 ± 3 nm, 40 mW), with intervals of 24 h. The 0.01 % CP solution caused statistically significant reductions in cell metabolism and alkaline phosphate (ALP) activity when compared with those of the groups not exposed to the bleaching agent. The LLLT did not modulate cell metabolism; however, the dose of 4 J/cm2 increased the ALP activity. It was concluded that 0.01 % CP reduces the MDPC-23 cell metabolism and ALP activity. The LLLT in the parameters tested did not influence the cell metabolism of the cultured cells; nevertheless, the laser dose of 4 J/cm2 increases the ALP activity in groups both with and without exposure to the bleaching agent. © 2013 Springer-Verlag London.

Effects of LED-laser hybrid light on bleaching effectiveness and tooth sensitivity: A randomized clinical study

The study evaluated the effectiveness and the sensitivity of in-office tooth bleaching with the use of a hybrid photo-activation system composed by LEDs and lasers. 40 patients, both genders, aged 18 through 25 years, were randomly distributed into two treatment groups: group I, 35% hydrogen peroxide, with a total bleaching time of 135 min divided into three sessions, and group II, 35% hydrogen peroxide and photo-thermal catalysis by an LED-laser system (300 mW cm-2), for a total bleaching time of 72 min divided into three sessions. The treatment efficiency was measured by reflectance spectroscopy and sensitivity by a visual analog scale (VAS). The final luminosity value (ΔL), color variation (ΔE) and sensitivity (S) resulting from the treatments were analyzed by the generalized estimating equations method (GEEs), and Bonferroni post hoc multiple comparisons at 5% significance. The two groups presented similar colors (ΔE) and luminosities (ΔL) after treatment. Group I presented a greater sensitivity index (37.6 ± 5.9%) compared to group II (11.1 ± 3.3%), statistically significant at p < 0.05. The use of LED-laser hybrid light, as a catalyst of the bleaching agents, showed a significant decrease of provoked tooth sensitivity and a treatment time reduced by 53%, with the same aesthetic results as without a light source. © 2013 Astro Ltd.

Effect of carbamide peroxide bleaching gel on composite resin flexural strength and microhardness

This study investigated the effect of 16% carbamide peroxide (Whiteness Perfect/FGM) on the Vickers microhardness and flexural strength of the restorative composites Filtek Z100 (hybrid), Filtek Z350 (nanofill), Brilliant (micro-hybrid) and Opallis (micro-hybrid). Discshaped (4×2 mm; n=5) and bar-shaped (12×2×1 mm; n=10) specimens of each restorative material were randomly divided into 2 groups: (G1) 16 weeks stored in distilled water; (G2) 16 weeks stored in distilled water, with 16% carbamide peroxide application during 6 h per day for the last 4 weeks. The mechanical properties were evaluated using a Vickers microhardness tester and a mechanical testing machine. Data were analyzed by twoway ANOVA and Tukey's (HSD) post-hoc test (α=0.05). Filtek Z100 presented the highest microhardness value, followed by Filtek Z350 and finally by Brilliant and Opallis (p=0.00). Filtek Z100 and Brilliant exhibited the highest flexural strength value, followed by Filtek Z350 and Opallis (p=0.00). Bleaching treatment decreased significantly microhardness of Brilliant and Opallis (p=0.00). The flexural strength of all studied materials was not affected by the home bleaching (p=0.28).

The Number of Bleaching Sessions Influences Pulp Tissue Damage in Rat Teeth

Introduction: Hydrogen peroxide tooth bleaching is claimed to cause alterations in dental tissue structures. This study investigated the influence of the number of bleaching sessions on pulp tissue in rats. Methods: Male Wistar rats were studied in 5 groups (groups 1S-5S) of 10 each, which differed by the number (1-5) of bleaching sessions. In each session, the animals were anesthetized, and 35% hydrogen peroxide gel was applied to 3 upper right molars. Two days after the experimental period, the animals were killed, and their jaws were processed for light microscope evaluation. Pulp tissue reactions were scored as follows: 1, no or few inflammatory cells and no reaction; 2, <25 cells and a mild reaction; 3, between 25 and 125 cells and a moderate reaction; and 4, 125 or more cells and a severe reaction. Results from each experimental group were compared between groups and within groups to the corresponding unbleached upper left molars and analyzed for significant differences using the Kruskal-Wallis test (P < .05). Results: All tissue sections showed significant bleaching-induced changes in the dental pulp. After 1 bleaching session, necrotic tissue in the pulp horns and underlying inflammatory changes were observed. The extent and intensity of these changes increased with the number of bleaching sessions. After 5 sessions, the changes included necrotic areas in the pulp tissue involving the second third of the radicular pulp and intense inflammation in the apical third. Conclusions: The number of bleaching sessions directly influenced the extent of pulp damage. © 2013 American Association of Endodontists.

Influence of whitening gel on pulp chamber temperature rise by in-office bleaching technique

INTRODUÇÃO: O clareamento dental representa uma manobra conservadora na recuperação estética de dentes com alterações cromáticas. Contudo, os tratamentos clareadores são passíveis de causar efeitos adversos, quando não bem planejados e executados. OBJETIVO: Este estudo avaliou a influência do gel clareador no aumento da temperatura intra-câmara pulpar através da técnica de clareamento dental fotoativado realizado em consultório. MATERIAL E MÉTODO: Um incisivo central superior humano foi seccionado na porção radicular 3 mm abaixo da junção cemento-esmalte. O canal radicular foi alargado para permitir a introdução do sensor do termômetro na câmara pulpar, a qual foi preenchida com pasta térmica, favorecendo a transferência de calor das paredes dentárias para o sensor do termômetro digital com termopar tipo K (MT- 401A) durante o clareamento. Três agentes clareadores fotossensíveis (peróxido de hidrogênio a 35%) foram utilizados, sendo: Whiteness HP (FGM), Whiteness HP Maxx (FGM) e Lase Peroxide Sensy (DMC). Um aparelho fotopolimerizador de led (Flash Lite - Discus Dental) foi empregado para a ativação dos géis clareadores. Seis ciclos de clareamento foram realizados para cada grupo testado. Os resultados foram submetidos à ANOVA de um critério e ao teste t (LSD) (α<0,05). RESULTADO: A menor média de variação de temperatura (ºC) foi observada com o Lase Peroxide Sensy (0,20), enquanto que a maior com o Whiteness HP (1,50). CONCLUSÃO: Os géis clareadores Whiteness HP e Whiteness HP Maxx interferiram significativamente no aumento da temperatura intra-câmara pulpar durante o clareamento, sendo esta variação dependente do tipo de gel clareador empregado.

Evaluation of metallic brackets adhesion after the use of bleaching gels with and without amorphous calcium phosphate (ACP): in vitro study

OBJETIVO: avaliar, in vitro, a influência do clareamento dentário com gel contendo fosfato de cálcio amorfo (ACP) na resistência da união adesiva de braquetes metálicos. MÉTODOS: trinta e seis dentes incisivos bovinos foram seccionados no limite coronorradicular e tiveram suas coroas incluídas em cilindros de PVC. Os corpos de prova foram divididos em três grupos (n = 12), de acordo com a realização do tratamento clareador e tipo de gel utilizado, sendo: G1 (controle) - sem clareamento; G2 - clareamento com gel sem ACP (Whiteness Perfect, FGM); G3 - clareamento com gel contendo ACP (Nite White ACP, Discus Dental). Os grupos G2 e G3 foram submetidos a 14 ciclos de clareamento, seguidos de intervalo de espera de 15 dias para a fixação adesiva dos braquetes metálicos. O ensaio mecânico de cisalhamento foi realizado em máquina universal Kratos, com velocidade de 0,5mm/min. Após o teste mecânico, os corpos de prova foram avaliados quanto ao índice de remanescente adesivo (ARI). Os resultados foram submetidos à ANOVA, ao teste de Tukey e ao de Kruskall-Wallis (α = 5%). RESULTADOS: diferenças significativas foram observadas entre os grupos testados. O grupo controle G1 (11,1MPa) mostrou uma resistência ao cisalhamento estatisticamente superior aos grupos submetidos ao clareamento (G2 = 5,40MPa; G3 = 3,73MPa), os quais não diferiram entre si. Não se observou diferença significativa para o ARI entre os grupos estudados. CONCLUSÃO: o clareamento dentário reduz a resistência da união adesiva de braquetes metálicos, enquanto a presença de ACP no gel clareador não influencia os resultados encontrados.

Effect of s/g ratio on kraft pulping and ecf bleaching of some poplars and eucalyptus

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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.

Effect of Sodium Ascorbate on Dentin Bonding After Two Bleaching Techniques

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

Accomplishing Esthetics Using Enamel Microabrasion and Bleaching-A Case Report

This case report describes the sequential steps that were used to treat unesthetic, white, hard-texture enamel stains of unknown etiology. A tapered fine diamond bur was used to remove superficial enamel followed by the use of an enamel microabrasion compound Opalustre (Ultradent Products Inc). This technique removed the stains and was followed by polishing with a fluoride paste to restore the enamel to a smooth finish. The teeth were subsequently bleached with carbamide peroxide (Opalescence 10%, Ultradent Products), which achieved the patient's desired esthetic results.

Effect of bleaching agents and soft drink on titanium surface topography

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

Mineral loss and color change of enamel after bleaching and staining solutions combination

Pigments of food and beverages could affect dental bleaching efficacy. The aim of this investigation was to evaluate color change and mineral loss of tooth enamel as well as the influence of staining solutions normally used by adolescent patients undergoing home bleaching. Initial hardness and baseline color were measured on enamel blocks. Specimens were divided into five groups (n = 5): G1 (control) specimens were kept in artificial saliva throughout the experiment (3 weeks); G2 enamel was exposed to 10% carbamide peroxide for 6 h daily, and after this period, the teeth were cleaned and stored in artificial saliva until the next bleaching session; and G3, G4, and G5 received the same treatments as G2, but after bleaching, they were stored for 1 h in cola soft drink, melted chocolate, or red wine, respectively. Mineral loss was obtained by the percentage of hardness reduction, and color change was determined by the difference between the data obtained before and after treatments. Data were subjected to analysis of variance and Fisher's test (a = 0.05). G3 and G5 showed higher mineral loss (92.96 +/- 5.50 and 94.46 +/- 1.00, respectively) compared to the other groups (p = 0.05). G5 showed high-color change (9.34 +/- 2.90), whereas G1 presented lower color change (2.22 +/- 0.44) (p = 0.05). Acidic drinks cause mineral loss of the enamel, which could modify the surface and reduce staining resistance after bleaching. (C) 2013 Society of Photo-Optical Instrumentation Engineers (SPIE)