External bleaching therapy with activation by heat, light or laser—A systematic review

Influence of light and laser activation of tooth bleaching systems on enamel microhardness and surface roughness

Objective

The objective of this study was to compare the effects of light and laser activation of in-office tooth bleaching systems on enamel microhardness and surface roughness.

Materials and Methods

Twenty-five enamel slabs were divided into three treatment groups: light-activated bleaching, laser-activated bleaching, and control. The baseline data were recorded for enamel microhardness (Vickers microhardness [VMH]) and surface roughness (Roughness average, Ra). The specimens were cured for 10 min upon hydrogen peroxide application for the light-activated bleaching group and activated with a laser source, 8 cycles, 10 s per cycle for the laser-activated group. The changes in VMH and Ra at days 1, 7, and 28 were evaluated. Kruskal-Wallis, Friedman, Wilcoxon, and Mann-Whitney tests were used to analyze both VMH and Ra between the treatment groups at different time intervals.

Results

There were a significant reduction in VMH values and significant differences between days 1, 7, and 28 against the baseline in the light-activated bleaching group (P = 0.001). The Ra values revealed significant differences in both light- (P = 0.001) and laser-activated (P = 0.033) groups.

Conclusion

Light activation of a bleaching agent caused a reduction in enamel microhardness and an increase in surface roughness when compared to laser activation.

Spectrophotometric evaluation of the effectiveness of Er,Cr:YSGG laser-assisted intracoronal tooth bleaching treatment using different power settings

BACKGROUND

Non-vital tooth discoloration is a common condition in dental practice. The aim of this in vitro study was to evaluate the efficacy of intracoronal bleaching treatments of non-vital teeth either activated or not by Er,Cr:YSGG laser (2780 nm) operating at 1.25 or 2.5 W.

METHODS

Twenty four human canines were artificially stained after implementation of root canal treatment. Subsequently, the teeth were randomly divided into three groups (n = 8): Group 1 (control) received intracoronal bleaching treatment with a bleaching gel containing 35 % hydrogen peroxide for 40 min, Group 2 received the same treatment assisted with Er,Cr:YSGG laser (2780 nm) operating at 1.25 W average power for 30 s and Group 3 received the same treatment with Group 2, but the average power was adjusted to 2.5 W. The bleaching treatments repeated after one week. Spectrophotometric analysis of tooth color change (ΔE) was implemented 7 days after both bleaching sessions.

RESULTS

The results of two-way ANOVA revealed that there was a tendency of no significant difference in color change between the three experimental groups (p = 0.063). However, the between-group comparisons showed that laser 2.5 W group had significantly higher ΔE than the control group after the first bleaching session. Moreover, a significant interaction between bleaching treatment and number of applications was detected (p = 0.026).

CONCLUSIONS

Er,Cr:YSGG laser irradiation significantly increased ΔE only after the first bleaching session when operating at 2.5 W. After the second bleaching session ΔE was not different compared to the control group, irrespectively of the laser power settings.

Stability and Influence of Storage Conditions on Nanofibrous Film Containing Tooth Whitening Agent

Carbamide peroxide (CP), a tooth whitening agent, is chemically unstable. The present study explores stability enhancement of CP by loading in a nanofibrous film (CP-F) composed of polyvinyl alcohol/polyvinylpyrrolidone/silica mixture, using an electrospinning technique. Kept at a temperature range of 60–80 °C for 6 h, CP in CP-F showed significantly higher stability than that in a polymer solution and in water, respectively. Degradation of CP in CP-F could be described by the first order kinetics with the predicted half-life by the Arrhenius equation of approximately 6.52 years. Physicochemical properties of CP-F after long-term storage for 12 months at different temperatures and relative humidity (RH) were investigated using scanning electron microscopy, X-ray diffractometry, differential scanning calorimetry, and Fourier transform infrared spectroscopy. It was found that high temperature and high humidity (45 °C/75% RH) could enhance water absorption and destruction of the nanofibrous structure of CP-F. Interestingly, kept at 25 °C/30% RH, the nanofibrous structure of CP-F was not damaged, and exhibited no water absorption. Moreover, the remaining CP, the mechanical properties, and the adhesive properties of CP-F were not significantly changed in this storage condition. It is concluded that the developed CP-F and a suitable storage condition can significantly improve CP stability.

Longitudinal, Randomized, and Parallel Clinical Trial Comparing a Violet Light-Emitting Diodes System and In-Office Dental Bleaching: 6-Month Follow-Up

Objective: This in vivo study compared two bleaching techniques with regard to the degree of tooth sensitivity (TS), color change, and treatment stability for a 6-month follow-up period. Materials and methods: Sixty volunteers were selected according to inclusion and exclusion criteria and submitted to in-office bleaching. For group 1, we performed one bleaching session with a 35% hydrogen peroxide gel and a second bleaching session after 7 days; for group 2, we performed two bleaching sessions with two applications per session, each session with a 7-day interval, using a light-emitting diodes (LEDs) device emitting violet light (405-410 nm) without employing peroxide-containing bleaching gel. TS was recorded immediately before and immediately after each bleaching session using the Variance Analogic Scale. The color of upper central incisors and upper canines at baseline was recorded immediately after each bleaching session, after 15, 30, and 180 days, with a value-oriented shade guide used by two well-trained observers. Results: The two whitening protocols results were similar regarding the immediate effectiveness and 6-month stability of tooth whitening. Dental bleaching with violet LED did not promote postoperative pain sensitivity at any of the evaluated times. However, dental bleaching performed with 35% hydrogen peroxide promoted higher postoperative pain sensitivity. Conclusions: The violet light alone provided dental bleaching and had the clinical advantage of promoting less immediate postoperative sensitivity; however, an unwanted repigmentation occurred after dental bleaching with light alone.

Effect of pH of bleaching agent on tooth bleaching action in vitro

This study investigated the effect of pH of bleaching agent, photo-irradiation time or application times on bleaching action using hematoporphyrin-stained papers (HSPs) and artificially stained bovine-teeth (BT). 23% H2O2 with pH 5.5, 6.0, 7.0, 8.0 and 9.0 were applied on the specimens. HSP was photo-irradiated for 1, 3 and 5 min. BT were photo-irradiated for 10 min and the bleaching was repeated ten times (n=10). CIE L*a*b* of the specimens were measured before and after the procedure. Data were analyzed by repeated-measures ANOVA followed by multiple comparisons with Bonferroni correction. For the HSP, longer irradiation time and higher pH yielded significantly higher color difference (ΔE). As for BT, increasing application times and higher pH resulted in higher ΔE. It was concluded that the pH of the bleaching agent significantly improved the bleaching effect with increased photo-irradiation time for HSP and with an increase of repeated application times for BT.

A Spectrophotometric Study on Light Attenuation Properties of Dental Bleaching Gels: Potential Relevance to Irradiation Parameters

Background: During in-office bleaching, appropriate light sources are applied in order to enhance the activity of the bleaching gels applied onto teeth. For this method to be effective, a high absorption of light within the gel is necessary. Variation in the light attenuation capability of the gel, the duration of application and light activation can contribute towards safety hazards associated with this procedure. Methods: In this study, seven different gels and hydrogen peroxide have been evaluated for their optical properties by means of spectrophotometry (440–1000 nm). The transmitted light spectrum was used to estimate the intensity loss for each gel. The mean intensity decreases observed were statistically analysed using an analysis of variance (ANOVA). Results: The five more-pigmented gels tested indicated a very similar intensity loss of around 80%, whereas the remaining two gels showed significantly less attenuation (predominantly, p < 10⁻⁶). Conclusions: Throughout the spectrum of wavelengths examined, and according to the underlying studies evaluated, five of the gels assessed demonstrated an attenuation high enough to possibly avoid overheating of the underlying enamel dentine and pulp. An evaluation of appropriate irradiation parameters is proposed.

Color stability of dental enamel bleached with violet LED associated with or without Low concentration peroxide gels

BACKGROUND

This study aimed to evaluate the in vitro color of dental enamel bleached with the violet LED, associated with or without low-concentration of peroxide; analyzed in two time intervals: 24 h later and 6 months after the treatment.

METHODS

Ninety fragments of bovine teeth (6 × 6 mm and 3 mm thick) were randomly divided into 6 groups according to bleaching treatment: NB - no bleaching, VL - Violet LED, HP- 7.5 % hydrogen peroxide, HP + VL - 7.5 % hydrogen peroxide + violet LED, CP - 22 % carbamide peroxide, CP + VL - 22 % carbamide peroxide + violet LED. The color change was analyzed by using a spectrophotometer, at time intervals of 24 h and 6 months after performing the bleaching techniques (n = 12). Scanning electron microscopy (SEM) was performed to verify the enamel surface morphology after treatment (n = 3).

RESULTS

The color change data were analyzed using ANOVA and a post-hoc Tukey tests (α = 0.05). The VL group showed chromatic changes after 24 h of treatment, however the groups submitted to bleaching gel treatments associated with or without violet LED (CP + VL, CP, HP, HP + VL) showed the highest color change values at all time intervals analyzed, with color stability after 6 months of treatment for the CP + VL group. Scanning electron microscopy analysis showed the greatest change in enamel surface for Groups CP and HP.

CONCLUSIONS

It could be concluded that violet LED had immediate bleaching effect without promoting significant changes in enamel morphology, however the association with carbamide peroxide 22 % showed color stability and greater bleaching efficacy than the use of violet LED alone, after 6 months.

Laser Influence on Dental Sensitivity Compared to Other Light Sources Used During In-office Dental Bleaching: Systematic Review and Meta-analysis

CLINICAL RELEVANCE

The use of laser light during bleaching will not reduce the incidence or severity of sensitivity and will not increase the degree of color change compared with nonlaser light sources.

SUMMARY

Objective: To evaluate whether the use of laser during in-office bleaching promotes a reduction in dental sensitivity after bleaching compared with other light sources.Methods: The present review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and is registered with PROSPERO (CDR42018096591). Searches were conducted in the PubMed/Medline, Web of Science, and Cochrane Library databases for relevant articles published up to August 2018. Only randomized clinical trials among adults that compared the use of laser during in-office whitening and other light sources were considered eligible.Results: After analysis of the texts retrieved during the database search, six articles met the eligibility criteria and were selected for the present review. For the outcome dental sensitivity, no significant difference was found favoring any type of light either for intensity (mean difference [MD]: -1.60; confidence interval [CI]: -3.42 to 0.22; p=0.09) or incidence (MD: 1.00; CI: 0.755 to 1.33; p=1.00). Regarding change in tooth color, no significant differences were found between the use of the laser and other light sources (MD: -2.22; CI: -6.36 to 1.93; p=0.29).Conclusions: Within the limitations of the present study, laser exerts no influence on tooth sensitivity compared with other light sources when used during in-office bleaching. The included studies demonstrated that laser use during in-office bleaching may have no influence on tooth color change.

Analysis of enamel structure and mineral density after different bleaching protocols using micro-computed tomography

OBJECTIVE

This study aims to investigate the effect of three different bleaching applications on structural integrity, mineral volume (MV) and density of the enamel by using micro-computed tomography (Micro-CT) and evaluate the colour effectiveness using CIEDE2000.

MATERIALS AND METHODS

Twenty-four maxillary premolar teeth were divided into three groups (n = 8) (group 1: 40% HP gel with erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser activation; group 2: 40% HP gel with diode laser activation; group 3: 16% CP gel). Bleaching protocols were applied and colour alteration was obtained. Data were calculated with CIEDE2000 before and after bleaching. A Micro-CT was used to scan the specimens before and after the bleaching application. Statistical analysis was performed by ANOVA.

RESULTS

No significant difference was observed between the groups for colour changes (p > .05). Micro-CT analysis showed significant differences in structural thickness, structural separation, mineral density and MV for the different ROIs before and after bleaching for all groups (p<.05).

CONCLUSIONS

All of the bleaching methods represented similar efficiency. However, bleaching with Er,Cr:YSGG laser was less harmful to enamel in comparison with other bleaching methods. The present results may be useful for establishing a numerical standard for the change in bleaching with laser systems in dental hard tissues.

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.

Strengthening effect of different fiber placement designs on root canal treated and bleached premolars

To evaluate the strengthening effect of five different fibers with different placement designs in root canal treated and intracoronally bleached premolars. Seventy extracted single-rooted premolars were distributed into 7 groups (G1-G7). Group 1 (G1) included the intact (I) teeth as the negative control. Group 2 (G2) included root canal treated, intra-coronally bleached and composite (C) restored teeth as the positive control. In the other five test groups after root canal treatment the teeth were intra-coronally bleached and fiber materials were placed into standard MOD cavities in the following different designs: an intracanal rigid fiber/Reforpost (G3,RF), an intracanal flexible fiber/ Everstick (G4, FF), four intracanal flexible pin fibers/Dentapreg Pin (G5,PF), an intercuspal flexible fiber /Dentapreg SFU (G6, IF) or an intra-coronal horseshoe-shaped/ Dentapreg SFU (G7,CF). All cavities were filled with a microfilled resin composite. Fracture resistance was tested using a universal testing machine under a crosshead speed of 1 mm/minute. One-way ANOVA and Duncan's Multiple Range tests were used for statistical analysis. Fracture types were recorded. The fracture resistance values in descending order were G1(I): 1190.97 N > G6 (IF): 1138.78 N > G5 (PF): 942.45 N > G3 (RF): 737.40 N > G4 (FF):694.29 N > G2 (C): 611.83 N > G7 (CF): 542.78 N. There were statistically significant differences among the groups (p ≤ 0.05). In all groups, repairable coronal oblique fractures were mostly observed. Flexible fibers placed intercuspally exhibited a significantly better strengthening effect than those of the intracanal flexible and rigid fibers (p < 0.05).

A review on dental whitening

OBJECTIVES

To provide a narrative review on vital dental whitening chemistry, toxicity and safety, vital dental whitening techniques, whitening systems, potential side effects of whitening and cyclic whitening using products with a range of concentrations and pH values. In addition, new developments and recommendations in the field of vital dental whitening will be presented to help clinicians understand the whitening process, its advantages, limitations, and the impact of whitening concentration and pH on enamel providing guidance in tailoring whitening treatments.

DATA

Data were gathered using the following keywords: dental whitening, roughness, hardness, sensitivity, hydrogen peroxide, whitening pH, whitening concentration, whitening chemistry, colour, and toxicity.

SOURCES

An electronic search was performed using PubMed and Scopus databases. Bibliographic material from papers reviewed was then used to find other relevant publications.

CONCLUSIONS

The effectiveness of vital dental whitening depends on many factors, such as the concentration/pH of the whitening agent, application duration, chemical additives, and re-mineralising agents used. Developing new whitening products and technologies such as nano-additives and alternative carrier systems is showing promising results, and might prove efficient in maximising whitening benefits by accelerating the whitening reaction and/or minimising expected reversible/irreversible enamel structural damage.

Effectiveness and SEM-EDX analysis following bleaching with an experimental bleaching gel containing titanium dioxide and/or chitosan

The aim of this study was to evaluate the bleaching effectiveness and mineral alterations following the use of experimental bleaching gels that included 6% hydrogen peroxide (HP), titanium dioxide (TiO₂) and/or chitosan in comparison with the routinely used 35% HP bleaching gel. Thirty-six maxillary anterior teeth were divided into three groups according to bleaching agent as follows: Group 1: 6% HP + TiO₂, Group 2: 6% HP + TiO₂ + chitosan, Group 3: 35% HP. Tooth colour was measured with a spectrophotometer before bleaching and after sessions one and two on days 14 and 30, respectively. Colour changes were assessed with the CIEDE2000 and CIELab formulas. Mineral analysis was performed with a scanning electron microscopy-energy dispersive X-ray (SEM-EDX) device before and 14 days after application. The enamel surfaces of randomly selected samples from each group were analysed by SEM. Two-way ANOVA was used to compare differences between groups. All tested materials resulted in significantly increased bleaching compared to the initial colour values (p < 0.05). Group 3 showed significantly more whitening compared to the other groups after the first and second sessions (p < 0.05). However, Group 2 presented prolonged whitening efficiency and reached a bleaching level similar to the 35% HP treatment after 14 and 30 days. The results of the CIEDE2000 and CIELab formulas were found to be correlated (r > 0.6). The increases in Ca were similar in Groups 2 and 3 (p > 0.05) and were significantly higher than that in Group 1 (p < 0.05). p was similarly decreased among all groups (p > 0.05). The combination of 6% HP, chitosan and TiO₂ appears to constitute a promising material for tooth whitening, showing good bleaching efficiency and acceptable mineral alterations.

Influence of low-level laser therapy on inflammation, collagen fiber maturation, and tertiary dentin deposition in the pulp of bleached teeth

OBJECTIVES

We evaluated the effects of low-level laser therapy (LLLT) using an infrared laser (IRL) and a red laser (RL) on the pulp of molar teeth in rats after dental bleaching to assess inflammation, collagen fiber maturation, and tertiary dentin formation.

MATERIALS AND METHODS

Eighty Wistar rats (Rattus norvegicus, albinus) were randomly divided into eight groups with 10 hemimaxillae in each of the following: control; bleached (Ble, 35% hydrogen peroxide [H₂O₂]); Ble-1IRL and Ble-1RL (one IRL [808 nm, 30 s, 3 J] or RL [660 nm, 15 s, 1.5 J] application immediately after H₂O₂); Ble-3IRL and Ble-3RL (three [immediately, 24 h, and 48 h] IRL or RL applications after H₂O₂); and 3IRL and 3RL (three IRL or RL applications without bleaching). The rats were euthanized after 2 and 30 days for histological evaluation of inflammation (hematoxylin-eosin) and maturation of collagen fibers (picrosirius red). Additionally, the dentin deposition in the specimens obtained at 30 days was quantified via microtomography of the pulp chamber volume. Statistical analyses were performed (P < 0.05).

RESULTS

Initially, severe damages to the pulp were observed in the Ble and Ble-1RL groups. Ble-1IRL and Ble-3RL groups showed lower inflammation. The bleached groups had a greater amount of mature collagen fibers than the control group. The Ble-3IRL group had a greater number of immature fibers than the Ble group. At 30 days, there was an absence of inflammation and equal proportion of mature and immature collagen fibers. All bleached groups showed a reduction in the volume of the pulp chamber.

CONCLUSION

Three consecutive applications of RL and one IRL application can minimize damage to the pulp of bleached teeth, whereas three IRL applications can minimize pulp fibrosis. However, LLLT did not prevent deposition of tertiary dentin.

CLINICAL RELEVANCE

This study describes LLLT protocols capable of minimizing inflammation and maturation of collagen fibers in pulp tissue after dental bleaching. However, the protocols proved insufficient for reducing the formation of tertiary dentin in bleached teeth.

Effect of application of desensitizers before bleaching on change of tooth shade

The aim of this in vitro study was to evaluate the effects of desensitizer pre-treatment on in-office bleaching using an artificial discoloration tooth model. The stained specimens were divided into four groups (n=10); without application (Control group), Shield Force plus (SF group), UltraEz (UE group) and Teeth Mate AP paste (TM group) applied before bleaching. Each group was bleached by an in-office bleaching agent. The CIE L*a*b* values were measured by a colorimeter before and after ten consecutive bleaching treatments and the color difference (∆E) was calculated. There was no statistical difference among ∆E values of Control, UE, and TM groups (p>0.05). There was a significant difference between SF and Control groups (p<0.001). It was concluded that application of TM and UE did not affect the change of tooth shade while SF application impeded the bleaching effect.

A New Approach for Dental Bleaching Using Violet Light With or Without the Use of Whitening Gel: Study of Bleaching Effectiveness

The objective of this study was to evaluate the effectiveness of violet light-emitting diodes (LEDs) in dental bleaching treatment when used in conjunction with bleaching gels containing different concentrations of hydrogen peroxide (HP). Here, 90 bovine teeth (n=15) were randomly assigned to the following groups: GI, placebo without light; GII, 35% HP without light; GIII, 17.5% HP without light; GIV, placebo with violet LED; GV, 35% HP with violet LED; and GVI, 17.5% HP with violet LEDs. Three bleaching sessions of 45 minutes were conducted; 21 cycles involving one minute of irradiation by violet LEDs with 30-second intervals were performed during each session of bleaching (GIV, GV, and GVI). Color changes (ΔE, ΔL, Δa, and Δb) were analyzed using a visible ultraviolet light spectrophotometer 7 days after each bleaching session. The mean ΔE, ΔL, Δa, and Δb values were compared between groups by analysis of variance and Tukey tests, with a significance level of 5%. The groups treated with 35% HP had higher ΔE and ΔL and lower Δb values, regardless of whether violet light was used. The group that received only violet LED differed from the control group in terms of ΔE, and the group treated with 17.5% HP and violet LED presented higher ΔE values than the group treated with 17.5% HP only. Thus, violet light did not influence bleaching efficacy when using 35% HP, but when used in conjunction with 17.5% HP, it increased the bleaching efficacy. Moreover, use of the violet LED only also prompted a bleaching effect, although it was less marked.

Are combined bleaching techniques better than their sole application? A systematic review and meta-analysis

OBJECTIVES

A systematic review and meta-analysis were performed to answer this research question: "Does combined in-office (IO) and at-home (AH) bleaching produce improved color change and lower tooth sensitivity (TS) better than solely AH or IO bleaching in adults?"

MATERIAL AND METHODS

Randomized controlled trials in adults that compared combined versus sole application bleaching were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. Meta-analyses were conducted for color change in shade guide units (∆SGU) and with a spectrophotometer (∆E*), risk, and intensity of TS, using the random effects model. Heterogeneity was assessed with Cochran's Q test and I² statistics. GRADE assessed the quality of the evidence. PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, SIGLE, IADR abstracts, unpublished, ongoing trial registries, dissertations, and theses were searched on August 28, 2017 (updated on January 29, 2019).

RESULTS

Twelve studies remained. Two were considered to have low RoB. For combined vs. IO bleaching, no significant difference for ∆E*, ∆SGU, and risk of TS were observed; data were not available to analyze the intensity of TS. For combined vs. AH bleaching, no significant difference for ∆E*, ∆SGU, but lower TS to risk (RR 1.40, 95% 1.10 to 1.80) and intensity (MD 1.40, 95% CI 0.18 to 2.63) were detected for AH bleaching. Quality of evidence was graded as low or very low in all meta-analyses.

CONCLUSION

Lower risk and intensity of TS was observed for the solely AH group without jeopardizing color change. However, more studies are still encouraged due to the low quality of evidence for most of the outcomes.

CLINICAL RELEVANCE

If clinicians are to choose between combined or sole AH bleaching, the solely AH may be preferable; combined bleaching may potentiate the risk of TS without benefits in color change. For combined or sole IO bleaching, no important clinical difference in color change and risk of TS were detected; however, intensity of TS could not be compared due to lack of data. Further studies should be conducted due to the low/very low quality of the evidence.

Effect of High Light Intensity Bleaching Protocol versus Descending Light Intensities Bleaching Protocol on Post Bleaching Teeth Sensitivity: A Randomized Clinical Trial

AIM

The study aimed to compare teeth sensitivity and shade after bleaching protocol with descending different light intensities versus bleaching protocol with the same high light intensity.

MATERIAL AND METHODS

Sample size was twenty-four patients. Each group consisted of twelve patients. Group, I patients received bleaching protocol of descending different light intensities. Group II patients received bleaching protocol with the same high light intensity; both groups used the same home bleaching gel kit for seven days according to manufacturer instructions and protocol. Baseline records were digital photographs, teeth sensitivity and teeth shade for 12 anterior teeth. Teeth sensitivity was assessed using five points verbal rating scale and Standardized 100 mm Visual analogue scale after 1 day, after 2 days and after 1 week. Teeth shades for twelve anterior teeth were recorded by VITA Easy Shade V (VITA Zahnfabrik H. Rauter GmbH & Co. KG, Germany) after 1 week by VITA Easy Shade V. Mann-Whitney test (non-parametric test, 2 independent samples) was used to compare teeth sensitivity between both bleaching protocols at each period. A paired t-test (parametric test, 2 related samples) was performed to compare the colour change in shade guide units (SGU) and ∆E values within high light intensity bleaching protocol. While Wilcoxon Signed-Rank test (non-parametric test, 2 related samples) was used to compare colour change light intensities bleaching protocol. Comparison of bleaching effectiveness (∆SGU and ∆Ediff) between both bleaching protocols was performed by the Mann-Whitney test.

RESULTS

Descending light intensities protocol showed a lower teeth sensitivity than high light intensity protocol after 1 and 2 days. There was no teeth sensitivity reported at 1-week post-bleaching. Regarding the teeth shade, descending light intensities protocol had a little higher effect on colour change in shade guide units (SGU) than high light intensity protocol effect. Both bleaching protocols showed there was no significant difference in ∆SGU recorded after bleaching between high and descending light intensities protocols.

CONCLUSION

Descending different light intensities protocol showed a lower teeth sensitivity than high same light intensity protocol. Descending light intensities protocol had a little higher effect on colour change in shade guide units (SGU) than high light intensity protocol effect.

Decomposition Rate, pH, and Enamel Color Alteration of At-Home and In-Office Bleaching Agents

Abstract This study evaluated the decomposition rate (DR), pH, enamel color alteration (DE) and whiteness index (DWI) promoted by at-home and in-office bleaching. Enamel surface was submitted to (n=10): at-home (10%, 15%, 20% carbamide peroxide - CP, 6% hydrogen peroxide -HP) and three 35% HP agents with light irradiation (LED, laser, and halogen) or no treatment (control). The DR and pH of agents were measured after 0, 2, 4, 6 and 8 h (at-home) or after 5, 15, 20, 30 and 40 min (in-office). Color parameters (L*, a*, b*, DE, DWI) were determined at baseline and after bleaching. DR, pH, L*, a*, b* data were analyzed by one-way (at-home) or two-way (in-office) repeated measures ANOVA and Tukey test. DE and DWI, by one-way (at-home) or two-way (in-office) ANOVA and Tukey test. DR of at-home agents was similar after 6 and 8 h (p>0.05), with pH close to neutral (6.5 to 6.9, CP) or acid 5.9 (6% HP). From 4 to 8 h, DE was higher for 15% and 20% CP compared with 10% CP (p<0.05). After 40 min, DR of 35% HP agents was similar and all exhibited significant DE in one application (p<0.05), regardless light irradiation. DWI indicated whitening effect with no differences among groups (p>0.05). One 35% HP showed alkaline pH, and the others, pH < 5.5. At-home agents could be applied for 2 h (15%, 20% CP, 6% HP) and 4 h (10% CP) and the in-office agents, up to 40 min in one application, without light.

Effect of pH conditioners on tooth bleaching

The purpose of this study was to evaluate the effect of pH conditioners on tooth bleaching using hematoporphirin-stained paper and artificially discolored bovine tooth model. Experimental bleaching gels containing 23% hydrogen peroxide, adjusting pH 7.0 by different pH conditioners (NaOH, NaHCO3, Na2CO3, KOH, KHCO3, and K2CO3), were prepared. Each bleaching gel was applied on a hematoporphirin-stained paper, and the light was exposed for 5 min. Before and after bleaching, color was measured and color difference was calculated. Artificially discolored bovine tooth samples were prepared and bleached by four experimental bleaching gels containing NaOH, NaHCO3, Na2CO3, or KHCO3. The bleaching time was 10 min with light exposure, and bleaching was repeated 10 times. The color of bleached surface was measured at each bleaching period, and color difference was calculated. In the experiment using hematoporphirin-stained paper, degrees of color difference were KHCO3 > NaHCO3 > KOH > NaOH > Na2CO3 ≥ K2CO3. In the experiment using bovine teeth, degrees of color difference were KHCO3 > NaHCO3 > NaOH > Na2CO3. It was concluded that the bleaching materials with same pH and different pH conditioners showed different bleaching effects and that both cation and anion in the pH conditioners affected bleaching effect.

Different light-activation systems associated with dental bleaching: a systematic review and a network meta-analysis

OBJECTIVES

A systematic review and a network meta-analysis were performed to answer the following research question: "Is there any light-activation protocol capable of improving color change efficacy when associated with an in-office bleaching gel in adults?"

MATERIAL AND METHODS

A search was performed in PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE without date and/or language restrictions in April 23, 2017 (updated on March 30, 2018). IADR abstracts (1990-2018), unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials conducted in adults that included at least one group treated with in-office dental bleaching with light activation were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A random-effects Bayesian-mixed treatment comparison (MTC) model was used to combine light-activated versus light-free in-office bleaching with direct light-free comparison trials. A meta-analysis with independent analysis (high- and low-concentrate hydrogen peroxide [HP]) was conducted for color change (∆E*, ∆SGU).

RESULTS

After the removal of duplicates, title, and abstract screening, 28 studies remained. Nine were considered to be at a low RoB, five were at a high RoB, and the remaining were at an unclear RoB. The MTC analysis showed no significant difference in color change (ΔE* and ΔSGU) between light-activation protocols and light-free in-office bleaching, regardless of the HP concentration in the efficacy of the bleaching.

CONCLUSION

No type of light-activated in-office bleaching was superior to light-free in-office bleaching for both high- and low-concentrate in-office bleaching gels (PROSPERO-CRD42017078743).

CLINICAL RELEVANCE

Although many times dental professionals use "laser whitening" as a form of marketing, this study confirmed that no type of light-activation for in-office bleaching can improve the bleaching efficacy.

Effects of High-Energy Curing Lights on Time-Dependent Temperature Changes of Pulp Space During Orthodontic Bonding

OBJECTIVE

The purpose of this study was to assess the temperature changes and cooling times during orthodontic bonding by a light-emitting diode (LED) and plasma arc lights (PAC) in different time and power modes with thermal imaging.

METHODS

A total of 100 human permanent upper first premolar teeth were included in the study. Five groups were conducted, 20 teeth each, and different energy outputs of curing lights were used for adhesive polymerization with different exposure times. The temperature changes in the pulp space and cooldown times were measured by a thermal imaging system. A paired t-test, analysis of variance (ANOVA), and Student-Newman-Keuls multiple comparison tests were used for data analysis.

RESULTS

A statistically significant temperature rise was detected with all curing lights (p<0.05). The greatest temperature changes were observed in the LED standard mode with 10 seconds of exposure time (6.66±1.98°C) and LED extra power mode with 6 seconds of exposure time (6.50±1.64°C) among groups, while using PAC for 3 seconds created the smallest temperature increase (1.81±0.99°C). An application of the LED extra power mode for 6 seconds exhibited the longest cooldown time (205.91±47.48 seconds), and the shortest cooldown time was detected as 71.30±43.15 seconds with the PAC 3-second application.

CONCLUSIONS

LED lights with an increased exposure time induced significant temperature rises, while no PAC light group exceeded the critical threshold value. The exposure time is more important than the energy output level of the light-curing system on temperature increments of the pulp chamber.

Clinical Study of Bleaching Gel Storage Temperature on Tooth Color and Sensitivity

OBJECTIVE

The objective of this triple-blind, split-mouth, randomized clinical trial was to evaluate the bleaching efficacy and tooth sensitivity of an in-office bleaching agent submitted to different storage temperatures (room temperature at 21.04°C±3.13°C or refrigeration at 5°C).

METHODS AND MATERIALS

Thirty volunteers were selected who had central incisors with color A2 or higher. The volunteers' maxillary hemi-arches received either the bleaching treatment with room temperature or refrigerated storage temperatures (two sessions of 3×15 minutes, one-week interval). Color variation was evaluated by subjective (Vita Classic and Vita Bleachedguide) and objective methods (Vita Easyshade spectrophotometer). Tooth sensitivity was evaluated with the visual analog scale (0-10) and the numerical rating scale (five points). The consistency of bleaching gels was evaluated by flow test, and pH was measured, both in triplicate. Color variation (SGU) and ΔE were analyzed by paired t-test (α=0.05). The absolute risk of pain was assessed by McNemar test (α=0.05), data from the numerical rating scale by the Wilcoxon signed-rank test (α=0.05), and visual analog scale by paired t-test. Comparison between the times within each group was analyzed by Friedman test. Gel consistency and pH were analyzed by one-way analysis of variance and Tukey post-test.

RESULTS

Regarding the absolute risk of tooth sensitivity, no significant difference was observed between the groups. The relative risk for tooth sensitivity was 1.13 (95%, confidence interval 0.70-1.82). Both tooth sensitivity scales were statistically similar. The results of the subjective evaluation (Vita Classic: p=0.73, Vita Bleachedguide: p=1.00) and the objective evaluation (p=1.00) of bleaching efficacy corresponded to the hypothesis of equality between groups after bleaching. Both pH values were around 7, and for the consistency test, there were significant differences between the groups (p=0.002).

CONCLUSIONS

Storage temperature of the analyzed in-office bleaching agent had no influence on tooth color effectiveness and tooth sensitivity.

Molecular damage and responses of oral keratinocyte to hydrogen peroxide

BACKGROUND

Hydrogen peroxide (H₂O₂)-based tooth bleaching reagents have recently increased in popularity and controversy. H₂O₂ gel (3%) is used in a Nightguard for vital bleaching; transient tooth sensitivity and oral mucosa irritation have been reported. Genotoxicity and carcinogenicity have also been significant concerns.

METHODS

We used primary cultured normal human oral keratinocytes (NHOKs) as an in vitro model to investigate the pathological effects to mitochondria functions on human oral keratinocytes exposed to different doses of H₂O₂ for different durations.

RESULTS

An MTT assay showed compromised cell viability at a dose over 5 mM. The treatments induced nuclear DNA damage, measured using a single-cell gel electrophoresis assay. A real-time quantitative polymerase chain reaction showed H₂O₂ induced significant increase in mitochondrial 4977-bp deletion. Mitochondrial membrane potential and apoptosis assays suggested that oxidative damage defense mechanisms were activated after prolonged exposure to H₂O₂. Reduced intracellular glutathione was an effective defense against oxidative damage from 5 mM of H₂O₂.

CONCLUSION

Our study suggests the importance for keratinocyte damage of the dose and the duration of the exposure to H₂O₂ in at-home-bleaching. A treatment dose ≥100 mM directly causes severe cytotoxicity with as little as 15 min of exposure.

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.

Evaluation of biochemical changes in dental tissues after different office bleaching methods

The color of the teeth is an important topic for many people and can be influenced by intrinsic and extrinsic stains. There is an increasing demand for whitening of the teeth year by year. The most popular way of whitening is "bleaching," which is the result of the breakdown of pigments located in the enamel and/or the dentin, caused by reactive oxygen species (ROS) released from bleaching agents. These bleaching agents could increase matrix metalloproteinase (MMP)-mediated collagen degradation in dentin. The aim of this study was to compare biochemical changes and oxidative stress levels of the human premolar dentin-pulp complex after three different bleaching methods containing hydrogen peroxide (H₂O₂) bleaching agents. Individuals, whose first four premolars were extracted for orthodontic purposes, included into the study. Group 1-Laser: bleaching gel containing 46% H₂O₂ (LaserWhite20 whitening gel, Biolase Technology Inc., San Clemente, CA, USA) and a diode laser activation (Ezlase 940 nm system). Group 2: 35% H₂O₂ containing whitening gel (Whiteness HP Maxx, FGM) and halogen light source activation (Optilux 501, Kerr, Orange, CA, USA). Group 3: 35% H₂O₂ containing whitening gel (Whiteness HP Maxx, FGM). Group 4-Control: No whitening treatment. According to the test results, there were no significant differences among groups in the values of cathepsin B and MMP proteolytic activities ( p > 0.05). The total ROS values released from the dentin tissue were higher than those obtained from the pulp tissue ( p < 0.05). There were significant differences among the bleaching groups in the ROS values released from the dentin tissue.

In vitro evaluation of visible light-activated titanium dioxide photocatalysis for in-office dental bleaching

The evaluation of the photocatalysis of visible light activated titanium dioxide employed in hydrogen peroxide (H₂O₂) was carried using seven H₂O₂ solutions (3.5 and 35%) and/or methylene blue (MB), with or without light irradiation (LI); the absorbance of MB was the bleaching indicator. Color analysis was performed on bovine teeth (n=12) using two different concentrations of H₂O₂, 6 and 35% associated with titanium dioxide (TiO₂). Data were analyzed with one and two-way ANOVA, and significance level of p<0.05. Solutions containing MB, H₂O₂ at 3.5 or 35%, and TiO₂, followed by LI, showed significant difference when compared with other groups. Greater MB reduction was found in 35% concentration. H₂O₂ 35%+TiO₂ gel showed no difference in comparison to control group. All groups for the color analysis assay showed ΔE higher than 3.3. In conclusion, TiO₂ and H₂O₂ association is a promisor alternative for reducing the clinical time of in-office dental bleaching.

Effect of lights with various wavelengths on bleaching by 30% hydrogen peroxide

The objective of this study was to evaluate the bleaching effect of light sources with various wavelengths using 30% hydrogen peroxide (HP) in vitro. The hematoporphyrin-stained paper was bleached with HP and irradiated for 10 min using LED light sources with 265, 310, 365, 405, or 450 nm respectively. In control group, HP was applied for 10 min without light irradiation. The bleaching procedure was repeated two times. The L*a*b* values of the samples before bleaching and after each bleaching step were measured using a colorimeter. Color changes of specimens were then calculated and statistically analyzed. There was an interaction between light sources and time of irradiation in the color change (p < 0.05). Time and light sources significantly affected ΔE and ΔL (p < 0.05). The light source of 256 nm showed the highest bleaching effect over time followed by that of 310 nm, which were statistically different from other groups (p < 0.001). The 365 nm, 450 nm groups, and control group showed low bleaching effect visually with no significant differences in ΔE and ΔL (p > 0.05). It was concluded that the wavelengths of the light sources affected the bleaching by HP. The 310-nm light can be a potential source for bleaching.

Effects of Amorphous Calcium Phosphate Administration on Dental Sensitivity during In-Office and At-Home Interventions

Background. Tooth bleaching is the most frequently employed whitening procedure in clinics. The major side effect of tooth bleaching is dental sensitivity during and after the treatment. Here, we evaluated whether the administration of amorphous calcium phosphate (ACP), during in-office and at-home procedures may impact on dental sensitivity. Methods. Eighty patients, responding to the study requirements were enrolled according to the following criteria. Group 1 (n = 40), received in-office, 10% ACP prior to 30% professional hydrogen peroxide application. The whitening procedure continued at home using 10% carbamide peroxide with 15% ACP for 15 days. Group 2 (n = 40) received only 30% hydrogen peroxide application and continued the whitening procedures at home, using 10% carbamide hydroxide, without ACP- Casein phosphopeptides (CPP), for 15 days. Dental sensitivity was recorded with a visual analogue scale (VAS) at baseline, immediately after, and at 15 days after treatment in the two groups. Results. We observed that patients receiving ACP in the bleaching mixture experienced decreased dental sensitivity (* p ≤ 0.05), as detected by VAS scale analysis immediately following the procedures. Patients receiving ACP-CPP during at-home procedures showed a statistically significant (*** p ≤ 0.0001) reduction of dental sensitivity. Conclusions. We demonstrated that ACP-CPP administration, while exerting the same whitening effects as in control subjects receiving potassium fluoride (PF), had an impact on the reduction of dental sensitivity, improving patient compliance.

Effect of sodium fluoride pretreatment on the efficacy of an in-office bleaching agent: An in vitro study

This in vitro study evaluated the effect of sodium fluoride (NaF) on the bleaching efficacy using an artificial discolored bovine tooth model. Twenty specimens were prepared from bovine teeth by staining with black tea extract and were divided into two groups (n = 10). In control group, specimens were immersed in distilled water for 30 min. In NaF group, specimens were applied with 0.2% NaF for 30 min. Then, the specimens in each group were bleached by an in-office bleaching material (Shofu Hi-Lite, Shofu, Kyoto, Japan). The CIE L*a*b* values were measured by a dental colorimeter before and after 10 consecutive bleaching treatments, and the color difference (ΔE) was calculated. Brightness and color difference (ΔE) increased in both groups per bleaching cycle. There were no statistical differences in ΔE values between both groups (p > 0.05). It was concluded that the application of NaF before bleaching did not interfere with the bleaching effect.

Comparison of Tooth Color Change After Bleaching With Conventional and Different Light-Activated Methods

Introduction: The demand for esthetic dental treatments is increasing in recent years mainly due to improved oral hygiene and better maintenance of oral health and teeth in older individuals. Bleaching of discolored anterior teeth is the most popular among esthetic dental treatments. Even individuals with sound teeth and adequate esthetics seek to have whiter teeth in the anterior region. The aim of this study was to evaluate tooth color changes following conventional in-office bleaching techniques compared to light-activated methods using different light sources. Methods: Seventy sound anterior teeth (devoided of caries and/or fracture), extracted for periodontal and orthodontic reasons were selected and allocated to 7 groups: (A) control, (B) conventional bleaching (C) LED-activated bleaching, (D) KTP laser-activated bleaching, (E) diode laser-activated bleaching, (F) Nd:YAG laser-activated bleaching and (G) CO2 laser-activated bleaching. Colorimetric evaluation was carried out before and after treatment using a spectrophotoradiometer. Data were analyzed by one- and two-way analysis of variance (ANOVA) as well as multiple comparison methods. Results: The results showed that all bleaching procedures were effective in reducing the yellowness index. However, the KTP laser-activated bleaching was significantly more effective than the other techniques in 95% confidence level. It was also seen that CO2 laser activated method has outperformed groups E, F and G and the conventional bleaching without light activation was not effective at all and represented similar results with the control group. Furthermore, the groups E and G had almost the same results in decreasing the yellowness index. Conclusion: The results showed that all bleaching techniques were effective however, the KTP laser-activated bleaching was significantly more efficient, closely followed by the CO2 laser-activated bleaching technique.

Hydrogen peroxide bleaching induces changes in the physical properties of dental restorative materials: Effects of study protocols

OBJECTIVE

The purpose of this study was to evaluate the influence of study protocols on the effects of bleaching on the surface roughness, substance loss, flexural strength (FS), flexural modulus (FM), Weibull parameters, and color of 7 restorative materials.

MATERIALS AND METHODS

The test materials included 4 composite resins, 1 glass-ionomer cement, 1 dental ceramic, and 1 polyacid-modified composite. The specimens were randomly divided into 4 groups (n = 20) according to different study protocols: a bleaching group at 25°C (group 25B), a bleaching group at 37°C (group 37B), a control group at 25°C (group 25C), and a control group at 37°C (group 37C). The specimens in the bleaching group were treated with 40% hydrogen peroxide for 80 min at the respective environmental temperatures. The surface roughness, substance loss, FS, FM, and color of the specimens were measured before and after treatment. FS data were also subjected to Weibull analysis, which was used to estimate of the Weibull modulus (m) and the characteristic strength (σ₀ ).

RESULTS

Surface roughness increased and significant color changes were observed for all tested specimens after bleaching treatment, except for the ceramic. After bleaching at 37°C, the polyacid-modified composite showed significantly reduced FS, FM, m, and σ₀ values in comparison to the control specimens stored at 37°C in whole saliva. Significant differences were also found between the 37B and 25B polyacid-modified composite groups in terms of surface roughness, FS, m, σ₀ , and color changes.

CONCLUSIONS

Varying effects of bleaching on the physical properties of dental restorative materials were observed, and the influences of the study protocols on bleaching effects were found to be material-dependent.

CLINICAL SIGNIFICANCE

The influence of study protocols on the effects of bleaching on the surface roughness, flexural properties, and color of dental restorative materials are material-dependent and should be considered when evaluating the effects of bleaching on dental restorative materials.

Influence of different types of light on the response of the pulp tissue in dental bleaching: a systematic review

OBJECTIVES

This systematic review (PROSPERO register: CRD42016053140) investigated the influence of different types of light on the pulp tissue during dental bleaching.

MATERIALS AND METHODS

Two independent authors conducted a systematic search and risk of bias evaluations. An electronic search was undertaken (PubMed/Medline, Embase, The Cochrane Library, and other databases) until May 2017. The population, intervention, comparison, outcomes (PICO) question was: "Does the light in dental bleaching change the response of the pulp to the bleaching procedure?" The intervention involved pulp tissue/cells after bleaching with light, while the comparison involved pulp tissue/cells after bleaching without light. The primary outcome was the inflammation/cytotoxicity observed in pulp after bleaching.

RESULTS

Out of 2210 articles found, 12 articles were included in the review; four were in vivo studies (one study in dogs/others in human), and eight were in vitro studies (cell culture/with artificial pulp chamber or not). The light source used was halogen, light-emitting diode (LED), and laser. Only one in vivo study that used heat to simulate light effects showed significant pulp inflammation. Only two in vitro studies demonstrated that light influenced cell metabolism; one using halogen light indicated negative effects, and the other using laser therapy indicated positive effects. Given that animal and in vitro studies have been identified, there remain some limitations for extrapolation to the human situation. Furthermore, different light parameters were used.

CONCLUSIONS

The effects of dental bleaching on the pulp are not influenced by different types of light, but different light parameters can influence these properties.

CLINICAL RELEVANCE

There is insufficient evidence about the influence of different types of light on inflammation/cytotoxicity of the pulp.

In Vitro Effect of Bleaching With 810 nm and 980 nm Diode Laser on Microhardness of Self-cure and Light-Cure Glass Ionomer Cements

Introduction: This study sought to assess the effect of bleaching combined with irradiation of 810 nm and 980 nm diode laser on microhardness of 2 commonly used self-cure and light-cure glass ionomer cements (GICs) in comparison with conventional bleaching (without laser). Methods: In this in vitro, experimental study, 60 samples were fabricated of A2 shade of Fuji IX and Fuji II LC GICs (n=30) and each group was divided into 3 subgroups (n=10). The first subgroups were subjected to bleaching with Opalescence Xtra Boost plus 980 nm diode laser irradiation. The second subgroups were subjected to bleaching with Opalescence Boost plus 810 nm diode laser irradiation and the third subgroups were subjected to bleaching with Opalescence Xtra Boost without laser. Microhardness was measured at baseline and after the intervention using Vickers hardness tester. The data were analyzed using two-way analysis of variance (ANOVA) (P<0.05). Results: Microhardness decreased in all subgroups after the intervention (P<0.001) irrespective of the type of GIC (P=0.201) or surface treatment (P=0.570). The baseline microhardness of the three subgroups within each group of GIC was not significantly different (P=0.456), but the baseline microhardness of conventional GIC was significantly higher than that of resin modified GIC (P=0.004). Conclusion: Bleaching with/without laser irradiation decreases the microhardness of GICs. The baseline microhardness of conventional GIC is higher than that of resin modified GIC.

Effect of Adhesive Restoration and Bleaching Technique on the Concentration of Hydrogen Peroxide In the Pulp Chamber

This study aimed to quantify the concentration of hydrogen peroxide into the pulp chamber in the presence or absence of adhesive enamel restorations and to analyze the resin-dentin interface of bleached groups. Bovine incisors (120) were randomly divided into three groups according to enamel treatment (n=40 each): (1) enamel without restoration (control); (2) enamel cavities (3 mm diameter × 1.5 mm depth) restored with a silorane-based (SB) system; or (3) enamel cavities (3 mm diameter × 1.5 mm depth) restored with a dimethacrylate-based (DB) system. Restorations were thermocycled, and all groups were submitted to one application of 35% hydrogen peroxide (HP) agent for 45 minutes and subjected to four light activation methods (n=10 each): without light, light-emitting diode (LED), LED/diode laser, or halogen light. Acetate buffer solution was placed into the pulp chamber before bleaching, and this solution was collected to spectrophotometrically determine the concentration of HP that reached the pulp chamber after bleaching. Rhodamine B was added to the HP agent and applied on additional enamel samples of each group for 24 hours. Samples were sectioned mesiodistally, and the bleaching agent was traced using confocal microscopy. According to two-way analysis of variance and Tukey test (α=0.05), the HP concentration in the pulp chamber of the control group was significantly lower than that of the SB group (p&lt;0.05), regardless of light activation. No differences were observed between DB and SB groups and between control and DB groups, except for the DB halogen light activated group, which exhibited higher HP intrapulpal concentration (p&lt;0.05). Confocal microscopy exhibited HP diffusion through the interface of the SB and DB restored groups as well as enamel prisms in the control group. The SB restorative system increased the HP diffusion into the pulp chamber, but HP was able to diffuse even in the absence of enamel restorations.

At-Home Bleaching: Color Alteration, Hydrogen Peroxide Diffusion and Cytotoxicity

This study evaluated the color change, cytotoxicity and hydrogen peroxide (HP) diffusion caused by different home bleaching protocols: 10% carbamide peroxide (CP) for 3 or 1.5 h, 6% hydrogen peroxide for 1.5 h or 45 min. To quantify the peroxide penetration, disks of bovine teeth were placed in artificial pulp chambers (APCs) containing acetate buffer, which was collected for evaluation in a spectrophotometer. For analysis of cytotoxicity, specimens were adapted in APCs containing culture medium, which subsequently was applied on MDPC-23 odontoblast-like cells for 1 h. Cellular metabolism was evaluated by methyl tetrazolium (MTT) assay and the color change of the specimens was analyzed using the CIE L * a * b * system. The data were submitted to ANOVA and Fisher test (α=5%). The treatment with 10% CP for 3 h was the most effective, and 6% HP for 45 min produced the lowest color change. The groups 10% CP for 1.5 h and 6% HP for 45 min had the lowest trans-enamel dentinal HP penetration, and the 6% HP for 1.5 h had the highest. None of the protocols affected cellular metabolism and morphology. In conclusion, reduced peroxide exposure time reduced the bleaching result; higher HP diffusion did not mean higher effectiveness.

Frequently Asked Questions about Vital Tooth Whitening

Improving patients’ aesthetics is an important request in daily practice. Tooth whitening is a treatment option available for improving aesthetics. This paper will pose questions asked by our patients on bleaching techniques and outcomes and offer appropriate up-to-date answers. Clinical relevance: This paper addresses the most important questions raised by patients and colleagues concerning vital tooth whitening (VTW).

Evaluation of pH Levels and Surface Roughness After Bleaching and Abrasion Tests of Eight Commercial Products

OBJECTIVE

This in vitro study evaluated the effect of different bleaching protocols and the variation of pH levels of bleaching gels regarding roughness and wear of bovine enamel, after in-office bleaching protocols and brushing.

MATERIALS AND METHODS

Ninety fragments were randomly divided into nine groups: C, control; WHP15, 35% hydrogen peroxide (HP) (Whiteness HP, FGM) three gel applications of 15 min each, three sessions with 1 week intervals; WHP45, 35% HP (Whiteness HP) one application/45 min, three sessions with 1 week intervals; LPS, 35% HP (Lase Peroxide, DMC) plus hybrid light (HL) [light-emitting diode (LED)/diode laser], four applications/7 min 30 sec (6 min of HL activation), one session; LPSII, 25% HP (Lase Peroxide II, DMC) plus HL, four applications/7 min 30 sec (6 min of HL activation), one session; LPL, 15% HP (Lase Peroxide Light, DMC) four applications/7 min 30 sec (6 min of HL activation), one session; WO, 35% HP (Whitegold Office, Dentsply) three applications/15 min, three sessions with 1 week intervals; WBC40, 35% HP (Whiteness HP Blue Calcium, FGM) one application/40 min, three sessions with 1 week intervals; and WBC50, 20% HP (Whiteness HP Blue Calcium) one application/50 min, three sessions with 1 week intervals. The median pH values were determined utilizing a pH meter during the initial and final gel applications. A rugosimeter was utilized to evaluate the surface roughness (Ra) before and after bleaching and brushing (100,000 strokes), and the surface wear after brushing.

RESULTS

For the results of the pH values, there was a decrease in the pH levels from the initial to the final bleaching time, except for the WBC50. The WO and WBC40 groups exhibited higher pH values. For the results of roughness and wear, there was an increase in surface roughness and wear among the groups.

CONCLUSIONS

The pH values tended to decrease from the initial to the final bleaching. After tooth brushing, bleaching procedures with lower pH products provided a significant increase in enamel wear and surface roughness.

Factors Affecting the Quality of Tooth Enamel for In Vivo EPR-Based Retrospective Biodosimetry

In vivo electron paramagnetic resonance biodosimetry on tooth enamel is likely to be an important technology for triage of overexposed individuals after a major radiological incident. The accuracy and robustness of the technique relies on various properties of the enamel such as the geometry of the tooth, the presence of restorations, whitening treatments or exposition to sunlight. Those factors are reviewed, and their influence on dosimetry specifically for triage purposes is discussed.

Peroxide dental bleaching via laser microchannels and tooth color measurements

The aim of this study was to use microchannels drilled by an Er:YAG laser into a human tooth through the enamel into the dentin for direct injection of hydrogen peroxide (HP) to produce a minimally invasive, rapid, tooth bleaching effect. The experiments were conducted in vitro. Five microchannels with a diameter of ?200???m and a depth of ?2??mm were drilled through the palatal side of a human tooth crown using the microbeam of an Er:YAG-laser with a wavelength of 2.94???m. After injection of an aqueous solution of 31%-HP through the microchannels, the tooth color was evaluated using a VITA shade guide and International Commission on Illumination L*ab color parameters. A tooth model used for the evaluation of the distribution of HP concentration was created and the amount of HP which can be injected into tooth dentin to bleach it safely was estimated. Injection of 1.5±0.1??mm3 of 31%-HP into the tooth led to noticeable bleaching within 3 h and significant improvement of tooth color within 24 h.