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

Indirect cytotoxicity of a 35% hydrogen peroxide bleaching gel on cultured odontoblast-like cells

The aim of this study was to evaluate the trans-enamel and trans-dentinal effects of a 35% hydrogen peroxide (H2O2) bleaching gel on odontoblast-like cells. Enamel/dentin discs obtained from bovine incisors were mounted in artificial pulp chambers (APCs). Three groups were formed: G1- 35% H2O2; G2- 35% H2O2 + halogen light application; G3- control. The treatments were repeated 5 times and the APCs were incubated for 12 h. Then, the extract was collected and applied for 24 h on the cells. Cell metabolism, total protein dosage and cell morphology were evaluated. Cell metabolism decreased by 62.09% and 61.83% in G1 and G2, respectively. The depression of cell metabolism was statistically significant when G1 and G2 were compared to G3. Total protein dosage decreased by 93.13% and 91.80% in G1 and G2, respectively. The cells in G1 and G2 exhibited significant morphological alterations after contact with the extracts. Regardless of halogen light application, the extracts caused significantly more intense cytopathic effects compared to the control group. After 5 consecutive applications of a 35% H2O2 bleaching agent, either catalyzed or not by halogen light, products of gel degradation were capable to diffuse through enamel and dentin causing toxic effects to the cells.

Clinical performance of vital bleaching techniques

This study compared the clinical outcome of bleaching techniques in vital teeth. After IRB approval and informed consent, 90 subjects were selected based on the shade of their anterior teeth (A2 or darker, Vita Classic shade guide). Subjects were assigned to three treatment groups in a split-mouth study design: Group I: HB (at-home bleaching with 10% carbamide peroxide for two weeks) vs OBL (in-office bleaching with 35% hydrogen peroxide, two sessions, two-week intervals, with light irradiation); Group II: OB (in-office bleaching without light irradiation) vs OBL; Group III: HB vs combination (one session plus HB). Color change and color rebound (deltaE) were measured for a 16-week period. Color measurements were carried out with both a spectrophotometer and a shade guide at baseline, 1, 2, 4, 8 and 16 weeks. Tooth sensitivity was evaluated using a VAS scale for 15 days. Both the Student's t-test and Tukey-Kramer test were used to analyze the results (p < 0.05). After one week, one session of OBL followed by HB resulted in lower color values, compared with the other bleaching methods. Group III resulted in the least shade values at one-week evaluation, when compared with the other bleaching methods. After two weeks, HE alone resulted in similar color changes as OB, OBL and OBL+HB. The use of light irradiation did not improve bleaching efficacy (OB = OBL). OBL and OB resulted in higher sensitivity rates than HB.

Effects of light sources and visible light-activated titanium dioxide photocatalyst on bleaching

The objective of this study was to evaluate, using methylene blue (MB), the effects of various light sources on the bleaching action of hydrogen peroxide (H(2)O(2)) with two titanium dioxide (TiO(2)) photocatalysts - an ultraviolet light-activated TiO(2) photocatalyst (UVTiO(2)) versus a visible light-activated TiO(2) photocatalyst (VL-TiO(2)). Five experimental solutions (VL-TiO(2)+H(2)O(2), UV-TiO(2)+H(2)O(2), H(2)O(2), VL-TiO(2), UV-TiO(2)) were prepared by mixing varying concentrations of H(2)O(2 )and/or TiO(2 )photocatalyst with MB solution. For H(2)O(2)-containing solutions (VL-TiO(2)+H(2)O(2), UV-TiO(2)+H(2)O(2), and H(2)O(2)), the concentration of H(2)O(2) was adjusted to 3.5%. For the four different light sources, low- and high-intensity halogen lamps and blue LED LCUs were used. All the experimental solutions were irradiated by each of the light sources for 7 minutes, and the absorbance at 660 nm was measured every 30 seconds to determine the concentration of MB as an indicator of the bleaching effect. On the interaction between the effects of light source and bleaching treatment, the high-intensity halogen with VL-TiO(2)+H(2)O(2) caused the most significant reduction in MB concentration. On the effect of light sources, the halogen lamps resulted in a greater bleaching effect than the blue LED LCUs.

In Situ Study of In-office Bleaching Procedures Using Light Sources on Human Enamel Microhardness

Regardless of the light sources used, the microhardness of human dental enamel did not present significant changes 14 days after in-office bleaching.

Clinical trial assessing light enhancement of in-office tooth whitening

OBJECTIVE

Evaluate a light-enhanced in-office tooth whitening system in order to assess tooth color and safety.

METHODS

Thirty-three adults were randomly assigned to one of three treatment groups. Professional treatment involved application of a 25% H(2)O(2) gel (Discus Dental ZOOM!) with light enhancement, H(2)O(2) gel alone, or the light alone with no peroxide. The 12 anterior teeth were treated three times for 20 minutes each. Efficacy was measured objectively as L*a*b* color change using digital images, tooth shade was measured, and safety was evaluated immediately after treatment and at posttreatment days 7 and 30.

RESULTS

After adjusting for baseline and age, immediate (end-of-treatment) means (SE) for Deltab* (yellowness) were -3.1 (0.25) for the gel + light, -2.0 (0.25) for the gel-only group, and -2.4 (0.25) for the light-only group. Significant (p < 0.05) color rebound was evident at posttreatment day 7. By day 30, adjusted means (SE)for Deltab* were -1.7 (0.20) for the gel + light group, -1.1 (0.20) for the gel-only group, and -0.5 (0.20) for the light-only group. Both peroxide groups differed significantly (p < 0.05) from light alone on Deltab* and DeltaL*. In the gel + light group, 91% of subjects experienced tooth sensitivity, the majority of which was moderate or severe. Adverse events were low in the light-only group.

CONCLUSION

Use of light enhancement for in-office whitening leads to immediate color change, after which there was significant color and shade rebound within 7 days as well as moderate-to-severe tooth sensitivity during and after treatment. CLINICAL SIGNIFICANCE Increased tooth sensitivity during treatment and appreciable short-term color rebound after treatment may impact the utility of in-office tooth whitening with peroxide and light as a stand-alone esthetic procedure. (J Esthet Restor Dent 21:336-347, 2009).

Effect of light-activated bleaching on the microleakage of Class V tooth-colored restorations

OBJECTIVE

In-office bleaching procedures utilizing highly concentrated 30%-35% hydrogen peroxide solutions or hydrogen peroxide releasing agents are used for tooth whitening. Some recommend that, to enhance the whitening process, light-activation of the bleaching agent should be performed. The current study evaluated the effect of plasma arc bleaching on the microleakage of Class V restorations restored with resin composite, compomer and resin-modified glass ionomer (RMGI).

MATERIALS AND METHODS

The buccal surfaces of 72 freshly extracted premolars were prepared with Class V cavities (4 x 2.5 x 1.5 mm) extended 1 mm apical to the CEJ. The prepared teethwere randomly divided into six groups. The cavities were restored with Single Bond and Z100 resin composite (Groups 1 and 2), Prompt L-Pop and F2000 compomer (Groups 3 and 4) and Vitremer RMGI (Groups 5 and 6), respectively. They were then thermocycled for 500 cycles. The samples from Groups 1, 3 and 5 were incubated at 37 degrees C and 100% humidity. Groups 2, 4 and 6 were bleached using in-office bleaching gel and the plasma arc bleaching unit, then incubated. All samples were sealed with nail varnish and immersed in 2% basic fuschin for 24 hours. The restorations were sectioned longitudinally and microleakage was evaluated using a scale ranging from 0 to 3. The data were analyzed using the Kruskal-Wallis test (alpha = 0.05).

RESULTS

No statistically significant differences between study groups were observed in both the enamel and dentinal margins (p > 0.05).

CONCLUSION

Plasma arc bleaching did not significantly affect the microleakage of existing tooth-colored restorations restored with Z100 resin composite, F2000 compomer and Vitremer RMGI.

In vitro evaluation of the effectiveness of bleaching agents activated by different light sources

PURPOSE

This study evaluated the efficacy of tooth whitening and color stability at different time periods after treatment.

MATERIALS AND METHODS

Blocks obtained from human molars were divided into 15 groups (n = 5) by bleaching agents: 35% hydrogen peroxide (Whiteness HP and Opalescence Xtra) and 37% carbamide peroxide (Whiteness Super); and light sources: halogen lamp and plasma arc lamp (bleach mode), LED/diode laser, argon laser, and no light source. The efficacy of bleaching was measured using a spectrophotometer. Six bleaching sessions were performed (times 1 to 6). The specimens were submitted to another reading 7, 15, and 30 days after the end of bleaching (times 7, 8, and 9). The results were submitted to ANOVA followed by Tukey test and polynomial regression (p < 0.05).

RESULTS

Carbamide peroxide significantly differed from hydrogen peroxide, presenting low reflectance values. Activated versus non-activated bleaching did not differ significantly for any gel tested, except for Whiteness HP activated by argon laser, which presented the lowest mean reflectance values. The results obtained with hydrogen peroxide revealed a decrease in reflectance values one month after the end of treatment. For carbamide peroxide, this decrease was not observed.

CONCLUSION

The halogen lamp presented the same or higher efficacy than non-activated bleaching, which had a longer gel contact period. When hydrogen peroxide was used, a decrease in reflectance values was observed 30 days after the end of bleaching.

In vitro efficacy and risk for adverse effects of light-assisted tooth bleaching

The use of optical radiation in the so-called light-assisted tooth bleaching procedures has been suggested to enhance the oxidizing effect of the bleaching agent, hydrogen peroxide. Documentation is scarce on the potential adverse effects of bleaching products and on optical exposure risks to eyes and skin. The efficacy of seven bleaching products with or without simultaneous use of seven different bleaching lamps was investigated using extracted human teeth. The bleaching effect was determined immediately after treatment and one week later. Tooth surfaces were examined for adverse alterations after bleaching using a scanning electron microscope. Source characteristics of eight lamps intended for tooth bleaching were determined. International guidelines on optical radiation were used to assess eye and skin exposure hazards due to UV and visible light emission from the lamps. Inspection of teeth one week after bleaching showed no difference in efficacy between teeth bleached with or without irradiation for any of the products. Scratches, probably from the cleaning procedure were frequently seen on bleached enamel irrespective of irradiation. Maximum permissible exposure time (t(max)) and threshold limit values were exceeded for about half the bleaching lamps investigated. One lamp exceeded t(max) even for reflected blue light within the treatment time. This lamp also exceeded t(max) values for UV exposure. The lamps were classified as "low risk" and as borderline to "moderate risk" according to a relevant lamp standard.

The efficacy of three different in-office bleaching systems and their effect on enamel microhardness

This in vitro study evaluated and compared the efficacy of three in-office bleaching systems and investigated their effect on enamel microhardness. Three groups of 12 teeth (third molars) each were bleached as follows: Group A: Opalescence Xtra Boost (38% HP), Group B: Easywhite Ready (30% HP) with plasma unit and Group C: Zoom2 system (25% HP with the Zoom2 unit). The teeth were stained with tea for 24 hours, followed by the appropriate bleaching procedure. Each bleaching cycle was conducted for 15 minutes. The bleaching procedure was repeated until a shade change of six tabs (VITA shade guide) was obtained. The shade of the teeth was evaluated before, immediately after bleaching and one month later, both visually and digitally. Additionally, the "change of shade tabs per minute" was calculated. For the digital evaluation, the photos were taken under the same circumstances and the L*a*b* values were calculated using Photoshop. Five additional enamel samples for each group were prepared, and Knoop microhardness was evaluated before and after 15 minutes of bleaching. According to the visual shade evaluation, the treatment cycles required to reach the defined level of bleaching were: 1.58 for Group A (23.7 minutes), 1.02 for Group B (16.2 minutes) and 1.25 for Group C (18.7 minutes). Immediately after bleaching, a significant difference was found between Groups A and B (p = 0.0094). However, one month after the bleaching procedure, no significant difference could be observed among the three groups. According to the digital evaluation, no significant differences were found among the three bleaching systems for each of the L*a*b* values and the three times tested (p > 0.05). No significant difference (p = 0.055) was noticed among the three groups regarding microhardness after bleaching.

Coronal resistance to fracture of endodontically treated teeth submitted to light-activated bleaching

OBJECTIVES

The aim of this study was to assess the fracture resistance of endodontically treated teeth submitted to bleaching with 38% hydrogen peroxide activated by light-emitting diode (LED)-laser system.

METHODS

Fifty maxillary incisors were endodontically treated, received a zinc phosphate barrier and were embedded in acrylic resin until cemento-enamel junction. The specimens were distributed into five groups (n=10) according to the number of bleaching sessions: GI, no treatment (control); GII, one session; GIII, two sessions; GIV, three sessions and GV, four sessions. The whitening gel was applied to the buccal surface of the tooth and inside the pulp chamber for three times in each session, followed by LED-laser activation. Specimens were submitted to the fracture resistance test (kN) and data were submitted to the Tukey-Kramer multiple comparisons test.

RESULTS

No significant difference (p>0.05) was found between GI (0.71+/-0.30) and GII (0.65+/-0.13), which presented the highest strength values to fracture. Groups III (0.35+/-0.17), IV (0.23+/-0.13) and V (0.38+/-0.15) showed lower resistance to fracture (p<0.01) when compared to GI and GII.

CONCLUSIONS

The fracture resistance of endodontically treated teeth decreased after two sessions of bleaching with 38% hydrogen peroxide activated by LED-laser system.

Frequency doubled neodymium:yttrium-aluminum-garnet and diode laser-activated power bleaching--pH, environmental scanning electron microscopy, and colorimetric in vitro evaluations

Corrosiveness of enamel surfaces of Smartbleach, Opus White, Opalescense Xtra Boost and a gel containing titanium dioxide (TiO(2)) particles, activated either by a frequency doubled neodymium: yttrium-aluminum-garnet (Nd:YAG) laser (532 nm) or a diode laser (810 nm) was evaluated by environmental scanning electron microscopy (ESEM). Changes in teeth color shades and the pH were also evaluated. Each bleaching agent was laser activated for 30 s and removed after 1 min or 10 min. This procedure was repeated up to four times, the bleaching agent receiving a maximum application time of 40 min, with total irradiation times of 0.5 min to 2 min of laser activation. The results of the pH measurements showed that only Smartbleach was in the alkaline pH range, whereas the other three were acidic. The surface effects were unrelated to the pH of the bleaching agents. With the exception of Opus White, no severe alterations on the enamel surface were detected. Although short application times were chosen, improved changes in brightness of up to ten steps on the Vitapan classical shade guide were detected.