Carbamide peroxide bleaching agents: effects on surface roughness of enamel, composite and porcelain

Effect of Bleaching Agents on Composite Resins with and without Bis-GMA: An In Vitro Study

The objective was to evaluate the change in color, hardness, and roughness produced by carbamide peroxide (CP) at two different concentrations on two resins. The 16% or 45% CP was applied to 66 resin discs with and without Bis-GMA. The color was measured with a spectrophotometer, and ΔEab and ΔE00 were calculated. Microhardness tester and SEM were used. In both composites, the a* and b* coordinates tended to be red and yellow, respectively, and were significant in the Bis-GMA group (p < 0.05). The ΔEab and ΔE00 were higher in the composite with Bis-GMA, regardless of the treatment received (p < 0.05). The microhardness was reduced in both composites regardless of the PC concentration compared to the control (p < 0.05). The 45% CP reduced the microhardness in the resin group with Bis-GMA compared to 16% CP (p < 0.001) but was not significant in the resin without Bis-GMA (p = 1). An increase in roughness was directly proportional to the concentration of CP, and it was more notable in the composite without Bis-GMA. The composite with Bis-GMA showed a greater tendency to darken than the one without Bis-GMA. The surface hardness of the composite was reduced in both composites and was not influenced by CP concentration in the composite without Bis-GMA. Bleaching is a common procedure nowadays. It is important to know how CP affects composites to establish a prognosis of the treatments in terms of color change, roughness, and hardness.

Effect of Bleaching on Resin-Infiltration-Masked Artificial White Spots In Vitro

Resin infiltration is an effective method to mask vestibular white spots. If needed, external bleaching is usually recommended before infiltration, whilst in clinical practice, this sequence may not always be feasible. This in vitro study evaluated the effect of bleaching after resin infiltration regarding surface roughness and color using bovine incisors. Unlike for the untreated specimens (control, n = 25), artificial caries lesions were created within the test group (n = 25) using a demineralization solution at 37 °C for five days (pH = 4.95). The lesions were subsequently infiltrated using a resin infiltrant (Icon, DMG, Hamburg, Germany), followed by polishing. Afterwards, all specimens were bleached with a 10% carbamide peroxide gel (Opalescence, Ultradent, South Jordan, UT, USA) for 8 h/day over a ten-day period. Between bleaching treatments, specimens were stored in an opaque container with moistened paper tissues at 37 °C. Surface roughness was measured using a profilometer, and color in the L*a*b* space was assessed spectrophotometrically before and after bleaching. Bleaching increased the L*-values of both infiltrated (mean ± SD; ΔL* = 3.52 ± 1.98) and untreated (control) specimens (ΔL* = 3.53 ± 2.30) without any significant difference between the groups (p = 0.983). Bleaching also induced a significant increase in the mean surface roughness of both infiltrated (p < 0.001) and untreated (p = 0.0134) teeth. In terms of clinical relevance; it can be concluded that bleaching resin-infiltrated enamel is as effective as bleaching sound enamel.

Tooth whitening: current status and prospects

As a safe, effective, economical, and convenient technique, tooth whitening is one of the most popular treatments for improving tooth discoloration. This review summarizes the theoretical and recent research developments in the classification and mechanisms of tooth discoloration, as well as the principles, agents, effects, and side effects of tooth whitening techniques. The aim is to provide a basis for the clinical treatment of tooth whitening techniques and to suggest possible new ideas for further research. The accepted mechanism of whitening is the redox reaction of oxides in the whitening reagent, and the whitening effect is remarkable. However, side effects such as tooth sensitivity and irritation of gum and other oral soft tissues can still occur. It is recommended that more monitoring be carried out in the clinic to monitor these side effects, and care should be taken to protect the soft tissues in the mouth during office whitening procedures. Furthermore, there is a need to develop new additives or natural whitening products to reduce the occurrence of side effects.

Synthesis, Characterization, and Investigation of Novel Ionic Liquid-Based Tooth Bleaching Gels: A Step towards Safer and Cost-Effective Cosmetic Dentistry

The objective of this study was to synthesize a novel choline hydroxide ionic liquid-based tooth bleaching gel. Ionic liquid-based gels were synthesized and characterized using FTIR along with pH testing. Tooth sample preparation was carried out in line with ISO 28399:2020. The effects of synthesized gels on tooth samples were tested. Tooth samples were stained and grouped into three experimental groups: EAI (22% choline hydroxide gel), EAII (44% choline hydroxide gel), and EB (choline citrate gel) and two control groups: CA (commercial at-home 16% carbamide peroxide gel) and CB (deionized water). The tooth color analysis, which included shade matching with the Vitapan shade guide (n = 2), and digital colorimetric analysis (n = 2) were evaluated. The surface characteristics and hardness were analyzed with 3D optical profilometry, Scanning Electron Microscopy (SEM), Energy Dispersive X-ray Spectroscopy (EDX), and Microhardness testing (n = 3), respectively. The tooth color analysis (Vitapan shade guide) revealed that all the tooth samples treated with synthesized choline citrate gel (EB) showed an A1 shade as compared to the other four groups, giving a range of shades. An analysis of the ΔE values from digital colorimetry; EAI, EAII, CA, and CB showed ΔE values in a range that was clinically perceptible at a glance. However, EB showed the highest value of ΔE. The mean microhardness values for the five groups showed that the effects of three experimental gels i.e., 44% choline hydroxide, 22% choline hydroxide, and choline citrate, on the microhardness of the tooth samples were similar to that of the positive control, which comprised commercial at-home 16% carbamide peroxide gel. SEM with EDX of three tested subgroups was closely related in surface profile, elemental composition, and Ca/P ratio. The roughness average values from optical profilometry of four tested subgroups lie within approximately a similar range, showing a statistically insignificant difference (p > 0.05) between the tested subgroups. The synthesized novel experimental tooth bleaching gels displayed similar tooth bleaching actions without any deleterious effects on the surface characteristics and microhardness of the treated tooth samples when compared with the commercial at-home tooth bleaching gel.

The effect of bleaching on surface roughness and gloss of different CAD/CAM ceramic and hybrid ceramic materials

OBJECTIVE

To assess the effect of bleaching on surface roughness and gloss of different CAD/CAM ceramic materials.

METHODS

The ceramic materials included IPS e.max CAD (lithium disilicate), VITA ENAMIC (polymer infiltrated ceramic), and Celtra Duo CAD (zirconia reinforced lithium silicate). Samples of each material were randomly divided into four groups (n = 10); a control group immersed in distilled water, the second and third groups were treated with 20% carbamide peroxide (20% CP) and 35% carbamide peroxide (35% CP) bleaching agents for 4 h/day and 60 min/day respectively for 7 days. The fourth group was treated with 40% hydrogen peroxide (40% HP) applied twice, each turn for 20 min. After treatment, the surface roughness (using 3D non-contact profilometry) and surface gloss were assessed followed by imaging with a scanning electron microscope. The data were analyzed using multiple linear regression and Kruskal-Wallis one-way ANOVA tests (α = 0.05).

RESULTS

The surface roughness (p = 0.157) and gloss (p = 0.073) of IPS e.max CAD were not significantly affected by the different bleaching treatments. Similarly, no significant effect on surface roughness (p = 0.162) and gloss (p = 0.965) were shown for Celtra Duo CAD. On the other hand, VITA ENAMIC was significantly affected when treated with 20% CP and 35% CP showing increased roughness (p = 0.001) and gloss (p = 0.008).

CONCLUSIONS

Home bleaching treatments (20% CP and 35% CP) significantly affected the surface roughness and gloss of VITA ENAMIC while IPS e.max CAD and Celtra Duo CAD were not affected by the different bleaching treatments.

Effectiveness and safety of bleaching agents on lithium disilicate glass ceramics

Background

Aesthetic expectations have increased the use of aesthetic materials in dentistry. Lithium disilicates are frequently used materials for these expectations. Bleaching is another method used to provide aesthetics. Bleaching processes on restorative materials are not fully known. This study investigated the effect of at-home and in-office bleaching methods on the color change, surface roughness, and topography of lithium disilicate glass-ceramic materials produced with two different techniques and subjected to different polishing procedures.

Methods

A total of 144 disc-shaped pressed and computer-aided design (CAD) lithium disilicate glass-ceramic specimens were randomly divided into four groups. Glazing and three different chair-side polishing procedures were performed. The specimens in each group were randomly divided into two groups and subjected to at-home and in-office bleaching processes (n=9). The home bleaching process was repeated with 16% carbamide peroxide agent for six hours for seven days, while the in-office bleaching process was applied with 40% hydrogen peroxide agent for two sessions of 20 minutes. After the bleaching processes, the final color and surface roughness experiments of the specimens were carried out, and the results were recorded. ANOVA and Tukey multiple comparison tests were used FOR the statistical analysis of the data (α=0.05).

Results

The material*polish*bleaching, polish*bleaching, material*bleaching, and material*polishing interactions were not statistically significant regarding color and roughness changes of both specimens (P>0.05).

Conclusion

Both bleaching processes can be safely applied to lithium disilicate glass-ceramic materials.

How home bleaching agents affect the color and translucency of CAD/CAM monolithic zirconia materials

To assess the effect of 10% carbamide peroxide (CP) and 6% hydrogen peroxide (HP) home bleaching agents on the translucency and color of monolithic zirconia. Ninety disc specimens were fabricated (diameter, 10 mm) from multi-layered (ML), ultra translucent multi-layered (UTML), and super translucent multi-layered (STML) zirconia blocks at three thicknesses (0.4,1,1.5 mm) (n=5). The samples were divided into two subgroups, which were treated with 6% HP (45 min per day) or 10% CP (8 h per day) for 14 days. The color of specimens was measured before bleaching (T0) and after bleaching on the third (T3), seventh (T7), and 14th (T14) day. Color (∆E) and translucency (TP) changes were calculated. The thickness varieties used in the samples and the bleaching agent types used created statistically significant differences only in TP and ∆E₀₀, respectively (p<0.05). Bleaching agents can affect TP and ∆E. Patients who have zirconia restorations should be careful when using home bleaching agents.

Efficiency of activated charcoal powder in stain removal and effect on surface roughness compared to whitening toothpaste in resin composite: In vitro study

Objectives

To evaluate the efficacy of activated charcoal powder on extrinsic stain removal and its effect on surface roughness in stained resin composite in comparison with whitening toothpaste.

Materials and methods

Sixty-six disk-shaped composite specimens were fabricated using a custom-made ring mold. The specimens were stained using a coffee solution and stored in distilled water at 37 °C. The specimens were divided randomly into two groups, Group 1: Thirty-Three disks were subjected to brushing using whitening toothpaste (Control), and Group 2: Thirty-Three disks were subjected to brushing using charcoal powder. Specimens were evaluated for surface color and surface roughness at baseline after staining protocol and after the brushing process.

Results

Changes in color and surface roughness were highly significant (p < 0.0001) after brushing with activated charcoal powder and whitening toothpaste. However, no significant differences were found in color (p = 0.90) and surface roughness (p = 0.33) between the two bleaching techniques.

Conclusion

The changes in the color and surface roughness of resin composite was significant after brushing with activated charcoal powder and whitening toothpaste. However, there were no significant differences between the two techniques.

The Effects of a coffee beverage and whitening systems on surface roughness and gloss of CAD/CAM lithium disilicate glass ceramics

OBJECTIVES

To investigate the effects of a coffee beverage and two whitening systems on the surface roughness and gloss of glazed Lithium Disilicate Glass-Ceramics (LDGC) for computer-aided design/computer-aided manufacturing (CAD/CAM) systems.

METHODS

Sixty-eight LDGC disks (12 × 10 × 2 mm) were prepared from blocks of CAD/CAM systems (IPS e.max CAD ceramic). Baseline measurements for surface roughness (Ra) and gloss (GU) were taken using a 3-D optical profilometer and a glossmeter, respectively; then specimens were randomized into four groups (n = 17). All specimens were immersed in a coffee solution (24 h × 12 days) then subjected to two whitening systems. G1-negative control (kept moist × 7 days); G2-positive control (brushed with distilled water, 200 g/load, 2 min twice daily × 7 days); G3-whitening toothpaste (Colgate optic white; relative dentin abrasivity (RDA) = 100, 200 g/load, 2 min twice daily × 7 days); and G4-simulated at-home bleaching protocol (Opalescence,15% carbamide peroxide (CP), 6 h/day × 7 days). The study outcomes were measured at baseline and after the treatments. Data were analyzed using paired T-test and one-way ANOVA (α = 0.05).

RESULTS

The mean surface roughness significantly increased (p ⩽ 0.002) for all groups after the designated treatment protocols. Among groups, the mean surface roughness of G2 and G3 were significantly higher (p ⩽ 0.001) (Ra: 0.51 and 0.57 μm, respectively) compared to the control group (Ra: 0.23 μm), and were not significantly different from G4 (Ra: 0.46 μm). Surface gloss decreased with no significant change within or among groups after treatment.

CONCLUSION

All glazed LDGC had a significant increase in surface roughness after being subjected to simulated 1 year of coffee drinking and whitening systems (15% CP and whitening toothpaste), and the greatest change was associated with brushing (simulating 8 months). However, coffee beverages and whitening systems had no significant effect on the surface gloss.

Effect of In-office Bleaching on Color, Translucency, and Whiteness Variations in CAD-CAM Monolithic Materials

Little is known about the impact of bleaching on the optical properties of computer-aided design and computer-aided manufactured (CAD-CAM) monolithic materials. The aim of the present study was to evaluate the effect of one session of in-office bleaching on stain removal, staining susceptibility, translucency, and whiteness variations of CAD-CAM monolithic materials. Disks were fabricated from Lava Ultimate (LU), Vita Enamic (VE), Vita Suprinity (VS), and IPS e.max CAD (IPS). A spectrophotometer was used to register Commission Internationale de l'Eclairage L*a*b* coordinates. For stain removal, 80 specimens from each material were assessed at baseline (R0) and after immersion in deionized water or coffee for 36.5 days followed or not by bleaching with 40% hydrogen peroxide (R1). For staining susceptibility, 80 specimens from each material were analyzed at baseline (R0'), and after having been bleached or not and immersed in deionized water or coffee (R1'). Both analyses were calculated as the color difference (ΔE00) between R1-R0 and R1'-R0', respectively. Differences in translucency (ΔTP00) and whiteness (ΔWID) between R1-R0 and R1'-R0' were also calculated. Data were analyzed by three-way ANOVA and the Games-Howell post hoc test (α=0.05). Clinical significance was based on 50%:50% perceptibility and acceptability thresholds for ΔE00, ΔTP00 and ΔWID, respectively. Surfaces were analyzed by scanning electron microscopy. Coffee increased ΔE00 in LU, VE, and VS, and decreased their translucency and whiteness, whereas the IPS had only its whiteness affected. Bleaching after immersion in coffee decreased ΔE00 in LU and VE, and increased translucency and whiteness of LU, VE, and VS. No effect was observed on IPS. Bleaching before immersion in coffee decreased translucency of LU, but within the acceptable interval, while VE exhibited lower ΔE00, and became more translucent and less dark. Both VS and IPS were not affected. One session of in-office bleaching benefited optical properties of the previously stained LU, VE, and VS, without increasing their susceptibility to staining or adversely providing clinically unacceptable variations in their translucency and whiteness. All variations exhibited by the IPS were below the perceptible threshold.

The effect of bleaching on the optical and physical properties of externally stained monolithic zirconia

Objective

This study aimed to investigate the effects of bleaching on the color, translucency, surface roughness, and surface hardness of monolithic zirconia with external stainin .

Methods

In this experimental study, 32 specimens of monolithic zirconia (1 × 1 mm; shade A2) were divided into two groups based on random permuted blocks. Overglaze and staining procedures were performed with a yellow stain or a value stain (GC Stain). Baseline color, translucency, roughness, and surface hardness were measured. The specimens were then randomly bleached with hydrogen peroxide (HP) 40% (20 min, twice with a 1‐week interval in between) as office bleaching or carbamide peroxide (CP) 20% (4 h per day for 14 days) as home bleaching. Finally, the color, translucency, surface roughness, and surface hardness were measured again.

Results

Bleaching with CP and HP caused a perceptible change in the color of the specimens (ΔE > 2), although this change was within the clinically acceptable range (ΔE < 3.3). HP significantly reduced the surface hardness of the specimens (p = 0.043). Changes in surface roughness of the specimens were neither statistically nor clinically significant (p = 0.19 and p = 0.25 for office and home bleaching, respectively).

Conclusion

The effects of home and office bleaching on the surface characteristics of monolithic zirconia were almost the same. It is not necessary to exchange or even to polish the surfaces of zirconia restorations after exposure to bleaching agents. Further studies are recommended to confirm the color stability of externally stained monolithic zirconia.

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.

Do bleaching gels affect the stability of the masking and caries-arresting effects of caries infiltration-in vitro

Objectives

The aim of this study was to evaluate the influence of different bleaching gels on the masking and caries-arresting effects of infiltrated and non-infiltrated stained artificial enamel caries lesions.

Materials and methods

Bovine enamel specimens (n = 240) with each two sound areas (SI and SC) and each two lesions (DI and DC) were infiltrated (DI and SI), stained (1:1 red wine-coffee mixture,70 days), and randomly distributed in six groups to be bleached with the following materials: 6%HP (HP-6), 16%CP (CP-16), 35%HP (HP-35), 40%HP (HP-40), and no bleaching (NBl,NBl-NBr). Subsequently, specimens were pH-cycled (28 days, 6 × 60 min demineralization/day) and all groups except NBl-NBr were brushed with toothpaste slurry (1.100 ppm, 2×/day, 10 s). Differences in colorimetric values (ΔL, ΔE) and integrated mineral loss (ΔΔZ) between baseline, infiltration, staining, bleaching, and pH cycling were calculated using photographic and transversal microradiographic images.

Results

At baseline, significant visible color differences between DI and SC were observed (ΔE_baseline = 12.2; p < 0.001; ANCOVA). After infiltration, these differences decreased significantly (ΔE_infiltration = 3.8; p < 0.001). Staining decreased and bleaching increased ΔL values significantly (p ≤ 0.001). No significant difference in ΔΔE was observed between before staining and after bleaching (ΔE_bleaching = 4.3; p = 0.308) and between the bleaching agents (p = 1.000; ANCOVA). pH-cycling did not affect colorimetric values (ΔE_pH-cycling = 4.0; p = 1.000). For DI, no significant change in ΔZ during in vitro period was observed (p ≥ 0.063; paired t test).

Conclusions

Under the conditions chosen, the tested materials could satisfactorily bleach infiltrated and non-infiltrated stained enamel. Furthermore, bleaching did not affect the caries-arresting effect of the infiltration.

Clinical relevance

The present study indicates that bleaching is a viable way to satisfactorily recover the appearance of discolored sound enamel and infiltrated lesions.

Effect of home and in-office bleaching systems on the nanomechanical properties of tooth enamel

Objectives

The purpose of this in vitro laboratory study was to gauge the nanomechanical properties of the tooth enamel surface using home and in-office bleaching products.

Methods

Thirty-six extracted lower lateral incisor teeth (sound and without caries, cracks or restorations) were selected. A silicone mould was used to affix the samples in resin after cutting away the roots. Next, the samples were indiscriminately divided into three treatment groups, i.e., 12 teeth in each study group (control, Opalescence Home, and Opalescence Boost), and treated according to their respective group procedures. Surface topography, nano-indentation, and visual analyses were performed. Data were examined statistically using one-way analysis of variance (p < 0.05).

Results

Both experimental bleaching products enhanced the surface roughness when compared to the samples in the control group. However, the control and Opalescence Boost groups showed insignificant differences. The lowest mean nanohardness (GPa) was observed in the Opalescence Boost group (1.56 GPa ± 0.68 GPa). In contrast, the highest mean nanohardness (GPa) was perceived in the control group (3.53 GPa ± 1.06 GPa). The modulus of elasticity was highly affected using Opalescence Boost (182.63 GPa ± 109.13 GPa) when compared to Control (322.69 GPa ± 168.24 GPa). On visual examination, pronounced roughness was observed in both the Opalescence Home and Opalescence Boost groups.

Conclusion

Both teeth whitening products damaged the enamel surface either by roughening the tooth surface or by affecting the nanomechanical properties. Therefore, teeth whitening products may be used, but with great caution.

Bleaching Stained Arrested Caries Lesions: In vivo Clinical Study

Objective  Conservative approaches to esthetically treat stained arrested caries lesions (s-ACLs) have not been explored in clinical studies. This study aims to investigate the efficacy of in-office dental bleaching agent, as a conservative approach, to esthetically treat s-ACLs.

Materials and Methods  Twelve patients ( n = 46) presented with s-ACLs were treated with 40% hydrogen peroxide (in-office bleaching protocol; 20 minutes × 3). Color values were measured using a spectrophotometer (CIE L*a*b*), aided with digital photography to assess visual color change clinically. Measurements were taken for each specimen at baseline and immediately after bleaching.

Statistical Analysis  The color change calculated before and after bleaching for each dental substrate was analyzed using paired t -test (α = 0.05).

Results  The bleached s-ACLs had a significant increase in L * values ( p < 0.001), and a significant decrease in both a * ( p = 0.001) and b * ( p = 0.007) values, indicating lighter color improvement (bleaching efficacy). The baseline mean of L *, a *, and b * values were 61.5, 2, and 15.4, respectively, and after bleaching were 67.7, 1.4, and 13.3, respectively, with a mean increase in ∆ E of >7.9, which resulted in a visible clinical stain improvement as orange/light brown stains were removed completely, while gray/black stains improved to a lesser extent.

Conclusion  Significant color improvement was observed when the in-office bleaching protocol (40% hydrogen peroxide) was used in orange/brown s-ACLs. However, it showed lesser improvement in gray/black s-ACLs.

Color stability, Roughness, and Microhardness of Enamel and Composites Submitted to Staining/Bleaching Cycles

Objective

To compare the effect of two bleaching systems (bleaching gel and whitening strips) on the color change, roughness, and microhardness of enamel and two resin composites.

Material and methods

Two cavities were prepared on bovine enamel specimens (n = 16) and restored with two composites: a nano-hybrid [Herculite Ultra (HU)] and a micro-hybrid composite [TPH Spectra (TS)]. Baseline color (CIE L*a*b*), roughness (μm), and microhardness (kgf/mm²) were measured using a spectrophotometer, optical profilometer, and Vickers microhardness (VHN) tester, respectively. The specimens were stained with coffee for 14 days, and randomized into two bleaching groups: gel and strips (n = 8), then submitted to a 10-day bleaching/staining test. Color, roughness, and microhardness were re-measured. The outcomes were analyzed using two-way ANOVA and Fisher’s-PLSD test (α = 0.05).

Results

Gel significantly improved the color (ΔE 4.9–8.3) and increased the roughness (Ra 0.04–0.08 μm) of all substrates (p < 0.0001) compared to strips. Enamel color was significantly improved (ΔE 5.4–8.3) compared to that of HU (ΔE 2.6–4.9) and TS (ΔE 2.0–4.9) with either gels or strips. TS roughness (0.03–0.08 μm) was significantly higher than that of enamel (0.01–0.05 μm) and HU (0.02–0.04 μm). Enamel had significantly reduced microhardness compared to HU (p = 0.0144).

Conclusion

Gels produced the greatest color improvement and roughness compared to strips. Enamel had significant color improvement but had the greatest decrease in microhardness.

Clinical significance

There was unacceptable color change between enamel and the composites after the combined cyclic effects of staining and bleaching.

Effect of dental bleaching on the microhardness and surface roughness of sealed composite resins

Objectives

The aim of this in vitro study was to evaluate the microhardness and surface roughness of composite resins before and after tooth bleaching procedures.

Materials and Methods

Sixty specimens were prepared of each composite resin (Filtek Supreme XT and Opallis), and BisCover LV surface sealant was applied to half of the specimens. Thirty enamel samples were obtained from the buccal and lingual surfaces of human molars for use as the control group. The surface roughness and microhardness were measured before and after bleaching procedures with 35% hydrogen peroxide or 16% carbamide (n = 10). Data were analyzed using 1-way analysis of variance and the Fisher test (α = 0.05).

Results

Neither hydrogen peroxide nor carbamide peroxide treatment significantly altered the hardness of the composite resins, regardless of surface sealant application; however, both treatments significantly decreased the hardness of the tooth samples (p < 0.05). The bleaching did not cause any change in surface roughness, with the exception of the unsealed Opallis composite resin and dental enamel, both of which displayed an increase in surface roughness after bleaching with carbamide peroxide (p < 0.05).

Conclusions

The microhardness and surface roughness of enamel and Opallis composite resin were influenced by bleaching procedures.

Effects of 16% Carbamide Peroxide Bleaching on the Surface Properties of Glazed Glassy Matrix Ceramics

Objective

To determine the influence of the home bleaching agent, Opalescence PF, on the surface roughness and microhardness of glazed glassy matrix CAD-CAM ceramics. Materials and Methods. The 28 sintered leucite- and lithium disilicate-reinforced ceramic specimens (IPS Empress CAD and IPS e.max CAD) were divided into control and bleached groups. The home bleaching agent was applied to specimens of bleached groups for 7 days. The surface roughness and microhardness of all specimens were measured. A scanning electron microscope was used to evaluate the surface properties. The data were statistically analyzed by two-way ANOVA.

Results

The control e.max CAD showed the lowest surface roughness values. For both Empress and e.max CAD, surface roughness was significantly higher for the bleached group (p < 0.05). No significant differences in microhardness were observed.

Conclusions

According to our study, patients should be careful when using home bleaching agents because whitening agents can affect the mechanical properties of full ceramic restorations like e.max CAD and Empress CAD. Ceramic polishing may be required in clinical situations where ceramic restorations are accidentally exposed to bleaching gels.

Nonprescription Bleaching versus Home Bleaching with Professional Prescriptions: Which One is Safer? A Comprehensive Review of Color Changes and Their Side Effects on Human Enamel

OBJECTIVES

 This study evaluates the efficacy and safety of the professionally prescribed and nonprescription over-the-counter (OTC) bleaching agents.

MATERIALS AND

METHODS:  Extracted human upper central incisors were prepared and stained with red wine for 14 days before being subjected to four different bleaching agents: professionally prescribed opalescence PF 15%, VOCO Perfect Bleach 10%, nonprescription OTC Crest 3D Whitestrips, and Whitelight Teeth Whitening System. Colorimetric measurement was performed with Vita Easyshade Handheld Spectrophotometer, enamel surface microhardness measured using Vickers Hardness machine, and surface roughness was evaluated with profilometer, before and after bleaching. Scanning electron microscope (SEM) evaluation and atomic force microscopy were conducted postbleaching.

STATISTICAL ANALYSIS

 The data were analyzed with t-test, two-way ANOVA, one-way ANOVA, and Turkey's test at a significance level of 5%.

RESULTS

 All bleaching products have the same efficacy to whiten stained enamel. Opalescence PF 15% showed significant increase in the microhardness (92.69 ± 68.316). All groups demonstrated significant increase in surface roughness (p < 0.05). SEM evaluation showed that Opalescence PF 15% resulted in same microscopic appearance as unbleached enamel, while VOCO Perfect Bleach 10%, Whitelight Teeth Whitening System and Crest 3D Whitestrips demonstrated mild to moderate irregularities and accentuated irregularities, respectively.

CONCLUSION

 Professionally prescribed bleaching agent of Opalescence PF 15% is effective tin whitening the teeth, while the other bleaching products may be effective but also have deleterious effects on the enamel.

In vivo and in vitro assessment of the bleaching effectiveness of a brush-off patch containing 3.0% hydrogen peroxide

OBJECTIVES

To evaluate the efficacy of a brush-off patch containing 3.0% hydrogen peroxide, which is a new over-the-counter (OTC) product for tooth whitening, and determine the optimal protocol for use.

MATERIALS AND METHODS

We performed an in vitro study using hydroxyapatite specimens and a clinical trial involving 140 volunteers. The brush-off patch was applied to the specimens (in vitro) or the maxillary anterior teeth (in vivo; 14 days) for 10 min twice daily (case 10 group) or 30 min once daily (case 30 group). We also included control groups in both experiments. Lightness (L*), redness (a*), and yellowness (b*) values were measured using a colorimeter. In the in vivo study, color changes were measured at baseline and 7 and 14 days after the start of patch application. The overall color change (ΔE) was statistically analyzed.

RESULTS

In the in vitro study, the color change (ΔE*) after the experiment was significantly different between the two case groups and the control group (p < 0.001). In the in vivo study, the case groups showed color changes at both 7 and 14 days after patch application. In particular, the change in the case 30 group was significantly more prominent on day 14 than on day 7 (p < 0.05).

CONCLUSION

Our findings suggest that brush-off patches containing 3.0% hydrogen peroxide are effective OTC products for tooth whitening.

CLINICAL RELEVANCE

For best results, brush-off patches containing 3.0% hydrogen peroxide can be applied once daily for 30 min.

Influences of Light-emitting Diode Illumination Bleaching Technique on Nanohardness of Computer-aided Design and Computer-aided Manufacturing Ceramic Restorative Materials

AIM

This study evaluated the effect of light-emitting diode (LED) illumination bleaching technique on the surface nanohardness of various computer-aided design and computer-aided manufacturing (CAD/CAM) ceramic materials.

MATERIALS AND METHODS

Twenty disk-shaped samples (width, length, and thickness = 10, 15, and 2 mm) were prepared from each of the ceramic materials for CAD/CAM, including Lava™ Ultimate (L_V), Vita Enamic® (E_n) IPS e.max® CAD (M_e), inCoris® TZI (I_C), and Prettau® zirconia (P_r). The samples from each type of ceramic were randomly divided into two groups based on the different bleaching techniques to be used on them, using 35% hydrogen peroxide with and without LED illumination. The ceramic disk samples were bleached according to the manufacturer's instruction. Surface hardness test was performed before and after bleaching using nanohardness tester with a Berkovich diamond indenter.

RESULTS

The respective Vickers hardness number upon no bleaching and bleaching without or with LED illumination [mean ± standard deviation (SD)] for each type of ceramic were as follows: 102.52 ± 2.09, 101.04 ± 1.18, and 98.17 ± 1.15 for L_V groups; 274.96 ± 5.41, 271.29 ± 5.94, and 268.20 ± 7.02 for E_n groups; 640.74 ± 31.02, 631.70 ± 22.38, and 582.32 ± 33.88 for M_e groups; 1,442.09 ± 35.07, 1,431.32 ± 28.80, and 1,336.51 ± 34.03 for I_C groups; and 1,383.82 ± 33.87, 1,343.51 ± 38.75, and 1,295.96 ± 31.29 for P_r groups. The results indicated surface hardness reduction following the bleaching procedure of varying degrees for different ceramic materials. Analysis of variance (ANOVA) revealed a significant reduction in surface hardness due to the effect of bleaching technique, ceramic material, and the interaction between bleaching technique and ceramic material (p < 0.05).

CONCLUSION

Bleaching resulted in a diminution of the surface hardness of dental ceramic for CAD/CAM. Using 35% hydrogen peroxide bleaching agent with LED illumination exhibited more reduction in surface hardness of dental ceramic than what was observed without LED illumination.

CLINICAL SIGNIFICANCE

Clinicians should consider protection of the existing restoration while bleaching.

Effect of different concentrations of carbamide peroxide on the staining susceptibility of resin composites

Context:

Bleaching can affect the surface properties of resin composites.

Aims:

The aim of this study was to evaluate the effect of three regimens of carbamide peroxide (CP) on staining susceptibility of silorane and methacrylate-based resin composites.

Methods:

In this study, 80 composite disks were prepared from A2 shade of P90 and Z250 composite resins (40 each). Samples were divided into three test groups based on the CP concentration (10%, 16%, and 22%) and bleached for 14 days. Controls were kept in distilled water. Then, specimens were immersed in a tea solution for 14 consecutive days. A spectrophotometer was used to measure the specimen colors in CIE L*a*b system, initially and after staining. Data were analyzed using SPSS 16 software using two-way ANOVA, t-test, and Tukey honestly significant difference tests at α = 0.05.

Results:

The color susceptibility of Z250 samples were significantly affected in groups bleached with 22% CP compared to the controls (P = 0.001). The different concentrations of CP did not affect the staining susceptibility of the P90 samples (P > 0.05).

Conclusions:

Bleaching of the tested resin composites did not increase their susceptibility to extrinsic staining in vitro except for the Z250 samples bleached with 22% CP.

Effects of three different bleaching agents on microhardness and roughness of composite sample surfaces finished with different polishing techniques

Background

The aim of this study was to evaluate effects of different polishing methods and whitening agents on surface hardness and roughness of nano-hybrid composite resin.

Material and Methods

In total, one hundred twenty disc-shaped specimens were prepared to nano-hybrid composite (Charisma Diamond). 60 samples were used for microhardness measurements and the others were used for the evaluation of surface roughness. Samples were divided randomly into two subgroups (n = 30 each). In first group a low-viscosity liquid polishing agent (Biscover LV) was applied. In the second group, nothing was applied. All the samples were stored in distilled water at 37°C for 24 h. After initial measurements were completed, samples were divided randomly into three subgroups for bleaching application. 10% carbamide peroxide (Opalescence PF), 45% carbamide peroxide (Opalescence PF Quick), 38% hydrogen peroxide (Opalescence Boost) was applied. Then microhardness and surface roughness measurements of samples were repeated and data were recorded as final values for each sample.

Results

When the polishing techniques were compared, no signicant difference was observed in surface hardness and roughness. When the bleaching agents were compared, the 10% carbamide peroxide and 38% hydrogen peroxide containing bleaching agent groups showed statistically significant differences between pre- and post-procedure hardness values (p<0.05).

Conclusions

Office-type bleaching agent containing CP was observed to be more secure for composite resins than other bleaching agents. No negative effect of glaze materials on the protection of surface roughness and hardness of composite resin was observed.

Key words:Composite resin, bleaching, surface hardness, surface roughness.

Evaluation of physical properties of a nanocomposite after aging, bleaching and staining

PURPOSE

The objective of the in vitro study was to assess the effect accelerated artificial aging, bleaching agents and coffee staining on the color, gloss, roughness and microhardness of a nanocomposite.

MATERIALS AND METHODS

120 (7 × 2 mm) were prepared and randomly divided into 2 groups (n = 60) depending on the aging. Each group was further subdivided into 6 subgroups (n = 10) according to the bleaching and staining as follows: 10% carbamide peroxide (10% CP), 10% CP + staining, 35% hydrogen peroxide (35% HP), 35% HP + staining, without bleaching treatment (WB) and WB + staining. Scanning electron microscopy was performed for qualitative analysis of the resin surface. Data were submitted to 3-way analysis of variance (ANOVA) and Tukey's test for multiple comparisons. As for ∆E, multiple comparisons were performed by using Tukey's and Dunnett's tests (α = 0.05).

RESULTS

The bleaching reduced significantly the microhardness of the nanocomposite in without aging groups. All physical properties were found to be negatively changed after the aging process, with bleaching treatment with 10% CP increasing significantly the roughness and loss of gloss compared to the 35% HP. Staining reduced microhardness of both with and without aging nanocomposite as well as the color of the former (E&gt;25), a significantly different result compared to controls.

CONCLUSIONS

The bleaching reduced the microhardness of the nanocomposite, whereas the aging process changed all the properties studied. The bleaching favored extrinsic staining of the with aging nanocomposite.

Effects of staining and bleaching on a nanohybrid composite with or without surface sealant

OBJECTIVE

The effect of different staining solutions and a bleaching procedure on color stability and surface roughness of a nanohybrid resin composite were evaluated with or without liquid resin polishing (RP).

MATERIALS AND METHODS

Ninety-six disc-shaped resin composite specimens (A1 Shade, Z550 Filtek 3M ESPE, St. Paul, MN, USA) were prepared and divided randomly into two groups (n = 48). Liquid RP (BisCover LV, Bisco Inc., Schaumburg, IL, USA) was applied in one group (RP) and not in the other (P). Specimen color and surface roughness were determined using a colorimeter and profilometer, respectively. After baseline measurements, each group was divided into four subgroups (n = 12) for immersion in a control (distilled water) or three different staining solutions (ice tea, red wine, and cola) for 1 week. Color and surface roughness were then reevaluated. After measurements, all specimens were bleached using a 35% hydrogen peroxide gel. The color and surface roughness of the specimens were reevaluated.

STATISTICAL ANALYSIS

Data were subjected to an analysis of variance for repeated measurements among the groups (P < 0.05).

RESULTS

Staining and bleaching did not change the surface roughness of the RP and P groups (P > 0.05). Discoloration in the red wine group was higher than for the other staining solutions for the RP (P < 0.001) and P groups (P = 0.018).

CONCLUSION

Application of liquid RP did not enhance the color stability and surface roughness of the composite resin restoration.

In vitro evaluation of the effect of different polishing techniques on the surface roughness of composite resins submitted to at-home and in-office bleaching procedures

Objective:

Bleaching agents may affect the properties of dental materials. The aim of this study was to evaluate the effect of different polishing techniques on the surface roughness of composite resins submitted to the at-home and in-office bleaching treatment.

Materials and Methods:

Disc-shaped specimens were carried out of nanofilled and microhybrid composites (n = 10). Finishing step was performed after light curing (L1) and polishing after 24 h with two systems (L2). Then, specimens were submitted to the home or in-office bleaching procedures, and roughness was re-evaluated (L3). The surface roughness (Ra) readings were measured at L1, L2, and L3 times using a profilometer. Data were statistically analyzed by multiple-way analysis of variance and Tukey test (α = 0.05).

Results:

The polishing procedures decreased Ra for both composites compared to baseline values (L1). The roughness of specimens polished with jiffy did not present significant difference after polishing step (L2) and bleaching treatment (L3). However, the groups polished with Sof-Lex discs had increase on the Ra values after bleaching.

Conclusion:

The polishing is an important procedure to reduce the roughness of dental restorations and composite surface polished with jiffy system improved the degradation resistance to the bleaching agents compared to Sof-Lex discs.

Roughness and microhardness of composites after different bleaching techniques

BACKGROUND

The aim of this study was to evaluate the roughness and microhardness of SonicFill™ (Kerr), and compare it with Filtek™ Supreme XTE (3M ESPE) after 2 bleaching regimens.

METHODS

Sixty cylindrical specimens (10 × 2 mm) of each of the 2 composites were prepared and divided into 6 groups (n = 20): groups 1, 2: no treatment; groups 3, 4: 10% carbamide peroxide (CP); and groups 5, 6: 35% hydrogen peroxide (HP) plus LED. After treatments, specimens were thermocycled (500 cycles, 5 °C/55 °C, dwell time 30 minutes). A mechanical roughness tester was employed to measure the surface roughness parameters and the Vickers test to measure microhardness. One-way ANOVA, Tukey and Bonferroni methods with a significance level of 5% were used for the statistical analysis.

RESULTS

For SonicFill™, there was no statistically significant difference in microhardness between the control group (no. 1) and the bleached groups (nos. 3, 5), but there was difference between CP and HP treatments; for Filtek™ Supreme XTE, there was no significant difference in microhardness among all groups. There was no significant difference in average roughness (Ra) and the root mean square of the roughness (Rq) among all groups. The mean roughness depth (Rz) parameter showed no statistically significant differences among all groups for SonicFill™, but in Filtek™ Supreme XTE, there was a significant increase between control and bleaching treatments; roughness skewness (Rsk) showed no statistically significant differences among all groups for SonicFill™ and Filtek™ Supreme XTE, except for nos. 2 and 4, where the Rsk increased with CP.

CONCLUSIONS

The microhardness of Filtek™ Supreme XTE is less affected by bleaching than that of SonicFill™. Both bleaching treatments affect Rz in Filtek™ Supreme XTE in contrast to SonicFill™, but only the CP treatment affects the Rsk of Filtek™ Supreme XTE, with no significant effect of SonicFill™.

Influence of standard load micro- and nanopatterned in surface roughness of bleached teeth and submitted to different surface treatments

The aim of this study was evaluate the dental enamel after whitening treatment with Opalescence Boost PF™ 38%, correlating the structural alterations in the surface of the enamel with its respective pH and verify if whitened teeth submitted to different finishing and polishing techniques show similar surface texture to healthy teeth (control group). Sixty premolars were divided in 6 groups (n = 10), which had been immersed in artificial saliva during all the experiment. Protocol whitening was performed according to the manufacturer recommendations, and then the specimens were submitted to different polishing technique with Sof-Lex Pop On™ disks, Flex Diamond™ felt disks using two different micrometric polishing pastes (Enamelize™ and Diamond Polish™) and two nanometric polishing pastes (Lummina-E Diamond and Lummina-E Alumina), according to the groups. Representative specimens were analyzed in scanning electronic microscopy (SEM). Whitening gel used in this experiment had modified the morphologic aspect of the enamel surface. It was found that two nanometric polishing pastes (G5 and G6) promoted a less rough surface compared to control group even after the whitening process.

Spectrophotometric evaluation of color changes of bleach-shade resin-based composites after staining and bleaching

Spectrophotometric evaluation of color changes of Bleach-shade resin-based composites after staining and bleaching.

AIM

The aim of this study was to evaluate the color stability of two commercially available bleach-shade resin composites (RC) after exposure to 3 storage solutions and the effect of 3 bleaching agents on the color stability and stain removal from stained RC.

MATERIALS AND METHODS

Two bleach-shade RC were evaluated in this study, including a nanoflled RC, Filtek(TM) Z350 XT (FZ), and a nanohybrid RC, Tetric(®) N-Ceram (TC), in the extra-white body (shade) (XWB) and L shades, respectively. Twenty-seven disk-shaped specimens, each measuring 12 mm in diameter and 2 mm in thickness, were prepared for each RC, with a total of 54 specimens. Specimens were randomly allocated into 3 groups of 9 specimens each and immersed in 3 storage solutions (distilled water, tea and coffee) for 7 days period. The 9 specimens in each staining group were further divided into 3 subgroups. Specimens in each subgroup (n = 3) were bleached using one of the bleaching agents (10 and 16% Zoom NiteWhite amorphous calcium phosphate (ACP), and Zoom 2 chairside with light activation) for 5 days period. The specimen colors were measured with spectrophotometer. The measurements were performed on each sample three times at baseline, after staining, and after bleaching. Color was expressed using the commission international de I'Eclairage (CIE) L*a*b* color space. The color differences (ΔE) between the three measurements were calculated and the results were statistically analyzed using Two-way and Three-way analysis of variance (ANOVA) and Tukey's posthoc tests. Level of significance was set at p < 0.05.

RESULTS

Tetric(®) N-ceram materials demonstrated significantly less color change than the FZ and the color change, which was greater after storage in coffee compared to tea, was statistically significant. The bleaching agents significantly influence the color changes of composite specimens. All groups showed (ΔE) values below 3.3 after bleaching, except for 'Zoom 2 chairside' with light activation groups, which is shown clinically unacceptable lighter shade (ΔE >3.3).

CONCLUSION

Bleach-shade composites showed significant discoloration (ΔE > 3.3) after being immersed into coffee and tea solutions. Nanoflled composites discolored more than nano-hybrid composites, and carbamide peroxide-based bleaching agents were effective in reducing the discoloration to a clinically acceptable value (ΔE > 3.3).

Evaluation of the effect of a home bleaching agent on surface characteristics of indirect esthetic restorative materials--part II microhardness

BACKGROUND

The exponential usage of esthetic restorative materials is beholden to society needs and desires. Interaction between the bleaching agents and the esthetic restorative materials is of critical importance.

AIM

This in vitro study has been conducted to evaluate the effect of a home bleaching agent, carbamide peroxide (CP) 38%, on the microhardness of the fiber reinforced composite (FRC), overglazed, autoglazed, or polished porcelain specimens.

MATERIALS AND METHODS

For overglazed, autoglazed, polished ceramics and also FRC cylindrical specimens (n = 20 per group) were prepared. The specimens were stored in distilled water at 37°C for 48 hours prior to testing. Six samples from each group were selected randomly as negative controls which were stored in distilled water at 37°C that was changed daily. CP 38% was applied on the test specimens for 15 minutes, twice a day for 14 days. By using Knoop-microhardness tester microhardness testing for baseline, control and test specimens was conducted. Data were statistically analyzed using paired t-test, Mann-Whitney test, and Kruskal-Wallis test.

RESULTS

Home bleaching significantly decreased the surface microhardness of all the test samples (p < 0.05), whereas the control groups did not show statistically significant changes after 2 weeks. The polished porcelain and polished composite specimens showed the most significant change in microhard-ness after bleaching process (p < 0.05).

CONCLUSION

Although the type of surface preparation affects the susceptibility of the porcelain surface to the bleaching agent, no special preparation can preclude such adverse effects.

CLINICAL SIGNIFICANCE

The contact of home bleaching agents with esthetic restorative materials is unavoidable. Therefore protecting these restorations from bleaching agents and reglazing or at least polishing the restorations after bleaching is recommended.

Effect of various tooth whitening modalities on microhardness, surface roughness and surface morphology of the enamel

The purpose of this study was to evaluate the effect of four whitening modalities on surface enamel as assessed with microhardness tester, profilometer, and scanning electron microscopy (SEM). Whitening was performed according to manufacturer's directions for over-the-counter (OTC), dentist dispensed for home use (HW) and in-office (OW) whitening. Do-it-yourself (DIY) whitening consisted of a strawberry and baking soda mix. Additionally, negative and positive controls were used. A total of 120 enamel specimens were used for microhardness testing at baseline and post-whitening. Following microhardness testing specimens were prepared for SEM observations. A total of 120 enamel specimens were used for surface roughness testing at baseline and post-whitening (n = 20 per group). Rank-based Analysis of Covariance was performed to compare microhardness and surface roughness changes. Tests of hypotheses were two-sided with α = 0.05. There was a significant difference in Knoop hardness changes (ΔKHN) among the groups (Kruskal-Wallis test, p < 0.0001). Significant hardness reduction was observed in the positive control and DIY group (p < 0.0001). Mean surface roughness changes (ΔRa) were significantly different among the groups (Kruskal-Wallis test, p < 0.0001). Surface roughness increased in the OTC group (p = 0.03) and in the positive control (p < 0.0001). The four whitening modalities-DIY, OTC, HW and OW induced minimal surface morphology changes when observed with SEM. It can be concluded that none of the four whitening modalities adversely affected enamel surface morphology. However, caution should be advised when using a DIY regimen as it may affect enamel microhardness and an OTC product as it has the potential to increase surface roughness.

Evaluation of the effect of a home-bleaching agent on the surface characteristics of indirect esthetic restorative materials: part I--roughness

BACKGROUND

Pressing esthetic demands of good looking make people undergo bleaching procedures. However, the effect of bleaching agents on esthetic restorative materials with different surface preparations has been poorly studied.

AIM

The aim of this study was to examine the effect of a homebleaching agent (carbamide peroxide: CP 38%) on the surface roughness of the polished fiber reinforced composite (FRC), overglazed, autoglazed, or polished ceramic samples.

MATERIALS AND METHODS

Twenty standardized cylindrical specimens were made of each of the following groups: over-glazed, autoglazed, polished porcelain and also FRC. The test specimens exposed to the CP 38%, 15 minutes, twice a day for 2 weeks according to the manufacturer's recommendation. Six samples from each group were selected randomly to form negative controls. Surface roughness measurements (Ra, micrometer) for baseline, test and control specimens were performed by use of a profilometer. Paired t-test, Mann-Whitney test, and Kruskal-Wallis test were used for statistical analyses.

RESULTS

The data showed that bleaching with CP 38% significantly increased the surface roughness of all the test samples (p < 0.05). The type of surface preparation caused significant differences between the susceptibility of porcelain subgroups to bleaching (p < 0.05). The polished porcelain specimens showed the highest changes after bleaching.

CONCLUSION

CP 38% significantly increases the surface roughness of the porcelains and FRC. The type of surface condition affects the amenability of the porcelain surface to the bleaching agent. Glazed porcelains were more resistant to roughness than the polished porcelains and also the composite.

CLINICAL SIGNIFICANCE

Roughening of porcelain and FRC occur following bleaching procedure. No special surface preparation of indirect esthetic restorative materials can completely preserve these materials from adverse effects of bleaching agents.

Evaluation of the effects of conventional versus laser bleaching techniques on enamel microroughness

Nowadays, bleaching of the teeth within the dental office is one of the most widespread techniques to correct tooth discoloration. Variability of the materials and techniques accompanied with the trend toward esthetic restorations with minimally invasive approaches are increasing. The use of laser in this regard has also been taken into consideration. The aim of this study was to evaluate the effects of in-office versus laser bleaching on surface roughness of enamel. Fifteen freshly extracted human molars were sectioned mesiodistally to produce 30 lingual and buccal enamel blocks. Samples were mounted in transparent acrylic resin blocks and polished before treatment. Samples were randomly assigned to laser bleaching (LB) and office bleaching (OB) groups (n = 15 each). Pretreatment evaluation of microroughness was carried out for all samples using profilometer. Samples were treated twice in the OB group with Opalescent Xtra Boost and in the LB group using a laser-activated gel. Microroughness was evaluated after bleaching in both groups. Data were analyzed using repeated measure ANOVA. Both methods increased enamel surface roughness. Microroughness changes were significantly different between the two groups (p < 0.05). Microroughness significantly increased in the OB group (p > 0.05), but there was no significant difference in pre- and post-treatment roughness evaluation in the LB group (p < 0.05). Laser was considered a safer technique because it demonstrated a less surface roughness increase in comparison with the conventional office bleaching procedure.

Antioxidant agents and their effects on shear bond strength of bleached enamel

AIM

The goal of this study was to fnd a method to eliminate bond strength reduction after vital bleaching.

MATERIALS AND METHODS

Sixty fat surfaces of enamel central human incisors were prepared by diamond disks. In the frst group, the samples immediately bonded to the tooth after bleaching. For the second group, the bleached samples were treated by sodium ascorbate for 1 hours. In the third and fourth groups the treatment was down using a new antioxidant agent for 1 hour and 15 minutes respectively. For the ffth group no bleaching was done. Cylindrical composite resin (Z 100) with a Single Bond adhesive system was bonded to the enamel with a special metal mold. After thermocycling, the samples were loaded at a crosshead speed of 0.5 mm/min. The mode of failures was inspected by the Dino Lite microscope and the microstructure of the debonding surfaces was observed by SEM. Considering normal data, statistical analysis was conducted by ANOVA and Tukey tests (p = 0.05).

RESULTS

The fourth group had maximum (21.82), while the frst group had the least (9.0971) shear bond strength. The ANOVA test showed a signifcant difference among the fve groups (p = 0.0002). There was not any signifcant statistical difference between the three types of debonding (p = 0.165).

CONCLUSION

The usage of sodium ascorbate or sodium ascorbate with detergent after vital bleaching are effective methods for reducing the damaging effects of bleaching agents on the shear bond strength of composite resin restoration to enamel. CLINICAL SIGNIFCANCE: Using antioxidants is necessary post bleaching and before resin bonding.

Effect of bleaching agents and whitening dentifrices on the surface roughness of human teeth enamel

OBJECTIVE

The aim of this in vitro study was to evaluate the surface roughness of human enamel bleached with 10% carbamide peroxide or 10% hydrogen peroxide bleaching agents at different times and also subjected to different superficial cleaning treatments.

MATERIALS AND METHODS

One hundred and forty flat enamel samples were divided into 14 groups, Group 1-Group 14 (G1-G14). G1-G7 were treated with 10% carbamide peroxide and different dentifrices, G8-G14 were treated with 10% hydrogen peroxide and different dentifrices (G1 and G8: not brushed as control groups; G2 and G9: brushed with Ipana® toothpaste; G3 and G10: brushed with Clinomyn® toothpaste; G4 and G11: brushed with Moos Dent® toothpaste; G5 and G12: brushed with Signal® toothpaste; G6 and G13: brushed with Colgate® toothpaste; G7 and G14: brushed without dentifrice). A profilometer was used to measure average roughness values of the initial surface roughness and at each 7-day-interval. The bleaching was performed for 6 h a day and the surface cleaning treatment was performed 3-times a day, 2 min each time, for 4 weeks. The samples were stored in distilled water during the test period.

RESULTS

Statistical analysis revealed significant differences in surface roughness values over time for all groups except G1 and G8 (not brushed). The results of the surface roughness of all groups were nearly the same.

CONCLUSIONS

The bleaching with 10% hydrogen peroxide and 10% carbamide peroxide did not alter the enamel surface roughness, but when the bleaching treatment was performed combined with abrasive dentifrices, a significant increase in roughness values was observed.

Histomorphologic alterations of human enamel after repeated applications of a bleaching agent

The objective of the study was to analyse the histomorphology of enamel after repeated applications of a professional bleaching regimen. Enamel specimens were obtained from buccal surfaces of 20 extracted human incisors. Two specimens were obtained for each tooth. Half of each tooth was maintained in distilled water and served as control; the other part was treated with a 38 percent hydrogen peroxide professional bleaching agent. The treated specimens were divided in four groups: in group 1, the professional bleaching protocol suggested by the manufacturer was applied once; in group 2, the same protocol was repeated twice; in group 3, three times; in group 4, four times. Between bleaching applications and before SEM evaluation, enamel specimens were maintained in artificial saliva for 1 week. Enamel specimens for each group were submitted to a qualitative scanning electron microscopy (SEM) analysis (200X, 500X, 1000X, 3000X), comparing the treated specimens with the related control enamel. Results of the SEM analysis showed no relevant alteration on the enamel surfaces, when the bleaching protocol was applied once or twice. However, significant changes of enamel surface morphology were SEM observed in groups 3 and 4, suggesting a predominance of depressions when bleaching procedure was repeated three or four times. From the results of this in vitro study, it is possible to state that bleaching procedures should not be carried out indiscriminately. SEM analysis showed important alterations of the prismatic structure of the enamel when the bleaching protocol was applied three and four times.

The effect of bleaching on toothbrush abrasion of resin composites

AIM

This experimental study was designed to focus on the effects of bleaching on toothbrush abrasion in three types of composites with different filler size.

MATERIALS AND METHODS

Forty eight disks were prepared from three types of composite and divided into 6 groups. In the first three groups the abrasion test was done. The remaining groups were bleached and the abrasion test was performed. The weight of the samples before and after abrasion was measured. Statistical analysis was done with one-way ANOVA and Duncan test.

RESULTS

There was a significant difference in abrasion of composites with different filler size (P < 0.05). The most amount of abrasion was observed in Z100 after being bleached. An increase in abrasion was noticed in all three types of tested composite after bleaching.

CONCLUSION

According to the findings, it is suggested to use a nano filled resin composite for restoration if the bleaching treatment is required.

Influence of Hydrogen Peroxide Bleaching Gels on Color, Opacity, and Fluorescence of Composite Resins

The aim of the present study was to evaluate the effect of 20% and 35% hydrogen peroxide bleaching gels on the color, opacity, and fluorescence of composite resins. Seven composite resin brands were tested and 30 specimens, 3-mm in diameter and 2-mm thick, of each material were fabricated, for a total of 210 specimens. The specimens of each tested material were divided into three subgroups (n=10) according to the bleaching therapy tested: 20% hydrogen peroxide gel, 35% hydroxide peroxide gel, and the control group. The baseline color, opacity, and fluorescence were assessed by spectrophotometry. Four 30-minute bleaching gel applications, two hours in total, were performed. The control group did not receive bleaching treatment and was stored in deionized water. Final assessments were performed, and data were analyzed by two-way analysis of variance and Tukey tests (p&lt;0.05). Color changes were significant for different tested bleaching therapies (p&lt;0.0001), with the greatest color change observed for 35% hydrogen peroxide gel. No difference in opacity was detected for all analyzed parameters. Fluorescence changes were influenced by composite resin brand (p&lt;0.0001) and bleaching therapy (p=0.0016) used. No significant differences in fluorescence between different bleaching gel concentrations were detected by Tukey test. The greatest fluorescence alteration was detected on the brand Z350. It was concluded that 35% hydrogen peroxide bleaching gel generated the greatest color change among all evaluated materials. No statistical opacity changes were detected for all tested variables, and significant fluorescence changes were dependent on the material and bleaching therapy, regardless of the gel concentration.

Effects of two in-office bleaching agents with different pH on the structure of human enamel: an in situ and in vitro study

This study evaluated the effects of two in-office bleaching agents (Beyond and Opalescence Boost) with different pH on the structure and mechanical properties of human enamel in vitro and in situ. One hundred and eight enamel slabs were obtained from freshly extracted premolars. The specimens were randomly distributed into nine groups (n=12), and the human saliva (HS) in the volunteers' oral cavities was used to simulate the in situ condition: Beyond + HS, Opalescence Boost (O-Boost) + HS, Control + HS, Beyond + artificial saliva (AS), O-Boost + AS, Control + AS, Beyond + distilled water (DW), O-Boost + DW, and Control + DW. The bleaching treatments were performed on the first and eighth day, and the total bleaching time was 90 minutes. Baseline and final surface roughness (RMS), surface morphology, microhardness, and fracture toughness (FT) were measured before the treatment and on the fifteenth day, respectively. Compared with control groups, surface alterations on enamel were found in the Beyond + AS and Beyond + DW groups under atomic force microscopy evaluation. Two-way analysis of variance and Tukey test revealed that the RMS showed significant intergroup differences for both storage condition and bleaching agent, whereas microhardness and FT revealed no significant alteration. The results indicated that in-office bleaching agents with low pH values could induce enamel morphology alterations under in vitro conditions. The presence of natural HS could eliminate the demineralization effect caused by low pH.

Ion release from a composite resin after exposure to different 10% carbamide peroxide bleaching agents

OBJECTIVE

This in vitro study evaluated the influence of two 10% carbamide peroxide bleaching agents - a commercial product (Opalescence PF; Ultradent Products, Inc.) and a bleaching agent prepared in a compounding pharmacy - on the chemical degradation of a light-activated composite resin by determining its release of ions before and after exposure to the agents.

MATERIAL AND METHODS

Thirty composite resin (Filtek Z250; 3M/ESPE) samples were divided into three groups: group I (exposed to Opalescence PF commercial bleaching agent), group II (exposed to a compounded bleaching agent) and group III (control - Milli-Q water). After 14 days of exposure, with a protocol of 8 h of daily exposure to the bleaching agents and 16 h of immersion in Milli-Q water, the analysis of ion release was carried out using a HP 8453 spectrophotometer. The values were analyzed statistically by ANOVA, Tukey's test and the paired t-tests. The significance level was set at 5%.

RESULTS

After 14 days of the experiment, statistically significant difference was found between group II and groups I and III, with greater ion release from the composite resin in group II.

CONCLUSIONS

The compounded bleaching agent had a more aggressive effect on the composite resin after 14 days of exposure than the commercial product and the control (no bleaching).

The Effect of Bleaching Agents on the Color Stability of Ceromer and Porcelain Restorative Materials In Vitro

Purpose

The aim of this in vitro study was to determine the color changes of five different restorative materials after exposing these materials to two different home bleaching agents.

Methods

This study applied bleaching agents to an ultralow-fusing porcelain, a low-fusing porcelain, two types of heat-pressed glass ceramics, and a ceromer. A total of 24 disc-shaped specimens were fabricated (with a diameter of 10 mm and a thickness of 2 mm) from each material (n=12). The initial color measurements were taken with a spectrophotometer. The first set of specimens were bleached with 10% hydrogen peroxide (HP) for one hour daily for 10 days. The other set of specimens were bleached with 10% carbamide peroxide (CP) bleaching gel for eight hours daily for 14 days. Data were analyzed with the one-way analysis of variance and Kruskal-Wallis statistical test. The difference in the prebleaching and postbleaching color of each material was considered to be statistically significant at p &lt; 0.05.

Results

The study found a statistically significant difference among the color changes of the test groups after exposing them to both bleaching agents (p&lt;0.05). Appreciable color change was observed in the Estenia (ΔE=3.99) specimens that were bleached with the HP, and noticeable color changes were observed in the Estenia (ΔE=1.89) and IPS Empress 2 (ΔE=1.66) groups when they were treated with the CP.

Conclusions

Restorations (especially polymer-containing restorative materials) should be protected before any bleaching procedure due to the high risk of color change.