Effectiveness and effect of non-vital bleaching on the quality of life of patients up to 6 months post-treatment: a randomized clinical trial

Dental aesthetic perception of patients submitted to activated charcoal-based bleaching agents: A randomized clinical trial

OBJECTIVE

To evaluate the effects of activated charcoal-based products used in two presentation forms (powder or toothpaste), compared to 10 % carbamide peroxide and conventional toothpaste on aesthetic perception and psychosocial impact before and after treatment.

METHODS

Fifty-six participants were divided into 4 experimental groups (n = 14). Activated charcoal-based powder (PW); Activated charcoal-based dentifrice (AC); Conventional fluoride toothpaste (CD) and 10 % carbamide peroxide (CP). All products were used for 14 days. Psychosocial impact on dental esthetics (PIDAQ), oral health impact profile (OHIP- Esthetics) and orofacial esthetics scale (OES) questionnaires were applied before and after treatment. Descriptive and exploratory data analyses were performed and analyzed using linear mixed models for repeated measures over time considering significance level of α = 0.05.

RESULTS

For PIDAQ, the CP group showed significant decrease in psychological impact, aesthetic perception domains and overall score, while in the PW group, there was only a significant decrease in the psychological impact domain. Decrease in OHIP was observed for the functional limitation domain scores for treatments with CP and PW, in the psychological discomfort domain, decrease was observed for all groups, while for the OES questionnaire, significant increase in the color domain was observed for the CP group.

CONCLUSION

Activated charcoal-based products showed lower scores in all questionnaires when compared with carbamide peroxide; thus, charcoal-based products promoted lower impact on quality of life and aesthetic perception.

CLINICAL RELEVANCE

In this randomized clinical trial, charcoal-based OTC products had inferior quality of life and aesthetic perception results compared to conventional carbamide peroxide bleaching.

Clinical Testing of Walking Bleach, In-Office, and Combined Bleaching of Endodontically Treated Teeth

Objective. The causes of internal posteruptive discoloration of teeth are bleeding, necroses, infections, and endodontic filling materials. The aim of this study was to establish the results of bleaching endodontically treated teeth using walking bleach, in-office, and combined techniques, using 30% carbamide peroxide and 35% hydrogen peroxide, as well as the effect of etiological factors, and the time elapsed after endodontic treatment on the success of bleaching. Materials and Methods. The research involved 30 endodontically treated teeth in healthy patients. Retroalveolar X-rays were taken to check the quality of root canal obturation. Endodontic treatment and obturation were carried out on the discolored non-vital teeth without any previous endodontic treatment. Before bleaching, two millimeters of the filling were removed from the root canal and the very entry into the canal was protected with glass ionomer cement. The teeth were divided into three groups, depending on the bleaching technique: walking bleach technique (10 patients), in-office technique (10 patients), and combined technique (10 patients). The teeth were bleached with 30% carbamide peroxide and 35% hydrogen peroxide. The bleaching procedure was repeated in all the patients three times. The color of all teeth was determined based on the Vita Classic guide before and after bleaching. The Χ2 square and Kruskal−Wallis tests were used to identify differences in teeth bleaching results. Results. A statistically significant difference (p < 0.05) was established between bleaching success and the time elapsed after endodontic treatment. There were no statistically significant differences observed between the bleaching success and etiological factors, bleaching techniques, or bleaching agents. Conclusions. The effectiveness of non-vital tooth bleaching is affected by the time elapsed after endodontic treatment.

Present status and future directions - Managing discoloured teeth

Managing tooth discolouration involves a range of different protocols for clinicians and patients in order to achieve an aesthetic result. There is an increasing public awareness in the appearance of their teeth and management of tooth discolouration may be inter-disciplinary and involve both vital and nonvital teeth. Vital teeth can be easily treated with low concentration hydrogen peroxide products safely and effectively using an external approach and trays. For endodontically treated teeth, the walking bleach technique with hydrogen releasing peroxide products is popular. However, there is an association with external cervical root resorption with higher concentrations of hydrogen peroxide of 30%-35%. There are also regulatory considerations for the use of hydrogen peroxide in certain jurisdictions internationally. Prosthodontic treatments are more invasive and involve loss of tooth structure as well as a life cycle of further treatment in the future. This narrative review is based on searches on PubMed and the Cochrane library. Bleaching endodontically treated teeth can be considered a safe and effective protocol in the management of discoloured teeth. However, the association between bleaching and resorption remains unclear although there is likely to be a relation to prior trauma. It is prudent to avoid thermocatalytic approaches and to use a base/sealer to cover the root filling. An awareness expectations of patients and multidisciplinary treatment considerations is important in achieving the aesthetic result for the patient. It is likely that there will be an increasing demand for aesthetic whitening treatments. Bleaching of teeth has also become increasingly regulated although there are international differences in the use and concentration of bleaching agents.

Effectiveness and color stability of bleaching techniques on blood-stained teeth: An in vitro study

OBJECTIVE

Evaluate the effectiveness and color stability of bleaching techniques on blood-stained teeth.

MATERIAL AND METHODS

The teeth were stained by blood and allocated to groups: walking bleach, inside/outside, and in-office bleaching. L*, a*, b*, C*, h° color coordinates were measured using a clinical spectrophotometer at baseline, weekly (T1-T2-T3), and at 1-week (T4), 6-months (T5), and 1-year (T6) follow-up evaluations. ΔE ab * , ΔE 00 , and ΔWI D were calculated between sequential evaluation timepoints and between baseline and each evaluation timepoint. Color coordinates and WI_D differences in each timepoint and technique were analyzed by Wilcoxon Signed Rank, Kruskal-Wallis and Mann-Whitney U test, respectively. ΔE ab * , ΔE 00 , and ΔWI D were interpreted by color visual thresholds.

RESULTS

The techniques presented a significant increase in L* and WI_D and, a significant decrease in a* and b* until the completion of treatments. Statistical differences between the techniques for a*, b* and WI_D were observed from T1 until T3. All techniques demonstrated excellent effectiveness for ΔE ab * , ΔE 00 , and ΔWI D between baseline and each evaluation and follow-up timepoints. However, at T6, it was possible to identify a rebound effect for all techniques.

CONCLUSIONS

All bleaching techniques presented excellent effectiveness. The stability of the whitening produced was maintained for 6 months.

CLINICAL SIGNIFICANCE

Effective whitening of blood-stained teeth was achieved using walking bleach (sodium perborate), inside/outside (hydrogen peroxide - 7.5%) and in-office techniques (hydrogen peroxide - 35%). The bleaching techniques were effective after the completion of the treatments. A slight rebound was observed at 1 year follow-up.

Comparison of the Bleaching Efficacy of Different Agents Used for Internal Bleaching: A Systematic Review and Meta-Analysis

INTRODUCTION

The aim of this study was to analyze and compare the efficacy of different bleaching agents typically used for internal bleaching of endodontically treated discolored teeth.

METHODS

Electronic databases (PubMed, Web of Science, and Cochrane Library) were searched by 2 reviewers for clinical trials in which the color of endodontically treated discolored teeth before and after internal bleaching was examined using shade guide units (ΔSGU) or a spectrophotometer/colorimeter (ΔE). The efficacies of the bleaching agents were compared using subgroup analyses. Statistical heterogeneity was assessed with the Cochran Q test and I² statistic. Publication bias was evaluated using funnel plots.

RESULTS

Eight studies were included in the systematic review, 6 of which could be included in the meta-analyses. Internal bleaching led to a significant change in tooth shade (ΔSGU: 6.27 [95% confidence interval, 5.36-7.17], ΔE: 12.83 [95% confidence interval, 9.46-16.20]). With regard to ΔSGU, the use of carbamide peroxide (35% or 37%), hydrogen peroxide (35%), and the combination of sodium perborate and hydrogen peroxide (3% or 30%) led to a better bleaching effect than sodium perborate (adjusted P value ≤ .026). Regarding ΔE, there were no significant differences between carbamide peroxide (37%), hydrogen peroxide (35%), and sodium perborate mixed with hydrogen peroxide (P = .051). The risk of bias of the included studies was classified as moderate to high.

CONCLUSIONS

Carbamide peroxide, hydrogen peroxide, and sodium perborate have a significant bleaching effect on discolored, root canal-treated teeth. For a valid assessment of shade stability and a comparison of bleaching agents and their concentrations, further studies with long-term recalls are necessary.

Evaluation of the effectiveness in teeth whitening of a single session with 6% hydrogen peroxide Laser/LED system

BACKGROUND

Due to the current importance of dental whitening, multiple studies have been carried out in order to achieve an efficient, effective, and innocuous procedure. This study aimed to compare the effectiveness and sensitivity of in-office dental bleaching with one versus two applications of 6% hydrogen peroxide (HP) gel with nitrogen titanium dioxide (TiO₂) nanoparticles activated by LED/Laser lamp in a single-session.

METHODS

This RCT with a split-mouth design was performed in twenty-seven volunteers. The in-office dental bleaching technique was performed using 6% HP with nitrogen TiO₂ nanoparticles. In each patient, groups were randomized by hemiarch: Group 1 received one application of 72 minutes and Group 2 received two applications of 36 minutes, both groups in a single-session.

RESULTS

There were no significant differences in the effectiveness of a single-session with one or two applications of 6% HP with nitrogen TiO₂ nanoparticles between both groups(p>0.05). A positive and increase of ∆E value was observed in both groups. Group 1 showed an increase of 4.45 in the immediate measurement, remaining at 4.41 until the one-week control, to increase up to an ∆E of 4.99 at one-month control. Group 2 showed a sustained increase of 4.02 units in the immediate control until reaching the maximum value of 5.46 units of ∆E at one-month control.

CONCLUSION

One session single application protocol of 6% Hydrogen Peroxide gel with nanoparticulate TiO₂ activated by LED/Laser is effective and efficient for dental bleaching.

Effects of whitening gels on color and surface properties of a microhybrid and nanohybrid composite

The aim of this study was to compare color changes, surface roughness and gloss of a microhybrid and nanohybrid composite whitened in a simulated in-office or at-home procedure using 40% hydrogen peroxide or 16% carbamide peroxide, respectively. CIELab coordinates were measured before, during and after treatment using VITA EasyShade V (VITA) and ∆E₀₀ calculated. Surface roughness was measured using a surface roughness tester (SJ210; Mitutoyo). Gloss was measured using a gloss checker (IG-331; Horiba). At-home whitening resulted in ∆E₀₀ of 1.23±0.49 (microhybrid) and 1.01±0.76 (nanohybrid). In-office exposure resulted in ∆E₀₀ of 0.69±0.38 (microhybrid) and 0.72±0.50 (nanohybrid). There were no significant differences in ∆E₀₀, surface roughness and gloss between whitening protocols (p>0.05). Color changes of a microhybrid and nanohybrid composite following simulated in-office or at-home whitening reached CIEDE2000 50:50% perceptibility but not acceptability threshold. Surface roughness and gloss of the microhybrid and nanohybrid composite were not affected by whitening.

In vitro efficacy of commercial and experimental proteolytic enzyme-based whitening dentifrices on enamel whitening and superficial roughness

OBJECTIVE

To evaluate the whiteness index (W_ID ) and surface roughness (Ra) of bovine enamel after simulated tooth brushing with different commercial and experimental whitening dentifrices.

MATERIALS AND METHODS

Cylindrical enamel bovine specimens were acid etched, stained, and divided in nine groups (n = 8): Colgate® Optic White®, Crest® Baking Soda and Peroxide, Arm and Hammer® Advanced White™ Extreme Whitening, Rembrandt® Deeply White® + Peroxide, Close up® White Attraction Natural Glow, Hinode Prowhite, and experimental dentifrice containing papain (PP), bromelain (PB), or papain and bromelain (PPB). Ra and W_ID were obtained initially and after 600, 1200, and 3,600 cycles of simulated tooth brushing. Data were analyzed using two-way analysis of variance test (α = 0.05).

RESULTS

Ra was significantly influenced by both dentifrice (p = 0.043) and period of tooth-brushing simulation (p < 0.001). Except for PP and PPB, all groups showed a statistically significant increase in Ra after simulated tooth brushing. After staining and brushing, none of the materials tested increased the initial W_ID .

CONCLUSIONS

The effect of commercial whitening dentifrices may be related to their high abrasiveness. Experimental formulations tested provided a similar effect without undesired wear of enamel. Whitening dentifrices only act through an abrasive effect rather than bleaching the tooth structures. When used, special care must be taken for avoid undesired wear of enamel. Experimental dentifrices provided similar removal of extrinsic stains without undesired abrasiveness; however, this effect may be due to the use of less aggressive abrasives in their formulations.

Personality traits, psychosocial effects and quality of life of patients submitted to dental bleaching

Background

Perception is defined as the ability to distinguish through the senses. All perception is dependent on factors such as personality, previously lived experiences and cultural elements. When planning an aesthetic treatment, consider the way the patients perceive the changes and outcomes is essential for reaching their expectations. The objective of this study was to assess if there was predominance of a personality trait of patient undergoing dental bleaching and if this treatment could promote changes in this traits, in the psychosocial impact and quality of life of these individuals.

Methods

The assessment of personality characteristics, quality of life, psychosocial and self-perception was a cross-sectional observational study and it was carried out by applying questionnaires to 55 patients that were submitted to a clinical phase. The psychometric instruments used were NEO FFI-R (personality), PIDAQ (psychosocial effect) and WHOQOL-BREF (quality of life). Each test domain was prior and after bleaching by Wilcoxon Signed Rank test (α = 0.05). The internal consistencies of each scale were evaluated by Cronbach's alpha.

Results

No statistical significant differences among personality traits means were observed among participants but there was predominance of two predominant personality traits in this study: conscientiousness (45.5%) and extraversion (34.5%). In four test domains of the PIDAQ, significant differences were observed before and after dental bleaching. The overall perception of the PIDAQ was also statistically significant demonstrating an improvement. There were no differences on overall or specific domains scores of the WHOQOL before and after treatment.

Conclusions

Subjects who underwent dental treatment improved their self-confidence and reduced concerns about dental aesthetics, social and personality impact of dental alterations.

Trial registration

This study was conducted in parallel to a clinical investigation that aimed to evaluate tooth sensitivity related to dental bleaching technique and registered in REBEC clinical registry under protocol RBR-6pt2n3 in 13 November 2013.

The change of teeth color, whiteness variations and its psychosocial and self-perception effects when using low vs. high concentration bleaching gels: a one-year follow-up

Background

Dental bleaching in traditional concentrations generates greater sensitivity. In this respect, new systems of lower concentration of hydrogen peroxide for tooth bleaching appeared, with color stability unknown over time. The aim of this study was to compare the change and stability of color with low-concentration (6%) hydrogen peroxide gel in an in-office bleaching setting relative to conventional 37.5% gel, including their effects on psychosocial and esthetic self-perception, after 1 year.

Methods

Patients (n = 25) were assessed at 12 months post bleaching treatment (whitening with 6% chemo-activated alkaline formula gel versus 37.5% traditional concentration gel). Color changes were measured objectively using total variation in color (ΔE), and subjectively using Vita Classical and Vita Bleached scale (ΔSGU) by calibrated evaluators (Kappa = 0.85). The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and Oral Health Impact Profile (OHIP-14) aesthetic questionnaires were used to measure the self-perception and the psychosocial impact of the bleaching protocols.

Results

The effect (ΔE) of 37.5% HP (8.37 ± 2.73) was significantly better than that of 6% HP (5.27 ± 2.53) in terms of color rebound after 1 year of follow-up. There were significant differences in psychosocial impact and esthetic self-perception measurements prior to bleaching versus one-year post-whitening time points; positive effects were maintained.

Conclusions

Low concentration (6%) achieved effective bleaching with good stability after 1 year, accompanied by a positive psychosocial impact and enhanced self-perception at follow-up.

Trial registration

NCT03217994 (before enrollment of the first participant). Data register: July 14, 2017.