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Donato MV, Dos Reis-Prado AH, Abreu LG, de Arantes LC, Goto J, Chaves HGDS, Cintra LTA, Briso ALF, Peixoto IFDC, Benetti F. Influence of dental bleaching on the pulp tissue: A systematic review of in vivo studies. Int Endod J 2024; 57:630-654. [PMID: 38470103 DOI: 10.1111/iej.14061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/08/2024] [Accepted: 02/23/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Although several studies indicate the harmful effects of bleaching on pulp tissue, the demand for this procedure using high concentrations of hydrogen peroxide (HP) is high. OBJECTIVES To investigate the influence of bleaching on the pulp tissue. METHODS Electronic searches were conducted (PubMed/MEDLINE, Scopus, Cochrane Library and grey literature) until February 2021. Only in vivo studies that evaluated the effects of HP and/or carbamide peroxide (CP) bleaching gels on the inflammatory response in the pulp tissue compared with a non-bleached group were included. Risk of bias was performed according to a modified Methodological Index for Non-Randomized Studies scale for human studies and the Systematic Review Centre for Laboratory Animal Experimentation's RoB tool for animal studies. Meta-analysis was unfeasible. RESULTS Of the 1311 studies, 30 were eligible. Of these, 18 studies evaluated the inflammatory response in animal models. All these studies reported a moderate-to-strong inflammatory response in the superficial regions of pulp, characterized by cell disorganization and necrotic areas, particularly during the initial periods following exposure to 35%-38% HP, for 30-40 min. In the evaluation of human teeth across 11 studies, seven investigated inflammatory responses, with five observing significant inflammation in the pulp of bleached teeth. In terms of tertiary dentine deposition, 11 out of 12 studies noted its occurrence after bleaching with 35%-38% HP in long-term assessments. Additionally, three studies reported significant levels of osteocalcin/osteopontin at 2 or 10 days post-treatment. Other studies indicated an increase in pro-inflammatory cytokines ranging from immediately up to 10 days after bleaching. Studies using humans' teeth had a low risk of bias, whereas animal studies had a high risk of bias. DISCUSSION Despite the heterogeneity in bleaching protocols among studies, High-concentrations of HP shows the potential to induce significant pulp damage. CONCLUSIONS High-concentrations of bleaching gel increases inflammatory response and necrosis in the pulp tissue at short periods after bleaching, mainly in rat molars and in human incisors, in addition to greater hard tissue deposition over time. However, further well-described histological studies with long-term follow-up are encouraged due to the methodological limitations of these studies. REGISTRATION PROSPERO (CRD42021230937).
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Affiliation(s)
- Mariana Viana Donato
- Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Lucas Guimarães Abreu
- Child's and Adolescent's Oral Health, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Lara Cancella de Arantes
- Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Juliana Goto
- Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | | | | | - André Luiz Fraga Briso
- Restorative Dentistry, School of Dentistry, São Paulo State University (Unesp), Araçatuba, Brazil
| | | | - Francine Benetti
- Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Carlos NR, Basting RT, Kantovitz KR, Bronze-Uhle ES, Lisboa Filho PN, Cavalli V, Basting RT. In-office Bleaching Activated With Violet LED: Effect on Pulpal and Tooth Temperature and Pulp Viability. Oper Dent 2024; 49:262-272. [PMID: 38632866 DOI: 10.2341/23-093-l] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES This study evaluated the influence of hydrogen peroxide (HP) with or without titanium dioxide nanotubes (TiO2) associated with violet LED (VL) regarding: a) the temperature change in the pulp chamber and facial surface; b) the decomposition of HP; and c) the cytotoxicity of the gels on pulp cells. METHODS AND MATERIALS The experimental groups were: HP35 (35% HP/Whiteness HP, FGM); HP35+VL; HP35T (HP35+TiO2); HP35T+VL; HP7 (7.5% HP/White Class 7.5%, FGM); HP7+VL; HP7T (HP7+TiO2); and HP7T+VL. TiO2 was incorporated into the bleaching gels at 1%. Eighty bovine incisors were evaluated to determine temperature change in 8 experimental groups (n=10/group). A k-type thermocouple was used to evaluate the temperatures of the facial surface and in the pulp chamber, achieved by enabling endodontic access to the palatal surface, throughout the 30-minute session. HP decomposition (n=3) of gels was evaluated by using an automatic potentiometric titrator at the initial and 30-minute time points. Trans-enamel and trans-dentinal cell viability were assessed with a pulp chamber device as well as enamel and dentin discs (n=6), and the treatment extracts (culture medium + diffused components) were collected and applied to MDPC-23 odontoblast cells to evaluate cell viability according to the MTT test. RESULTS A temperature increase in the pulp chamber was observed in the presence of VL at 30 minutes (p<0.05) (Mann-Whitney test). Also at 30 minutes, HP35 showed greater decomposition in the presence of VL rather than in its absence (p<0.05) (mixed linear models and the Tukey-Kramer test). HP7 provided greater cell viability than the groups treated with HP35 (p<0.05) (generalized linear models test). Cell viability was significantly lower for HP7 in the presence of VL (p<0.05). CONCLUSION Pulpal temperature increased with VL (maximum of 1.9°C), but did not exceed the critical limit to cause pulp damage. Less concentrated HP resulted in higher cell viability, even when associated with VL.
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Affiliation(s)
- N R Carlos
- *Natalia Russo Carlos, DDS, MSc, PhD student, Faculdade São Leopoldo Mandic, Campinis, São Paulo, Brazil
| | - R T Basting
- Rosanna Tarkany Basting, MSc, PhD, Post-doc student, Faculdade São Leopoldo Mandic, Campinis, São Paulo, Brazil
| | - K R Kantovitz
- Kamila Rosamilia Kantovitz, DDS, MSc, PhD, professor, Faculdade São Leopoldo Mandic, Campinis, São Paulo, Brazil
| | - E S Bronze-Uhle
- Erika Soares Bronze-Uhle, Phys, Post-doc student, São Paulo State University (UNESP)
| | - P N Lisboa Filho
- Paulo Noronha Lisboa Filho, Phys, MSc, PhD, professor, São Paulo State University (UNESP), São Paulo, Brazil
| | - V Cavalli
- Vanessa Cavalli, DDS, MSc, PhD, professor, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - R T Basting
- Roberta Tarkany Basting, DDS, MSc, PhD, professor, Faculdade São Leopoldo Mandic, Campinas, São Paulo, Brazil
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Carneiro TDS, Favoreto MW, Rodrigues JPF, Sutil E, Centenaro GG, Freitas IDMD, Reis A, García LC, Loguercio AD. In-office dental bleaching in adolescents using 6% hydrogen peroxide with and without gingival barrier: a randomized double-blind clinical trial. J Appl Oral Sci 2024; 32:e20230416. [PMID: 38536995 PMCID: PMC11037928 DOI: 10.1590/1678-7757-2023-0416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND At low concentrations used for in-office bleaching gels, such as 6% HP, gingival barrier continues to be performed. If we take into account that, in the at-home bleaching technique, no barrier is indicated, it seems that the use of a gingival barrier fails to make much sense when bleaching gel in low concentration is used for in-office bleaching. OBJECTIVE This double-blind, split-mouth, randomized clinical trial evaluated the gingival irritation (GI) of in-office bleaching using 6% hydrogen peroxide (HP) with and without a gingival barrier in adolescents, as well as color change and the impact of oral condition on quality of life. METHODOLOGY Overall, 60 participants were randomized into which side would or would not receive the gingival barrier. In-office bleaching was performed for 50 minutes with 6% HP in three sessions. The absolute risk and intensity of GI were assessed with a visual analogue scale. Color change was assessed using a digital spectrophotometer and color guides. The impact of oral condition on quality of life was assessed using the Brazilian version of the Oral Health Impact Profile (α=0.05). RESULTS The proportion of patients who presented GI for the "with barrier" group was 31.6% and for the "without barrier" group, 30% (p=1.0). There is an equivalence for the evaluated groups regarding GI intensity (p<0.01). Color change was detected with no statistical differences (p>0.29). There was a significant impact of oral condition on quality of life after bleaching (p<0.001). CONCLUSIONS The use or not of the gingival barrier for in-office bleaching with 6% HP was equivalent for GI, as well as for bleaching efficacy, with improvement in the impact of oral condition on quality of life.
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Affiliation(s)
- Taynara de Souza Carneiro
- Universidade Estadual de Ponta Grossa, Departamento de Dentística Restauradora, Ponta Grossa, Brasil
- Universidad Rey Juan Carlos, Facultad de Ciencias de la Salud, IDIBO, Madrid, España
| | - Michael Willian Favoreto
- Universidade Estadual de Ponta Grossa, Departamento de Dentística Restauradora, Ponta Grossa, Brasil
| | | | - Elisama Sutil
- Universidade Estadual de Ponta Grossa, Departamento de Dentística Restauradora, Ponta Grossa, Brasil
| | - Gabrielle Gomes Centenaro
- Universidade Estadual de Ponta Grossa, Departamento de Dentística Restauradora, Ponta Grossa, Brasil
| | | | - Alessandra Reis
- Universidade Estadual de Ponta Grossa, Departamento de Dentística Restauradora, Ponta Grossa, Brasil
| | - Laura Ceballos García
- Universidad Rey Juan Carlos, Facultad de Ciencias de la Salud, IDIBO, Madrid, España
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Coppola G, Teodosio LM, Assis HC, Bertolini GR, Castro-Vasconcelos GA, Sousa-Neto MD, Lopes-Olhê FC. Chemical, morphological and microhardness analysis of coronary dentin submitted to internal bleaching with hydrogen peroxide and violet LED. Photodiagnosis Photodyn Ther 2023; 44:103862. [PMID: 37890812 DOI: 10.1016/j.pdpdt.2023.103862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Violet LED has been used for internal bleaching, however its implications on coronary dentin composition are unclear. The present study aims to evaluate the effect of bleaching with violet LED, either associated with 35 % hydrogen peroxide or not, on microhardness, chemical composition, and morphological characteristics of coronal dentin. METHODS Thirty maxillary canines were selected to obtain 30 blocks of coronal dentin, distributed in 3 groups (n = 10): 35 % hydrogen peroxide (HP); violet LED (LED); HP 35 % + LED, (HP+LED). The chemical analysis was performed by FTIR and the morphological evaluation of the dentin structure by confocal laser scanning microscopy before (T0) and after treatment (T1). The microhardness analysis was performed by microdurometer after bleaching. The data were submitted to repeated measures ANOVA test (P> 0.05). RESULTS The intensity of the inorganic peaks decreased after bleaching for all groups (P = 0.003). There was an increase in the organic peak intensity after bleaching with HP, a decrease for LED, while HP+LED did not change the intensity (P = 0.044). Moreover, the inorganic/organic ratio decreased for HP (P = 0.022), while for LED and HP+LED there was no significant changes (P>0.05). HP and HP+LED showed lower microhardness values compared to LED (P< 0.05). Regarding morphological changes, an increase in the perimeter of the dentinal tubules was found for all groups, with the smallest increase being observed for LED. CONCLUSION HP bleaching decreased the chemical stability and microhardness of the coronal dentin, while the violet LED treatments had no significant impact on dentin stability. In all groups, there was an increase in exposure of the dentinal tubules after bleaching, which was less pronounced with the violet LED bleaching.
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Affiliation(s)
- Gabriel Coppola
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, Rua Célia de Oliveira Meirelles 350, University of São Paulo, Ribeirão Preto, SP 14024-070, Brazil
| | - Leonardo Moreira Teodosio
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, Rua Célia de Oliveira Meirelles 350, University of São Paulo, Ribeirão Preto, SP 14024-070, Brazil
| | - Helena Cristina Assis
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, Rua Célia de Oliveira Meirelles 350, University of São Paulo, Ribeirão Preto, SP 14024-070, Brazil
| | - Gunther Ricardo Bertolini
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, Rua Célia de Oliveira Meirelles 350, University of São Paulo, Ribeirão Preto, SP 14024-070, Brazil
| | - Gustavo Alexandre Castro-Vasconcelos
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, Rua Célia de Oliveira Meirelles 350, University of São Paulo, Ribeirão Preto, SP 14024-070, Brazil
| | - Manoel D Sousa-Neto
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, Rua Célia de Oliveira Meirelles 350, University of São Paulo, Ribeirão Preto, SP 14024-070, Brazil
| | - Fabiane Carneiro Lopes-Olhê
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, Rua Célia de Oliveira Meirelles 350, University of São Paulo, Ribeirão Preto, SP 14024-070, Brazil.
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Teodosio LM, Gambarini L, Faria-e-Silva AL, Pires-de-Souza FDCP, de Souza-Gabriel AE, Mazzi-Chaves JF, Sousa-Neto MD, Lopes-Olhê FC. Bleaching effect of violet LED of 405-410 nm on stained endodontically treated teeth. Photodiagnosis Photodyn Ther 2022; 39:102929. [DOI: 10.1016/j.pdpdt.2022.102929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/05/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
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Rossi B, Morimoto S, Tedesco TK, Cunha SR, Horliana ACRT, Ramalho KM. Effectiveness of Violet LED alone or in association with bleaching gel during dental photobleaching: A Systematic Review. Photodiagnosis Photodyn Ther 2022; 38:102813. [PMID: 35304311 DOI: 10.1016/j.pdpdt.2022.102813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/17/2022] [Accepted: 03/14/2022] [Indexed: 11/17/2022]
Abstract
AIMS To conduct a systematic review to determine the efficacy of violet led in promoting dental bleaching itself or accelerating dental bleaching when associated with peroxides. METHODS Clinical and in vitro studies were identified by a search on November 27th 2020 in the PubMed and Scopus databases. Inclusion criteria were: 1) studies related to bleaching; 2) studies related to violet LED Light (405-410nm); and 3) studies that analyzed efficacy. The authors assessed the studies for risk of bias independently. Authors extracted outcomes including color change evaluation and pain assessment independently. RESULTS During the search process, 895 articles were found in the previously cited databases. After the first screening consisting of title and abstract evaluations, 18 articles were selected. Finally, 13 articles met the eligibility criteria and were included in this review, being 5 clinical trial/case series and 8 in vitro studies. In vitro studies showed a high risk of bias and interventional studies showed a low risk of bias. CONCLUSION The violet Led seems to have the potential to bleach teeth without peroxides, with a clinical perceptible color alteration. However, the effect is small in comparison to bleaching using peroxides. When Violet Led is used in association with peroxides, it seems to potentialize the bleaching result. However, due to the high heterogeneity between studies, a small number of clinical studies, and the high risk of bias of the in vitro included studies, the results are not definitive, and further well-designed studies are needed to reach safe evidence.
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Affiliation(s)
- Bianca Rossi
- School of Dentistry, Ibirapuera University, Brazil
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Youssef SA, Cunha SR, Mayer-Santos E, Brito SA, de Freitas PM, Ramalho J, Morimoto S, Gonçalves F, Ramalho KM. Influence of 35% hydrogen peroxide gel renewal on color change during in-office dental photobleaching with violet LED: A split-mouth randomized controlled clinical trial. Photodiagnosis Photodyn Ther 2021; 36:102509. [PMID: 34455106 DOI: 10.1016/j.pdpdt.2021.102509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/22/2021] [Accepted: 08/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND To clinically evaluate the effect of 35% hydrogen peroxide gel renewal in association with violet LED (405-410nm) through a split-mouth randomized controlled clinical trial. METHODS The treatment consisted in 3 bleaching sessions of 15 min each, with an interval of 7 days between them, using 35% hydrogen peroxide combined to violet LED irradiation. Selected patients had two experimental segments for the split-mouth design: No change of the bleaching gel during each session (NBGR) and 3 changes of the bleaching gel every 5 min for each session (BGR). During the 3 bleaching sessions, the selected quadrant received the same treatment. Patients had their upper canines and central incisors teeth color measured with a subjective (color scale - VITA Classical) and an objective (spectrophotometer - VITA Easyshade) method and their teeth sensitivity measured using a Visual Analog Scale (VAS) before, immediately after each bleaching session, and 14 days and 2 months (60 days) after the end of the treatment. RESULTS The protocol adopted in the present study reached satisfactory results regarding color change. No statistical difference between groups was observed immediately after the end of the treatment and in the follow-up analysis for both subjective and objective color evaluation. No difference in tooth sensitivity between segments was observed. CONCLUSION There is no need for bleaching gel renewal when following the clinical protocol of 3 sessions of 15 min in a bleaching protocol of 35% hydrogen peroxide combined with violet LED.
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Affiliation(s)
- Shady A Youssef
- Universidade Ibirapuera, Av. Interlagos, 1329, São Paulo, SP 04661-100, Brazil
| | - Sandra Ribeiro Cunha
- College of Dentistry, University of Iowa, 801 Newton Road, Iowa City, IA, United States
| | - Eric Mayer-Santos
- Laboratório Especial de Laser em Odontologia (LELO), Universidade de São Paulo, Faculdade de Odontologia, Av. Professor Lineu Prestes, 2227, São Paulo, SP, Brazil
| | - Sara Alves Brito
- Universidade Ibirapuera, Av. Interlagos, 1329, São Paulo, SP 04661-100, Brazil
| | - Patrícia Moreira de Freitas
- Laboratório Especial de Laser em Odontologia (LELO), Universidade de São Paulo, Faculdade de Odontologia, Av. Professor Lineu Prestes, 2227, São Paulo, SP, Brazil
| | - Juliana Ramalho
- Universidade Ibirapuera, Av. Interlagos, 1329, São Paulo, SP 04661-100, Brazil
| | - Susana Morimoto
- Universidade Ibirapuera, Av. Interlagos, 1329, São Paulo, SP 04661-100, Brazil
| | - Flavia Gonçalves
- Universidade Ibirapuera, Av. Interlagos, 1329, São Paulo, SP 04661-100, Brazil
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Álvarez-Quiceno D, Rojas-Martínez PA, Cruz-González AC. Change of dental color and temperature through two bleaching agents boosted with light emitted by diodes. J ESTHET RESTOR DENT 2021; 33:1010-1016. [PMID: 34092026 DOI: 10.1111/jerd.12794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/13/2021] [Accepted: 05/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The use of light sources during the application of bleaching can reduce the time and improve the results, but at the same time this can increase the dental temperature. The objective of this study was to evaluate the performance of two bleaching agents and the increase in dental temperature with the use of light emitted by diodes (LED)-unit. MATERIALS AND METHODS Forty third molars were obtained and randomized: the whiteness without lamp (WHN) and Pola office without lamp (PON) groups, two bleaching systems based on 35% hydrogen peroxide were used, according to manufacturer specifications. For the whiteness with lamp (WHL) and Pola office with lamp (POL) groups the same bleaching agents were light boosted. A spectrophotometer and ∆WID equation was used to record and analyzed teeth color. An infrared thermometer was used to record the external and internal temperature. A ∆T was obtained by the difference of the temperature of the groups with and without LED (WHN-WHL and PON-POL). For statistical analysis Kruskal-Wallis test and Anova test were performed. RESULTS The WHN, PON, WHL, and POL groups reported ∆WID values of 4.88 ± 1.08, 9.26 ± 3.27, 5.70 ± 2.48, 12.08 ± 5.44, respectively. The dates of internal temperature were 1.01 and 1.07°C, and for external temperature were 1.61 and 1.15°C respectively. CONCLUSIONS With the limitations of this study, both bleaching agents reported a significant increase in ∆WID with and without association of light. Significant temperature increases were also observed. The highest average temperature increase was approximately 1.61°C. CLINICAL SIGNIFICANCE Bleaching agents boosted with LED may improve the results of bleaching, but it is not essential to obtain good results.
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Qi F, Otsuki M, Hiraishi N, Hatayama T, Wijethunge CL, Tagami J. Effect of photo-thermal acceleration on in-office bleaching. Odontology 2021; 109:828-835. [PMID: 33991277 PMCID: PMC8387248 DOI: 10.1007/s10266-021-00612-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Abstract
The purpose is to evaluate the effect of photo-thermal acceleration on in-office bleaching efficiency using a bleaching agent without photocatalysts in vitro. Artificially discolored bovine lower incisors were prepared, and the mixed in-office bleaching material contained hydrogen peroxide 23% was applied by following treatment for 10 min: high-(HI group) and low-intensity LED lights (LI group), oven at 38 °C (OV group), and room temperature at 23 °C (RT group). Color was measured before and after bleaching and color difference (∆E*) was calculated. The data were statistically analyzed using a two-way ANOVA and Tukey’s post hoc test. The temperature change (∆T) of applied bleaching agent in HI and LI groups was measured using a thermography and was analyzed using a T test. The bleaching procedures were repeated 6 times. Irradiation in the HI group resulted in the highest ΔE, followed by the LI group whose ΔE was significantly lower. Both irradiated modes exhibited higher ΔE compared to non-irradiated OV and RT groups which were not significantly different from each other. The average temperature rise of bleaching agents in HI and LI groups after 10 min irradiation was 15.00 °C and 11.80 °C, respectively. The effect of photo-thermal acceleration was proved for an in-office bleaching agent without photocatalysts in vitro.
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Affiliation(s)
- Feng Qi
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Masayuki Otsuki
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan.
| | - Noriko Hiraishi
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Takashi Hatayama
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Chamari Lasindra Wijethunge
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
| | - Junji Tagami
- Cariology and Operative Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8549, Japan
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Sobral MFP, Cassoni A, Tenis CA, Steagall W, Brugnera Junior A, Bagnato VS, Botta SB. Longitudinal, Randomized, and Parallel Clinical Trial Comparing a Violet Light-Emitting Diodes System and In-Office Dental Bleaching: 6-Month Follow-Up. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:403-410. [PMID: 33567218 DOI: 10.1089/photob.2019.4764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: This in vivo study compared two bleaching techniques with regard to the degree of tooth sensitivity (TS), color change, and treatment stability for a 6-month follow-up period. Materials and methods: Sixty volunteers were selected according to inclusion and exclusion criteria and submitted to in-office bleaching. For group 1, we performed one bleaching session with a 35% hydrogen peroxide gel and a second bleaching session after 7 days; for group 2, we performed two bleaching sessions with two applications per session, each session with a 7-day interval, using a light-emitting diodes (LEDs) device emitting violet light (405-410 nm) without employing peroxide-containing bleaching gel. TS was recorded immediately before and immediately after each bleaching session using the Variance Analogic Scale. The color of upper central incisors and upper canines at baseline was recorded immediately after each bleaching session, after 15, 30, and 180 days, with a value-oriented shade guide used by two well-trained observers. Results: The two whitening protocols results were similar regarding the immediate effectiveness and 6-month stability of tooth whitening. Dental bleaching with violet LED did not promote postoperative pain sensitivity at any of the evaluated times. However, dental bleaching performed with 35% hydrogen peroxide promoted higher postoperative pain sensitivity. Conclusions: The violet light alone provided dental bleaching and had the clinical advantage of promoting less immediate postoperative sensitivity; however, an unwanted repigmentation occurred after dental bleaching with light alone.
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Affiliation(s)
| | | | | | | | - Aldo Brugnera Junior
- Department of Basic Optics and Applied Life Sciences FSC-USP, National Institute of Science and Technology INCT, São Paulo, Brasil
| | - Vanderlei Salvador Bagnato
- Departamento de Física e Ciência dos Materiais, Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, Brasil
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Casado B, Pellizzer EP, Souto Maior JR, Lemos C, Vasconcelos B, Moraes S. Laser Influence on Dental Sensitivity Compared to Other Light Sources Used During In-office Dental Bleaching: Systematic Review and Meta-analysis. Oper Dent 2020; 45:589-597. [PMID: 32502260 DOI: 10.2341/19-064-l] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2019] [Indexed: 11/23/2022]
Abstract
CLINICAL RELEVANCE The use of laser light during bleaching will not reduce the incidence or severity of sensitivity and will not increase the degree of color change compared with nonlaser light sources. SUMMARY Objective: To evaluate whether the use of laser during in-office bleaching promotes a reduction in dental sensitivity after bleaching compared with other light sources.Methods: The present review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and is registered with PROSPERO (CDR42018096591). Searches were conducted in the PubMed/Medline, Web of Science, and Cochrane Library databases for relevant articles published up to August 2018. Only randomized clinical trials among adults that compared the use of laser during in-office whitening and other light sources were considered eligible.Results: After analysis of the texts retrieved during the database search, six articles met the eligibility criteria and were selected for the present review. For the outcome dental sensitivity, no significant difference was found favoring any type of light either for intensity (mean difference [MD]: -1.60; confidence interval [CI]: -3.42 to 0.22; p=0.09) or incidence (MD: 1.00; CI: 0.755 to 1.33; p=1.00). Regarding change in tooth color, no significant differences were found between the use of the laser and other light sources (MD: -2.22; CI: -6.36 to 1.93; p=0.29).Conclusions: Within the limitations of the present study, laser exerts no influence on tooth sensitivity compared with other light sources when used during in-office bleaching. The included studies demonstrated that laser use during in-office bleaching may have no influence on tooth color change.
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Evaluation of the color change and tooth sensitivity in treatments that associate violet LED with carbamide peroxide 10 %: A randomized clinical trial of a split-mouth design. Photodiagnosis Photodyn Ther 2020; 30:101679. [DOI: 10.1016/j.pdpdt.2020.101679] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/14/2020] [Accepted: 01/27/2020] [Indexed: 12/22/2022]
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Prasad A, Du L, Zubair M, Subedi S, Ullah A, Roopesh MS. Applications of Light-Emitting Diodes (LEDs) in Food Processing and Water Treatment. FOOD ENGINEERING REVIEWS 2020. [PMCID: PMC7223679 DOI: 10.1007/s12393-020-09221-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Light-emitting diode (LED) technology is an emerging nonthermal food processing technique that utilizes light energy with wavelengths ranging from 200 to 780 nm. Inactivation of bacteria, viruses, and fungi in water by LED treatment has been studied extensively. LED technology has also shown antimicrobial efficacy in food systems. This review provides an overview of recent studies of LED decontamination of water and food. LEDs produce an antibacterial effect by photodynamic inactivation due to photosensitization of light absorbing compounds in the presence of oxygen and DNA damage; however, such inactivation is dependent on the wavelength of light energy used. Commercial applications of LED treatment include air ventilation systems in office spaces, curing, medical applications, water treatment, and algaculture. As low penetration depth and high-intensity usage can challenge optimal LED treatment, optimization studies are required to select the right light wavelength for the application and to standardize measurements of light energy dosage.
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Affiliation(s)
- Amritha Prasad
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5 Canada
| | - Lihui Du
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5 Canada
| | - Muhammad Zubair
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5 Canada
| | - Samir Subedi
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5 Canada
| | - Aman Ullah
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5 Canada
| | - M. S. Roopesh
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB T6G 2P5 Canada
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Clinical analysis of color change and tooth sensitivity to violet LED during bleaching treatment: A case series with split-mouth design. Photodiagnosis Photodyn Ther 2019; 27:59-65. [DOI: 10.1016/j.pdpdt.2019.05.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/13/2019] [Accepted: 05/17/2019] [Indexed: 12/21/2022]
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Cuppini M, Leitune VCB, Souza MD, Alves AK, Samuel SMW, Collares FM. In vitro evaluation of visible light-activated titanium dioxide photocatalysis for in-office dental bleaching. Dent Mater J 2018; 38:68-74. [PMID: 30449826 DOI: 10.4012/dmj.2017-199] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The evaluation of the photocatalysis of visible light activated titanium dioxide employed in hydrogen peroxide (H2O2) was carried using seven H2O2 solutions (3.5 and 35%) and/or methylene blue (MB), with or without light irradiation (LI); the absorbance of MB was the bleaching indicator. Color analysis was performed on bovine teeth (n=12) using two different concentrations of H2O2, 6 and 35% associated with titanium dioxide (TiO2). Data were analyzed with one and two-way ANOVA, and significance level of p<0.05. Solutions containing MB, H2O2 at 3.5 or 35%, and TiO2, followed by LI, showed significant difference when compared with other groups. Greater MB reduction was found in 35% concentration. H2O2 35%+TiO2 gel showed no difference in comparison to control group. All groups for the color analysis assay showed ΔE higher than 3.3. In conclusion, TiO2 and H2O2 association is a promisor alternative for reducing the clinical time of in-office dental bleaching.
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Affiliation(s)
- Marla Cuppini
- Department of Conservative Dentistry, Dental Materials Laboratory, School of Dentistry, Universidade Federal do Rio Grande do Sul
| | - Vicente Castelo Branco Leitune
- Department of Conservative Dentistry, Dental Materials Laboratory, School of Dentistry, Universidade Federal do Rio Grande do Sul
| | - Marcela de Souza
- Department of Conservative Dentistry, Dental Materials Laboratory, School of Dentistry, Universidade Federal do Rio Grande do Sul
| | - Annelise Kopp Alves
- Department of Materials, Ceramic Materials Laboratory, School of Engineering, Universidade Federal do Rio Grande do Sul
| | - Susana Maria Werner Samuel
- Department of Conservative Dentistry, Dental Materials Laboratory, School of Dentistry, Universidade Federal do Rio Grande do Sul
| | - Fabrício Mezzomo Collares
- Department of Conservative Dentistry, Dental Materials Laboratory, School of Dentistry, Universidade Federal do Rio Grande do Sul
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Effect of lights with various wavelengths on bleaching by 30% hydrogen peroxide. Lasers Med Sci 2018; 34:901-906. [PMID: 30421363 DOI: 10.1007/s10103-018-2670-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/19/2018] [Indexed: 12/11/2022]
Abstract
The objective of this study was to evaluate the bleaching effect of light sources with various wavelengths using 30% hydrogen peroxide (HP) in vitro. The hematoporphyrin-stained paper was bleached with HP and irradiated for 10 min using LED light sources with 265, 310, 365, 405, or 450 nm respectively. In control group, HP was applied for 10 min without light irradiation. The bleaching procedure was repeated two times. The L*a*b* values of the samples before bleaching and after each bleaching step were measured using a colorimeter. Color changes of specimens were then calculated and statistically analyzed. There was an interaction between light sources and time of irradiation in the color change (p < 0.05). Time and light sources significantly affected ΔE and ΔL (p < 0.05). The light source of 256 nm showed the highest bleaching effect over time followed by that of 310 nm, which were statistically different from other groups (p < 0.001). The 365 nm, 450 nm groups, and control group showed low bleaching effect visually with no significant differences in ΔE and ΔL (p > 0.05). It was concluded that the wavelengths of the light sources affected the bleaching by HP. The 310-nm light can be a potential source for bleaching.
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Mondelli RFL, Soares AF, Pangrazio EGK, Wang L, Ishikiriama SK, Bombonatti JFS. Evaluation of temperature increase during in-office bleaching. J Appl Oral Sci 2016; 24:136-41. [PMID: 27119761 PMCID: PMC4836920 DOI: 10.1590/1678-775720150154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 09/30/2015] [Indexed: 12/04/2022] Open
Abstract
The use of light sources in the bleaching process reduces the time required and promotes satisfactory results. However, these light sources can cause an increase in the pulp temperature.
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Affiliation(s)
- Rafael Francisco Lia Mondelli
- Departamento de Dentística, Endodontia e Materiais Odontológicos, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brasil
| | - Ana Flávia Soares
- Departamento de Dentística, Endodontia e Materiais Odontológicos, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brasil
| | - Eugenio Gabriel Kegler Pangrazio
- Departamento de Dentística, Endodontia e Materiais Odontológicos, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brasil
| | - Linda Wang
- Departamento de Dentística, Endodontia e Materiais Odontológicos, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brasil
| | - Sergio Kiyoshi Ishikiriama
- Departamento de Dentística, Endodontia e Materiais Odontológicos, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brasil
| | - Juliana Fraga Soares Bombonatti
- Departamento de Dentística, Endodontia e Materiais Odontológicos, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brasil
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Calderini A, Sciara S, Semeria C, Pantaleo G, Polizzi E. Comparative clinical and psychosocial benefits of tooth bleaching: different light activation of a 38% peroxide gel in a preliminary case-control study. Clin Case Rep 2016; 4:728-35. [PMID: 27525071 PMCID: PMC4974415 DOI: 10.1002/ccr3.605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 05/06/2016] [Accepted: 05/25/2016] [Indexed: 11/10/2022] Open
Abstract
Tooth bleaching is a widespread dental treatment with important psychosocial antecedents and outcomes involved. In the activation of in-office bleaching agents, a selective light radiation, that is, a diode laser seems to be a positive choice to decrease the time of bleaching without surface modification and with no residual tooth sensitivity for maximum effect and minimal clinical and psychological side effects.
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Affiliation(s)
- Angelo Calderini
- Department of Dentistry and School of Dental Hygiene Faculty of Medicine Vita-Salute San Raffaele University San Raffaele Hospital Via Olgettina 58 - 20132 Milano Italy
| | - Simona Sciara
- UniSR Social Lab [Research Methods] Faculty of Psychology Vita-Salute San Raffaele University Via Olgettina 58 - 20132 Milano Italy
| | - Chiara Semeria
- Department of Dentistry and School of Dental Hygiene Faculty of Medicine Vita-Salute San Raffaele University San Raffaele Hospital Via Olgettina 58 - 20132 Milano Italy
| | - Giuseppe Pantaleo
- Department of Dentistry and School of Dental Hygiene Faculty of Medicine Vita-Salute San Raffaele University San Raffaele Hospital Via Olgettina 58 - 20132 Milano Italy; Uni SR Social Lab [Research Methods] Faculty of Psychology Vita-Salute San Raffaele University Via Olgettina 58 - 20132 Milano Italy
| | - Elisabetta Polizzi
- Department of Dentistry and School of Dental Hygiene Faculty of Medicine Vita-Salute San Raffaele University San Raffaele Hospital Via Olgettina 58 - 20132 Milano Italy
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Šantak V, Zaplotnik R, Tarle Z, Milošević S. Optical Emission Spectroscopy of an Atmospheric Pressure Plasma Jet During Tooth Bleaching Gel Treatment. APPLIED SPECTROSCOPY 2015; 69:1327-1333. [PMID: 26647056 DOI: 10.1366/15-07962] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Optical emission spectroscopy was performed during atmospheric pressure plasma needle helium jet treatment of various tooth-bleaching gels. When the gel sample was inserted under the plasma plume, the intensity of all the spectral features increased approximately two times near the plasma needle tip and up to two orders of magnitude near the sample surface. The color change of the hydroxylapatite pastille treated with bleaching gels in conjunction with the atmospheric pressure plasma jet was found to be in correlation with the intensity of OH emission band (309 nm). Using argon as an additive to helium flow (2 L/min), a linear increase (up to four times) of OH intensity and, consequently, whitening (up to 10%) of the pastilles was achieved. An atmospheric pressure plasma jet activates bleaching gel, accelerates OH production, and accelerates tooth bleaching (up to six times faster).
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Affiliation(s)
- Vedran Šantak
- Institute of Physics, Bijenička cesta 46, 10000 Zagreb, Croatia
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Rakic M, Klaric E, Sever I, Rakic IS, Pichler G, Tarle Z. Real-time local experimental monitoring of the bleaching process. Photomed Laser Surg 2015; 33:230-5. [PMID: 25844683 DOI: 10.1089/pho.2014.3877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The purpose of this article was to investigate a new setup for tooth bleaching and monitoring of the same process in real time, so to prevent overbleaching and related sideeffects of the bleaching procedure. BACKGROUND DATA So far, known bleaching procedures cannot simultaneously monitor and perform the bleaching process or provide any local control over bleaching. MATERIALS AND METHODS The experimental setup was developed at the Institute of Physics, Zagreb. The setup consists of a camera, a controller, and optical fibers. The bleaching was performed with 25% hydrogen peroxide activated by ultraviolet light diodes, and the light for monitoring was emitted by white light diodes. The collected light was analyzed using a red-green-blue (RGB) index. A K-type thermocouple was used for temperature measurements. Pastilles made from hydroxylapatite powder as well as human teeth served as experimental objects. RESULTS Optimal bleaching time substantially varied among differently stained specimens. To reach reference color (A1, Chromascop shade guide), measured as an RGB index, bleaching time for pastilles ranged from 8 to >20 min, whereas for teeth it ranged from 3.5 to >20 min. The reflected light intensity of each R, G, and B component at the end of bleaching process (after 20 min) had increased up to 56% of the baseline intensity. CONCLUSIONS The presented experimental setup provides essential information about when to stop the bleaching process to achieve the desired optical results so that the bleaching process can be completely responsive to the characteristics of every individual, leading to more satisfying results.
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Laser teeth bleaching: evaluation of eventual side effects on enamel and the pulp and the efficiency in vitro and in vivo. ScientificWorldJournal 2015; 2015:835405. [PMID: 25874258 PMCID: PMC4385673 DOI: 10.1155/2015/835405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/13/2014] [Accepted: 11/13/2014] [Indexed: 12/12/2022] Open
Abstract
Light and heat increase the reactivity of hydrogen peroxide. There is no evidence that light activation (power bleaching with high-intensity light) results in a more effective bleaching with a longer lasting effect with high concentrated hydrogen peroxide bleaching gels. Laser light differs from conventional light as it requires a laser-target interaction. The interaction takes place in the first instance in the bleaching gel. The second interaction has to be induced in the tooth, more specifically in the dentine. There is evidence that interaction exists with the bleaching gel: photothermal, photocatalytical, and photochemical interactions are described. The reactivity of the gel is increased by adding photocatalyst of photosensitizers. Direct and effective photobleaching, that is, a direct interaction with the colour molecules in the dentine, however, is only possible with the argon (488 and 415 nm) and KTP laser (532 nm). A number of risks have been described such as heat generation. Nd:YAG and especially high power diode lasers present a risk with intrapulpal temperature elevation up to 22°C. Hypersensitivity is regularly encountered, being it of temporary occurrence except for a number of diode wavelengths and the Nd:YAG. The tooth surface remains intact after laser bleaching. At present, KTP laser is the most efficient dental bleaching wavelength.
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Laser all-ceramic crown removal and pulpal temperature—a laboratory proof-of-principle study. Lasers Med Sci 2015; 30:2087-93. [DOI: 10.1007/s10103-015-1738-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
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Féliz-Matos L, Hernández LM, Abreu N. Dental Bleaching Techniques; Hydrogen-carbamide Peroxides and Light Sources for Activation, an Update. Mini Review Article. Open Dent J 2015; 8:264-8. [PMID: 25646134 PMCID: PMC4311381 DOI: 10.2174/1874210601408010264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 10/19/2014] [Accepted: 11/17/2014] [Indexed: 11/22/2022] Open
Abstract
Hydrogen and carbamide peroxides have been successfully used for many years; in the past century the dental bleaching technique suffered several changes and almost 10 years before new millennium the technique was finally recognized by the international agencies of regulation. It is important that Dentists handle the peroxides with the essential knowledge, because it is demonstrated that satisfactory final results of this technique depend on the correct diagnosis of stains, management of the substrates (enamel and dentin) and as well sensitivity. Dentists are exposed to several dental bleaching techniques, products and brands, and in the last 2 decades the devices for light activation of the peroxides have become an extensive catalog. Today, the technique is also suffering changes based on the effectiveness of the different light sources for peroxide activation and its relation to satisfactory final results of the technique. The purpose of this literature review is to explain the determinant factors that influence satisfactory final results of the techniques and provide a general overview, in order to achieve a treatment decision based on evidence.
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Affiliation(s)
- Leandro Féliz-Matos
- Department of Academic Research/School of Dentistry, Universidad Iberoamericana, UNIBE. Santo Domingo, Dominican Republic
| | - Luis Miguel Hernández
- Department of Academic Research/School of Dentistry, Universidad Iberoamericana, UNIBE. Santo Domingo, Dominican Republic
| | - Ninoska Abreu
- Department of Academic Research/School of Dentistry, Universidad Iberoamericana, UNIBE. Santo Domingo, Dominican Republic
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