The effect of long-term use of tooth bleaching products on the human enamel surface

Evaluation of Relative Dentin Abrasivity in Whitening Toothpastes Containing Acids

INTRODUCTION AND AIMS

This study aimed to evaluate the relative dentin abrasivity of whitening toothpastes containing acids using the Radioactive Dentin Abrasivity - Profilometry Equivalent (RDA-PE).

METHODS

A total of 100 bovine dentin specimens were prepared and assigned to the following groups (n = 10): 5 hydrogen peroxide (HP) whitening toothpastes (WTH1-WTH5) with or without acid (citric acid, ethylenedinitrilotetraacetic acid disodium, and phosphoric acid), 2 whitening toothpastes with silica and containing citric or phosphoric acid (WTS1 and WTS2), one conventional toothpaste (CT), and 2 reference slurries (RS). All specimens were brushed for 4,000 or 10,000 strokes using toothbrush and toothbrushing machine. The average dentin depth was measured using a noncontact profilometery, and the RDA-PE value was calculated based on the RS. The pH of the solution, average particle size, particle content, and particle hardness were measured. The RDA-PE data were analysed using one-way analysis of variance and Tukey's test, and the effects of the 4 measured factors on RDA-PE were investigated via multiple regression analysis.

RESULTS

The RDA-PE values of the HP whitening toothpastes (mean value: 19-46) were significantly lower, whereas those of the silica whitening toothpastes (80 or 111) were similar to those of the RS after 4,000 strokes (100). The RDA-PE values of all whitening toothpastes were significantly lower than the RS values after 10,000 strokes (242). The HP whitening toothpastes were slightly acidic (pH ≤6) compared to the other solutions. The HP (2.9%-3.7%) and silica (8.9% or 9.9%) whitening toothpastes had significantly lower particle content than RS (16.6%). The particle content significantly influenced the RDA-PE values by multiple regression results.

CONCLUSIONS

The RDA-PE values of whitening toothpastes varied. The particle content in the solution was a key factor affecting the RDA-PE value.

CLINICAL RELEVANCE

Whitening toothpastes containing acids did not cause significant dentin abrasion.

Effects of experimental in-office bleaching gels incorporated with co-doped titanium dioxide nanoparticles on dental enamel physical properties

To evaluate the physical properties of enamel submitted to hydrogen peroxide (HP) incorporated with titanium dioxide nanoparticles (NP) co-doped with nitrogen and fluorine and irradiated with violet LED light (LT). Enamel-dentin disks were randomly allocated (T0) into groups, according to HP (HP6, HP15, or HP35) and NP (no NP, 5NP, or 10NP) concentrations, and irradiated or not with LT. A negative control (NC) group was set. After three bleaching sessions (T1, T2, and T3), specimens were stored in saliva for 14 days (T4). Enamel surface microhardness number (KHN), surface roughness (Ra), cross-sectional microhardness (ΔS), energy-dispersive spectroscopy (EDS), scanning electron (SEM), and polarized light (PLM) microscopies were performed. Surface KHN was significantly influenced by NP over time, independently of LT irradiation. At T3 and T4, gels with 5NP and 10NP exhibited no KHN differences compared to NC and baseline values, which were not observed under the absence of NP. NP incorporation did not statistically interfere with the ΔS and Ra. PLM images exhibited surface/subsurface darkening areas suggestive of demineralizing regions. SEM demonstrated some intraprismatic affection in the groups without NP. EDS reported a higher enamel calcium to phosphorus ratio following 10NP gels applications. Gels with NP maintained the enamel surface microhardness levels and seemed to control surface morphology, upholding the mineral content. None of the proposed experimental protocols have negatively influenced the enamel surface roughness and the cross-sectional microhardness.

In vitro evaluation of the effect of different bleaching varnishes: Hydrogen peroxide penetration into the pulp chamber and color change

OBJECTIVE

To evaluate the penetration of hydrogen peroxide (HP) into the pulp chamber and the color change of different bleaching varnishes in low concentrations used for at-home bleaching.

MATERIALS AND METHODS

Ninety healthy premolars were used, randomly distributed into nine groups (n = 10) according to bleaching varnish (PL, PolaLuminate; VS, VivaStyle Paint On Plus; CA, Cavex Bite&White whitening pen and; AW AlignerWhite) and time (10 and 30 min), and a control group (no bleaching). The penetration of HP was evaluated by UV-Vis spectroscopy. To evaluate the color change (ΔEab , ΔE00 , ΔWID ) a digital spectrophotometer was used (α = 0.05).

RESULTS

The AW group in 10 min and the control group showed similar and lower HP penetration in the pulp chamber when compared to the other groups (p = 0.003). Increasing the application time to 30 minutes elevated the amount of HP inside the pulp chamber for all groups (p = 0.003), except for PL (p > 0.05). When applied for 30 min all bleaching varnishes showed higher color change (ΔWID ) when compared to 10 min (p = 0.04).

CONCLUSIONS

For all bleaching varnishes evaluated, PolaLuminate applied for 30 min showed lower penetration into the pulp chamber and higher bleaching effects.

CLINICAL SIGNIFICANCE

The use of bleaching varnishes seems promising for teeth bleaching, but it varies according to user product and protocol.

Feasibility and Safety of Adopting a New Approach in Delivering a 450 nm Blue Laser with a Flattop Beam Profile in Vital Tooth Whitening. A Clinical Case Series with an 8-Month Follow-Up

A prospective observational case series included six patients who presented with discoloured upper and lower teeth extending from the right second premolar to the left second premolar. The photoactivation dosimetry and treatment protocol were as follows: λ 450 nm, 1 W, CW; flattop beam profile; 1 cm2; 15 J/spot; 10 irradiated spots; an irradiation time of 15 s/spot; three whitening cycles in a single session. Blanc One ULTRA+ was the bleaching agent. A visual analogue scale (VAS) was utilised to evaluate the pain intensity and dental hypersensitivity during treatment immediately after complete treatment (T1), 24 h (T2), and 8 h (T3) postoperatively, and at an 8-month follow-up timepoint (T4), whereas the dental colour shade change was assessed using the VITA colour shade guide pre-treatment (T0), T1, and T4. The Gingival index and modified Wong Baker faces scale were utilised to evaluate gingival inflammation and patients' treatment satisfaction, respectively. Our findings revealed a reduction in the dental colour shade of the six cases between 2 and 10- fold (average of 3.5-fold) at T1 and maintained at T4, indicating significant improvement in the colour shade change with optimal outcomes. The percentage of this improvement for all the patients was ranged between 16.6% and 33.3%. At all timepoints, a "0" score was provided for pain intensity, dental hypersensitivity, and gingival inflammation. Our study demonstrates the feasibility and safety of a λ 450 nm laser delivered with a flattop handpiece to achieve optimal whitening outcomes without adverse effects. This offers a useful guide for dental clinicians for vital in-office tooth whitening. Extensive clinical studies with large data are warranted to validate our study protocol.

Color match analysis of single-shade and multi-shade composite resins using spectrophotometric and visual methods after bleaching

The aim of this study is to evaluate the color match of the materials after the staining and bleaching procedures applied to the teeth restored with single-shade and multi-shade composite resins. Cavities prepared on the facial surface of human incisors were restored with two different composite resins. After 24 h, the color matching parameters between the initial filling-tooth of the samples were recorded. Then, the color measurements of the samples subjected to the coloring process were repeated. Each composite resin group was randomly divided into 2 subgroups and home and office bleaching methods were applied to the samples. After bleaching, color measurements were repeated. In terms of periods, a statistically significant difference was found in ΔE values 1 day and 28 days after bleaching (p<0.05). In addition, it was found that the color match between filling-tooth was generally weaker in Omnichroma material and after home bleaching.

The effect of ascorbic acid and cranberry on the bond strength, surface roughness, and surface hardness of bleached enamel with hydrogen peroxide and zinc phthalocyanine activated by photodynamic therapy

AIM

To evaluate the effect of different bleaching methods 40% (hydrogen peroxide) HP and Zinc Phthalocyanine (ZP) activated by photodynamic therapy (PDT) with the utilization of diverse procedures of reversal (10% ascorbic acid and 6% cranberry solution) on bond values, surface microhardness and surface roughness of bleached enamel surface.

MATERIAL AND METHODS

An aggregate of 60 extracted human mandibular molars was gathered and the buccal surface of each specimen was exposed to 2 mm of enamel surface for bleaching with chemical and photoactivated agents with the use of reversal solutions. Specimens were divided into six groups (n = 10) at random- Group 1: samples bleached with 40% HP with 10% ascorbic acid (reversal agent), group 2: ZP activated by PDT with 10% ascorbic acid (reversal agent), group 3: 40% HP with 6% cranberry solution as a reversal agent, group 4: ZP activated by PDT with 6% cranberry solution, group 5: 40% HP and group 6: ZP activated by PDT with no reversal agents. Resin cement restoration was performed via etch and rinse technique and SBS was estimated by using the universal testing machine, SMH by using Vickers hardness tester, and Ra by stylus profilometer. Statistical analysis was executed using the ANOVA test and the Tukey multiple tests (p<0.05).

RESULTS

Enamel surface bleached with 40% HP reversed with 10% ascorbic acid displayed the highest SBS while 40% HP with no reversal agent use showed the least SBS. For SMH, ZP activated by PDT when applied on the enamel surface and reversed with 10% ascorbic acid showed the highest SMH while when bleached with 40% HP and reversed with 6% cranberry solution showed the least SMH value. For Ra, Group 3: samples bleached with 40% HP with 6% cranberry solution as reversal agent showed the highest Ra value while bleaching of enamel surface with ZP activated by PDT with 6% cranberry displayed the least Ra value.

CONCLUSION

Bleached enamel surface with Zinc Phthalocyanine activated by PDT with the application of 10% ascorbic acid as reversal solution has demonstrated the highest SBS and SMH with acceptable surface roughness for bonding adhesive resin to the enamel surface.

Treatment Durations and Whitening Outcomes of Different Tooth Whitening Systems

Background and Objectives: Tooth whitening is a relatively conservative and effective option to treat discolored teeth. However, questions remain whether in-office or at-home tooth whitening products with short treatment durations are as effective and stable as products with longer treatment durations. Materials and Methods: Forty human third molars with intact enamel surfaces were divided into four groups of ten each, subjected to discoloration challenges with coffee for 60 h, and they were treated with four professional tooth whitening systems: two for take-home use-6% hydrogen peroxide for 30 min/d for a total of 7 h in 14 days (HP6), 10% carbamide peroxide for 10 h/d for 140 h in 14 days (CP10), as well as two for in-office use-35% HP for 10 min × 3 (HP35) for a total of 30 min and 40% HP for 20 min × 3 (HP40) for a total of 60 min. Teeth colors were assessed in the CIE L*a*b* color space with a spectrophotometer immediately and six months after whitening treatments. Surface roughness (Sa) for the treated and untreated enamel surfaces of the teeth in all groups were evaluated with a three-dimensional laser scanning microscope after six months. Results: No significant differences were found between HP6 and CP10 groups immediately after whitening (∆E 10.6 ± 1.6 vs. 11.4 ± 1.7, p > 0.05) and at six months after treatments (∆E 9.0 ± 1.9 vs. 9.2 ± 2.5, p > 0.05), or between HP35 and HP40 groups immediately after whitening (∆E 5.9 ± 1.2 vs. 5.3 ± 1.7, p > 0.05) and at six months after treatments (∆E 7.2 ± 1.6 vs. 7.7 ± 1.3, p > 0.05). The two at-home whitening systems achieved significantly better whitening outcomes than the two in-office products immediately after whitening (p < 0.05). However, at six months after treatments, the differences between at-home and in-office treatments had narrowed significantly (p > 0.05). There were no statistically significant differences with respect to the Sa values between the treated and untreated surfaces (p > 0.05). Conclusions: Tooth whitening products in the same product category have similar whitening efficacies, despite significant differences in treatment durations (7 vs. 140 h, and 30 min vs. 60 min, respectively). Take-home products achieved better whitening outcomes than in-office products, but they needed 14 to 280 times longer treatment durations.

The Effect of In-Office Bleaching with Different Concentrations of Hydrogen Peroxide on Enamel Color, Roughness, and Color Stability

The aim of this study is to evaluate the effectiveness of in-office bleaching in esthetic dentistry on the roughness and color stability of the enamel surface, using different concentrations of hydrogen peroxide (HP). Fifty human incisors were randomly divided into 5 groups (n = 10). No bleaching was performed in the control group. For these groups, concentrations of 40% HP with fluoride (F), 35% HP with calcium (Ca), 25% HP with nano-hydroxyapatite (nHA) and 18% HP with nHA were used for bleaching in the test groups. Surface roughness was assessed at baseline after bleaching occurred. Color measurements were first obtained at baseline, then after the first and second sessions of bleaching, and, finally, after the staining protocol. Scanning electron microscopy and atomic force microscopy were performed. Statistical analysis was conducted with a one-way ANOVA, followed by a post hoc Tukey's test and a paired-samples t-test (p < 0.05). All the bleaching gels used exhibited a similar color change (p > 0.05). Bleaching gels containing 18% HP with nHA and that containing 35% HP with Ca caused less surface roughness of the enamel. Of these concentrations, 25% HP with nHA caused the most surface roughness and no significant difference was observed, compared with 40% HP with F. The highest coloration after bleaching was observed in 40% HP with F and 25% HP with nHA. The lowest coloration was obtained in 35% HP with Ca and 18% HP with nHA but no significant difference was observed between them and the control group. A concentration above 18% HP does not increase the bleaching effectiveness. The results show that 18% HP with nHA and 35% HP with Ca resulted in the least increase in enamel surface roughness when compared to high-concentrate HP; however, it also prevented recoloration after bleaching.

Microhardness change of human dental enamel due to power bleaching with different gels

AIM

Since the introduction of bleaching treatments in the office, different lights have been suggested to accelerate the bleaching reaction. This study aimed to evaluate the microhardness of tooth enamel after office bleaching using different materials.

Effect of bioactive glass paste on efficacy and post-operative sensitivity associated with at-home bleaching using 20% carbamide peroxide: a randomized controlled clinical trial

Background

The aim of this study was to evaluate the effect of bioactive glass (BAG) 45S5 paste on colour change and tooth sensitivity (TS) when used in combination with 20% carbamide peroxide (CP) during at-home vital tooth bleaching.

Methods

Twenty-four patients were selected and assigned into two experimental groups (n = 12) in a double-blind study design. Each patient received 20% CP followed by the application of either BAG paste or non-active placebo paste. The shade evaluation was performed using a digital spectrophotometer based on the CIE L*a*b* colour space system at different time points and the overall colour changes ΔE were calculated. TS was evaluated using visual analogue scale (VAS). The values of ΔE and TS were statistically analysed using paired t-test. The level of statistical significance was established at p = 0.05.

Results

The overall colour changes (ΔE) between baseline and each time point showed no significant differences between BAG and placebo groups (p > 0.05). The use of BAG paste significantly decreased TS reported by the participants.

Conclusions

The association of BAG paste with at-home bleaching treatment presents a promising method as it decreased TS and did not deteriorate bleaching efficacy.

Trial registration This study was approved and registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under Registration number: ACTRN12621001334897.

Effect of Over-The-Counter Tooth-Whitening Products on Enamel Surface Roughness and Microhardness

Background: To evaluate the efficacy of new over-the-counter tooth-whitening products on enamel surface roughness and microhardness. Methods: A total of 120 enamel specimens were prepared and randomly allocated into six groups. Group A was treated with 10% carbamide peroxide; Group B was immersed in distilled water; Group C was treated with hydrated silica, sodium hexametaphosphate toothpaste; Group D was treated with sodium bicarbonate; Group E was treated with 0.25% citric acid; and Group F was treated with hydrated silica, charcoal powder. Results: A, B, and D demonstrated decreased Ra, whereas Groups C, E, and F showed an increased Ra after whitening. The changes in Ra from T0 to T1 in each group was statistically significant (p < 0.001) except for Group B (p = 0.85). The groups showed decreased KHN after whitening, except for specimens in Group B (distilled water). The KHN from T0 to T1 decreased significantly for groups A, C, E, and F (p = 0.001). Significant difference was observed at T1 (p < 0.0001). Conclusion: Within the limitations of this study, it could be demonstrated that surface roughness and enamel microhardness changes were influenced by the type, composition, and exposure time of the whitening product.

Is prolonged bleaching more harmful to dental enamel than daily dietary and hygienic oral habits?

The ultrastructural and mechanical properties of enamel surface were evaluated after prolonged bleaching treatments with 10% carbamide peroxide in the presence or absence of orange juice (erosive challenge) and toothbrushing (abrasive challenge). In total, 145 incisor bovine teeth were used in this study. Twenty-five samples were prepared for the ultrastructural evaluations, and 120 samples were prepared for microhardness and roughness tests. These 120 samples were divided into eight experimental groups (n = 15): G1- artificial saliva; G2- abrasion; G3- erosion; G4- dental bleaching; G5- erosion + abrasion; G6- bleaching + abrasion; G7- bleaching + erosion; and G8- bleaching + erosion + abrasion. All groups were tested at T0 (before treatment), T1 (14 days), T2 (21 days), and T3 (28 days). Two-way analysis of variance for repeated measures and the post hoc Sidak tests (p ≤ 0.05) were used. The roughness evaluation demonstrated an increase in damage for all experimental groups with an increase in the time period. For microhardness, the groups exposed to artificial saliva (AS) and abrasive challenge did not show any differences at any time points, while the other groups showed a decrease in microhardness from T0 to T3. Ultrastructural evaluation showed different surface alterations in response to the treatments. Despite prolonged bleaching periods, the procedure caused lesser enamel surface alterations than exposure to orange juice alone or in combination with brushing.

Evaluation of Monomer Elution and Surface Roughness of a Polymer-Infiltrated Ceramic Network CAD-CAM Material After Er,Cr:YSGG Laser-assisted Tooth Bleaching

PURPOSE

The aim of this in vitro study was to examine the effect of Er,Cr:YSGG laser-assisted tooth bleaching treatment on the elution of monomers and surface roughness of a hybrid computer-aided design-computer-aided manufacturing (CAD-CAM) material, and to compare it with a resin composite for direct restorations.

METHODS AND MATERIALS

Forty specimens of a hybrid CAD-CAM material (Enamic) and forty of a conventional resin composite (Tetric) were fabricated and randomly divided into four groups (n=10). Half of the specimens of each material were stored in distilled water and the other half in artificial saliva for 7 days. At the end of this period, the storage medium was analyzed by high-performance liquid chromatography (HPLC), and the surface roughness parameters of the specimens were evaluated by optical imaging noncontact interferometric profilometry. Afterwards, half of the specimens of each tested material received a conventional in-office tooth bleaching treatment and the other half an Er,Cr:YSGG laser-assisted bleaching treatment, and then they were again incubated in distilled water and artificial saliva for an additional 7-day time period. At the end of this period, the effect of the bleaching treatments on elution of monomers and surface roughness of the tested materials was evaluated.

RESULTS

Bisphenol A (BPA), urethane dimethacrylate (UDMA), triethylene glycol dimethacrylate (TEGDMA), and bisphenol A-glycidyl dimethacrylate (BisGMA) were eluted from the conventional resin composite into both the solutions tested. Only TEGDMA was eluted from the hybrid CAD-CAM material. However, no statistically significant differences were found among the surface roughness parameters of both materials. Both the conventional and Er,Cr:YSGG laser-assisted tooth bleaching treatments affected the monomer elution from the composite resin. However, there were no statistically significant differences (p<0.05) between the treatments.

CONCLUSIONS

According to the results of this study, tooth bleaching with Er,Cr:YSGG laser or conventional technique is safe, even if the bleaching agent comes in contact with hybrid CAD-CAM restorations.

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 bleaching agents on hardness, surface roughness and color parameters of dental enamel

Background

In this study was evaluated the effect of carbamide peroxide (CP) and hydrogen peroxide (HP) in different concentrations on hardness, roughness, and color parameters (color change - ΔE, lightness - ΔL, and yellow-blue axis - Δb) of bovine teeth.

Material and Methods

Fifty square dental blocks (7 x 7 x 2 mm) were submitted to initial readings of Knoop hardness, surface roughness (Ra), and color parameters. Specimens were divided into 5 groups (n = 10): control group was kept in artificial saliva during the experimental period; CP 20% was bleached for 2 h daily for 14 days, HP 9.5% was bleached for 30 min daily for 14 days, HP 38% the bleaching gel was applied for 15 min, gel was removed and it was reapplied for two more times, the bleaching session was repeated for another 2 times every 7 days, totaling three sessions, and in CP 45% three sessions of 30 min each were performed of 7 in 7 days. All groups after the bleaching procedures had the bleaching gel removed, washed, and kept in artificial saliva. At the end of bleaching treatment, the hardness, roughness, and color parameters (ΔE, ΔL, and Δb) were re-evaluated. Data were analyzed by ANOVA, Tukey, and Dunnett tests (α = 0.05).

Results

Bleaching promoted a reduction in hardness, the CP 45% showed the lowest hardness and the CP 20% the highest, the HP 9.5% and HP 38% showed intermediate values of hardness. Bleaching agents did not affect the roughness. CP 20% and HP 38% promoted the highest values of ΔE and higher reduction of yellowish tone of tooth. Lightness increase after bleaching treatment for all groups.

Conclusions

All the bleaching agents tested showed effectiveness, but with reduced hardness.

Key words:Carbamide peroxide, hydrogen peroxide, tooth whitening, hardness, roughness.

Influence of Prolonged Dental Bleaching on the Adhesive Bond Strength to Enamel Surfaces

The objective of this in vitro study was to assess the influence of prolonged bleaching pre- and postrestoration on the bond strength (microshear) to enamel using 4% hydrogen peroxide (PH4). In the postrestorative bleached specimens evaluation, the composite cylinders were assembled after bleaching, while in the prebleached specimens, the cylinders were assembled before. Therefore, in the postbleached specimens, 60 bovine teeth were randomly assigned as follows: G1: control; G2: 14 days bleaching before bond strength (BS) testing; G3: 21 days; and G4: 28 days. In prebleached specimens, 180 bovine teeth were randomly assigned as follows: G1: control; G5: 14 days bleaching, storage in artificial saliva (AS) for 24 h before BS testing; G6: 14 days beaching, AS storage for 7 days before BS testing; G7: 21 days bleaching, AS storage for 24  h before BS testing; G8: 21 days bleaching, AS storage for 7 days before BS testing; G9: 28 days bleaching, AS storage for 24 hours before BS testing; and G10 : 28 days bleaching, AS storage for 7 days before BS testing. The results were submitted to ANOVA one-way (postrestoration bleaching) and two-way (prerestoration bleaching) and Tukey's post hoc test (p ≤ 0.05). In the postrestoration bleaching, no statistical difference between times was found. However, when bleached groups were compared to the control (G1), an expressive difference was detected (p ≤ 0.0001). For prerestoration bleaching, all experimental groups were statistically different from G1 (p ≤ 0.05), except G6 (p ≥ 0.01), and for G5 and G6, statistical differences were found (p ≤ 0.01). There were no significant differences between G7 and G8 and between G9 and G10, regardless of the AS storage times (p ≥ 0.05). It was concluded that prolonged bleaching with PH4 decreased adhesion resistance regardless of the moment of the bleaching (post- and prerestoration bleaching).

In Vitro Re-Hardening of Bleached Enamel Using Mineralizing Pastes: Toward Preventing Bacterial Colonization

The search for materials able to remineralize human hard tissues is a modern medical challenge. In this study, the protective effect on the enamel microhardness by a paste based on hydroxyapatite and sodium fluoride (Remin Pro) was evaluated after two different enamel bleaching procedures. Forty sound human incisors were randomly assigned to different treatments: bleaching with an in-office agent (Perfect Bleach Office+); bleaching with an at-home agent (Perfect Bleach); bleaching with the in-office agent followed by the prophylaxis paste; bleaching with the at-home agent followed by the prophylaxis paste; no treatment (control). Bleaching was performed at 0, 8, 24 and 32 h, followed by a 3-min re-mineralizing treatment in the subgroups designed to receive it. Specimens underwent a micro-hardness tester and a mean Vickers Hardness number was considered for each specimen. ANOVA exhibited significant differences among groups. Post-hoc Tukey testing showed significant micro-hardness decrease after the application of both the two bleaching agents. The treatment with prophylaxis paste significantly increased the micro-hardness values of bleached enamel.

Effect of CPP-ACP on efficacy and postoperative sensitivity associated with at-home vital tooth bleaching using 20% carbamide peroxide

OBJECTIVES

To evaluate CPP-ACP effect on colour change and tooth sensitivity (TS) associated with at-home vital tooth bleaching using 20% carbamide peroxide (CP).

METHODS

A randomised double-blind placebo-controlled clinical trial was conducted to measure the TS and tooth colour change of 24 patients at 3-day, 7-day, 14-day and 30-day periods. The participants were instructed to apply 20% CP (7 days-04 h each) followed by the application of either CPP-ACP or non-active placebo paste, delivered by the bleaching custom tray (7 days-30 min each). Lightness (L*), redness (a*) and yellowness (b*) were measured using a digital spectrophotometer and the overall colour changes ∆E were calculated. ∆E and TS values were statistically analysed. The level of statistical significance was established at p = 0.05.

RESULTS

No significant differences were detected between CPP-ACP and placebo groups regarding the ∆E. The ∆E measurements presented significant differences within CPP-ACP groups between 3-day vs. 14-day and 30-day measurements. The CPP-ACP application reduced significantly the TS reported by the participants at 3-day when compared with the placebo group.

CONCLUSION

The application of CPP-ACP paste during at-home tooth bleaching with 20% CP was beneficial since its use reduced the TS and presented no deteriorating effect on the colour change.

CLINICAL RELEVANCE

The current findings are of importance for clinicians to manage TS reported by patients when a high CP bleaching agent is used.