Effect of light activation on tooth whitening efficacy and hydrogen peroxide penetration: An in vitro study

New Insights Regarding the Use of Relevant Synthetic Compounds in Dentistry

Worldwide, synthetic compounds are used for both in-office and at-home dental care. They are a valuable resource for both prophylactic and curative treatments for various dental problems, such as tooth decay, periodontal diseases, and many more. They are typically preferred due to their broad range of actions and ability to produce targeted, rapid, and long-lasting effects. Using a 0.12% chlorhexidine mouthwash is capable of reducing the plaque index from 47.69% to 2.37% and the bleeding index from 32.93% to 6.28% after just 2 weeks. Mouthwash with 0.1% OCT is also highly effective, as it significantly lowered the median plaque index and salivary bacterial counts in 152 patients in 5 days compared to a control group (p < 0.0001), while also reducing the gingival index (p < 0.001). When povidone-iodine was used as an irrigant during the surgical removal of mandibular third molars in 105 patients, it resulted in notably lower pain scores after 2 days compared to a control group (4.57 ± 0.60 vs. 5.71 ± 0.45). Sodium hypochlorite is excellent for root canal disinfection, as irrigating with 1% NaOCl completely eliminated the bacteria from canals in 65% patients. A 0.05% CPC mouthwash proved effective for perioperative patient care, significantly decreasing gingival bleeding (p < 0.001) and suppressing Streptococcus levels even one week post-surgery. Lastly, a 6% H2O2 paint-on varnish and 6% H2O2 tray formulations successfully bleached the teeth of 40 patients, maintaining a noticeably whiter appearance up to the 6-month follow-up, with significant color differences from the baseline (p < 0.005). Synthetic compounds have a large research base, which also provides a greater awareness of their mechanism of action and potential adverse effects. For a better understanding of how they work, several methods and assays are performed. These are protocolary techniques through which a compound's efficacy and toxicity are established.

Effects of Different Light-Assisted Power Bleaching Techniques on the Penetration of Hydrogen Peroxide into the Pulp Chamber

Background: In-office bleaching is one of the most commonly used procedures for discolored tooth treatment. Although the efficacy of tooth bleaching has been investigated, depending on the applied technique and the used materials, bleaching procedures might irritate the tooth pulp and induce surface changes in enamel. The aim of this study was to evaluate the effect of four different bleaching techniques on the penetration of hydrogen peroxide (HP) into the pulp chamber. Materials and methods: Seventy-two single-rooted sound human teeth were used. The samples were prepared and evaluated in four groups. Group 1: 35% HP gel alone (HP Gel); group 2: Nd:YAG laser (0.25 W and 10 Hz with a fiber tip size of 200 μm) irradiation was added (HP Gel+laser); group 3: HP gel mixed with graphite particles (10th of millimeter in size) derived from crashed pencil lead in association with Nd:YAG laser (HP Gel+laser+graphite); and group 4: HP gel in association with light-emitting diode (LED) (litex 686, 50 Hz, 450-490 nm) (HP Gel+LED). The amount of HP penetrating into the pulp chamber was evaluated using acetate buffer and standard graphs. Data were analyzed with one-way ANOVA test, using SPSS 17. Post hoc Tukey test was used for between-group comparisons (α = 0.05). Results: Statistical analyses showed that the HP Gel+laser+graphite group had significantly higher level of HP penetration than other groups (p < 0.001). Moreover, pulp chamber penetration of HP in the HP Gel+laser group was greater than the LED and control groups (p < 0.001). The difference between control and LED groups was not significant (p = 0.99). Conclusions: Laser bleaching associated with HP Gel and graphite particles resulted in increased penetration of HP into the pulp chamber compared with the LED and control groups.

Change of dental color and temperature through two bleaching agents boosted with light emitted by diodes

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 ∆WI_D 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 ∆WI_D 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 ∆WI_D 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.

Analysis of enamel structure and mineral density after different bleaching protocols using micro-computed tomography

OBJECTIVE

This study aims to investigate the effect of three different bleaching applications on structural integrity, mineral volume (MV) and density of the enamel by using micro-computed tomography (Micro-CT) and evaluate the colour effectiveness using CIEDE2000.

MATERIALS AND METHODS

Twenty-four maxillary premolar teeth were divided into three groups (n = 8) (group 1: 40% HP gel with erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser activation; group 2: 40% HP gel with diode laser activation; group 3: 16% CP gel). Bleaching protocols were applied and colour alteration was obtained. Data were calculated with CIEDE2000 before and after bleaching. A Micro-CT was used to scan the specimens before and after the bleaching application. Statistical analysis was performed by ANOVA.

RESULTS

No significant difference was observed between the groups for colour changes (p > .05). Micro-CT analysis showed significant differences in structural thickness, structural separation, mineral density and MV for the different ROIs before and after bleaching for all groups (p<.05).

CONCLUSIONS

All of the bleaching methods represented similar efficiency. However, bleaching with Er,Cr:YSGG laser was less harmful to enamel in comparison with other bleaching methods. The present results may be useful for establishing a numerical standard for the change in bleaching with laser systems in dental hard tissues.

A review on dental whitening

OBJECTIVES

To provide a narrative review on vital dental whitening chemistry, toxicity and safety, vital dental whitening techniques, whitening systems, potential side effects of whitening and cyclic whitening using products with a range of concentrations and pH values. In addition, new developments and recommendations in the field of vital dental whitening will be presented to help clinicians understand the whitening process, its advantages, limitations, and the impact of whitening concentration and pH on enamel providing guidance in tailoring whitening treatments.

DATA

Data were gathered using the following keywords: dental whitening, roughness, hardness, sensitivity, hydrogen peroxide, whitening pH, whitening concentration, whitening chemistry, colour, and toxicity.

SOURCES

An electronic search was performed using PubMed and Scopus databases. Bibliographic material from papers reviewed was then used to find other relevant publications.

CONCLUSIONS

The effectiveness of vital dental whitening depends on many factors, such as the concentration/pH of the whitening agent, application duration, chemical additives, and re-mineralising agents used. Developing new whitening products and technologies such as nano-additives and alternative carrier systems is showing promising results, and might prove efficient in maximising whitening benefits by accelerating the whitening reaction and/or minimising expected reversible/irreversible enamel structural damage.

Cytotoxic Effects of Zoom® Whitening Product in Human Fibroblasts

Tooth whitening procedures are increasing; however, side effects can occur, such as damage to pulp cells, by the whitening products. This study aims to assess the cellular effects promoted by a whitening product, namely, the oxidative stress fostered by the active agent hydrogen peroxide, with and without photoactivation. Additionally, if cellular recovery occurred, we intended to determine the time point where cells recover from the tooth whitening induced damage. Human fibroblasts were exposed to hydrogen peroxide, Zoom^®, Zoom^® + irradiation, and irradiation alone. The following analysis was performed: metabolic activity evaluation by the MTT assay; cell viability, mitochondrial membrane potential, peroxides production, superoxide radical production, and reduced glutathione expression by flow cytometry. We determined the IC₅₀ value for all groups, and a dose-dependent cytotoxic effect was verified. At the times analyzed, hydrogen peroxide groups showed no metabolic activity recovery while a cell recovery was observed after 24 h (Zoom^®) and 48 h (Zoom^® + irradiation). Cell death was seen in hydrogen peroxide and Zoom^® + irradiation groups, mainly by apoptosis, and the irradiation had a cytotoxic effect per se. This in vitro study supports that whitening products with moderate hydrogen peroxide (HP) concentration have a temporary effect on cells, allowing a cellular recovery.

A New Approach for Dental Bleaching Using Violet Light With or Without the Use of Whitening Gel: Study of Bleaching Effectiveness

The objective of this study was to evaluate the effectiveness of violet light-emitting diodes (LEDs) in dental bleaching treatment when used in conjunction with bleaching gels containing different concentrations of hydrogen peroxide (HP). Here, 90 bovine teeth (n=15) were randomly assigned to the following groups: GI, placebo without light; GII, 35% HP without light; GIII, 17.5% HP without light; GIV, placebo with violet LED; GV, 35% HP with violet LED; and GVI, 17.5% HP with violet LEDs. Three bleaching sessions of 45 minutes were conducted; 21 cycles involving one minute of irradiation by violet LEDs with 30-second intervals were performed during each session of bleaching (GIV, GV, and GVI). Color changes (ΔE, ΔL, Δa, and Δb) were analyzed using a visible ultraviolet light spectrophotometer 7 days after each bleaching session. The mean ΔE, ΔL, Δa, and Δb values were compared between groups by analysis of variance and Tukey tests, with a significance level of 5%. The groups treated with 35% HP had higher ΔE and ΔL and lower Δb values, regardless of whether violet light was used. The group that received only violet LED differed from the control group in terms of ΔE, and the group treated with 17.5% HP and violet LED presented higher ΔE values than the group treated with 17.5% HP only. Thus, violet light did not influence bleaching efficacy when using 35% HP, but when used in conjunction with 17.5% HP, it increased the bleaching efficacy. Moreover, use of the violet LED only also prompted a bleaching effect, although it was less marked.

Hydrogen Peroxide Diffusion through Enamel and Dentin

The purpose of this study was to evaluate the in vitro diffusion of commercial bleaching products (hydrogen peroxide (HP) or carbamide peroxide (CP) based) with different application protocols. Human enamel-dentin discs were obtained and divided into 20 groups. Four commercial products based on HP (Pola Office+(PO), Perfect Bleach (PB), Norblanc Office-automix (NO), and Boost (BT)), and one based on CP (PolaDay CP (PD)), were evaluated with different application protocols (3 applications × 10 min or 1 application × 30 min, with or without light activation). Artificial pulp chambers with 100 µL of a buffer solution were prepared. After each application, the buffer was removed and diffused HP was quantified by fluorimetry. Data were analyzed with two-way analysis of variance (ANOVA) and Tukey’s test. In groups where 3 × 10 min applications were done, after the first 10 min, PB, NO, and PD showed similar diffusion (p < 0.05). After the second and third applications, diffusion proved similar for PO and PD, while PB exhibited the greatest diffusion. In the 30 min application groups, PO and BT showed no significant differences (p > 0.05), with similar results for NO and PD. Comparing products with or without light activation, PO, BT, and PB showed significantly greater diffusion with light activation (p < 0.05). Reapplication, and light activation, increased HP diffusion independently of the concentration of the product.

The Effect of Delivery System and Light Activation on Tooth Whitening Efficacy and Hydrogen Peroxide Penetration

PURPOSE

To evaluate the whitening efficacy of a new two-layer technology in-office system compared to a conventional gel-type system and determine hydrogen peroxide penetration (HPP) into the pulp cavity.

MATERIALS AND METHODS

Extracted molars (n = 60) were assigned to group NC: glycerol gel; group QPRO: 20% HP varnish (Zoom Quick Pro, Philips Oral Healthcare); group ZOOM_NL: 25% HP gel (Zoom Chairside Whitening); and group ZOOM_WL: 25% HP gel (Zoom Chairside Whitening) with light-activation. HPP levels were estimated with leucocrystal-violet and horseradish-peroxidase. Instrumental color measurements were performed at baseline (T₀ ), 1-day post first whitening (T₁ ), 1-day post second whitening (T₂ ), 1-day post third whitening (T₃ ), and 1-month post whitening (T₄ ). One-way analysis of variance followed by post hoc Tukey's HSD test was performed to detect difference in ΔE* and HP penetration levels (α = 0.05).

RESULTS

ΔE* of NC was lower than other groups, whereas ΔE* of ZOOM_WL was greater than the other three groups, at T₃ and T₄ . Mean HPP level obtained from ZOOM_WL (1.568 ± 0.753 μg/mL) was significantly greater than those obtained from the other groups, whereas the mean HPP level observed in NC group (-0.131 ± 0.003 μg/mL) was significantly lower than the other groups.

CONCLUSIONS

Tooth whitening efficacy and HPP levels vary based on whitening systems used.

CLINICAL SIGNIFICANCE

The two-layer technology in-office varnish system may be an alternative whitening option to reduce chair time in the office. (J Esthet Restor Dent 28:313-320, 2016).

Effect of Light-Activated Tooth Whitening on Color Change Relative to Color of Artificially Stained Teeth

PURPOSE

There is still controversy as to the efficacy of light activation used in tooth whitening. The purpose of this study was to evaluate the effect of light activation on tooth color change relative to the artificial dye color.

MATERIALS AND METHODS

Extracted human third molars (160) were randomly distributed into eight groups of 20 specimens each based on artificial staining and use of light activation. All groups received three 45-minute sessions of in-office whitening at 3-day intervals. Color measurements were performed with an intraoral spectrophotometer at baseline prior to staining (T0), after artificial staining (T1), 1-day--(T2), and 1-week--(T3) post-whitening. Color differences were calculated relative to after artificial staining color parameters (L*1, a*1, b*1) with the use of a software analysis program enabling synchronization of two images.

RESULTS

Within the same staining groups, the light-activated samples exhibited a greater color change than their nonlight-activated counterparts. However, only in the case of the yellow-stained samples at 1-day post-whitening was there a significant difference between the nonlight-activated and light-activated groups (Tukey's post hoc multiple comparison test for pairwise comparisons, p < 0.05).

CONCLUSIONS

Light activation is a valid method for enhancing the efficacy of tooth whitening with respect to overall color change and works best with yellow stains.

CLINICAL SIGNIFICANCE

Light activation is a valid method for enhancing the efficacy of tooth whitening with respect to overall color change and works best with yellow stains.

Effect of Different Light Sources and Enamel Preconditioning on Color Change, H2O2 Penetration, and Cytotoxicity in Bleached Teeth

This study evaluated the effects of acid etching of the enamel and the combination of different light sources (halogen light, light-emitting diodes [LEDs], and LED/Laser) and the bleaching product on color change, penetration of hydrogen peroxide (H2O2), and cytotoxicity over time. The color change (ΔE) and the amount of H2O2 that permeated the tooth tissue were analyzed using a spectrophotometer. Cell metabolism and morphology were evaluated using the methylthiazol tetrazolium assay and scanning electron microscopy, respectively. The ΔE values and H2O2 permeation were not significantly different under any of the experimental conditions. Tooth whitening significantly reduced cell metabolism, regardless of whether a light source was used. Preconditioning the enamel did not influence the cellular metabolism in any group. In conclusion, combining the bleaching product with different light sources and/or preconditioning the enamel resulted in few significant changes in color, transenamel and transdentinal penetration of H2O2, or cytotoxicity and cell morphology.

Efficacy of whitening oral rinses and dentifrices on color stability of bleached teeth

Objective: This study aimed to evaluate the effect of whitening toothpastes and mouthrinses on the color stability of teeth bleached with 16% carbamide peroxide (CP) after immersion in coffee solution.

Materials and methods: Specimens obtained from bovine incisors were bleached with 16% CP for 14 days. After bleaching, the specimens were stained in coffee solution for 24 h and randomly divided into eight groups according to the following products (n = 10): distilled water (control group, DW), Scope White mouthrinse (SW), Crest 3D White mouthrinse (CWR), Crest 3D White toothpaste (CWT), Crest 3D White toothpaste and Crest 3D White mouthrinse (CWT + CWR), Listerine Whitening toothpaste (LWT), Listerine Whitening mouthrinse (LWR), and Listerine Whitening mouthrinse and Listerine Whitening toothpaste (LWR + LWT). Color measurements were conducted using a spectrophotometer. The data were assessed by analysis of variance for repeated measures and Tukey’s multiple comparison test (p < 0.05).

Results: Immersion in coffee solution after bleaching caused perceptible staining on tooth specimens (ΔE > 3.46). The whitening effect of CWR on teeth stained after bleaching was significantly greater than that in the other groups (p < 0.001). Tooth whitening (ΔE) in each group showed no significant difference from 6 to 12 weeks (p > 0.05). The combination of mouthrinse and toothpaste did not increase the degree of tooth whitening.

Conclusion: Whitening mouthrinse and toothpaste had similar effects on the control group in terms of whitening of teeth stained after bleaching. Nevertheless, Crest 3D White mouthrinse produced the greatest recovery whitening effect among all the products tested.

Color alteration, hydrogen peroxide diffusion, and cytotoxicity caused by in-office bleaching protocols

OBJECTIVES

This study evaluated the color alteration, cytotoxicity, and hydrogen peroxide (HP) diffusion associated with different in-office bleaching protocols.

MATERIALS AND METHODS

Bovine enamel/dentin disks were subjected to three bleaching sessions with 35 % HP (three 15-min applications), 35 % HP (one 45-min application), or 20 % HP (one 45-min application). The control group was not bleached. Before bleaching, the disks were adapted to artificial pulp chambers positioned in compartments containing 1 ml of acetate buffer or medium, so that the dentin remained in contact with these substances. Immediately after bleaching, the HP that diffused through the disks was stabilized by acetate buffer and was quantified (two-way repeated measures ANOVA/Fisher's protected least significant difference (PLSD) test; α = 5 %). Cells of mouse dental papilla cell-23 (MDPC-23) were incubated in this culture media for 1 h, followed by analysis of cellular metabolism (methyl tetrazolium assay) (one-way ANOVA/Tukey test; α = 5 %) and morphology (scanning electron microscopy). The specimen color alteration (ΔE) was analyzed by reflection spectrophotometry (two-way repeated measures ANOVA/Fisher's PLSD test; α = 5 %).

RESULTS

All protocols showed equal effectiveness at the end of the treatment. HP diffusion was significantly higher in the groups bleached with 35 % HP. Reapplication of 35 % HP resulted in increased diffusion only in the first session; however, the decrease in cell metabolism was similar for all studied protocols.

CONCLUSION

Despite greater peroxide diffusion in the groups treated with 35 % HP, all protocols showed the same effectiveness and were cytotoxic to MDPC-23 cells.

CLINICAL RELEVANCE

Bleaching protocols using high HP concentrations should be avoided because they exert aggressive actions on odontoblast-like cells.

Penetration of hydrogen peroxide and degradation rate of different bleaching products

This study's aim was to evaluate the degradation rate of hydrogen peroxide (H2O2) and to quantify its penetration in tooth structure, considering the residence time of bleaching products on the dental enamel. For this study, bovine teeth were randomly divided according to the bleaching product received: Opalescence Xtra Boost 38%, White Gold Office 35%, Whiteness HP Blue 35%, Whiteness HP Maxx 35%, and Lase Peroxide Sensy 35%. To analyze the degradation of H2O2, the titration of bleaching agents with potassium permanganate was used, while the penetration of H2O2 was measured via spectrophotometric analysis of the acetate buffer solution, collected from the artificial pulp chamber. The analyses were performed immediately as well as 15 minutes, 30 minutes, and 45 minutes after product application. The data of degradation rate of H2O2 were submitted to analysis of variance (ANOVA) and Tukey tests, while ANOVA and Fisher tests were used for the quantification of H2O2, at the 5% level. The results showed that all products significantly reduced the concentration of H2O2 activates at the end of 45 minutes. It was also verified that the penetration of H2O2 was enhanced by increasing the residence time of the product on the tooth surface. It was concluded that the bleaching gels retained substantial concentrations of H2O2 after 45 minutes of application, and penetration of H2O2 in the dental structure is time-dependent.