Clinical comparison between the bleaching efficacy of 37% peroxide carbamide gel mixed with sodium perborate with established intracoronal bleaching agent

Evaluation of the penetration of intracoronal bleaching agents into the cervical region using different intraorifice barriers

Background

The present study aimed to make a comparison between the effects of 35% hydrogen peroxide gel (HP) and sodium perborate with distilled water (SP) bleaching agents on the sealing characteristics of glass ionomer cement (GIC), TheraBase, ProRoot MTA and Biodentine intraorifice barriers.

Methods

One hundred and twelve single-rooted mandibular human premolar teeth extracted from young patients (14–25 years) were chosen. Root cement and cementoenamel junction (CEJ) of teeth were examined under a stereomicroscope at 10 × magnification to ensure there was no cement defect or dentin gap in CEJ. After the endodontic access cavities were opened on the occlusal surfaces of the teeth, the working length was determined. Instrumentation of each root canal was performed with a ProTaper Gold rotary system in the determined working length and filled with gutta-percha + AH Plus with a single cone technique using. Root fillings were removed 3 mm short of the CEJ and sealed with one of the following intraorifice barrier materials (n = 30/group): 1. GIC; 2. TheraBase; 3. ProProot-MTA; 4. Biodentine. In each of the sub-groups, either HP or SP was used to perform intracoronal bleaching on days 1, 4, and 7. All outer surfaces of the specimens except the 3 mm cervical region were covered with nail polish and modeling wax layers. Specimens were immersed in a 5 ml Eppendorf tube that contained 2 mL of distilled water. The penetration of peroxide release was measured using the colorimetric ferric thiocyanate method. Statistical analysis of the data was performed with Three-way ANOVA and Tukey’s test (P = 0.05).

Results

In the HP groups, GIC showed the greatest peroxide release when compared with other tested groups on day 1 (P < 0.05). Biodentine and ProRoot MTA displayed a significantly lower peroxide leakage when compared to GIC and TheraBase on days 1 and 4 (P < 0.05). While GIC and TheraBase were used, HP observed higher peroxide penetration when compared with SP on days 1 and 4 (P < 0.05).

Conclusions

Peroxide diffusion was significantly influenced by the kind of intracoronal bleaching agents and intraorifice barrier materials used.

Study of the Intra-Coronal Pressure Generated by Internal Bleaching Agents and Its Influence on Temporary Restoration

Intra-coronal bleaching is a treatment that whitens non-vital teeth from within the pulp chamber, a procedure by which oxygen and free radicals are released. This in vitro study analyzed and compares the oxygen expansion produced when different bleaching agents encounter dental tissues during this type of bleaching. Here, 120 lower incisors were included and prepared to achieve conditions as close as practicable to internal bleaching with the walking bleach technique. The access cavity of the lingual surface was prepared to seal glass tubes with oil inside them by adhesive restoration once the bleach was placed inside the pulp chamber. The following bleaching groups were used: hydrogen peroxide (HP) 30% (n = 30), sodium Perborate (SP) with distilled water (n = 30), a mixture of HP 30% with SP (n = 30) and a control group (n = 30). After 10 days, the oil displacement that took place through the tube due to oxygen release was measured daily. Displacement of the oil was observed in all groups except the control group. The final mean expansion at 10 days was 335.24 ± 76.85 mm for the HP 30% group, 8.40 ± 1.74 mm for the SP group and 183.07 ± 49.93 mm for the HP30% + SP mixture. Significant statistical differences were observed between the three groups using the Games–Howell post hoc test, where HP30% caused the greatest expansion and SP the least expansion. These results suggest that the higher the amount of HP in the sample, the more oxygen expansion is observed, so that temporary restoration must be performed more carefully to avoid displacement.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Assessment of Oxygen Expansion during Internal Bleaching with Enamel and Dentin: A Comparative In Vitro Study

Internal bleaching is a conservative, non-invasive, and simple treatment that is frequently performed in daily clinical practice. The present in vitro study analyzes the oxygen expansion of different bleaching agents resulting from the oxidation reaction when interacting with enamel and dentin. Enamel and dentin were crushed separately until obtaining a fine powder with particles of an approximate size between 0.06 and 0.2 mm. Each enamel and dentin sample were mixed with 37% carbamide peroxide (CP 37%), 30% hydrogen peroxide (HP 30%), sodium perborate (SP) combined with HP 30% (HP 30% + SP) and SP with distilled water (SP). A total of 280 1 mm diameter glass tubes were used with 70 for each bleaching agent (30 for powdered enamel evaluation, 30 for powdered dentin evaluation, and 10 controls). The bleaching agents were placed in the prepared tubes immediately after mixing the components. As expansion occurred, the oil inside the tube was displaced, through which the resulting expansion was evaluated and measured for 10 days. A significant expansion was observed that varied in magnitude according to the bleaching agent and the tooth structure used. Student's t test and Welch's ANOVA were used to analyze the data obtained. The highest mean expansion of both enamel and dentin was observed with 30% HP (66.6 mm for enamel, 94.5 mm for dentin) followed by HP 30% + SP (48.6 mm for enamel, 52.7 mm for dentin), CP 37% (38.4 mm for enamel, 52.6 mm for dentin) and finally SP with water (12.7 mm for enamel, 4.4 mm for dentin). It was observed that the expansion in the SP group with enamel was significantly lower than in the rest of the groups, while that registered for HP 30% was significantly higher. (p < 0.001). The results with dentin were similar, with a significantly lower expansion for SP and higher for HP 30% (p < 0.001). The oxygen expansion observed as a result of the interaction between bleaching agents and dental tissues could contribute to improving our understanding of bleaching and its results. These results suggest that bleaching agents react with the organic component of the tooth structure.

An acetoxy functionalized Al(III) based metal-organic framework showing selective "turn on" detection of perborate in environmental samples

Here, we have described the design, preparation and detailed characterization of a new acetoxy functionalized aluminium based metal-organic framework (MOF) called CAU-10-OCOCH3 (1) (CAU stands for Christian-Albrechts-University). The desolvated compound was employed for the detection of perborate in a pure aqueous environment. The presented MOF based perborate sensing probe (1) was synthesized by employing 5-acetoxyisophthalic acid and AlCl3·6H2O as the linker molecule and metal salt source, respectively, in DMF/H2O medium at 120 °C for 12 h. The material (1') showed a very selective fluorescent turn-on response towards perborate in aqueous medium with the coexistence of several competitive analytes. A dramatic increment (65 fold) in emission intensity of the probe was observed within 5 min of the addition of perborate. A chemo-selective reaction between perborate and the acetoxy functionality and subsequent hydrolysis of the acetoxy group to the hydroxy group is the main cause of the turn-on nature of detection. The material showed a detection limit of 1.19 μM. The probe was also applied for the recognition of perborate in several environmental water samples. The material is the first ever MOF based probe for selective detection of perborate.

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

OBJECTIVES

The aim of this study was to evaluate the esthetic perception of patients at 6 months after bleaching of non-vital teeth with 35% of hydrogen peroxide and 37% of carbamide peroxide using a walking bleach technique. We also assessed psychosocial impacts as well as the clinical effectiveness and stability of the color change.

MATERIALS AND METHODS

The teeth bleaching treatment was randomly assigned to two groups according to the bleaching agent used: G1 HP = 35% of hydrogen peroxide (n = 25) and G2 CP = 37% of carbamide peroxide (n = 25). The non-vital bleaching was performed in four sessions using the walking bleach technique. The color was objectively (ΔE) and subjectively (ΔSGU) evaluated. The esthetic perception and psychosocial factors were evaluated before treatment as well as one and 6 months post-treatment using Oral Health Impact Profile (OHIP) esthetics and Psychosocial Impact of Dental Esthetics Questionnaire (PIDAQ).

RESULTS

The color change (ΔE) at 6 months (G1 = 14.53 ± 5.07 and G2 = 14.09 ± 6.61) for both color groups remained stable until the 6-month post-treatment (p > 0.05). There was a decrease in the values of OHIP esthetics and PIDAQ after treatment compared to the baseline (p < 0.05), and this effect was maintained 6 months post-treatment.

CONCLUSIONS

Both agents were highly effective and maintained the color stability at 6 months; this positively affected the esthetic perception and psychosocial impact of patients who also remained stable over time.

CLINICAL RELEVANCE

Non-vital bleaching produces a positive and stable impact on the esthetic perception and psychosocial factors at medium-term follow-ups.

Fracture resistance of simulated immature teeth after internal bleaching procedures

The aim of this study was to evaluate the fracture resistance of simulated immature teeth after internal bleaching. The teeth were assigned as follows (n = 12/group); Group-1: The pulp chamber was filled with ProRootMTA and bleached intracoronally with sodium perborate mixed with 37% carbamide peroxide gel; Group-2: The pulp chamber was filled with ProRootMTA without bleaching; Group-3: The pulp chamber was filled with Biodentine and bleached intracoronally as Group-1; Group-4: The pulp chamber was filled with Biodentine without bleaching; and Group-5: Teeth received no intervention (control). The specimens were loaded vertically until root fracture occurred. The data were analysed with Kruskal-Wallis and Dunn tests. There was no significant difference between the fracture resistances of the experimental groups (P > 0.05). However, all experimental groups had significantly lower fracture resistance than the control group (P < 0.05). Neither the tested calcium silicate cements nor the bleaching procedures had a significant impact on fracture resistance values.

Evaluation of Extraradicular Diffusion of Hydrogen Peroxide during Intracoronal Bleaching Using Different Bleaching Agents

Objectives. Extra radicular diffusion of hydrogen peroxide associated with intracoronal teeth bleaching was evaluated. Methods. 108 intact single rooted extracted mandibular first premolars teeth were selected. The teeth were instrumented with WaveOne system and obturated with gutta percha and divided into four groups (n = 27) according to the bleaching materials used. Each main group was divided into three subgroups (n = 9) according to the time of extra radicular hydrogen peroxide diffusion measurements at 1, 7, and 14 days: group 1 (35% hydrogen peroxide), group 2 (35% carbamide peroxide), group 3 (sodium perborate-30% hydrogen peroxide mixture), and group 4 (sodium perborate-water mixture). Four cemental dentinal defects were prepared just below the CEJ on each root surface. The amount of hydrogen peroxide that leached out was evaluated after 1, 7, and 14 days by spectrophotometer analysis. The results were analyzed using the ANOVA and Tukey's test. Results. Group 1 showed highest extra radicular diffusion, followed by group 3 and group 2, while group 4 showed the lowest mean extra radicular diffusion. Conclusion. Carbamide peroxide and sodium perborate-water mixture are the most suitable bleaching materials used for internal bleaching due to their low extra radicular diffusion of hydrogen peroxide.

A fluorescent light-up platform with "AIE + ESIPT" characteristics for multi-target detection both in solution and on paper strip

We report a fluorescent light-up platform for multi-target detection in aqueous solution and on paper strip. The platform is based on a salicylaldazine fluorogen with aggregation-induced emission (AIE) and excited state intramolecular proton transfer (ESIPT) characteristics, which shows distinct advantages including ease of chemical modifications, free of self-quenching effect, excellent light-up ratio and large Stokes shift. To demonstrate the versatility of the platform, palladium cation and perborate anion, as well as UV light, were selected as the targets. The three representative probes, AIE-Pd, AIE-perborate and AIE-UV, light up specifically in the presence of the target both in aqueous solution and on paper strip. The immediate naked-eye response makes the probes ideal for instrument-free and power-free detection.

Effect of several bleaching agents on teeth stained with a resin-based sealer

AIM

To evaluate the effect of peroxide-based bleaching agents on teeth stained with AH26 sealer (Dentsply De Trey, Konstanz, Germany), using digital images and computer analysis.

METHODOLOGY

Thirty-five maxillary central incisors were root filled, and the internal walls of the access cavity were coated with AH26 sealer. Internal bleaching commenced 4 months after the root fillings. In three experimental groups (n = 10), the teeth were bleached for 21 days using 45% carbamide peroxide (CP) gel, 45% sodium perborate + carbamide peroxide (SP + CP) or sodium perborate + distilled water (SP + W). No bleaching was undertaken in the control group. Digital images of each specimen were made before treatment, 4 months after endodontic treatment and 2 weeks after bleaching. Colour differences (∆E) were calculated by determining L*a*b* values using digital images and imaging software. Differences between the original colour and sealer-stained teeth, between sealer-stained and bleached teeth and between original colour and bleached teeth were calculated. Data were analysed using one-way anova and Duncan tests (α = 0.05).

RESULTS

Colour differences between baseline and sealer staining were in the range of 8.1-9.9, but differences between the groups were not significant. After bleaching, the degree of lightening was essentially identical for the carbamide peroxide and sodium perborate + carbamide peroxide groups, but was significantly greater (P < 0.05) in these two groups than in the sodium perborate + water group.

CONCLUSION

For bleaching AH26 sealer-stained teeth, carbamide peroxide gel and carbamide peroxide gel mixed with sodium perborate were equally effective and significantly better than sodium perborate mixed with water.

Effect of bleaching agents on sealing properties of different intraorifice barriers and root filling materials

Objective: To evaluate the effect of intracoronal bleaching agents on the sealing properties of different intraorifice barriers and root filling materials. Study Design: The root canals of extracted human premolars (n=180) were prepared by using System GT rotary files and filled with either gutta-percha+AH Plus or Resilon+Epiphany sealer. In both groups, the coronal 3mm of root filling was removed and replaced with one of the following materials applied as intraorifice barriers (n=30/group): 1. ProProot-MTA; 2. Conventional Glass ionomer cement; and 3. Hybrid resin composite. In each subgroup, intracoronal bleaching was performed using either sodium perborate with distilled water or 35% hydrogen peroxide gel for 3 weeks. The leakage of specimens was measured using fluid-filtration and dye penetration tests. The data were analyzed statistically with One-way ANOVA, Repeated Measures t-test and Independent Samples t-test (p=0.05). Results: The fluid conductance values of the test groups were not influenced by the type of the bleaching agent, the intraorifice barrier, or the root filling material (all p>0.05). However, the extent of dye leakage was significantly affected by the type of intraorifice barrier material (p<0.05), which showed the following statistical ranking: glass ionomer cement > resin composite > ProRoot-MTA (p<0.05). Conclusions: The effect of 35% hydrogen peroxide gel or sodium perborate/distilled water on the sealing properties of tested intraorifice barriers and root filling materials varied conforming leakage assessment. These properties were not affected by using fluid filtration test, while the glass ionomer barrier showed the greatest amount of dye leakage in both gutta-percha and Resilon root-filled teeth.

Key words:Tooth Bleaching, root canal filling materials, glass ionomer cement, mineral trioxide aggregate, micro leakage

Effect of high-concentrated bleaching agents on the bond strength at dentin/resin interface and flexural strength of dentin

This study evaluated the effect of bleaching agents on bond strength at the dentin/resin interface and the flexural strength of dentin. Forty maxillary canines were selected for the study. In the shear strength test, 40 slabs of intracoronary dentin (5 x 5 mm) obtained from buccal surfaces of the crowns were included in acrylic resin. In the flexural strength test, 40 dentin bars (8 x 2 x 2 mm) were obtained from the roots. The 40 hemi-sections of the lingual surface were prepared for scanning electron microscopy (SEM). The specimens were divided into 4 groups according to the bleaching protocol (n=10): Unbleached (control), Sodium perborate + 20% hydrogen peroxide (SP + 20% HP), 37% carbamide peroxide (37% CP) and 38% hydrogen peroxide (38% HP). After 7 days, the bond strength specimens were restored and tested. Dentin bars were bleached and subjected to a three-point bending test. Data (MPa) were analyzed by ANOVA and Tukey's test (α=0.05). In the shear test, the control group was superior (p<0.05) to the bleached groups, which, in turn, were statistically similar (p>0.05). In the flexural strength test, the control group also had the highest values and differed significantly from the other groups (p<0.05). SEM revealed smear layer in all groups, with fissures in the bleached specimens. SP + 20% HP and 38% HP showed discontinuous interfaces with few tags. In conclusion, bond strength of restorative material to dentin and flexural strength of dentin were reduced after the use of high-concentration bleaching agents.

pH-changes during intracoronal bleaching: an in vivo study

OBJECTIVES

This study aimed to measure pH changes during 14 days intracoronal bleaching with hydrogen peroxide/sodium perborate and carbamide peroxide/sodium perborate.

MATERIALS AND METHODS

Twenty patients presenting endodontically treated central maxillary incisors with color alterations were divided in two groups (n = 10): Group CP + SP: 37% carbamide peroxide + sodium perborate paste; Group HP + SP: 30% hydrogen peroxide + sodium perborate paste. The pH values were measured using a digital microprocessor at different times: Baseline, 2, 7 and 14 days. Data were analyzed with two-way ANOVA followed by Tukey's test (α = 0.05).

RESULTS

ANOVA showed p < 0.00 which indicated significant difference between the groups. The mean values (± sd) and the results of the Tukey´s test were: HP + SP/14 days-7.98 (±0.58)a; HP + SP/7 days-8.59 (±0.18)b; HP + SP/2 days- 8.83 (±0.32)bc; HP + SP/Baseline-8.83 (±0.01)bc; CP + SP/ Baseline-8.89 (±0.01)bc; CP + SP/14 days-9.11 (±0.58)cd; CP + SP/7 days-9.54 (±0.16)de; CP + SP/2 days-9.66 (±0.08) de. The group HP + SP resulted in significantly lower pH values compared with group CP + SP.

CONCLUSION

It can be concluded that both associations showed alkaline pH values; however, there was significant reduction in the pH values of the 30% hydrogen peroxide associated with sodium perborate after 14 days.

CLINICAL SIGNIFICANCE

The association of hydrogen peroxide and carbamide peroxide with sodium perborate paste presented alkaline characteristics during the 14-day evaluated period. Thus, regarding pH changes, both associations can be considered safe as intracoronal bleaching agents.