One‐year bleaching efficacy using two HP products with different pH: A double‐blind randomized clinical trial

Effect of an experimental desensitizing gel on bleaching-induced tooth sensitivity after in-office bleaching—a double-blind, randomized controlled trial

OBJECTIVES

To evaluate the risk and intensity of tooth sensitivity (TS), and the efficacy of in-office bleaching after applying an experimental desensitizing gel composed of 10% calcium gluconate, 0.1% dexamethasone acetate, 10% potassium nitrate, and 5% glutaraldehyde.

MATERIAL AND METHODS

In a split-mouth, double-blind, placebo-controlled study, 50 participants had their upper hemiarches randomized into experimental and placebo groups. Desensitizing and placebo gels were applied for 10 min before in-office bleaching (35% hydrogen peroxide, 1 × 50 min; two bleaching sessions; 1-week interval). TS was recorded immediately after bleaching, 1, 24, and 48 h after each session, with a 0-10 visual analogue scale (VAS) and a five-point numerical rating scale (NRS). The color was recorded in all groups at baseline, 1 week after each session, and 1 month after the end of bleaching using shade guide units (ΔSGUs) and a spectrophotometer (ΔE_ab, ΔE₀₀, and ΔWI_D).

RESULTS

Most participants (96%) felt some discomfort during treatment regardless of the study group. The odds ratio for pain was 0.65 (95% CI 0.1 to 4.1; p = 1.0). The intensity of TS did not differ between groups (p > 0.31), and it was only 0.34 VAS units lower in the experimental group. A significant color change occurred in both groups regardless of the group.

CONCLUSIONS

The desensitizing experimental gel applied before in-office bleaching did not reduce the risk and the intensity of TS and did not affect color change.

CLINICAL RELEVANCE

Although the experimental desensitizing agent with varying mechanisms of action did not jeopardize the color change, it did not reduce the risk or intensity of in-office bleaching.

CLINICAL TRIAL REGISTRATION NUMBER

RBR-7T7D4D.

Color Change after 25% Hydrogen Peroxide Bleaching with Photoactivation: A Methodological Assessment Using Spectrophotometer versus Digital Photographs

This study aimed to evaluate the color change of teeth bleached with light activation using two different objective color measurement approaches after two years of clinical follow-up. A cross-sectional retrospective clinical study according to STROBE was followed including 30 participants. The 25% hydrogen peroxide gel (Philips Zoom) was applied with a supplementary LED light for 15 min in four cycles. Tooth color was assessed based on CIEL*a*b* values using a spectrophotometer (Spectroshade) at different time points (baseline, post bleaching, 1 week, 1 year, and 2 years). Standardized digital photographs were taken at each time point. The L*, a*, and b* values were measured from the digital photographs using Adobe Photoshop software. The color difference (ΔE) was separately calculated using the L*, a*, and b* values obtained with spectrophotometric and photographic analyses at each evaluation time. Data were analyzed with non-parametric tests (p < 0.05). A color regression was detected by both measurement approaches after 1 and 2 years (p < 0.05). Greater ΔE values were acquired with the spectrophotometer compared to the digital photographic analysis (p < 0.05). Although a greater color change was observed with the spectrophotometer, both approaches were able to detect the color rebound using the 25% hydrogen peroxide light-activated in-office system. Digital photographic analysis might therefore be used to assess color change after bleaching.

Does polishing of bleached enamel affect roughness and tooth color stability after exposure to coffee?

OBJECTIVE

This laboratory randomized study was designed to evaluate the effect of polishing on roughness and color stability of bleached teeth after coffee immersion.

MATERIALS AND METHODS

Ninety bovine crowns were randomly allocated to six groups (n = 15), according to bleaching protocols: At-home: standard protocol using 10% hydrogen peroxide (HP) or In-office: standard protocol using 35% HP; and with polishing protocols: (1) no polishing, (2) bleached enamel polished with #0.5 μm or (3) #2-4 μm diamond particles grit pastes. Samples were daily immersed into coffee solution for 45 min followed by mechanical brushing simulation (30 s) for 30 days. The surface roughness (Ra) and color alteration, expressed by ΔEab , ΔE00 , and whitening index (WI) were analyzed at baseline, after bleaching/polishing protocols and after coffee solution staining. The surface from each group was examined using a scanning electron microscope. Data were analyzed by two-way repeated measure analysis of variance followed by the Tukey test (α = 0.05).

RESULTS

Staining increases Ra, ΔEab , ΔE00 , and decreases WI values. Polishing after bleaching did not prevent staining, however, tooth polished with #0.5 μ-grit polishing paste showed better performance than #2-4 μ-grit (ΔEab : p = 0.001/ΔE00 : p = 0.003). Scanning electron microscope revealed a more irregular surface after coffee staining for all groups regardless bleaching/polishing protocols.

CONCLUSIONS

Using #0.5 μ-grit diamond paste to polish 35%HP in-office bleached enamel reduces the roughness and tooth staining. However, polishing after 10%HP at-home bleached enamel neither affects roughness nor improves tooth color stability after exposure to coffee.

CLINICAL SIGNIFICANCE

Polishing after at-home bleaching does not have benefits but after 35% hydrogen peroxide in-office bleaching, the polishing with #0.5 μ-grit polishing paste is indicated to reduce roughness and the tooth staining over time.

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

OBJECTIVE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICAL SIGNIFICANCE

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

Assessment of the temporal variation of electrical potential and pH of different bleaching agents

INTRODUCTION

Tooth whitening procedures are under continuous investigation to improve esthetic outcomes and reduce bleaching sensitivity (BS) precipitating from treatments. During the dental bleaching process it is known that the release of free radicals degrades the organic pigment molecules of the tooth and with this an amount of energy is released. Nonetheless, previous studies have never investigated the temporal correlation between of pH and electric potential (EP) generated in this treatment.

OBJECTIVES

Therefore, the objective of the present study was to investigate temporal variations of pH and EP associated with three different commercially available bleaching gels and the correlation levels between parameters of interest to provide relevant information regarding the kinetics of oxidation reactions in dental bleaching procedures.

METHODS

The study was divided into 3 groups (n = 9) in function of hydrogen peroxide concentration (either 6%, 15% and 35%). The temporal evolution of pH and EP values were determined using a highly-accurate and previously calibrated pH meter at specific time-points (5, 10, 15 and 30 min).

RESULTS

Data obtained were submitted to one-way ANOVA of repeated measures with Bonferroni post-test (α = 0.05). The results of the study showed difference in the factor gel concentration (p < 0,0001), time (p < 0,0001) and interaction (gel/time) (p = 0.002) while throughout the intervals evaluated the groups remained relatively stable and without significant difference in the intragroup variation of pH (p < 0.05) and in EDP only with significant difference in the 5 min interval of the 35% concentration. A 2nd order polynomial relationship test showed high correlation levels.

CONCLUSION

It can thus be concluded that there is a negative relationship between EP and pH variation in the different gel concentrations.

CLINICAL SIGNIFICANCE

The findings of the present study suggest that bleaching gels of higher concentration may provoke BS that are more intense and durable due to significant electric depolarization of neuronal extensions of pulpal tissues.

Polymeric biomaterials maintained the esthetic efficacy and reduced the cytotoxicity of in-office dental bleaching

Evaluate the kinetics of hydrogen peroxide (H₂ O₂ ) degradation, esthetic efficacy and cytotoxicity of a bleaching gel with 35%H₂ O₂ applied on enamel previously covered or not with polymeric nanofibrillar scaffold (SNan), polymeric primer catalyst (PPol), and both. Standardized enamel/dentin discs (n = 128) obtained from bovine teeth were adapted to pulp chambers. After covering enamel with the polymeric products, the bleaching gel was applied for 45 min, establishing the following groups: G1: no treatment (negative control); G2: 35%H₂ O₂ (positive control); G3: SNan; G4: PPol; G5: SNan + PPol; G6: SNan + 35%H₂ O₂ ; G7: PPol + 35%H₂ O₂ ; G8: SNan + PPol + 35%H₂ O₂ . The kinetics of H₂ O₂ degradation (n = 8), bleaching efficacy (ΔE/ΔWI; n = 8), trans-amelodentinal cytotoxicity (n = 8), and cell morphology (n = 4) were assessed (ANOVA/Tukey test; p < 0.05). Greater H₂ O₂ degradation occurred in G7 and G8. Bleaching efficacy (ΔE) was higher in G6, G7, and G8 in comparison with G2 (p < 0.05). However, no difference was observed for ΔWI (p > 0.05). G8 presented the lower level of trans-amelodentinal diffusion of H₂ O₂ , oxidative stress, and toxicity to the MDPC-23 cells (p < 0.05). Polymeric biomaterials increased the kinetics of H₂ O₂ decomposition, as well as maintained the esthetic efficacy and minimized the cytotoxicity caused by a bleaching gel with 35%H₂ O₂ . CLINICAL SIGNIFICANCE: Application of a bleaching gel with 35%H₂ O₂ on enamel previously covered by polymeric biomaterials maintains the esthetic efficacy and reduces the cytotoxicity caused by a single session of in-office dental bleaching.

One-year follow-up evaluation of reservoirs in bleaching trays for at-home bleaching

OBJECTIVE

To evaluate the color change stability and patient satisfaction after one-year of at-home bleaching with 10% carbamide peroxide (CP) in trays with or without reservoirs.

MATERIALS AND METHODS

Forty-six patients were subjected to bleaching with CP (3 h/daily; 21 days) with a bleaching tray with or without reservoirs. The color was measured one-month and one-year after the completion of bleaching using the spectrophotometer (ΔEab, Δ00 and ΔWi), and shade guide units (ΔSGU). Patients' satisfaction were assessed using a 5-point Likert Scale questionnaire. Data were submitted to paired t-test (α = 0.05).

RESULTS

No significant difference between color change after one-month and one-year was observed (VITA Classical shade guide unit and the ΔWi; p > 0.53). Significant differences were observed for the VITA Bleachedguide 3D-MASTER shade guide, ΔEab and ΔE00 (p < 0.03). The level of patient satisfaction was similar between groups (p = 1.00).

CONCLUSIONS

Bleaching tray design did not have any influence on the bleaching stability for the 10% CP (Opalescence PF, Ultradent). Patients were very satisfied with the bleaching outcomes regardless of the bleaching tray design.

CLINICAL RELEVANCE

Placement of reservoirs in bleaching trays does not increase longevity of dental bleaching. No clinically important color rebound was observed 1 year after bleaching with 10% CP.

Effects of a reduced in-office bleaching protocol with 37.5% hydrogen peroxide on effectiveness and tooth sensitivity: A double-blind randomized clinical trial

OBJECTIVE

This randomized clinical trial evaluated the effectiveness and tooth sensitivity (TS) of 37.5% hydrogen peroxide (37.5HP) in-office bleaching with reduced protocol.

MATERIALS AND METHODS

Forty participants with shade mean C2 or darker for the six maxillary anterior teeth were randomly allocated into two treatment groups (n = 20): two (37.5HP2) or three (37.5HP3) 8 min applications/clinical session. Three clinical sessions were performed with a 1 week interval. Color evaluations were done with a spectrophotometer at baseline and 1 week post-bleaching. TS was measured during and up to 48 h after bleaching using a five-point numeric rating scale. Color change was evaluated by Student's t-test for independent samples. The absolute risk and intensity of TS were analyzed by Fisher's and Mann-Whitney/Friedman tests (p < 0.05).

RESULT

Both treatment groups resulted in a significant tooth whitening 1 week post-bleaching (p < 0.001). There were no significant differences between 37.5HP2 and 37.5HP3 for ΔE*_ab , ΔE₀₀ and ∆WI_D . Also, there were not differences between groups regarding high absolute risk (p = 1.0) and low intensity of TS at all time assessments (p > 0.7).

CONCLUSIONS

The in-office bleaching with two 37.5% HP applications produced the same whitening degree, risk and intensity of TS to that performed with three gel applications.

CLINICAL SIGNIFICANCE

Clinicians should opt to use a neutral 37.5% HP in-office bleaching gel for two 8 min applications/clinical session because produces the same whitening effectiveness, risk and low intensity of TS as the protocol proposed by manufacturer (three 8 min applications).

A meta-analysis of ozone effect on tooth bleaching

This systematic review assessed the effectiveness of ozone (O₃) in the color change of in-office tooth bleaching in vital teeth (TB) and the sensitivity control. Only randomized controlled clinical trials were included. Seven databases were used as primary search sources, and three additional sources were searched to capture the "grey literature" partially. The JBI tool was used to assess the risk of bias. TB was assessed using the ΔELab color change metric comparing tooth color pre- and post-bleaching. We meta-analyzed the ΔELab estimates per method and calculated the absolute standardized mean difference using random-effect models. The GRADE approach assessed the certainty of the evidence. The ΔELab estimates ranged from 1.28 when the O₃ was used alone to 6.93 when combined with hydrogen peroxide (HP). Two studies compared O₃ and HP alone, but their TB was similar (SMD = - 0.02; 95%CI: - 0.54; 0.49). The bleaching effectiveness for the combination of O₃ + HP compared to HP was similar (SMD = 0.38; 95%CI: - 0.04; 0.81). Thus, based on the available literature, our findings suggest that O₃ is not superior to the conventional technique using HP on the change of tooth color. The O₃ did not present sensitivity when used alone. When O₃ was used in combination with HP, patients reported hypersensitivity only when O₃ was applied before HP, i.e., no sensitivity was perceived when O₃ was applied after HP.

Assessment of the effect of experimental bleaching agent with nano-bioactive material on postoperative sensitivity: A randomized, triple blind clinical trial

OBJECTIVES

This clinical study aimed to evaluate the effect of incorporating bioactive nanoparticles (n-Bm) inside an in-office bleaching gel on the risk and intensity of tooth sensitivity (TS) and on bleaching effectiveness.

MATERIALS AND METHODS

Sixty-six participants were selected and randomly assigned into two groups: control-only in-office gel and experimental-in-office gel with n-Bm. Teeth were bleached in two sessions (3 × 15-min). TS was recorded using a VAS and NRS. The color change was evaluated by subjective (VITA Classical and VITA Bleachedguide) and objective (Easyshade spectrophotometer) methods at baseline and 30 days after the end of treatment. The TS was evaluated by McNemar, Wilcoxon Signed Rank, and paired t test. The color changes between groups were compared using paired t test (α = 0.05).

RESULTS

No significant differences between the groups were observed in the risk (control = 27% [95%IC 18-39]; experimental = 21% [95%IC 13-32]) and intensity of TS, as well as in the color change (p >0.05) for any color measurement.

CONCLUSION

The inclusion of n-Bm into the bleaching agents did not affect the whitening effectiveness, as well as the risk and intensity of TS between groups. However, the results of the absolute risk of TS were low for both in-office gels used.

CLINICAL SIGNIFICANCE

Despite no significant differences between groups, both experimental bleaching agents present suitable results with low values for TS.

Bleaching toothpaste with two different concentrations of hydrogen peroxide: A randomized double-blinded clinical trial

OBJECTIVES

This randomized double-blinded clinical trial evaluated the bleaching efficacy and incidence of contact hypersensitivity of three kinds of bleaching toothpaste.

METHODS

Forty-nine participants above A2 shade on the maxillary central incisor (#11) and canine (#13) were randomized into three groups: TW group (n = 15), 0.75 % HP-containing toothpaste (Toothwhole white); VL group (n = 15), 0.75 % HP-containing toothpaste (Vussen 7); and VH group (n = 17), 2.8 % of HP-containing toothpaste (Vussen 28). Participants were instructed to manually brush their teeth for 3 min, 3 times per day for 12 weeks. They were followed-up after 4 and 12 weeks. Shade measurements were performed using a spectrophotometer (SP), and data were calculated with CIELab (ΔE_ab^*) and CIEDE2000 (ΔE₀₀) formula. Additionally, visual inspection (VI) using the Vitapan classical shade guide was also performed, and the correlation between the two measurements was analyzed by comparing the CIELab (ΔE_ab^*) values. The incidence of contact hypersensitivity at each follow-up was recorded. A mixed-effect model was performed to assess shade changes and chi-square tests for the incidence of contact hypersensitivity, respectively.

RESULTS

At 12 week follow-up, all groups showed ΔE_ab^*  above 3.46, and ΔE₀₀ above 2.25 for tooth #11. For tooth #13, the ΔE_ab^* and ΔE₀₀ of VH and TW groups only were above those thresholds. Shade change varied according to toothpaste and follow-up points. SP and VI showed a moderate positive correlation for L*, a*, and b*, respectively (P < 0.05). Contact hypersensitivity was not significantly different among the groups (P > 0.05).

CONCLUSIONS

Bleaching toothpaste with higher HP yields a better shade change than other toothpaste after 12 weeks.

CLINICAL SIGNIFICANCE

The use of bleaching toothpaste with a higher HP concentration results in a better shade improvement.