An In Vitro Study on the Effects of Hydrogen Peroxide-Based Bleaching Agents on Enamel: Field Emission Scanning Electron Microscopy (FESEM) With Energy Dispersive Spectroscopy (EDS) Evaluation

Aim and objective The aim of the present in vitro study is to evaluate the morphological and elemental alterations in enamel following bleaching with hydrogen peroxide-based bleaching agents of different concentrations and pH values when exposed to different treatment times. Materials and method Twenty extracted maxillary central incisors were selected for the study. Tooth samples were prepared by sectioning the tooth cervico-incisally into two halves. The teeth were divided into different groups based on the bleaching protocol and bleaching agent applied: Group IA, Group IB, Group IIA, and Group IIB. Group IA received a 35% hydrogen peroxide-based bleaching agent of pH 6 for 10 minutes with light application. Group IB received a 35% hydrogen peroxide-based bleaching agent of pH 6 for 30 minutes with light activation. Group IIA received a 40% hydrogen peroxide-based bleaching agent of pH 8.5 for 10 minutes with chemical activation. Group IIB received a 40% hydrogen peroxide-based bleaching agent of pH 8.5 for 30 minutes with chemical activation. The morphology of the enamel before and after the application of the bleaching agent was evaluated using field emission scanning electron microscopy. The elemental analysis of enamel between the control and test samples was done with the help of energy dispersive spectroscopy. Results Paired t-test was used to analyze the data obtained from the study. The test samples showed erosive alterations in enamel surface morphology and also a decrease in the concentration of minerals when compared to the corresponding control groups. Conclusions The present study evidences the erosive potential of hydrogen peroxide-based bleaching agents. It can be concluded that bleaching agents containing high concentrations of hydrogen peroxide with acidic pH can cause mineral loss and surface erosion of enamel which is extremely detrimental to the tooth integrity.

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.

Color adjustment potential of single-shade resin composite to various-shade human teeth: Effect of structural color phenomenon

This study evaluated the effect of the structural color phenomenon in resin composites (RCs) on the color adjustment of restorations by investgating their color reproduction performance in human incisors of various shade. Cervical cavities were filled with a single-shade RC with 260 nm spherical fillers (Omnichroma (OMN)), conventional A2-shade RCs (Estelite Σ Quick or Clearfil AP-X), or experimental RCs with 5-50 nm fumed silica fillers (R1) and 100 nm spherical fillers (R2). Color parameters (L*C*h*) were measured using a CIE XYZ camera along the centerline of the restorations, and the color difference (∆E₀₀) between corresponding areas of intact and restored teeth was calculated. Additionally, the reflectance spectra of OMN, R1, and R2 were investigated. OMN exhibited significantly lower ∆E₀₀ than other tested RCs (p<0.05) and its reflection spectrum ranged from blue to red, while a blue peak was observed with R1 and R2, indicating a higher color adjustment potential of OMN.

Influence of Tooth Pigmentation on H2O2 Diffusion and Its Cytotoxicity After In-office Tooth Bleaching

Clinical Relevance

Pigments in tooth structures affect the diffusion of H2O2 through enamel and dentin. The bleaching methodology can be impacted.

SUMMARY

Objective: The aim of this study was to evaluate the influence of the presence of pigments in tooth structures on the trans-enamel and trans-dentin diffusion of hydrogen peroxide (H2O2) and its cytotoxicity after carrying out an in-office bleaching therapy.

Methods and Materials: A bleaching gel with 35% H2O2 was applied for 45 minutes (three times for 15 minutes) on enamel and dentin discs (n=6), either previously submitted to the intrinsic pigmentation protocol with a concentrated solution of black tea, or not, defining the following groups: G1, unbleached untreated discs (control 1); G2, unbleached pigmented discs (control 2); G3, bleached untreated discs; G4, bleached pigmented discs. The discs were adapted to artificial pulp chambers, which were placed in wells of 24-well plates containing 1 mL culture medium (Dulbecco’s modified Eagle’s medium [DMEM]). After applying the bleaching gel on enamel, the extracts (DMEM + components of bleaching gel that diffused through the discs) were collected and then applied on the cultured MDPC-23 odontoblast-like cells. Cell viability (methyl tetrazolium assay and Live & Dead, Calcein AM, and ethidium homodimer-1 [EthD-1] probes), the amount of H2O2 that diffused through enamel and dentin (leuco-crystal violet product), and the H2O2-mediated oxidative cell stress (SOx) and components of degradation were assessed (analysis of variance/Tukey; α=0.05).

Results: There was no significant difference between the groups G1 and G2 for all the parameters tested (p&gt;0.05). Reduction in the trans-enamel and trans-dentin diffusion of H2O2 occurred for G4 in comparison with G3. Significantly lower cell viability associated with greater oxidative stress was observed for G3 (p&lt;0.05). Therefore, in-office tooth bleaching therapy performed in pigmented samples caused lower cytotoxic effects compared with untreated samples submitted to the same esthetic procedure (p&lt;0.05).

Conclusion: According to the methodology used in this investigation, the authors concluded that the presence of pigments in hard tooth structures decreases the trans-enamel and trans-dentin diffusion of H2O2 and the toxicity to pulp cells of an in-office bleaching gel with 35% H2O2.

Integrating spectrophotometric and XRD analyses in the investigation of burned dental remains

Heat alters colour and crystallinity of teeth by destruction of the organic content and inducing hydroxyapatite crystal growth. The colour and crystallite changes can be quantified using spectrophotometric and x-ray diffraction analyses, however these analyses are not commonly used in combination to evaluate burned dental remains. In this study, thirty-nine teeth were incinerated at 300-1000 °C for 15 and 30 min and then measured using a spectrophotometer and an x-ray diffractometer. Response variables used were lightness, L*, and chromaticity a* and b* and luminance (whiteness and yellowness) for colour, and crystal size for crystallinity. Statistical analysis to determine the attribution of these variables revealed yellowness and crystal size were significantly affected by temperature (p < 0.05), whilst duration of heat-exposure showed no significant effect. This study suggests the inclusion of both spectrophotometric and x-ray diffraction in investigating thermal-heated teeth is useful to accurately estimate the temperature teeth are exposed to.

Randomized clinical study of alterations in the color and surface roughness of dental enamel brushed with whitening toothpaste

OBJECTIVES

This clinical study evaluated the influence of whitening toothpaste on color and surface roughness of dental enamel.

MATERIALS AND METHODS

Initially, the abrasiveness of the toothpastes used (Sorriso Dentes Brancos [SDB]; Colgate Luminous White and Close up White Now) was tested on 30 (n = 10) plexiglass acrylic plates that were submitted to mechanical tooth brushing totalizing 29,200 cycles. Subsequently, 30 participants were selected, and received a toothbrush and nonwhitening toothpaste (SDB). The participants used these products for 7 days and initial color readouts (Spectrophotometer) and surface roughness of one maxillary central incisors was performed after this period of time. For surface roughness readouts, one replica of the maxillary central incisor was obtained by a polyvinyl siloxane impression material (Express) and polyurethane resin. After baseline measurements, participants were separated into three groups (n = 10), according to the toothpaste used. The participants returned after 7, 30, and 90 days when new color readouts and surface roughness were recorded. The measured values were statistically analyzed (2-way-ANOVA, repeated measures, Tukey, P < .05).

RESULTS

Whitening toothpastes did not promote significant (P > .05) color alteration and nor increased the surface roughness of the dental enamel in brushing time of the study.

CONCLUSIONS

The abrasiveness of whitening toothpaste and the brushing trial period did not affect the surface roughness of dental enamel. However, color changes observed on enamel were above the perceptibility and acceptability thresholds reported in the literature.

CLINICAL SIGNIFICANCE

The over-the-counter toothpastes tested had an effect on dental enamel color above the perceptibility and acceptability thresholds but did not change the surface roughness of the teeth.

Effect of pH on whitening efficacy of 35% hydrogen peroxide and enamel microhardness

OBJECTIVE

This study aimed to evaluate the effect of 35% hydrogen peroxide at different pH values and the degree of tooth staining on whitening efficacy and enamel microhardness.

MATERIALS AND METHODS

90 enamel-dentin specimens were obtained from bovine incisors. They were randomly divided into 2 groups (n = 45), 1 group was immersed in a staining broth for 14 days, and another group was not stained and kept in distilled water at 37°C. Twenty-four hours after the staining procedure, each group was distributed into 3 subgroups that were whitened by 35% hydrogen peroxide with different pH values (5, 7, and 8.4) for 30 minutes. The color was measured at baseline and 7 days after whitening. Microhardness was measured at baseline, immediate, 24 hours, and 1 month after the whitening procedure. Data were submitted to 2-way analysis of variance (ANOVA) and the Tukey test for multiple comparisons for color analysis. Repeated measures ANOVA and the Tukey test were used to analyze microhardness data.

RESULTS

The color change of the stained groups (ΔE₀₀  = 4.6) was significantly higher than that of the nonstained groups (ΔE₀₀  = 3.7). Microhardness value decreased significantly immediately after whitening for all subgroups and did not return to initial values. For each measurement time, microhardness was not significantly different among subgroups with different pH values.

CONCLUSIONS

Despite the effectiveness of 35% hydrogen peroxide, changes on gel pH did not affect the whitening efficacy, and the enamel was superficially demineralized, regardless of pH values.

CLINICAL SIGNIFICANCE

Independently of the pH value of whitening gel, enamel undergoes superficial demineralization and with a reduction in superficial microhardness that does not return to the initial values. However, using hydrogen peroxide with different pH values does not alter the whitening effect.

Influence of enamel prism orientations on color shifting at the border of resin composite restorations

This study aimed to investigate the influence of enamel prism orientations on color adjustment of resin composite restoration. The color measurements (L*, C*, or h* values) at the restored bovine enamel disk (1.0 mm-thick) with resin composite (Estelite Asteria, Estelite Pro, Kalore, Clearfil Majesty) were performed using a CIE XYZ camera (RC500). The color shifting rate and range at the coronal and cervical border were calculated. The coronal border was significantly lower L* and C* color shifting rate than the cervical border (p<0.05). The L* color shifting range was significantly affected by regions in the 3-mm cavity group (p<0.05), but not in the 1-mm cavity group (p>0.05), while the C* color shifting range was not significantly affected by regions (p>0.05). The coronal enamel border with diagonal-cut of enamel prisms would have an advantage for color adjustment of resin composite restorations compared to the cervical border with longitudinal-cut of enamel prisms.

Color Correlations among Six Types of Permanent Anterior Teeth

STATEMENT OF PROBLEM

When multiple teeth are missing, the color for missing teeth should be estimated based on the color of remaining teeth.

PURPOSE

The purpose was to determine the strength of color correlations among six types of permanent anterior teeth.

METHODS

Color of 12 anterior teeth was measured by Shade Vision System for 47 volunteers. The color coordinates in each type of teeth such as maxillary central incisor (MX1), lateral incisor (MX2), and canine (MX3), and mandibular central incisor (MD1), lateral incisor (MD2), and canine (MD3) were determined. Correlations and differences among the corresponding color coordinates of each type of teeth were determined.

RESULTS

Compared with MX1, the differences were in the range of -3.2 to -6.5 in L*, 0.5 to 2.7 in a*, -0.7 to 7.5 in b*, and the color difference (ΔE*ab ) was 4.5 to 10.3. The color difference by ΔE00 formula was 3.1-6.7. Although the color coordinates were different by tooth type, they generally showed correlations (p < 0.001).

CONCLUSIONS

For the color estimation of missing MX1, the color coordinates of MD1 were the strongest predictors. In case of missing MX3, L* and a* of MD3 and b* of MX1 were the strongest predictors for each corresponding coordinates.

CLINICAL SIGNIFICANCE

The color for missing teeth, especially for maxillary central incisor and maxillary and mandibular canines, could be estimated based on those of the same type teeth on the opposing arch. These results should be applied for clinical color selection for missing teeth.(J Esthet Restor Dent 28:S5-S13, 2016).

Real-time local experimental monitoring of the bleaching process

OBJECTIVE

The purpose of this article was to investigate a new setup for tooth bleaching and monitoring of the same process in real time, so to prevent overbleaching and related sideeffects of the bleaching procedure.

BACKGROUND DATA

So far, known bleaching procedures cannot simultaneously monitor and perform the bleaching process or provide any local control over bleaching.

MATERIALS AND METHODS

The experimental setup was developed at the Institute of Physics, Zagreb. The setup consists of a camera, a controller, and optical fibers. The bleaching was performed with 25% hydrogen peroxide activated by ultraviolet light diodes, and the light for monitoring was emitted by white light diodes. The collected light was analyzed using a red-green-blue (RGB) index. A K-type thermocouple was used for temperature measurements. Pastilles made from hydroxylapatite powder as well as human teeth served as experimental objects.

RESULTS

Optimal bleaching time substantially varied among differently stained specimens. To reach reference color (A1, Chromascop shade guide), measured as an RGB index, bleaching time for pastilles ranged from 8 to >20 min, whereas for teeth it ranged from 3.5 to >20 min. The reflected light intensity of each R, G, and B component at the end of bleaching process (after 20 min) had increased up to 56% of the baseline intensity.

CONCLUSIONS

The presented experimental setup provides essential information about when to stop the bleaching process to achieve the desired optical results so that the bleaching process can be completely responsive to the characteristics of every individual, leading to more satisfying results.

Influence of pH on the Effectiveness of Hydrogen Peroxide Whitening

Objective

To evaluate the influence of pH on the bleaching effect of hydrogen peroxide on chromogen agents.

Method

Hydrogen peroxide 50% was mixed with red wine or with an alcoholic solution of tobacco in glass cuvettes, resulting in final peroxide concentrations of 16.97% and 21.12%, respectively. The pH of this mixture was measured and adjusted with 3.3 M HCl solution or 2.5 M NaOH solution to obtain the final pH values of 3.0, 4.0, 5.0, 6.0, 7.0, 8.0, and 9.0. After mixing, the color of these solutions was evaluated in a reflectance spectrophotometer; readings were repeated after 10 minutes for the wine solution and 20 minutes for the tobacco solution. Ten samples were prepared for each solution at each pH. Color changes (Delta E) were calculated. The data were statistically analyzed using analysis of variance one-way and Tukey tests, with a significance level of 5%.

Results

There were significant differences among the different pH values for the wine and tobacco solutions (p=0.0001). The Tukey test showed that for both solutions, pH 9.0 resulted in a significantly greater bleaching effect than the other values tested.

Conclusion

The efficacy of hydrogen peroxide bleaching is directly proportional to the increase in its pH.

Comparison of effectiveness of abrasive and enzymatic action of whitening toothpastes in removal of extrinsic stains - a clinical trial

OBJECTIVE

To compare the effectiveness of abrasive component (perlite/calcium carbonate) and enzymatic component (papain and bromelain) of whitening toothpaste in removal of extrinsic stains.

METHODS

This study is a randomized, triple blind and parallel group study in which 90 subjects aged 18-40 years were included. At baseline, stains scores were assessed by Macpherson's modification of Lobene Stain Index and subjects were randomly assigned to two groups with 45 subjects in each. Group 1 used whitening toothpaste with enzymatic action and group 2 with abrasive action. After 1 month, stain scores were assessed for the effectiveness of the two toothpastes and 2 months later to check the stain prevention efficacy. Wilcoxson's test was used to compare between baseline 1 and 2 months stain scores, and Mann-Witney U-test was applied for intragroup comparison.

RESULTS

The mean baseline total stain score for the subjects allocated to the enzymatic toothpaste was 37.24 ± 2.11 which reduced to 30.77 ± 2.48 in 1 month, and for the abrasive paste, total stain reduced from 35.08 ± 2.96 to 32.89 ± 1.95. The reductions in total stain scores with both the pastes were significant compared with baseline stain scores (at 1 month Group 1, P = 0.0233 and Group 2, P = 0.0324; at 2 months, Group 1 P = 0.0356). Both the toothpastes proved to be equally good in removal of extrinsic stains; however, the enzymatic paste showed better results as compared to abrasive toothpaste.

CONCLUSION

Whitening toothpaste with abrasive action and enzymatic action are equally effective in removal of extrinsic stains; however, whitening toothpaste with abrasive action needs to be used with caution.

Efficacy of extrinsic stain removal by novel dentifrice containing papain and bromelain extracts

To evaluate the stain removal efficacy of a novel dentifrice containing papain and bromelain extracts (Glodent) in comparison with a control dentifrice (Colgate regular). This was a randomized, positive-controlled, double-blinded, clinical study. Subjects were randomly divided into one of the two study groups. Pre-treatment and post treatment photographs of the 4 anterior teeth were recorded under standardized conditions and analyzed for lightness or luminosity values using Adobe Photoshop. The difference between the mean pre-treatment luminosity of test and control groups was not statistically significant. In both test and control groups, the post-treatment luminosity was significantly higher than pre- treatment luminosity (P < 0.001 and P = 0.003 respectively). The mean post-treatment luminosity for test group was found to be significantly higher than control group. The mean percentage removal of stains for test group was significantly higher than control group. The test dentifrice showed significant stain removal when compared to control which could be attributed to the role of proteolytic enzymes in the test dentifrice.

Crown discoloration induced by endodontic sealers: spectrophotometric measurement of Commission International de I'Eclairage's L*, a*, b* chromatic parameters

Despite the improvement of endodontic materials, crown discoloration induced by root canal sealers remains a concerning clinical issue. The aim of this study is the measurement of the alterations in CIE L*, a*, b* chromatic parameters of tooth crowns after placement of commonly used and new-generation endodontic sealers in pulp chambers. Eighty intact, fully developed third mandibular molars were randomly assigned in five groups. Crowns were cross-sectioned from the root complex 1 mm below the cement-enamel junction. The internal axial walls of the pulp chambers were debrided and coated with endodontic sealers (Roth-811, AH-26, Guttaflow, Epiphany SE). The apical access was sealed with glass-ionomer cement. The control group was only debrided. Crowns were stored in individually marked vials in standard conditions (100% humidity, 37°C). The spectral reflectance lines were recorded with a UV-Vis spectrophotometer in the visual spectrum. The CIE L*a*b* parameters were obtained by a linked computer software before sealer placement (baseline), after one week, one, three, and six months, respectively. Statistical analysis was performed with two-way mixed ANOVA models. The level of statistical significance was set at p<0.05. With the exception of the control group, experimental groups presented varying chromatic alterations. Among all experimental groups, Roth-811 sealer induced the most severe alterations in CIE L*, a*, b* chromatic parameters, during all observation periods. After root canal obturation, the clinician should be aware of the presence of remaining root canal filling materials. Thorough debridement of the pulp chamber is essential for the prevention of sealer-induced discoloration.

Whitening toothpastes: a review of the literature

OBJECTIVES

To review and summarise the whitening agents contained within tooth whitening toothpaste formulations, their mode of action in tooth whitening, and the in vitro and clinical methods used to evaluate and demonstrate their efficacy.

METHODS

Original scientific full papers or reviews listed in ISI Web of Science and Medline were included in this review using the search terms white*, toothpaste and dentifrice.

CONCLUSIONS

Due to the reported consumer and patient dissatisfaction with their perceived tooth color, toothpaste manufacturers have responded by developing a vast array of contemporary whitening toothpastes. One of the key functional ingredients in whitening toothpastes is the abrasive system. In general, these have been designed to give effective removal of extrinsic stains and help prevent tooth stains from reforming without undue abrasivity towards the dental hard tissues. Whitening toothpastes may contain additional agents that augment the abrasive cleaning by aiding the removal and/or prevention of extrinsic stains, for examples, peroxide, enzymes, citrate, pyrophosphate and hexametaphosphate, or optical agents such as blue covarine which can improve tooth whiteness following tooth brushing. In vitro methods used to evaluate tooth whitening efficacy typically determine the ability of a toothpaste formulation to remove/prevent model extrinsic stains on substrates such as enamel or hydroxyapatite or changes in the intrinsic color of tooth specimens. Clinical protocols for evaluating the efficacy of whitening toothpastes typically determine either stain removal or prevention, where changes in natural stain or chlorhexidine/tea induced stain are measured typically over 2-6 weeks. In some clinical studies the overall tooth color change was measured using techniques such as Vita shade guides, colorimeters and image analysis of digital photographs of teeth.

A review of tooth colour and whiteness

OBJECTIVES

To review current knowledge on the definition of tooth whiteness and its application within dentistry, together with the measured range of tooth colours.

METHODS

'Medline' and 'ISI Web of Sciences' databases were searched electronically with key words tooth, teeth, colour, colour, white and whiteness.

CONCLUSIONS

The application of colour science within dentistry has permitted the measurement of tooth colour in an objective way, with the most common colour space in current use being the CIELAB (Commission Internationale de l'Eclairage). Indeed, many investigators from a range of different countries have reported L*, a* and b* values for teeth measured in vivo using instrumental techniques such as spectrophotometers, colorimeters and image analysis of digital images. In general, these studies show a large range in L*, a* and b* values, but consistently show that there is a significant contribution of b* value or yellowness in natural tooth colour. Further developments in colour science have lead to the description of tooth whiteness and changes in tooth whiteness based on whiteness indices, with the most relevant and applicable being the WIO whiteness index, a modified version of the CIE whiteness index.

Interactions of hydroxyapatite surfaces: conditioning films of human whole saliva

Hydroxyapatite is a very interesting material given that it is the main component in tooth enamel and because of its uses in bone implant applications. Therefore, not only the characterization of its surface is of high relevance but also designing reliable methods to study the interfacial properties of films adsorbed onto it. In this paper we apply the colloidal probe atomic force microscopy method to investigate the surface properties of commercially available hydroxyapatite surfaces (both microscopic particles and macroscopic discs) in terms of interfacial and frictional forces. In this way, we find that hydroxyapatite surfaces at physiological relevant conditions are slightly negatively charged. The surfaces were then exposed to human whole saliva, and the surface properties were re-evaluated. A thick film was formed that was very resistant to mechanical stress. The frictional measurements demonstrated that the film was indeed highly lubricating, supporting the argument that this system may prove to be a relevant model for evaluating dental and implant systems.

Fluoropolymers as low-surface-energy tooth coatings for oral care

A range of low-surface-energy fluoropolymers has been synthesised and their effectiveness as dental-care coatings for plaque, stain and erosion prevention has been evaluated using a series of oral care models employing pressed discs of calcium hydroxyapatite or sections of human teeth. Since the blocking of dentinal tubules is a key mechanistic strategy in the treatment of dentine hypersensitivity, the capability of these non-permanent fluoropolymer coatings to occlude the pore structure of human dentine and to reduce the outward flow of simulated dentinal fluid has also been investigated. Several of the fluoropolymer coatings have been found to inhibit bacterial adhesion but no correlation has been established between anti-adhesion efficacy and fluorine content or surface energy. All the fluoropolymers have been seen to reduce stain uptake by pellicle-coated HA discs, with homopolymers being considerably more effective than copolymers. Some fluoropolymer coatings have also been shown to inhibit the acid demineralisation of hydroxyapatite discs and to reduce dentine permeability. Coatings of the 2:1 copolymer of 1H,1H,2H,2H-perfluorodecyl acrylate and 2-hydroxyethyl acrylate are most promising, exhibiting significant anti-adhesion and anti-erosion efficacy and reducing dentine permeability to a level that is comparable with that achieved with the standard treatment employed in commercial anti-sensitivity formulations.

Nonvital tooth bleaching: a review of the literature and clinical procedures

Tooth discoloration varies in etiology, appearance, localization, severity, and adhesion to tooth structure. It can be defined as being extrinsic or intrinsic on the basis of localization and etiology. In this review of the literature, various causes of tooth discoloration, different bleaching materials, and their applications to endodontically treated teeth have been described. In the walking bleach technique the root filling should be completed first, and a cervical seal must be established. The bleaching agent should be changed every 3-7 days. The thermocatalytic technique involves placement of a bleaching agent in the pulp chamber followed by heat application. At the end of each visit the bleaching agent is left in the tooth so that it can function as a walking bleach until the next visit. External bleaching of endodontically treated teeth with an in-office technique requires a high concentration gel. It might be a supplement to the walking bleach technique, if the results are not satisfactory after 3-4 visits. These treatments require a bonded temporary filling or a bonded resin composite to seal the access cavity. There is a deficiency of evidence-based science in the literature that addresses the prognosis of bleached nonvital teeth. Therefore, it is important to always be aware of the possible complications and risks that are associated with the different bleaching techniques.

Precision of in vivo spectrophotometric colour evaluation of natural teeth

The aim of the study was to evaluate the precision of a reflectance spectrophotometer during longitudinal assessment of tooth colour in vivo. The spectrophotometric data of five standardized circular areas on the labial surfaces of six teeth (four upper and two lower), from 22 dental students, were recorded on three separate days (1st, 3rd and 30th) employing a repeated-measuring design (n = 3). Total colour differences were calculated according to the equation DeltaEpsilon = [(DeltaL*)(2) + (Deltaa*)(2) + (Deltab*)(2)](1/2). It was found that all measured teeth areas, recorded by the same examiner (DeltaEpsilon(INTRA)), demonstrated minor colour changes during the three different time intervals, which did not exceed in every case the 50:50% perceptibility threshold of DeltaEpsilon = 1, thus indicating a good match. The smallest DeltaEpsilon values were recorded for the upper central incisors, whereas lower central incisors and upper first premolars revealed the most significant colour differences (0.68 +/- 0.21 and 0.70 +/- 0.25 DeltaEpsilon-units, respectively). The central zone of the middle third of each labial tooth surface exhibited the most precise recordings. With regard to interexaminer reproducibility (DeltaEpsilon(INTER)), the mesial and distal areas of all measured teeth presented the most statistically significant colour differences (0.48 +/- 0.15 and 0.50 +/- 0.17 DeltaEpsilon-units, respectively). It is concluded that the spectrophotometer tested in the present study can provide a precise measurement of tooth colour in vivo. However, in rejection of the null hypothesis, the type (posterior teeth, mandibular incisors) and the mesial and distal areas of natural teeth affected the repeatability and reproducibility of intraoral spectrophotometric measurements.

Vital tooth whitening

Vital tooth whitening, when administered correctly, is by all accounts one of the safest, most conservative, least expensive, and most effective aesthetic procedures currently available to patients. This article traces the evolution of the technology, describes what is known about the mechanism of action and explores such issues as toxicology and side effects associated with tooth whitening. The article also describes the various tooth-whitening systems, which include dentist-supervised night-guard bleaching, in-office or power bleaching, and bleaching with over-the-counter bleaching products. Combination treatments and light-activated treatments are also discussed. Finally, the article summarizes the areas of research needed in this field.

Review of the extrinsic stain removal and enamel/dentine abrasion by a calcium carbonate and perlite containing whitening toothpaste

There has been an increase in the demand from consumers and patients for products that whiten teeth. To meet this demand, a whitening toothpaste containing calcium carbonate and perlite as the abrasive system and an efficacious fluoride source has recently been launched. The aim of the current paper is to review the toothpaste's stain removal efficacy and its effects on enamel and dentine wear. It has been shown to be effective at removing model extrinsic stain in vitro. Further, it has been shown to be more effective in removing naturally occurring extrinsic tooth stain than a silica non-whitening control toothpaste after two weeks of twice daily brushing in a parallel group, double-blind clinical study using 152 adult volunteers. In addition, the enhanced whitening effect did not give a clinically relevant level of wear to enamel or a significant increase in dentine wear compared to marketed non-whitening toothpaste formulations, as shown by using an in situ type model with ex vivo brushing.

Effect of toothpaste with natural calcium carbonate/perlite on extrinsic tooth stain

OBJECTIVE

The current study was designed to determine the effect of natural calcium carbonate toothpaste containing Perlite and microgranules (Whitening toothpaste) on extrinsic tooth stain compared to a standard commercial toothpaste formulation with precipitated calcium carbonate (PCC) as abrasive and a commercial toothpaste with dicalcium phosphate dihydrate (DCPD) as abrasive.

METHODS

The toothpastes were evaluated in a double blind, three-cell, stratified (tobacco use; baseline tooth stain level), parallel group design study involving 600 subjects with extrinsic tooth stain. Subjects brushed twice daily with their allocated toothpaste for four weeks. Extrinsic tooth stain was measured using the Macpherson modification of the Lobene stain index.

RESULTS

ANCOVA showed significant differences between toothpastes (p=0.037). Subsequent multiple comparisons using pairwise t-tests, showed the Whitening toothpaste to be superior to the DCPD toothpaste (p=0.014) and the PCC toothpaste (p=0.067). When a Box-Cox transformation was made to the data (y0.6) to improve normality, these two differences were more accurately estimated at p=0.004 and p=0.03 respectively.

CONCLUSION

The Whitening toothpaste has been shown to be significantly more effective in tooth stain removal than the two standard commercial toothpaste formulations.

An in situ model to study the toothpaste abrasion of enamel

OBJECTIVES

In order to understand the clinical relevance of dentifrice abrasivity on the dentition in vivo, an in situ enamel wear model has been developed.

MATERIALS AND METHODS

Polished human enamel blocks were indented with a Knoop diamond, attached to dentures and worn by adult volunteers for 24 h per day. The blocks were brushed for 30 s, twice per day with dentifrices of known relative dentine abrasivity (RDA) and relative enamel abrasivity (REA). The dentifrices used were either dentifrice A (RDA=85, REA=3.4), dentifrice B (RDA=189, REA=2.0) or dentifrice C (RDA=132, REA=42.7). After 28 days, the blocks were removed and the geometry of each Knoop indent was remeasured. From the baseline and post-treatment values of indent length, the amount of enamel wear was calculated from the change in the indent depth.

RESULTS

The median values for enamel wear of dentifrices A, B and C were -0.02, 0.01 and -0.48 microm, respectively. The differences between dentifrice C and dentifrices A and B were of statistical significance.

CONCLUSION

This study has demonstrated the usefulness of an in situ technique for investigating the relationship between the abrasivity of a dentifrice in vitro and the wear of enamel in situ.

In vitro evaluation of a novel 6% hydrogen peroxide tooth whitening product

OBJECTIVES

The aims of this study were to evaluate the in vitro tooth whitening effects of a novel 6% hydrogen peroxide containing tooth whitener Xtra White (XW) on extrinsic stain and intrinsic tooth colour and the effects on enamel and dentine microhardness. In addition, to determine the levels of peroxide found in tooth pulp chambers after treatment with XW in vitro.

METHODS

Extrinsic stain changes were determined by measuring colour changes of tea stained hydroxyapatite discs after treatment with water, placebo gel, XW or Colgate Simply White (CSW). Intrinsic tooth colour changes were determined by treating extracted human teeth in vitro with a placebo gel, XW or CSW for a simulated two weeks use and measuring colour differences with a chroma meter. Teeth treated with placebo gel and XW were cross-sectioned and the subsurface enamel and dentine was polished and the microhardness determined. The peroxide concentration found in extracted tooth pulp chambers was determined spectrophotometrically.

RESULTS

XW gave significantly more extrinsic stain removal (p<0.0001) and an increase in tooth whiteness (p<0.05) than a placebo gel, but was not significantly different to CSW. There were no significant differences in subsurface enamel and dentine microhardness values for the placebo and XW treated teeth. The mean concentration of peroxide found in the tooth pulp chambers was 0.44 mM, which is over 3000 times below the concentration reported to cause pulpal enzyme damage.

CONCLUSIONS

XW has been shown to be an effective tooth whitening product in vitro with support for its safety on subsurface enamel and dentine together with its safety on tooth pulp tissue.

Tooth colour: a review of the literature

OBJECTIVES

To review current knowledge with respect to tooth colour and its measurement.

METHODS

'Medline' database for the period 1966 to the present day and 'ISI Web of Science' database for the period 1974 to the present day were searched electronically with key words tooth, teeth, colour and color.

CONCLUSIONS

The colour and appearance of teeth is a complex phenomenon, with many factors such as lighting conditions, translucency, opacity, light scattering, gloss and the human eye and brain influencing the overall perception of tooth colour. The measurement of tooth colour is possible via a number of methods including visual assessment with shade guides, spectrophotometry, colourimetry and computer analysis of digital images. These methods have successfully been used to measure longitudinal tooth colour changes when the dentition has undergone tooth whitening procedures.

Clinical evaluation of a novel whitening gel, containing 6% hydrogen peroxide and a standard fluoride toothpaste

OBJECTIVES

The aim of this study was to determine the effect on tooth colour (after 1 and 2 weeks use) of a self-applied tooth-whitening gel containing 6% hydrogen peroxide using a novel applicator, compared to a standard fluoride toothpaste.

METHODS

A 2-week, examiner-blind, stratified, parallel design clinical trial was conducted. Efficacy was measured by comparing the Vita shade scores recorded at baseline and after 1 and 2 weeks of product application. To qualify for the study, subjects were required to have at least one upper incisor/canine tooth measuring Vita shade A3 or darker. All upper incisors/canines of qualifying subjects were evaluated for change in Vita shade irrespective of their level of whiteness at baseline, allowing for the whitening gel to be tested on the full range of Vita tooth shades. One hundred and seventeen subjects were divided into two groups, balanced according to their darkest tooth shade. One group followed a 2-week, twice-daily regimen of brushing with toothpaste followed by the application of the hydrogen peroxide whitening gel. The other group brushed twice daily with toothpaste for 2 weeks.

RESULTS

Subjects using the whitening gel showed a statistically significant improvement, (p<0.05) in mean tooth shade score of 0.75 and 1.02 units after 1 and 2 weeks, compared to baseline. These improvements from baseline were significantly greater than those observed for the toothpaste only group (0.14 and 0.35 units change after 1 and 2 weeks).

CONCLUSIONS

The self-applied tooth-whitening gel containing 6% hydrogen peroxide has been shown to significantly improve the whiteness of teeth after 1 and 2 weeks of product use, compared to the baseline and the toothpaste only group.

Quantitative light-induced fluorescence: a potential tool for general dental assessment

Current dental diagnostic methods can detect caries but cannot quantify the mineral status of a lesion. Quantitative light-induced fluorescence (QLF) measures the percentage of fluorescence change of demineralized enamel with respect to surrounding sound enamel, and relates it directly to the amount of mineral lost during demineralization. Development of caries-like lesions and subsequent remineralization of the lesions were monitored by QLF. The results showed that the percentage of fluorescence change (Delta Q) increased linearly with the demineralization time and decreased with increased remineralization time. Stained teeth were whitened with a bleaching agent and the change in stain intensity (Delta E) was quantified using QLF. The results showed that Delta E decreased linearly as the tooth regained its natural color. Factors that might affect the use of QLF to detect and quantify caries were also examined. It was concluded that QLF could be used to detect and longitudinally monitor the progression or remineralization of incipient caries, however lesion detection may be limited by the presence of saliva or plaque and enhanced by staining. The change in shade of discolored teeth by whitening agents could be quantitatively measured by QLF.