Erosion and Abrasion of Enamel and Dentin Associated With At-Home Bleaching

Influence of violet LED and fluoride-containing carbamide peroxide bleaching gels on early-stage eroded/abraded teeth

PURPOSE

This study evaluated enamel with early-stage erosion/abrasion following bleaching with 20% and 45% carbamide peroxide (CP) gels containing fluoride (F) and irradiated with violet LED (LED).

METHODS

Enamel blocks were immersed in 1% citric acid (5 min) and artificial saliva (120 min) three times to produce early-stage enamel erosion. Simulated toothbrushing was performed only after the first saliva immersion, to provoke enamel abrasion. The erosive/abraded enamel samples were submitted to (n=10): LED/CP20, CP20, LED/CP20_F, CP20_F, LED/CP45, CP45, LED/CP45_F, CP45_F, LED, and control (without treatment). The pH of the gels was assessed, and color (ΔE₀₀) and whiteness index (ΔWI_D) changes were calculated after cycling (T₁), and 7 days from bleaching (T₂). Enamel surface roughness average (Ra) and Knoop microhardness (kg/mm², %SHR) were evaluated at baseline (T₀) at T₁ and T_2. Scanning electron microscopy evaluated the enamel surface morphology at T₂.

RESULTS

The gels' pH was neutral and CP20 and CP45 exhibited no differences in ΔE₀₀ and ΔWI_D (p>0.05) but LED increased these parameters for CP20_F and CP45. Erosion/abrasion significantly decreased mean kg/mm², and the LED group was the only one not increasing microhardness after bleaching (p>0.05). None of the groups fully recovered the initial microhardness. All groups exhibited %SHR similar to the control (p>0.05) and the increase in Ra was detected only after erosion/abrasion. CP20_F groups exhibited a more preserved enamel morphology.

CONCLUSION

Light irradiation combined with low-concentrated CP gel promoted a bleaching effect comparable to the high-concentrated CP. The bleaching protocols did not adversely impact the surface of early-stage eroded/abraded enamel.

Nanoparticles as Next-Generation Tooth-Whitening Agents: Progress and Perspectives

Whitening agents, such as hydrogen peroxide and carbamide peroxide, are currently used in clinical applications for dental esthetic and dental care. However, the free radicals generated by whitening agents cause pathological damage; therefore, their safety issues remain controversial. Furthermore, whitening agents are known to be unstable and short-lived. Since 2001, nanoparticles (NPs) have been researched for use in tooth whitening. Importantly, nanoparticles not only function as abrasives but also release reactive oxygen species and help remineralization. This review outlines the historical development of several NPs based on their whitening effects and side effects. NPs can be categorized into metals or metal oxides, ceramic particles, graphene oxide, and piezoelectric particles. Moreover, the status quo and future prospects are discussed, and recent progress in the development of NPs and their applications in various fields requiring tooth whitening is examined. This review promotes the research and development of next-generation NPs for use in tooth whitening.

Tooth Color Change and Erosion: Hydrogen Peroxide Versus Non-peroxide Whitening Strips

AIM

The study evaluated the efficacy and potential erosion of non-peroxide strips compared to hydrogen peroxide (HP) whitening strips (WSs).

METHODS

Color evaluation samples (N=64) were distributed into four groups and treated according to manufacturer's directions. NC: Negative control treated with water; BT: Non-peroxide Brilliant Dissolving Strips; FM: Non-peroxide Fancymay Teeth WSs; WS: Crest 3D Brilliance HP White Strips. A contact-type spectrophotometer was used to measure color at baseline (T1), 1-day posttreatment (T2), and 1-week posttreatment (T3). Teeth were cut to a rectangular block for micro-CT erosion assessment. The samples (N=30) were divided into five groups. In addition to the four groups for color assessment, a positive control (PC) treated with 0.25% citric acid was added. The samples were scanned, reconstructed, and measured for erosion depth using a micro-CT analysis program software. Kruskal-Wallis test was used to determine differences in color change and erosion depth among the groups. Tests of hypotheses were two-sided with an alpha level of 0.05.

RESULTS

The mean ΔE*ab at 1-day/1-week posttreatment were 2.4/2.5, 2.8/2.9, 2.8/3.2, and 8.6/11.0 for NC, BT, FM, and WS, respectively. There was a statistically significant difference for ΔE*ab at 1-day and 1-week posttreatment (p<0.001). Group WS had the highest color change, while the other three groups did not differ from each other (p>0.05). Mean erosion depths in microns were 0.52, 0.58, 0.42, 0.49, and 29.55 for NC, BT, FM, WS, and PC, respectively. There was a statistically significant difference among the groups (p=0.004). Group PC had the greatest erosion, while the other groups had negligible erosion that did not differ from each other (p>0.05).

CONCLUSION

Peroxide WSs had superior whitening efficacy compared to non-peroxide strips. None of the tested products compromised tooth structure integrity through enamel erosion.

Effect of bioactive glasses and neodymium:yttrium-aluminum-garnet laser on dentin permeability

Context:

Dental hypersensitivity and loss of dental tissues are commonly observed in patients, and most of the problems are caused due to total or partial exposure of dentinal tubules.

Aims:

The purpose of this study is to evaluate the performance of 45S5 bioactive glass and niobophosphate (NbG) associated with neodymium: yttrium-aluminum-garnet (Nd:YAG) laser for the reduction of dentin permeability.

Materials and Methods:

Fifty bovine dentin discs were made and distributed randomly into five groups (n = 10). The Nd:YAG laser was applied with the bioactive glasses using the energy parameters (60 and 80 mJ), forming the groups; NbG_60: NbG + Nd:YAG (60 mJ); NbG_80: NbG + Nd:YAG (80 mJ), 45S5_60: 45S5 + Nd:YAG (60 mJ); 45S5_80: 45S5 + Nd:YAG (80 mJ) and C: control (untreated dentin). The permeability was measured with a split chamber device. The samples were subjected to the erosive challenge and a new permeability measurement was done. Furthermore, the dentin was analyzed by scanning electron microscopy/energy-dispersive X-ray spectroscopy (SEM/EDS).

Statistical Analysis Used:

The data were analyzed using Kruskal–Wallis and Dunn's tests (α = 0.05).

Results:

Greater reduction in dentinal permeability was observed for 45S5 bioactive glasses (45S5_60 and 45S5_80) followed by NbG_80 and NbG_60 (P < 0.05). The SEM/EDS analysis showed the formation of a barrier after the dentin treatment.

Conclusions:

Bioactive glasses with Nd:YAG laser on the dentin surface may be a promising alternative for the reduction of dentin permeability.

Effect of Vital Bleaching on Micromorphology of Enamel Surface: an in Vitro Study

OBJECTIVES

The aims of this in vitro study was to investigate the effects of bleaching agents commonly used in micromorphology of the enamel surface and to assess the effect of concentration and of adding fluoride in the bleaching agents.

METHODS

Sixty freshly extracted intact teeth were stored in distilled water. One half of each tooth was served as control, the other part was treated with bleaching agent. Samples were randomly divided into six groups of ten, according to the bleaching agents: G1- at-home-CP10; G2- at-home-CP16; G3- at-home-CP22; G4- in-office-CP35; G5- in-office-HP40 with fluoride; G6- in-office-HP40 without fluoride. Enamel specimens for each group were then submitted to a quantitative scanning electron microscopy. Number of pores and their diameter were measured to assess porosity of enamel surface.

RESULTS

SEM analysis revealed enamel surface porosity after bleaching. Significant increase in number and major diameter of pores in bleached samples (p<0.001) were observed. The comparison between samples treated with 10% PC and samples treated with 22% PC showed significant increase in number of pores (p=0.006) and major diameter (p=0.001) from samples treated with 22% PC. Statistical analyses showed significant increase in the number of pores (p=0.006) from samples treated with 40% HP without fluoride compared to samples treated with 40% HP containing fluoride.

CONCLUSIONS

Bleaching products with low concentration cause less porosity at surface of the enamel compared to concentrated products. Adding fluoride in the bleaching agent appears to reduce porosity of enamel surface.

Influence of Erosion/Abrasion and the Dentifrice Abrasiveness Concomitant with Bleaching Procedures

Purpose

The aim of this study was to evaluate the effect of erosive/abrasive cycles and two different levels of abrasiveness of dentifrices over enamel and dentin subjected to bleaching.

Methods

Enamel and dentin bovine specimens were prepared and submitted to an at-home bleaching treatment using 9.5% hydrogen peroxide gel, which was applied daily (30 min/14 days). Concomitant with bleaching, an erosive cycle was performed using citric acid (0.3%, pH 3.8, 5 mins, 3×/day), followed by immersions in artificial saliva for remineralization (30 mins). Abrasion was done with two (high and low abrasiveness) dentifrices (2×/day, 120 seconds) after the first and third erosive immersion each day. Enamel and dentin softening were assessed by microhardness and erosive tooth wear by optical profilometry. Data were submitted to repeated measures ANOVA, followed by the Tukey’s test with a significance level of 5%.

Results

For the enamel and considering the erosive-abrasive cycle, significant differences were found between the groups tested, the bleaching, and the abrasiveness of the dentifrice tested; however, the final microhardness values were significantly lower than the initial ones. For dentin, differences were found between the eroded/abrasion and the non-eroded/abrasion groups, with the former presenting lower microhardness values compared with the latter. In addition, bleaching decreased the microhardness values only for the highly abrasive dentifrice, and the final values were lower than for the initial ones for all tested groups.

Conclusion

The use of high and low abrasiveness dentifrices during bleaching and concomitant with erosion/abrasion cycles is more harmful to dentin than to enamel.

Clinical Relevance

Although bleaching is considered a conservative treatment, it can cause deleterious effects to dental hard tissue. The association of an at-home bleaching technique with erosion and high- or low- abrasive dentifrices harms dentin more than enamel.

Influence of Different Time Intervals among the in-Office Bleaching Sessions on the Tooth Enamel Mass Variation

AbstractThis study evaluated the effect of different time intervals between tooth bleaching sessions on the variation of tooth enamel mass, using a 35% hydrogen peroxide (HP35) gel. Twenty bovine incisor teeth were collected and cross-sectioned twice, leaving only the middle coronal portion. The dentin layer was removed, leaving only the buccal dental enamel. The samples were randomly divided into 2 groups (n = 10): G1 (with a 7-day time interval between each bleaching session), and G2 (with a 2-day time interval between each bleaching session). Three bleaching sessions were performed for each group. Each specimen’s mass was measured using an electronic analytical scale, first at the beginning of the experiments (T0), and then immediately after each bleaching intervention (T1, T2 and T3, respectively). All samples were stored in artificial saliva and kept in a biological chamber during the time of the study. The data analysis was performed using ANOVA for the related samples (p = 0.05). The results showed a reduction in the enamel mass values in G2 after the 3rd session when comparing to enamel mass values presented at the beginning of the study. On the other hand, G1 presented an increase in the mass values at the end of the third session, and these intragroup differences were statistically significant (p <0.001). It was concluded that bleaching treatment with 7-day intervals between sessions leads to no tooth enamel mass loss, whereas the reduced 2–day time interval between sessions caused a significant tooth enamel mass loss. Keywords: Tooth. Tooth Bleaching. Tooth Enamel. Resumo                                                                 Este estudo avaliou a influência de diferentes intervalos de tempo entre as sessões de clareamento com peróxido de hidrogênio a 35% (PH35) sobre a variação de massa do esmalte dental. Foram utilizados 20 dentes incisivos bovinos hígidos, seccionados em duas porções transversais, com a camada de dentina vestibular toda removida, restando apenas o esmalte dental vestibular. As amostras foram distribuídas em 2 grupos (n=10): G1 - intervalo de tempo de 7 dias entre as sessões de clareamento, e G2 - Intervalo de 2 dias entre as sessões de clareamento. Foram realizadas 3 aplicações de gel clareador em cada grupo. A pesagem dos espécimes foi realizada antes do início do tratamento clareador e ao final de cada intervenção clareadora, em uma balança analítica eletrônica. Os espécimes foram armazenados em saliva artificial, e mantidos em estufa biológica. Os dados foram submetidos à ANOVA para amostras relacionadas (p=0.05). O G2 apresentou uma redução nos valores de massa do esmalte quando comparados os tempos antes do clareamento (T0 - 0.1650g) e após a 3° sessão (T3 - 0.1643g). Entretanto, o G1 apresentou um aumento nos valores de massa ao término da terceira sessão (T0 - 0.1615g e T3 - 0.1624g), sendo essas diferenças intragrupos estatisticamente significantes (p<0.001). Foi possível concluir que no clareamento com intervalo de 7 dias entre as sessões não houve perda de massa do esmalte dental, ao passo que quando reduzido o intervalo entre as sessões para 2 dias, uma perda significativa de massa foi observada. Palavras-chave: Dente. Clareamento Dental. Esmalte Dentário.

Protective Effect of Adhesive Systems associated with Neodymium-doped Yttrium Aluminum Garnet Laser on Enamel Erosive/Abrasive Wear

AIM

This study evaluated the efficacy of self-etching adhesive systems associated or not associated with the neodymium-doped yttrium aluminum garnet (Nd:YAG) laser on the protection against enamel erosive/abrasive wear.

MATERIALS AND METHODS

Bovine enamel specimens were demineralized with 0.3% citric acid (5 minutes). The samples were randomly assigned to eight groups (n = 20): SB - Single Bond Universal (3M/ESPE); SB+L - Single Bond Universal + laser (80 mJ/10 Hz); FB - Futurabond U (Voco); FB+L -Futurabond U + laser; GEN - G-aenial bond (GC); GEN+L -G-aenial bond + laser; L - laser irradiation; and C - no treatment. The laser was applied before light curing. The samples were subjected to erosive/abrasive challenges (0.3% citric acid - 2 minutes and tooth brushing four times daily for 5 days). Enamel surface loss was recovered profilometrically by comparison of baseline and final profiles. The adhesive layer thickness, retention percentage of the protective layer, and microhardness of cured adhesive were measured. Data were analyzed using one-way analysis of variance and Tukey's test (5%).

RESULTS

There were significant differences for all parameters (p = 0.0001). Mean values ± SD and results of the Tukey's test were: Surface wear: GEN - 4.88 (±1.09)a, L - 5.04 ± 0.99)a, FB - 5.32 (±0.93)ab, GEN + L - 5.46 (±1.27)abc, SB + L - 5.78 (±1.12)abc, FB + L - 6.23 (±1.25)bc, SB - 6.35 (±1.11)c, and C - 6.46 (±0.61)c; layer thickness: GEN - 15.2 (±8.63)c, FB - 5.06 (±1.96)a, GEN + L - 13.96 (±7.07)bc, SB + L - 4.24 (±2.68)a, FB + L - 9.03 (±13.02)abc, and SB - 7.49 (±2.80)ab; retention: GEN - 68.89 (±20.62)c, FB - 54.53 (±24.80)abc, GEN + L - 59.90 (±19.79)abc, SB + L - 63.37 (±19.30)bc, FB + L - 42.23 (±17.68) a, and SB - 47.78 (±18.29)ab; microhardness: GEN - 9.27 (±1.75)c; FB - 6.99 (±0.89)b; GEN + L - 6.22 (±0.87)ab; SB + L - 15.48 (±2.51)d; FB + L - 10.67 (±1.58)c; SB - 5.00 (±1.60)a.

CONCLUSION

The application of Futurabond U and G-aenial bond on enamel surface, as well as the Nd:YAG laser irradiation alone, was able to reduce the enamel wear. The use of laser after the adhesive systems did not improve their efficacy.

CLINICAL SIGNIFICANCE

Erosive/abrasive wear is a prevalent condition in clinical practice affecting many patients. The association of adhesive systems and Nd:YAG laser is of considerable clinical interest because it assesses new treatments to reduce the erosive/abrasive wear that would help dentists in clinical treatment decisions to reduce enamel wear and achieve a successful treatment.

An In Vitro Evaluation of Human Enamel Surfaces Subjected to Erosive Challenge After Bleaching

OBJECTIVES

This study aimed to evaluate whether tooth enamel bleached with hydrogen peroxide (H₂ O₂ ) is more susceptible to erosion when compared with unbleached tooth enamel; and whether the presence of calcium (Ca) in the bleaching gel influenced this process.

MATERIALS AND METHODS

Enamel blocks were prepared from human molars, and submitted to surface microhardness analysis (baseline). Blocks were prepared and randomly divided into four treatment groups (n = 20): G1 and G2-bleached with 7.5% H₂ O₂ , with and without Ca, respectively; G3 and G4-bleached with 35% H₂ O₂ , with and without Ca, respectively. After bleaching, these groups were submitted to an erosive challenge with 1% citric acid. G5 and G6 (n = 20, each) were the negative (without bleaching) and positive controls (without bleaching, but with erosion), respectively. The percentage of surface hardness loss (%SHL), the 3D non-contact profilometry and Scanning Electron Microscopy (SEM) analyses were performed.

RESULTS

G2 showed the highest %SHL after bleaching. G1 presented the lowest %SHL in comparison with G2, G3, G4, and G6 after erosion (p < 0.05), which was confirmed only by the SEM analysis.

CONCLUSION

It is suggested that low concentration of H₂ O₂ with calcium can be recommended for at-home bleaching agents, which may avoid the mineral loss of bleached enamel after an erosive challenge.

CLINICAL SIGNIFICANCE

Low concentration of H₂ 0₂ with calcium can be recommended for at-home bleaching agents, which may avoid the mineral loss of bleached enamel after an erosive challenge. (J Esthet Restor Dent 29:128-136, 2017).

Artificial Saliva Formulations versus Human Saliva Pretreatment in Dental Erosion Experiments

The aim of this study was to evaluate the erosion-preventive effect of different artificial saliva formulations and human saliva in vitro compared to human saliva in situ. In the in vitro experiment, bovine enamel and dentin specimens were stored in artificial saliva (4 different formulations, each n = 20), deionized water (n = 20) or human saliva (n = 6 enamel and dentin specimens/volunteer) for 120 min. In the in situ experiment, each of the 6 enamel and dentin specimens was worn intraorally by 10 volunteers for 120 min. The specimens were then eroded (HCl, pH 2.6, 60 s). Half of the specimens were subjected to microhardness analysis (enamel) and the determination of calcium release into the acid (enamel and dentin), while the other half were again placed in the respective medium or worn intraorally, respectively, for 120 min before a second erosion was performed. Knoop microhardness of enamel and the calcium release of enamel and dentin into the acid were again determined. Statistical analysis was conducted by two-way repeated-measures ANOVA or two-way ANOVA (α = 0.05). Enamel microhardness was not significantly different between all test groups after the first and the second erosive challenge, respectively. Enamel calcium loss was significantly lower in situ compared to the in vitro experiment, where there was no significant difference between all test groups. Dentin calcium loss was significantly lower than deionized water only after the first and than all except one artificial saliva after the second erosion. Under the conditions of this experiment, the use of artificial saliva formulations and human saliva in vitro does not reflect the intraoral situation in dental erosion experiments adequately.

Erosion Potential of Tooth Whitening Regimens as Evaluated with Polarized Light Microscopy

AIMS

Tooth whitening is a widely utilized esthetic treatment in dentistry. With increased access to over-the-counter (OTC) systems concerns have been raised as to potential adverse effects associated with overuse of whitening materials. Therefore, this study aimed to evaluate enamel erosion due to different whitening regimens when used in excess of recommended guidelines.

MATERIALS AND METHODS

Extracted human teeth (n = 66) were randomly divided into 11 groups (n = 6/group). Specimens were exposed to OTC products: Crest Whitestrips and 5-minute natural white and a do-it-yourself (DIY) strawberry whitening recipe. Within each regimen, groups were further divided per exposure time: specimens receiving the recommended product dosage; 5 times the recommended dosage; and 10 times the recommended dosage. Negative and positive controls were treated with grade 3 water and 1.0% citric acid, respectively. Specimens were nail-varnished to limit application to a 1 × 4 mm window. Following treatment, specimens were sectioned and erosion (drop in μm) measured using polarized light microscopy. Two-sample t-test was used to detect difference in amount of enamel erosion between negative and positive groups, while one-way analysis of variance (ANOVA), followed by post hoc Dunnett's test was used to detect difference between set of treatment groups and negative control groups or among all experimental groups.

RESULTS

There was significant difference in mean amount of enamel erosion (p < 0.0001). Mean enamel erosion for positive control group was significantly greater than that for negative control group (23.50 vs 2.65 μm). There was significant effect for type of treatments on enamel erosion [F(9,50) = 25.19; p < 0.0001]. There was no significant difference between the negative control and each of treatment groups (p > 0.05 for all instances), except for Natural White_10 times treatment group (p < 0.0001) that was significantly greater than the negative control group (14.82 vs 2.65 μm).

CONCLUSION

Caution is advised when using certain over-the-counter products beyond recommended guidelines as there is potential for enamel erosion.

CLINICAL SIGNIFICANCE

Enamel erosion due to the overuse of whitening products varies for different modalities and products. Therefore, caution is advised when using certain over-the-counter products beyond recommended guidelines, as there is potential for enamel erosion.

Microhardness evaluation of silorane and methacrylate composites submitted to erosion and abrasion processes

Objective: The aim of this study was to evaluate the Knoop hardness number (KHN) of methacrylate (MC) and silorane (SC) composites after being submitted to erosion and abrasion processes. Material and methods: Forty samples were made with each composite: MC and SC. The samples were divided into eight groups (n = 10) according to the type of composite (G1-G4, MC; G5-G8, SC) and the beverages involved in the erosion process (G1 and G5 - Control (C), without erosion, with abrasion; G2 and G6 - Orange Juice (OJ), abrasion; G3 and G7 - Smirnoff Ice® (SI), abrasion; G4 and G8 - Gatorade® (GA), abrasion). The KHN test was performed 24 h after the last cycle of erosion/abrasion. Results: The MC groups showed smaller KHN values for the SI group (p < 0.05) when compared to the Control and OJ groups; however, for the SC groups, no differences were found (p > 0.05). Conclusion: Methacrylate composite when submitted to acidic beverages erosive challenge combined with abrasive process might alter its surface microhardness. However, the beverages used in the present study were not able to interfere in silorane composite surface microhardness.

Effect of home-bleaching gels modified by calcium and/or fluoride and the application of nano-hydroxyapatite paste on in vitro enamel erosion susceptibility

OBJECTIVE

This in vitro study compared the effect of bleaching agents modified by the addition of calcium and/or fluoride and the application of a nano-hydroxyapatite paste after bleaching, on the susceptibility of enamel to erosion.

MATERIALS AND METHODS

Bovine enamel cylindrical samples (3 mm diameter) were assigned to six groups (n = 20 specimens/group) according to the bleaching agent: no bleaching (C-control), 7.5% hydrogen peroxide gel (HP), HP with 0.5% calcium gluconate (HP+Ca), HP with 0.2% sodium fluoride (HP+F), HP with calcium and fluoride (HP+Ca+F) and HP followed by the application of a nano-hydroxyapatite agent (HP+NanoP). The gels were applied on the enamel surface (1 h) followed by cyclic erosive challenges (Sprite Zero®-2 min), for 14 days. The paste was applied after bleaching for 5 min (HP+NanoP). The enamel surface alteration was measured by contact profilometry (µm) (after 7 and 14 days).

RESULTS

C-control (mean ± SD: 2.29 ± 0.37 at 7 days/4.86 ± 0.72 at 14 days) showed significantly lower loss compared to the experimental groups. HP+Ca (3.34 ± 0.37/6.75 ± 1.09) and HP+F (4.49 ± 0.92/7.61 ± 0.90) presented significantly lower enamel loss than HP (4.18 ± 0.50/10.30 ± 1.58) only for 14 days and HP+Ca+F (4.92 ± 1.03/8.12 ± 1.52) showed values similar to the HP+F group. The HP+NanoP (5.51 ± 1.04/9.61 ± 1.21) resulted in enamel loss similar to the HP after 14 days.

CONCLUSIONS

It was found that 7.5% hydrogen peroxide increased the susceptibility of enamel to erosion. The addition of calcium or fluoride to the bleaching gel reduced the erosion effect, while the nano-hydroxyapatite agent did not provide any protective effect.

Tooth-bleaching procedures and their controversial effects: A literature review

AIM

This review article will help clinicians improve their understanding of the history of bleaching procedures, bleaching types, components, mechanisms, and their effects on soft tissue, tooth structures, resin composite, and bonding.

METHODS

The controversial issues about bleaching procedures and their effects are reviewed. Additionally, the consequences of pre- and post-bleaching on the bonding potential of composite resin restorations to tooth structure are discussed.

CONCLUSION

The overall goal of the paper is to help reduce risks for patients.

Microleakage effect on class V composite restorations with two adhesive systems using different bleaching methods

OBJECTIVE

The main objective of this study was to evaluate the effects of an at-home and two in-office (chemically activated and KTP laser-activated) bleaching methods on the microleakage of composite resin restorations bonded with etch-and-rinse and self-etch adhesive systems.

MATERIALS AND METHODS

Class V cavity preparations were performed on 96 premolars and teeth were divided into two groups according to the two adhesive systems (etch-and-rinse and self-etch). After cavities were restored with an adhesive systems and composite resin, they were submitted to thermocycling procedures. Teeth were divided into four sub-groups according to the bleaching systems (control, at-home bleaching, chemically activated office bleaching and KTP laser-activated office bleaching). After the bleaching procedure, teeth were evaluated for marginal leakage. All data were analyzed using the Mann-Whitney U and Kruskal-Wallis tests (p < 0.05).

RESULTS

The results of the present study showed that the control group presented lower microleakage values compared with the groups treated with bleaching agents, except for the chemically activated in-office bleaching. When the scores of microleakage at the enamel and gingival margins of the four groups were compared, the differences among the groups were found to be statistically significant (p < 0.05). Comparing the gingival and enamel margins in each group, statistically significant differences were found in the at-home group (p < 0.05) and no significant differences were seen in the other groups (p > 0.05). No significant difference was found between the adhesive systems after treatment with the same bleaching techniques.

CONCLUSION

Under the conditions of this study, microleakage of composite resin restorations differs according to the bleaching methods used and no difference was found between the adhesive systems.

Bleaching gels containing calcium and fluoride: effect on enamel erosion susceptibility

This in vitro study evaluated the effect of 35% hydrogen peroxide (HP) bleaching gel modified or not by the addition of calcium and fluoride on enamel susceptibility to erosion. Bovine enamel samples (3 mm in diameter) were divided into four groups (n = 15) according to the bleaching agent: control-without bleaching (C); 35% hydrogen peroxide (HP); 35% HP with the addition of 2% calcium gluconate (HP + Ca); 35% HP with the addition of 0.6% sodium fluoride (HP + F). The bleaching gels were applied on the enamel surface for 40 min, and the specimens were subjected to erosive challenge with Sprite Zero and remineralization with artificial saliva for 5 days. Enamel wear was assessed using profilometry. The data were analyzed by ANOVA/ Tukey's test (P < 0.05). There were significant differences among the groups (P = 0.009). The most enamel wear was seen for C (3.37 ± 0.80 μm), followed by HP (2.89 ± 0.98 μm) and HP + F (2.72 ± 0.64 μm). HP + Ca (2.31 ± 0.92 μm) was the only group able to significantly reduce enamel erosion compared to C. The application of HP bleaching agent did not increase the enamel susceptibility to erosion. However, the addition of calcium gluconate to the HP gel resulted in reduced susceptibility of the enamel to erosion.

Erosion and abrasion on dental structures undergoing at-home bleaching

This review investigates erosion and abrasion in dental structures undergoing at- home bleaching. Dental erosion is a multifactorial condition that may be idiopathic or caused by a known acid source. Some bleaching agents have a pH lower than the critical level, which can cause changes in the enamel mineral content. Investigations have shown that at-home tooth bleaching with low concentrations of hydrogen or carbamide peroxide have no significant damaging effects on enamel and dentin surface properties. Most studies where erosion was observed were in vitro. Even though the treatment may cause side effects like sensitivity and gingival irritation, these usually disappear at the end of treatment. Considering the literature reviewed, we conclude that tooth bleaching agents based on hydrogen or carbamide peroxide have no clinically significant influence on enamel/dentin mineral loss caused by erosion or abrasion. Furthermore, the treatment is tolerable and safe, and any adverse effects can be easily reversed and controlled.

Microtensile bond strength of resin composite to dentin treated with Er:YAG laser of bleached teeth

The objective of this study was to evaluate the influence of Er:YAG laser (λ = 2.94 μm) on microtensile bond strength (μTBS) and superficial morphology of bovine dentin bleached with 16% carbamide peroxide. Forty bovine teeth blocks (7 × 3 × 3 mm(3)) were randomly assigned to four groups: G1- bleaching and Er:YAG irradiation with energy density of 25.56 J/cm(2) (focused mode); G2 - bleaching; G3 - no-bleaching and Er:YAG irradiation (25.56 J/cm(2)); G4 - control, non-treated. G1 and G2 were bleached with 16% carbamide peroxide for 6 h during 21 days. Afterwards, all blocks were abraded with 320 to 600-grit abrasive papers to obtain flat standardized dentin surfaces. G1 and G3 were Er:YAG irradiated. Blocks were immediately restored with 4-mm-high composite resin (Adper Single Bond 2, Z-250-3 M/ESPE). After 24 h, the restored blocks (n = 9) were serially sectioned and trimmed to an hour-glass shape of approximately 1 mm(2) at the bonded interface area, and tested in tension in a universal testing machine (1 mm/ min). Failure mode was determined at a magnification of 100× using a stereomicroscope. One block of each group was selected for scanning electron microscope (SEM) analysis. μTBS data was analyzed by two-way ANOVA and Tukey test (α = 0.05). Mean bond strengths (SD) in MPa were: G1- 32.7 (5.9)(A); G2- 31.1 (6.3)(A); G3- 25.2 (8.3)(B); G4- 36.7 (9.9).(A) Groups with different uppercase letters were significantly different from each other (p < .05). Enamel bleaching procedure did not affect μTBS values for dentin adhesion. Er:YAG laser irradiation with 25.56 J/cm(2) prior to adhesive procedure of bleached teeth did not affect μTBS at dentin and promoted a dentin surface with no smear layer and opened dentin tubules observed under SEM. On the other hand, Er:YAG laser irradiation prior to adhesive procedure of non-bleached surface impaired μTBS compared to the control group.