Use of antioxidants to restore bond strength after tooth bleaching with peroxides

This review compiles the literature on the antioxidants used after tooth bleaching with either low or high-concentrated carbamide and hydrogen peroxide to recover the bond strength. Antioxidants used in bleached teeth are mainly natural and non-enzymatic, except for catalase. Commonly, antioxidants are applied to remove any reactive oxygen species (ROS) residues left from bleaching gels, which adversely affect adhesive procedures, such as restorations or orthodontic brackets bonding. Even though sodium ascorbate, the most thoroughly investigated antioxidant, showed the most efficient bond strength recovery at 10% concentration, its performance depends on the type of solution and the application time. Natural extracts, such as proanthocyanidins and green tea, showed satisfactory results in the reversal of bond strength at 5% and 10% concentrations, respectively. Sodium ascorbyl phosphate, α-tocopherol, and catalase exhibited promising results, but further research is required. The adhesive system type plays an important role in the outcome of enamel bond strength after the antioxidant application. The postponement of either restorations or orthodontic brackets cementation following bleaching procedures seems to be efficiently replaced by antioxidant application prior to bonding procedures. However, the efficacy of using an antioxidant to recover bond strength depends on its type and application time.

Effects of remaining dentin thickness on the bond strength of bleached dentin

Background

The bond strength of resin composites to dentin was reported to be related to either the remaining dentin thickness (RDT) or bleaching treatment. However, information is limited regarding the effects of RDT on the bond strength of bleached dentin. The present study aimed to investigate the effects of RDT on the microshear bond strength (μSBS) of resin cement to bleached dentin.

Methods

A total of 120 dentin specimens were prepared and randomly divided into 2 groups: a bleaching group (group B) and a control group (group C). Hydrogen peroxide with a concentration of 35% (Ultradent, USA) was applied on the dentin surface for 2 × 1 d for group B, while no bleaching treatment was performed for group C. After the treatment, the specimens were finished and polished to obtain different RDTs (2, 1, and 0.5 mm) and divided into 3 groups of 20 specimens each. The bonding procedure was performed using Panavia V5 (Kuraray, Japan) with a bonding area of 0.785 mm². For each group, half of the specimens were subjected to 5000 thermal cycles (subgroup T), while the other half did not receive thermocycling (subgroup N) (n = 10). The specimens were then subjected to the μSBS test using a universal testing machine. Data were analyzed by a three-way analysis of variance (α = 0.05). The fracture modes of the specimens were confirmed with a measuring microscope. Representative specimens with different fracture modes were observed with scanning electron microscopy (SEM).

Results

The μSBS values were significantly affected by bleaching treatment (p < 0.001), whereas no significant effect was observed for thermocycling (p = 0.293). In terms of RDT, a significantly different μSBS value was found among the subgroups with different RDTs in group C (p = 0.003). However, the RDT did not significantly affect the μSBS values of bleached dentin in group B (p = 0.779). The μSBS values were significantly lower in group B than in group C (p < 0.001). A higher percentage of adhesive failure was observed in group B than in group C.

Conclusion

Based on the present findings, it can be concluded that the RDT did not affect the bond strength of resin cement to bleached dentin.

Clinical significance

Since RDT did not affect the bond strength of resin cement to bleached dentin, bonding procedures should not be performed immediately after intracoronal bleaching, even if the dentin is planned to be removed due to a tooth preparation process.

Effect of Er: YAG Laser on Microtensile Bond Strength of Bleached Dentin to Composite

Introduction: In non-vital tooth bleaching, dentin is in direct contact with the bleaching agent, 1 to 3-week delay is needed to eliminate free radicals from tooth structure. The present study aimed to evaluate the effect of irradiation of Er: YAG laser on immediate microtensile bond strength of bleached dentin to composite. Methods: Sixty sounds human teeth were collected and randomly divided into 4 groups (n=15): no bleaching (NB), opalescence endo hydrogen peroxide (HP) gel bleaching, sodium perborate (SP) bleaching and laser bleaching with heydent gel (LB). The groups were divided into 3 subgroups (n=5): no surface treatment, Er: YAG laser irradiation and 10% sodium ascorbate (SA). All samples were restored and underwent microtensile bond strength testing. Statistical analysis was carried out using one-way and two-way ANOVA. Results: Bond strength in NB-SA group had a significant difference with the NB group (P<0.05) while no significant difference was noted between NB and NB-Er groups (P=0.55). Application of SA and Er: YAG laser after bleaching with SP did not enhance the bond strength (P=0.07). Conclusion: Application of SA and Er: YAG laser after HP gel bleaching significantly enhanced the bond strength. Application of Er: YAG laser after internal bleaching with HP gel could enhance the bond strength.

Evaluating the effect of antioxidant agents on shear bond strength of tooth-colored restorative materials after bleaching: A systematic review

PURPOSE

The main objective of the present study was to make a systematic review of how antioxidant agents affect shear bond strength of tooth-colored restorative materials after bleaching.

DATA SOURCES

Electronic search was used to extract the related articles on the targeted key words such as "antioxidant", "dental bleaching" and "shear bond strength" (SBS) from MeSH, PubMed, Medline, and Cochrane electronic data bases. These articles were all published before 2016.

STUDY SELECTION

Inclusion criteria were restricted to English journal articles concerning humans, clinical trials, cohorts and case-control studies. Therefore, systematic reviews, case reports, letters to editors, editorials and congress abstracts were excluded from the analysis.

CONCLUSIONS

Most studies conducted on the issue have produced experimental data which are rather controversial, and there is no general agreement about the reported outcomes. As an illustration, most studies have not considered the relationship between the type of antioxidant materials and the shear bond strength. In point of fact, some researchers (e.g Kimyai et al.) have concluded that antioxidants like gel and solution leave similar effects on SBS. Alternatively, certain studies (e.g., Kunt et al.) have produced inconclusive data regarding the impact of one week postponement of the restorative process on SBS after the bleaching process. The results of the studies evaluating the role of various adhesive systems used after bleaching have demonstrated that regardless of the type of adhesive system used, applying antioxidants before restorative procedures can adversely affect the bleaching agents utilized for SBS. It has also been suggested that the type of the adhesive system used might be correlated with the magnitude of SBS. The results obtained from the systematic review of the articles under investigation reflected that the use of antioxidant agents, regardless of their type, form, concentration and duration of application, can improve SBS after bleaching.

Effect of Different Anti-Oxidants on Shear Bond Strength of Composite Resins to Bleached Human Enamel

INTRODUCTION

The bond strength of the composite to the bleached enamel plays a very important role in the success and longevity of an aesthetic restoration.

AIM

The aim of this study was to compare and evaluate the effect of Aloe Vera with 10% Sodium Ascorbate on the Shear bond strength of composite resin to bleached human enamel.

MATERIALS AND METHODS

Fifty freshly extracted human maxillary central incisors were selected and divided into 5 groups. Group I and V are unbleached and bleached controls groups respectively. Group II, III, IV served as experimental groups. The labial surfaces of groups II, III, IV, V were treated with 35% Carbamide Peroxide for 30mins. Group II specimens were subjected to delayed composite bonding. Group III and IV specimens were subjected to application of 10% Sodium Ascorbate and leaf extract of Aloe Vera following the Carbamide Peroxide bleaching respectively. Specimens were subjected to shear bond strength using universal testing machine and the results were statistically analysed using ANOVA test. Tukey (HSD) Honest Significant Difference test was used to comparatively analyse statistical differences between the groups. A p-value <0.05 is taken as statistically significant.

RESULTS

The mean shear bond strength values of Group V showed significantly lower bond strengths than Groups I, II, III, IV (p-value <0.05). There was no statistically significant difference between the shear bond strength values of groups I, II, III, IV.

CONCLUSION

Treatment of the bleached enamel surface with Aloe Vera and 10% Sodium Ascorbate provided consistently better bond strength. Aloe Vera may be used as an alternative to 10% Sodium Ascorbate.