Color Regression and Maintenance Effect of Intracoronal Whitening on the Quality of Life: RCT-A One-year Follow-up Study

Bleaching efficacy and quality of life of different bleaching techniques - randomized controlled trial

OBJECTIVES

To evaluate bleaching efficacy and oral health-related quality of life (ORHQoL) of three bleaching systems with similar hydrogen peroxide (HP) concentration for up to 6 months post-treatment.

MATERIALS AND METHODS

A randomized controlled trial was designed with three parallel groups: group A - in-office 6% HP paint-on varnish; group B - at-home 6% HP with adaptable tray; group C - at-home 16% carbamide peroxide with custom tray. At three different stages (baseline, after bleaching, and 6-month follow-up), ORHQoL was evaluated by the OHIP-14 questionnaire and tooth color of the upper canines and central incisors were measured by two shade guides and a spectrophotometer (measuring CIE L*a*b* with respective color/whiteness differences - ΔE00/ΔWID). Results were presented as mean and 95% confidence intervals and statistical tests were performed appropriately, considering a significance level of α = 0.05.

RESULTS

All groups presented significant color differences (P < 0.05) between all stages, with ΔE00/ΔWID surpassing the perceptibility threshold in 98% cases, with group C's results being significantly (P < 0.05) higher when compared to other groups, although with significantly (P < 0.05) higher values of color relapse. Significative ORHQoL improvements (P < 0.05) were detected after bleaching in a global analysis with no differences between techniques.

CONCLUSIONS

All techniques presented bleaching efficacy, color stability, and improvements in ORHQoL up to 6 months post-treatment.

CLINICAL SIGNIFICANCE

Clinicians may consider both at-home and in-office bleaching techniques with 6% HP to attain long-lasting satisfactory clinical results while producing positive changes in ORHQoL.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Effect of Antioxidant and Buffering Agent Mixture on Dentin Shear Bond Strengths of Laminate Veneer and pH Change of External Medium After Intracoronal Bleaching

Aim:

To investigate the effect of sodium ascorbate (SA), an antioxidant and calcium hydroxide (Ca(OH)2), a buffering agent mixture, on the shear bond strength of a luting resin to dentin, and pH changes of the extraradicular medium solution after intracoronal bleaching with hydrogen peroxide.

Materials and Methods:

In this in vitro study, 60 human maxillary central incisors were randomly assigned into six groups ( n: 10): Group 1: restored, no bleach; group 2: bleached, bonded immediately; group 3: bleached, treated with 10% SA applications before bonding; group 4: bleached, treated with calcium hydroxide applications before bonding; group 5: bleached, treated with CaOH2 and SA mixture applications before bonding; group 6: delay bonding by seven days. For bleach treatment in groups 2 to 6, intracoronal bleaching was performed with 35% hydrogen peroxide for four days. SA or CaOH2 or mixture of SA and CaOH2 were left in the access cavity for four days. Hybrid blocks, 4 mm × 4 mm wide × 2–mm thick, were luted with resin cements on dentin surface and then the specimens were subjected to shear bond strength testing. Analysis of variance and Tukey post hoc multiple comparison tests were applied ( P < .05).

Results:

G2 and G4 showed significantly low bond strength values and they were lower than the other groups ( P < .05). There were no significant differences between G1, G3, and G6 ( P > .05). The pH values had risen markedly in the groups containing calcium hydroxide (G4 and G5) after four days ( P < .05).

Conclusion:

The application of 10% SA or 10% SA and CaOH2 mixture were effective at reversing bleaching effects on bond strength. CaOH2 or CaOH2 and 10% SA mixture increased the external medium pH and were effective for alkalinization after intracoronal bleaching.

Influence of Professional Teeth Whitening on Oral Hygiene: Long-term Results

Aims:

The aim of this article is to estimate the long-term influence of professional dental bleaching on quality of oral hygiene (year after procedure).

Materials and Methods:

A randomized controlled prospective clinical repeated study was carried out 6 months after the previous one, i.e., 1 year after the oral hygiene procedure, among 60 patients divided into two groups. In the first group, professional oral hygiene and bleaching using 25% hydrogen peroxide were performed. In the second group only, oral hygiene was performed. Dynamics of hygienic index of Quigley-Hein modified by S. Turesky was estimated.

Results:

In the first group, the average value of the hygienic index of Quigley-Hein modified by S. Turesky was significantly lower a year after procedure than before (1.33±0.09 and 2.34±0.14, respectively). In the second group, this index exceeded 2.45 and nearly returned to the initiated level (2.45±0.07 and 2.44±0.08, respectively). Patients underwent professional teeth whitening in the long-term period, and the level of oral hygiene was significantly higher than that in the control group.

Conclusion:

Professional dental bleaching has good long-term influence on the level of oral hygiene and serves as a significant motivation factor for maintaining health of oral cavity.

Effects of whitening gels on color and surface properties of a microhybrid and nanohybrid composite

The aim of this study was to compare color changes, surface roughness and gloss of a microhybrid and nanohybrid composite whitened in a simulated in-office or at-home procedure using 40% hydrogen peroxide or 16% carbamide peroxide, respectively. CIELab coordinates were measured before, during and after treatment using VITA EasyShade V (VITA) and ∆E₀₀ calculated. Surface roughness was measured using a surface roughness tester (SJ210; Mitutoyo). Gloss was measured using a gloss checker (IG-331; Horiba). At-home whitening resulted in ∆E₀₀ of 1.23±0.49 (microhybrid) and 1.01±0.76 (nanohybrid). In-office exposure resulted in ∆E₀₀ of 0.69±0.38 (microhybrid) and 0.72±0.50 (nanohybrid). There were no significant differences in ∆E₀₀, surface roughness and gloss between whitening protocols (p>0.05). Color changes of a microhybrid and nanohybrid composite following simulated in-office or at-home whitening reached CIEDE2000 50:50% perceptibility but not acceptability threshold. Surface roughness and gloss of the microhybrid and nanohybrid composite were not affected by whitening.

The change of teeth color, whiteness variations and its psychosocial and self-perception effects when using low vs. high concentration bleaching gels: a one-year follow-up

Background

Dental bleaching in traditional concentrations generates greater sensitivity. In this respect, new systems of lower concentration of hydrogen peroxide for tooth bleaching appeared, with color stability unknown over time. The aim of this study was to compare the change and stability of color with low-concentration (6%) hydrogen peroxide gel in an in-office bleaching setting relative to conventional 37.5% gel, including their effects on psychosocial and esthetic self-perception, after 1 year.

Methods

Patients (n = 25) were assessed at 12 months post bleaching treatment (whitening with 6% chemo-activated alkaline formula gel versus 37.5% traditional concentration gel). Color changes were measured objectively using total variation in color (ΔE), and subjectively using Vita Classical and Vita Bleached scale (ΔSGU) by calibrated evaluators (Kappa = 0.85). The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and Oral Health Impact Profile (OHIP-14) aesthetic questionnaires were used to measure the self-perception and the psychosocial impact of the bleaching protocols.

Results

The effect (ΔE) of 37.5% HP (8.37 ± 2.73) was significantly better than that of 6% HP (5.27 ± 2.53) in terms of color rebound after 1 year of follow-up. There were significant differences in psychosocial impact and esthetic self-perception measurements prior to bleaching versus one-year post-whitening time points; positive effects were maintained.

Conclusions

Low concentration (6%) achieved effective bleaching with good stability after 1 year, accompanied by a positive psychosocial impact and enhanced self-perception at follow-up.

Trial registration

NCT03217994 (before enrollment of the first participant). Data register: July 14, 2017.

The effects of at-home whitening on patients' oral health, psychology, and aesthetic perception

BACKGROUND

The aesthetic self-perception and psychosocial impact of whitening is poorly explored in the literature; it is even less clear whether the effect of whitening may influence the psychology or social relations of patients. Therefore, the aim of this trial is to evaluate the impact of an at-home whitening procedure on patients' quality of life. Also, this study's secondary objective is the adaptation and validation of the Spanish version of the OES questionnaire (OES-SP).

METHODS

Fifty eight patients underwent whitening with 10% carbamide peroxide (CP) gel for 1 h daily for 3 weeks. For these participants, the OHIP-Esthetics, PIDAQ, and OES surveys were applied before, one week after, and one month after the whitening procedure. Oral health-related quality of life was measured using the OHIP-Esthetics survey and the psychosocial impact using the PIDAQ survey. The orofacial aesthetics was measured by OES and validated for the Spanish Chilean context. The treatment efficacy (ΔE and ΔSGU) and data from the OHIP-Esthetics PIDAQ and OES surveys were compared using the Wilcoxon Signed-Rank test.

RESULTS

The whitening procedure was effective (ΔE = 5.9 ± 1.8). The OHIP-Esthetics results were significant when comparing the initial baseline survey prior to the treatment and one week after whitening (p < 0.001) and when comparing the baseline and one-month results (p < 0.001). The overall score on the PIDAQ, after one week post-whitening, was separated into factors and all factors were statistically significant (p < 0.03); the factors for the one-month results were also all statistically significant (p < 0.001), except the social impact factor. The OES questionnaire had statistically significantly increased scores both one week and one month post-treatment (p < 0.0001). The reliability, validity, and responsiveness of the OES-SP were satisfactory.

CONCLUSION

The at-home whitening procedure with carbamide peroxide 10% had a positive effect on patients' oral health-related quality of life, psychology, and aesthetic perception after one month post-whitening. The Chilean Spanish version of the OES showed satisfactory psychometric characteristics to evaluate dental whitening.

TRIAL REGISTRATION

NCT02605239 . Date that the study was retrospectively registered: 11-11-2015.