The effect of home-use and in-office bleaching treatments combined with experimental desensitizing agents on enamel and dentin

Can different agents reduce the damage caused by bleaching gel to pulp tissue? A systematic review of basic research

Objectives

This study aimed to investigate the effectiveness of different topical/systemic agents in reducing the damage caused by bleaching gel to pulp tissue or cells.

Materials and Methods

Electronic searches were performed in July 2023. In vivo and in vitro studies evaluating the effects of different topical or systemic agents on pulp inflammation or cytotoxicity after exposure to bleaching agents were included. The risk of bias was assessed.

Results

Out of 1,112 articles, 27 were included. Nine animal studies evaluated remineralizing/anti-inflammatories agents in rat molars subjected to bleaching with 35%-38% hydrogen peroxide (HP). Five of these studies demonstrated a significant reduction in inflammation caused by HP when combined with bioglass or MI Paste Plus (GC America), or following KF-desensitizing or Otosporin treatment (n = 3). However, orally administered drugs did not reduce pulp inflammation (n = 4). Cytotoxicity (n = 17) was primarily assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay on human dental pulp cells and mouse dental papilla Cell-23 cells. Certain substances, including sodium ascorbate, butein, manganese chloride, and peroxidase, were found to reduce cytotoxicity, particularly when applied prior to bleaching. The risk of bias was high in animal studies and low in laboratory studies.

Conclusions

Few in vivo studies have evaluated agents to reduce the damage caused by bleaching gel to pulp tissue. Within the limitations of these studies, it was found that topical agents were effective in reducing pulp inflammation in animals and cytotoxicity. Further analyses with human pulp are required to substantiate these findings.

Trial Registration

PROSPERO Identifier: CRD42022337192.

Sol-Gel Technologies to Obtain Advanced Bioceramics for Dental Therapeutics

The aim of this work is to review the application of bioceramic materials in the context of current regenerative dentistry therapies, focusing on the latest advances in the synthesis of advanced materials using the sol-gel methodology. Chemical synthesis, processing and therapeutic possibilities are discussed in a structured way, according to the three main types of ceramic materials used in regenerative dentistry: bioactive glasses and glass ceramics, calcium phosphates and calcium silicates. The morphology and chemical composition of these bioceramics play a crucial role in their biological properties and effectiveness in dental therapeutics. The goal is to understand their chemical, surface, mechanical and biological properties better and develop strategies to control their pore structure, shape, size and compositions. Over the past decades, bioceramic materials have provided excellent results in a wide variety of clinical applications related to hard tissue repair and regeneration. Characteristics, such as their similarity to the chemical composition of the mineral phase of bones and teeth, as well as the possibilities offered by the advances in nanotechnology, are driving the development of new biomimetic materials that are required in regenerative dentistry. The sol-gel technique is a method for producing synthetic bioceramics with high purity and homogeneity at the molecular scale and to control the surfaces, interfaces and porosity at the nanometric scale. The intrinsic nanoporosity of materials produced by the sol-gel technique correlates with the high specific surface area, reactivity and bioactivity of advanced bioceramics.

In vitro dentin permeability and tubule occlusion of experimental in-office desensitizing materials

OBJECTIVES

This study investigates the dentin permeability (by hydraulic conductance) and tubule occlusion (by confocal and scanning electron microscopies) of in-office desensitizing materials.

MATERIALS AND METHODS

Bovine dentin blocks were immersed in EDTA to open dentinal tubules. Placebo varnish (PLA), fluoride varnish (FLU), NaF 5% + 5% nanoparticulate sodium trimetaphosphate varnish (TMP), universal adhesive system (SBU), S-PRG filler varnish (SPRG), Biosilicate (BIOS), and amelotin (AMTN) solution were the materials tested. After application, the specimens underwent an erosive-abrasive challenge. Dentin permeability was evaluated at T0 (initial), T1 (after treatment), and T2 (after challenge). Confocal and scanning electron microscopy (SEM) were used to evaluate, respectively, length and number of dentinal tubule occlusions and opened dentinal tubules, after challenge. Permeability and SEM data were analyzed by two-way repeated measures ANOVA and Tukey's tests. Confocal data were analyzed by one-way ANOVA, Tukey's test, and Kruskal-Wallis and Dunn's tests. Spearman and Pearson's correlation tests were also used. Significance level was set at 5%.

RESULTS

At T1, the AMTN group showed the lowest permeability value, following the increasing order at T2: AMTN = SBU < BIOS = SPRG < TMP < FLU < PLA. The SBU group had the highest value of occluded dentinal tubule length. The AMTN group presented more occluded dentinal tubules compared to PLA and FLU. AMTN and SBU had the lowest values of opened dentin tubules. Results showed a negative correlation between the analyses.

CONCLUSION

The SBU and AMTN solution were more effective in reducing dentin permeability by occluding dentin tubules.

CLINICAL RELEVANCE

All materials reduced permeability after challenge, except fluoride varnish.

Effects of the Incorporation of Bioactive Particles on Physical Properties, Bioactivity and Penetration of Resin Enamel Infiltrant

Purpose

The resinous infiltrant lacks remineralizing activity. This research aimed to develop and evaluate bioactivity, physico-mechanical properties and penetration of resin infiltrants containing Biosilicate or nanohydroxyapatite.

Methods

Experimental resin infiltrant (ERI; 75/25 wt.% TEGDMA/BisEMA) was divided among the groups Pure Experimental (PE); ERI + Biosilicate 5 or 10% (Bio5; Bio10), ERI + 10% nanohydroxyapatite (Hap10), and Icon (DMG, Germany). Bioactivity was analyzed by SEM, EDS and FT-IR/ATR after soaking in SBF. Degree of conversion (DC), sorption and solubility (SO; SOL), flexural strength, modulus of elasticity (FS; E-modulus), contact angle (CA) and penetration were characterized. Extent of penetration was analyzed by treating white spot lesions (WSL) in human dental enamel samples with the infiltrants and subsequently analyzing specimens by confocal laser scanning microscopy. Data from each test were submitted to ANOVA and Tukey's tests (p < 0.01).

Results

SEM, EDS and FT-IR showed the formation of precipitates and increase in the rates of Ca and P in the groups with bioactive particles, after storage in SBF. Hap10 showed higher DC and CA values than all the other groups. Groups Bio5 and Bio10 showed CA values similar to those of Icon, higher SO and SOL values, and reduction in other properties. All infiltrants were capable of penetrating into the WSLs.

Conclusion

The incorporation of Biosilicate (5 or 10%) or nanohydroxyapatite (10%) into ERI induced mineral deposition on the surface and did not compromise infiltration and penetration into WSLs, however, compromising their physico-mechanical properties.

Effect of bioactive glass paste on efficacy and post-operative sensitivity associated with at-home bleaching using 20% carbamide peroxide: a randomized controlled clinical trial

Background

The aim of this study was to evaluate the effect of bioactive glass (BAG) 45S5 paste on colour change and tooth sensitivity (TS) when used in combination with 20% carbamide peroxide (CP) during at-home vital tooth bleaching.

Methods

Twenty-four patients were selected and assigned into two experimental groups (n = 12) in a double-blind study design. Each patient received 20% CP followed by the application of either BAG paste or non-active placebo paste. The shade evaluation was performed using a digital spectrophotometer based on the CIE L*a*b* colour space system at different time points and the overall colour changes ΔE were calculated. TS was evaluated using visual analogue scale (VAS). The values of ΔE and TS were statistically analysed using paired t-test. The level of statistical significance was established at p = 0.05.

Results

The overall colour changes (ΔE) between baseline and each time point showed no significant differences between BAG and placebo groups (p > 0.05). The use of BAG paste significantly decreased TS reported by the participants.

Conclusions

The association of BAG paste with at-home bleaching treatment presents a promising method as it decreased TS and did not deteriorate bleaching efficacy.

Trial registration This study was approved and registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) under Registration number: ACTRN12621001334897.

Effects of desensitizing products on the reduction of pain sensitivity caused by in-office tooth bleaching: a 24-week follow-up

Objective

To clinically assess the effect of desensitizing gels and dentifrices on the reduction in pain sensitivity and color variation during tooth bleaching.

Methodology

A total of 108 volunteers were randomly separated into the following groups of n=12: GT/S-glycerine and thickener/sucralose; NF/S-potassium nitrate and sodium fluoride/sucralose; NA/S-potassium nitrate and arginine/sucralose; GT/AC-glycerine and thickener/arginine and calcium carbonate; NF/AC-potassium nitrate and sodium fluoride/arginine and calcium carbonate; NA/AC-potassium nitrate and arginine/arginine and calcium carbonate; GT/PN-glycerine and thickener/potassium nitrate; NF/PN-potassium nitrate and sodium fluoride/potassium nitrate; and NA/PN-potassium nitrate and arginine/potassium nitrate. Sensitivity was assessed with the numerical analogue scale, and color variation (ΔE) was measured with a spectrophotometer. The sensitivity values obtained were subjected to a multivariate analysis of variance (MANOVA) and color variation values were subjected to a randomized analysis of variance (p<0.05).

Results

The NF/AC, NA/AC, NF/PN, and NA/PN groups presented lower sensitivity values and reduced sensitivity compared to those of the other groups throughout the clinical sessions. None of the groups showed sensitivity at the 24-week assessment. Statistically, no significant difference were observed in the color values among the groups four weeks after the beginning of bleaching (p=0.074). Additionally, the color assessment of all groups was statistically similar four weeks (p=0.084) and 24 weeks (p=0.118) after the beginning.

Conclusion

Our results indicate that adding NF/S, NA/S, NF/AC, and NA/AC desensitizers to tooth bleaching protocols reduces pain sensitivity without affecting its effectiveness.

Experimental gel containing bioactive glass-ceramic to minimize the pulp damage caused by dental bleaching in rats

Objectives

This study evaluated if the use of a bioactive glass-ceramic-based gel, named Biosilicate (BS), before, after or mixed with bleaching gel, could influence the inflammation of the dental pulp tissue of rats’ molars undergoing dental bleaching with hydrogen peroxide (H₂O₂).

Methodology

The upper molars of Wistar rats (Rattus norvegicus, albinus) were divided into Ble: bleached (35% H₂O₂, 30-min); Ble-BS: bleached and followed by BS-based gel application (20 min); BS-Ble: BS-based gel application and then bleaching; BS/7d-Ble: BS-based gel applications for 7 days and then bleaching; Ble+BS: blend of H₂O₂ with BS-based gel (1:1, 30-min); and control: placebo gel. After 2 and 30 days (n=10), the rats were euthanized for histological evaluation. The Kruskal-Wallis and Dunn statistical tests were performed (P<0.05).

Results

At 2 days, the Ble and Ble-BS groups had significant alterations in the pulp tissue, with an area of necrosis. The groups with the application of BS-based gel before H₂O₂ had moderate inflammation and partial disorganization in the occlusal third of the coronary pulp and were significantly different from the Ble in the middle and cervical thirds (P<0.05). The most favorable results were observed in the Ble+BS, which was similar to the control in all thirds of the coronary pulp (P>0.05). At 30 days, the pulp tissue was organized and the bleached groups presented tertiary dentin deposition. The Ble group had the highest deposition of tertiary dentin, followed by the Ble-BS, and both were different from control (P<0.05).

Conclusion

A single BS-based gel application beforehand or BS-based gel blended with a bleaching gel minimize the pulp damage induced by dental bleaching.

Effect of photobiomodulation with low-level laser therapy combined with potassium nitrate on controlling post-bleaching tooth sensitivity: clinical, randomized, controlled, double-blind, and split-mouth study

OBJECTIVES

To evaluate the effect of photobiomodulation with low-level laser therapy (PBM-LLLT) combined with 5% potassium nitrate (KNO₃) on controlling tooth sensitivity (TS) after in-office tooth bleaching.

MATERIALS AND METHODS

Fifty volunteers were selected based on the inclusion and exclusion criteria and were randomly allocated into four groups: G1 (control): placebo gel application, 35% hydrogen peroxide bleaching (HP35) and mock PBM-LLLT without light emission; G2: placebo gel application, bleaching with HP35 and PBM-LLLT; G3: application of KNO₃, bleaching with HP35 and mock PBM-LLLT; and G4: application of KNO₃, bleaching with HP35 and PBM-LLLT. A pain assessment questionnaire was used to evaluate TS during the 21 days of treatment. The Friedman test was used for intragroup analysis, and the Wilcoxon and Mann-Whitney tests were used for intergroup comparisons.

RESULTS

The intragroup evaluation showed significant differences among the evaluation times in all groups (p ≤ 0.05). The highest pain sensitivity levels were recorded on the 1st, 8th, and 15th days. In G1, TS manifested for up to 3 days after each bleaching session, while G2, G3, and G4 presented TS only on the days of the bleaching sessions. Intergroup analysis showed that TS manifestation differed significantly between G1 and the other groups (p ≤ 0.05) but did not differ significantly among G2, G3, and G4 (p ≥ 0.05).

CONCLUSION

PBM-LLLT and KNO₃ are effective at reducing pain sensitivity after tooth bleaching, but no synergistic effect between these treatments was observed for the different evaluation periods.

CLINICAL RELEVANCE

The effect of PBM-LLLT combined with KNO₃ on post-bleaching tooth sensitivity is similar to their individual use alone.

Clinical, double blind, randomized controlled trial of experimental adhesive protocols in caries-affected dentin

OBJECTIVE

To evaluate the clinical performance of posterior resin composite restorations regarding experimental and regular adhesive protocols in caries affected-dentin (CAD).

MATERIAL AND METHODS

A total of 92 class I and class II cavities with carious lesions were selected and randomly assigned to the following groups: (1) bioactive glass-ceramic powder/two-step etch and rinse system, (2) control/two-step etch and rinse system, (3) bioactive glass-ceramic powder/two-step self-etching system, and (4) control/two-step self-etching system. Two operators carried out the adhesive protocols and restored the cavities with a nano-hybrid resin composite. Participants were followed up at 1 week and 6, 12, and 18 months for clinical evaluation performed by two blinded examiners and calibrated according to FDI criteria. Data were analyzed using Kruskal-Wallis and Dunn tests with a confidence of 95%.

RESULTS

The clinical performance of resin composite restoration was not affected by the experimental use of an adhesive protocol including a bioactive glass-ceramic powder for 18 months post-procedure. However, there was a significant difference between group 2 and group 4 (p < 0.05) for marginal adaptation (18 months). Group 2 was significantly different from group 3 (p < 0.05) for fracture of material/retention (18 months) and marginal adaptation (1 week); group 2 showed a better performance.

CONCLUSION

Adhesive protocols can alter the clinical performance of posterior restorations in terms of marginal adaptation and the fracture of material/retention in CAD.

CLINICAL SIGNIFICANCE

Adhesive protocols may influence the success of resin composite restorations in CAD; this is important because failure can lead to caries, re-incidence, and/or clinical re-work.

Influence of Time Intervals between Bleaching Procedures on Enamel Microhardness and Surface Roughness

BACKGROUND

Dental bleaching has been increasingly sought out to improve dental aesthetics, but it may cause changes in dental enamel.

OBJECTIVE

To assess the influence of different time intervals on bleaching gel applications with regard to the Microhardness (MH) and Surface Roughness (SR) on dental enamel.

MATERIAL AND METHODS

Forty bovine incisors were randomly divided into two groups (G1 and G2) and both were bleached with 35% Hydrogen Peroxide (HP35) (n=20; G1: seven-day interval and G2: two-day interval). The MH and SR tests were performed before bleaching (T0) and after the first (T1), second (T2), and third (T3) bleaching gel applications. The specimens were stored in artificial saliva between each application (37°C). The data were analyzed using the student's t-test (p ≤ 0.05) for dependent samples.

RESULTS

The reduced time interval (two days) led to a significant reduction in MH, while MH was not affected during the seven-day interval. The SR results increased regardless of the bleaching gel application time interval.

CONCLUSION

The decreased time interval of two days between bleaching gel applications caused changes in MH but did not influence the SR of dental enamel.

Protocols for sodium ascorbate application on intracoronary dentin bleached with high-concentrated agent

Purpose:

Composite resin restorations are normally replaced after the internal bleaching of endodontically treated-teeth because the bleaching agent does not alter the color of the restorative material. This study evaluated the effect of 10% sodium ascorbate (SA) applied at different protocols on bleached dentin.

Materials and Methods:

One-hundred slabs of intracoronary bovine dentin were divided into 5 groups: 2 controls-GI without bleaching (positive), GII bleached with 35% hydrogen peroxide (HP) (negative); and 3 experimentals – GIII. 35% HP + SA at protocol 1 (dripping, washing and drying the solution), GIV. 35% HP + SA at protocol 2 (dripping and aspirating the solution) and GV. 35% HP + SA at protocol 3 (dripping, rubbing and aspirating the solution). Sixty fragments were restored and subjected to shear bond strength test (n = 12). Forty fragments (n = 8) were prepared for chemical analysis (energy dispersive X-ray spectrometry) and surface morphology (scanning electron microscopy). Data were analyzed by ANOVA and Tukey test (P < 0.05).

Results:

GI (3.169 ± 1.510a) had the highest means values, similar to GIV (2.752 ± 0.961a) and GV (2.981 ± 1.185a) (P < 0.05). Inferior values were obtained in GII (1.472 ± 0.342b) and GIII (2.037 ± 0.742ab) had intermediate values (P > 0.05). Oxygen concentration was reduced in groups treated with SA, and the surface exhibited residual granules of the solution.

Conclusion:

The 10% SA solution reestablishes the bond strength of restorative material to bleached dentin, especially if active protocols of application and aspiration were used.

Effectiveness of a new non-hydrogen peroxide bleaching agent after single use - a double-blind placebo-controlled short-term study

Tooth whitening represents perhaps the most common aesthetic procedure in dentistry worldwide. The efficacy of bleaching depends on three aspects: bleaching agent, bleaching method, and tooth color.

Changes to Glazed Dental Ceramic Shade, Roughness, and Microhardness after Bleaching and Simulated Brushing

PURPOSE

To evaluate shade stability, surface roughness, microhardness, and compressive strength of a glazed feldspathic ceramic subjected to bleaching and simulated brushing.

MATERIALS AND METHODS

Eighty-eight glazed feldspathic ceramic specimens were made from microparticulate leucite and divided into eight groups (n = 10). The whitening products used were: Opalescence Trèswhite Supreme (Ultradent), Opalescence®\ PF 15% (Ultradent), and Oral-B 3D White Whitestrips. All substances for whitening were used for 4 hours/day for a period of 14 days; the control group was not bleached. Next, half of the specimens were individually brushed. Microhardness and surface roughness data were subjected to three-way ANOVA and Tukey test. The diametrical tensile strength data were subjected to two-way ANOVA. The shade change data were analyzed using Kruskal-Wallis, Mann-Whitney, and the Student-Newman-Keuls test. The significance level was set at 5%.

RESULTS

Glazed feldspathic ceramic surface microhardness was significantly affected by bleaching agents (p = 0.007). Initially, glazed ceramic microhardness was significantly higher than that observed after contact with the bleaching agents, whether or not brushing was performed. The specimens submitted to bleaching in preloaded trays presented lower surface roughness values after brushing (p = 0.037). The surface roughness was significantly lower in the brushed specimens (p = 0.044). The diametrical tensile strength was not significantly affected by the application of bleaching agents (p = 0.563) or by brushing (p = 0.477). When the specimens were brushed, however, shade change was significantly influenced by the bleaching agent used (p = 0.041).

CONCLUSIONS

Bleaching agents associated with brushing cycles can alter surface properties and shade stability of glazed feldspathic ceramics, though such findings may not reflect the performance of unglazed feldspathic ceramics.

Effect of different bleaching regimens on the flexural strength of hybrid composite resin

Background:

The entire effects of different bleaching regimens on the mechanical properties of composite resins have remained unknown. The purpose of this study was to evaluate the effects of different bleaching regimens on the flexural strength (FS) of hybrid composite resins.

Materials and Methods:

In this in vitro study, 80 bar-shaped specimens of hybrid composite resins were fabricated and randomly divided into four groups, 20 specimens in each group. First group (C) was considered as control. The other groups were treated by home bleaching (HB) agent, in-office bleaching (IB) agent, and the combination regimens (HIB), respectively. The FS was evaluated by three-point bending test by using a Universal Testing Machine. All data were analyzed by using Statistical Package for the Social Sciences (SPSS) software version 18, analysis of variance (ANOVA), and Turkey's post hoc statistical tests (α = 0.05).

Results:

The maximum mean value of FS was seen in HB group with significant differences to other groups (P < 0.05). Also, the minimum FS was observed in group HIB.

Conclusion:

Application of different bleaching regimens does not have any adverse effect on the FS of hybrid composite resins. However, the administration of HB regimens seemed to have lesser negative impact on the FS.