Effect of tooth-bleaching on the carbonate concentration in dental enamel by Raman spectroscopy

Biological action of bleaching agents on tooth structure: A review

The use of bleaching agents to remove stains is one of the main dental procedures to improve the aesthetics of teeth. This review presents the main agents used for tooth whitening, existing clinical protocols, and the structural changes that may occur through their use. The main bleaching agents consist of hydrogen peroxide and carbamide peroxide, which are used in bleaching techniques for vital teeth. These techniques can be performed in the office by a professional or by the individual in a home en-vironment under professional guidance. Bleaching agents come in a variety of concentrations and there are over-the-counter products available on the market with lower concentrations of hydrogen peroxide. Due to the chemical characteristics of the agents, changes in the organic and inorganic content of the tooth structure can be observed. These changes are related to morphological changes characterized by in-creased permeability and surface roughness, such changes compromise the mechanical resistance of the tooth. Furthermore, bleaching agents can promote molecular changes after reaching the dental pulp, resulting in oxidative stress of pulp cells and the release of pro-inflammatory mediators. Despite the bleaching effectiveness, tooth sensitivity is considered the main side effect of use. Therefore, among the heterogeneity of protocols, those that used the bleaching agent for a prolonged time and in lower con-centrations presented more harmful effects on the tooth structure.

The Effect of In-Office Bleaching with Different Concentrations of Hydrogen Peroxide on Enamel Color, Roughness, and Color Stability

The aim of this study is to evaluate the effectiveness of in-office bleaching in esthetic dentistry on the roughness and color stability of the enamel surface, using different concentrations of hydrogen peroxide (HP). Fifty human incisors were randomly divided into 5 groups (n = 10). No bleaching was performed in the control group. For these groups, concentrations of 40% HP with fluoride (F), 35% HP with calcium (Ca), 25% HP with nano-hydroxyapatite (nHA) and 18% HP with nHA were used for bleaching in the test groups. Surface roughness was assessed at baseline after bleaching occurred. Color measurements were first obtained at baseline, then after the first and second sessions of bleaching, and, finally, after the staining protocol. Scanning electron microscopy and atomic force microscopy were performed. Statistical analysis was conducted with a one-way ANOVA, followed by a post hoc Tukey's test and a paired-samples t-test (p < 0.05). All the bleaching gels used exhibited a similar color change (p > 0.05). Bleaching gels containing 18% HP with nHA and that containing 35% HP with Ca caused less surface roughness of the enamel. Of these concentrations, 25% HP with nHA caused the most surface roughness and no significant difference was observed, compared with 40% HP with F. The highest coloration after bleaching was observed in 40% HP with F and 25% HP with nHA. The lowest coloration was obtained in 35% HP with Ca and 18% HP with nHA but no significant difference was observed between them and the control group. A concentration above 18% HP does not increase the bleaching effectiveness. The results show that 18% HP with nHA and 35% HP with Ca resulted in the least increase in enamel surface roughness when compared to high-concentrate HP; however, it also prevented recoloration after bleaching.

ATR-FTIR, EDS and SEM evaluations of enamel structure after treatment with hydrogen peroxide bleaching agents loaded with nano-hydroxyapatite particles

Background

Tooth whitening is one of the most requested dental treatments, but it still presents some side effects. Indeed, the bleaching agent can generate patients’ discomfort and dental hard tissue damages, not achieving an efficient and long-lasting treatment with optimum whitening effect. To overcome these limitations, the bleaching agents containing nano-hydroxyapatite can represent a reliable solution to avoid these detrimental effects.

Methods

In this study, human third molars were treated with commercial bleaching agents, containing nano-hydroxyapatite (nHA) and 6% (at-home treatment), 12% and 18% (in-office treatments) of hydrogen peroxide (HP), named respectively G1, G2 and G3. The results were evaluated descriptively and analytically using Attenuated Total Reflectance-Fourier Transform Infrared Spectroscopy (ATR-FTIR), Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray spectroscopy (EDS), comparing the treated groups with a commercial gel containing 10% carbamide peroxide (CONV) and with a non-treated control group (CTRL).

Results

ATR-FTIR analysis revealed a similar composition in carbonates and phosphates for CTRL, G1 and G2 groups, which showed no significant differences in their spectral profiles; an increased amount of organic matter was found in G3, while CONV displayed an intermediate behavior. SEM analysis did not highlight significant changes in the enamel microstructure of G1 and CONV when compared to CTRL; the pattern observed in G2 presented a slight increase of enamel irregularities, while G3 displayed a partial removal of the aprismatic layer and microporosities. No evident effects due to nHA were observed in the structure of the hydroxyapatite component of G1, G2 and CONV, if compared to CTRL, while G3 showed a slight loss of crystallinity. In all groups, EDS identified slight changes in the concentration of chemical elements O and Ca, while the Ca/P ratio was similar when compared to CTRL.

Conclusion

The obtained results suggest that the application of the tested commercial bleaching agents, with a concentration of HP up to 12%, does not alter the morphological and chemical composition of the enamel surface and maintains its crystallinity.

Enamel sample preparation for AFM: Influence on roughness and morphology

Human dental enamel is organized by prisms that are structured between 3 and 6 µm in diameter. Determining the relationships between different treatments on the surface of enamel using ultrastructural analysis is the purpose of many in vitro experiments. Different sample pretreatments have been reported in the literature. Grinding and polishing are common procedures for enamel preparation. They provide a flat and standardized surface, which is imperative for the use of some techniques such as ATR-FTIR. However, for morphological analysis, SEM and AFM represent easier methods to measure and reduce the biological sample variation. Therefore, the objective of this study was to establish how different forms of enamel preparation can influence the advent of artifacts during ultrastructural observation, especially by AFM analysis. Four groups (n = 10) were tested: (a) without preparation; (b) polishing with a diamond paste; (c) grinding with decreasing granulations of silicon carbide papers; (d) grinding with polishing. Images were obtained using the Peak-Force Tapping mode. After the first images were obtained, all fragments were acid etched with 37% phosphoric acid for 30 seconds, rinsed for 60 seconds, and dried intensively. Upon grinding and polishing, the exposure of the inner enamel surfaces provided a less mineralized layer that was marked by scratches and a higher susceptibility to treatments. Moreover, using native enamel provided more valuable information on the surface and the roughness changes for clinical applications. In addition, phosphoric acid is an option for observing the prismatic arrangement after grinding and/or polishing changes the morphology. RESEARCH HIGHLIGHTS: The use of native enamel samples to investigate the effects of different treatments on surface should be preferred in research, when the technique allows it.

Titanium dioxide in dental enamel as a trace element and its variation with bleaching

Background

Titanium is a less studied trace element in dental enamel. Literature relates an increased Titanium concentration with a decreased enamel crystal domain size, which in turn is related to a higher color value. The aim of our study was to analyze the effect of tooth bleaching agents on its concentration in dental enamel by means of confocal Raman spectroscopy.

Material and Methods

Human teeth were randomly distributed in six experimental groups (n=10) and submitted to different bleaching protocols according to the manufacturer´s instructions. Confocal Raman spectroscopy was carried out in order to identify and quantify the presence of titanium dioxide molecules in enamel prior to and during whitening. Statistical analysis included repeated measures analysis of variance (p≤0.05) and Bonferroni pairwise comparisons.

Results

Titanium dioxide concentration was negatively affected by the longer bleaching protocols (at-home bleaching gels). All in-office whitening products increased significantly the studied molecule (p≤0,05).

Conclusions

All dental specimens depicted the presence of titanium dioxide as a trace element in dental enamel. Bleaching gels that have to be applied at higher concentrations but for shorter periods of time increase the concentration of titanium dioxide, whilst at-home whitening gels used for longer periods of time despite the lower concentration caused a loss in titanium.

Key words:Bleaching, whitening, hydrogen peroxide, carbamide peroxide, Raman spectroscopy, titanium dioxide.

Neurosensory analysis of tooth sensitivity during at-home dental bleaching: a randomized clinical trial

Objective The objective of this study was to evaluate dental sensitivity using visual analogue scale, a Computerized Visual Analogue Scale (CoVAS) and a neurosensory analyzer (TSA II) during at-home bleaching with 10% carbamide peroxide, with and without potassium oxalate. Materials and Methods Power Bleaching 10% containing potassium oxalate was used on one maxillary hemi-arch of the 25 volunteers, and Opalescence 10% was used on the opposite hemi-arch. Bleaching agents were used daily for 3 weeks. Analysis was performed before treatment, 24 hours later, 7, 14, and 21 days after the start of the treatment, and 7 days after its conclusion. The spontaneous tooth sensitivity was evaluated using the visual analogue scale and the sensitivity caused by a continuous 0°C stimulus was analyzed using CoVAS. The cold sensation threshold was also analyzed using the TSA II. The temperatures obtained were statistically analyzed using ANOVA and Tukey's test (α=5%). Results The data obtained with the other methods were also analyzed. 24 hours, 7 and 14 days before the beginning of the treatment, over 20% of the teeth presented spontaneous sensitivity, the normal condition was restored after the end of the treatment. Regarding the cold sensation temperatures, both products sensitized the teeth (p<0.05) and no differences were detected between the products in each period (p>0.05). In addition, when they were compared using CoVAS, Power Bleaching caused the highest levels of sensitivity in all study periods, with the exception of the 14th day of treatment. Conclusion We concluded that the bleaching treatment sensitized the teeth and the product with potassium oxalate was not able to modulate tooth sensitivity.