In situ Effect of Nanohydroxyapatite Paste in Enamel Teeth Bleaching

Tooth whitening: current status and prospects

As a safe, effective, economical, and convenient technique, tooth whitening is one of the most popular treatments for improving tooth discoloration. This review summarizes the theoretical and recent research developments in the classification and mechanisms of tooth discoloration, as well as the principles, agents, effects, and side effects of tooth whitening techniques. The aim is to provide a basis for the clinical treatment of tooth whitening techniques and to suggest possible new ideas for further research. The accepted mechanism of whitening is the redox reaction of oxides in the whitening reagent, and the whitening effect is remarkable. However, side effects such as tooth sensitivity and irritation of gum and other oral soft tissues can still occur. It is recommended that more monitoring be carried out in the clinic to monitor these side effects, and care should be taken to protect the soft tissues in the mouth during office whitening procedures. Furthermore, there is a need to develop new additives or natural whitening products to reduce the occurrence of side effects.

Do Different Tooth Bleaching-Remineralizing Regimens Affect the Bleaching Effectiveness and Enamel Microhardness In Vitro?

Objective

Tooth bleaching may negatively affect the enamel surface properties, such as reduction in hardness values, and remineralizing agents can reverse these effects. This study evaluated the effect of remineralizing agents before, during, and after the bleaching process on enamel's whitening effectiveness and microhardness.

Methods and Materials

The initial color of 104 bovine incisors after immersion in tea solution was recorded, and then, the teeth were randomly divided into eight groups (n = 13). Group 1 (NC) was considered the control with no treatment, and Group 2 (B) was bleached with 40% hydrogen peroxide gel. The 3% fluorohydroxyapatite (FHA) and 2% sodium fluoride (NaF) were applied before (FHA/B, NaF/B), during (FHA + B, NaF + B) and after (B/FHA, B/NaF) the bleaching process in other groups. The final color and microhardness in three depths of 20-30, 50-60, and 100-120 µm were measured. Data were analyzed using Shapiro-Wilk, one-way ANOVA, Tukey, Games Howell, repeated measurement, and LSD tests.

Results

The FHA + B presented the lowest ΔE, significantly lower than other groups, except B/FHA. The ΔE in B/FHA was significantly lower than B/NaF. The bleaching significantly reduced the enamel hardness in three depths. The highest microhardness values were reported for B/NaF and NaF + B, which have no noticeable difference with NC, while FHA/B showed the lowest hardness in three depths, which was significantly lower than NC.

Conclusion

The application of NaF before, during, and after the bleaching improved the microhardness of bleached enamel as the unbleached one with no adverse effect on whitening effectiveness.

Acidic Monetite Complex Paste with Bleaching Property for In-depth Occlusion of Dentinal Tubules

Background

Dentin hypersensitivity (DH) is a common dental clinical condition presented with a short and sharp pain in response to physical and chemical stimuli. Currently no treatment regimen demonstrates long-lasting efficacy in treating DH, and unesthetic yellow tooth color is a concern to many patients with DH.

Aim

To develop a bi-functional material which can occlude dentinal tubules in-depth and remineralize dentin for long-lasting protection of the dentin–pulp complex from stimuli and bleach the tooth at the same time.

Methods

A mixture containing CaO, H₃PO₄, polyethylene glycol and H₂O₂ at a specific ratio was mechanically ground using a planetary ball. The mineralizing complex paste was characterized by X-ray diffraction (XRD) and scanning electron microscopy (SEM). Dentin was exposed to the synthesized paste for 8 h and 24 h in vitro. The mineralizing property was evaluated using SEM and microhardness tests. Red tea-stained tooth slices were exposed to the synthesized paste for 8 h and 24 h in vitro. The bleaching effect was characterized by a spectrophotometer.

Results

The complex paste had very a fine texture, was injectable, and had a gel-like property with 2.6 (mass/volume) % H₂O₂ concentration. The X-ray diffraction pattern showed that the inorganic phase was mainly monetite (CaHPO₄). The mineralizing complex paste induced the growth of inorganic crystals on the dentin surface and in-depth occlusion of dentin tubules by up to 80 μm. The regenerated crystals were integrated into the dentin tissue on the dentin surface and the wall of dentinal tubules with a microhardness of up to 126 MPa (versus 137 Mpa for dentin). The paste also bleached the stained dental slices.

Conclusion

The mineralizing complex paste is a promising innovative material for efficient DH management by remineralizing dentin and in-depth occlusion of dentin tubules, as well as tooth bleaching.

Effect of Indigenously Developed Nano-Hydroxyapatite Crystals from Chicken Egg Shell on the Surface Hardness of Bleached Human Enamel: An In Vitro Study

Objective:

The objective was to evaluate the effect of nano-hydroxyapatite (nHA) derived from chicken eggshell on bleached human enamel in comparison with commercial casein phophopeptide-amorphous calcium phosphate (CPP-ACP) paste using Vickers microhardness test.

Materials and Methods:

nHA powder was prepared from chicken eggshell using combustion method. nHA slurry was prepared by mixing 1.8 g of nHA powder with 0.3 ml of distilled water. Forty intact maxillary anterior teeth were collected and decoronated, and the crowns were embedded in acrylic mold with the labial enamel surfaces exposed. Baseline microhardness evaluation was done (T₀). The specimens were randomly divided into the following four groups (n = 10) based on the surface treatment of enamel: Group 1: no bleaching treatment; Group 2: bleaching with 30% hydrogen peroxide (HP) solution; Group 3: bleaching followed by the application of CPP-ACP; and Group 4: bleaching followed by the application of nHA. The specimens were stored in artificial saliva at 37°C for 2 weeks, after which they were subjected to Vickers microhardness test (T₁₄). One-way ANOVA and Tukey's post hoc multiple comparison tests were used for statistical analysis (P < 0.05).

Results:

Bleaching with HP significantly decreased the enamel microhardness. CPP-ACP and nHA derived from chicken eggshell increased the enamel microhardness significantly. There was no significant difference in microhardness values among the CPP-ACP and nHA groups.

Conclusion:

Nano-hydroxyapatite sourced from chicken eggshell was as effective as CPP-ACP in remineralizing and restoring the lost microhardness of bleached enamel.