Fast Cross-Linked Hydrogel as a Green Light-Activated Photocatalyst for Localized Biofilm Disruption and Brush-Free Tooth Whitening

Biofilm-driven caries and tooth discoloration are two major problems in oral health care. The current methods have the disadvantages of insufficient biofilm targeting and irreversible enamel damage. Herein, an injectable sodium alginate hydrogel membrane doped with bismuth oxychloride (Bi₁₂O₁₇Cl₂) and cubic cuprous oxide (Cu₂O) nanoparticles was designed to simultaneously achieve local tooth whitening and biofilm removal through a photodynamic dental therapy process. This fast cross-linked hydrogel could form a biofilm removal coating on the target tooth surface precisely. Afterward, reactive oxygen species was effectively released on demand under green light, which could not only eradicate the biofilm but also whiten the tooth non-destructively in a facile manner without significant damage to both the enamel and biological cells. After the usage, the removal of this hydrogel can also enhance the effect of biofilm destruction and caries prevention.

The Thickness and Opacity of Aesthetic Materials Influence the Restoration of Discolored Teeth

OBJECTIVES

This study aimed to evaluate the influence of thickness and opacity on the ability of composite resin and ceramic veneer restorations to mask discolored teeth.

METHODS

Ninety veneers were made of lithium disilicate ceramic, shades BL1 and 0 (IPS e.max Press, Ivoclar Vivadent), and 60 were made of composite resin, shade BL-L (IPS Empress Direct, Ivoclar Vivadent). The veneers measured 4 mm in width x 4 mm in length and had a thickness of 0.7, 1.0, or 1.2 mm. One hundred and fifty human premolars were selected to obtain 150 dental fragments with the following dimensions: 4 mm x 4 mm x 3 mm (width x length x thickness). The fragments were discolored, submitted to color measurement and randomly assigned to 15 groups (n=10) according to the type and opacity of the restorative material (IPS e.max Press: high translucency [HT], low translucency [LT], and medium opacity [MO]; IPS Empress Direct: dentin and enamel) and thickness of the veneers (0.7, 1.0, and 1.2 mm). After cementation of the ceramic or composite resin veneers using a translucent resin cement (RelyX veneer, 3M), a final color measurement was taken from each specimen and the total color variation (ΔE) was calculated by subtracting the initial and the final color measurement. The final lightness (L*) of the restored dental fragments was also calculated.

RESULTS

The highest ΔE values were observed for the LT and MO ceramic groups, followed by dentin composite resin. Regarding the different thicknesses of ceramic veneers, every 1.2-mm-thick group had higher values of ΔE, considering their respective opacities (p<0.05). The highest lightness values were found for the LT and MO ceramic veneers (thickness of 1.2 mm). Dentin-shade composite resins showed similar lightness values in all groups.

CONCLUSION

The best thickness/opacity combinations for masking discolored dental substrates were LT and MO ceramic veneers with 1.2-mm thickness. Dentin-shade composite resin veneers with a thickness of 0.7-1.0 mm showed good ability to mask discolored dental substrates.

Clinical Performance of Enamel Microabrasion for Esthetic Management of Stained Dental Fluorosis Teeth

CLINICAL RELEVANCE

Enamel microabrasion is an effective first-line esthetic treatment for the removal of tooth stains due to fluorosis, with an improvement in the appearance of teeth that is associated with a high level of patient acceptance.

SUMMARY

[Study of masking ability of laminate veneers for discolored teeth]

OBJECTIVE

To select the most effective method among different masking treatments, such as different thickness and transparence, tissue surface's opaque coating, and opaque resin cement to restore discolored teeth esthetically by porcelain veneer.

METHODS

Four extracted intact maxillary central incisors were prepared for porcelain veneer restoration and each three heat pressed porcelain veneers from three thicknesses (0.8 mm, 1.0 mm, 1.2 mm) and two transparency(high transparence, HT and low transparence, LT))in Vita shade A2 were fabricated for each tooth, in total of 72 pieces. The surfaces of three prepared teeth were then painted to mimic situations of severe dental fluorosis, severe tetracycline teeth, and necrotic teeth. Each of the veneers was temporarily cemented to the corresponding tooth surface using try-in cements with three different colors (transparent, opaque, and yellow), then used the shade guide (3D master) and electronic colorimeter (easy shade) to record the shade of each porcelain veneer through hue, lightness, and chroma reading. After that, high-transparence porcelain veneers in thickness of 0.8 mm was fused with a layer of opaque porcelain in tissue surface, and were shade matched again after cementation. Statistic treatments were performed to analyze the difference in each masking method.

RESULTS

For each 0.2 mm increase in the veneer thickness of porcelain, the average lightness was reduced by 1 unit, while the chroma was not changed which was independent of the type of the resin cements. When the thickness of the porcelain veneer was decreased to 0.8 mm, the opacity effect was not remarkable even if a low-transparence porcelain veneer was used. Transparent and yellow resin cements had poor opaque performance, while opaque resin cement could reduce the lightness by 2 units and the chroma was also reduced. The opaque layer of the tissue surface could be applied uniformly, and the lightness and chroma could be reduced to Vita 2M1 to 2M1.5 levels regardless of the color of resin cements, which suggested a stable opacity effect for different discolored teeth in this study.

CONCLUSION

For porcelain veneer restoration of discolored teeth, thickened veneers are the most effective means to display a natural transmittance and color. Tissue surface's opacity coatings and opaque resin cements can also be used to reduce grayscale and increase lightness.

[Study of masking ability of laminate veneers for discolored teeth]

OBJECTIVE

To select the most effective method among different masking treatments, such as different thickness and transparence, tissue surface's opaque coating, and opaque resin cement to restore discolored teeth esthetically by porcelain veneer.

METHODS

Four extracted intact maxillary central incisors were prepared for porcelain veneer restoration and each three heat pressed porcelain veneers from three thicknesses (0.8 mm, 1.0 mm, 1.2 mm) and two transparency(high transparence, HT and low transparence, LT))in Vita shade A2 were fabricated for each tooth, in total of 72 pieces. The surfaces of three prepared teeth were then painted to mimic situations of severe dental fluorosis, severe tetracycline teeth, and necrotic teeth. Each of the veneers was temporarily cemented to the corresponding tooth surface using try-in cements with three different colors (transparent, opaque, and yellow), then used the shade guide (3D master) and electronic colorimeter (easy shade) to record the shade of each porcelain veneer through hue, lightness, and chroma reading. After that, high-transparence porcelain veneers in thickness of 0.8 mm was fused with a layer of opaque porcelain in tissue surface, and were shade matched again after cementation. Statistic treatments were performed to analyze the difference in each masking method.

RESULTS

For each 0.2 mm increase in the veneer thickness of porcelain, the average lightness was reduced by 1 unit, while the chroma was not changed which was independent of the type of the resin cements. When the thickness of the porcelain veneer was decreased to 0.8 mm, the opacity effect was not remarkable even if a low-transparence porcelain veneer was used. Transparent and yellow resin cements had poor opaque performance, while opaque resin cement could reduce the lightness by 2 units and the chroma was also reduced. The opaque layer of the tissue surface could be applied uniformly, and the lightness and chroma could be reduced to Vita 2M1 to 2M1.5 levels regardless of the color of resin cements, which suggested a stable opacity effect for different discolored teeth in this study.

CONCLUSION

For porcelain veneer restoration of discolored teeth, thickened veneers are the most effective means to display a natural transmittance and color. Tissue surface's opacity coatings and opaque resin cements can also be used to reduce grayscale and increase lightness.

Effect of pH conditioners on tooth bleaching

The purpose of this study was to evaluate the effect of pH conditioners on tooth bleaching using hematoporphirin-stained paper and artificially discolored bovine tooth model. Experimental bleaching gels containing 23% hydrogen peroxide, adjusting pH 7.0 by different pH conditioners (NaOH, NaHCO3, Na2CO3, KOH, KHCO3, and K2CO3), were prepared. Each bleaching gel was applied on a hematoporphirin-stained paper, and the light was exposed for 5 min. Before and after bleaching, color was measured and color difference was calculated. Artificially discolored bovine tooth samples were prepared and bleached by four experimental bleaching gels containing NaOH, NaHCO3, Na2CO3, or KHCO3. The bleaching time was 10 min with light exposure, and bleaching was repeated 10 times. The color of bleached surface was measured at each bleaching period, and color difference was calculated. In the experiment using hematoporphirin-stained paper, degrees of color difference were KHCO3 > NaHCO3 > KOH > NaOH > Na2CO3 ≥ K2CO3. In the experiment using bovine teeth, degrees of color difference were KHCO3 > NaHCO3 > NaOH > Na2CO3. It was concluded that the bleaching materials with same pH and different pH conditioners showed different bleaching effects and that both cation and anion in the pH conditioners affected bleaching effect.

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

OBJECTIVE:

This randomized clinical study evaluated two parameters: 1) the clinical color rebound of whitening patients' tooth discoloration using the walking bleaching technique and 2) the impact on psychological and aesthetic self-perception at the one-year follow-up of patients who underwent bleaching of nonvital teeth.

METHODS AND MATERIALS:

Fifty study participants with nonvital tooth discoloration were recruited. Teeth were assigned randomly into one of two groups: 1) 35% hydrogen peroxide (n=25) and 2) 37% carbamide peroxide (n=25). Intracoronal bleaching was carried out over the course of four sessions using the walking bleach technique. Tooth color was evaluated after each session in order to measure the total color variation (ΔE). The guide was arranged from highest (B1) to lowest values (C4) for evaluating color, and color changes using Vita Classical Shade (ΔSGUs) units were calculated. Subjective and objective assessments were compared with the counterpart of the tooth. Aesthetic perception and psychosocial factors were evaluated before and after treatment by the Oral Health Impact Profile (OHIP) and Psychological Impact of Dental Impact Questionnaire (PIDAQ) surveys.

RESULTS:

Color changes (ΔE) were 15.48 ± 5.17 and 14.02 ± 4.85 for carbamide and hydrogen peroxide groups, respectively. There were no significant differences ( p>0.05) between these two groups at the one-year follow-up. There was a decrease in the PIDAQ scores after treatment compared to baseline values ( p<0.05). The majority of OHIP values regressed to baseline values.

CONCLUSION:

The technique of walking bleaching was highly effective and showed minimal color rebound in nonvital teeth and had a positive effect on patients' psychological impact at the one-year follow-up.

Effects of Different Stain Removal Protocols on Bonding Orthodontic Brackets to Enamel

AIM

To evaluate the effect of different stain removal protocols with or without topical fluoride application on the bond strength of orthodontic brackets to enamel.

MATERIALS AND METHODS

Eighty extracted premolars were randomly assigned into four groups according to the stain removal protocol. The stain removal protocols were (1) using rubber cup with prophylaxis paste in (G1, n = 20), (2) air-abrasion with prophy-jet polishing system (G2, n = 20), (3) micro-abrasion with opalusture polishing paste (G3, n = 20), and (4) macro-abrasion with ultrafine diamond finishing tips (G4, n = 20). Ten teeth in each group (SG1, n = 10) had no topical fluoride treatment after stain removal protocol, while the rest (SG2, n = 10) were subjected to topical fluoride application. After bonding the orthodontic brackets, all specimens were thermocycled before testing their bracket-enamel bond strength. The debonded bracket and enamel surfaces of each specimen were also assessed to determine the adhesive remnant index (ARI) for each subgroup.

RESULTS

Specimens in G2, G3, and G4 recorded lower shear bond strength as compared with G1 (p < 0.05). For all groups, specimens in SG2 demonstrated lower bond strength than their counterpart in SG1 (p < 0.05). No significant differences were detected between the ARIs of different subgroups (p > 0.05).

CONCLUSION

Bonding orthodontic brackets is affected by the protocol of removing enamel stains. The use of the rubber cup with prophylaxis paste provided the highest bracket-enamel bond strength. Topical fluoride application usually complicates the bonding process of orthodontic brackets to cleaned enamel surfaces.

CLINICAL SIGNIFICANCE

The results of the current study indicate higher bracket bond strength to enamel surfaces treated with different stain removal protocols than the clinically acceptable values (5.9-7.8 MPa). However, the more aggressive enamel pretreatment methods should not be considered unless the clinical situation necessitates such action. Postponing the topical fluoride application is advisable to follow the bracket bonding procedure. This action would prevent the negative effect of topical fluorides on bracket-enamel bond strength.

Clinical evidence on a unique two-step stannous fluoride dentifrice and whitening gel sequence

PURPOSE

Recently, a unique two-step product was introduced that includes sequential use of a novel 0.454% stannous fluoride dentifrice followed by a 3% hydrogen peroxide whitening gel. The technology targeted advanced gingival health benefits plus esthetic benefits such as tooth whitening. The two-step sequence has unique brushing instructions to maximize the efficacy of each step; the stannous fluoride dentifrice is used for 1 minute of brushing followed by 1 minute of brushing with the hydrogen peroxide gel. This two-step sequence has been studied in numerous clinical trials over a series of years. This comprehensive program included different populations and sites, endpoints and time points, with responses measured versus different positive and negative research controls. A total of six clinical trials are reported herein. Outcomes from this research program demonstrate the significant gingival health efficacy of the two-step product, providing therapeutic efficacy comparable to chlorhexidine, and its positive impact on plaque, tooth stain and breath odor.

CLINICAL SIGNIFICANCE

This unique dentifrice/gel sequence delivers a combination of advanced gingivitis efficacy with significant stain reduction - benefits that will positively impact oral health as well as patient compliance.

Hydroxyapatite and Self-Assembling Peptide Matrix for Non-Oxidizing Tooth Whitening

OBJECTIVES

The aim of this combined in vitro and in vivo study was to evaluate the efficacy of tooth whitening using a mixture of Self- Assembling Peptide Matrix (SAPM) and hydroxyapatite (HA).

METHODS

The mixture was applied on stained bovine teeth, and the tooth color was measured using a spectrophotometer; mean changes in L*a*b values between measurements were expressed as DE. Additionally, the nature of the surface layer was investigated by ATRFTIR and EDX. The optical changes due to the additional surface layer were measured using a goniometer. Finally, a proof-of-concept clinical study was performed investigating the mixture of SAPM+HA.

RESULTS

The results verified that the SAPM remained on the tooth surface and acted as a temporary adhesive to attach the HA particles to the tooth surface. Further, the optical changes due to the additional surface layer indicated a diffuse reflection to be the origin of the optical whitening. Lastly, the mixture of SAPM+HA showed significant and visible whitening after one application, increasing throughout the first week of home application (DE = 4.9 ± 3.3) and remaining stable for 30 days (DE = 4.8 ± 3.6).

CONCLUSIONS

The combination of SAPM+HA particles caused optical whitening based on diffuse reflection by the HA particles on the tooth surface. The whitening effect and its magnitude observed in vitro were also seen in vivo.

[Comparative study of enamel discoloration related to bonding with different orthodontic adhesives and cleaning-up with different procedures]

PURPOSE

The aim of this study was to compare if there was any difference in the enamel discoloration after staining when three orthodontic adhesives and 4 enamel clean-up methods were tested.

METHODS

Three types of orthodontic adhesives were used: chemically cured resin, light-cured resin and resin-modified glass-ionomer cement. A total of 120 human extracted premolars were included. Ten teeth of each orthodontic adhesive were randomly cleaned-up with 1 of 4 different procedures and stained in coffee for 7 days: carbide bur (TC), carbide bur and Sof-Lex polishers (TC＋SL), carbide bur and One Gloss polishers (TC＋OG), carbide bur and PoGo polishers (TC＋PG). Colour measurements were made with Crystaleye dental spectrophotometer at baseline and after storage in a coffee solution for 1 week. Two way ANOVA and Bonferroni test were used for statistical analysis with SPSS 13.0 software package.

RESULTS

The colour change values of adhesive materials in the TC group were the greatest. The lowest ΔE* values were obtained from the TC＋SL group. However, there was no significant difference between the TC＋SL and TC＋PG group (P>0.05). The resin-modified glass-ionomer cement group showed the lowest colour differences and chemically cured resin group showed the highest ΔE* values among all orthodontic adhesives (P<0.05).

CONCLUSIONS

The colour change of enamel surface is affected by the type of adhesive materials and clean-up procedures.

Efficacy of Teeth Whitening with a Mouthwash: In Vitro and In Vivo Approaches

OBJECTIVES

Two different studies were conducted to evaluate the whitening efficacy of a mouthwash versus a placebo using in vitro and in vivomodels. The tested mouthwash was formulated with no oxidizing or abrasive agents containing chlorhexidine (CHX) and polyvinylpyrrolidone (PVP).

METHODS

The purpose of the in vitro study was to determine whether the mouthwash formulation OC15AB could reduce the accumulation of staining in an accepted stain model. Bovine central incisors were cut to obtain enamel specimens of ~8 × 8 mm2. The specimens were then immersed in human saliva (room temperature, slight stirring) for one hour to allow a pellicle film to form. They were then placed in contact with a staining solution containing coffee and tea. The amount of stain (tooth color) was quantified photometrically (Minolta C221 colorimeter) using the L* value of the L*a*b* scale. The purpose of the in vivo study was to evaluate the whitening power and tolerability of OC15AB versus a placebo mouthwash in a double-blind, randomized clinical study. In total, 40 subjects were divided randomly into two homogeneous groups. Each group used a different mouthwash (OC15AB or placebo) for 56 consecutive days. During this period, clinical and instrumental parameters, namely variations in tooth color and mucosal and gum alterations, were evaluated. The in vivo study analyses used a two-sided Student's t-test. Evaluations within groups used t-tests for paired data.

RESULTS

From the in vitro test, OC15AB had a significant effect in reducing stain accumulation over the entire treatment period. The in vivo test showed that OC15AB was well tolerated and had whitening power in the subjects. OC15AB demonstrated a statistically significant reduction in extrinsic tooth staining from baseline and versus the placebo.

CONCLUSIONS

The in vitro and in vivo methods used to investigate the whitening efficacy of the mouthwash formulation produced similar and consistent results. The experimental model used is an important tool in the search for new technologies for teeth whitening. Our preliminary experimental data confirm the possibility of achieving a whitening effect using a mouthwash formulation with no oxidizing or abrasive agents containing CHX and PVP. The formulation tested demonstrated a significant reduction, in vitro and in vivo, in extrinsic tooth staining from baseline and versus the placebo.

[Evaluation of the effectiveness of cold-light whitening technique on tetracycline pigmentation teeth and aged extrinsic stain teeth]

PURPOSE

To evaluate the clinical effectiveness of cold-light whitening technique on tetracycline pigmentation teeth and aged extrinsic stain teeth.

METHODS

One hundred and fifty-two cases bleached by cold-light whitening technique were included in this study. The patients' teeth were divided into 3 groups: aged extrinsic stain teeth, mild tetracycline pigmentation teeth and moderate tetracycline pigmentation teeth. Visual determination of shade and Olympus crystaleye spectrophotometer were used to measure the tooth discoloration after bleaching. SPSS17.0 software package was used for statistical analysis.

RESULTS

Visual determination showed that the efficiency of aged extrinsic stain teeth was significantly higher than that of mild and moderate tetracycline teeth group (P<0.05). Colorimetric method showed that the △E of moderate tetracycline teeth was significantly lower than aged extrinsic teeth and mild tetracycline teeth (P<0.05) . The △E of cervix changed more significantly than that of central and incisal edge in both mild and moderate tetracycline teeth group (P<0.05).

CONCLUSIONS

The effect of cold-light whitening technique on aged extrinsic stain teeth is better than that of the tetracycline pigmentation teeth. Cold-light whitening technique can improve pigmentation of tetracycline teeth cervix．.

Restoration of discolored endodontically treated anterior teeth: a minimally invasive chemomechanical approach

In the case of discolored devitalized anterior teeth, several treatments are available to enhance the esthetic outcome, from noninvasive external/internal bleaching to freehand resin composites and more complex prosthetic solutions such as veneers or full crowns. Innovative computer-aided design/computer-aided manufacturing (CAD/CAM) chairside technologies and the introduction of new industrially polymerized composite resin blocks coupled with modern adhesive strategies have reduced both biological and financial costs compared to the classic post-core-crown approach. The aim of this article is to show how these new materials can be used in association with noninvasive internal and external tooth bleaching to restore a discolored, fractured, non-vital central incisor.

Color restoration and stability in two treatments for white spot lesions

This study evaluated the effectiveness of resin infiltration or enamel microabrasion for restoring color changes caused by incipient carious lesions as well as the color stability achieved by these treatments. Enamel specimens were subjected to cariogenic challenge to produce white spot lesions (WSLs) using a microcosm biofilm model. These lesions were treated with resin infiltration or enamel microabrasion (n = 8), and color changes were measured with a spectrophotometer at baseline and after the treatments. Untreated specimens were used as a control. The treated specimens were then immersed in coffee for 1 week, and tooth color was measured again. Data for ΔL*, Δa*, Δb*, and ΔE were analyzed by two-way repeated measures ANOVA and Tukey's test (α = 0.05). Caries induction resulted in significant color changes, mainly decreased lightness. Neither resin infiltration nor enamel microabrasion were able to restore tooth color. The specimens subjected to resin infiltration and the control specimens were more susceptible to color changes following immersion in coffee. In conclusion, enamel microabrasion and resin infiltration were unable to restore the initial tooth color observed prior to WSL induction. Moreover, resin-infiltrated enamel seems more susceptible to staining solutions than enamel subjected to microabrasion.

An induced extrinsic tooth stain prevention model to investigate whitening potential of sugar-free chewing gums

PURPOSE

To establish an accelerated clinical test method to evaluate the effectiveness of sugar-free gums in prevention of the formation of extrinsic stains when chewed over a 2-week period in conjunction with daily tooth brushing. A secondary objective was to compare three methods for measuring extrinsic stain.

METHODS

25 healthy adult volunteers were enrolled in a single center, examiner blind, randomized 4-way crossover clinical study. Starting with a stain-free baseline, subjects rinsed five times daily with freshly brewed black tea, followed either by chewing one of three different gums for 12 minutes or not chewing (negative control). Extrinsic stain was measured at 1 and 2 weeks by modified Lobene Stain Index (MLSI), digital imaging, and a Vita EasyShade spectrophotometer.

RESULTS

At 2 weeks, MLSI scores showed a statistically significant mean reduction of 43% or greater versus no-gum control for all three gum treatments. Digital image analysis and Vita EasyShade measurement showed reductions of yellowness (measured by difference in ∆b* values between the three gums and the non-gum control treatment) ranging from 0.28 to 0.34 and 3.52 to 4.18 Δb* units, respectively, for subjects using the chewing gums versus no-gum control (P< 0.05) after 2 weeks. This clinical study demonstrated that sugar-free gum can effectively reduce new stain formation along with daily tooth brushing in as little as 2 weeks when used in conjunction with tea rinsing to help promote more rapid stain formation. All three test methods confirmed the results, albeit with different levels of statistical significance. A minor modification of gum base polymer, or change of flavors, did not significantly impact the prevention of new stain formation.

CLINICAL SIGNIFICANCE

Regular consumption of sugar-free chewing gum helps prevent extrinsic dental stain accumulation and provides a simple and enjoyable means for consumers to maintain their natural tooth color.

Efficacy of different protocols for at-home bleaching: A randomized clinical trial

PURPOSE

To evaluate the efficacy of two products used for at-home bleaching with different application times.

METHODS

80 participants were enrolled and divided into four groups, (1) 10% carbamide peroxide 1 hour a day; (2) 10% carbamide peroxide overnight; (3) 7.5% hydrogen peroxide 1 hour a day; and (4) 7.5% hydrogen peroxide overnight. The duration of treatment was 14 days. Color measurement was performed using a dental spectrophotometer on the right maxillary central incisor and the canine, at baseline and 2 weeks after. Participants recorded daily tooth sensitivity. To evaluate the influence of concentration and time on bleaching results (ΔE) the one-way ANOVA with Bonferroni post-hoc test and the Student's t-test were used.

RESULTS

Group 2 showed the highest value of ΔE (ΔE = 10.59 ± 2.68), followed by Group 4 (ΔE = 8.95 ± 2.32), Group 1 (ΔE = 8.05 ± 3.86), and Group 3 (ΔE = 7.08 ± 1.99). There were differences between Groups 2 and 3 (P= 0.001) and between Groups 2 and 1 (P= 0.032). The same product applied overnight was more effective than applied 1 hour a day (P< 0.05). Different concentrations during the same application time achieved similar results. The reported tooth sensitivity was mild.

CLINICAL SIGNIFICANCE

At-home bleaching is time but not concentration dependent and its secondary effects depend on the active agent concentration; therefore, there is no need to use high concentration products. The most effective protocol is low concentrations (10% carbamide peroxide) with overnight use.

Effectiveness and Impact of the Walking Bleach Technique on Esthetic Self-perception and Psychosocial Factors: A Randomized Double-blind Clinical Trial

OBJECTIVE

This trial evaluates the impact of psychosocial and esthetic self-perceptions of patients undergoing nonvital tooth bleaching using the walking bleach technique. We also assessed the clinical effectiveness of bleaching tooth discoloration.

METHODS

Fifty volunteers with nonvital tooth discoloration were enrolled. Teeth were randomized into two groups: 35% hydrogen peroxide (n=25) and 37% carbamide peroxide (n=25). Intracoronal bleaching was performed over four sessions using the walking bleach technique. Tooth color was evaluated at each session to measure total color variation. The shade guide was arranged from highest (B1) to lowest (C4) values to assess the color and calculate the color change in the number of shade guide units. Subjective and objective assessments were compared with the tooth counterpart. Esthetic self-perception and psychosocial factors were assessed before and after treatment.

RESULTS

Color change was 15.48<5.17 for hydrogen peroxide and 14.02<4.85 for carbamide peroxide. There was no significant difference at any time point (p>0.05) except at sessions 3 and 4 (p<0.05). Overall, whitened teeth values were similar to those of counterpart teeth (p>0.05). There was a decrease in Oral Health Impact Profile and Psychosocial Impact of Dental Esthetics questionnaire scores after treatment compared with baseline (p<0.05).

CONCLUSION

The walking bleach technique was highly effective on nonvital teeth and had a positive effect on self-esthetic perception and psychological impact for the patients.

Using Cross-Polarized Photography as a Guide for Selecting Resin Composite Shade

The restoration of single discolored maxillary anterior teeth is still a difficult task, as not only shape and surface characterization play an important role in the success of the treatment, but the propagation of light throughout the restorative material does as well. In some cases, small changes in morphology, color, and brightness will be noticeable. These factors are sometimes very tricky, and shade guides alone are difficult to use for color selection. This article proposes a protocol of employing cross-polarization imaging for improving the accuracy of the shade selection of resin composites. The step-by-step technique is presented for the restoration of a single discolored tooth.

A randomized clinical study to evaluate the effect of an ultra-low abrasivity dentifrice on extrinsic dental stain

PURPOSE

To investigate the stain-removal efficacy of an experimental ultra-low abrasivity anti-sensitivity dentifrice containing sodium tripolyphosphate (STP) and a cocamidopropyl betaine/sodium methyl cocoyl taurate detergent system.

METHODS

This was a single-center, examiner-blind, randomized, parallel-group study. Extrinsic dental stain was assessed on the facial surfaces of the six maxillary and six mandibular anterior teeth and the lingual surfaces of the six mandibular anterior teeth using the Macpherson modification of the Lobene Stain Index (MLSI). Treatments were: ultra-low abrasivity dentifrice [5% w/w KNO3, 5% w/w STP, 1,100 ppm fluoride as sodium fluoride; relative dentin abrasivity (RDA) ~10; n=54]; moderate abrasivity fluoride dentifrice (1,100 ppm fluoride as sodium monofluorophosphate; RDA ~68; n= 57); higher abrasivity daily-use whitening dentifrice (1,100 ppm fluoride as sodium fluoride; RDA~137; n= 57). Subjects brushed for 1 minute, twice daily, for 8 weeks.

RESULTS

Mean total MLSI [ Area × Intensity (A×I) ] change from baseline score at Weeks 4 and 8 was significant (P< 0.0001) for all groups. At Week 8, for the ultra-low abrasivity dentifrice versus the moderate and higher abrasivity dentifrices, mean total MLSI (A×I) scores (P< 0.0001), along with MLSI endpoints in facial, lingual, and interproximal regions (P= 0.0035 to P< 0.0001), favored the ultra-low abrasivity dentifrice. Dentifrices were generally well-tolerated. The ultra-low abrasivity dentifrice containing 5% STP reduced extrinsic dental stain more effectively than moderate or higher abrasivity dentifrices.

CLINICAL SIGNIFICANCE

The ultra-low abrasivity, anti-sensitivity dentifrice containing 5% STP reduced extrinsic dental stain more effectively than moderate or higher abrasivity dentifrices, and is thus suitable for patients with sensitive teeth who wish to control extrinsic dental stain.

Randomized Controlled Trial to Explore the Effect of Experimental Low Abrasivity Dentifrices on Enamel Gloss and Smoothness, and the Build-up of Extrinsic Tooth Stain

OBJECTIVES

To evaluate and compare examiner-assessed changes in enamel gloss, extrinsic dental stain, and surface smoothness following one, two, four, and eight weeks of twice-daily use of an experimental low abrasivity desensitizing dentifrice (relative dentin abrasivity [RDA] ~40) containing 5% sodium tripolyphosphate (STP) chemical cleaning agent and 1% aluminum trioxide abrasive. This was compared with an ultra-low abrasivity dentifrice (5% STP only; RDA ~13), a moderate abrasivity fluoride dentifrice (RDA ~80), and a higher abrasivity marketed whitening dentifrice (RDA ~142).

METHODS

This was a single-center, examiner-blind, randomized, controlled, parallel group study in healthy adults stratified by gloss score and age. Following a washout period with a conventional silica abrasive dentifrice, subjects received a dental scale and polish and were randomized to treatment. Subjects brushed their teeth for two minutes, twice daily, with their assigned dentifrice. Enamel gloss was assessed visually by comparing the facial surfaces of the maxillary incisors to the Sturzenberger gloss standards. Extrinsic dental stain was measured on the 12 anterior teeth (facial and lingual) using the Macpherson modification of the Lobene Stain Index (MLSI). Tooth smoothness was assessed using scanning electron microscope (SEM) analysis of a silicone impression of the central incisors.

RESULTS

Of 120 screened subjects, 95 were randomized to the study. Subjects using the low abrasivity aluminum trioxide/STP dentifrice demonstrated statistically significant (p < 0.05) and increasing improvements in surface gloss over baseline at all time points, with a significant treatment effect compared to all other study dentifrices from Week 2 (p < 0.05). With respect to dental stain, the low abrasivity dentifrice group had the lowest stain score at each post-treatment time point and demonstrated statistically significantly less stain compared to all study dentifrices at Weeks 2 (p < 0.05) and 8 (p < 0.01). For tooth smoothness, at Week 8, statistically significant increases in surface smoothness were observed for most treatment groups compared to baseline (p < 0.05), except for the moderate abrasivity dentifrice.

CONCLUSIONS

This study shows the benefit of a low abrasivity dentifrice containing STP and aluminum trioxide in reducing stain build-up and increasing tooth gloss compared to a non-alumina ultra-low abrasivity STP-containing dentifrice, and moderate and high abrasivity dentifrices, over an eight-week period.

Correction of a Single Discolored Anterior Tooth Due to Internal Resorption: A Clinical Report

For patients with a single discolored tooth who desire to have it lightened, a thorough examination and radiographic analysis need to be performed prior to initiating any bleaching treatment so that the cause of the discoloration can be determined. Underlying pathology, such as internal resorption, is often asymptomatic and difficult to diagnose and if left untreated could result in tooth loss. This article describes a case of a patient with a discolored maxillary central incisor resulting from internal resorption and the subsequent endodontic and bleaching therapy performed to resolve the pathology and achieve an acceptable esthetic result.

[Effect of ceramic thickness and resin cement shades on final color of heat-pressed ceramic veneers]

Objective: To analyze the effect of ceramic materials thickness and resin cement shades on the final color of ceramic veneers in the discolored teeth, and to investigate the color agreement of try-in pastes to the corresponding resin cements. Methods: Sixty artificial maxillary central incisor teeth (C2 shade) were used to simulate the natural discolored teeth and prepared according to veneer tooth preparation protocol. Veneers of different thickness in the body region (0.50 and 0.75 mm) were fabricated using ceramic materials (LT A2 shade, IPS e.max Press). The ceramic veneer specimens were bonded to the artificial teeth using the 6 shades of resin cements (Variolink Veneer: shades of LV-3, LV-2, HV+3; RelyX™ Veneer: shades of TR, A3, WO) (n=5). A clinical spectrophotometer was used to measure the color parameters of ceramic veneers at the cervical, body and incisal regions. Color changes of veneers before and after cementation were calculated and registered as ΔE1, and the changes between try-in paste and the corresponding resin cements were registered as ΔE2. Results: Three-way ANOVA indicated that ΔE1 and ΔE2 values were significantly affected by the ceramic thickness, resin cement shades and measuring regions (P<0.05). The ΔE1 values of six shades ranged from 0.59-8.27. The ΔE1 values were more than 2.72 when the ceramic veneers were cemented with resin cements in shades of HV+3 and WO. The ΔE2 values of six shades ranged from 0.60-2.56. The shades of HV+3, WO and A3 resin cements were more than 1.60. Conclusions: Different thickness of ceramic materials, resin cement shades and measuring regions could affect the final color of ceramic veneers. The color differences of some resin cements and corresponding try-in pastes might be observed in clinical practice.

Minimally Invasive Dentistry: A Conservative Approach to Smile Makeover

The concept of minimally invasive dentistry is based on preserving tooth structure, especially enamel. A conservative method to treat discolored teeth that have diastemas is a freehand additive technique using composite resin. While selecting the correct shade of resin can be challenging, newer composite resin formulations are being developed with optical properties that enable the material to more effectively blend into the dentition. This case report describes the use of conservative approaches and materials to treat discolored, unevenly spaced teeth and restore harmony and balance to a patient's smile.

[Preliminary clinical evaluation of the esthetic effect of deep discolored anterior teeth restored with zirconia veneers]

OBJECTIVE

To observe the esthetic effect of deep discolored anterior teeth restored by zirconia veneers.

METHODS

Small defected deep discolored anterior teeth with complete root canal therapy were restored by zirconia veneers (n=15). The same name teeth on the other side of the same dental arch were chosen as control teeth. The color difference values ΔE of the neck 1/3, the middle 1/3 and the incisor 1/3 between the deep discolored tooth and the normal control tooth before and after therapy were measured to evaluate the esthetic effect of zirconia veneer restoration. At the same time, the marginal fit of zirconia veneers was checked by the standard of United States Public Health Service (USPHS). The integrity of the veneers was also examined.

RESULTS

On the labial side, fibers color difference values ΔE of the neck 1/3, the middle 1/3 and the incisor 1/3 between deep discolored teeth and normal control teeth were measured by the electronic colorimeter, which were 24.92±3.00,26.64±4.00 and 21.94±3.31 respectively. All the values were above 4.0, which were considered unacceptable in clinic. After restoration by zirconia veneers, the color difference values ΔE of the middle 1/3 and the incisor 1/3 between the restored and control teeth were 1.82±0.17 and 1.84±0.21. Both values were less than 2.0, which indicated both good color matching. The color difference value ΔE of the neck 1/3 was 3.92±0.48, which was less than 4.0 and could be accepted in clinic. The statistical analysis of the colors of the teeth before and after restoration compared with the control teeth was done by Paired t test. The t values in the neck 1/3, the middle 1/3 and the incisor 1/3 were 30.37, 21.56, 23.37 respectively. In the three group, all the P<0.001. There were obvious statistical differences. According to the standard of USPHS, the marginal fit of all the restored teeth was perfect (grade A). No zirconia veneers were broken or detached in the period of observation.

CONCLUSION

Zirconia veneers can be a good method to restore deep discolored anterior teeth. However, it should be used cautiously when the patient's esthetic expectation was too high.

A Randomized Controlled Clinical Trial to Evaluate Extrinsic Stain Removal of a Whitening Dentifrice

OBJECTIVES

To evaluate the extrinsic stain removal efficacy of a new whitening dentifrice containing sodium hexametaphosphate (SHMP) over a two-week period.

METHODS

This study used a controlled and randomized, examiner-blind, single-center, two-treatment, parallel group design. Subjects with visible extrinsic dental stain on facial surfaces of their anterior teeth, and meeting all study criteria, were entered into the trial. The test group received the whitening dentifrice with sodium fluoride and SHMP and an ADA reference soft manual toothbrush. Subjects in the control group received a dental prophylaxis after the initial examination at Baseline and were instructed to use their usual oral hygiene products at home. Subjects returned at Day 3 and Week 2 for re-evaluation of extrinsic dental stain. Extrinsic stain was measured using the Interproximal Modified Lobene (IML) Stain Index; safety was assessed based on clinical examination.

RESULTS

Fifty subjects (mean age 32.0 years) completed the study, with 25 in each group. Statistically significant reductions in composite stain for whole tooth, as well as interproximal, gingival, and body surfaces were observed for both groups at Day 3 and Week 2 (p < 0.0001) with no significant differences between the two groups (p > 0.3). At Day 3, median percent reductions in composite IML stain from Baseline were 98% for the prophylaxis group and 100% for the test dentifrice group. At Week 2, median percent reductions in composite IML stain were 100% compared to Baseline for both groups. No adverse events were reported for either group.

CONCLUSIONS

The whitening dentifrice demonstrated a statistically significant reduction in IML stain after three days and two weeks of use relative to baseline. Stain reduction with the toothpaste was comparable to a dental prophylaxis.

Clinical Study to Determine the Stain Removal Effectiveness of a New Dentifrice Formulation

OBJECTIVES

This randomized, prospective clinical trial was conducted to determine the safety and effectiveness of a new whitening dentifrice formulation in comparison to that of both a negative and a positive control dentifrice.

METHODS

Seventy-nine qualifying subjects were randomly assigned to either the new whitening dentifrice (Arm & Hammer® Truly Radiant™ Clean & Fresh Toothpaste), a positive control whitening dentifrice (Crest® 3-D White® Radiant Mint Toothpaste), or a negative control regular dentifrice (Colgate® Cavity Protection Toothpaste). The subjects brushed with their assigned dentifrice for two minutes, twice daily, for five days. Extrinsic tooth stain was assessed using a Modified Lobene Stain Index (MLSI) at baseline and after five days of product use.

RESULTS

All entering subjects completed the study. There were no significant differences (p > 0.05) in stain among the three groups at baseline. The Arm & Hammer Truly Radiant and positive control groups had statistically significant (p < 0.001) mean composite MLSI reduction scores of 13.2% and 7.8%, respectively, from baseline to day five. The negative control dentifrice group was virtually unchanged during this period. Intergroup comparisons showed the Truly Radiant group to have significantly greater stain removal (p < 0.0001) scores than the negative control. The Truly Radiant group also had greater stain removal than the positive control, though the differences were not statistically significant.

CONCLUSIONS

This study demonstrates that five-days' use of Arm & Hammer Truly Radiant Clean & Fresh dentifrice was significantly more effective in stain removal than a regular (non-whitening) dentifrice and comparable in effectiveness to a whitening dentifrice positive control.

Efficacy of E-Learning via the Website of Tehran University of Medical Sciences for Diagnosing Tooth Discolorations and Treatment Planning by Senior Dental Students

The efficacy of methods like e-learning as a supplement to traditional face-to-face instruction needs to be evaluated in dental courses. This study aimed to assess the efficacy of posting case presentations on one of the educational websites of  the virtual school of Tehran University of Medical Sciences called "SARMAD" to enhance the ability of senior dental students to diagnose tooth discolorations and offer treatment plans. This experimental study had a pre-test/post-test control group design and was conducted on 63 senior dental students. After filling out the primary questionnaire and obtaining a written informed consent, students participated in a pre-test and were then randomly divided into two groups of intervention and control. Fifteen case presentations were posted on the university website (SARMAD) during 6 weeks and discussed. Then, students participated in a post-test. Students' perspectives and their satisfaction with the website were assessed by a questionnaire. For ethical purposes, the same program was also offered to the controls. The post-test score was significantly higher than the pre-test score in the intervention group (P<0.001); but in the control group, the post-test score was only slightly higher than the pre-test score (P=0.128). In the intervention group, 70% stated that they would suggest this method as an efficient educational modality; 93.3% stated that this method would be beneficial as a supplement to conventional education; 16.7% ranked the SARMAD website excellent, 30% ranked it good, 33.3% acceptable, 16.7% moderate and 3.3 poor. It appears that this instructional modality may be efficiently used as a supplement to traditional instruction in undergraduate dental curricula.

Effect of Light-Activated Tooth Whitening on Color Change Relative to Color of Artificially Stained Teeth

PURPOSE

There is still controversy as to the efficacy of light activation used in tooth whitening. The purpose of this study was to evaluate the effect of light activation on tooth color change relative to the artificial dye color.

MATERIALS AND METHODS

Extracted human third molars (160) were randomly distributed into eight groups of 20 specimens each based on artificial staining and use of light activation. All groups received three 45-minute sessions of in-office whitening at 3-day intervals. Color measurements were performed with an intraoral spectrophotometer at baseline prior to staining (T0), after artificial staining (T1), 1-day--(T2), and 1-week--(T3) post-whitening. Color differences were calculated relative to after artificial staining color parameters (L*1, a*1, b*1) with the use of a software analysis program enabling synchronization of two images.

RESULTS

Within the same staining groups, the light-activated samples exhibited a greater color change than their nonlight-activated counterparts. However, only in the case of the yellow-stained samples at 1-day post-whitening was there a significant difference between the nonlight-activated and light-activated groups (Tukey's post hoc multiple comparison test for pairwise comparisons, p < 0.05).

CONCLUSIONS

Light activation is a valid method for enhancing the efficacy of tooth whitening with respect to overall color change and works best with yellow stains.

CLINICAL SIGNIFICANCE

Light activation is a valid method for enhancing the efficacy of tooth whitening with respect to overall color change and works best with yellow stains.

Direct Composite Restorations to Mask Intrinsic Staining: An Eighteen-Year Follow-Up

In this case example, the use of direct composite resin allowed for a relatively simple, conservative treatment that provided excellent function and aesthetics, while preserving healthy dental tissue. The importance of continued follow-up and a periodic maintenance and minor repair process will ensure longevity of the restorations, as aesthetics, and the occlusion.

Esthetic rehabilitation with tooth bleaching, enamel microabrasion, and direct adhesive restorations

The aim of this case report is to report esthetic rehabilitation with combined tooth bleaching, enamel microabrasion, and anterior restoration replacement in a 26-year-old man. Clinical examination showed deficient restorations in the maxillary anterior teeth, significant discoloration of the maxillary left central incisor, and hypoplastic stains affecting the maxillary right lateral incisor. A radiograph of the left central incisor showed satisfactory endodontic treatment, allowing preparation for the walking bleach technique. For 3 weeks, 37% carbamide peroxide in the pulp chamber was renewed every week. In-office bleaching with 35% hydrogen peroxide was also performed on the maxillary teeth. After 21 days, all teeth had been bleached to shade A1. After bleaching was completed, enamel microabrasion of the maxillary right lateral incisor was conducted with 6% hydrochloric acid. In later sessions, microhybrid composite resin restorations were placed in all 4 maxillary incisors. A combination of dental bleaching techniques, enamel microabrasion, and resin restorations was a successful and conservative choice for reestablishing the natural appearance of discolored teeth, improving the self-esteem of the patient.

Stain removal efficacy of two manual toothbrushes

PURPOSE

To evaluate the dental stain removal efficacy of two commercially-available manual toothbrushes.

METHODS

This was a randomized, examiner-blind, parallel-group, two treatment clinical trial of 2 weeks duration. Subjects qualifying for the study had a mean Modified Lobene Stain Index of ≥ 1.5 on at least two anterior teeth. Subjects were randomly allocated to one of two groups, receiving a test manual toothbrush (Oral-B 3D White Radiant) or a positive control (PC) manual brush to be used for 1 minute, twice daily for 2 weeks with a standard, anti-cavity fluoride dentifrice. Subjects were given written and verbal instructions, and the first use was supervised at the baseline visit. Stain was measured at baseline and after 2 weeks of product use. Stain measurements were conducted using the Modified Lobene Stain Index (MLSI) and the Interproximal Modified Lobene Stain Index (IMLSI).

RESULTS

Use of the two manual brushes resulted in statistically significant reductions of surface stain relative to baseline after 2 weeks of use. The mean MLSI composite stain reductions versus baseline were 1.37 for White Radiant and 0.87 for PC (P < 0.001 for both). Using the IMLSI, the mean stain reductions for composite, gingival and interproximal regions were 1.68, 1.20 and 1.68 for White Radiant (P < 0.001) and 1.25, 0.97 and 1.43 for PC (P ≤ 0.002). ANCOVA yielded statistically significant between group differences, with greater composite stain removal observed for White Radiant using both indices (P ≤ 0.025).

Resin Infiltration for Aesthetic Improvement of Mild to Moderate Fluorosis: A Six-month Follow-up Case Report

PURPOSE

To determine whether fluorosed areas of teeth can be successfully treated with resin infiltration and whether the results are long lasting.

MATERIALS AND METHODS

For the present case of mild to moderate dental fluorosis, the microinvasive resin infiltration technique was chosen, following suboptimal results of in-office vital tooth bleaching to improve the aesthetic appearance of the affected teeth.

RESULTS

Six months after treatment, the white opaque and brown discolourations remain masked.

CONCLUSION

This case report demonstrates that resin infiltration is an agreeable option for this type of tooth discolouration, rather than choosing more invasive, conventional procedures. More studies need to be completed to determine longer-term outcomes of the technique.

Effect of Melamine Sponge on Tooth Stain Removal

OBJECTIVES

To investigate the stain removal ability of melamine sponge before aesthetic tooth whitening in extracted teeth.

METHODS

Melamine sponge of thickness 40 mm was compressed and the destruction of the partition wall structure during the compression process was examined under a stereoscopic microscope. An extracted human tooth was cleaned by normal polishing or with melamine sponge for 90 s. To evaluate the stain level, the tooth surfaces were photographed under a stereoscopic microscope at 0, 30, 60 and 90 s. The residual stained region was traced in a high-magnification photograph, and the stain intensity was presented as a change, relative to the intensity before the experiment (0 s).

RESULTS

Mechanical cleaning by toothbrushing produced polishing scratches on the tooth surface, whereas use of the melamine sponge resulted in only minimal scratches. As the compression level increased, the stain-removing effect tended to become stronger.

CONCLUSION

Melamine sponge can remove stains from the tooth surface more effectively and less invasively compared to a conventional toothbrush. As no new scratches are made on the tooth surface when using a melamine sponge brush, the risk of re-staining is reduced. Cleaning using a melamine sponge brush can be easily and effectively performed at home and in a dental office.

Splinted Porcelain Laminate Veneers With a Natural Tooth Pontic: A Provisional Approach for Conservative and Esthetic Treatment of a Challenging Case

Esthetic rehabilitation of discolored anterior teeth is always a great challenge, especially in the presence of pathology. Fortunately, conservative management in the esthetic zone has become more feasible in compromised cases because of the development of restorative materials and advances in dental adhesives. This report presents a complicated case of a patient with tetracycline-related discoloration, multiple root resorption, and a periapical lesion. Treatment was conservative and used a natural tooth pontic and splinted porcelain laminate veneers.

Comprehensive Risk-Based Diagnostically Driven Treatment Planning: Developing Sequentially Generated Treatment

The clinical example presented in this article demonstrates a risk-based, diagnostically driven treatment planning approach by focusing on 4 key categories: periodontal, biomechanical, functional, dentofacial. In addition, our unique approach allowed the comprehensive clinical management of a patient with complex restorative needs. A full-mouth rehabilitation was completed sequentially without sacrificing the amount of dentistry necessary to restore health, comfort, function, and esthetics. The result exceeded the patient's expectation and was made financially possible by extending treatment over numerous years.

Using functional analysis to determine if esthetically driven treatment requires comprehensive care for long-term success

This article reviews the case of a male patient with esthetic concerns about a large diastema between teeth Nos. 8 and 9. Through functional analysis, the clinician determined that the patient had a mild temporomandibular disorder, as well as a constriction in his anterior envelope of function. These issues will affect the prognosis of treatment if only orthodontics is used to close the diastema. The clinician determined that implementing a systematic treatment planning approach was critical in achieving a successful outcome, which was accomplished with a combination of orthodontics, occlusal deprogramming, and complex prosthodontics restorations.

The non-vital discolored central incisor dilemma

The restoration of anterior teeth is frequently a demanding mission. Patients generally have high expectations for the anterior region, which makes the emotional side of treatment especially important. When this involves discolored endodontically treated teeth, consensus can hardly ever be found as to the chosen approach. Bleaching with direct composites is undoubtedly the most conservative choice for these cases. However, this may require more maintenance (touch-up bleaching and repairs) in the long term, which is an important issue for adult patients. On the other hand, bonded porcelain veneers represent a more 'high-end' option, as they recover the original biomechanics of the intact tooth, allow an optimal masking of the substrate, remain stable, and have a reasonable biological cost when compared to full-coverage crowns. This strategy is explained in this article and documented with a clinical case. We describe treatment planning based on the biomimetic concept, taking into consideration what is possible with current materials and techniques when combined with the patient's particular needs, including the introduction of an innovative step during dentin sealing--the microsuction. The laboratory work was totally accomplished by 'teledentistry', with no direct contact between the dental technologist and the patient.

Stain Removal Assessment of Two Manual Toothbrushes with an Interproximal Tooth Stain Index

OBJECTIVE

To assess a newly developed index to measure interproximal stain and evaluate the stain removal efficacy of two commercially available manual toothbrushes.

METHODS

This was a randomized, examiner-blind, parallel-group, two-treatment clinical trial of two weeks' duration. Subjects qualified for the study if they had an average Modified Lobene Stain Index of ≥ 1.5 from two anterior teeth. At baseline, subjects brushed in front of a mirror for one minute under supervision. All subjects were provided with a standard 0.243% sodium fluoride dentifrice and were randomly assigned either an Oral-B Pulsar manual brush (OBP) or a Colgate Whitening manual brush (CW) to use for two weeks. Stain was reassessed after two weeks of product use. Stain measurements were conducted using the Modified Lobene Stain Index and the new Interproximal Modified Lobene Stain Index, which allows for assessment of stain in hard-to-reach areas using the same area and intensity scales as the Modified Lobene Stain Index.

RESULTS

Use of the two manual brushes resulted in statistically significant reductions in surface stain relative to baseline after two weeks of use. Median stain reductions were 78% and 60% for the OBP and CW, respectively, as measured by the Modified Lobene Stain Index. The mean changes in the composite scores from baseline to week two were 1.85 and 1.57 for the two treatment groups, respectively. Statistically significant reductions from baseline were also found for the intensity and extent of stain measures (p < 0.001). Similar trends were found using the new Interproximal Modified Lobene Index. Composite median stain removal percentages versus baseline were 88% and 73% for the OBP and CW groups, respectively (p < 0.001). For the interproximal sites, a median stain removal of 92% was observed with the OBP brush and 83% reduction with the CW brush. For the gingival sites, the median stain removal percentages were 83% and 50%, respectively For the body region, a median stain removal of 100% was found for both treatment groups. No statistically significant differences were found between the two groups for the mean composite scores for either index.

CONCLUSION

Both manual brushes showed effective stain removal, including interproximal hard-to-reach sites. The Interproximal Modified Lobene Stain Index gave clinically relevant results consistent with the traditional Modified Lobene Stain Index, while allowing assessment of interproximal regions.

Esthetic non-invasive IPS e.max CAD veneers using the Cerec system: Two case reports

Incisors can sometimes become discolored due to trauma. In most cases, the trauma involves complicated fractures of dentin and enamel that necessitates immediate restorative treatment. In some cases, the trauma is minor and does not involve any structural damage to the tooth. In these cases, the pulp tissue reacts to the trauma, causing discoloration. In the following two cases involving anterior teeth, there were no changes visible at the apex of the incisor. We assumed that the pulp tissue remained vital to some degree and was able to react in several ways to the trauma. In both cases, we saw a change in color of a central incisor, combined with an irregularity in the position of the anterior teeth. The patients involved both explicitly wished to alter the color of the darker incisor in order to restore the harmony of their smiles.

Color masking of developmental enamel defects: a case series

Developmental defects involving color alteration of enamel frequently compromise the esthetic appearance of the tooth. The resin infiltration technique represents an alternative treatment for color masking of these lesions and uniformization of tooth color. This technique is considered relatively simple and microinvasive, since only a minimal portion of enamel is removed. This article illustrates the color-masking effect with resin infiltration of fluorosis and traumatic hypomineralization lesions with a case series. The final esthetic outcomes demonstrated the ability of the resin infiltrant to mask the color of white developmental defect lesions, resulting in satisfactory clinical esthetic improvements. However, in more severe cases, the color-masking effect was not complete.

Management of the single discoloured tooth. Part 2: Restorative options

This is the second article of a two part series covering the aetiology, prevention and broad range of management options for the single discoloured tooth. The article covers situations where masking and simulation techniques with direct composite are required. Direct composite, indirect composite and ceramic veneers are then considered, as well as full coverage crowns. The option of extraction of the affected tooth and its prosthodontic replacement will also be considered. Clinical cases are used to illustrate various scenarios.

CLINICAL RELEVANCE

The single discoloured tooth is a commonly encountered clinical problem in general dental practice. A wide variety of management options exist and it is recommended that general dental practitioners consider adopting minimally invasive techniques in the first instance before moving on to more invasive therapies.