Inflammatory parameters and color alterations of dental bleaching in patients wearing fixed orthodontic appliance: a randomized clinical trial

BACKGROUND

Many orthodontic patients request dental bleaching during orthodontic treatment to achieve a faster aesthetic resolution, however, no attention has been paid to the inflammatory processes that can occur when both therapies are indicated together. So, this clinical trial evaluated the inflammatory parameters and color alterations associated with dental bleaching in patients wearing a fixed orthodontic appliance.

METHODS

Thirty individuals aged between 18 and 40 years were equally and randomly allocated into three groups: FOA (fixed orthodontic appliance), BLE (dental bleaching), and FOA + BLE (fixed orthodontic appliance + dental bleaching). The orthodontic appliances and the bleaching procedures were performed in the maxillary premolars and molars. For dental bleaching a 35% hydrogen peroxide was used. The gingival crevicular fluid (GCF) and nitric oxide (NO-) levels were evaluated at different time-points. Color evaluation was performed using an Easyshade spectrophotometer at baseline (FOA, FOA + BLE, BLE), one month after (FOA + BLE) and 21 days after appliance removing (FOA + BLE and FOA groups), in each tooth bleached. The ANOVA and Tukey's tests, with a significance level of 5%, were used for statistical analysis.

RESULTS

The GCF volume in the FOA + BLE and FOA groups significantly increased at the time points evaluated (p < 0.001); however, this did not occur in the BLE group (p > 0.05). On the other hand, NO- levels significantly decreased during dental bleaching with or without fixed orthodontic appliances (FOA + BLE and BLE groups; p < 0.05), while no significant changes were observed in the FOA group (p > 0.05). Significant changes in color were observed in the FOA + BLE and BLE groups compared to in the FOA group (p < 0.01). However, the presence of fixed orthodontic appliance (FOA + BLE) negatively affected the bleaching efficacy compared to BLE group (p < 0.01).

CONCLUSIONS

Dental bleaching did not increase the inflammatory parameters in patients wearing fixed orthodontic appliance. However, in the presence of orthodontic appliances, the bleaching efficacy was lower than that of bleaching teeth without orthodontic appliances.

TRIAL REGISTRATION

RBR-3sqsh8 (first trial registration: 09/07/2018).

Eighteen-month clinical evaluation of a new universal adhesive applied in the "no-waiting" technique: a randomized clinical trial

OBJECTIVE

The aim of this double-blind, randomized clinical trial was to evaluate the 6- and 18-month clinical performances of a new universal adhesive applied in the "no-waiting" (NW) technique to non-carious cervical lesions (NCCLs) using two evaluation criteria.

MATERIALS AND METHODS

One hundred and seventy-six restorations were assigned to four groups according to the adhesive system, adhesive strategy, and application mode: Prime&Bond Active (PB) applied using the etch-and-rinse (ER) and self-etch (SE) strategies with 20 s applications and Clearfil Universal Bond Quick (CQ) applied using the ER and SE strategies with the NW technique. The composite resin restorations were evaluated at baseline and after 6 and 18 months using the World Dental Federation (FDI) and US Public Health Service (USPHS) criteria. The Friedman repeated measures analysis of variance and Wilcoxon test were used for statistical analyses (α = 0.05).

RESULTS

No significant differences were observed among any of the groups or criteria after 6 months (p > 0.05). After 18 months, 10 restorations were lost (p > 0.05) (2 with PB-ER [95.5%; 95%CI: 92-100%], 4 with PB-SE [90.9%; 95%CI: 82-98%], 0 with CQ-ER [100%; 95%CI: 92-100%], and 4 with CQ-SE [90.9%; 82-98%]). The restorations performed with the SE strategy showed more marginal discrepancies than those performed with the ER strategy, mainly when the FDI criteria were used (p < 0.05). Those that used the PB-SE showed fewer marginal discrepancies than those that used the CQ-SE (FDI; p < 0.05). A few restorations showed marginal discrepancies after the USPHS analysis (p > 0.05).

CONCLUSIONS

The results when using the CQ-SE and -ER strategies with the NW technique were similar to those when using the PB-SE and -ER strategies in standard applications to non-carious cervical lesions after 6 and 18 months of clinical evaluation.

CLINICAL RELEVANCE

After 6 and 18 months, the application of Clearfil Universal Bond Quick with the "no-waiting" technique showed similar clinical performance compared to the standard application of Prime & Bond Active applied using the standard application time (20 s).

TRIAL REGISTRATION

ClinicalTrials.gov identifier RBR-5f9gps.

Efficacy of products for bleaching and whitening under orthodontic brackets

INTRODUCTION

Many patients wearing orthodontic appliances request alterations in the shade of their teeth during orthodontic treatment.

OBJECTIVE

This study aimed to evaluate the efficacy of different products for bleaching and whitening under orthodontic brackets.

METHODS

Seventy bovine incisors were randomly divided into five groups (n = 14): C) non-whitening toothpaste (control); WTsi) hydrated silica whitening toothpaste; WThp) 2% hydrogen peroxide whitening toothpaste; OB) in-office bleaching; and HB) at-home bleaching. Two buccal surface areas were evaluated using the Easyshade spectrophotometer: under the metal bracket (experimental) and around the bracket (control). The paired t-test, ANOVA, and Tukey tests were applied for statistical analysis.

RESULTS

Intragroup comparisons showed that in groups C, WThp and HB, there were statistically significant differences in the enamel color changes (ΔEab) between under and around the bracket areas (C - under bracket = 7.97 ± 2.35, around bracket = 2.86 ± 0.81, p< 0.01; WThp - under bracket = 4.69 ± 2.98, around bracket = 2.05 ± 1.41, p< 0.01; HB - under bracket = 7.41 ± 2.89, around bracket: 9.86 ± 3.32, p= 0.02). Groups WTsi, OB and HB presented similar perception of tooth whiteness (ΔWID) between the tested areas. Intergroup comparisons demonstrated that under the bracket area, the color change (ΔEab) was similar for all groups, except WThp (C = 7.97 ± 2.35; WTsi = 8.54 ± 3.63; WThp = 4.69 ± 2.98; OB = 9.31 ± 4.32; HB = 7.41 ± 2.89; p< 0.01).

CONCLUSIONS

The dental color changes were effective for the products tested in groups WTsi, OB and HB in the presence of metallic orthodontic brackets.

Evaluation of the Bond Strength of Densely Sintered Ceramics Subjected to Extended Firing

Introduction

Critical failures in ceramic materials can be caused by the processing mode, which includes all steps taken in the manufacture of a ceramic part, from molding to firing.

Purpose

To evaluate the effect of extended firing on bond strength in densely sintered ceramics of the zirconium reinforced lithium silicate, lithium disilicate, and feldspathic ceramic.

Materials and Methods

Three types of ceramics were evaluated: zirconium reinforced lithium silicate, lithium disilicate, feldspathic ceramic. A total of 6 ceramic blocks, two for each material were used in the study. Each block was cut into four square sections. A total of 24 ceramic surfaces were randomly distributed into 6 groups (n = 4 surfaces per group) divided according to the variables: heat treatment: conventional firing or extended firing; test time: immediate (24 hours after cementation) or longevity (after 1000 cycles of thermocycling). The bond strength tests were performed in a semi-universal test machine for microshear bond strength. For data analysis, the Shapiro-Wilk test was performed to evaluate the normality between the groups measured, and regarding homoscedasticity (homogeneity of variances) by the Bartlett test. The comparisons between the groups were made using the nonparametric Kruskal-Wallis test.

Results

There was no statistically significant difference of the resistance values in relation to the thermal treatment methods (conventional firing and extended firing) in any ceramic group (p <0.05). Among the times (immediate and long), there was a statistically significant difference (p <0.05), with higher resistance values for immediate time.

Conclusion

Extended firing did not influence the micro-shear bond strength of zirconium reinforced lithium silicate, lithium disilicate, feldspathic ceramic.

Clinical effects of the exposure to red wine during at-home bleaching

OBJECTIVES

This clinical trial evaluated the effects of red wine exposure on the effectiveness of at-home bleaching with 10% carbamide peroxide, degree of tooth sensitivity, and levels of periodontal inflammatory markers.

METHOD AND MATERIALS

Eighty participants were assigned to two groups, namely, those who drank red wine (experimental group), and those who did not drink red wine (control group). The experimental group participants rinsed their mouths with 25 mL of red wine four times a day during the bleaching period. Shade evaluation was assessed visually by using the Vita Classical and Vita Easyshade techniques. Tooth sensitivity was evaluated by the numeric and visual analog scales, and the salivary and gingival crevicular fluids were collected for assessment of nitric oxide (NO) levels, a marker of inflammation. Differences in color change were analyzed by one-way analysis of variance (ANOVA). The absolute risks of tooth sensitivity were compared by the Fisher exact test. Tooth sensitivity intensity data sets for both the visual analog scale and the numeric rating scale were compared using the Wilcoxon signed rank test (α = .05). Repeated measures and two-way ANOVA followed by the Bonferroni test were used to assess time-course and differences between groups in NO production.

RESULTS

The bleaching technique was effective regardless of wine consumption (P > .05). Tooth sensitivity was classified as mild, with no differences between groups (P > .05). Red wine reduced both the gingival crevicular fluid and salivary levels of NO (P < .05).

CONCLUSION

Red wine does not interfere with the effectiveness and sensitivity of at-home teeth bleaching with 10% carbamide peroxide and protects against bleaching-induced inflammation.

Personality traits, psychosocial effects and quality of life of patients submitted to dental bleaching

Background

Perception is defined as the ability to distinguish through the senses. All perception is dependent on factors such as personality, previously lived experiences and cultural elements. When planning an aesthetic treatment, consider the way the patients perceive the changes and outcomes is essential for reaching their expectations. The objective of this study was to assess if there was predominance of a personality trait of patient undergoing dental bleaching and if this treatment could promote changes in this traits, in the psychosocial impact and quality of life of these individuals.

Methods

The assessment of personality characteristics, quality of life, psychosocial and self-perception was a cross-sectional observational study and it was carried out by applying questionnaires to 55 patients that were submitted to a clinical phase. The psychometric instruments used were NEO FFI-R (personality), PIDAQ (psychosocial effect) and WHOQOL-BREF (quality of life). Each test domain was prior and after bleaching by Wilcoxon Signed Rank test (α = 0.05). The internal consistencies of each scale were evaluated by Cronbach's alpha.

Results

No statistical significant differences among personality traits means were observed among participants but there was predominance of two predominant personality traits in this study: conscientiousness (45.5%) and extraversion (34.5%). In four test domains of the PIDAQ, significant differences were observed before and after dental bleaching. The overall perception of the PIDAQ was also statistically significant demonstrating an improvement. There were no differences on overall or specific domains scores of the WHOQOL before and after treatment.

Conclusions

Subjects who underwent dental treatment improved their self-confidence and reduced concerns about dental aesthetics, social and personality impact of dental alterations.

Trial registration

This study was conducted in parallel to a clinical investigation that aimed to evaluate tooth sensitivity related to dental bleaching technique and registered in REBEC clinical registry under protocol RBR-6pt2n3 in 13 November 2013.

Effects of Exposure to Cola-Based Soft Drink on Bleaching Effectiveness and Tooth Sensitivity of In-Office Bleaching: A Blind Clinical Trial

OBJECTIVE

The purpose of this single-blind (evaluators) and parallel design study was to evaluate whether exposure to a cola-based soft drink during bleaching treatment with 35% hydrogen peroxide (HP) affects color change and bleaching-induced tooth sensitivity.

MATERIAL AND METHODS

Forty-four patients with central incisors darker than A2 were selected. Participants who did not drink cola-based soft drinks were assigned to the control group (CG), while participants who drank a cola-based soft drink at least twice a day were assigned to the experimental group (EG). For the CG, foods with staining dyes were restricted. For the EG, there was no restriction on food and patients were asked to rinse their mouths with a cola-based soft drink for 30 s, 4 times daily. For both groups, 2 sessions with three 15 min applications of 35% HP were performed. Shade evaluation was assessed via subjective (VITA classical and VITA bleacheguide shade guides) and objective methods (Easyshade spectrophotometer) at baseline, during bleaching (first, second, and third weeks), and post bleaching (1 week and 1 month). Patients recorded their sensitivity perceptions using a numerical rating scale and 0-10 visual analog scales. Variation in shade guide units and the 2 colors (DE) were evaluated with a Student's t-test (α = 0.05) and Mann-Whitney test (α = 0.05). Absolute risk of tooth sensitivity and intensity of tooth sensitivity were evaluated by a Chi-square test (α=0.05).

RESULTS

Effective bleaching was observed for both groups after 30 days, without statistical difference (p > 0.08). There was no significant difference in absolute risk of bleaching-induced tooth sensitivity between the 2 groups (p = 0.74). Higher and significant scores in pain scales were detected for the EG in comparison to the CG (p < 0.05).

CONCLUSION

Even that the cola-based soft drink exposure during in-office bleaching treatments did not affect the bleaching's effectiveness; patients reported a higher intensity in bleaching-induced tooth sensitivity.

Effect of Sonic Application of Self-Adhesive Resin Cements on Push-Out Bond Strength of Glass Fiber Posts to Root Dentin

The aim of this study was to evaluate the influence of a sonic application of self-adhesive resin cements on the bond strength of glass fiber posts to root dentin. Eighty bovine incisors were randomly divided into eight groups (n = 10). Four self-adhesive resin cements were used-RelyX U200 (3M/ESPE), Bifix SE (Voco), seT PP (SDI), and Panavia SA (Kuraray). The cements were inserted into the root canal in two different modes-Centrix syringe (control) or with a sonic device (Sonic Smart). The roots were sectioned and taken to a universal test machine (Instron 3342) to perform the push-out test. The fracture pattern was evaluated by stereomicroscope and scanning electron microscope. The bond strength data were analyzed by two-way ANOVA and Tukey tests (α = 0.05). The interaction between the main factors was significant (p = 0.002). The sonic application increased the bond strength in comparison with the conventional application for the RelyX U200 (p < 0.001) and Bifix SE (p < 0.017) cements. However, for the seT PP and Panavia SA cements, the bond strength values did not differ significantly (p > 0.05). The fracture pattern showed adhesive at the interface between the luting cement and the dentin. Using a sonic device in the application of self-adhesive resin cement helpedpromote an increase in the bond strength for RelyX U200 and Bifix SE.

Evaluation of several clinical parameters after bleaching with hydrogen peroxide at different concentrations: A randomized clinical trial

OBJECTIVE

This randomized double-blind clinical trial compared tooth sensitivity (TS), bleaching efficacy, and cytokine levels after applying in-office bleaching treatments containing 15% and 35% hydrogen peroxide (HP15% and HP35%, respectively).

METHODS

Twenty-five volunteers were randomly assigned to receive HP15% or HP35% treatment. The bleaching agent was applied in three 15-min applications per session. Two bleaching sessions were separated by a 1-week interval. The participants scored TS using a visual analog scale and numerical rating scale. Bleaching efficacy was determined by subjective and objective methods. Gingival crevicular fluid was collected from three jaws sites per patient for the analysis of fluid volume. Flow cytometry was used to analyze gingival crevicular fluid levels of interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-10, tumor necrosis factor, and interferon-gamma. All measurements were obtained before and after bleaching. All data were statistically analyzed (α=0.05).

RESULTS

The absolute risk and intensity of TS was higher for HP35% than for HP15% (p>0.002). One month post-bleaching, HP35% produced more bleaching than HP15% (p=0.02). However patient perception (p=0.06) and patient satisfaction (p=0.53) with regard to bleaching were not significantly different. No significant differences existed in the gingival fluid volume (p>0.38) or in any cytokine level (p>0.05) for either HP concentration.

CONCLUSION

Treatment: with HP35% is more effective than HP15%, but generates a greater risk and intensity of TS. No inflammatory changes occurred despite the difference in the HP concentrations.

CLINICAL SIGNIFICANCE

Hydrogen peroxide at a lower concentration (e.g., 15%) should be considered a good treatment alternative for in-office bleaching because the higher concentration for in-office bleaching generates a greater risk and intensity of TS for patients.

Acid Etching with Modified Phosphoric Acid to Increase the Longevity of the Bonded Interface

PURPOSE

To evaluate the effect of three phosphoric acids modified with chlorhexidine (CHX), benzalkonium chloride (BAC), or proanthocyanidins (PRO) and one conventional phosphoric acid (CON) on the immediate (24 h; IM) and 1-year composite-dentin microtensile bond strength (μTBS) and nanoleakage (NL), using an etch-and-rinse adhesive.

MATERIALS AND METHODS

A flat dentin surface was exposed on 28 caries-free extracted molars, which were then randomly assigned to four groups (n = 7). After etching and rinsing with one phosphoric acid per group, the adhesive (Adper Single Bond 2) was applied on a moist dentin surface. Composite buildups (Filtek Z350) were constructed incrementally and bonded stick specimens (0.8 mm2) were prepared and submitted to the microtensile test (0.5 mm/min) immediately (24 h) or after 1 year of water storage. For nanoleakage, 2 bonded sticks from each tooth at each storage period were immersed in 50 wt% ammoniacal silver nitrate, polished, and analyzed by SEM in backscattered mode. Data were submitted to a two-way ANOVA and Tukey's test (α = 0.05).

RESULTS

After 1 year, stable μTBS values were observed only for the modified phosphoric acids (CHX, BAC, and PRO). Also, NL was more evident in the CON group than in the CHX, BAC and PRO groups (p < 0.05) after 1-year water storage.

CONCLUSIONS

Compared to the control, the phosphoric acid etchants which contained protease inhibitors (CHX, BAC and PA) promoted the stability of composite-dentin microtensile bond strength and showed less nanoleakage after 1 year of water storage. They represent an effective way of prolonging the stability of the composite-dentin bonds without creating an additional bonding step.

Evaluation of Bond Strength, Marginal Integrity, and Fracture Strength of Bulk- vs Incrementally-filled Restorations

PURPOSE

This study evaluated the effect of application technique and preparation size on the fracture strength (FS), microtensile bond strength (μTBS) and marginal integrity (MI) of direct resin composite restorations.

MATERIALS AND METHODS

Conservative (5 × 2 × 2 mm) or extended (5 × 4 × 2 mm) preparations below the cementoenamel junction were performed in 140 human maxillary premolars (n = 70 per group). After adhesive application (XP Bond), half of each group was restored with the bulk technique (one 4-mm increment of Surefill SDR Flow plus one 1-mm horizontal capping layer of TPH3 [Spectrum TPH3 resin composite]) and half incrementally (TPH3 in three horizontal incremental layers, 1.5 to 2 mm each), all using a metal matrix band. After storage (24 h at 37°C), the proximal surfaces of each tooth were polished with Sof-Lex disks. For FS measurement, 60 restorations were mounted in a universal testing machine and subjected to a compressive axial load applied parallel to the long axis of the tooth, running at a crosshead speed of 0.5 mm/min. For μTBS testing, 40 teeth were longitudinally sectioned to obtain resin-dentin bonded sticks from the cavity floor (bonded area: 0.8 mm2). Specimens were tested in tension at 0.5 mm/min. The external marginal integrity of both proximal surfaces was analyzed using SEM of epoxy resin replicas. The μTBS, marginal integrity, and fracture resistance data were subjected to two-way ANOVA, and Tukey's post-hoc test was used for pair-wise comparisons (a = 0.05).

RESULTS

Fracture resistance, microtensile bond strength, and marginal integrity values were not statistically significantly affected by application technique or preparation size (p = 0.71, p = 0.82, and p = 0.77, respectively).

CONCLUSIONS

The use of a bulk-fill flowable composite associated with a conventional resin composite as a final capping layer did not jeopardize the fracture strength, bond strength to dentin, or marginal integrity of posterior restorations.

Effect of Carbamide Peroxide on the Push-out Bond Strength of Different Composition Glass-Ionomer Cement to Root Canal Dentin when used as Cervical Barrier

AIM

To evaluate the effect of 37% carbamide peroxide on the bond strength of conventional or resin-modified glass-ionomer cements when used as a cervical barrier in endodontically-treated teeth.

MATERIALS AND METHODS

After root canal instrumentation and obturation, 40 specimens of the cement-enamel junction were obtained after transversal root canal sectioning from human extracted canines. The root canal specimens were standardized and filled with the following materials (n = 10, each group): G1: zinc phosphate (control), G2: Ketac glass-ionomer, G3: vitrebond glass-ionomer or G4: GC GL glass-ionomer. After 24 hours, the specimens were subjected to an application of 37% carbamide peroxide for 21 days, changed each 7 days and stored in an artificial pulp chamber. The specimens were then submitted to push-out bond strength testing with an electromechanical test machine (EMIC) and the failure mode in each specimen was analyzed with confocal microscopy (LEXT).

RESULTS

G3 and G4 showed higher bond strengths values than the other groups (p < 0.05), and were similar to each other (p > 0.05). G1 showed the lowest bond strength value (p < 0.05).

CONCLUSION

Glass-ionomer cements showed higher bond strength values than the zinc phosphate cement, and resin-modified glass-ionomer cements presented the highest push-out values to root canal dentin (GC, GL and Vitrebond).

CLINICAL SIGNIFICANCE

Glass ionomer cements are recommended to use as cervical barrier materials before the internal dental bleaching, but its efficiency is questionable.

Influence of Relining Post on the Bond Strength of Resin Cements

This study evaluated the influence of relining fiber posts on the bond strength (BS) of resin cements in the root canal. Forty bovine teeth were divided in four groups (n = 10): G1 (ARC)-fiber post cemented with resin cement RelyX ARC; G2 (ARC+Z350)-relined fiber post cemented with RelyX ARC; G3 (U200)-fiber post cemented with self-adhesive cement RelyX U200; G4 (U200+Z350)-relined fiber post cemented with RelyX U200. The roots were sectioned in six 1.2-mm slices and the push-out test was performed. Data were analyzed by three-way analysis of variance (ANOVA), and Tukey's test (a = 0.05). For the conventional resin cement, there was no significant difference between groups G1-ARC (15.5 ± 3.8) and G2-ARC+Z350 (16.1 ± 4.5). For the self-adhesive cement, the results revealed higher BS values for relined posts G4-U200 + Z350 (19.9 ± 7.9) as compared to non-relined posts G3-U200 (14.4 ± 4.5). For both cements, in groups of relined posts, the apical and the cervical thirds presented similar BS. Relining enhances the performance of the self-adhesive resin cement, and the interaction between relining and root third influences the BS to the conventional resin cement.