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PubMed2003

Use of shade guides for color measurement in tooth-bleaching studies.

UNLABELLED: Several different methods are used to measure tooth color in bleaching studies. The ADA Acceptance Program Guidelines for Home Use Tooth Whitening Products specify the use of a value-oriented shade guide and/or electronic color measurement devices. Since people perceive color differently, shade guides are a subjective measure. Differences between raters and by the same rater are well documented in the dental literature. The purposes of this article will be to discuss the advantages and disadvantages using shade guides to measure color change related to tooth whitening, and to evaluate the correlation of data gathered from the use of shade guides to electronic color measurement devices. Using an order published by the manufacturer, both the TRUBYTE Bioform and Vita Classical guides can be arranged by value. A study by O'Brien demonstrated however, that the order is flawed and the change in brightness from tab to tab varies greatly. Despite these disadvantages, a review of data from several clinical trials demonstrates that Vita Classical shade guide data is consistent with data gathered using electronic color measurements. Furthermore, the O'Brien data can be used to make both these guides better measurement systems. The ADA Certification program standards define the degree of overall color change that should be considered clinically important. This issue is as critical as the measurement system used. Reporting color changes that are neither detectable to the human eye nor considered by the public to be important offers the profession little usable information. Given that any standard for color change during bleaching must relate to the abilities of the human eye, it is the conclusion of the author that shade guides should remain a critical element of any bleaching study. CLINICAL SIGNIFICANCE: Clinicians are frequently exposed to reports of bleaching agents that have been shown to result in a change of 6, 7, 8, etc., tabs. Without understanding the limitations of the shade guide used, reports of a specific shade tab change are of little use and may actually be misleading.

Color↗
PubMed1990

Vital tooth bleaching: the White and Brite technique.

A new system of vital and nonvital teeth bleaching is a cosmetic and conservative method of treating dentition discolored by ingested substances, trauma, or other causes. The system also allows individuals with normal range dentition to whiten their teeth to meet cosmetic demands. This article reviews the literature, examines the effects of conventional teeth bleaching techniques, presents a new method for bleaching vital and nonvital teeth, and discusses the impact of new methods on the science of teeth whitening.

Humans↗
PubMed2006

Effect of tooth-bleaching on the tensile strength and staining by caries detector solution on bovine enamel and dentin.

PURPOSE: To evaluate the tensile strength and staining of enamel and dentin after extracoronal or intracoronal bleaching using conventional bleaching agents. METHODS: Extracted bovine incisors were divided into eight groups of 10 specimens. Individual groups were treated by extracoronal bleaching (E) using in-office and home techniques with different concentrations of hydrogen peroxide (H2O2) and carbamide peroxide (CP); no bleaching (EN), 35% H2O2 and 10% CP (E35H-10C), 35% H2O2 and 20% CP (E35H-20C), 35% CP and 10% CP (E35C-10C), 35% CP and 20% CP (E35C-20C). Intracoronal "walking bleaching" (I) was performed after 24 hours of root canal treatment in the three remaining groups; no bleaching (IN); sodium perborate dissolved in 35% H2O2 (ISP-35H); and sodium perborate in distilled water (ISP-W). Mini dumbbell shapes of enamel and dentin with central cross-section diameters of 1.5 x 0.5 mm and 3 x 1 mm respectively were prepared for tensile testing using an Instron machine. Fracture surfaces were examined using SEM. Bleached enamel and dentin specimens were stained and evaluated using Caries Detector solution. Staining scores were analyzed using Kruskal-Wallis H and Mann-Whitney test (P < 0.05). RESULTS: Tensile strengths (mean +/- SD) of enamel and dentin respectively for each group in MPa were: EN = 30.5 +/- 3.3 and 85.4 +/- 3.0, E35H-10C = 14.8 +/- 2.3 and 58.9 +/- 2.0, E35H-20C = 10.6 +/- 2.6 and 55.5 +/- 2.2, E35C-10C = 25.4 +/- 3.4 and 70.8 +/- 2.5, E35C-20C = 20.3 +/- 4.1 and 67.2 +/- 3.3, IN = 26.5 +/- 4.1 and 85.9 +/- 2.5, ISP-35H = 13.6 +/- 3.1 and 46.7 +/- 2.3, ISP-W = 21.7 +/- 3.3 and 68.3 +/- 4.4. ANOVA and Tukey HSD test found statistically significant differences among and between groups respectively (P < 0.05). No significant difference was found between non-bleached groups (IN and EN) of enamel and dentin. Mean tensile strengths of all bleached groups were significantly lower than those of non-bleached groups. Fracture surfaces demonstrated the different morphologies for bleached and non-bleached enamel and dentin.

Analysis of Variance↗
PubMed1995

Nonvital tooth bleaching: guidelines for the clinician.

The combination of intracoronal and extracoronal bleaching represents a conservative treatment to restore esthetics to darkened or stained nonvital teeth. Notwithstanding the eventual risks and difficulties accompanying such technique, nonvital teeth often can be successfully lightened. This article presents a few guidelines for bleaching nonvital teeth as well as a clinical case to illustrate the indications and clinical protocol for the technique.

Clinical Protocols↗
PubMedDate not supplied

[Clinical evaluation of two tooth bleaching techniques].

The purpose of this paper was to assess the clinical ability of two bleaching techniques. Patients with at least one darkened teeth caused by mechanical injuries or imperfection in the endodontic therapy were included in this study. The first step was to take an initial photography. After that the teeth were subjected to the bleaching procedures. The techniques employed were proposed by NUTTING & POE or LACERDA et alii. The assessments were made by three trained examiners using the initial and final pictures. The scores were attributed according to the color of the teeth. The data were submitted to the statistical analysis, when was possible to verify that both techniques were equally effective.

Humans↗
PubMed2001

Experimental study to test the potential tumor promotion effect of a tooth bleaching agent.

Carbamide Peroxide is routinely employed as a whitener for tooth enamel. Oral mucosa protection is recommended to avoid inflammatory reactions. Experimental work has demonstrated its irritative effect on gastric mucosa when swallowed. The activity of certain oxidizing agents as tumoral promoters has been demonstrated and associated to their capacity to induce hyperplasia. Within this context it seemed of interest to assess the possible action of carbamide peroxide as a tumoral promoter in oral mucosa with or without a precancerous condition. Its action was tested in 2 models which are highly sensitive to chemical cancerization: a) Dorsum skin or SENCAR mice treated with carbamide peroxide daily or twice a week with or without prior initiation with dimethylbenz(a)anthracene (DMBA). Control mice were submitted to the standard carcinogenesis protocol, i.e. initiation with DMBA and promotion with 12-O-tetradecanoyl phorbol acetate (TPA). b) Hamster cheek pouch submitted to topical application of carbamide peroxide 3 times a week with or without prior initiation with DMBA, hamster cheek pouch submitted to repeated topical application of DMBA as a complete carcinogen: application twice a week in the control group and identical treatment + 1 weekly application of carbamide peroxide to evaluate its capacity to enhance the process. The effects were assessed between 1 and 14 weeks of treatment at different intervals for the different experimental protocols. The control cases exhibited hyperplasia and tumor induction in keeping with the known sequence for both carcinogenesis models. None of the cases revealed a promoter or enhancer capacity of carbamide peroxide. These results indicate the lack of risk involved in the application of carbamide peroxide even in oral mucosa with a precancerous condition due to the action of initiation agents such as tobacco and alcohol.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1997

Restorative considerations with vital tooth bleaching.

This paper explores the implications of bleaching procedures on restorative dentistry. The effects of tooth whitening systems on the bond strength, marginal integrity, color and other properties of restorative materials are reviewed. Also, clinical considerations in combining bleaching and aesthetic restorative techniques are discussed.

Carbamide Peroxide↗
PubMed1997

Effect of nonvital tooth bleaching on microleakage of resin composite restorations.

Thirty-six extracted, noncarious, nonfractured human incisors were divided into four groups of nine teeth. Endodontic access cavities were prepared, the pulp chamber was debrided, the root canals were cleansed, and root canal treatment was completed. Pulp cavities of teeth in group 1 received a cotton pellet and were sealed with Cavit. Groups 2, 3, and 4 received a mixture of 30% hydrogen peroxide and sodium perborate for 3, 4, and 7 days, respectively, were sealed with Cavit, and were stored in a humidor until used. Cavit and the other materials were removed, and the cavities were rinsed and restored with Scotchbond Multipurpose and Silux. The teeth were thermocycled, stained with 50% silver nitrate, and sectioned longitudinally. Dye penetration was measured. Results indicated that bleaching adversely affected the marginal seal at the tooth-restoration interface, as evidenced by increased microleakage; the highest rate of microleakage was found after the 7-day application of bleaching materials.

Dental Leakage↗
PubMed2003

Development and evaluation of a method in vitro to study the effectiveness of tooth bleaching.

AIM: To develop and evaluate a reproducible intrinsic discolouration model in vitro, based on tea, which would allow the effectiveness of bleaching to be evaluated. METHOD: The crown portions of extracted human third molars were sectioned bucco-lingually in half. Colour assessments were made at baseline, post staining and post whitening using a standard clinical shade guide (SG), a shade vision clinical colorimeter system (SVS) and a reflectance chromometer. Internal staining employed a standard tea solution into which groups of five specimens were placed from 1 to 6 days. All assessments demonstrated maximum staining within one day. Groups of stained specimens were exposed to 1. Water (placebo control) 2. Enamel polished 3. Enamel polished and bleached through enamel 4. Bleached through enamel 5. Bleached through dentine 6. Bleached through enamel and dentine 7. Exposed to the bleach vehicle (minus active control). Control and bleach gel treatments were for 30 min. Comparisons of treatment effects were made using unpaired t-test on groups selected a priori for analysis. RESULTS: SG and SVS revealed that control and polish treatments had no or little effect respectively on tooth shade but all bleach treatments produced marked and statistically significant whitening effects and to a similar magnitude. Bleaching treatments returned the majority of specimens to the original shade or beyond representing a SG mean change of 13.8-15 shade guide units (SGU). Chromometer readings were consistent except that polishing alone increased tooth lightness slightly. CONCLUSIONS: Teeth were reproducibly stained internally, to provide a model in vitro by which to evaluate bleaching. The model, could be used to study many aspects of vital tooth bleaching, but has the limitation, without in vivo or in situ data, of cautiously extrapolating the effects in vitro to outcome clinically.

Colorimetry↗
PubMed1993

Role of catalase in the elimination of residual hydrogen peroxide following tooth bleaching.

Hydrogen peroxide at high concentrations may cause damage to the tooth structure and to the surrounding periodontal tissues. The efficacy of catalase applied following intracoronal bleaching to eliminate residual hydrogen peroxide was examined and compared with prolonged water rinses. Extracted human premolars were treated endodontically and bleached with 30% hydrogen peroxide. Upon completion of the bleaching procedure, the teeth were treated with either catalase or water. Radicular hydrogen peroxide penetration was measured immediately after bleaching and following each catalase and/or water rinse. A correlation between the number of water rinses and the reduction in the radicular hydrogen peroxide penetration was found. Three cycles of 5-min water rinses and 1-h immersion of the teeth in water significantly reduced the residual hydrogen peroxide penetration. One treatment with catalase applied for 3 min totally eliminated the residual hydrogen peroxide. It is therefore suggested that catalase be used as an adjunct following intracoronal bleaching of nonvital teeth to effectively eliminate the residual hydrogen peroxide from the pulp chamber and from the surrounding periodontal tissues.

Catalase↗