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PubMed1985

Systematic assessment of color removal following vital bleaching of intrinsically stained teeth.

Various treatment variables associated with a standard bleaching technique were systematically recorded in 53 individuals exhibiting intrinsic discoloration of permanent teeth. These variables (predictors) included: (1) etiology (fluoride or tetracycline); (2) age of the patient; (3) the presented color of the stain; (4) the intensity of that color; (5) a long versus short bleaching time technique; and (6) the number of bleaching sessions. These were assessed as to their relationship with the results of treatment (dependent variable). The findings of a multiple regression analysis revealed that the contributions of the individual predictors were significantly different between those stains caused by tetracycline ingestion (N = 27) and those stains due to fluoride ingestion (N = 20). The analysis also revealed that those variables contributing to a significant proportion of the variance in results of treatment when tetracycline was the cause were: (1) the color of the stain and (2) the number of bleaching sessions. When fluoride was apparently the causal agent: (1) the bleaching time technique; (2) age of the patient; (3) color of the stain; and (4) the number of bleaching sessions contributed to a significant proportion of the variance in the results of treatment.

Adolescent↗
PubMed2004

Use of 37% carbamide peroxide in the walking bleach technique: a case report.

Dental bleaching represents an effective, conservative, and relatively low-cost method for improving the appearance of discolored pulpless teeth. Among the bleaching techniques, the walking bleach technique with sodium perborate associated with water or hydrogen peroxide stands out because of its esthetic results and safety. A modified walking bleach technique with the use of 37% carbamide peroxide as the bleaching agent is presented. Additionally, the adverse effects of dental bleaching in the following restorative procedures are discussed, showing the advantages with the use of 37% carbamide peroxide.

Carbamide Peroxide↗
PubMed1991

Dental bleaching.

Bleaching techniques of both vital and nonvital teeth are reviewed. Current techniques and their origins are investigated, and the appropriate uses for various methods examined. The current research shows that bleaching, while highly effective, must be viewed with caution. The bleaching process cannot be viewed as entirely benign. The influx of bleaching agents prescribed for home-administration use by dentists is particularly deficient in the amount of independent, refereed research on their long-term effects on oral tissues.

Dental Pulp Devitalization↗
PubMedDate not supplied

Overview and status of mouthguard bleaching.

Since the bleaching of vital teeth using a tray delivery system with a 10 percent carbamide peroxide first became common knowledge in March, 1989, there has been much discussion, improvement, and questions concerning the process and the various products available. This article presents an overview of its history, the variations in techniques, and questions concerning safety, including the impact on tooth structure, the pulp, soft tissue of the mouth, and systemic ingestion. It divides currently available products according to their composition, into either a carbamide peroxide with and without carbopol, a hydrogen peroxide of varying concentrations, a hydrochloric acid, or other categories. It discusses the various delivery mechanisms and comments on their apparent effectiveness, as well as reflecting the current knowledge base of the profession.

Carbamide Peroxide↗
PubMed2006

Bleaching teeth treated endodontically: long-term evaluation of a case series.

The chromatic stability of nonvital discolored teeth, subjected to the combined intracoronal bleaching technique and to endodontic treatment, was evaluated at a distance of 16 yr (1989-2005). The series comprised 50 patients (age range 7-30 yr) selected from among those attending the Dental Clinic at "Federico II" University, Naples, between 1987 and 1989. After 16 yr, only 35 cases could be evaluated: in 22 of these cases (62.9%) the color had remained stable and was similar to that of adjacent teeth, indicating a successful outcome of the combined bleaching technique. There were 13 cases (37.1%) classified as failures because of marked color relapse. Radiology showed none of the cases re-examined to have undergone internal or external root resorption. These results confirm the validity of the combined intracoronal bleaching technique in terms of efficacy, rapid esthetic result, and safety.

Adolescent↗
PubMed1990

The management of postbleaching cervical resorption.

Cervical resorption has been repeatedly associated with intracoronal bleaching procedures. This report reviews literature associated with postbleaching resorption, a case, and a rationale for management. We observed cervical resorption upon recall of an intracoronal bleaching case. It was successfully treated with a calcium hydroxide "recalcification" procedure. Twenty-three months later, no further resorption has been observed.

Adolescent↗
PubMed1997

Effect of fluoride treatment on remineralization of bleached enamel.

The objective of the study was to evaluate the remineralizing capacity of different fluoride treatments on dental enamel bleached with carbamide peroxide (Opalescence). Sixty bovine enamel slabs were subjected to four cycles comprising bleaching (12 h) and remineralization in artificial saliva (8 h). The samples were evenly distributed among four groups (A-D). During the first hour of the remineralization period the specimens in Group A were covered with a fluoride varnish (Duraphat; 2.23% F-). In group B the enamel slabs were stored in a fluoride solution (0.2% F- as NaF) for 1 min prior to remineralization. Group C did not receive a fluoride treatment, and group D (control) was stored in distilled water instead of bleaching. Microhardness (VHN) was evaluated before the experiments and after the second and fourth cycle, respectively. Final hardness was calculated as percentage of the initial hardness. Analysis of variance was applied to the data followed by pairwise comparisons with corrected level of significance (P < 0.01). Hardness decreased significantly in groups A-C compared to the control group (D). The bleached and unfluoridated specimens (group C) showed a significantly higher hardness loss compared to the fluoridated specimens, whereas no significant difference was observed between the two fluoridated groups. It is concluded that remineralization of bleached enamel is improved by application of highly concentrated fluorides.

Analysis of Variance↗
PubMed2003

The effects of seven carbamide peroxide bleaching agents on enamel microhardness over time.

BACKGROUND: Different concentrations of carbamide peroxide (10 to 22 percent) have been used successfully as bleaching agents, but the adverse effects on enamel microhardness at different times are unknown. METHODS: The authors analyzed seven bleaching agents and a placebo. The agents were applied on the surface of human dental fragments for eight hours per day for 42 days and stored in vials containing artificial saliva. Microhardness measurements were performed at baseline, eight hours and seven, 14, 21, 28, 35 and 42 days, as well as at seven and 14 days after treatment had ended. RESULTS: Enamel treated with different bleaching agents or a placebo experienced a similar decrease in microhardness values over time, with the exception of fragments exposed to Opalescence PF 20 percent (Ultradent Products, South Jordan, Utah), or OPA20. Until the 49th day, the enamel exposed to OPA20 exhibited the lowest differences from baseline values. After 14 posttreatment days, enamel treated with placebo, Nite White 10 percent Excel (Discus Dental, Los Angeles), Nite White 16 percent Excel and Opalescence 10 percent exhibited the greatest differences from baseline values. An increase in enamel microhardness occurred at the end of the posttreatment period, although baseline values were not reached. CONCLUSIONS: Different concentrations of carbamide peroxide agents result in decreases in enamel microhardness. A post-bleaching period in artificial saliva resulted in recovery of baseline microhardness values (one agent) or an increase in values, although baseline values were not reached for these products. Clinical Implications. Higher concentrations of carbamide peroxide containing 0.11 percent ion fluoride can bleach teeth in a shorter period, with fewer hazardous effects on the enamel mineral content.

Carbamide Peroxide↗
PubMed2004

Monitoring of demineralized dentin microhardness throughout and after bleaching.

PURPOSE: To evaluate the effect of six bleaching agents: Nite White [NW] 10% and 22% Excel 2Z (Discus Dental), Rembrandt (REM) 10% and 22% (DenMat), Opalescence (OPA) 10% and 20% (Ultradent) and a placebo agent on demineralized dentin microhardness at different time intervals. METHODS: 105 human dentin slabs (3 x 3 mm) were embedded, planed and submitted to cariogenic challenges, composed of de- and remineralization cycles. For 42 days, specimens were exposed to bleaching agents, consisting of applying them daily for 8 hours, removing and storing the specimens in artificial saliva for 16 hours. At the end of the bleaching treatment, specimens were kept in artificial saliva for 14 days. Knoop Microhardness tests were performed on specimens' surface before (baseline), during (8 hours, 7, 14, 21, 28, 35 and 42 days) and after bleaching procedures (7 and 14 days). RESULTS: The ANOVA for split-plot showed significant effect on the interaction between bleaching agent and time (alpha =0.05). Tukey's test revealed no significant differences on demineralized dentin microhardness exposed to bleaching agents until Day 7. Regression analyses demonstrated that NW 10% and 22% and OPA 10% and 20% increased dentin microhardness in different magnitudes, whereas REM 10% and 22% induced mineral loss during bleaching agent application, followed by microhardness recovery in the post-treatment period.

Analysis of Variance↗
PubMed1991

Removal of intrinsic enamel stains with vital bleaching and modified microabrasion.

This study utilized a vital bleaching agent as well as an enamel microabrasion compound with low hydrochloric acid concentration to remove intrinsic stains on the facial surfaces of anterior teeth. In addition, scanning electron microscopic analyses of enamel from extracted teeth compared the etching pattern of the commercial compound used in this study to 18% hydrochloric acid. Type 1 and Type 2 etch patterns were observed with 18% hydrochloric acid after 5 and 20 seconds, respectively. Milder and more diffuse etch patterns were observed with the enamel microabrasion compound. A conservative form of treatment to remove intrinsic stains would employ the use of a vital bleaching agent, followed by an enamel microabrasion compound.

Acid Etching, Dental↗
PubMed2003

Effectiveness of treatment with carbamide peroxide and hydrogen peroxide in subjects affected by dental fluorosis: a clinical trial.

Dental fluorosis is an endemic dental health problem around the world; so, it is important to develop clinical alternatives that are non-invasive and inexpensive. In this study, nightguard vital bleaching technique (NVBT), using carbamide and hydrogen peroxide as active agents, has shown itself to be effective in whitening teeth affected by dental fluorosis. Carbamide peroxide at 10 and 20% and hydrogen peroxide at 7.5% showed good clinical effectiveness in improving clinical appearence, but it is important to point out that clinical success is only in cases of class 1 to 3 of the Tooth Surface Index of Fluorosis. When comparing 10 and 20% concentrations of carbamide peroxide, there was no difference in the clinical effectiveness (p > 0.05); but when comparing both concentrations of carbamide peroxide against hydrogen peroxide, results showed that carbamide peroxide was more effective in whitening in cases of dental fluorosis, the difference being statistically significant (p < 0.05). NVBT has two advantages: it is a non-invasive technique and the relationship cost/benefit is excellent; only a few patients reported tenderness or mild tooth sensitivity.

Adolescent↗
PubMed2003

Effect of internal bleaching agents on dentinal permeability of non-vital teeth: quantitative assessment.

The aim of this in vitro study was to assess quantitatively dentin permeability of pulpless teeth after intracoronal bleaching therapy with three different agents. Twenty-four maxillary central incisors were randomly assigned to four groups according to the bleaching agent used: I--non-bleached control; II--37% carbamide peroxide; III--sodium perborate/20% hydrogen peroxide paste; IV--27% carbamide peroxide. After standard access and root-canal preparation the access opening, biomechanical preparation and root-canal filling, a cervical glass ionomer plug was prepared and intracoronal bleaching procedures were carried out in a standardized fashion. The access cavities were opened and the teeth were externally sealed and immersed in a 10% copper sulfate aqueous solution for 30 min, in vacuum for the first 5 min. Then, samples were removed, dried with absorbing paper and immersed in a 1% rubianic acid alcohol solution, for the same above-mentioned period in solution and in vacuum. Copper ion penetration was indicated by the rubianic acid staining. Mean values and SD for the experimental groups were: I--7.88% (+/-1.33), II--16.94% (+/-5.72); III--11.45% (+/-3.90) and IV--8.98% (+/-4.19). Data were submitted to one-way anova. The results showed that the 37% carbamide peroxide provided the highest increase in dentin permeability, followed by sodium perborate with 20% hydrogen peroxide. The 27% carbamide peroxide provided the lowest results and showed statistical similarity to the control group. On basis of these findings, it may be concluded that, among the tested intracoronal bleaching agents, 37% carbamide peroxide presented an optimized overall performance in increasing dentinal permeability.

Analysis of Variance↗
PubMed2005

Endodontic problems.

If modern clinical techniques were carefully followed, many common endodontic problems would never occur. Incorrectly designed access cavities may make root canals both difficult to identify and to instrument. Careful study of the pre-operative radiograph is essential. Various aids are available to remove fractured instruments and failed root fillings, but the problem must first be correctly diagnosed. As more patients seek cosmetic procedures, the practitioner should be familiar with the 'walking bleach' procedure, again after careful diagnosis of the cause of the discolouration. The practitioner should also be fully aware of the prognosis for this and other endodontic procedures.

Dental Instruments↗
PubMed1997

Bleaching teeth: practitioner trends.

Since the mid-1980s, bleaching teeth has grown significantly in popularity. This article provides an overview of current practitioner trends relative to this procedure.

Carbamide Peroxide↗
PubMed1993

Efficacy of foam liner in 10% carbamide peroxide bleaching technique.

The purpose of this study was to determine if the use of a foam liner in a tray during the nightguard vital bleaching technique would cause a difference in the rate of bleaching or the final shade of the bleached teeth. Ten subjects were selected who had previously successfully bleached their maxillary arch by using a 10% carbamide peroxide solution. Vacuum-formed guards were fabricated for the mandibular arch so that one quadrant was covered with a conventional-style guard, and the other quadrant was covered with a foam-lined guard. All patients were successful in bleaching their mandibular arch. No patient reported any difference between the two quadrants in the rate of bleaching or in the final shade, nor was any difference apparent to the operators clinically or in photographic evaluation. It appears that the addition of a foam insert does not noticeably alter the clinical result of home bleaching. If bleaching is successful in one arch, it can be expected to be effective in the other arch.

Acrylic Resins↗
PubMedDate not supplied

Commonly asked questions about nightguard vital bleaching.

There are three basic classes of materials and techniques used for the bleaching of vital teeth. These include the in-office bleaching technique with 35 percent hydrogen peroxide, the Nightguard vital bleaching technique with 10 percent carbamide peroxide, and the over-the counter bleaching kits with three-to-six percent hydrogen peroxide. The most popular of these techniques is Nightguard vital bleaching also referred to as dentist-prescribed, home-applied bleaching. This article looks at the current status of the Nightguard vital bleaching technique, with a special emphasis on the clinical aspects of the treatment, along with the most commonly asked questions concerning the procedure. It would still appear that this form of dentist-prescribed, home-applied bleaching, when preceded by a proper examination and correct diagnosis, applied with a properly fitted prosthesis, and monitored as needed by a dentist, is as safe as other accepted dental procedures or commonly ingested foodstuffs.

Appointments and Schedules↗
PubMed2006

Sealing capacity of a photochromatic flowable composite as protective base in nonvital dental bleaching.

AIM: To evaluate microleakage of a flowable composite used as a protective isolating base, applied with different adhesive systems. METHODOLOGY: Seventy root-filled teeth were divided into seven groups. A flowable composite base (Tetric Flow Chroma) was used with three adhesive techniques (Syntac, Excite, Excite DCS; in the three cases with and without acid etching) and in a control group without dentine conditioning or adhesive placement. A 30% hydrogen peroxide solution was applied for 24 h in the pulp chambers, followed by the placement of a dye (silver nitrate) for 4 h. Each tooth was sectioned longitudinally, and examined under 4x magnification to assess the tooth/restoration dye leakage following a four-degree scale. Percentage of dye penetration was registered. Statistical analysis was made through the Tukey and Mann-Whitney U-tests. RESULTS: Maximum leakage (100% of specimens) was recorded in the control group without an adhesive system. In the groups subjected to acid etching, the percentage of leakage corresponded to Excite DSC (10%), followed by Syntac (20%) and Excite (30%). In the groups in which only an adhesive system was used, 50% of the teeth demonstrated dye leakage. Statistically significant differences in terms of leakage were observed between the control group and the experimental groups (P < 0.05). There were no significant differences among the experimental groups, but comparing the leakage percentages obtained between the groups in which the teeth were subjected to prior acid etching, and those in which no etching was carried out, observed differences were significant (P = 0.04). CONCLUSIONS: There were no significant differences between the adhesive systems in terms of leakage. Acid etching significantly reduced leakage.

Acid Etching, Dental↗