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In this paper the development of techniques to remove intrinsic vital stains are summarized. The mechanism of chemical agents is described as well as the nature of the stain and its treatment. Finally a rationale for selecting patients for treatment and its prognosis is presented and discussed.
This study compared the sealing ability of TERM as an interim restoration for the "walking bleach" technique when using either sodium perborate/water or sodium perborate/superoxol. Thirty-three extracted maxillary premolars were restored with TERM after placing either a cotton pellet (control), a paste of sodium perborate and water, or a paste of sodium perborate and superoxol in the chamber. Microleakage was assessed at 24 h, 8 days, and 15 days using a fluid filtration method. Statistical analysis revealed both "walking bleach" groups had significantly higher numbers of teeth demonstrating microleakage than the control group. There was no statistically significant difference in microleakage between the two "walking bleach" groups. The results of this study indicated that the temporary restorative material, TERM, provided an unsatisfactory seal when used with either walking bleach technique. When used over a cotton pellet, TERM provided an excellent seal.
The conservative technique of professionally dispensed and supervised, home-administered vital bleaching is now a routine treatment in the dental profession. This double-blind study evaluated the Rembrandt Lightening Gel and Whitening Toothpaste for shade change, colorimeter shade change. As well, it evaluated soft tissue health by periodontal probing, plaque index, and bleeding index. A patient questionnaire evaluated perception of whitening, perception of oral hygiene, average hours per day, and average days per week. Bleaching trays were worn over a 4-week period. The bleaching system showed definitive whitening effects as evaluated with the Vita shade guide and the colorimeter. The bleaching system had no deleterious effects on the soft tissue. The Rembrandt toothpaste alone demonstrated two-shade lightening. This vital bleaching system shows definitive whitening of the teeth in short periods of time with no adverse effects.
BACKGROUND: Several studies have been published about the effect of carbamide peroxide on enamel surface morphology. However, only a few studies have been carried out under intraoral conditions. The purpose of this study was to investigate the effect of two commercially available 10% carbamide peroxide bleaching products (Colgate Platinum and Starbrite) on the enamel surface morphology under intraoral conditions. MATERIALS AND METHODS: Twenty-four subjects were divided into two groups and assigned a product to use for 2 weeks. Epoxy resin replicas obtained from the maxillary right central incisors of the subjects before, immediately after, and 3 months after the bleaching procedure were examined under a scanning electron microscope. RESULTS: Immediately after the bleaching procedure, the surface porosity of enamel had increased in the Colgate Platinum group, whereas erosive surface alterations were observed in the Starbrite group. At 3 months, the surface morphology of enamel in the Colgate Platinum group was similar to the untreated enamel surface. In the Starbrite group, erosive defects on the enamel surface had decreased within 3 months, and the appearance of the enamel surface was almost the same as the untreated enamel. CONCLUSION: Even though both bleaching agents caused alterations in the surface morphology of enamel, these alterations were reversed within 3 months following treatment. CLINICAL SIGNIFICANCE: The results of this study suggest that 10% carbamide peroxide bleaching products cause alterations in enamel surface morphology immediately after bleaching, and the degree of these alterations depends on the brand of bleaching agent and duration of application time. However, these alterations revert to almost normal within 3 months.
OBJECTIVE: The purpose of this study was to evaluate the degree of color change, any rebound effect, and sensitivities associated with using 2 different concentrations of carbamide peroxide in vivo. METHOD AND MATERIALS: Twenty-five subjects used 10% and 15% agents in trays for 14 days on different sides of their maxillary arches. Subjects returned in 3 days and at 1, 2, 3, and 6 weeks for evaluation of color change and rebound effect. Shade matching, photographic means, and a colorimeter were used for evaluation. Subjects self-reported gingival and tooth sensitivity on a scale of 1 (no sensitivity) to 5 (severe sensitivity). RESULTS: After 2 weeks, delta L*, delta a*, delta b*, delta E* and delta shade guide rank means for the 10% whitening agent were 6.50, -1.37, -4.63, 8.79, and -15.40, respectively; for the 15% agent, they were 8.72, -1.63, -5.90, 11.03, and -16.59, respectively. After 6 weeks, delta L*, delta a*, delta b*, delta E*, and delta shade guide rank means for the 10% whitening agent were 3.04, -0.99, -3.19, 5.13, and -13.13, respectively; for the 15% agent, they were 3.48, -1.01, -3.60, 5.58, and -13.65, respectively. Means for gingival sensitivity were 1.18 and 1.21 for the 10% and 15% agents, respectively; means for tooth sensitivity were 1.21 and 1.26 for the 10% and 15% agents, respectively. CONCLUSION: All 3 methods of evaluation revealed a significant difference in the tooth lightness achieved by 10% and 15% products at 2 weeks but no significant difference at 6 weeks. No statistically significant difference was found in gingival or tooth sensitivity.
Intracoronal bleaching of pulpless discolored teeth is a valuable treatment modality currently disregarded by many clinicians because of the potentially disastrous consequence of cervical resorption. A patient-administered, intracoronal carbamide peroxide bleaching technique is described. This modified walking bleach method minimizes the risks because treatment time is reduced to days as opposed to weeks of the original walking bleach protocol; the concentration of the hydrogen peroxide is markedly reduced; and residual hydrogen peroxide is completely eliminated with the use of catalase prior to the definitive restoration.
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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 than 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.
AIM: To determine the effect of intracoronal bleaching agents on adhesion of bonding agents to pulp chamber dentine. METHODOLOGY: Forty extracted human maxillary anterior teeth were randomly divided into four groups of 10 teeth each. Bleaching agents were sealed in pulp chambers for 7 days, as in clinical use. Group 1 (control): distilled water, group 2: 35% hydrogen peroxide, group 3: sodium perborate mixed with water, and group 4: sodium perborate mixed with 35% hydrogen peroxide. Teeth were stored in saline at 37 degrees C for 7 days. After the bleaching agent was removed, teeth were leached in water for a further 7 days prior to bonding. The crown was cut vertically from mesial to distal and the labial pulp chamber dentine was prepared for bonding with Clearfil SE-Bond and filled with resin composite (Clearfil AP-X). The bonded specimens were kept moist at 37 degrees C for 24 h. Microtensile bond strengths were determined using a universal testing machine. Additional teeth were prepared using the same bleaching procedures to investigate the scanning electron microscopic appearance of the dentine surface. RESULTS: Mean values (+/-SD) of microtensile bond strength for the experimental groups were: group 1: 5.29 +/- 2.21 MPa, group 2: 5.99 +/- 1.51 MPa, group 3: 9.17 +/- 1.65 MPa and group 4: 3.99 +/- 1.31 MPa. Dentine treated with sodium perborate in water (group 3) had significantly higher mean bond strength when compared with the other three groups (P < 0.05, Tukey's test). Mean bond strength was lowest when dentine was treated with sodium perborate plus hydrogen peroxide (group 4). CONCLUSIONS: In terms of subsequent bond strength during restoration, sodium perborate mixed with distilled water appears to be the best intracoronal bleaching agent.
Clinical experience with an innovative, dual-action, in-office bleaching regimen that has both chemical and photoactivated mechanisms is described. This internal bleaching procedure was performed in three patients, each with different characteristics. In general, the results obtained were satisfactory. In the 6-month period of follow-up, no adverse effects related to the application of the bleaching agent were found. The different factors that may have influenced the results achieved are discussed.
Discolored teeth are the primary aesthetic concern among dental patients. While many seek professional advice and treatment, an alarming number opt for non-professional quick-fix solutions. The in-office bleaching modality often is overlooked in favor of at-home vital bleaching. But this option has been proven to be effective, quick and safe-either alone or in combination with other aesthetic treatments-as a method of brightening and enhancing a patient's smile.
In this study a simple and time-saving method for internal bleaching of discolored root-filled teeth is presented. The method used sodium perborate moistened with water and the access cavity temporarily sealed with Cavit between visits. Bleaching was carried out in 95 teeth, with a satisfactory initial result in 90% of the cases. After 3 years of observation, recurrence of discoloration was found in 20% of the teeth seen at follow-up examination. After 5 years of observation a total of 29.4% showed discoloration or recurrence of discoloration. The method is easy, fast and essentially without complications. It is therefore recommended as an alternative to full crown restoration, assuming the tooth is not too weakened because of large fillings.
Dentist-prescribed, at-home bleaching with 10% carbamide peroxide was used to lighten the apparent color of teeth with preexisting porcelain veneers. Veneers had been placed over unprepared, tetracycline-stained teeth; the translucency of the veneers over the discolored teeth resulted in a graying of the veneers. A custom-fitted tray with no reservoirs and no gingival scalloping was fabricated. A 10% carbamide peroxide material was applied nightly for 9 months to achieve the maximum change in the underlying tooth color. The patient was pleased with the apparent color change. Tooth sensitivity during treatment was minimal (lasting 4 days total); the patient treated sensitivity by brushing with a potassium nitrate-containing toothpaste or applying fluoride in the tray.
The early loss of permanent teeth following trauma or congenital aplasia may be corrected by orthodontic or prosthetic means, sometimes combined with implant therapy. The orthodontic solution results usually in different anatomic, functional, and esthetic problems. Prosthetic and implant procedures, on the other hand, are very demanding and require long-term maintenance. Considering these limitations, a comprehensive diagnostic and treatment plan is mandatory to achieve the most satisfactory clinical result. Modern restorative modalities, such as recontouring, bleaching, and resin composite bonding, may improve the final clinical result after orthodontic space closure. In more difficult situations, veneers and crowns may also be indicated.
This study compared the dentin bond strength of a self-etching primer/adhesive system with dentin surface pH with or without bleaching and observed the morphological changes in bleached dentin treated with a self-etching primer. Dentin disks were prepared from the coronal-labial region of 32 human anterior teeth. The pulpal surfaces of the dentin disks were polished with 600-grit SiC paper under running water. The dentin surfaces on all specimens were bleached with a mixture of 30% hydrogen peroxide and sodium perborate in 100% humidity at 37 degrees C for one week. The bleaching agent was then rinsed off with water for 5, 15 or 30 seconds. All specimens were stored in water at 37 degrees C. Half of the five-second rinsing specimens were stored in water for an additional week. Dentin surface pH with or without bleaching was examined using a pH-imaging microscope (SCHEM-100). A self-etching primer/adhesive system (Clearfil SE Bond) was applied to bleached or unbleached dentin according to the manufacturer's instructions. After 24-hour water storage, the bonded specimens were prepared for microtensile testing. Microtensile bond strength (microTBS) to dentin was measured using a universal-testing machine (EZ test, Shimadzu, Japan) at a crosshead speed of 1.0 mm/minute. Data were analyzed by one-way ANOVA and Scheffe's test (alpha=0.05). The pH values of the dentin surfaces of the 5 and 15 second rinsing groups were significantly higher than the control group (p<0.05), while the 30-second rinsing and one-week water storage groups had similar surface pH values to the control group (p<0.05). The microTBS of 5, 15 and 30 second rinsing specimens after bleaching were significantly lower than the control specimens (p<0.05). However, after one-week of water storage, the microTBS returned to the control group. The application of a bleaching agent increased the pH value of the dentin surface and decreased the bond strength of the self-etching primer/adhesive system. One-week water storage after bleaching recovered the surface pH and the microTBS to dentin.
This experiment aimed at evaluating, in vitro, the chromatic alteration of dental crowns submitted to internal bleaching. Color alterations were evaluated by means of spectrophotometric analysis and visual observation, at the following experimental phases: initial reading (LI), after-darkening reading (LE), immediate after-bleaching reading (LC), bleaching checked after 15 days (LC15) and after 30 days (LC30). After finding the values of L* (luminosity), a* and b* (shade and saturation), which made it possible to quantify the chromatic alterations of the specimens, color differences (deltaE ) were assessed by means of the CIE Lab Program. The statistical analysis of the results did not reveal any significant difference between conventional bleaching and bleaching activated by Er:YAG laser. No statistical difference was observed between the results after 15 and 30 days, for both experimental groups.
PURPOSE: To evaluate the effect of nonvital bleaching on the shear bond strength of composite resin using three adhesive systems. MATERIALS AND METHODS: Two hundred seventy bovine teeth were assigned to 3 groups (n = 90): SP, paste of sodium perborate and water; CP, 37% carbamide peroxide; CO, control group (no treatment). After the bleaching treatment, the teeth in each group were cut into enamel (E) and dentin (D) sections. The teeth were embedded in polyester resin and polished in order to obtain a flat E or D surface. Each group was divided into 6 subgroups (n = 15) according to substrate (E and D) and adhesive system: SB, Single Bond (solvent: water/alcohol); PB, Prime & Bond NT (solvent: acetone); CLF, Clearfil SE Bond (solvent: water). The adhesive system was applied on each flat surface according to the manufacturer's instructions and a cylinder of composite resin Z-250 was overlaid. The specimens were stored in distilled water for 7 days at 37 degrees C. The SBS test was performed in a universal testing machine with crosshead speed of 0.5 mm/min. The data obtained (in MPa) were statistically analyzed with two-way ANOVA and Tukey's test (p < or = 0.05). RESULTS: The bleaching treatment influenced the SBS, regardless of the adhesive system used. On enamel, the SP and CP bleaching treatments reduced the SBS values. On dentin, the SP bleaching agent reduced the SBS values, but the CP bleaching did not. CONCLUSION: Nonvital bleaching treatment with sodium perborate may adversely affect shear bond strength of composite resin for both enamel and dentin. Similar effects can be expected from 37% carbamide peroxide bleaching agent on enamel but not dentin bonding strength. The use of water/alcohol and acetone-based adhesive systems cannot reverse the effects of bleaching treatments on bond strengths.