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PubMed2005

Shear bond strength evaluation of composite resin on enamel and dentin after nonvital bleaching.

BACKGROUND: Studies have shown that bleaching agents interfere with the adhesion of composite resin placed immediately after bleaching. PURPOSE: The aim of this study was to evaluate the shear bond strengths of composite resin after four different durations since the time of nonvital bleaching (1 d and 1, 2, and 3 wk). MATERIALS AND METHODS: Two hundred seventy bovine teeth were assigned to nine groups (n = 30) according to the bleach used and the time between bleaching and restoration: group 1--sodium perborate (SP), 1 day after bleaching (AB); group 2--SP, 1 week AB; group 3--SP, 2 weeks AB; group 4--SP, 3 weeks AB; group 5--37% carbamide peroxide (CP), 1 day AB; group 6--CP, 1 week AB; group 7--CP, 2 weeks AB; group 8--CP, 3 weeks AB; group 9--control group (no treatment). After the bleaching treatment, the teeth in each group were sectioned and the enamel and dentin were separated. The teeth were cut, embedded in polyester resin, and polished to obtain flat enamel and dentin surfaces. The adhesive system was applied and a cylinder of composite resin was bonded on each flat surface. The specimens were stored in distilled water for 7 days at 37 degrees C. The shear bond strength test was performed in a universal test machine (Emic DL-500, São José dos Pinhais, São Paulo, Brazil) at a crosshead speed of 0.5 mm/min. RESULTS: The data were subjected to analysis of variance, Dunnett's t-test, and Tukey's least significant difference at p < or = .05 and showed a statistically significant decrease in bond strengths of composite resin for enamel and dentin 1 day after the nonvital bleaching. CLINICAL SIGNIFICANCE: The decrease in shear bond strength values is time dependent. A delay in bonding procedures for composite resin restoration is recommended. According to the results, a satisfactory time to perform the restoration of composite resin for both enamel and dentin is 2 weeks after bleaching.

Analysis of Variance↗

PubMed1998

The applications and integration of at-home bleaching into private dental practice.

Since the introduction of home bleaching, the "whitening" of teeth has become much more common. This article describes at-home bleaching and the integration of this new treatment modality into the private dental practice. Case reports of the use of bleaching with and without restorative dentistry are presented, as well as tips on patient education and the timing of therapy.

Carbamide Peroxide↗

PubMed2004

In vitro penetration of bleaching agents into the pulp chamber.

AIM: To investigate pulp chamber penetration of bleaching agents in teeth following restorative procedures. METHODOLOGY: Bovine lateral incisors were sectioned 3 mm apical to the cemento-enamel junction and the coronal pulpal tissue was removed. Teeth were divided into six groups (n = 10): G1, G2 and G3 were not submitted to any restorative procedure, while G4, G5 and G6 were submitted to Class V preparations and restored with composite resin. Acetate buffer was placed in the pulp chamber and treatment agents were applied for 60 min at 37 degrees C as follows: G1 and G4, immersion into distilled water; G2 and G5, 10% carbamide peroxide (CP) exposure; G3 and G6, 35% CP bleaching. The buffer solution was removed and transferred to a glass tube where leuco crystal violet and horseradish peroxidase were added, producing a blue solution. The optical density of the blue solution was determined spectrophotometrically at 596 nm. A standard curve made with known amounts of hydrogen peroxide was used to convert the optical density values of the coloured samples into microgram equivalents of hydrogen peroxide. Data were submitted to anova and Tukey's test (5%). RESULTS: Amounts of hydrogen peroxide found in the pulp chamber of G2 and G5 specimens (0.1833 +/- 0.2003 micro g) were significantly lower (P = 0.001) when compared to G3 and G6 specimens (0.4604 +/- 0.3981 micro g). Restored teeth held significantly higher (P = 0.001) hydrogen peroxide concentrations in the pulp chamber than intact teeth. CONCLUSION: Higher concentrations of the bleaching agent produced higher levels of hydrogen peroxide in the pulp chamber, especially in restored teeth.

Analysis of Variance↗

PubMed2003

Sealing evaluation of the cervical base in intracoronal bleaching.

Discoloration of non-vital teeth is an esthetic deficiency frequently requiring bleaching treatment. The purpose of this study was to evaluate in vitro the cervical base efficacy in order to prevent or to minimize the leakage along the root canal filling and into the dentinal tubules. Thirty-eight extracted single-root human teeth were used, which were biomechanically prepared, filled, and divided into three experimental groups: G1, a cervical base was applied (3 mm of thickness) below the cemento-enamel junction, with resin-modified glass-ionomer cement (Vitremer); G2, the base was done with glass-ionomer cement (Vidrion R); and G3 (Control), did not receive any material as base. A mixture of sodium perborate and hydrogen peroxide 30% was placed inside the pulp chamber for 3 days, and the access opening was sealed with Cimpat. This procedure was repeated thrice. Soon after this, a paste of calcium hydroxide was inserted into the pulp chamber for 14 days. All teeth were covered with two layers of sticky wax, except the access opening, and immersed in blue India Ink for 5 days. The results did not show statistically significant differences between the three groups concerning the leakage inside the dentinal tubules. Regarding the apical direction, a statistical difference (ANOVA P < 0.05) was observed among the experimental group G1 and control group G3. No statistically significant difference was observed between G2 and G3 groups. Therefore, the placement of a cervical base before internal bleaching procedures is still recommended.

Analysis of Variance↗

PubMed2006

Bleaching non vital primary teeth: case report.

Trauma and pulpal infections in primary dentition are part of the routine of the pediatric dentist. Common consequences in these cases are alterations in dental color, compromising patient's esthetics and his interaction in social environment. Bleaching intends to preserve dental structure already weakened and to show immediate esthetic results. This clinical case shows a bleaching technique in devitalized primary teeth using bleaching agent with 35% hydrogen peroxide activated by photo polymerizer. This technique is simple and shows immediate satisfactory results.

Acid Etching, Dental↗

PubMedDate not supplied

The effect of 10% carbamide peroxide bleaching material on microhardness of sound and demineralized enamel and dentin in situ.

This in situ study evaluated the microhardness of sound and demineralized enamel and dentin submitted to treatment with 10% carbamide peroxide for three weeks. A 10% carbamide peroxide bleaching agent--Opalescence/Ultradent (OPA)--was evaluated against a placebo agent (PLA). Two hundred and forty dental fragments--60 sound enamel fragments (SE), 60 demineralized enamel fragments (DE), 60 sound dentin fragments (SD) and 60 demineralized dentin fragments (DD)--were randomly fixed on the vestibular surface of the first superior molars and second superior premolars of 30 volunteers. The volunteers were divided into two groups that received bleaching or the placebo agent at different sequences and periods at a double blind 2 x 2 crossover study with a wash-out period of two weeks. Microhardness tests were performed on the enamel and dentin surface. The SE and DE submitted to treatment with OPA showed lower microhardness values than the SE and DE submitted to treatment with PLA. There were no statistical differences in microhardness values for SD and DD submitted to the treatment with OPA and PLA. The results suggest that treatment with 10% carbamide peroxide bleaching material for three weeks alters the enamel microhardness, although it does not seem to alter the dentin microhardness.

Adult↗

PubMedDate not supplied

Bleaching and/or porcelain veneers: case reports.

Four case studies are presented in which the concept that bleaching, porcelain veneer restorations, or a combination of both constitute a conservative treatment approach for discolored, malformed, malaligned, and worn dentition. These treatments can be used effectively not only for aging dentitions, but also for the very young, which makes them an attractive treatment modality.

Adult↗

PubMed1998

A quantitative comparison of traditional and non-peroxide bleaching agents.

Single-rooted premolar teeth, stained with blood utilizing the technique devised by Freccia & Peters (1981), were subjected to traditional and non-peroxide bleaching agents. Colour changes were recorded over a period of 7 days using a Speedmaster R75-CP Reflection Densitometer. The most efficient removal of staining occurred after the application of 30% hydrogen peroxide, with sodium perborate being 75% as effective. All bleaching agents realized their optimum efficacy within the first 3 days. A combination of three enzymes (amylase, lipase and trypsin) with disodium edetate was not as effective as the routine bleaching agents; however, the combination did have a modifying effect on the blood stains. It is suggested that other non-peroxide agents should be investigated to determine their efficacy in removing staining from experimentally induced blood-stained teeth.

Adolescent↗

PubMed2006

In vitro assessment of a gel base containing 2% chlorhexidine as a sodium perborate's vehicle for intracoronal bleaching of discolored teeth.

The purpose of this study was to assess a gel base containing 2% chlorhexidine (CHX) as a vehicle to be mixed with sodium perborate for intracoronal bleaching of discolored teeth, comparing its bleaching efficacy to sodium perborate mixed with other vehicles; 37% carbamide peroxide and 30% hydrogen peroxide. There were 110 fresh bovine incisors artificially stained using whole blood. The samples were divided into 11 groups and the intracoronal bleaching was performed using the "walking bleach technique". The bleaching agents were replaced three times at 7-day intervals. Using digital photos and a shade guide created for bovine teeth, the samples were evaluated at day 0, 7, 14, 21, and 28. On evaluation day, the photos were examined by three endodontists giving scores from 1 to 5 based on the shade guide created. Data were analyzed statistically by Kruskall-Wallis test. After 28 days, all evaluated teeth received scores that were statistically similar. Groups that used sodium perborate and a liquid vehicle bleached faster than those that used a gel based vehicle. The CHX gel allowed dissociation for the bleaching agent. The 2% CHX gel exhibited a good potential for use as a vehicle for sodium perborate or as a complement for carbamide peroxide.

Animals↗

PubMed2002

Effect of calcium hydroxide as a supplementary barrier in the radicular penetration of hydrogen peroxide during intracoronal bleaching in vitro.

AIM: To examine pH changes in the cervical external root surface, when calcium hydroxide was used as a supplementary barrier to the protective base material during intracoronal bleaching. METHODOLOGY: Twenty-eight single-rooted human premolars extracted for orthodontic reasons were instrumented with K-Flex files, obturated with gutta-percha and subjected to thermocatalytic bleaching. The teeth were divided into four groups. In group A, a glass-ionomer cement barrier was placed at the cemento-enamel junction (CEJ) level and in group C, the barrier was placed 1 mm apical to the CEJ. In groups B and D, Ca(OH)2 was placed in contact and apical to the glass-ionomer cement at the CEJ and 1 mm apical to the CEJ, respectively. The teeth were placed in vials containing distilled water and the pH values of the medium surrounding the teeth were recorded after 1, 2, 4, 10 and 15 days, following renewal of the medium. RESULTS: The pH in the medium became acidic in all groups. No statistically significant differences existed between groups for all the experimental days (P = 0.790). CONCLUSION: The placement of Ca(OH)2 as a supplementary barrier during intracoronal bleaching did not have a significant effect in reversing the acidic pH created at the external root surface in vitro. Its potential effect during these procedures in vivo needs to be further investigated.

Adult↗

PubMed2004

Morphological evaluation of enamel surface after application of two 'home' whitening products.

PURPOSE: The purpose of this study was to investigate the effect on enamel surface morphology of two commercially available bleaching products (AZ Whitestrips 6% hydrogen peroxide - Procter & Gamble; Platinum TWS 10% carbamide - Colgate Oral Pharmaceuticals) and their ability to prevent enamel demineralization in the presence of cariogenic solution, with or without saliva. MATERIALS AND METHODS: Forty sound teeth were used to obtain 90 enamel fragments. Lactic acid (pH = 4.4) was used as a demineralizing cariogenic solution. The specimens were randomized into eight groups: Group A: product A + cariogenic solution; Group B: product B + cariogenic solution; Group C: cariogenic solution; Group D: (control group) stored in deionized water; Group E: product A + deionized water; Group F: product B + deionized water; Group G: product A + saliva; Group H: product B + saliva. Scanning electron microscope (SEM) analysis was performed to detect the type of lesions induced by the treatments. A score rating system was used to perform a non-parametric statistical analysis. RESULTS: Our study confirms that enamel alterations (i.e. removal of intraprismatic core and presence of deep porosities and pits) occur as a result of the application of a cariogenic solution (lactic acid). The enamel surface presented a honeycomb surface only in untreated samples previously stored in lactic acid solution. Conversely, both products were able to prevent enamel alterations caused by exposure to lactic acid. Saliva treatment reduced the degree of enamel lesions of both treated and untreated groups. Treatment with product A achieved better preservation of enamel integrity. CONCLUSION: Whitening treatment conducted with two 'home' bleaching agents had no adverse effects on enamel surface morphology. Several morphological aspects suggest that the tested products may even prevent demineralization of the enamel surface after exposure to lactic acid.

Carbamide Peroxide↗

PubMed2006

At-home vital bleaching: a comparison of hydrogen peroxide and carbamide peroxide treatments.

Tray bleaching of vital teeth performed at home by the patient under the dentist s supervision, whether alone or in combination with any of the in-office techniques, provides an interesting alternative to other methods employed in this type of dental treatment. This bleaching procedure applies low-concentration peroxides to the enamel by means of a custom-made mouth tray specifically designed for this purpose. The aim of this study is to examine and compare two commercially-available bleaching products, at equivalent concentrations, for use in this technique: VivaStyle (Vivadent) and FKD (Kin); the former is a 10% carbamide peroxide and the latter a 3.5% hydrogen peroxide formulation. It examines the parameters that must be monitored during the application of this type of procedure and presents 6 cases (3 treated with one of the above-mentioned products and the other 3 with the other), establishing the bleaching power of the products and the appearance and intensity of post-operatory hypersensitivity. The results obtained show that both products are effective for the purpose for which they were designed. In general, dental hypersensitivity was minimal.

Carbamide Peroxide↗

PubMed2003

Treatment of endemic fluorosis and tetracycline staining with macroabrasion and nightguard vital bleaching: a case report.

A patient, diagnosed with a combination of level 3 endemic dental fluorosis and degree 1 tetracycline staining, was treated sequentially by macroabrasion techniques and nightguard vital bleaching. Various pairings of diamond and carbide burs, abrasive disks, rotary polishing points, and diamond polishing pastes were tested to obtain the optimal combination for macroabrasion. This conservative treatment regimen produced results that were termed "excellent" by the patient and met the goals of the dentists.

Adult↗

PubMed2002

Effect of hydrogen peroxide and sodium perborate on biomechanical properties of human dentin.

This study compared the ultimate tensile strength, micropunch shear strength, and microhardness of bleached and unbleached human dentin. Forty-four intact premolars were root canal treated and randomly divided into four groups. Bleaching agents were sealed in pulp chambers, as in clinical use. Group 1 (control) was treated with water, group 2 with 30% hydrogen peroxide, group 3 with sodium perborate mixed with water, and group 4 with sodium perborate mixed with 30% hydrogen peroxide. The teeth were stored in saline at 37 degrees C for 7 days. The teeth were then sectioned and biomechanical tests were carried out on dentin specimens that were obtained from all teeth. Intracoronal bleaching with 30% hydrogen peroxide and sodium perborate used either alone or in combination weakened dentin. Hydrogen peroxide alone tended to be more damaging than sodium perborate used alone or sodium perborate mixed with hydrogen peroxide.

Analysis of Variance↗

PubMed1992

A scanning electron microscopy study of the effect of bleaching agents on enamel: a preliminary report.

The effect of bleaching agents on the enamel surface was examined by scanning electron microscopy. The comparison of treated to untreated enamel revealed that the treated surface had increased surface change and porosity after the equivalent of 30 hours of exposure to the bleaching agent. The degree of alteration of enamel surface was not uniform and was influenced by cleanliness (oral hygiene) of the treated teeth and apparent variation in calcification. The enamel surface developed varying degrees of surface porosity and alteration.

Acid Etching, Dental↗

PubMed2002

Effect of bleaching agents on the hardness and morphology of enamel.

PURPOSE: The goal of the present laboratory study was to analyze the effect of two home bleaching agents (Opalescence 10%, Ultradent, and Hi-Lite II, Shofu) as well as the separate solutions of 10% carbamide peroxide primary components (3% hydrogen peroxide and 7% urea) on enamel microhardness and surface morphology. MATERIALS AND METHODS: Thirty human molars stored in water for no longer than 3 months were selected. Their facial and lingual surfaces were embedded in acrylic resin, and the specimens were polished with up to 600-grit sandpaper. The 30 molar sections were divided into five groups as per treatment modality (n = 6); group 1, 10% carbamide peroxide bleach with carbopol (Opalescence, Ultradent); group 2, oxygen-free gel bleach (Hydroxylite, Hi-Lite II, Shofu); group 3, 3% hydrogen peroxide with carbopol (Dermus Pharmacy, Florianópolis, SC, Brazil); group 4, 7% urea treatment (Dermus Pharmacy); and control, group 5, artificial saliva (Dermus Pharmacy). Prior to treatment, six indentations (Vickers) were made on each of the six surfaces in each group under a load of 100 g for 30 seconds. Bleaching procedure was conducted for 3 hours per day for 2 weeks, the control group excepted. Following each bleaching session, the specimens were washed with deionized water and kept in artificial saliva at 37 degrees C, this solution being changed daily. Pre- and post-treatment microhardness data were analyzed using a two-way analysis of variance. In a similar way, 30 other specimens underwent the same procedures. After the bleaching period, the samples were observed under the scanning electron microscope. RESULTS: Specimens submitted to bleaching treatment with 3% hydrogen peroxide gel as described in this study showed a significant reduction of surface microhardness (p < .0001). The other treatment modalities had no effect on surface microhardness. No morphologic alterations were observed on enamel submitted to bleaching gel of 10% carbamide peroxide (Opalescence), oxygen-free gel (Hi-Lite II, Shofu), or 7% urea solution compared with the control (artificial saliva). However, the specimens bleached for 3 hours per day for 2 weeks with 3% hydrogen peroxide gel presented areas of mild erosion. The effect, nevertheless, was not uniform, occurring with varying intensity on all samples of enamel bleached with 3% hydrogen peroxide. CLINICAL SIGNIFICANCE: Bleaching treatment conducted with two home bleaching agents (Opalescence 10%, Ultradent, and Hi-Lite II, Shofu) had no adverse effects on enamel microhardness or on surface morphology. Bleaching with 3% hydrogen peroxide can have a negative effect on enamel hardness and surface morphology when performed as described in this study.

Acrylic Resins↗

PubMed1999

Five-year follow-up of internal bleaching.

A 5-year clinical follow-up study was conducted to determine the longevity of originally acceptable results for internal bleaching. The "walking internal bleaching" method is an acceptable technique of lightening discolored anterior teeth to provide an esthetically pleasing match with adjacent teeth. This follow-up study revealed a success rate of 79% for all indications after 5 years. If the indication is limited to one palatal endodontic opening, the total success rate can reach 91%. However, a 98% success rate is common when subjective evaluation of patients is considered. The results clearly indicated that internal bleaching provides long-term success for treatment of discolored nonvital anterior teeth over a period of years and does not have any detrimental effect on dental hard tissue. In ideal cases, if the procedure is performed precisely, the success rate can exceed 90% after five years.

Adolescent↗

PubMed1992

Effects of external bleaching on indentation and abrasion characteristics of human enamel in vitro.

The application of home-bleaching procedures as a means of lightening multiple teeth has become increasingly popular. Very few studies, however, have determined the effect of this treatment upon dental hard tissues. This in vitro study evaluated the effects of a 10% carbamide peroxide gel on the apparent fracture toughness, hardness, and abrasion characteristics of human enamel. The apparent fracture toughness of enamel was reduced by about 30% after bleaching for a period of 12 hours with no significant change in surface hardness. Enamel treated with the bleaching gels also exhibited a small but significant decrease in abrasion resistance. This behavior was most likely due to an alteration of the organic matrix of enamel under the chemical action of hydrogen peroxide. Further investigation of the clinical significance of this process is needed.

Analysis of Variance↗