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PubMed1994

Effectiveness, side effects and long-term status of nightguard vital bleaching.

In this clinical trial of nightguard vital bleaching for six weeks, 92 percent of the patients experienced some lightening of treated teeth. About 97 percent of patients with teeth stained through aging, inherent discoloration, brown fluorosis or trauma experienced lightening, as did 75 percent with tetracycline-stained teeth. Sixty-six percent experienced side effects, which resolved in 24 to 48 hours. Earliest re-treatment was done after one year in less time. Minimal color change occurred for 74 percent after 1 1/2 years and 62 percent after three years.

Adult↗
PubMed1994

Radicular penetration of hydrogen peroxide during intra-coronal bleaching with various forms of sodium perborate.

The development of external cervical root resorption following internal bleaching of discoloured pulpless teeth is associated with the use of hydrogen peroxide. The aim of the study was to determine radicular penetration of hydrogen peroxide following intracoronal bleaching with various forms of sodium perborate. 63 extracted human incisors were root filled and stained artificially. Standardized cementum defects were created on the mesial and distal aspects of the root directly below the cemento-enamel junction (CEJ). Using the walking bleach technique all teeth were bleached for a 6-day period, with replacement of the bleaching paste after days 1 and 3. Sodium perborate monohydrate (MH), trihydrate (TRH) or tetrahydrate (TH) was mixed with H2O2 or H2O and subsequently placed intracoronally 1 mm below the labial CEJ. The teeth were divided into six groups: I. MH + H2O2(30%) (n = 12); II. TRH + H2O2(30%) (n = 12); III. TH + H2O2(30%) (n = 12); IV. TH + H2O (n = 12); V. TH + H2O, gel (n = 12); VI. no bleaching paste (n = 3). At baseline and at days 1, 3 and 6 the amount of H2O2 taken up from the surrounding medium of each root was indirectly recorded and calculated as p.p.m. Almost all teeth of the experimental groups showed leakage of hydrogen peroxide compared to those of the control group. The radicular penetration of hydrogen peroxide was significantly higher in teeth of groups I and III than in those of groups IV and V (P < or = 0.001). In conclusion, the amount of hydrogen peroxide leakage depends, among other factors, on the form of sodium perborate used.(ABSTRACT TRUNCATED AT 250 WORDS)

Borates↗
PubMed1998

Efficacy, longevity, side effects, and patient perceptions of nightguard vital bleaching.

Since its introduction into dentistry in 1989, nightguard vital bleaching has been proven to be a simple and safe procedure to whiten discolored teeth. Efficacy of the technique is 95% for nontetracycline-stained teeth, and with extended treatment time, tetracycline-stained teeth can be expected to lighten in 90% of cases. Satisfactory retention of the shade change can be expected in 63% of patients 3 years posttreatment and at least 35% at 7 years. Side effects are usually mild and transient, disappearing within days of treatment completion. Patients report that they are glad they went through the procedure, and 97% recommend the procedure to a friend.

Anti-Bacterial Agents↗
PubMed2000

Nightguard vital bleaching: dark stains and long-term results.

Since its introduction to dentistry in 1989, nightguard vital bleaching has proven to be a simple and safe procedure for lightening discolored teeth. Efficacy of the technique is 98% for non-tetracycline-stained teeth, and with extended treatment time, tetracycline-stained teeth can be expected to lighten in 86% of cases. Satisfactory retention of the shade change without additional treatment can be expected in 63% of patients 3 years post-treatment and in at least 42% of patients at 7 years. Side effects are usually mild and transient, disappearing within days of treatment completion. Patients report that they are glad they went through the procedure and 98% recommend the procedure to a friend.

Anti-Bacterial Agents↗
PubMed1992

The laboratory and clinical safety evaluation of a dentifrice containing hydrogen peroxide and baking soda.

This study reports the laboratory, clinical, and microbiological finding of the safety testing and daily use of a dentifrice delivering 0.75% hydrogen peroxide and 5% baking soda. Laboratory studies using Ca45 labeled teeth and biologically stained teeth confirmed that the dentifrice did not decalcify enamel or bleach teeth. Over the course of a six-month period, 62 subjects using a hydrogen peroxide-baking soda dentifrice and 21 subjects using a control dentifrice were examined for oral soft tissue change and hard tissue alterations. No soft tissue changes attributable to the use of either dentifrice were noted. Experienced clinicians using Trubyte shade guide teeth observed no significant changes to the subjects' anterior teeth following 6 months use of the test dentifrice. Paired discrimination tests revealed that the examiners could distinguish color differences in the shade guide teeth at 0.7%. Microbiological monitoring of the subjects for six months use of their assigned dentifrice and for the following months on the control dentifrice, revealed neither an increased incidence of candida nor increased candida counts.

Adult↗
PubMed2005

Subsurface microhardness of enamel and dentin after different external bleaching procedures.

PURPOSE: To evaluate the influence of various bleaching systems on subsurface microhardness of enamel and dentin. METHODS: 60 bovine crowns were distributed among seven groups (A: Opalescence Xtra Boost, B: Opalescence Quick, C: Rapid White, D: Whitestrips, E: Opalescence 10%, F: Opalescence PF 15%). The crowns were sectioned and baseline hardness (Knoop) of enamel and dentin was assessed on the sectioned surface at various distances from the enamel surface. The sectioned surface was covered with wax and the enamel was treated for 10 days with the bleaching agents A-F according to manufacturers' instructions. Bleaching with C-F was conducted each day (C: twice per day for 10 minutes, D: twice per day for 30 minutes, E: 8 hours, F: 4 hours), systems A-B were applied on first and fifth days (A: twice for 10 minutes, B: 1 hour). Finally, hardness was re-assessed. Data were statistically analyzed to compare baseline hardness and final hardness in the respective groups (P< 0.05). RESULTS: Analysis showed that in Group C, hardness was significantly reduced in both enamel and dentin. In the remaining groups, significant reduction of hardness was observed up to the following depths [microm] in enamel; A: 250, B: 700, D: 300, E: 150, F: 150. In these groups no significant hardness changes were recorded in subsurface dentin.

Animals↗
PubMed2000

Effects of three concentrations of carbamide peroxide on the structure of enamel.

Carbamide peroxide bleaching agents have raised important questions on their potential adverse effects on the structure of enamel. The purpose of this study was to examine the effects of three carbamide peroxide bleaching agents in different concentrations (10, 16 and 35%) on the structure of enamel. Forty enamel slabs prepared from human third molars were divided equally among four groups. The specimens in the first and second group were subjected to 10% or 16% carbamide peroxide for 8 h per day for 6 weeks. Thirty-five percent carbamide peroxide was applied to the third group for 30 min a day for a 4 day period according to the manufacturers recommendation. The fourth group served as the control and was kept in artificial saliva during the test period. At the completion of the treatment, all the specimens were examined by infrared absorbtion spectroscopy and X-ray diffraction analysis. The results revealed that 10% or 16% carbamide peroxide did not seem to effect the structure of enamel, whereas 35% carbamide did affect the structure. The use of lower concentrations of carbamide peroxide (10-16%) is recommended over higher concentrations (35%) to avoid changes to the enamel.

Carbamide Peroxide↗
PubMed2001

Cytotoxicity of intracanal bleaching agents on periodontal ligament cells in vitro.

Intracoronal bleaching of nonvital teeth is a simple and conservative procedure for esthetic restoration of discolored teeth. However it is possible that damage to the periodontal ligament may occur if the bleaching agents contact this tissue. The purpose of this study was to examine the cytotoxicity of intracanal bleaching agents on human periodontal ligament (PDL) cells in vitro. Three bleaching agents, 30% hydrogen peroxide (H2O2), 2.0 g/ml sodium perborate (SP) solution, and 2.0 g/ml SP in H2O2, were diluted from 10(-3) to 10(-7) with Eagle's minimal essential medium and incubated with PDL cells isolated and cultured from extracted teeth. Cytotoxicity was assessed quantitatively by determining the amount of lactic dehydrogenase activity released from the cells after exposure to the agents for 24 or 72 h. Dose-response curves were plotted, and TD50 values (dilution causing the release of 50% of control lactate dehydrogenase activity) and 95% confidence limits determined. The rank order of the TD50 values after exposure for 24 h was SP in H2O2 (most toxic) > H2O2 > SP solution (least toxic). After 72 h SP in H2O2 still produced the greatest cytotoxic effect. However the SP solution was more cytotoxic than H2O2 at this time point. It is concluded that the mixture of SP with H2O2 was the most toxic to the PDL cells in vitro.

Borates↗
PubMedDate not supplied

Demineralization effects of 2 bleaching procedures on enamel surfaces with and without post-treatment fluoride application.

In this in vitro study, the demineralization effect of 2 different bleaching procedures on enamel surfaces with and without the post-treatment application of fluoride was determined. Bovine enamel specimens (n= 180) were ground flat, polished and divided into 6 groups. Group A (n=30) specimens were bleached with Opalescence, 10% carbamide peroxide (Ultradent Products, Inc) for 8 hours daily for 2 weeks; Group B (n=30) specimens were treated with Whitestrips, 5.3% hydrogen peroxide (Procter & Gamble) for 1 hour daily for 2 weeks; Group C (n=30): the same as Group A, but after bleaching, a fluoride varnish was applied on the specimens and left for 1 hour (Duraphat, 2.26% F-); Group D (n=30): the same as Group B, followed by the same fluoride application as Group C; Group E (n=30): the specimens were covered with a glycerin gel as a control group; Group F (n=30): specimens were kept in Coca Cola 1 hour daily for 2 weeks. The mineral loss (vol% microm) and lesion depth (microm) were measured by microradiography. Data analysis was accomplished using the Kolmogorov-Smirnov, Kruskal-Wallis and Mann-Whitney U tests (p<0.05) (SPSS 11.0). The median mineral loss was statistically significantly higher in the non-fluoride groups (A: 271.20 vs C: 128.00 and B: 364.90 vs D: 151.10). The highest mineral loss was found in Group F (581.85 vol% microm) and was lowest in Group E (32.80 vol% microm). No statistically significant difference between groups was found for lesion depth.

Animals↗
PubMed1998

Use of different concentrations of carbamide peroxide for bleaching teeth: an in vitro study.

OBJECTIVE: This in vitro study compared the shade changes in extracted teeth during 2 weeks' whitening with 5%, 10%, or 16% carbamide peroxide. METHOD AND MATERIALS: After color calibration, the sole examiner selected 110 extracted unrestored, noncarious teeth, shade A3 or darker on a value-oriented guide. The teeth were randomly distributed into equal color groups. The control group (11 teeth) was treated with 0.9% saline, while the experimental groups (33 teeth each) were treated with 5%, 10%, or 16% carbamide peroxide. The solutions remained on the teeth for 8 hours. The teeth and tray were rinsed with tap water for 2 minutes, then rehydrated in 0.9% saline for 16 hours in the humidifier. The shade was assessed, and the process was repeated daily for 2 weeks. RESULTS: Repeated-measures analysis of variance indicated a significant difference in overall shade values between the control and all carbamide peroxide-treated groups at days 8 and 15. A Kaplan-Meier Survival Analysis indicated a quicker two-tab color change for the 10% and 16% groups than the 5% group. However, continuation of the 5% treatment to 3 weeks resulted in shades that approached the 2-week 10% and 16% values. CONCLUSION: Lower concentrations of carbamide peroxide take longer to whitening teeth but eventually achieve the same result as higher concentrations. Higher concentrations may cause increased sensitivity.

Analysis of Variance↗
PubMed1999

Invasive cervical resorption following trauma.

Invasive cervical resorption is an insidious and often aggressively destructive form of external root resorption which may occur as a late complication following dental trauma particularly where it involves damage to cementum and supporting tissues. While this resorption may be evident clinically as a pink coronal discolouration, later with cavitation of the enamel, often there are no obvious external signs and the condition is only detected radiographically. It is characterised by the invasion of the cervical region of the root by fibrovascular tissue which progressively resorbs dentine, enamel and cementum. The dental pulp remains protected by an intact layer of dentine and predentine until late in the process. Ectopic calcifications can be observed in advanced lesions both within the invading fibrous tissue and deposited directly onto the resorbed dentine surface. The aetiology of invasive cervical resorption is unknown but trauma has been documented as a potential predisposing factor. A recent study by the author of 222 patients with a total of 257 teeth which displayed varying degrees of invasive cervical resorption showed that trauma alone was a potential predisposing sole factor in 14% of patients and 15.1% of teeth. Trauma in combination with bleaching, orthodontics or delayed eruption was found in an additional 11.2% of patients or 10.6% of teeth and of these a combination of trauma and bleaching occurred in a relatively high proportion of 7.7% of patients or 7.4% of teeth. This study also revealed that of other potential predisposing factors orthodontics was the most common sole factor constituting 21.2% of patients and 24.1% of teeth examined. Successful treatment of invasive cervical resorption is dependent on the extent of the resorptive process. Teeth with invasive cervical resorption have been divided into four classes. Whilst several treatment modalities are possible, a clinical evaluation of the treatment of this condition by the topical application of a 90% aqueous solution of trichloracetic acid, curettage, endodontic therapy where necessary and restoration with a glass ionomer cement has been evaluated on 94 patients with a total of 101 teeth with a minimum follow-up period of three years. Results indicate a satisfactory treatment outcome can be anticipated in Class 1, 2 and 3 cases. In Class 4 resorption no treatment or alternative therapy is recommended. Diagnosis of lesions at an early stage of development is highly desirable and therefore the patients who have a potential for the development of this condition by virtue of a history such as trauma should be monitored radiographically at intervals throughout life.

Calcinosis↗
PubMedDate not supplied

The effect of 10% carbamide peroxide, carbopol and/or glycerin on enamel and dentin microhardness.

This study evaluated the effects of 10% carbamide peroxide, carbopol and glycerin and their associations on microhardness over time on enamel and dentin. Eight treatment agents were evaluated: a commercial bleaching agent containing 10% carbamide peroxide (Opalescence 10% Ultradent), 10% carbamide peroxide, carbopol, glycerin, 10% carbamide peroxide + carbopol, 10% carbamide peroxide + glycerin, carbopol + glycerin and 10% carbamide peroxide + carbopol + glycerin. Three hundred and twenty human dental fragments, 80 sound enamel fragments (SE), 80 demineralized enamel fragments (DE), 80 sound dentin fragments (SD) and 80 demineralized dentin (DD) fragments, were exposed to the treatment agents (n=10). These agents were applied onto the surface of the fragments eight hours a day for 42 days. After eight hours, they were washed from the dental fragment surfaces after five back-and-forth movements with a soft bristle toothbrush under distilled and deionized running water. During the remaining time (16 hours per day), the fragments were kept in individual vials in artificial saliva. After the 42-day treatment period, the specimens were kept individually in artificial saliva for 14 days. Knoop microhardness measurements were performed at baseline, after eight hours, and 7, 14, 21, 28, 35 and 42 days, and 7 and 14 days post-treatment (corresponding to 49 and 56 days after the initial treatment agent applications). The non-parametric Kruskal-Wallis analysis showed significant differences among the agents at each time interval, except at baseline for sound and demineralized enamel and dentin. For SE, SD and DD, there was a decrease in microhardness values during treatment with all agents. There was a tendency towards lower microhardness values after treatment with carbopol and its associations for sound tissues. DD showed low microhardness values during and after treatment with CP and its associations. For DE, there was an increase in microhardness values during treatment with all agents and in the post-treatment phase. The baseline microhardness values were not recovered during the 14-day post-treatment phase. Opalescence 10%, carbamide peroxide, carbopol, glycerin and their associations may change the microhardness of sound and demineralized dental tissues, even in the presence of artificial saliva.

Acrylic Resins↗
PubMed1998

Nightguard bleaching to lighten a restored, nonvital discolored tooth.

Traditional techniques to lighten discolored endodontically treated teeth have used bleaching materials that had to be applied and directly monitored by dentists. These bleaching techniques have been associated with cervical resorption in nonvital teeth, and the treatment outcome is often difficult to predict. This article describes the use of nightguard bleaching to obtain an esthetic result for a restored nonvital tooth that had been treated with limited success with traditional office-based bleaching procedures.

Adult↗
PubMedDate not supplied

Tooth color improvement for children and teens: enamel microabrasion and dental bleaching.

Enamel microabrasion and carbamide peroxide-dentist supervised home applied dental bleaching are conservative methods of improving the appearance of teeth. Children and teens can benefit from these procedures. This article describes the step-by-step clinical technique of enamel microabrasion and a protocol for custom-tray-applied, home tooth-bleaching. Representative case histories are documented with photographs.

Adolescent↗
PubMed2001

Effect of light-enhanced bleaching on in vitro surface and intrapulpal temperature rise.

PURPOSE: This study investigated the effect of the presence, absence, and aging of a heat-enhancing compound (colorant) added to bleaching gel on the temperature rise of the gel itself, as well as the temperature rise within the pulp chamber, when a tooth was exposed to a variety of light-curing units in vitro. MATERIALS AND METHODS: An extracted human upper central incisor was fitted with thermocouples placed in the pulp chamber as well as on the facial tooth surface. A temperature-controlled simulated intrapulpal fluid flow was provided to the tooth, and bleaching agent (Opalesence XTRA, Ultradent) containing heat-enhancing colorant, aged colorant, or no colorant was applied to the facial surface. The tooth and light-curing unit were placed in a thermostatically controlled oven at 37 degrees C, and real-time gel and intrapulpal temperature values were recorded digitally. Light-curing units used were a plasma arc light (PAC) (PowerPac, ADT), a conventional quartz tungsten halogen source (QTH) (Optilux 501, Demetron/Kerr), the QTH light used in high-power (bleaching) mode, and an argon ion laser (AccuCure 3000, LaserMed). An exposure scenario simulating light-enhanced bleaching of 10 upper teeth was developed. Temperature rise over the pre-exposure, baseline value associated with the last light exposure in the bleaching sequence was calculated for each curing and bleaching combination. Five replications for each test condition were made. Temperature rise values were compared using analysis of variance (ANOVA) at a preset alpha of 0.05. RESULTS: When fresh colorant-containing bleach was used, the PAC light increased bleach temperature 39.3 degrees C above baseline. With no added colorant, temperature rise was 37.1 degrees C. The QTH light in bleach mode resulted in gel temperature 24.8 degrees C above baseline, whereas the temperature increase was only 11.5 degrees C when no colorant was used. Conventional QTH light use increased fresh bleach temperature by 17.7 degrees C, whereas an increase of only 11.1 degrees C was measured without colorant. The argon ion laser produced equivalent temperature rise regardless of the presence or freshness of the colorant, approximately 9.4 degrees C. Intrapulpal temperatures were all significantly lower than those recorded in the bleaching gel and ranged from 5 degrees to 8 degrees C. As a rule, the presence of fresh heat-enhancing colorant in the bleaching gel resulted in a significant intrapulpal temperature increase (approximately 1 degrees C) over that reached using other lights. The PAC and the QTH light used in bleach mode induced greater intrapulpal temperature rise than the laser. CLINICAL SIGNIFICANCE: Freshness of bleaching agent incorporating light-activated, heat-enhancing colorant influences temperature rise of bleaching gel and also may increase intrapulpal temperature values. Use of intense lights does elevate bleach temperature and also results in increased intrapulpal temperature that may further impact on patient sensitivity and pulpal health resulting from this treatment.

Analysis of Variance↗