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A 180-day clinical investigation of the tooth whitening efficacy of a bleaching gel with added amorphous calcium phosphate.

OBJECTIVE: The purpose of this study was to determine if there are any significant long-term clinical benefits, or side effects, caused by the addition of amorphous calcium phosphate (ACP) to a professional, 16% peroxide bleaching gel. METHODOLOGY: This study examined the effect of bleaching gel with added ACP in a subset of subjects (n=27) from a previously published, short-term (n=50) study, in which two groups were assigned to use either an experimental ACP-containing gel or a similar "control" gel. Both groups used the product for four hours (or overnight) daily for 14 days. In the present study, the long-term ACP effects on tooth color, gingival health, and three measures of dentinal hypersensitivity at post-treatment days +90 and +180 were assessed. RESULTS: In the previously published study, at day +five, the difference in tooth whitening efficacy (relative to baseline) between the test group and the control group was only 0.19 shades and was not statistically significant. In the present study, at day +90, the differences between the groups had almost doubled, and were calculated to be 0.34 shades (statistically different; t-test p = 0.002). Furthermore, at day +180, the differences had more than doubled again, with the ACP group subjects' teeth being 0.78 shades lighter than the control group's teeth (statistically different; t-test p = 0.002). Considered as a percentage, at day +180 the ACP group had retained nearly 10% more of their original whitening treatment result compared to control. There were no other significant differences found between the two groups. Tooth sensitivity, soft tissue health, and gingival health remained similar to baseline levels. CONCLUSIONS: This study demonstrated that the ACP product offers 10% better long-term (6-months) whitening efficacy than the traditional bleaching gel tested. The long-term safety of the product has also been demonstrated, as there were no adverse gingival or other effects seen at either day +90 or day +180.

Adult↗

Bleaching agents.

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Dental Enamel↗

Postoperative dental bleaching: effect of microleakage on Class V tooth colored restorative materials.

The effect of 3 percent, 11 percent, and 16 percent carbamide peroxide bleaching solutions and 35 percent hydrogen peroxide bleaching gel on microleakage of Class V composite resins, resin modified glass ionomer cements, and compomer restorative materials together with corresponding (if indicated) fourth/fifth generation bonding agents was evaluated using previously extracted human teeth. Five groups of Class V cavity preparations were placed in enamel of the facial surfaces of 200 teeth. Groups A through D included 40 restorations each (4 different restorative materials and their accompanying bonding agent multiplied by 10 teeth) treated with 3 percent, 11 percent, and 16 percent carbamide peroxide bleach and 35 percent hydrogen peroxide bleach. Group E included 40 restorations without treatment of bleach and stood as the control. The restorative materials included were: Fuji II LC resin modified glass ionomer cement, Helioprogress composite resin/-Heliobond adhesive system, Aelitefil composite resin/Allbond 2 adhesive and Dyract compomer material/Prime & Bond adhesive system. Bleaching agents included were Rembrandt 3 percent peroxide gel, Perfecta 16 percent carbamide peroxide gel, White & Brite 11 percent carbamide peroxide solution and Superoxyl 35 percent hydrogen peroxide gel. All teeth were thermally stressed for 100 cycles and microleakage were assessed by dye penetration. The results were tabulated using Analysis of Variance (ANOVA) testing procedures. The Aelitefil composite resin material behaved the least favorably (relative to microleakage) compared to the other materials when exposed to various concentrations of dental bleaching agents.

Analysis of Variance↗

Pulp reaction to vital bleaching.

This study evaluated the histological changes in dental pulp after nightguard vital bleaching with 10% carbamide peroxide gel. Fifteen patients between 12 and 26 years of age with caries-free first premolars scheduled for orthodontic extraction were treated with 10% Opalescence (Ultradent Products, Inc). Tooth #5 had four days of bleaching, tooth #12 was treated for two weeks, tooth #21 was bleached for two weeks followed by two weeks without treatment and tooth #28, serving as the control, was without treatment. All teeth were extracted at the same time. Immediately after extraction, 4 mm of the most apical portion of the root was sectioned off and each specimen was placed in a vial containing 10% neutral buffered formalin. The samples were prepared for histological evaluation at the Scandinavian Institute of Dental Materials (NIOM) and microscopically examined independently at both NIOM and Indiana University School of Dentistry (IUSD). Pulp reactions were semi-quantitatively graded as none, slight, moderate and severe. Slight pulpal changes were detected in 16 of the 45 bleached teeth. Neither moderate nor severe reactions were observed. The findings indicate that the slight histological changes sometimes observed after bleaching tend to resolve within two weeks post-treatment. Statistical differences existed only between the untreated control and the four-day (p=0.0109) and two-week (p=0.0045) treatment groups. The findings from this study demonstrated that nightguard vital bleaching procedures using 10% carbamide peroxide might cause initial mild, localized pulp reactions. However, the minor histological changes observed did not affect the overall health of the pulp tissue and were reversible within two weeks post-treatment. Therefore, two weeks of treatment with 10% carbamide peroxide used for nightguard vital bleaching is considered safe for dental pulp.

Adolescent↗