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Microhardness and color changes of human dentin with repeated intracoronal bleaching.

This study investigated the effects of three intracoronal bleaching techniques on the color and microhardness changes of human dentin and compared them to a control group. Twenty-four dentin slabs were derived from extracted maxillary anterior teeth and evenly distributed among four groups. The pulpal surface of each dentin slab was treated with one of the following bleaching techniques: thermocatalytic treatment with 30% hydrogen peroxide, walking bleaching with 2% sodium perborate and a combination treatment that uses both methods. In the control group, the specimens were treated with distilled water. All specimens were subjected to repeated treatment with fresh bleaching pastes on days 0, 7, 14 and 21. During the experimental period, all specimens were placed in individual vials maintained at 37 degrees C and 100% humidity. CIELab color parameters and microhardness (VHN) were evaluated prior to the experiments and seven days after each treatment. All bleaching treatments effectively increased L* values and decreased b* values of dentin. Thermocatalytic bleaching significantly reduced dentin hardness to half its original value after four treatment cycles; whereas, treatment with either walking bleaching or the combined technique did not significantly affect dentin hardness. Because the combination treatment had shown great bleaching efficacy, it can serve as an alternative approach for severely stained teeth.

Analysis of Variance↗

Change in pH of plaque and 10% carbamide peroxide solution during nightguard vital bleaching treatment.

The purpose of this study was to evaluate in vivo changes in the pH of plaque and of a 10% carbamide peroxide solution occurring within the bleaching guard during a 2-hour nightguard vital bleaching procedure. Baseline pH values for plaque and the carbamide peroxide solution were established. A small hole was placed in the anterior interproximal region of the guard to allow placement of the pH electrode. The pH of the carbamide peroxide solution was measured at 5-minute intervals. After 2 hours, the guard was removed and pH of the plaque was remeasured. The procedure was repeated three times on each of four subjects. The mean baseline pH reading for plaque was 6.31 and mean final pH reading was 6.86. The difference was statistically significant. At initial placement of the carbamide peroxide-filled guard, the mean intraguard pH was 4.50 (range of 2.80 to 7.80). The mean peak intraguard pH of 8.06 (range of 7.30 to 8.43), which was significantly different from baseline, was obtained within 31 minutes. The pH of plaque, saliva, and a 10% carbamide peroxide bleaching solution within the guard increased significantly during bleaching and remained significantly elevated for the duration of the study (2 hours).

Carbamide Peroxide↗

A clinical evaluation of bleaching using whitening wraps and strips.

This study evaluated the degree of color change of teeth and the sensitivities of teeth and gums in an in vivo study. Ranir Whitening Wraps (WW2) and Crest Whitestrips Premium (WP2) were used twice a day and Ranir Whitening Wraps (WW1) were used once a day. Color evaluations occurred at baseline, after five and seven-day use of bleaching agent and 14 days post-bleaching. Color change was evaluated objectively and subjectively. Sensitivity evaluations were also accomplished. Seventy-six of the 78 subjects enrolled completed the study. All three products significantly lightened teeth. WW2 lightened more than WP2 and WW1 in L*, a*, b*, E and shade guide value. WP2 lightened more than WW1 in a*, b*, E and shade guide value. There was no difference in tooth sensitivity, but WW1 and WP2 caused less gingival sensitivity than WW2. The mean age of smokers was seven years younger than nonsmokers who qualified.

Adult↗

Effect of bleaching agents on the fluoride release and microhardness of dental materials.

The use of bleaching agents has become a popular procedure for whitening teeth. Recently introduced polyacid-modified composite resins (compomers) have several favorable features, such as improved physical properties and fluoride release. Because these two materials have many possibilities to interact in the oral cavity during dental treatment, it is necessary to understand such interaction. To evaluate the effect of a bleaching agent on dental restoratives, three compomers were photopolymerized and then bleached for 1, 2, 3 and 5 days with the use of 30% hydrogen peroxide. Fluoride release, surface microhardness, and surface modifications were evaluated. It was found that the cumulative fluoride release was found to be linearly correlated to the tested periods of bleaching in all compomers. Among the tested compomers, F2000 showed the highest cumulative fluoride release. Bleached compomers became soft because of surface degradation, so the surface microhardness decreased. F2000 showed an apparent crack formation that was not observed in other compomers. The nearly linear correlation between the filler content and microhardness was found in the control samples. However, the same correlation was not observed after the compomers were stored in a bleaching agent or distilled water.

Compomers↗

Effect of peroxide-based bleaching agents on enamel ultimate tensile strength.

This study evaluated the effects of peroxide bleaching regimens on the ultimate tensile strength (UTS) of human enamel. A resin composite block was built-up on the bonded occlusal surface of 14 extracted, sound, erupted third molars to enable posterior preparation for the microtensile test. The bonded teeth were serially sectioned in a buccal-lingual direction into approximately 0.7-mm thick slices. Each slice was trimmed with a fine diamond bur to reduce the area of the buccal, internal slope of the cusps to a dumb-bell shape with a cross-sectional area of less than 1 mm2. The samples were randomly divided into seven groups (n = 10): unbleached control group and bleached groups treated with six bleaching regimens. The specimens were tested in tension at 0.5 mm/minute and the data were analyzed by ANOVA and Tukey test. Specimens from the control group presented 51.3 +/- 8.6 MPa, while the UTS of bleached enamel ranged from 22.0 +/- 5.6 to 36.3 +/- 9.1 MPa. All bleaching procedures significantly reduced enamel UTS (p < 0.05). Differences were also observed among treatments. The results suggested that bleaching regimens can significantly reduce enamel UTS.

Analysis of Variance↗

Effect of bleaching agents on enamel permeability.

PURPOSE: To evaluate enamel permeability after external bleaching procedures. METHODS: The coronal portion of 75 human canines were covered with an acid resistant varnish, except for a 7.1 mm2 circular area on the labial surface and, according to a randomized complete block design, specimens were allocated to bleaching treatments using carbamide peroxide-containing agents (CP): 10%, 16% or 37%; or a 35% hydrogen peroxide product (HP). The control group was exposed to artificial saliva. The bleaching agents were applied following the manufacturer's recommendations over 21 days. In between bleaching exposures, specimens were stored in artificial saliva. Samples were then prepared according to a histochemical coloring method based on copper sulfate and dithiooxamide solutions. Digital images captured in an optical microscope were used to measure the percentage of copper ion penetration over the total enamel thickness on three sections taken from the exposed area. RESULTS: Analysis of Deviance showed a significant difference for the permeability values among groups (P = 0.046). Likelihood ratio test revealed that the use of the CP10% and HP35% agents caused significantly greater enamel permeability than did the control treatment. No significant differences in percentage of copper ion penetration were found among CP10%, CP16%, CP37% and HP35%. This in vitro study demonstrated that depending on the external bleaching procedure, enamel permeability may be increased.

Analysis of Variance↗

In vitro determination and quantification of 30% hydrogen peroxide penetration through dentin and cementum during bleaching.

Bleaching pulpless teeth with 30% hydrogen peroxide was reported to cause external cervical root resorption. It was hypothesized that H2O2 penetrated open dentin tubules to initiate an inflammatory response that could result in root resorption. No direct experimental evidence was provided to support this theory. An in vitro model for determination and quantification of H2O2 penetration during bleaching procedures is suggested. Artificial defects of the cementum covering the cementoenamel junction were performed in 22 extracted human premolars. After 15 minutes of thermocatalytic bleaching, H2O2 could be detected in the medium surrounding all the tested teeth. Cervical root permeability to 30% H2O2 could reach up to 82% of the total amount applied.

Dental Cementum↗

Effects of staining and bleaching on color change of dental composite resins.

STATEMENT OF PROBLEM: Discoloration of resin-based composites by colored solutions is a common problem. The use of bleaching agents for discolored natural teeth is becoming increasingly popular. It is not clear if bleaching agents can remove the stain from composite resins. PURPOSE: The purpose of this study was to investigate the effects of 2 staining solutions and 3 bleaching systems on the color changes of 2 dental composite resins. MATERIAL AND METHODS: Forty-five disk-shaped specimens (9 x 2.5 mm) of each of 2 composite resins, Filtek Supreme (FS) and Esthet X (EX), were prepared. The specimens were then divided into 3 groups of 15 specimens each and immersed in 2 staining solutions (coffee or red wine) or distilled water (control) for 3 hours daily over a 40-day test period. The 3 groups were then divided into 3 subgroups (n = 5), and 3 bleaching agents (Crest Night Effects, Colgate Simply White Night, or Opalescence Quick) were applied to the surface of the specimens over a 14-day period. Color of the specimens was measured with a spectrophotometer using CIELAB color space relative to CIE standard illuminant D55 at baseline, after staining, and after bleaching. The color differences (deltaE(ab)*) between the 3 measurements were calculated. The value deltaE(ab)* = 3.3 was used as an acceptable value in subjective visual evaluations. Analysis of variance and nonparametric analysis (Kruskal-Wallis test and Mann-Whitney test) were used to analyze the data. RESULTS: After staining, FS had more color change than EX and was more affected by the wine solution. After bleaching, the color of both EX and FS specimens returned to the baseline. The color differences between bleaching and baseline were less than value deltaE(ab)* = 3.3 for all groups. CONCLUSION: The nanocomposite (FS) changed color more than the microhybrid composite (EX) as a result of staining in coffee or red wine solutions. After bleaching, discoloration was removed completely from the composite resins tested.

Analysis of Variance↗

Assessing the effects of 10 percent carbamide peroxide on oral soft tissues.

To examine the effects of a 10 percent carbamide peroxide bleaching gel on the oral soft tissues, the authors conducted a prospective, double-blind, placebo-controlled clinical investigation. Fifty-two patients completed a two-week treatment regimen, applying either a placebo or a 10 percent carbamide peroxide gel in a soft tray for eight hours a day. Clinicians examined the participants' oral soft tissues at baseline and one week, two weeks and six weeks after the first treatment. The examiners recorded the Silness and Löe plaque and gingival indexes, nonmarginal gingival index and nongingival oral mucosal index at each examination. The data collected at these intervals did not indicate that any soft tissue damage had occurred as a result of the bleaching regimen.

Adult↗

Shear bond strength of composite resin to unbleached and bleached human dentine.

The purpose of this study was to compare the shear bond strength of composite resin to unbleached and bleached human dentine when used in conjunction with new dentine bonding systems. One hundred extracted, caries free, permanent human molars were used in this study. An in vitro walking bleach model was developed to stimulate clinical conditions during bleaching. It was found that the mean shear bond strength of composite resin to bleached dentine attained was lower than that to unbleached dentine. The value of 6.7 MPa bond strength to bleached human dentine demonstrated by All-Bond dentine conditioner and adhesive (Technique 1B) was much higher than in previous reports.

Borates↗

Effect of salivary biofilm on the adherence of oral bacteria to bleached and non-bleached restorative material.

OBJECTIVE: The objective of this work was to examine the effect of in vitro salivary biofilm on the adherence of oral bacteria to bleached and non-bleached restorative material (Charisma). METHODS: Charisma samples, prepared in silicon models, were treated with either 10% carbamide peroxide (CP) or 10% hydrogen peroxide (HP). After incubation with the bleaching agent for a period of one, two or three days, the samples were coated with freshly collected human saliva. The adsorption pattern of the saliva to the restorative material was determined using gel electrophoresis coupled with computerized densitometry techniques. The amount of salivary proteins adsorbed onto the treated surfaces was measured using the Bradford method. Sucrose-dependent bacterial adhesion to the salivary-coated Charisma was tested using radio-labeled Streptococcus mutans, Streptococcus sobrinus and Actinomyces viscosus. Adhesion of each bacterium to surfaces pretreated with the bleaching agents was compared with saliva coated bleached surfaces. RESULTS: The profile of salivary proteins adsorption followed a similar pattern in Charisma samples pretreated with either CP or HP or untreated samples. However, the total amount of salivary proteins adsorbed onto the samples decreased after bleaching with CP or HP. Salivary biofilm, coating the surface of the restorative material, significantly decreased sucrose-dependent adhesion of Streptococcus sobrinus and Streptococcus mutans to the bleached and non-bleached surfaces, compared to non-coated specimens (p < 0.05). Saliva had a minor effect on adhesion of Actinomyces viscosus. SIGNIFICANCE: Our study demonstrates the importance of salivary biofilm in controlling adhesion of oral bacteria to restorative material pretreated with bleaching agents or untreated.

Actinomyces viscosus↗

The effect of a vital bleaching technique on enamel surface morphology and the bonding of composite resin to enamel.

This study examined the effect of a nightguard vital bleaching procedure on enamel surface morphology and the shear bond strength of a composite resin luting cement to enamel. Extracted human teeth were bleached for 1 week using a vital bleaching product. Control teeth were brushed with a fluoride toothpaste and processed similarly to the bleached teeth, however the bleaching product was substituted with artificial saliva in the night guards. Teeth were stored in artificial saliva for 24 h, 1, 6 or 12 weeks and then examined for any surface changes using light and scanning electron microscopy. The effect of etching surfaces with 37% phosphoric acid was examined at the scanning electron microscope level. The shear bond strength of composite resin luting cement to both buccal and lingual surfaces of bleached and control teeth was determined. Light microscopy investigation suggested the bleaching process resulted in a loss of mineral from enamel which was evident 24 h after bleaching and was sustained following 12 weeks storage in artificial saliva. Scanning electron microscopy showed a definite change in the surface texture of the bleached enamel surface. Acid etching of the bleached enamel surface produced loss of prismatic form and the enamel appeared overetched. The mean shear bond strength between composite resin luting cement and etched enamel tended to be lower for bleached enamel surfaces, however no significant difference in shear bond strength was noted between control and experimental groups. The results of this study suggest that bleaching resulted in changes to the surface and subsurface layers of enamel. Although surface changes were observed in the etched enamel, the shear bond strength of composite resin luting cement to etched bleached enamel appeared to be clinically acceptable.

Acid Etching, Dental↗

In situ effect of 10% carbamide peroxide on resin-dentin bond strengths: a novel pilot study.

PURPOSE: This pilot study used a novel study design to evaluate the effect of a 10% carbamide peroxide bleaching gel on the bond strength of a resin-based composite system to dentin. MATERIALS AND METHODS: Dentin disks were obtained from human third molars, polished to 600 grit, and mounted on the palatal aspect of a removable orthodontic retainer. Two disks were exposed to a 10% carbamide peroxide bleaching gel for 2 h/d for 21 days, whereas two disks were not treated and served as controls. A retainer was worn by the participant regardless of whether bleaching was used, simulating the action of the saliva/oral fluids on the dentin specimens. After the treatment phase, the dentin disks were retrieved and a resin-based composite system was applied to the specimens following manufacturer's instructions. Composite dentin "sticks" were obtained and tested in microtensile mode. Bond strength values were obtained for treated (n = 20) versus nontreated (n = 26) dentin and were analyzed statistically. RESULTS: Mean bond strengths values (SD) were 29.9 MPa (6.2) and 39.2 MPa (5.8) for treated and nontreated dentin specimens, respectively (p < .001). CONCLUSION: The results of this study suggest that nightguard (home) bleaching with 10% carbamide peroxide for 2 h/d for 21 days significantly affects resin-dentin bond strengths when dentin is exposed to bleaching material. CLINICAL SIGNIFICANCE The findings of this novel pilot study imply that dentin bonding, such as to exposed root surfaces and cervical areas of the teeth, should not be performed immediately after bleaching with 10% carbamide peroxide.

Adult↗

Esthetic alternative for fluorosis blemishes with the usage of a dual bleaching system based on hydrogen peroxide at 35%.

Esthetic dental procedures in pediatric dentistry represent sources of satisfaction and realization, as much for the patient as for the professional. Lack of dental esthetics may develop psychological problems in infant as well as in adolescent patients. Blemishes produced by fluorosis appear as a challenge to the pediatric dentist and alternatives for treatment are desired. The scope of this present paper is to relate a clinical case with esthetic solution for blemishes in teeth enamel due to fluorosis. A dual system of bleaching was used (photo/chemically activated) based on hydrogen peroxide at 35% (Hi-Lite-Shofu) in a male eight-year-old patient with white fluorosis blemishes on teeth 11 and 21. The bleaching system used was efficient in bleaching teeth with white blemishes due to fluorosis, thus masking the blemishes and providing a more uniform appearance.

Child↗

Bleaching, bonding, and veneering: a rationale for material and technique choice.

A vast number of materials and multiple choice treatment options are available for dental corrections, ranging from conservative bleaching to more extensive veneering and crowning. Thus, the choice of the proper technique and materials is a challenge for dentists faced with performing aesthetic dental corrections.

Composite Resins↗

Dental bleaching efficacy with diode laser and LED irradiation: an in vitro study.

BACKGROUND AND OBJECTIVES: Bleaching techniques achieved significant advances with the use of coherent or incoherent radiation sources to activate the bleaching agents. This in vitro study compares the whitening efficacy of LED and diode laser irradiation using the two agents Opalescence X-tra and HP Whiteness. STUDY DESIGN/MATERIALS AND METHODS: A total of 60 bovine incisors were randomly divided into six groups, three for each bleaching agent, receiving only agent, agent and LED (wavelength 470 nm), agent and 1.6 W diode laser (808 nm). The results of the irradiations were characterized using the CIEL*a*b* system. RESULTS: Significant differences in the chroma value are obtained for the two whitening agents and for the different light sources. In terms of lightness, the association of Laser and Whiteness HP bleaching gel showed significantly better results than when the same agent was used alone or in combination with LED. CONCLUSIONS: Best overall results are obtained with the Whiteness HP and Laser association.

Animals↗

Bacterial adherence to bleached surfaces of composite resin in vitro.

OBJECTIVE: The effect of bleaching agents on bacterial adherence to polished surfaces of composite resin restorations was assessed in vitro. STUDY DESIGN: Samples of light-curing composite resins were treated with either 10% carbamide peroxide or 10% hydrogen peroxide for 1, 3, or 7 days. Bacterial adherence of Streptococcus mutans, Streptococcus sobrinus, and Actinomyces viscosus to the treated resin samples was analyzed and compared with adherence to nonbleached controls. RESULTS: A 10% solution of carbamide peroxide caused a significant increase in surface adherence of Streptococcus mutans and Streptococcus sobrinus after 3 days (P < .01). A 10% solution of hydrogen peroxide caused a significant increase in surface adherence of Streptococcus mutans and Streptococcus sobrinus after 3 and 7 days (P < .01). A decrease in adherence of Actinomyces viscosus was found after treatment with 10% hydrogen peroxide for 7 days (P < .05). CONCLUSIONS: It appears that bleaching agents may affect adherence of certain cariogenic microorganisms to the outer surfaces of composite resin restorations.

Actinomyces viscosus↗