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The effect of elapsed time following bleaching on enamel bond strength of resin composite.

Recent studies have concluded that carbamide peroxide bleaching agents significantly affect the bond strength of composite to bleached enamel. This study evaluated the effects of bleaching regimen with different carbamide peroxide concentrations and post-treatment times on composite bond strength to enamel. Two hundred and four flat buccal and lingual enamel surfaces obtained from erupted sound third molars were randomly divided into 17 groups (n = 12). Sixteen experimental groups comprised the evaluation of four carbamide peroxide home bleaching agents (Opalescence 10%-20% and Whiteness 10%-16%) and four time intervals after bleaching (one day, one, two and three weeks). Specimens of control group were not submitted to bleaching and were stored in artificial saliva at 37 degrees C for 10 days. The specimens of experimental groups were exposed to one daily application of carbamide peroxide for six hours for 10 consecutive days. After each daily treatment and post-bleaching, the specimens were stored in artificial saliva solution. Bonds were formed with Scotchbond MP and Z-100 composite resin, and shear bond test was carried out 24 hours after adhesive-composite application. Two-way ANOVA showed that the bond strengths were significantly different (p < 0.05). For the first two weeks post-bleaching, the bond strengths of resin to enamel were low. After a lapse of three weeks, the bond strength returned to that of the untreated control group. Increased concentration did not prolong the time needed prior to bonding.

Analysis of Variance↗

Simultaneous bleaching of vital teeth and an open-chamber nonvital tooth with 10% carbamide peroxide.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of bleaching a nonvital tooth with an open pulp chamber while simultaneously bleaching the other vital teeth with 10% carbamide peroxide. METHOD AND MATERIALS: Ten discolored nonvital teeth were treated. Each nonvital tooth was prepared as in the conventional "walking bleaching" fashion, so that the gutta-percha was sealed from the pulp chamber. The 10% carbamide peroxide was injected into the chamber of the nonvital tooth and loaded into the custom-fitted tray for all teeth. The nonvital teeth were bleached from both the inside and the outside. The patient closed the orifice with a cotton pellet during the day and changed the cotton pellet after meals. The patient applied fresh solution nightly. RESULTS: All teeth were successfully lightened. The time required to lighten the nonvital tooth was related to the duration of the discoloration. CONCLUSION: With proper patient selection and education, this technique can provide an effective way to lighten nonvital and vital teeth simultaneously, especially where extended treatment time may be required for difficult discolorations.

Adult↗

Bonding to previously bleached teeth.

Some authors have reported a decrease in the bond strength of restorative composite resin to previously bleached enamel. Since there has been an increase in the number of adult patients seeking orthodontic treatment, this study was undertaken to determine whether the act of bleaching would somehow affect the bonding of orthodontic brackets to enamel surfaces. Sixty extracted premolar teeth were divided into 6 groups of 10, for comparison of the shear/peel bond strength of orthodontic brackets to enamel using light-cured composite resin cement and a resin-modified glass-ionomer cement. For each material, one group of teeth was used for bonding to unbleached enamel, and the other two for bonding to enamel at 24 hours and 14 days after bleaching. The experimental method simulated clinical procedures as closely as possible. No significant difference in the shear/peel bond strength was found between the bleached and the unbleached groups. t was concluded, therefore, that at-home bleaching with Nite Lite does not affect the shear/peel bond strength of light-cured composite resin and resin-modified glass-ionomer cements used for bracket bonding.

Adult↗

Esthetic dentistry in the twenty-first century. Healthy beauty.

The goal of esthetic dentistry in the twenty-first century is to attain healthy beauty by harmonizing morphology and function. Morphologic beauty is achieved by using restorative techniques such as ceramo-metal restoration, all-ceramic restoration, laminate veneer, bleaching, and the treatment of malocclusion. Functional beauty is obtained by facilitating the primary functions of the stomatognathic organ, namely, mastication, speech, and craniomandibular stability. In the next century, esthetic dentistry must combine the present focus of morphologic beauty with the goals of functional beauty to attain true, healthy beauty.

Adult↗

Microleakage in endodontically treated teeth: influence of calcium hydroxide dressing following bleaching.

AIM: The purpose of the present study was to evaluate microleakage of a fourth generation dentine-bonding agent and composite restoration during a walking bleach treatment. METHODOLOGY: Thirty extracted non-carious incisors were selected and conventional root canal treatment was performed. Teeth were randomly divided into 3 groups (n = 10): group A (control), access cavities were restored with a fourth generation dentine-bonding agent, and incrementally restored with composite resin; group B, a paste composed of sodium perborate and hydrogen peroxide was placed into the pulp chamber and sealed with glass ionomer cement for 7 days, teeth were then restored in the same manner as group A; group C, a paste of sodium perborate and hydrogen peroxide was placed in the pulp chamber for 7 days and then after removal of the bleaching mixture, pulp chambers were filled with a calcium hydroxide paste and cavities sealed with glass ionomer for 1 week. The cavities were then restored with bonded restorations as in groups A and B. Teeth were subjected to thermal cycling and immersed in methylene blue for 8 h. Teeth were sectioned from buccal to lingual, through the centre of the restoration, using a diamond disk. Leakage was assessed using a standard scheme, under magnification (x20). Data were submitted to statistical analysis using nonparametric Kruskal-Wallis test. RESULTS: Groups A and C exhibited similar leakage patterns, and both demonstrated less leakage values than group B (P < 0.05). CONCLUSIONS: It was concluded that bleaching with sodium perborate and hydrogen peroxide increases microleakage; short-term use of a calcium hydroxide medicament did not increase microleakage.

Borates↗

[Bleaching of devitalized teeth with ultrasonic assistance].

A new bleaching technique for pulpless teeth is demonstrated by a clinical case. The principle of the method is to clean the dentinal tubules by an 1% sodium hypochlorite solution activated by a 40 endosonofile. A mixture of sodium perborate and a 3% hydrogen peroxide is left in the pulp chamber between the treatment sessions.

Adult↗

Ultra-morphological study of the interaction of dental adhesives with carbamide peroxide-bleached enamel.

PURPOSE: To evaluate the effects of a carbamide peroxide bleaching agent on interfaces formed by two one-bottle dental adhesives to etched enamel. The null hypotheses tested in this study were that vital bleaching with a commercial 10% carbamide peroxide gel would not (1) increase the concentration of oxygen in the superficial layer of enamel or (2) induce ultra-morphological changes in resin-enamel interfaces. MATERIALS AND METHODS: Five extracted human incisors were treated with 10% carbamide peroxide (Opalescence) for 4 h/day for 1 week and were compared with non-bleached teeth for oxygen, calcium, and phosphorus relative concentration using EDS. Mean elemental concentrations were analyzed using a t-test (bleached vs. unbleached enamel), one-way ANOVA (for surface location and also for depth) and three-way ANOVA (with bleaching treatment, surface location, and depth as the main factors). For TEM, fifteen extracted human molars were sectioned to obtain two crown halves. After roughening the occlusal surface, one half was bleached with Opalescence while the other half was stored in artificial saliva for 1 week. Enamel was etched for 15 s with a 35% phosphoric acid and bonded with one of three adhesives (Prime & Bond 2.1, Syntac Single-Component, or Scotchbond Multi-Purpose Adhesive-control) and a composite resin (Protect Liner F). Small enamel/resin sticks with a cross-section of 1.0 mm x 1.0 mm were removed and the specimens were processed for TEM observation. RESULTS: Vital bleaching with 10% carbamide peroxide caused no significant changes in relative oxygen concentration of enamel. For calcium and phosphorus, bleaching resulted in significant decreased relative concentrations. Bleaching also resulted in morphological alterations in the most superficial enamel crystallites. Some altered crystallites exhibited electron-lucent cores and reduced thickness of material around the core.

Acid Etching, Dental↗

Degradation of bleaching gels in vivo as a function of tray design and carbamide peroxide concentration.

This study determined the degradation of nine bleaching agents with different concentrations after two hours in vivo following the manufacturers' recommendations. The nine carbamide peroxide products are 10%, 15% and 20% Opalescence, 10%, 15% and 22% Rembrandt and 10%, 16% and 22% Nite White Excel 2. Each subject wore the tray with the bleaching agent for two hours on three separate occasions. The amount of remaining carbamide peroxide was determined after each use. Evaluation of remaining amount of carbamide peroxide was calculated by the US Pharmacopeia method. The study showed that the total carbamide peroxide percent recovered was significantly higher for Opalescence products (47% to 54%) compared to Nite White (22% to 25%) and Rembrandt bleaching gels (15% to 16%). It concluded that this difference was mostly due to the use of facial reservoirs with Opalescence products, and also that whitening gel in trays with reservoirs and trays without reservoirs degraded at the same rate.

Adult↗

In vitro peroxide penetration into the pulp chamber from newer bleaching products.

AIM: To investigate peroxide penetration from newer bleaching products into the pulp chamber. METHODOLOGY: Fifty extracted human maxillary central incisor teeth were separated into five groups (n = 10). All the teeth were sectioned 3 mm apical to the cemento-enamel junction; the intracoronal pulp tissue was removed, and the pulp chamber filled with acetate buffer. Buccal crown surfaces of teeth in the experimental groups were subjected to either a whitening strip (containing 5.3% hydrogen peroxide-G1) or one of three paint-on liquid whiteners (containing 19% sodium percarbonate peroxide-G2, 18% carbamide peroxide-G3 and 8.7% hydrogen peroxide-G4). The teeth in the control group (G5) were exposed only to distilled water. The acetate buffer solution in each tooth was then transferred to a glass test tube after 30 min and leuco-crystal violet and enzyme horseradish peroxidase were added, producing a blue solution. The optical density of the resultant blue colour in the tubes was measured by a UV-visible spectrophotometer at a wavelength of 596 nm. The values were converted into microgram equivalents of HP using a spectrophotometric calibration curve. Data were analysed statistically using the Kruskal-Wallis Analysis of Variance and the Mann-Whitney U-test. RESULTS: Statistically significant differences were found between all of the groups (P < 0.05). Pulpal peroxide was not observed in the control group. The amount of hydrogen peroxide (microg) found in the pulp chamber of G1 (0.726 +/- 0.024) > G4 (0.443 +/- 0.017) > G3 (0.231 +/- 0.011) > G2 (0.175 +/- 0.012). CONCLUSIONS: The peroxides from the whitening strip and paint-on whiteners penetrated into the pulp chamber to varying degrees.

Carbamide Peroxide↗

Decomposition rate of hydrogen peroxide bleaching agents under various chemical and physical conditions.

The decomposition rate of 30% hydrogen peroxide was measured when hydrogen peroxide was mixed with 36% hydrochloric acid and anaesthesia either in 5:5:1 solution and in a solution of 20% sodium hydroxide at temperatures of 16 degrees to 20 degrees C and at 45 degrees C, respectively. The effect of ferris chloride on the decomposition of hydrogen peroxide was also observed. The decomposition of 30% hydrogen peroxide in sodium hydroxide solution was faster than that in the mixture of hydrochloric acid and ether at low temperature (16 degrees to 20 degrees C). The decomposition of hydrogen peroxide was accelerated by heat. The experiment implies that the bleaching effect of hydrogen peroxide can be achieved without heat by use of a sodium hydroxide solution. Further study on the rationale of the compound of the McInnes solution (hydrogen peroxide, hydrochloric acid, and anaesthesia ether mixed at a ratio of 5:5:1) is needed.

Chemical Phenomena↗

Tray-forming technique for dentist-supervised home bleaching.

This article provides a comprehensive and detailed description of the technique for making a custom tray for the delivery of bleaching gel in dentist-supervised home bleaching systems. Specific recommendations about certain steps and materials are made and the advantages offered by these variations are explained. This information should facilitate the preparation of the tray by the dental staff in office or provide some guidelines to the dental laboratory to improve its service. The resulting appliance may offer some advantages for patient comfort during specific treatment regimens.

Carbamide Peroxide↗

The effects of bleaching application time on the dental pulp.

This study evaluated and compared pulpal responses of teeth exposed to a 10 percent carbamide peroxide bleaching gel using short and extended application times. Of 28 subjects, four discontinued use because of thermal sensitivity. For the remaining participants, there was no difference between the pulpal readings recorded before the use of the gel or at any point during the study.

Adult↗

Effects of a carbamide peroxide agent and desensitizing dentifrices on enamel microhardness.

PURPOSE: To evaluate the in vitro microhardness of enamel treated with a 10% carbamide peroxide agent and two desensitizing dentifrices at different bleaching times. MATERIALS AND METHODS: A 10% carbamide peroxide bleaching agent was evaluated (Rembrandt 10%) (REM). A placebo agent was used as a control group (PLA). The bleaching and the placebo agents were applied to human enamel dental fragments for 8 hours per day, followed by immersion for 5 minutes in a slurry solution of desensitizing dentifrices: Sensodyne (S) or Sensodyne Fluor (SF). During the remaining time, the enamel fragments were individually stored in 13.5 ml of artificial saliva. Knoop microhardness measurements were performed at baseline, 8 hours, 7, 14, 21, 28, 35 and 42 days of treatment and at 7 and 14 days of a post-treatment period. RESULTS: Analysis of variance and Tukey's test showed no differences in enamel microhardness for REM + SF (P=0.069) and PLA + SF (P=0.93) within each time interval. The dental fragments treated with REM + S and PLA + S showed an increase in microhardness values within each time interval (P<0.0001). There were significant differences among the treatment agents from the 28th to the 56th day. The use of 10% carbamide peroxide bleaching and a desensitizing dentifrice significantly increased the enamel microhardness values during the bleaching treatment and after 14 days after the completion of the treatment. After the post-treatment period, the enamel fragments treated with a placebo agent and with a 10% carbamide peroxide agent and with a desensitizing fluoride dentifrice maintained the baseline values.

Carbamide Peroxide↗

Sealing ability of two intermediate restorative materials in bleached teeth.

This study compared the radicular penetration of bleaching agents in endodontically treated teeth containing an IRM base, a Cavit base, and no base. Forty-five extracted human maxillary central incisors treated with conventional endodontic therapy with laterally condensed gutta percha and sealer were randomly divided into three groups: (1) Cavit base, (2) IRM base and (3) no base. In groups 1 and 2, a 3.5 mm thickness of base material was placed at the time of obturation. After storage in saline for 1 week, the teeth were bleached with a mixture of 35% hydrogen peroxide and sodium perborate, combined with a 10% methylene blue dye solution, using a combination thermocatalytic and non-thermocatalytic bleaching technique. The apical distance of dye penetration was measured. The control group demonstrated dye penetration to the apex, indicating that a base is required to prevent leakage of bleaching agents when this combination of bleaching techniques is used. The mean distance of leakage was 3.43 mm (+/- 1.14) for the Cavit group and 5.94 mm (+/- 1.72) for the IRM group. Analysis with a t-test revealed that Cavit was a more effective barrier to leakage than IRM (T = 4.20, P less than 0.001).

Borates↗

Effect of bleaching on subsurface micro-hardness of composite and a polyacid modified composite.

OBJECTIVE: To investigate the influence of different bleaching techniques on subsurface physical properties of composite and polyacid modified composite tested via determination of micro-hardness. METHODS: Specimens of Tetric Flow, Tetric EvoCeram and Compoglass were light cured (2.5mm thickness) and stored in artificial saliva for 2 weeks (n=12/group). The samples were only removed for application of the following bleaching agents in a humid atmosphere: Either Vivastyle (1h/d), Whitestrips (30min/d), sodium-perborate-water mixture (once for 72h), Simply White (1h/d), or Opalescence XtraBoost (1st and 5th day for 15min) were applied on the surfaces of the samples. Untreated specimens served as negative controls, samples treated with ethyl alcohol for 1h acted as positive controls. After the bleaching period, samples were cross-sectioned and the micro-hardness (Knoop) of different subsurface levels (0.1mm-2.0mm) was determined. RESULTS: All bleaching techniques significantly reduced the Knoop-hardness of the restoratives compared to untreated controls. Thereby, bleaching significantly affected not only superficial but also the deep layers of the specimens: in superficial layers (0.1mm, 0.2mm) lowest micro-hardness values amounted to 69.5% and 76.3% of the respective untreated controls (Compoglass/Vivastyle). In deeper subsurface levels, the lowest hardness was observed with Opalescence/Tetric EvoCeram (0.3mm: 78.3%; 0.4mm: 80%; 0.5mm: 80.5%; 1.0mm: 84.2%; 2.0mm: 84.4%). SIGNIFICANCE: Bleaching with the tested bleaching agents softens the adhesive restorative materials examined. Due to the fact that subsurface layers are also affected, polishing of the surface may not suffice for re-establishing the physical properties of the surface of the fillings.

Borates↗

Comparative clinical trials and the changing marketplace for oral care: innovation, evidence and implications.

The development of a trayless bleaching system (Crest Whitestrips) and a novel battery-powered toothbrush (Crest SpinBrush) has fueled growth in the bleaching and power toothbrush markets. Beyond offering convenient, low-cost options for patients, the effectiveness of each product is supported by a robust clinical program. New comparative research involving these products expands evidence on the clinical meaningfulness of the benefits of this whitening system and powered toothbrush for patient care.

Clinical Trials as Topic↗

Immediate bonding to bleached enamel.

This research sought to determine the shear bond strength, degree of resin infiltration and failure mode when organic solvent-based adhesives (acetone or ethanol) were used in immediate bonding to enamel bleached with 10% carbamide peroxide or 38% hydrogen peroxide systems. Seventy-two non-carious bovine incisors were randomly assigned to three groups of 24 specimens each-control group (deionized water), 38% hydrogen peroxide bleach group and 10% carbamide peroxide bleach group. Each group was further subdivided into two subgroups of 12 specimens each according to the adhesive system used to bond the resin composite to enamel surfaces. The two adhesive systems used were Single Bond, an ethanol-based adhesive, and One Step, an acetone-based adhesive. The shear bond strengths of 38% hydrogen peroxide and 10% carbamide peroxide were significantly lower compared to the non-bleached controls. Fractography revealed an adhesive failure mode in all specimens. Qualitative comparisons of resin tags present in the bleached and unbleached specimens using scanning electron microscopy (SEM) revealed few, thin and fragmented resin tags when 38% hydrogen peroxide and 10% carbamide peroxide were used.

Acetone↗

In vitro action of various carbamide peroxide gel bleaching agents on the microhardness of human enamel.

The authors verified a decrease in human enamel microhardness after application of the following carbamide peroxide gel bleaching agents for 8 hours daily for 1 week: 10% Nite White, 16% Nite White, Opalescence, Karisma Alpha and Perfect Smile. Statistical analysis showed that these agents caused a decrease in enamel microhardness. Nite White (16%) was the most effective in reducing enamel microhardness and Opalescente the least effective. Nite White (10%), Karisma Alpha and Perfect Smile fell into a statistically intermediate position.

Carbamide Peroxide↗