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PubMedDate not supplied

[The effect of 2 bleaching agents on the enamel surface. An in-vitro study].

We present a study "in vitro" of the effect of bleaching agents on dental surfaces using the "Walking bleaching technique". We found that hydrogen peroxide bleached more quickly than carbamide although, after a period of six weeks, the results were the same as far as whitening was concerned. In the scanning electron microscope we observed significantly different changes in each case. Carbamide caused a regular and uniform opening of the enamel prisms of the surface while hydrogen peroxide produced more severe superficial destruction with the appearance of patterning similar to the acid etching, and the presence of some crystalline areas emerging from the body of the prisms.

Carbamide Peroxide↗

PubMed1991

Effect of cementum defects on radicular penetration of 30% H2O2 during intracoronal bleaching.

Bleaching pulpless teeth with 30% hydrogen peroxide has been reported to cause external cervical root resorption. It has been hypothesized that H2O2 penetrating through open dentin tubules can initiate an inflammatory reaction which could result in root resorption. Extracted human premolars were treated endodontically and bleached intracoronally using the thermocatalytic technique. The teeth were divided into three groups; one group with no cementum defects at the cementoenamel junction, one group with artificial cementum defects at the cementoenamel junction, and another group with artificial cementum defects at the middle third of the root. The radicular penetration of 30% hydrogen peroxide in the three groups was assessed directly and compared using an in vitro model. Radicular penetration of hydrogen peroxide was found in all of the groups tested. The penetration of hydrogen peroxide was significantly higher in teeth with cementum defects at the cementoenamel junction than in those without defects.

Dental Cementum↗

PubMed2006

Separate whitening effects on enamel and dentin after fourteen days.

The purpose of this study was to investigate the mechanism of action of a bleaching agent, as it relates to enamel and dentin. Twenty-six extracted human molar teeth were sectioned at the cemento-enamel junction and were randomly assigned to two groups. L*a*b* readings were taken with a spectrophotometer: on buccal surfaces of the crown, at enamel and dentin. The teeth were exposed to carbamide peroxide or placebo gel and L*a*b* scores were again recorded to determine color changes. Treatments were compared using ancova test with baseline color as the covariate. Relative to placebo, buccal surfaces exhibited the greatest Deltab* and DeltaL* color change. On buccal surfaces, the adjusted mean (SE) treatment differences were -7.8 (1.00) for Deltab* and 5.7 (0.97) for DeltaL, with groups differing significantly (p < 0.0001). On enamel surfaces, treatment differences were -3.6 (0.61) for Deltab* and 4.6 (0.80) for DeltaL* (p < 0.0001). Dentin exhibited the least color improvement. Adjusted mean (SE) treatment differences were -1.9 (0.87) for Deltab* and 2.4 (1.10) for DeltaL*, with groups differing significantly (p < 0.02) on dentin color change. The majority of color change seen on the buccal surface of tooth crowns exposed to carbamide peroxide 15% was because of the color change in enamel. As compared to enamel, dentin was less affected after 14 days.

Analysis of Variance↗

PubMed2002

In vitro evaluation of the effect of a current bleaching agent on the electrochemical corrosion of dental alloys.

The nightguard bleaching of discoloured teeth is currently performed by using % 10 carbamide peroxide. While the material is effective on the bleaching of natural teeth, it may deteriorate crowns, bridges and amalgam restorations placed in the mouth. The purpose of the present study was to investigate the effect of 10% carbamide peroxide on the electrochemical corrosion of various dental casting alloys used for fixed partial dentures and dental amalgam. Tafel extrapolation curves were obtained by the corrosion cell that facilitated simulation of the oral environment and comparison of the corrosion rates of alloys and amalgam was accomplished. The results revealed that unpolished amalgam and nickel-chromium alloy samples had the most and noble alloys had the least corrosion rate.

Carbamide Peroxide↗

PubMed1993

Efficacy of vital home bleaching.

The nightguard vital bleaching technique has become a very common and accepted procedure for many dental practitioners. Much has been written about the procedure's history, safety and technique; little has been done to quantify the specific color changes of teeth resulting it. This clinical study attempted to give a numerical value to the color change through the use of a light transmission densitometer. The maxillary teeth of twenty-five patients were treated as the control. A significant whitening was observed for a majority of the patients during the four-week duration of the study.

Adult↗

PubMed1999

The safety-in-use of 10% carbamide peroxide (Opalescence) for bleaching teeth under the supervision of a dentist.

Fears that the dentist-supervised use of a product that contains carbamide peroxide and that emits hydrogen peroxide may not be safe from the viewpoints of toxicity and cancer risk were engendered by unrealistic animal tests. These fears prompted the UK Government Departments of Trade and Industry (DTI) and of Health (DOH) to try to prohibit the marketing of Opalescence (manufactured by Ultradent Inc.). Faced with the fact that Opalescence had already been awarded a CE mark under the EC Medical Devices Directive, the DTI and DOH attempted to bring about its prohibition by reclassifying Opalescence as falling under the EC Cosmetics Directive, according to which the marketing of products containing more than 0.1% hydrogen peroxide is not permitted.

Animals↗

PubMed2003

Evidence-based decision making in action: Part 2--evaluating and applying the clinical evidence.

This is the second of a two-part series addressing the use of evidence-based decision making (EBDM) in the use of home bleaching. In Part 1, a case scenario demonstrated the skills involved in (1) structuring a clinical question and (2) conducting an online search using PubMed.1 Part 2 demonstrates the third and fourth steps in the EBDM process, i.e., (3) critical appraisal to assess the validity of a study and (4) applying that information to clinical decision making. This 4-step approach to EBDM recognizes that clinicians can never be completely current with all conditions, medications, materials, and products. Thus, EBDM provides a mechanism for addressing these gaps in knowledge in order to provide the best care possible.

Decision Support Techniques↗

PubMedDate not supplied

Influence of different bleaching systems on fracture toughness and hardness of enamel.

This study evaluated the influence of different bleaching procedures on the fracture toughness and microhardness of enamel. The labial aspects of 72 bovine incisors were prepared for microhardness determination. At baseline, Knoop hardness (KH) determination was conducted on each specimen. Moreover, the fracture toughness (FT) of enamel was assessed using Vickers hardness indentations with a load of 9.8 N. The length of both indentations and enamel cracks were recorded and used for calculation of FT. The samples were divided among six (A-F) groups (n = 12) and sectioned, resulting in a control and an experimental half. The samples were stored in artificial saliva for 10 days. The experimental halves were removed from the saliva and subjected to bleaching according to manufacturers' instructions (A: Opalescence Xtra, B: Opalescence Quick, C: Rapid White, D: Whitestrips, E: Opalescence 10%, F: Opalescence PF 15%). Bleaching with C-F was conducted daily (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 the first and fifth day (A: twice for 10 minutes, B: 1 hour). Finally, Knoop hardness and FT were assessed and statistically compared to baseline values using Wilcoxon-tests (p < 0.05). KH and FT of the controls remained stable during storage in saliva. All bleaching regimens resulted in a statistically significant percentage loss of KH (mean + standard error of means): A: 17.3 +/- 2.8%, B: 8.6 +/- 3.3%; C: 83.5 +/- 0.61%, D: 29.0 +/- 1.9%, E: 9.0 +/- 2.91%, F: 5.4 +/- 2.2%. The percentage changes (mean + standard error of means) of FT in the experimental specimens were as follows: A: 3.9 +/- 9.5%, B: 0.1 +/- 4.7%; D: -8.2 +/- 7.1%, E: -18.9 +/- 4.7%, F: -12.0 +/- 4.7%. Due to severe surface softening, FT could not be determined for the samples in Group C. Applying Opalescence 10% resulted in a significant reduction in FT compared to baseline. In the remaining groups, changes in FT were not statistically significant.

Animals↗

PubMed1992

Effects of home bleaching preparations on composite resin color.

The lightening of teeth is done professionally by exposure to warm hydrogen peroxide solutions or at home with an active bleaching gel of perhydrol urea or carbamide peroxide. This study compared the effects of two commercial bleaching gels on the color of composite resin with those in a previous study using the dental office technique. Commercial composite resins test specimens were exposed to the bleaching gels or water (control) for 312 hours at 37 degrees C at 100% relative humidity. Color change value was calculated with before-and-after solution exposure L*a*b* color values. ANOVA (alpha = 0.01) revealed no differences in the color of the specimens after use of the test solutions. All color change values were less than 2 or the normal limit of visual acuity. No visual color change was evident for these composite resins. The at-home method recorded no shade-altering effects compared with the professional technique, which created a noticeable color change.

Analysis of Variance↗

PubMed1991

Histological characterization of bleaching-induced external root resorption in dogs.

External root resorption occasionally develops after intracoronal bleaching with hydrogen peroxide. In this study, an experimental model was established to study thermocatalytic bleaching-induced root resorption in dogs. Histological examination after 6 months revealed that 18% of the teeth had root resorption lesions. The lesions could be divided into three types. In type I, root excavations were associated with a dense inflammatory cell infiltrate. Type II lesions were characterized by granulation tissue formation. In type III, the lesions were filled with reparative cementum. The three types probably represent different phases of one process. Calcium hydroxide had no effect on the occurrence or type of resorption. The instability of hydrogen peroxide and the presence of inflammatory resorption lesions 6 months postoperatively suggest hydrogen peroxide-induced toxic radicals or denaturants as potential irritants.

Animals↗

PubMedDate not supplied

[Evaluation of pH variation and cervical dentin permeability in teeth submitted to bleaching treatment].

External cervical root resorption is one of the disadvantages of the bleaching procedure. There are several mechanisms that may be responsible for causing resorption, such as the chemical and physical action of the utilized materials and the morphology of the cementoenamel junction. The purpose of this study was to investigate the presence of a communication between the pulp chamber and the external root surface. The investigation was carried out by means of pH tests and measurement of dye infiltration into cervical dentin after the bleaching procedure. Thirty-four human permanent incisors were submitted to endodontic treatment. The teeth were assigned to three experimental groups, according to the level at which the filling was cut, and to the sealing of the root canal entrance with glass ionomer cement. Sodium perborate and 30% hydrogen peroxide were utilized for bleaching. pH readings were carried out after 30 minutes, 24 h, 48 h and 72 h from the beginning of the procedure. The teeth were immersed in 0.5% basic fuchsin for 24 h in order to determine possible differences in the permeability of cervical dentin. The results revealed that pH tended to change when the root filling was cut at the entrance of the canal, when 2 mm of the filling were removed, and when the canal entrance was sealed with glass ionomer. Dentinal permeability increased in the three experimental groups, in comparison with the control group. These slight differences may suggest a communication between the pulp chamber and the external root surface.

Dentin↗

PubMed2003

The effect of current bleaching agents on the color of light-polymerized composites in vitro.

STATEMENT OF PROBLEM: Bleaching agents may affect the color of existing composite restorations. PURPOSE: The purpose of this study was to compare the effect of 10% carbamide peroxide and 10% hydrogen peroxide on the color of light-polymerized hybrid, macrofilled, and polyacid-modified composites. MATERIAL AND METHODS: Two light-polymerized hybrid composites (3M Valux and Spectrum TPH), 1 macrofilled condensable composite (Solitaire), and 2 polyacid-modified composites (Dyract AP and Compoglass) were used. The hybrid composites served as controls. The color of 8 specimens of each material was analyzed by use of a spectrophotometer before bleaching. The specimens were then divided randomly into 2 subgroups (n=4). One group was immersed in 10% carbamide peroxide solution and the other in 10% hydrogen peroxide, for 8 hours each for 14 consecutive days. After bleaching, color changes (Delta E) were determined for each material and compared by use of the Kruskal-Wallis test, followed by the Mann-Whitney U test (P<.05). RESULTS: After bleaching with carbamide peroxide, the color changes (Delta E) for Dyract AP (2.18; SD = 1.41), Compoglass (1.14; SD = 0.26) and Solitaire (1.56; SD = 0.89) were higher than the color changes recorded for 3M Valux (0.63; SD = 3.60), and Spectrum TPH (0.66; SD = 1.24). The differences between materials bleached with carbamide peroxide were not statistically significant. After bleaching with hydrogen peroxide, the color changes for Dyract AP (9.39; SD = 0.53) and Compoglass (5.15; SD = 0.52) were higher than the changes recorded for Spectrum TPH (4.53; SD = 1.53) and 3M Valux (3.41; SD = 4.40), whereas the color change of Solitaire (3.69; SD = 0.57) was significantly higher than that of 3M Valux (P=.01). The color changes for all restorative materials tested were clinically detectable after the application of 10% hydrogen peroxide. However, clinically noticeable discoloration was observed only for Dyract AP treated with 10% carbamide peroxide. CONCLUSION: In comparison to 10% carbamide peroxide, 10% hydrogen peroxide caused more color changes in the composites tested.

Carbamide Peroxide↗

PubMed2004

Factors affecting mercury release from dental amalgam exposed to carbamide peroxide bleaching agent.

PURPOSE: To assess, in vitro, the effects of aging and surface polishing on mercury release from dental amalgams exposed to 10% carbamide peroxide at two pH levels. METHODS: Samples of fresh and aged amalgam, polished and unpolished, were treated with 10% carbamide peroxide at pH 4.5 and at pH 6.5 for periods of 1, 4, 7, 10 and 13 days. At each time period, mercury concentrations in solution were measured using a cold-vapor atomic absorption mercury analyzer system and compared to control samples treated with phosphate buffer. RESULTS: Amalgam samples exposed to 10% carbamide peroxide released significantly more mercury in solution than samples exposed to phosphate buffer controls. Mercury release was time-dependent and significantly higher in aged amalgam than in fresh amalgam (P < 0.001). Mercury release was also pH-dependent and higher in unpolished amalgam.

Analysis of Variance↗

PubMedDate not supplied

Carbamide peroxide bleaching: effects on enamel surface hardness and bonding.

Three 10% carbamide peroxide home bleaching agents were evaluated to determine their effects on tensile bond strength of resin to enamel and enamel surface hardness. Eighty extracted bicuspid crowns were divided into four groups (three bleaching agents and control), and treated with the bleaching agents for five consecutive days. A bonding site on the buccal surface of each crown was etched with phosphoric acid and an orthodontic bracket bonded in place. The specimens were thermocycled and loaded to failure in an Instron Universal Testing Machine. Five hardness specimens per group were measured prebleaching and after five days' exposure. Analysis by one-way ANOVA indicated no significant differences in bond strength between the four groups (P > 0.05). There were also no differences in pre- or postbleaching Knoop hardness values for the four groups (P > 0.05). This study indicated that in short-term regimens 10% carbamide peroxide does not significantly affect enamel surface hardness or bonding ability.

Analysis of Variance↗

PubMedDate not supplied

In vivo kinetics of bleaching gel with three-percent hydrogen peroxide within the first hour.

This in vivo study determined the kinetics of 3% hydrogen peroxide in a bleaching gel within the first hour. The material used in this study was 3% hydrogen peroxide gel (Perfecta 3/15, Premier Dental Products Co) and the study involved 10 subjects who met the inclusion and exclusion criteria. Each subject wore the tray with gel six different times on separate days. Evaluation of the remaining amount of hydrogen peroxide was calculated by the method stated in US Pharmacopoeia. The study results indicate that the mean percentage of hydrogen peroxide recovered for 5, 10, 20, 30, 45 and 60 minutes was 61, 56, 49, 44, 38 and 32, respectively. The amount of hydrogen peroxide in the saliva sample after one hour was 0.42 mg. Excluding the first 10 minutes, the kinetics of hydrogen peroxide in the tray and teeth sample was exponential.

Gels↗

PubMed2000

Effect of whitening agents containing carbamide peroxide on cariogenic bacteria.

PURPOSE: The purpose of this study was to investigate the in vitro antibacterial effects of three different carbamide peroxide products (Nitewhite, Opalescence, and Proxigel) on cariogenic microorganisms (mutans streptococci [MS] and lactobacilli), and to evaluate the effects of a 10% carbamide peroxide solution (Proxigel) on salivary levels of MS and lactobacilli clinically. MATERIALS AND METHODS: Growth inhibition studies were performed to determine the concentration and exposure time of carbamide peroxide to give total inhibition of recoverable growth of MS and lactobacilli. Paraffin-stimulated saliva samples were collected from subjects before and after 6 weeks of treatment with 10% carbamide peroxide in bleaching trays, and levels of MS and lactobacilli were determined. RESULTS: The growth inhibition studies showed no visible growth of MS or lactobacilli at 24-, 48-, or 72-hour incubation, after a 2-hour exposure to 1% carbamide peroxide. Identical results were obtained with all three carbamide peroxide products. In the clinical study, the mean salivary MS levels, expressed as logarithm colony-forming units per milliliter (CFU/mL), were 5.38 for the pretreatment samples and 5.23 for the post-treatment samples. The differences were not statistically significant (p > .05). However, there was a reduction in logarithm lactobacilli counts from a mean of 4.12 pretreatment to a mean of 2.74 post-treatment. This was statistically significant (p < .05).

Adult↗

PubMed2000

The walking bleach procedure: an in vitro study to measure microleakage of five temporary sealing agents.

The purpose of this study was to compare the in vitro sealing capacity of five materials, each used as a temporary sealing agent for the walking bleach technique. All teeth received traditional biomechanical root canal instrumentation, after which the walking bleach agent was placed in the pulp chamber space. The occlusal access was sealed with one of five temporary materials: two hydraulic filling materials, a photoactivated resin composite, a zinc oxide-eugenol cement, and a zinc oxide phosphate cement with/without the placement of a piece of rubber sheet that was placed as a barrier to isolate filling material from the bleaching agent. All teeth were stored in a 1% solution of Alcian blue with thermal cycling stress. After 1 wk, they were sectioned longitudinally, and ranked by graded scores of 0 to 3, according to the degree of the dye penetration. Significantly less dye microleakage was observed in the two hydraulic materials than in the photoactivated resin. Both zinc oxide-eugenol and zinc phosphate cements showed a considerable amount of microleakage. There were no significant differences between the groups with and without a rubber sheet. Our data demonstrate that hydraulic filling materials provide the most favorable cavosurface seal when they are firmly packed into the cavity space to prevent microleakage.

Alcian Blue↗

PubMed1993

Esthetic applications of restorative materials and techniques in the anterior dentition.

The esthetic expectations of our patients can be met by doing a thorough initial examination with emphasis on periodontal health, caries incidence, occlusion, possible orthodontic corrections, esthetic needs, and economic concerns. Through proper communication with the patient, a written treatment plan can be developed that uses the various techniques of bleaching, cosmetic recontouring, direct resin bonding, porcelain veneering, or crowning to meet the patient's restorative needs. The most conservative noninvasive techniques should be evaluated first. Often, bleaching and partial direct bonding are all that is needed. If the dentition is badly worn or discolored, then more extensive treatment is indicated. Patients frequently have concerns about longevity of restorations or require very high levels of esthetic correction, which can only be accomplished with more invasive techniques. When patients understand what can be accomplished and are involved in the treatment decision, then successful results are assured. Esthetic restorative dentistry is probably the most rewarding aspect of practice today, but it is also the most challenging. New materials appear and techniques change so rapidly that it is sometimes difficult to keep up. Practitioners should acquire a thorough knowledge of available methods and materials, learn the limitations of these materials and techniques, and master skills through continuing education (courses, journals, and newsletters) as well as chairside repetition as new procedures become available.

Crowns↗