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PubMed1996

Clinical efficacy of a degradable film-forming product containing carbamide peroxide to reduce tooth discolouration.

The methods used to lighten tooth discolouration while conserving the tooth structure have attracted much attention in a society which places a high value on esthetics. The purpose of this article is to present a home bleaching agent that uses a film-forming preparation containing carbamide peroxide (CP) which, while degrading, serves as a slow release delivery system of the bleaching agent. The efficacy of the preparation containing 3% CP and 10% CP on reduction of tooth discolouration is evaluated by a Chromameter in a double-blind placebo-controlled study. The effect of the tested bleaching agent on the gingival status, plaque accumulation and pulp sensitivity is also assessed.

Adolescent↗
PubMed2000

Bleaching and temporomandibular disorder using a half tray design: a clinical report.

A maxillary soft, custom-fitted tray was fabricated for a patient to perform nightguard vital bleaching. Treatment was interrupted after the patient experienced pain in the temporomandibular joint area shortly after wearing the bleaching prosthesis. The tray was trimmed so the labial, incisal and buccal cusps were covered and Sc) the patient had complete tooth-to-tooth contact in the maximum intercuspal position. The prosthesis proved to be retentive even without the presence of the bleaching material. The thick, sticky bleaching material was contained in the half tray design and the tray was held in place. The patient was able to continue the bleaching process for the 2-week duration necessary to achieve successful lightening of the teeth without further TMD symptoms.

Adult↗
PubMed2005

Bleaching-induced colour change in plastic filling materials.

The purpose of this in vitro study is to compare the colour changes of five different tooth-coloured restoratives: Ormocer (Definite/Degussa), compomer (Dyract AP/Dentsply De Tray), packable composite (Filtek P60/3M), flowable composite (Filtek Flow/3M) and hybrid composite (Filtek Z250/3M) after two different bleaching regimens [Vivastyle (10% carbamide peroxide)/Vivadent and Crest Professional Whitestrips (6.5% hydrogen peroxide strip bands)/Procter & Gamble]. Fifteen specimens of 30 x 30 x 2mm(3) size were fabricated from each material and randomly divided into three groups of five. Specimens in group one were stored in distilled water at 37 degrees C for two weeks and served as control. Group two specimens were treated with Vivastyle for two hours per day for two weeks and group three specimens were treated with Whitestrips for 30 min twice daily for two weeks. During the test period the specimens were kept at 37 C and in 100% relative humidity. At the end of the bleaching regimens colour measurements of the control and test groups were made with UV visible recording spectrophotometer. Colour changes were calculated with the use of the CIE-LAB uniform colour scale and compared by the use of Kruskall-Wallis test, followed by the Mann-Whitney U test. Control, Vivastyle and Whitestrips L*, a* and b* values differed significantly for all materials except Filtek Z250 (p < 0.05). All restorative materials demonstrated significantly higher colour change (DeltaE) with Whitestrips (p < 0.05). Dyract AP demonstrated the highest colour change both for the bleaching regimens followed by Filtek Flow, Definite, Filtek P60, and Filtek Z250 showed the smallest colour change. Colour change of plastic restorative materials during bleaching is both filling material and bleach specific.

Color↗
PubMed2003

The effect of a 10% carbamide peroxide home bleaching system on the gingival health.

Esthetics plays an important role in dentistry today. Because of an increased emphasis on beauty and health, cosmetic dentistry has been the thrust to the forefront of many practices. Many health products are used for bleaching teeth, but all side effects are not known. Tooth sensitivity and gingival irritation are the most common side effects, but they are typically mild and transient in nature. The aim of this investigation was to evaluate objectively the effect of 10% carbamide peroxide gel (Opalescence Utradent Inc, USA) on gingival health by measuring changes in Bleeding Index, Plaque Index, and Gingival Index. Eighteen subjects, 11 female and 7 male, age range 15-30 years (mean 24 years), were selected for the study as a convenient sample. Their teeth had either fluorosis, dental stains, smoking, or tetracycline staining. The Opalescence system was used as office monitored, at-home bleaching for three weeks. There was a statistically significant reduction in bleeding on probing (1% - 37%, p < or = 0.003), Plaque Index (4% - 50%, p < or = 0.000), and Gingival Index (2.5% - 34%, p < or = 0.002). Only two subjects reported tooth hypersensitivity, and none of the subjects complained about gingival irritation. There was a positive change in tooth color as far as staining was concerned. Further research including randomized controlled, double blind clinical trials is needed to confirm these findings and to examine other factors related to bleaching of teeth.

Adolescent↗
PubMed1999

Efficacy of nightguard vital bleaching technique beyond the borders of a shortened tray.

PURPOSE: The purpose of this study was to determine if bleaching extends beyond the borders of a shortened tray or if a demarcation line is found. MATERIALS AND METHODS: Fifteen extracted teeth were selected darker than B2 on a Vita Lumin Shade guide (Vita Lumin, Bad Sackingen, Germany). The teeth were mounted in arch-like fashion in dental stone. Alginate impressions were made, and a stone replica of the four arches of teeth was generated. Vacuum-formed bleaching trays were fabricated for each arch, without and with reservoirs, as per the product to be tested. The nonreservoir trays were trimmed to one half the clinical crown length, and the reservoir trays were trimmed 1 mm beyond the border of the half-length reservoir. Measurements were taken from the cementoenamel junction (CEJ) to the tray border for each tooth. The trays averaged 5.1 mm short of the CEJ. The reservoir group was treated with viscous glycerin-based 10% carbamide peroxide (Opalescence, Ultradent Products Inc., South Jordan, Utah); the nonreservoir group with creamy dentifrice-based 10% carbamide peroxide (Platinum, Colgate Oral Pharmaceuticals, Canton, Massachusetts). The trays were loaded and fully seated on the teeth. Excess bleaching material was removed with a toothbrush and water rinse. Each assembly was placed in a humidor with incisal edges down to simulate oral conditions. The process was repeated for fourteen 6- to 8-hour bleaching sessions. Blinded and nonblinded operators determined post-bleaching shades, with consensus reached on differing shades. RESULTS: All teeth demonstrated lightening of 1 to 10 (mean 5.2) increments on the value-oriented shade guide. The bleaching effect extended beyond the tray and no demarcation lines were noted on any of the teeth. CLINICAL SIGNIFICANCE: This in vitro study suggests that successful bleaching occurs beyond the borders of inadvertently shortened trays. The clinician does not necessarily need to remake the tray if the tray does not cover all portions of the tooth.

Carbamide Peroxide↗
PubMed2006

The effect of 16 percent carbamide peroxide on enamel staining susceptibility.

STATEMENT OF PROBLEM: Recently, vital bleaching by carbamide peroxide has become more popular; therefore, it is necessary to study the effect of this agent on enamel and dentin. PURPOSE: The purpose of this study was to evaluate the effect of a 16 percent carbamide peroxide bleaching gel, Vivastyle, on enamel staining susceptibility. MATERIALS AND METHODS: Thirty bovine specimens were selected and randomly divided into two groups of 15. The experimental group was subjected to Vivastyle gel and then was immersed in coffee for half an hour daily for three weeks. The control group was only immersed in coffee. The teeth were evaluated using a colorimeter to measure L*, a*, b* of each tooth. Value (black to white) is denoted as L*, wheres chroma (a* b*) is denoted as red (+a*), green (_a*), yellow (+b*), and blue (_b*). Total color differences between two colors (deltaE) were calculated using the following formula: deltaE = [(deltaL*)2 + (deltaa*)2+(deltab*)2]: deltaE1.Bleached, AE2: bleached and immersed in coffee, deltaE3: immersed in coffee. RESULTS: Mean differences were: deltaE1 = 9.478, deltaE2 = 13.808 and deltaE3 = 7.230. Paired comparison by use of Duncan test showed there was a significant difference between deltaE1 and deltaE2 (P0.000); and t test showed there was no significant difference between deltaE3 and deltaE1. (P0.08 > 0.05), but deltaE3 showed a significant difference with deltaE2(P0.000). CONCLUSION: After vital bleaching, the enamel staining susceptibility significantly increased.

Animals↗
PubMed1999

Clinical trial of three 10% carbamide peroxide bleaching products.

BACKGROUND: A profusion of commercial bleaching systems exists on the market today, but there are few clinical comparisons of these systems. METHODS: In this study, three different commercial 10% carbamide peroxide bleaching systems were used by 24 patients in an overnight protocol for two weeks. Each patient used two of the bleaching products simultaneously in a side-by-side comparison. RESULTS: The mean onset of tooth whitening was 2.4 +/- 1.7 days. Tooth sensitivity was the most frequent side effect, as 64% of the patients reported tooth sensitivity occurring after 4.8 +/- 4.1 days and lasting for 5.0 +/- 3.8 days. Although intrapatient differences were recorded for the three commercial 10% carbamide peroxide bleaching systems by the patients, there were no statistical differences in the time of onset of subjective tooth whitening and the onset, frequency and duration of tooth sensitivity among the three commercial bleaching systems when compared pairwise or independently (p < 0.05). CONCLUSION: Selection of which bleaching product to use should be based on the concentration of the active ingredient, the viscosity of the product and other marketing features. Further research is needed to investigate the causes of tooth sensitivity and methods to reduce its severity and frequency.

Adolescent↗
PubMed1997

Effect of 10 percent carbamide peroxide on color of provisional restoration materials.

To improve esthetic results, nightguard vital bleaching of teeth using 10 percent carbamide peroxide, or CP, may be indicated when an anterior tooth is restored with a provisional crown. This study evaluated the effect of NGVB solutions containing 10 percent CP on the color stability of provisional restoration materials. Disks were fabricated from six representative provisional restoration materials and were tested in five different 10 percent CP bleaching agents. An orange discoloration occurred with provisional materials that contained methacrylate when they were exposed to 10 percent CP bleaching solutions.

Carbamide Peroxide↗
PubMed1989

[Tooth discoloration possibly caused by medication (tetracycline)].

In this study, the following procedures to remove discoloration were performed, using a modified version of the Walking-Bleach method. 1) The stained dentin was removed as much as possible. 2) Effect of decolarion were enhanced by etching on the dentin. 3) After a desirable color was obtained, total etching and restoration with adhesive composite resin were conducted for strengthening and aesthetic recovery. Tooth discoloration due to tetracycline, 3 subjects in this study, has previously been regarded as difficult to bleach, could be carried out satisfactorily with few appointments. Consequently, this modification of the Walking-Bleach method was considered as one of effective methods.

Humans↗
PubMed2006

[Improvement of aesthetics by porcelain laminate veneers].

PATIENT: The patient consulted our department with a chief complaint of aesthetic problems due to anterior tooth discoloration. Since improvement by bleaching was considered impossible, porcelain laminate veneer restorations were performed. DISCUSSION: Insertion took too long for the patient's satisfaction due to the repetition of color adjustment and recontouring. The veneer preparation area should be limited to enamel; however when dentin is exposed, it is important to treat with primer before adhesion. CONCLUSION: In this case, establishing a selection criterion for bleaching, a combined approach was also considered. Although the preparation area is limited to enamel, phosphoric acid etching should be avoided when dentin is exposed. The treatment process should be arranged so as to reduce the manipulation period.

Adult↗
PubMedDate not supplied

Permeability of enamel following light-activated power bleaching.

This study sought to ascertain whether in-office photocured bleaching techniques would increase permeability to enamel. A 7.1 mm2 circular area located in the middle third of the coronal portion of 90 human canines was isolated by applying an acid-resistant varnish to the remaining surfaces of the tooth. According to a randomized complete block design (n = 15), specimens were treated using a 35% hydrogen peroxide bleaching product activated by an integrated LED/diode laser (LED/laser) source or a quartz tungsten halogen (QTH) light. Bleaching was accomplished by applying the 35% hydrogen peroxide agent to the enamel surface in three 10-minute sessions, conducted at one-week intervals over a period of three weeks. For the photocured bleached groups, a bleaching agent was applied to the specimen and irradiated with the LED/laser device or the QTH light for 30 seconds. Negative control groups were exposed to artificial saliva or irradiated by the LED/laser device or the QTH light. Specimens were subjected to a histochemical coloring method that employed copper sulfate and dithio-oxamide solutions. Three 300-microm thick sections taken from the exposed area were imaged in an optical microscope. Permeability was measured in the digitized images as the percentage of copper ions penetration over the total enamel thickness. Friedman's test (alpha = 0.05) showed significant difference among groups. Least significant difference test revealed that in comparison with the group treated with 35% hydrogen peroxide only, there was no significant increase in enamel permeability when bleaching was activated by either the LED/laser or QTH light devices but all bleached groups showed higher permeability than the unbleached/nonirradiated group.

Analysis of Variance↗
PubMed2002

Safety and stability of nightguard vital bleaching: 9 to 12 years post-treatment.

PURPOSE: The purposes of this retrospective case series study were to evaluate safety issues and determine participants' perceptions of a nightguard vital bleaching (NGVB) technique approximately 10 years post-treatment (average, 118 mo; range, 108-144 mo). MATERIALS AND METHODS: The study sample included 30 (79%) of 38 participants who had completed a previous NGVB study using a 10% carbamide peroxide solution (Proxigel or Gly-Oxide) in a custom tray for 6 weeks. Participants were asked whether there had been any change in the shade of their teeth post-treatment and, if so, to quantify the change on a verbal scale. In addition, 19 participants had gingival index and tooth vitality evaluated clinically, external cervical root anatomy evaluated radiographically, and enamel surface changes evaluated microscopically. RESULTS: Thirty-five (92%) of the original 38 participants had successful lightening of their teeth. At approximately 10 years post-treatment (average, 118 mo; range, 108-144 mo), external cervical resorption was not diagnosed and gingival index and tooth vitality findings were considered within the normal expectations for the sample studied, suggesting minimal clinical post-NGVB side effects at approximately 10 years. Scanning electron microscopic observations did not reveal substantial differences between treated and nontreated surfaces. Color stability, as perceived by 43% of the participants, may last approximately 10 years (average, 118 mo; range, 108-144 mo) post-treatment. CLINICAL SIGNIFICANCE: Nightguard vital bleaching using 10% carbamide peroxide is safe and effective, with no noticeable side effects, at approximately 10 years (average, 118 mo; range, 108-144 mo) post-treatment. Color stability, as perceived by 43% of the participants, may last 108 to 144 months post-whitening.

Adult↗
PubMed1996

Effects of hydrogen peroxide-containing bleaching agents on the morphology of human enamel.

The effects of four bleaching agents (Opalescence, HiLite, 30% hydrogen peroxide, and 30% hydrogen peroxide mixed with sodium perborate) and 37% phosphoric acid on the external surface of human enamel were examined with the scanning electron microscope. The materials were applied to the enamel surfaces of 60 specimens obtained from 10 teeth. Each test agent was applied to one specimen from each tooth. One specimen of each tooth was left untreated. Comparison to the untreated control surfaces revealed that enamel exposed to the bleaching agents underwent slight morphologic surface alterations. The enamel surfaces treated with phosphoric acid, in contrast, showed severe morphologic alterations.

Dental Enamel↗
PubMed2005

Two-year clinical evaluation of nonvital tooth whitening and resin composite restorations.

BACKGROUND: Adhesive systems, resin composites, and light curing systems underwent continuous improvement in the past decade. The number of patients asking for ultraconservative treatments is increasing; clinicians are starting to reevaluate the dogma of traditional restorative dentistry and look for alternative methods to build up severely destroyed teeth. PURPOSE: The purpose of this study was to evaluate the efficacy of nonvital tooth whitening and the clinical performance of direct composite restorations used to reconstruct extensive restorations on endodontically bleached teeth. MATERIALS AND METHODS: Twenty-one patients 18 years or older were included in this clinical trial, and 26 endodontically treated and bleached maxillary and mandibular teeth were restored using a microhybrid resin composite. Patients with severe internal (tetracycline stains) and external discoloration (fluorosis), smokers, and pregnant and nursing women were excluded from the study. Only patients with A3 or darker shades were included. Teeth having endodontic access opening only to be restored were excluded; conversely, teeth having a combination of endodontic access and Class III/IV cavities were included in the study. A Vita shade guide (Vita Zahnfabrik, Bad Säckingen, Germany) arranged by value order was used to record the shade for each patient. Temporary or existing restorations were removed, along with a 1 mm gutta-percha below the cementoenamel junction (CEJ), and a resin-modified glass ionomer barrier was placed at the CEJ. Bleaching treatment was performed using a combination of in-office (OpalescenceXtra, Ultradent Products, South Jordan, UT, USA) and at-home (Opalescence 10% PF, Ultradent Products) applications. Two weeks after completion of the bleaching, the teeth were restored using a combination of PQ1 adhesive system and Vit-l-escence microhybrid resin composite (Ultradent Products). Wedge-shaped increments were placed and cured using the VIP Light (Bisco, Inc Schaumburg, IL, USA) through a combination of pulse and progressive curing techniques. RESULTS: All but one restoration were evaluated by two independent evaluators every 6 months during a 2-year period using modified US Public Health Service criteria. No restoration failed and "alpha" scores were recorded for all parameters but color stability, which was scored "bravo." Analysis of variance showed a significant shade change between baseline (mean=14.4+/-1.9) versus 2 weeks (mean=1.6+/-0.7) and 2 years (mean=2.8+/-1.7) (p<.0001). Although a significant shade change was observed between 2 weeks and the 2-year follow-up (p=.008), no significant difference was reported between the baseline and 2 weeks (12.9+/-2) versus baseline and 2 years (11.9+/-2.3). CONCLUSIONS: Significant tooth lightening was reported after the completion of whitening therapy on devitalized teeth; shade rebound was reported in less than 50% of the treated teeth and was limited to a maximum of four shades. A microhybrid resin composite demonstrated excellent clinical performance in the restoration of all endodontically treated and bleached teeth after a 2-year evaluation period. CLINICAL SIGNIFICANCE: Nonvital tooth whitening is responsible for a significant change in color of endodontically stained teeth. Successful nonvital tooth-whitening therapy allows for conservative tooth preparation, preserving and reinforcing sound tooth structure. The proper use of modern adhesive systems along with resin composite restorations precludes the use of more extensive restorative treatment, delaying expensive crown and bridge procedures.

Carbamide Peroxide↗
PubMed2006

External bleaching therapy with activation by heat, light or laser--a systematic review.

OBJECTIVE: External bleaching procedures utilizing highly concentrated 30-35% hydrogen peroxide solutions or hydrogen peroxide releasing agents can be used for tooth whitening. To enhance or accelerate the whitening process, heat-activation of the bleaching agent by light, heat or laser is described in the literature. The aim of the present review article was to summarize and discuss the available information concerning the efficacy, effects and side effects of activated bleaching procedures. SOURCES: Information from all original scientific full papers or reviews listed in PubMed or ISI Web of Science (search term: (bleaching OR brightening OR whitening OR colour) AND (light OR laser OR heat OR activation)) were included in the review. DATA: Existing literature reveals that activation of bleaching agents by heat, light or laser may have an adverse effect on pulpal tissue due to an increase of intra-pulpal temperature exceeding the critical value of 5.5 degrees C. Available studies do not allow for a final judgment whether tooth whitening can either be increased or accelerated by additional activation. CONCLUSION: Therefore, application of activated bleaching procedures should be critically assessed considering the physical, physiological and patho-physiological implications.

Humans↗
PubMed1989

Surgical-restorative treatment of bleaching-related external root resorption.

Three teeth in 2 patients were treated after intracoronal bleaching with 30% hydrogen peroxide had resulted in external root resorption. An attempt to treat one tooth by placing an intracoronal dressing with calcium hydroxide had failed. The resorption defects were exposed surgically by reducing and re-contouring the alveolar crest. The restorations were made during the surgical procedure, with a light-cured composite in one case and with amalgam in the other, and were of compromised quality due to the difficulty of control. One year follow-up examinations revealed periodontal complications in both cases, in the form of a further resorption of the alveolar crest and gingival edema. These sequelae suggested that the restoration of bleaching-related resorption defects should have been a secondary stage, after the surgical exposure of the defects had been completed first. For the purpose of exposing the defects, the level of the alveolar crest should be reduced enough to secure a biological width from the restorations.

Adult↗
PubMed2004

Considerations in intracoronal bleaching.

Intracoronal bleaching is a simple, useful procedure for restoring the colour of discoloured root-filled teeth that are not extensively restored. It is important to minimise the extraradicular diffusion of hydrogen peroxide, as excessive levels of hydrogen peroxide in conjunction with existing inflammatory changes in the periodontium predispose the tooth to external root resorption. To keep the levels of extraradicular diffusion of hydrogen peroxide below the safety limit, it is imperative that an effective intermediate base cement of at least 2 mm be placed at the level of the buccal cemento-enamel junction over the root-filling prior to bleaching. The use of 35% carbamide peroxide as the intracoronal bleaching agent seems to combine the safety of sodium perborate together with the efficacy of 35% hydrogen peroxide. As bleaching agents may reduce the composite-tooth bond of some adhesive systems, the post-bleaching composite restoration should be delayed for at least three weeks.

Borates↗