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PubMed2001

Posterior restorations--a clinical view.

This paper examines the state-of-the-art in the direct restoration of posterior teeth. The existing paradigms for the management of caries are questioned and some existing methods of cavity preparation are reviewed. Dental restorations need to be durable but able to adapt to a changing environment brought about by wear of the adjacent tooth substance and by fatigue processes within the tooth itself. The wear of restorative materials needs to be matched to that of the tooth, otherwise differential loss of either the restorative material or the enamel may destabilize the occlusion. Esthetic instability due to natural darkening of the tooth with age, punctuated by clinical intervention with bleaching procedures, adds a further dimension to the concept of a permanent restoration. Clinical methods that minimize the disruptive effects of dental restorations upon the remaining tooth structure are a continuing challenge.

Bicuspid↗
PubMed2004

Overestimating hybrid layer quality in polished adhesive/dentin interfaces.

The most popular techniques for determining the quality of the hybrid layer (HL) have relied on morphologic characterization of the polished adhesive/dentin (a/d) interfaces before and after acid-bleach chemical treatment. Using these techniques, the existence of smooth, acid-resistant layers has been consistently reported for most adhesive systems. The purpose of this study was to determine whether popular specimen preparation techniques that include polishing and acid-bleach treatment modify the a/d interface, mask the complexity of the HL, and lead to inaccurate assessment of the quality of the HL. To understand the impact of specimen preparation techniques on the morphology of the resin-dentin interface, polished and unpolished specimens from the same tooth were closely compared after different acid-bleach chemical treatment procedures. Two one-bottle adhesives, that is, 3M Single Bond and Pulpdent UNO, exhibiting distinct differences in hydrophilic/hydrophobic composition, were used in this investigation. Using specimens from the same tooth, the effect of chemical treatments on the morphology of the resin-dentin interdiffusion zone and the differences in the morphology of polished and unpolished specimens after these same treatments were studied with scanning electron microscopy. It was shown that conventional specimen preparation techniques that include polishing and acid-bleach treatment can adversely affect and even obscure the structural detail of the a/d interface in specimens that possess a porous HL. The results indicated that the Pulpdent UNO/dentin interface had better quality than the 3M Single Bond/dentin interface. The difference in the quality of HL can be attributed to factors such as compositional differences that impact the adhesive interaction with water, that is present within the substrate during wet bonding. The inability of the conventional acid-bleach procedure to reveal the differences in the scanning electron microscopy interfacial morphology was overcome in this investigation by using a multistep technique.

Acid Etching, Dental↗
PubMed1982

Clinical management of non-carious enamel defects.

Enamel defects not caused by decay may occur singly or may be generalized over the entire tooth surface. In the past, treatment of these aesthetic problems required large cavity preparations or full crown coverage of the affected teeth. Now, with the advent of various resin restorative materials capable of bonding to enamel, new techniques are being developed which are less radical. By etching the surface of the enamel with varying concentrations of dilute phosphoric acid, sufficient porosity is produced to allow the resin to adhere to it. Thus, by removing a minimal amount of tooth structure, the affected area can be masked with a thin layer of resin material after the surface has been properly prepared. If the fault in the enamel is generalized, the whole surface of the tooth may be restored using this technique, effectively covering the tooth with an aesthetic veneer. The new resin filling materials offer good colour stability as well as resistance to abrasive wear. Tests have revealed that this mode of treatment has a successful retention rate of over 92 per cent after 5 years. Lightly discoloured or stained defects of the enamel may be treated by bleaching the affected area with no adverse effect on the pulp tissue. Those teeth not improved by bleaching can be conservatively managed by veneering their surfaces with smooth finishing plastic materials.

Acid Etching, Dental↗
PubMed2004

Desensitizing agent efficacy during whitening in an at-risk population.

BACKGROUND: Nightguard vital bleaching (NGVB) has gained acceptance among dentists and patients as a simple and effective procedure to lighten discolored teeth. Although the efficacy and predictability of NGVB have been well established, it has been documented that patients undergoing the procedure may experience side effects such as tooth sensitivity (TS) and gingival irritation (GI). A previous NGVB study suggested that selected participants might benefit from a regimen of a desensitizing agent (DSA) to decrease or prevent TS during whitening. PURPOSE: The purpose of this study was to determine whether the daily use of an active DSA (UltraEZ, Ultradent Products Inc., South Jordan, UT, USA) during NGVB would decrease TS in a population at risk for TS when compared with a placebo. MATERIALS AND METHODS: Forty subjects participated in this single-blind randomized clinical trial. All participants had indicated that they had preexisting TS or other risk factors for TS during NGVB. To evaluate TS caused by the tray alone, participants wore custom-fitted maxillary whitening trays containing no DSA or whitening solution during week 1. Next, participants were randomly assigned to apply either the active DSA or placebo daily for 14 days in the trays for 30 minutes prior to whitening. The placebo was the same formulation as UltraEZ but without the desensitizing agents (3% potassium nitrate and 0.11% by weight fluoride ion). The bleaching solution was a 10% carbamide peroxide whitening solution (Opalescence, Ultradent Inc.). Post treatment, participants were followed up for 1 week, during which time they used neither trays nor solutions. Throughout the study, participants completed a daily diary to record their perceptions of TS and the time spent wearing the tray with the whitening solution. RESULTS: Forty-one percent of the active group had at least 1 day of TS during treatment compared with 78% of the placebo group. The difference was statistically significant (p = .027) using the two-tailed Fisher exact test. CLINICAL SIGNIFICANCE: This study suggests that the use of an active 3% potassium nitrate and 0.11% fluoride desensitizing agent for 30 minutes prior to whitening may decrease tooth sensitivity when compared with a placebo in a population at risk for tooth sensitivity.

Administration, Topical↗
PubMed2004

Vital bleaching with a thin peroxide gel: the safety and efficacy of a professional-strength hydrogen peroxide whitening strip.

BACKGROUND: Use of higher peroxide concentrations for professional at-home vital bleaching often balances two factors in patient compliance: whitening and tolerability. Development of a polyethylene strip coated with a very thin (0.10-millimeter) layer of 14 percent hydrogen peroxide gel (Crest Whitestrips Supreme, Procter & Gamble, Cincinnati)--which represents an increase in concentration and a decrease in amount of gel--was believed to allow for greater at-home whitening with little additional oral soft-tissue exposure to peroxide. METHODS: The authors conducted a randomized, double-blind, two-week clinical trial with 38 adults to evaluate the safety and efficacy of twice-daily use of the thin, concentrated bleaching gel strip versus the effects of a control product (Crest Whitestrips, Procter & Gamble). The two products differed only in concentration (14 percent versus 6 percent) and gel layer thickness (0.10 mm versus 0.20 mm). The authors measured efficacy from digital images using the Commission Internationale de l'Eclairage L*a*b* color scale. They assessed safety via subject interviews and clinical examination and compared treatments using analysis of covariance. RESULTS: Relative to baseline color, both strip groups exhibited significant (P < .001) improvement in yellowness, brightness and composite color change. Between-group comparisons after two weeks demonstrated significant (P < .003) color improvement for the experimental strip relative to the control. Both products were well-tolerated generally. Despite the concentration differences, clinical examination of each group showed a similar low level (11 percent) of "minor oral irritation." CONCLUSION: Use of the thin 14 percent hydrogen peroxide gel strip resulted in greater whitening, including 42 to 49 percent greater improvement in tooth color and faster whitening onset than that seen with a 6 percent hydrogen peroxide whitening strip, without clinical evidence of increased oral-tissue irritation. CLINICAL IMPLICATIONS: Use of whitening strips with a thin, concentrated layer of hydrogen peroxide gel may represent a useful approach for professionally directed at-home vital bleaching.

Adolescent↗
PubMed2000

Penetration of the pulp chamber by carbamide peroxide bleaching agents on teeth restored with a composite resin.

This in vitro study was performed to evaluate the effect of various concentrations of carbamide peroxide bleaching agents on the pulp chambers of teeth restored by a composite resin. Forty-nine human extracted anterior teeth were used. All the teeth were sectioned 3 mm apical of the cemento-enamel junction and the intracoronal tissue removed. The teeth were separated into the seven groups each containing seven teeth. Twenty-eight teeth were used as controls (groups I-IV), standardized cavities were prepared with the remaining 21 teeth (groups V, VI, VII), and restored with a hybrid composite resin (XR Herculite). Acetate buffer was placed in the pulp chamber to absorb and stabilize any peroxide that might penetrate. Group I was exposed only to distilled water. Groups II and V were applied with 10% CP (Contrast PM), groups III and VI were applied with 15% CP (Contrast PM), groups IV and VII were applied with 35% CP (Quik Start) and left for 30 min at 37 degrees C. Then, the acetate buffer solution in the pulp chamber of each tooth was removed and the chamber was then rinsed twice with 100 ml of distilled water. The contents then had leucocryctal violet and enzyme horseradish peroxidase added. The optical density of the resulting blue solution was determined spectrophotometrically, and was converted into microgram equivalents of hydrogen peroxide. A higher level of bleaching agent penetrated into the pulp chamber in the restored teeth than in the sound teeth.

Analysis of Variance↗
PubMed1999

In vivo degradation of bleaching gel used in whitening teeth.

BACKGROUND: The purpose of the study described here was to determine the in vivo degradation rate of 10 percent carbamide peroxide, or CP, gel in bleaching trays. The degradation rate indicates the remaining concentration of the active agent on the facial surfaces at various intervals. METHODS: The researchers fabricated bleaching trays with 0.5-millimeter reservoirs and loaded them with a 10 percent CP whitening gel. The tray was seated in place in 15 patients for six different intervals that ranged from 15 seconds to 10 hours. When the tray was removed, three samples were collected from each patient: the gel remaining in the tray; the adherent gel scraped from the teeth; and a "grab" sample from the reservoir of tooth no. 8. The researchers analyzed these samples for CP according to the method specified by the U.S. Pharmacopeial Convention. RESULTS: The percentage of CP recovered decreased as the intervals increased: 87 percent at 15 seconds, 10 percent at 10 hours. Log of tray, teeth and grab samples, respectively, at 15 seconds were 0.94, 0.98 and 0.96 and at 10 hours were -0.13, -0.38 and 0.11. The first-hour degradation rate for tray, teeth and grab samples, respectively, was 2.0 times, 3.6 times and one time the rate during the next nine hours. The within-subject repeatability of the samples was excellent. CONCLUSIONS: The degradation rate of CP during the bleaching process is biexponential. In the tray and teeth samples, the degradation rate was accelerated during the first hour. Further research is needed to determine the cause of this acceleration. CLINICAL IMPLICATIONS: The active agent in CP bleaching gel is available in bleaching trays for more than 10 hours. After two hours, more than 50 percent of the active agent is available, and 10 percent is available after 10 hours.

Adult↗
PubMed2005

Clinical evaluation of a novel dental whitening lamp and light-catalyzed peroxide gel.

OBJECTIVE: This study examined whether an ultraviolet light enhanced the whitening efficacy of a peroxide gel containing a photo-Fenton activator. METHODOLOGY: Fifty subjects were enrolled into the trial at two geographically separate sites. As directed by the randomization keys, teeth of half of the study subjects were concurrently exposed to the whitening lamp, while the gel was on their teeth, for a total light exposure of 45 minutes. The other half of the subjects received no light treatment. At each examination, clinical data were collected on the gingival index, shade score, and self-assessed dentinal hypersensitivity. RESULTS: Changes in tooth shade were significantly better (approximately 26% improvement; p < 0.05) for subjects exposed to the gel and dental whitening lamp (average = 7.7 shade changes) compared to subjects exposed to the gel only (average 6.1 shades) immediately after treatment. No reports of erythema, desquamation, ulceration of soft tissues, gross changes in teeth, gingiva, or restorations were documented. The relative changes in mean sensitivity scores were similar for both groups, with no significant differences between the Light and No-light groups at any interval. CONCLUSION: The whitening effect was improved by approximately 26% when the Zoom2 dental whitening lamp was used. It was demonstrated that the a photo-Fenton activator used with a bleaching light and 20% hydrogen peroxide gel is safe and effective for whitening teeth rapidly.

Adolescent↗
PubMed2004

Evaluation of a 6% hydrogen peroxide tooth whitening gel on enamel and dentine microhardness in vitro.

OBJECTIVES: The aims of this study were to evaluate the effects of a novel 6% hydrogen peroxide containing tooth whitener, Xtra White (XW), on enamel and dentine microhardness in vitro. METHODS: Polished human enamel and dentine specimens were prepared and baseline microhardness determined. In study 1, enamel specimens were exposed to 20 min cycles of either water, XW or Sprite Light for up to 28 cycles. In studies 2 and 3, enamel specimens were treated with 20 min cycles of either XW or water and exposed to whole saliva at all other times. In study 3, an additional exposure to a fluoride containing toothpaste was conducted. In total, 28 treatments were conducted in order to simulate a 2 weeks product use. In study 4, dentine specimens were treated as per study 3. Final microhardness measurements were taken and for studies 3 and 4 colour measurements were additionally taken. RESULTS: XW and water gave no statistically significant (p>0.05) changes in enamel and dentine microhardness after 28 treatments. Sprite Light gave a significant (p<0.00002) reduction in enamel microhardness after one 20 min treatment. XW showed significant bleaching of enamel and dentine specimens as compared to the water control. CONCLUSIONS: XW does not have any significant effect on enamel and dentine microhardness.

Cariostatic Agents↗
PubMed2004

Effect of hydrogen peroxide on intertubular dentine.

OBJECTIVES: To evaluate the effect of 30% hydrogen peroxide on the surface changes and nanomechanical properties of intertubular dentine. METHODS: Five freshly extracted human premolars were sectioned and two specimens were obtained from each tooth. Atomic force microscopy (AFM) images of dentine were taken. Baseline hardness and Young's modulus of intertubular dentine were determined using nanoindentation testing and recorded. The specimens were then treated with either 0.5 ml of Hank's balanced salt solution (control group) or 30% hydrogen peroxide at 24 degrees C for 24 h. AFM imaging and determination of hardness and Young's modulus of intertubular dentine were then repeated. The images were compared and statistical analyses of hardness and Young's modulus were carried out using paired sample t-tests. RESULTS: The AFM images showed recession of the intertubular dentine surface post-bleaching. For the control group, there was no significant change in hardness (p=0.124) and Young's modulus (p=0.438) of intertubular dentine. However, a significant decrease in hardness (p=0.002) and Young's modulus (p=0.001) of intertubular dentine was observed for the experimental group. CONCLUSIONS: Exposure to 30% hydrogen peroxide for 24 h caused surface changes to intertubular dentine and significantly decreased the hardness and Young's modulus of intertubular dentine.

Dentin↗
PubMed2006

Influence of carbamide peroxide on enamel fluoride uptake.

OBJECTIVE: Aim of the study was to evaluate the influence of carbamide peroxide (CP) on enamel fluoride uptake by comparing enamel fluoride uptake from a 1% amine fluoride (AmF) gel with the fluoride acquisition from a 10% carbamide peroxide agent supplemented with 1% AmF. MATERIALS AND METHODS: Three enamel cylinders (4mm in diameter) were prepared from the buccal surfaces of 60 bovine incisors. One sample of each tooth was used for determination of baseline fluoride content of the respective tooth. The two remaining samples were allocated to the experimental series 1 or 2, respectively. Each series consisted of five experimental groups (A-E, n=12) and differed with respect to the length of the treatment period with the gels (A-D). The experimentally designed gels (pH 5.5) used in the study were as follows: A (10% CP), B (10% CP, 1% F(-) as AmF), C (1% F(-) as AmF), D (no CP, no F(-)) and were formulated on the same basis. The enamel samples were covered for 4h with the respective gel at 37 degrees C and were then transferred to artificial saliva for 20 h (series 1). The samples of group E served as controls and were not treated with a gel. In series 2, treatment with the gels and storage in saliva was conducted seven times. Finally, the samples were assessed for KOH-soluble and structurally bound fluoride. RESULTS: Only the enamel samples treated with the fluoridated bleaching gel (group B) and with the amine fluoride gel (group C) exhibited significant fluoride acquisition. Thereby, both gels showed significantly lower uptake in series 1 as compared to series 2. Both KOH-soluble and structurally bound fluoride acquisition was significantly higher in group C than in group B. CONCLUSION: Treatment with a carbamide peroxide gel supplemented with amine fluoride causes less fluoride acquisition in enamel than a pure amine fluoride gel. Under the conditions of the study, it is assumed that carbamide peroxide seems to influence enamel fluoride uptake.

Amines↗
PubMed2004

Hydrogen peroxide poisoning.

Hydrogen peroxide is an oxidising agent that is used in a number of household products, including general-purpose disinfectants, chlorine-free bleaches, fabric stain removers, contact lens disinfectants and hair dyes, and it is a component of some tooth whitening products. In industry, the principal use of hydrogen peroxide is as a bleaching agent in the manufacture of paper and pulp. Hydrogen peroxide has been employed medicinally for wound irrigation and for the sterilisation of ophthalmic and endoscopic instruments. Hydrogen peroxide causes toxicity via three main mechanisms: corrosive damage, oxygen gas formation and lipid peroxidation. Concentrated hydrogen peroxide is caustic and exposure may result in local tissue damage. Ingestion of concentrated (>35%) hydrogen peroxide can also result in the generation of substantial volumes of oxygen. Where the amount of oxygen evolved exceeds its maximum solubility in blood, venous or arterial gas embolism may occur. The mechanism of CNS damage is thought to be arterial gas embolisation with subsequent brain infarction. Rapid generation of oxygen in closed body cavities can also cause mechanical distension and there is potential for the rupture of the hollow viscus secondary to oxygen liberation. In addition, intravascular foaming following absorption can seriously impede right ventricular output and produce complete loss of cardiac output. Hydrogen peroxide can also exert a direct cytotoxic effect via lipid peroxidation. Ingestion of hydrogen peroxide may cause irritation of the gastrointestinal tract with nausea, vomiting, haematemesis and foaming at the mouth; the foam may obstruct the respiratory tract or result in pulmonary aspiration. Painful gastric distension and belching may be caused by the liberation of large volumes of oxygen in the stomach. Blistering of the mucosae and oropharyngeal burns are common following ingestion of concentrated solutions, and laryngospasm and haemorrhagic gastritis have been reported. Sinus tachycardia, lethargy, confusion, coma, convulsions, stridor, sub-epiglottic narrowing, apnoea, cyanosis and cardiorespiratory arrest may ensue within minutes of ingestion. Oxygen gas embolism may produce multiple cerebral infarctions. Although most inhalational exposures cause little more than coughing and transient dyspnoea, inhalation of highly concentrated solutions of hydrogen peroxide can cause severe irritation and inflammation of mucous membranes, with coughing and dyspnoea. Shock, coma and convulsions may ensue and pulmonary oedema may occur up to 24-72 hours post exposure. Severe toxicity has resulted from the use of hydrogen peroxide solutions to irrigate wounds within closed body cavities or under pressure as oxygen gas embolism has resulted. Inflammation, blistering and severe skin damage may follow dermal contact. Ocular exposure to 3% solutions may cause immediate stinging, irritation, lacrimation and blurred vision, but severe injury is unlikely. Exposure to more concentrated hydrogen peroxide solutions (>10%) may result in ulceration or perforation of the cornea. Gut decontamination is not indicated following ingestion, due to the rapid decomposition of hydrogen peroxide by catalase to oxygen and water. If gastric distension is painful, a gastric tube should be passed to release gas. Early aggressive airway management is critical in patients who have ingested concentrated hydrogen peroxide, as respiratory failure and arrest appear to be the proximate cause of death. Endoscopy should be considered if there is persistent vomiting, haematemesis, significant oral burns, severe abdominal pain, dysphagia or stridor. Corticosteroids in high dosage have been recommended if laryngeal and pulmonary oedema supervene, but their value is unproven. Endotracheal intubation, or rarely, tracheostomy may be required for life-threatening laryngeal oedema. Contaminated skin should be washed with copious amounts of water. Skin lesions should be treated as thermal burns; surgery may be required for deep burns. In the case of eye exposure, the affected eye(s) shod eye(s) should be irrigated immediately and thoroughly with water or 0.9% saline for at least 10-15 minutes. Instillation of a local anaesthetic may reduce discomfort and assist more thorough decontamination.

Administration, Inhalation↗
PubMed2003

The use of mineral trioxide aggregate to create an apical stop in previously traumatized adult tooth with blunderbuss canal. Case report.

The case presented here demonstrates an alternative to conventional treatments in managing a non-vital blunderbuss canal. The use of MTA (mineral trioxide aggregate) to establish an apical stop allows for expedient completion of root canal therapy with predictable results. Following root canal therapy, non-vital bleaching techniques may be employed, offering a means of restoring the tooth to its natural shade without the need for additional tooth preparation. Surgery is avoided, and the technique can easily be followed by the general practitioner.

Adult↗
PubMedDate not supplied

Selling to the moneyed masses.

Over the past decade, the distribution of household incomes has shifted so much that a much larger proportion of consumers now earn significantly higher-than-average incomes--while still falling short of being truly rich. As a result, what used to be a no-man's-land for new product introductions has in many categories become an extremely profitable "new middle ground." How can marketers capitalize on this new territory? The key, say the authors, is to rethink the positioning and design of offerings and the ways they can be brought to market. Take, for instance, how Procter & Gamble redefined the positioning map for tooth-whitening solutions. A decade ago, dental centers were popularizing expensive bleaching techniques that put the price of a professionally brightened smile in the 400 dollars range. At the low end, consumers also had the choice of whitening toothpastes that cost anywhere from 2 dollars to 8 dollars. P&G wisely positioned itself between the two ends, successfully targeting the new mass market with its 35 dollars Whitestrips. In product categories where it's clear the middle ground has already been populated, it's important for companies to design or redesign offerings to compete. An example is the Polo shirt. How do you sell a man yet another one after he's bought every color he wants? Add some features, and call it a golf shirt. Here, marketers have introduced designs based on the concept of "occasional use" in order to stand out. Finally, companies wishing to reach the "almost rich" can change how they go to market. Perhaps no mass retailer has made a stronger bid for the mass affluent than Target Stores, which has pioneered a focus the company itself characterizes as upscale discount. The strategy has made Target an everyday shopping phenomenon among well-heeled urbanites and prosperous professionals.

Consumer Behavior↗
PubMedDate not supplied

Effects of in-office tooth whiteners on hardness of tooth-colored restoratives.

This study investigated the effects of in-office tooth whiteners on the hardness of hybrid (Spectrum TPH), polyacid-modified (Dyract AP), PRG (Reactmer) composites and a resin-modified glass ionomer cement (Fuji II LC). Twenty-seven specimens of each material were fabricated, randomly divided into three groups of nine and treated as follows--Group 1: stored in distilled water at 37 degrees C for three weeks (control); Group 2: treated with carbamide peroxide (Opalescence Quick) for 30 minutes/week for three weeks; Group 3: treated with 35% hydrogen peroxide power bleach (Opalescence Xtra) for 30 minutes/week for three weeks. For Groups 2 and 3, specimens were stored in distilled water at 37 degrees C during the hiatus periods. The treated specimens were subsequently subjected to microhardness testing (load = 500gf; dwell time = 15 seconds). Results were analyzed using ANOVA/Scheffe's test (p<0.05). For all treatment groups, Spectrum was significantly harder than the other materials and Reactmer was significantly harder than Dyract and Fuji II LC. The effects of in-office tooth whiteners on microhardness were material-dependent. No significant difference in hardness was observed between treatment groups for Dyract and Reactmer. For Spectrum and Fuji II LC, specimens treated with Opalescence Quick were significantly harder than those treated with Opalescence Xtra. No significant difference in hardness was observed between the control and bleached groups for all materials. The hardness of resin-modified glass-ionomer cements, hybrid, polyacid-modified and PRG composites is therefore not significantly affected by the use of 35% carbamide peroxide and 35% hydrogen peroxide in-office tooth whiteners.

Analysis of Variance↗