Influência do LED Violeta associado ou não ao gel clareador na inflamação, mineralização e maturação colágena do tecido dentinário e pulpar / Influence of violet LED associated or not with peroxide gel on inflammation, mineralization, and collagen fiber maturation in dentin and pulp tissue

Objetivo: Avaliar a influência do LED Violeta, associado ou não ao gel clareador a base de peróxido de hidrogênio (PH) a 17,5% no complexo dentino-pulpar de ratos. Materiais e métodos: Molares superiores de 80 ratos foram distribuídos nos grupos (n = 10): CONT ­ sem tratamento, PH ­ 1 aplicação de 30 minutos de PH a 17,5%, LED ­ 1 aplicação de 20 minutos do LED Violeta, e PH+LED - aplicação do PH e LED Violeta. Imediatamente (T0), e aos 7 (T1), 15 (T2) e 30 dias (T3) após o tratamento, os ratos foram eutanasiados e as maxilas processadas para avaliação histológica, imunoistoquímica (IL-17, IL-23 e osteocalcina), e de picrosírius red, sendo realizados os testes de Wilcoxon e Mann-Whitney e Teste-T pareado e Teste-T, respectivamente. (α = 0,05). Resultados: Necrose e infiltrado inflamatório severo foram observados nos grupos PH e PH+LED. Apenas o grupo PH+LED manteve a imunomarcação severa para IL-17 e IL-23, diferindo do grupo LED e PH que apresentaram moderada imunomarcação em T0. Os grupos PH e PH+LED apresentaram severa imunomarcação de OCN em T2 e moderada imunomarcação em T3. O grupo LED apresentou menor quantidade de fibras imaturas em T2 e T3 que o grupo CONT. Conclusão: A terapia com LED violeta não induziu inflamação e fibrose no tecido pulpar, apesar de acelerar a maturação das fibras de colágeno da dentina e, quando associada ao peróxido de hidrogênio, pode tornar os dentes mais sensíveis(AU)

Objective: Was to evaluated the influence of the Violet LED, associated or not with a 17.5% hydrogen peroxide (HP) bleaching gel in the dentin-pulp complex of rats. Materials and methods: Upper molars of eighty Wistar rats were distributed in the groups (n = 10): CONT - without treatment, HP - 1 application of 30 minutes of 17.5% HP, LED - 1 application of 20 minutes of the Violet LED, and HP+LED - application of HP and LED Violet. Immediately (T0), and at 7 (T1), 15 (T2) and 30 days (T3) after treatment, the rats were euthanized and the jaws were processed for histological, immunohistochemical evaluation (IL-17, IL-23 and osteocalcin), and picrosirius red, with Wilcoxon and Mann-Whitney tests and paired T-test and T-test, respectively (α = 0.05). Results: Necrosis and severe inflammatory infiltrate were observed in the PH and PH+LED groups. Only the PH+LED group maintained severe immunostaining for IL-17 and IL-23, differing from the LED and PH group which presented moderate T0 immunostaining. The PH and PH+LED groups presented severe immunostaining of OCN in T2 and moderate immunostaining in T3. The LED group had a lower amount of immature fibers in T2 and T3 than the CONT group. Conclusion: Violet LED therapy induced no inflammation and fibrosis in the pulp tissue, however accelerating the maturation of dentin collagen fibers and, when associated with hydrogen peroxide, can make the teeth more sensitive(AU)

Titanium dioxide nanotubes incorporated into bleaching agents: physicochemical characterization and enamel color change

Abstract Titanium dioxide nanotubes are nanostructures that can accelerate the oxidation reaction of bleaching procedures and promote a more effective whitening effect. Objective This study evaluated physicochemical properties of bleaching agents incorporated with titanium dioxide (TiO2) nanotubes, and the effects on tooth color change at different periods. Methodology 40 premolars were treated according to the following groups (n=10): CP - 10% carbamide peroxide (1 hour daily/21 days); CPN - CP incorporated into TiO2; HP - 40% hydrogen peroxide (three 40-minute sessions/7 days apart); HPN - HP incorporated into TiO2. Color shade was evaluated at five different periods (baseline, after 7, 14 and 21 days of bleaching, and 7 days after end of treatment) according to Vita Classical, CIELab and CIEDE2000 scales. Mean particle size (P), polydispersity (PO) and zeta potential (ZP) were evaluated using dynamic light scattering. Data on the different variables were analyzed by mixed model tests for measures repeated in time (ZP e L*), generalized linear models for measures repeated in time (P, PO, Vita Classical and b*), and Friedman and Mann-Whitney tests (a* and color change/ΔE and ΔE00). Results CP and CPN presented higher P, higher PO and lower ZP than HP and HPN (p≤0.05). All groups showed a significant decrease in Vita Classical color scores after 7 days of bleaching (p<0.05), and HPN presented a greater significant reduction than the other groups. L* increased in TiO2 presence, in all groups, without any differences (p>0.05) in bleaching time. A significant reduction occurred in the a* and b* values for all the groups, and HPN presented lower a* and b* values (p<0.05) than CPN. ΔE was clinically noticeable after 7 days, in all groups, and all groups resulted in a perceptible color change according to ΔE00. Conclusion TiO2 did not influence physicochemical properties of the bleaching agents. HPN presented more effective tooth bleaching than CPN.

Evaluation of reservoirs in bleaching trays for at-home bleaching: a split-mouth single-blind randomized controlled equivalence trial

Abstract Objectives This randomized, split-mouth, single-blinded trial assessed whether the use of reservoirs in at-home bleaching trays is equivalent to non-reservoir trays. Our choice of an equivalence trial was based on the expectation that a non-reservoir tray is sufficient to produce a color change. Secondary outcomes such as tooth sensitivity (TS) and gingival irritation (GI) were also assessed. Methodology Forty-six patients were selected with canines shade A2 or darker. In half of the patient's arch, bleaching trays were made with reservoirs and the other half, without reservoirs. At-home bleaching was performed with carbamide peroxide (CP) 10% (3 h daily; 21 days). Color change was evaluated with a digital spectrophotometer (ΔE, ΔE00, and Whiteness Index) and shade guide units (ΔSGU) at baseline, during and one-month post-bleaching. TS and GI were assessed with a numeric scale (NRS) and a visual analog scale (VAS). Results After one month, the equivalence of reservoir and non-reservoir groups were observed in all color instruments (p>0.05). Fifteen and sixteen patients presented pain (absolute risk: 33% and 35%, 95%, confidence interval (CI) 21-46% and 23-49%) in the reservoir and non-reservoir side, respectively. The odds ratio for pain was 0.8 (95%CI 0.2-3.0) and the p-value was non-significant (p=1.0). TS intensity was similar between both groups in any of the pain scales (p>0.05). No difference in the GI was observed (p>0.05). Conclusions The protocol with reservoirs is equivalent in color change to the non-reservoir, although no superiority of the latter was observed in terms of reduced TS and GI with at-home 10% carbamide peroxide bleaching. Clinical Relevance The presence of reservoirs in a bleaching tray did not improve color change or affect tooth sensitivity and gingival irritation.

Effects of different degrees of acidity and concentration of bleaching agents on human enamel mineral content and surface morphology over time / Efeitos de diferentes graus de acidez e concentração de agentes clareadores no conteúdo mineral e morfologia superficial do esmalte humano ao longo do tempo

Objective: The aim of this study was to evaluate the effect of pH and concentration of bleaching agents on the mineral content and surface morphology of human dental enamel for 14 days. Material and Methods: Eighty human central incisors were randomly divided into 8 groups (n=10): G1-7.5% hydrogen peroxide/ pH=9.0; G2­9.5% hydrogen peroxide/pH=9.0; G3- 7.5% hydrogen peroxide/pH=7.0; G4-9.5% hydrogen peroxide/pH=7.0; G5-10% carbamide peroxide/ pH=5.0; G6-16% carbamide peroxide/pH=5.0; G7- 37% phosphoric acid 15s (positive control); G8-no treatment (negative control). The mineral analysis of the bleaching gel collected was assessed by ICP-AES and surface morphology was observed by SEM. Results: Friedman and Dunn's statistical test demonstrated significant differences among the proposed treatments (p0.01). However, the latter groups showed significantly higher values as compared to groups G1, G2, G3 and G4 (p<0.01). Conclusion: Alteration in enamel mineral content may not be influenced by concentration when bleaching agents with the same pH are compared. The most apparent alterations in mineral content and surface morphology may be noted when more acidic products are used. The daily mineral content measurement may not be influenced by repeated applications of bleaching agents. (AU)

Objetivo: Este estudo avaliou o efeito do pH e da concentração de agentes clareadores no conteúdo mineral e na morfologia da superfície do esmalte dental humano durante 14 dias. Material e Métodos: Oitenta incisivos centrais humanos foram aleatoriamente divididos em 8 grupos (n = 10): G1-peróxido de hidrogênio 7.5% /pH = 9.0; G2 - peróxido de hidrogênio 9.5%/pH = 9,0; G3 - peróxido de hidrogênio 7.5%/pH = 7,0; G4-de peróxido de hidrogênio 9.5% / pH = 7,0; G5 - Peróxido de carbamida 10% / pH = 5.0; G6 - peróxido de carbamida 16%/pH = 5.0; G7- ácido fosfórico 37% (controle positivo); G8 - sem tratamento (controle negativo). A análise mineral do gel clareador coletado foi avaliada por ICP-AES e a morfologia da superfície foi observada por MEV. Resultados: Os testes estatísticos de Friedman e Dunn demonstraram diferenças significativas entre os tratamentos propostos (p<0,01). Nenhuma diferença significativa foi encontrada entre os grupos tratados com peróxido de hidrogênio (G1, G2, G3 e G4) ou entre os grupos G5, G6 e G7 (p>0,01), no entanto, os estes grupos apresentaram valores significativamente maiores em relação aos grupos G1, G2, G3 e G4 (p <0,01). Conclusão: Alterações no conteúdo mineral do esmalte não foram influenciadas pela concentração dos agentes clareadores quando os mesmos pH são comparados. As alterações mais significativas no conteúdo mineral e na morfologia da superfície foram notadas quando clareadores mais ácidos foram utilizados. A mensuração diária do conteúdo mineral não foi influenciada por repetidas aplicações de agentes clareadores. (AU)

Neurosensory analysis of tooth sensitivity during at-home dental bleaching: a randomized clinical trial

Abstract Objective The objective of this study was to evaluate dental sensitivity using visual analogue scale, a Computerized Visual Analogue Scale (CoVAS) and a neurosensory analyzer (TSA II) during at-home bleaching with 10% carbamide peroxide, with and without potassium oxalate. Materials and Methods Power Bleaching 10% containing potassium oxalate was used on one maxillary hemi-arch of the 25 volunteers, and Opalescence 10% was used on the opposite hemi-arch. Bleaching agents were used daily for 3 weeks. Analysis was performed before treatment, 24 hours later, 7, 14, and 21 days after the start of the treatment, and 7 days after its conclusion. The spontaneous tooth sensitivity was evaluated using the visual analogue scale and the sensitivity caused by a continuous 0°C stimulus was analyzed using CoVAS. The cold sensation threshold was also analyzed using the TSA II. The temperatures obtained were statistically analyzed using ANOVA and Tukey's test (α=5%). Results The data obtained with the other methods were also analyzed. 24 hours, 7 and 14 days before the beginning of the treatment, over 20% of the teeth presented spontaneous sensitivity, the normal condition was restored after the end of the treatment. Regarding the cold sensation temperatures, both products sensitized the teeth (p<0.05) and no differences were detected between the products in each period (p>0.05). In addition, when they were compared using CoVAS, Power Bleaching caused the highest levels of sensitivity in all study periods, with the exception of the 14th day of treatment. Conclusion We concluded that the bleaching treatment sensitized the teeth and the product with potassium oxalate was not able to modulate tooth sensitivity.

Edemogenic test and hydrogen peroxide degradation rate of bleaching gels with different desensitizing agents / Teste edemogênico e taxa de degradação do peróxido de hidrogênio de géis clareadores com diferentes agentes dessensibilizantes

Objective: The at-home bleaching technique leads to the intimate contact of the bleaching gel with gingival tissues, so this study evaluated the immediate inflammatory response, through the edemogenic test, induced by at-home bleaching gels of 10% carbamide peroxide with different desensitizing agents, the quantification of hydrogen peroxide released and bleaching gels pH. Material and Methods: Forty-eight rats were divided into groups (n=12): CTRL-control group, WP-Whiteness Perfect 10% (FGM Produtos Odontológicos, Joinville, SC, Brazil), OPA-Opalescence 10% (Ultradent Products Inc., South Jordan, IT, USA), and PB-Power Bleaching (BM4, Palhoça, SC, Brazil). For the edemogenic test, all rats received an intravenous injection of Evan's Blue; after 30 min, 0.2 mL of each bleaching gels was injected into the subcutaneous tissue of the rats, and the results of the vascular permeability were assessed after 3 and 6h. The amount of HP released and pH of each product was also determined. Data were submitted to statistical test (p <0.05 ). Results: At 3h, the PB showed higher vascular permeability than the other groups. At 6h, the PB produced similar vascular permeability than WHI, and higher than OPA and CTRL groups. The OPA group had a higher vascular permeability at 6h compared to 3h; there is no difference in other groups. The PB group had higher HP concentrations than the other groups. Conclusion: In general, the PB caused a more considerable amount of inflammatory edema and higher amount of HP released. This results suggesting that these bleaching gels cause greater aggression in soft gingival tissues that eventually ends up in contact with bleaching products. (AU)

Objetivo: A técnica de clareamento domiciliar leva ao contato íntimo do gel clareador com tecidos gengivais, assim, este estudo avaliou a resposta inflamatória imediata, através do teste edemogênico, induzido por gel de clareamento caseiro à base de peróxido de carbamida a 10% com diferentes agentes dessensibilizantes, a quantificação de peróxido de hidrogênio liberado e o pH dos géis branqueadores. Material e Métodos: Quarenta e oito ratos foram divididos em 4 grupos (n = 12): grupocontrole CTRL, WP-Whiteness Perfect 10% (FGM Produtos Odontológicos, Joinville, SC, Brasil), OPA-Opalescence 10% (Ultradent Products Inc., South Jordan, IT, EUA) e PB-Power Bleaching (BM4, Palhoça, SC, Brasil). Para o teste edemogênico, todos os ratos receberam uma injeção intravenosa de Evan's Blue; após 30 min, 0,2 mL de cada gel clareador foi injetado no tecido subcutâneo dos ratos, e os resultados da permeabilidade vascular foram avaliados após 3 e 6 horas. A quantidade de HP liberada e o pH de cada produto também foram determinados. Os dados foram submetidos ao teste estatístico (P <0,05). Resultados: Às 3h, o PB apresentou maior permeabilidade vascular que os demais grupos. Às 6h, o PB produziu permeabilidade vascular semelhante ao WHI e maior que os grupos OPA e CTRL. O grupo OPA apresentou maior permeabilidade vascular às 6h em relação às 3h; Não existe essa diferença em outros grupos. O grupo PB apresentou maiores concentrações de HP que os demais grupos. Conclusão: Em geral, o PB causou maior quantidade de edema inflamatório e maior quantidade de HP liberado. Estes resultados sugerem que estes géis branqueadores causam maior agressividade nos tecidos gengivais moles que eventualmente acabam em contato com produtos de branqueamento. (AU)

High-concentration carbamide peroxide can reduce the sensitivity caused by in-office tooth bleaching: a single-blinded randomized controlled trial

Abstract Objectives A single-blinded, randomized, parallel clinical trial evaluated the use of 37% carbamide peroxide (CP) on bleaching effectiveness and tooth sensitivity reported by patients undergoing in-office tooth bleaching, in comparison with the results of using 35% hydrogen peroxide. Material and Methods Forty patients were allocated to receive two sessions of in-office tooth bleaching using either 35% hydrogen peroxide (HP) or 37% CP. Each patient's sensitivity level was evaluated during and up to 24 h after bleaching. The effectiveness of the bleaching procedures was evaluated with a spectrophotometer one week after each session and 30 days after the last session. The impact of tooth bleaching on the patients' perceptions regarding smile changes, in addition to the bleaching procedures and their results, were also recorded. Absolute and relative sensitivity risks were calculated. Data on sensitivity level were analyzed using the Mann-Whitney or T-test, and data from the color evaluation were subjected to 2-way repeated measures ANOVA. Results The use of CP reduced the risk and level of tooth sensitivity to values close to zero, whereas the difference between the bleaching agents disappeared after 24 h. An increased bleaching effect was observed for HP, mainly due to an improved reduction of redness and yellowness. Participants perceived improved tooth bleaching for HP and reduced sensitivity for CP, but no differences regarding the comfort of the techniques were noted. Conclusions In our study, 37% CP resulted in reduced tooth sensitivity but decreased the tooth bleaching effectiveness. However, both bleaching agents resulted in high levels of patient satisfaction.

Crown discoloration promoted by materials used in regenerative endodontic procedures and effect of dental bleaching: spectrophotometric analysis

Abstract Regenerative endodontic procedure (REP) has been proposed as a new approach to treat immature permanent teeth. However, materials used in REP for root canal disinfection or cervical sealing may induce tooth discoloration. Objectives To assess tooth crown’s color after intracanal treatment with triple antibiotic paste (TAP) or calcium hydroxide (CH); cervical sealing with glass ionomer cement (GIC) or mineral trioxide aggregate (MTA); and bleaching with carbamide peroxide. Material and Methods After pulp removal and color spectrophotometer measurement, 50 bovine incisors were divided into 4 experimental groups and one control (untreated). Experiments were performed in phases (Ph). Ph1: TAP (ciprofloxacin, metronidazole, minocycline), TAPM (ciprofloxacin, metronidazole, amoxicillin), DAP (ciprofloxacin, metronidazole), or CH treatment groups. After 1 and 3 days (d); 1, 2, 3 weeks (w); and 1, 2, 3 and 4 months (m), color was measured and medications were removed. Ph2: GIC or MTA cervical sealing, each using half of the specimens from each group. Color was assessed after 1d, 3d; 1w, 2w, 3w; 1m and 2m. Ph3: Two bleaching sessions, each followed by color measurement. Data were analyzed with ANOVA and post-hoc Holm-Sidak method. Results Ph1: Specimens of TAP group presented higher color alteration (ΔE) mean than those of TAPM group. No significant difference was found among TAP or TAPM and CH, DAP or Control groups. Ph2: cervical sealing materials showed no influence on color alteration. Ph3: Different ΔE means (from different groups), prior to bleaching, became equivalent after one bleaching session. Conclusions TAP induces higher color alteration than TAPM; color alteration increases over time; cervical sealing material has no influence on color alteration; and, dental bleaching was able to recover, at least partially, the tooth crown’s color.

Recuperação da estrutura do esmalte dentário após clareamento caseiro excessivo com uso de fluoreto de sódio / Remineralization of dental enamel using sodium fluoride after excessive athome bleaching

O objetivo do estudo foi avaliar a remineralização do esmalte dentário com solução fluoretada, após uso excessivo de gel para clareamento dentário. Quarenta corpos de prova foram obtidos a partir de 20 terceiros molares humanos hígidos. Os dentes foram incluídos e tiveram suas superfícies planificadas e polidas com lixas d'água de carbeto de silício de granulações decrescentes (400, 600, 1200, 1500 e 2000). Metade das superfícies de cada corpo de prova foi impermeabilizada com verniz cosmético de modo a proteger dos agentes clareadores, atuando como grupo controle (Gc). Em seguida, os corpos de prova foram divididos de forma randomizada em 4 grupos: G16 - 3 sessões de clareamento com peróxido de carbamida a 16%; G16F - 3 sessões de clareamento com peróxido de carbamida a 16% e posteriormente fluoretado; G22 - 3 sessões de clareamento com peróxido de carbamida a 22%; G22F - 3 sessões de clareamento com peróxido de carbamida a 22% e posteriormente fluoretado. Todos os corpos de prova foram submetidos ao teste de dureza Vickers. Os grupos Gc (314,93±46,20 VHN) e G16F (283,03±77,04 VHN) apresentaram as maiores médias de dureza superficial. Os demais grupos (G-16 - 238,80±68,02 VHN; G-22F - 218,73±58,64 VHN; G-22 - 197,73±41,0 VHN) apresentaram médias estatisticamente inferiores aos grupos G-C e G-16F, não diferindo entre si. Concluiu-se que o excesso de clareamento foi prejudicial sobre a superfície do esmalte dentário, sendo minimizado pela aplicação da solução fluoretada. A diminuição da desmineralização foi mais evidente quando se utilizou a concentração de 22% de peróxido de carbamida (AU).

The aim of this study was to evaluate the remineralization of dental enamel with a fluoride solution after excessive use of teeth bleaching gel. Forty specimens were obtained from 20 healthy human third molars. The teeth were immersed in resin and their surfaces were planned and polished with wet silicon carbide sanding sheets of gradually decreasing grits (400, 600, 1200, 1500 and 2000). Half of the surface of each specimen was sealed with cosmetic varnish in order to protect it from bleaching agents, acting as a control group (CG). The specimens were then randomly divided into four groups: G16 - 3 sessions of bleaching with 16% carbamide peroxide; G16F - three sessions of bleaching with 16% carbamide peroxide followed by fluoridization; G22 - 3 sessions of bleaching with 22% carbamide peroxide; G22F - 3 sessions of bleaching with 22% carbamide peroxide and then fluoridated. All specimens were tested using the Vickers hardness test. CG groups (314.93 ± 46.20 VHN) and G16F (283.03 ± 77.04 VHN) presented the highest average surface hardness. The other groups (G-16 - 238.80 ± 68.02 VHN; G-22F - 218.73 ± 58.64 VHN; G-22 to 197.73 ± 41.0 VHN) presented statistically lower averages than the CG and G-16F, with no difference between them. It could be concluded that the excess bleaching was detrimental to the dental enamel surface and damage was reduced by applying the fluoride solution. The reduction in demineralization was more evident when the 22% carbamide peroxide concentration was used (AU).

Inflammatory response of human dental pulp to at-home and in-office tooth bleaching

ABSTRACT Tooth bleaching is a technique of choice to obtain a harmonious smile, but bleaching agents may damage the dental pulp. Objective: This study evaluated the inflammatory responses of human dental pulp after the use of two bleaching techniques. Material and Methods: Pulp samples were collected from human third molars extracted for orthodontic reasons and divided into three groups: control - no tooth bleaching (CG) (n=7); at-home bleaching with 15% carbamide peroxide (AH) (n = 10), and in-office bleaching with 38% hydrogen peroxide (IO) (n=12). Pulps were removed and stained with hematoxylin-eosin for microscopic analysis of inflammation intensity, collagen degradation, and pulp tissue organization. Immunohistochemistry was used to detect mast cells (tryptase+), blood vessels (CD31+), and macrophages (CD68+). Chi-square, Kruskal-Wallis, and Mann Whitney tests were used for statistical analysis. The level of significance was set at p<.05. Results: The inflammation intensity and the number of macrophages were significantly greater in IO than in AH and CG (p<0.05). The results of CD31+ (blood vessels per mm2) were similar in CG (61.39±20.03), AH (52.29±27.62), and IO (57.43±8.69) groups (p>0.05). No mast cells were found in the pulp samples analyzed. Conclusion: In-office bleaching with 38% hydrogen peroxide resulted in more intense inflammation, higher macrophages migration, and greater pulp damage then at-home bleaching with 15% carbamide peroxide, however, these bleaching techniques did not induce migration of mast cells and increased the number of blood vessels.

Avaliação de cor da resina composta após manchamento com café solúvel, vinho tinto e Coca-Cola® seguido de clareamento dental / Color resin assessment made after staining with soluble coffee, red wine and Coke® followed by dental bleaching

O objetivo desse estudo in vitro foi avaliar a alteração de cor da resina composta (RC) submetida à pigmentação pelo café solúvel, vinho tinto e Coca-Cola®, bem como a alteração após o clareamento dental com peróxido de carbamida (PC) 16%. Foram confeccionados vinte espécimes de RC na cor A1 (Opallis, FGM) e aleatorizados em quatro grupos (n=5), de acordo com as soluções corantes: café solúvel, Coca-Cola®, vinho tinto e água destilada (controle). A cor inicial dos corpos de prova foi mensurada com espectrofotômetro Vita Easyshade e, em seguida, iniciou-se o processo de manchamento com as soluções corantes durante 72h. Após, foi realizado clareamento caseiro com PC 16%, por 3h diárias durante três semanas. A cor foi avaliada inicialmente, após o manchamento e pós-clareamento. Os dados foram submetidos ao teste de ANOVA e Tukey (a= 0,005). Observou-se maior pigmentação do café solúvel (24,4±3,0), seguido pelo vinho tinto (20,2± 2,0) e Coca-Cola® (3,7±1,2). Após o uso do PC 16% foi observada remoção de pigmentos de todos os espécimes de RC. Não houve diferença estatisticamente significante entre o controle (1,4±0,3), Coca-Cola® (1,2±0,4) e vinho tinto (1,6±1,1), apenas o grupo exposto ao café solúvel (5,9±3,3) diferiu estatisticamente do controle. Concluiu-se que os corantes foram capazes de pigmentar a RC, em especial o café solúvel. O clareamento caseiro com PC 16% foi eficaz na remoção dos pigmentos, porém os espécimes expostos ao café solúvel não retornaram à coloração inicial. Pacientes que consomem bebidas com corantes podem apresentar alterações na coloração das restaurações em RC, em especial pelo consumo do café solúvel (AU).

The aim was to evaluate in vitro the color change of composite resin submitted to pigmentation by instant coffee, red wine, and Coke®, as well as the change after bleaching with carbamide peroxide (CP) 16%. Twenty composite resin specimens were fabricated in color A1 (Opallis, FGM) and randomly divided into four groups (n= 5) according to the coloring solutions: instant coffee, Coke®, red wine and, control (distilled water). The initial color was measured with a spectrophotometer Vita Easyshade and then began the process of staining with the staining solutions for seventy-two hours. After staining, home bleaching with carbamide peroxide 16% was carried out for three hours daily for three weeks. The color assessment was performed before and after staining and after bleaching. Data were submitted to ANOVA and Tukey test (a = 0,005). There was greater pigmentation instant coffee (24.4±3.0), followed by red wine (20.2±2.0), and Coke® (3.7±1.2). After bleaching of pigment removal was observed in all resin specimens. There was no statistically significant difference between the control (1.4±0.3) and the groups Coke® (1.2±0.4) and red wine (1.6±1.1), only instant coffee (5.9±3.3) differed from control. It was concluded that the coloring solutions were able to alter resin pigment, especially instant coffee. The at home bleaching was effective for removal of resin pigments exposed to instant coffee, red wine and, Coke® and only the specimens exposed to instant coffee did not return to the initial color of the composite resin. Patients who consume drinks with dyes may present alterations in the color of CR restorations, especially due to instant coffee consumption (AU).

Toxicidade do peróxido de carbamida 16% adicionado de nanopartículas de hidroxiapatita / Carbamide peroxide toxicity added 16% hydroxyapatite nanoparticles

O clareamento dental é um dos tratamentos mais realizados nos consultórios odontológicos a fim de melhorar a aparência do sorriso. O procedimento consiste na aplicação de um gel clareador, a base de peróxido de carbamida ou de hidrogênio, sobre os dentes a serem clareados. A sensibilidade dentária é o efeito adverso mais frequentemente relatado no clareamento dentário e é a principal causa de desmotivação dos pacientes. O mecanismo pelo qual se produz a sensibilidade após clareamento dentário ainda não foi completamente elucidado; no entanto, parece estar associado à rápida difusão dos agentes clareadores através do esmalte e dentina que, devido ao seu grau de citotoxicidade, podem agir agredindo as células pulpares, causando sensibilidade. O objetivo deste estudo foi avaliar a biocompatibilidade de nanopartícula de hidroxiapatita adicionada ao gel clareador peróxido de carbamida 16% com flúor e sem flúor e, para tanto, foram realizados testes de citotoxidade empregando MTT. Como resultados verificou-se que as nanopartículas de hidroxiapatita, quando comparadas aos géis de peróxido de carbamida a 16% com e sem flúor, foram as menos citotóxicas (p< 0.05). As diluições citotóxicas convertidas para 70% das amostras testadas também foram comparadas através do teste de Anova com tukey. Foi possível observar que as partículas de nanoHap quando adicionadas nos géis de clareamento com e sem flúor reduziu significativamento a citotoxidade. Concluímos que o novo material proposto nesta investigação apresenta melhor biocompatibilidade do que o gel sem hidroxiapatita, acompanhado da redução da citotoxidade, tais aspectos sugerem que as nanopartículas de hidroxiapatita podem ter aplicações clínicas futuras em tecidos mineralizados em procedimentos de clareamento dental, contribuindo para a redução da sensibilidade dentária.

The dental bleaching is one of the most procedures performed at dental offices to improve the appearance of the smile. The procedure consists of the application of a bleching gel, based on carbamide peroxide or hydrogen over the teeth to be whitened. Tooth sensibility is the frequently reported adverse effect on tooth whitening and is the leading cause of demotivation by the patients. The mechanism that provides the sensibility after tooth whitening has not already been fully elucidated; however, it appears to be associated with the rapid diffusion of bleaching agents through the enamel and dentin that, because of their degree of cytotoxicity, may act attacking pulp cells, causing the sensibility. The aim of this study was to evaluate the biocompatibility of hydroxyapatite nanoparticles added to whitening gel of 16% carbamide peroxide with and without fluoride and, therefore, cytotoxicity tests were performed using MTT. As a result, it was found that the hydroxyapatite nanoparticles, compared to the gels of 16 % carbamide peroxide with and without fluoride, were less cytotoxic (p <0.05). Cytotoxic dilutions converted to 70 % of the tested samples were compared using ANOVA test with Tukey. We concluded that the new material proposed in this research has a better biocompatibility in comparison with the gel without hydroxyapatite, followed by a reduction of cytotoxicity. These aspects suggest that the hydroxyapatite nanoparticles may have clinical future applications in mineralized tissues when dental bleaching procedures are performed, contributing to the reduction of tooth sensitivity. We conclude that the new material proposed in this research has a better biocompatibility of the gel without hydroxyapatite, accompanied by a reduction of cytotoxicity, these aspects suggest that the hydroxyapatite nanoparticles may have future clinical applications in mineralized tissues in dental bleaching procedures, contributing to a reduction tooth sensitivity.

Estudo comparativo entre as técnicas de clareamento dental em consultório e clareamento dental caseiro supervisionado em dentes vitais: uma revisão de literatura / Comparative study of tooth whitening techniques in office and supervised at home in vital teeth: a literature review

Com a valorização da estética dentária, aliada à atual filosofia conservadora da Odontologia, as técnicas de clareamento apresentaram uma evolução clínica considerável. A alteração de cor dental vem sendo um dos problemas estéticos mais procurados pelos pacientes no consultório odontológico. O emprego das técnicas clareadoras caseiras e em consultório, quando corretamente executadas, possibilitam resultados estéticos satisfatórios. O objetivo deste estudo foi apresentar as técnicas de clareamento dental (caseiro e consultório), por meio de uma revisão narrativa de literatura. Realizou-se uma discussão dos principais procedimentos adotados, comparando-se os efeitos a curto e longo prazo, vantagens, desvantagens e efeitos colaterais. Nesses tratamentos, os principais agentes clareadores utilizados são o peróxido de carbamida e o peróxido de hidrogênio. Disponíveis em diversas concentrações, são responsáveis por promover resultados satisfatórios no branqueamento dos dentes, cabendo ao cirurgião-dentista efetuar uma análise do perfil do paciente, com vistas à escolha da melhor alternativa de tratamento. Mediante revisão apresentada, ambos os tratamentos foram semelhantes. No entanto, algumas peculiaridades devem ser observadas: para pacientes com sensibilidade dental, o mais indicado é o clareamento caseiro; em pacientes com retração gengival, o mais indicado é o de consultório

With the appreciation of aesthetic dentistry, combined with the current conservative philosophy of dentistry, the bleaching techniques had considerable clinical progress. The dental discoloration comes being one of the most popular aesthetic problems by patients in the dental office. The use of at-home and in-office bleaching techniques, when properly executed, enable satisfactory esthetic results. The aim of this study was presenting the tooth bleaching techniques (at-home and in-office), through a literature narrative review. It was held a discussion of the main procedures adopted, by comparing the short-term and long-term effects, advantages, disadvantages and side effects. At these treatments, the main used bleaching agents are carbamide peroxide and hydrogen peroxide. Available in varying concentrations, are responsible for promoting satisfactory results in whitening teeth, leaving the dentist perform an analysis of the patient?s profile, with a view to choosing the best alternative treatment. Upon review presented, both treatments were similar. However, some peculiarities must be observed: for patients with tooth sensitivity, the most suitable is the at-home bleaching; in patients with gingival recession, the most suitable is the in-office bleaching

Can a bleaching toothpaste containing Blue Covarine demonstrate the same bleaching as conventional techniques? An in vitro, randomized and blinded study

ABSTRACT Objective The purpose of this in vitro study was to compare the efficacy of a bleaching toothpaste containing Blue Covarine vs. conventional tooth bleaching techniques using peroxides (both in-office and at-home). Material and Methods Samples were randomly distributed into five experimental groups (n=15): C - Control; BC – Bleaching toothpaste containing Blue Covarine; WBC – Bleaching toothpaste without Blue Covarine; HP35 - In-office bleaching using 35% hydrogen peroxide; and CP10 – At-home bleaching with 10% carbamide peroxide. The dental bleaching efficacy was determined by the color difference (ΔE), luminosity (ΔL), green-red axis (Δa), and blue-yellow axis (Δb). The CIELab coordinates were recorded with reflectance spectroscopy at different times: T0 - baseline, T1 – immediately after bleaching, T2 - 7 days, T3 - 14 days, and T4 - 21 days after the end of treatments. Data were analyzed by a repeated measures mixed ANOVA and post hoc Bonferroni test, with a significance level of 5%. Results No significant differences were found between the treatment groups C, BC, and WBC. The groups HP35 and CP10 showed significantly higher whitening efficacy than groups C, BC, and WBC. Conclusions There were no significant differences in the whitening efficacy between a Blue Covarine containing toothpaste, a standard whitening toothpaste, and a control. Neither of the whitening toothpastes tested were as effective as in-office or at-home bleaching treatments.

Análise do clareamento dental caseiro realizado com diferentes produtos: relato de caso / Analysis of at-home dental bleaching using different products: case report

Os tratamentos odontológicos estéticos são muito procurados atualmente. Entre eles, o clareamento dental ocupa lugar de destaque. Por esse motivo, muitos trabalhos são realizados a fim de avaliar seus efeitos clínicos sobre a estrutura dental. Este trabalho teve como objetivo relatar e discutir os aspectos relacionados à alteração de cor, bem como à sensibilidade causadas pelo clareamento dental caseiro, utilizando peróxido de carbamida ou hidrogênio em diferentes concentrações. O caso clínico apresentado, assim como a literatura atual, mostra que os produtos são igualmente eficazes para o clareamento de dentes vitais. No entanto, com relação à ocorrência de sensibilidade, a utilização de produtos a base de peróxido de hidrogênio gerou maior sensibilidade quando comparado ao peróxido de carbamida, com o qual este inconveniente raramente ocorre. Pequenas irritações gengivais também puderam ser observadas durante o tratamento com peróxido de hidrogênio a 6%. Concluiu-se que o clareamento com os produtos a base de peróxido de carbamida a 10% ou com peróxido de hidrogênio a 6% aplicados em moldeiras produzem resultados satisfatórios, proporcionando aumento na autoestima e devolvendo ao paciente o prazer em sorrir

Aesthetic dental treatments are very popular nowadays. Among them, dental bleaching occupies a prominent place. Por esse motivo, muitos trabalhos são realizados a fim de avaliar seus efeitos clínicos sobre a estrutura dental. Due to the high demand for bleaching treatments, many studies have been conducted to evaluate its effects on tooth structure. This study aimed to report and discuss the aspects related to color change as well as the side effects caused by dental home bleaching using carbamide peroxide or hydrogen in different concentrations. This case reported and recent literature shows that the available products are similarly effective for vital dental bleaching. However, considering the occurrence of dental sensitivity, the use of hydrogen peroxide-based products promoted higher levels of this symptom when compared to carbamide peroxide. Gingival irritations were also verified during the treatment, regardless the product used. It was concluded that dental bleaching using 10% carbamide peroxide or 6% hydrogen peroxide accomplished with the aid of a tray produces satisfactory results, providing patients a greater selfesteem and pleasure in smiling

Bochechos com água oxigenada são carcinogênicos e indicados na internet: implicações ortodônticas e fundamentos / Mouthwash with hydrogen peroxide are carcinogenic and displayed on the internet: orthodontic implications and foundations

Em breve, teremos trabalhos sobre os efeitos do peróxido de hidrogênio na união dos braquetes aderidos ao esmalte, sobre os elásticos intermaxilares, os metais e cerâmicas dos próprios braquetes, na fixação da contenção e outras implicações práticas clínicas dos bochechos com água oxigenada, livremente indicados irresponsavelmente via internet, por pessoas despreparadas. Esses bochechos com água oxigenada pretensamente visam a antissepsia e a clareação dentária, estando “indicados” para uso diário e/ou semanal; no entanto, esses bochechos têm efeitos cocarcinogênicos na mucosa bucal e demais mucosas do trato gastrintestinal. Nesse artigo, procuraremos informar e dar fundamentos para que os profissionais da Odontologia e auxiliares possam embasar suas reflexões, opiniões e condutas relacionadas ao tema “uso indiscriminado e livre de peróxido de hidrogênio na boca sobre os dentes e mucosa bucal”.

Clareamento em dentes não vitais pela técnica walking bleach associado a clareamento em dentes vitais pela técnica caseira supervisionada / Non-vital walking bleaching technique associated with at-home tooth bleaching under professional supervision

A associação de técnicas de clareamento dental de dentes vitais e não vitais requer do profissional a individualização de um protocolo de trabalho para cada paciente. Este artigo mostra o relato de um caso clínico em que se utilizam diferentes técnicas de clareamento dental, aplicadas em dentes não vitais e vitais, com apoio na literatura existente. O protocolo de trabalho objetivou um tratamento com menor risco de reabsorção cervical externa e hipersensibilidade dentinária e com controle do nivelamento da cor obtida com o clareamento, entre os diferentes substratos dentais.

The combination of techniques for vital and non-vital tooth bleaching requires the establishment of a working protocol for each patient. This article shows a case report where different techniques of dental bleaching were used, both for non-vital and vital teeth, supported by the existing literature. The aim of this working protocol was to provide a treatment with minimal risk of external cervical resorption, dental hipersensitivity and control of the final shade in the different dental substrates.

Restabelecendo a estética anterior: aplicação personalizada de cerâmica em coroas ametálicas / Restablishing anterior esthetics: customized application of ceramics in metal-free crowns

O caso clínico aqui exposto foi realizado em um paciente jovem que apresentava os elementos 11 e 12 com tratamento endodôntico, núcleos metálicos fundidos, remanescentes radiculares escurecidos, desalinhamento do colo cervical e coroas puras de porcelana acinzentadas. Foi planejado clareamento dental, remoção dos núcleos metálicos, retratamento endodôntico de ambos os elementos, confecção de pinos de fibra de vidro anatomizados com resina composta, cirurgia plástica gengival para recontorno cervical e novas coroas em cerâmica pura com estrutura de dissilicato de lítio.

The clinical case was performed in a young patient that presented both maxillary central incisors with endodontic treatment, cast post-and-cores, darkened root remnants, lack of uniform cervical margins and grayish appearance of all-ceramic crowns. Treatment planning comprised bleaching treatment, removal of the cast post-and-cores, endodontic retreatment of both teeth, fiber-reinforced core build-up using fiber posts and composite resin, periodontal plastic surgery for recontouring of cervical margins and new lithium dissilicate all-ceramic crowns.

Avaliação da eficácia do clareamento externo com peróxido de hidrogênio a 6% e 7.5% / Evaluation of the effectiveness of external bleaching using 6% and 7.5% hydrogen peroxide

O presente estudo avalia in vivo a eficácia do tratamento clareador caseiro e a presença ou não de sensibilidade (SE), comparando dois agentes de uso diurno: (1) peróxido de hidrogênio (PH) 6% e (2) PH 7,5% com o peróxido de carbamida (PC) a 10% de uso noturno, como controle. Para tal, 35 pacientes foram selecionados e, em cada indivíduo, a arcada superior ou inferior foi aleatoriamente designada para uso de um dos agentes clareadores, dando início ao tratamento de quatro semanas pela arcada superior. Elaboraram-se escores para comparar as colorações inicial e final, por meio de fotografias e escala Vita. Como resultado, não houve diferença estatisticamente significante do tratamento clareador e da percentagem da SE entre o PC10%, PH6% e 7,5%. Conclui-se que o uso do PH6% ou PH7,5% por menos tempo e durante o dia possibilita ao tratamento clareador ser tão eficaz quanto o PC10% da técnica noturna.

This in vivo study evaluated the effectiveness and sensitivity rates (SE) of home-made bleaching treatment comparing two agents for daytime use: (1) 6% hydrogen peroxide (HP) and (2) 7.5% HP, and 10% carbamide peroxide (CP) for overnight use as a control. For this purpose, 35 individuals were selected and each was randomly assigned the maxillary or mandibular arch for using one of the bleaching agentes. The treatment was made initially in the maxillary arch for 4 weeks. Scores were recorded to compare the initial and final shades by photographs using a shade guide (Vita Classical). The results showed no significant difference for bleaching treatment and percentage of SE between 10% CP, 6% HP, and 7.5% HP. It was concluded that using 6%HP or 7.5%HP for shorter periods of time during the day was as effective as 10% CP overnight bleaching technique using mouthguards.

Avaliação da alteração de cor, difusão de peróxido de hidrogênio e citotoxicidade trans-amelodentinária causadas por diferentes técnicas de clareamento dental / Evaluation of color change, diffusion of hydrogen peroxide and trans-enamel and trans-dentinal cytotoxicity caused by different techniques of dental bleaching

Tem sido demonstrado que o tempo que o clareador permanece sobre o esmalte, a concentração do produto, a espessura do esmalte e da dentina presente em cada grupo de dentes, podem influenciar na penetração do peróxido na câmara pulpar e que esta ocorrência pode estar relacionada à inflamação da polpa e que nem sempre esses fatores estão associados à maior efetividade da técnica. Sendo assim, o objetivo deste estudo foi avaliar a alteração de cor, a citotoxicidade e a difusão do H2O2 causados por diferentes protocolos de clareamento dental. O presente estudo foi dividido em dois capitulos, no capitulo 1 foram estudados protocolos de clareamento de consultório: peróxido de hidrogênio a 35% (PH35%), três aplicaçoes de 15 minutos ou uma aplicação de 45 minutos; e peróxido de hidrogênio a 20% (PH20%) uma aplicação de 45 minutos. No capitulo 2 foram estudados protocolos caseiros: peróxido de carbamida 10% (PC10%), por 3 horas ou 1,5 horas e peróxido de hidrogênio 6% (PH6%), por 1,5 horas ou 45min. Para tanto, discos de esmalte/dentina foram clareados por 7, 14 e 21 dias pela técnica caseira ou receberam 3 sessões de clareamento de consultório, uma por semana. A alteração de cor dos espécimes (∆E) foi analisada por espectrofotometria de reflexão UV. Discos adaptados a câmaras pulpares artificiais foram posicionados em compartimentos contendo 1 ml de tampão acetato ou meio de cultura, de forma que a superfície dentinária permaneceu em contato direto com estas soluções. Imediatamente após o clareamento, o total de PH foi quantificado no tampão acetato e o meio de cultura foi aplicado por 1h em células MDPC-23, previamente semeadas em placas de acrílico. O metabolismo celular foi avaliado pelos teste MTT e a morfologia celular foi avaliada através de microscopia eletrônica de varredura. No capitulo 1 os resultados mostraram que ao final do tratamento a alteração cromática foi semelhante em todos os protocolos clareadores, observando-se que apesar de ter ocorrido...

It has been shown that the time that the bleach gel keeps on the enamel, the product concentration, the thickness of enamel and dentin in each group of teeth, among other factors, can influence the penetration of peroxide in the pulp chamber and that this occurrence may be associated with pulp inflammation and tooth sensitivity, and these factors are not associated with higher effectiveness of the technique. Thus, the aim of this study was to evaluate the color change, the cytotoxicity and the diffusion of H2O2 caused by different bleaching protocols. This study was divided into two chapters , in chapter 1 in-office bleaching protocols were studied: 35 % hydrogen peroxide (35% HP), three aplications of 15 minutes or an application of 45 minutes; and 20% hydrogen peroxide (20%HP) an application of 45 minutes. At-home protocols were studied in chapter 2: 10% carbamide peroxide (10 % CP ) for 3 hours or 1.5 hours; and 6% hydrogen peroxide (6% HP) for 1.5 hours or 45 min. Therefore, disks of enamel / dentin were bleached for 7, 14 and 21 days by the at-home technique or received 3 in office bleaching sessions, one per week. The color alteration of the specimens (∆E) was analyzed by spectrophotometry UV reflection. Discs adapted to artificial pulp chambers were placed in wells containing 1 ml of acetate buffer or culture medium, so that the dentine surface remained in contact with these solutions. Immediately after the bleaching, the total of HP was measured in acetate buffer and culture medium was applied for 1h at MDPC -23 cells previously seeded in acrylic plates. Cell metabolism was assessed by MTT assay and cell morphology was evaluated by scanning electron microscopy. In chapter 1 the results showed that at the end of the treatment the color change was similar in all bleaching protocols, noting that although there was less intense penetration of hydrogen peroxide in the group treated with lower concentrations of peroxide, all protocols caused decrease in...