How a 16% Carbamide peroxide home Bleaching agent affects the surface properties of chairside CAD/CAM materials? / ¿Cómo afecta un agente blanqueador casero de peróxido de carbamida al 16% a las propiedades de la superficie de los materiales CAD/CAM de consultorio?

Abstract Surface changes of restorative materials after bleaching have clinical importance in terms of the durability and survival of restorations. This study aimed to evaluate the effect of home bleaching on the surface roughness, microhardness, and surface analysis of four different types of chairside computer-aided design and computer-aided manufacturing (CAD/CAM) materials. Specimens were prepared from composite resin (Brilliant Crios: BC), resin nanoceramic (Lava Ultimate: LU), polymerinfiltrated ceramic-network (Vita Enamic: VE), and zirconia-reinforced lithium silicate glass-ceramic (Vita Suprinity: VS) CAD/CAM materials. Specimens were polished using 800, 1000, 1200, and 2000 grit SiC papers. Each restorative material was randomly divided into two groups; control and bleaching (n=10). The 16% carbamide peroxide bleaching agent (Whiteness Perfect 16%, FGM) was applied to the specimens for 4 h/ day for 14 days. Surface roughness values (Ra) were obtained using a profilometer, and microhardness values (VHN) were obtained using a Vickers microhardness test. Surface analysis of specimens was evaluated by scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). Data were analyzed Two-way ANOVA and Fishers Least Significant Difference (LSD) test (p<0.05). After bleaching, the surface roughness of BC (p<0.001) and VE (p<0.032) significantly increased. Bleaching did not significantly affect the microhardness of CAD/CAM materials. SEM evaluation showed material-dependent surface damages after bleaching procedures. The effect of 16% carbamide peroxide home bleaching agent on surface roughness and microhardness of chairside CAD/CAM materials is material-dependent. Before bleaching, restorative materials should be protected by applying a protective barrier and contact with the bleaching agent should be minimized. Also, after bleaching, the restoration surface should be carefully inspected, and re-polishing might be beneficial.

Resumen Los cambios en la superficie de los materiales de restauración tras el blanqueamiento tienen importancia clínica en cuanto a la durabilidad y supervivencia de las restauraciones. Este estudio tenía como objetivo evaluar el efecto del blanqueamiento en casa sobre la rugosidad de la superficie, la microdureza y el análisis de la superficie de cuatro tipos diferentes de materiales de diseño asistido por computadora y fabricación asistida por computadora (CAD/CAM). Se prepararon especímenes de materiales CAD/CAM de resina compuesta (Brilliant Crios: BC), de nanocerámica de resina (Lava Ultimate: LU), de cerámica en red infiltrada por polímeros (Vita Enamic: VE) y de cerámica de vidrio de silicato de litio reforzada con circonio (Vita Suprinity: VS). Las muestras se pulieron con papeles de SiC de grano 800, 1000, 1200 y 2000. Cada material de restauración se dividió aleatoriamente en dos grupos: control y blanqueo (n=10). El agente blanqueador de peróxido de carbamida al 16% (Whiteness Perfect 16%, FGM) se aplicó a las muestras durante 4 h/día durante 14 días. Los valores de rugosidad de la superficie (Ra) se obtuvieron utilizando un perfilómetro, y los valores de microdureza (VHN) se obtuvieron utilizando una prueba de microdureza Vickers. El análisis de la superficie de las muestras se evaluó mediante microscopía electrónica de barrido (SEM) y espectroscopia de rayos X de energía dispersiva (EDX). Los datos se analizaron mediante ANOVA de dos vías y la prueba de diferencia mínima significativa (LSD) de Fisher (p<0,05). Tras el blanqueamiento, la rugosidad de la superficie del CB (p<0,001) y del VE (p<0,032) aumentó significativamente. El blanqueamiento no afectó significativamente a la microdureza de los materiales CAD/CAM. La evaluación SEM mostró daños superficiales dependientes del material después de los procedimientos de blanqueo. El efecto del agente blanqueador casero de peróxido de carbamida al 16% sobre la rugosidad de la superficie y la microdureza de los materiales CAD/CAM en el sillón depende del material. Antes del blanqueamiento, los materiales de restauración deben protegerse aplicando una barrera protectora y debe minimizarse el contacto con el agente blanqueador. Además, después del blanqueamiento, la superficie de la restauración debe inspeccionarse cuidadosamente y puede ser beneficioso volver a pulirla.

Efectividad de sustancias químicas en el clareamiento y biopelícula dental aplicado en el consultorio y ambulatorio / Effectiveness of chemical substances in bleaching and dental biofilm applied in the office and outpatient

El blanqueamiento dental está considerado como pieza fundamental en el embellecimiento de los seres humanos, ya que permite la restauración de la "sonrisa perfecta". Este proceso en sí, es poco invasivo y juega como un gran papel como aliado en la restauración satisfactoria de la sonrisa y autoestima del paciente. Es un procedimiento que debe ser aplicado cuidadosamente para lograr los efectos positivos del mismo. El fundamento de esta técnica es aclarar la tonalidad que han sufrido los dientes por diversos factores: extrinsecos, intrínsecos y decoloraciones internas. Durante el procedimiento, es usual el uso de peróxido de hidrógeno (H2O2) en concentraciones que van del 10 al 32 % en volumen o el peróxido de carbamida, un compuesto conformado por peróxido de hidrógeno y urea concentraciones del 10 al 22 %. El uso de peróxido de hidrógeno se lleva a cabo fundamentalmente en los consultorios, mientras que el uso del peróxido de carbamida es un procedimiento doméstico. A pesar de los excelentes resultados que se obtiene al usar ambos blanqueadores, su uso puede ocasionar erosiones dentales y sensibilidad dentaria. El primer caso, puede llevar a la adherencia de bacterias cariogénicas como el Strepctococus mutans responsable de caries. Los resultados obtenidos, demostraron que el peróxido de hidrógeno es un agente más agresivo que el peróxido de carbamida, lo cual origina mayor sensibilidad dentaria y un mayor control bacteriano; en cambio el peróxido de carbamida fue mejor blanqueador y originó menor sensibilidad dental(AU)

Tooth whitening is considered a fundamental piece in the beautification of human beings, since it allows the restoration of the "perfect smile". This process itself is minimally invasive and plays a great role as an ally in the satisfactory restoration of the patient's smile and self-esteem. It is a procedure that must be carefully applied to achieve its positive effects. The basis of this technique is to clarify the shade that the teeth have suffered due to various factors: extrinsic, intrinsic and internal discoloration. During the procedure, the use of hydrogen peroxide (H2O2) in concentrations ranging from 10 to 32% by volume or carbamide peroxide, a compound made up of hydrogen peroxide and urea concentrations of 10 to 22%, is usual. The use of hydrogen peroxide is mainly carried out in offices, while the use of carbamide peroxide is a home procedure. Despite the excellent results obtained by using both whiteners, their use can cause dental erosion and tooth sensitivity. The first case can lead to the adherence of cariogenic bacteria such as Streptococcus mutans responsible for caries. The results obtained showed that hydrogen peroxide is a more aggressive agent than carbamide peroxide, which causes greater dental sensitivity and greater bacterial control; On the other hand, carbamide peroxide was a better whitener and caused less dental sensitivity(AU)

Estética y color en dientes calcificados: Informe de tres casos clínicos con blanqueamiento / Esthetics and shade in calcified teeth. Report of three clinical cases with whitening

Objetivo: El objetivo de este informe es presentar tres casos clínicos de piezas dentarias anterosuperiores calcificadas y con decoloración, resueltos según tres protocolos clínicos de blanqueamiento diferentes, con un mismo fin: devolver la estética al sector anterior. Casos clínicos: Cada una de las tres situaciones clínicas de decoloración dentaria se trató siguiendo un protocolo diferente. A partir del análisis clínico y radiográfico, se estableció un diagnóstico y un plan de tratamiento acorde. Todos los casos evolucionaron de manera favorable y siguen siendo controlados periódicamente. Conclusiones: En casos clínicos como los que se muestran en este trabajo, en los que el conducto y la cámara pulpar están calcificados u obliterados totalmente, sería posible realizar blanqueamiento interno y externo para recuperar la armonía óptica de forma conservadora. Este tipo de tratamientos permitiría responder a la alta prevalencia de demanda estética debido a traumatismos y cambios de coloración (AU)

Aim: To present three clinical cases of discoloration in calcified upper anterior teeth, that were resolved following different clinical protocols for teeth whitening to return the aesthetics of the anterior teeth. Clinical cases: Each clinical case of discoloration was treated following a different treatment protocol based on a correct clinical and radiographic diagnosis. All cases had a favourable outcome and have no regular review. Conclusion: In clinical cases as those presented in this article where the canal and pulp chamber are totally calcified or obliterated, it was possible to perform internal and or external whitening to restore optical harmony in a conservative way. This type of treatment would allow responding to the high prevalence of aesthetic demand due to trauma and colour changes (AU)

Estabilidad del color en el blanqueamiento intracoronal / Color stability in intracoronal whitening

RESUMEN Introducción: El blanqueamiento intracoronal es una alternativa mínimamente invasiva que permite devolver el color a dientes no vitales tincionados. La estabilidad del color logrado es fundamental para evaluar la predictibilidad de este tipo de tratamiento. Objetivo: Evaluar la estabilidad del color 3 años después del blanqueamiento intracameral con peróxido de hidrógeno y carbamida a diferentes concentraciones. Métodos: Se utilizaron 44 premolares extraídos por indicación ortodóncica, los cuales fueron tratados endodónticamente y pigmentados artificialmente con cromógenos sanguíneos. Las muestras fueron divididas aleatoriamente en 4 grupos de estudio (n = 11) siendo: grupo A: peróxido de carbamida 37 por ciento, grupo B: peróxido de hidrógeno 35 por ciento, grupo C: peróxido de carbamida 100 por ciento y grupo D: control; para luego realizar 4 aplicaciones de agente blanqueador con un intervalo de 4 días entre cada aplicación. El registro del color se realizó mediante espectrofotometría, lo que permitió obtener los valores CIE L*a*b* para calcular la variación total de color entre los parámetros iniciales y finales del tratamiento, así como el control a los 3 años. Resultados: Los resultados fueron analizados mediante las pruebas de Shapiro-Wilks, ANOVA y Mann-Whitney, sin registrar diferencias significativas en la variación total de color al control de los 3 años (p > 0,05). Conclusión: Los resultados del blanqueamiento intracoronal, independiente del tipo y concentración del agente utilizado en este estudio son estables en el tiempo y cualquier variación regresiva de color debe ser atribuida a factores extrínsecos(AU)

ABSTRACT Introduction: Intracoronal whitening is a minimally invasive procedure to restore natural color to stained non-vital teeth. The color stability achieved is fundamental to evaluate the predictability of this type of treatment. Objective: Evaluate color stability 3 years after intracameral whitening with carbamide and hydrogen peroxide at various concentrations. Methods: A total 44 premolars were used which had been extracted by orthodontic indication. The premolars were treated endodontically and artificially pigmented with blood chromogenes. The samples were randomly divided into 4 study groups (n = 11): Group A: 37 percent carbamide peroxide, Group B: 35 percent hydrogen peroxide, Group C: 100 percent carbamide peroxide and Group D: control. Four applications were then made of the whitening agent with a 4-days' separation between them. Color was recorded by spectrophotometry, obtaining the values CIE L*a*b* to estimate total color variation between the initial and final parameters of the treatment, as well as control at 3 years. Results: The results were analyzed with Shapiro-Wilk, ANOVA and Mann-Whitney tests, not finding any significant differences in total color variation with respect to the 3 years' control (p > 0.05). Conclusion: The results of the intracoronal whitening studied are stable throughout time, regardless of the type and concentration of the agent used, and any regressive color variation should be attributed to extrinsic factors(AU)

Regresión de la luminosidad del color posblanqueamiento dental casero en pacientes fumadores y no fumadores / Color luminosity regression after home tooth whitening in smoking and nonsmoking patients

Introducción: Existen muchos estudios de efectividad del blanqueamiento dental; sin embargo, son muy pocos los que hablan de regresión de color (fenómeno que se produce posterior a un blanqueamiento dental), lo mismo ocurre en relación a pacientes fumadores. Objetivo Determinar la regresión de la luminosidad del color en pacientes sometidos a blanqueamiento dental casero con peróxido de carbamida al 10 por ciento, en pacientes fumadores y no fumadores. Métodos: Estudio descriptivo, transversal, en 43 pacientes de un grupo de 60 previamente tratados de forma casera durante 3 semanas con peróxido de carbamida al 10 por ciento. Fueron divididos en un grupo experimental (pacientes fumadores GE) y grupo control (no fumadores GC). Se midió la variación del color con el espectrofotómetro Vita Easyshade® a la semana, mes, 6 meses y 9 meses posblanqueamiento. Los datos obtenidos mediante la medición con el espectrofotómetro fueron analizados por el test de Shapiro Wilk y Kolmogorov-Smirnov para evaluar normalidad de la distribución y, posteriormente, sometidos al test Mann-Whitney U y Wilcoxon W (#945; = 0,05). Resultados: El delta L* fue: 2,3 (GE) y 3,66 (GC); deltas calculados con datos de los 9 meses vs. semana posblanqueamiento. No hubo diferencias estadísticamente significativas entre ambos grupos. Conclusiones: No existen diferencias estadísticamente significativas en la regresión del color posteriores al blanqueamiento casero con peróxido de carbamida al 10 por ciento en pacientes fumadores y no fumadores(AU)

Introduction: Many studies have been conducted about the effectiveness of tooth whitening, but few refer to color regression (a phenomenon occurring after tooth whitening) or to smoking patients. Objective: Determine color luminosity regression in smoking and nonsmoking patients undergoing home tooth whitening with 10 percent carbamide peroxide. Methods: A descriptive cross-sectional study was conducted of 43 patients from a group of 60 previously undergoing home treatment with 10 percent carbamide peroxide for 3 weeks. The patients were divided into an experimental group (EG, smoking patients) and a control group (CG, nonsmoking patients). A Vita Easyshade® spectrophotometer was used to measure color variation one week, one month, 6 months and 9 months after whitening. The data obtained by spectrophotometry were analyzed with the Shapiro-Wilk and the Kolmogorov-Smirnov tests to evaluate the normality of the distribution, and then they were subjected to the Mann-Whitney-Wilcoxon U test (α = 0,05). Results: Delta L* was 2,3 (EG) and 3,66 (CG); delta values were estimated from data obtained 9 months vs. one week after whitening. No statistically significant differences were found between the groups. Conclusions: No statistically significant color regression differences are found in either smoking or nonsmoking patients after home whitening with 10 percent carbamide peroxide(AU)

Over-the-counter tooth whitening agents: a review of literature

Abstract There is an increased accessibility of over-the-counter (OTC) whitening agents with very little data in the literature regarding their effectiveness. This review was done to determine their effectiveness of the predominant OTC whitening agents from 2006 until 2018 where a comparison of each agent was made with a placebo, no treatment or with other OTC whitening agents. The major categories of OTC whitening agents such as dentifrices, whitening strips and paint on gels. Dentist prescribed bleaching applied at home and in-office bleaching studies and studies that demonstrated whitening products to participants were excluded. Articles were searched for in the databases of Medline (Ovid), PubMed, the Cochrane Library and Cochrane Central Register of Controlled Trials. Twenty-four articles were included in the systematic review and the quality of studies was determined by the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) ranking criteria. Compared to other OTC, strips are reported to be effective. Two studies determined whitening strips to be effective. Whitening strips have been shown to be effective when compared with placebos and other OTC whitening agents. Dentifrices are effective in changing the shade of the tooth "by removing extrinsic stains" when compared to a placebo and non-whitening dentifrices, but they are not as effective in comparison to whitening strips. There is a lack of evidence with regards to the effectiveness of paint-on gels. While there is some evidence that OTC can alter shade in the short term, there is a need for better-designed studies.

Resumo Há um aumento da acessibilidade dos agentes clareadores de venda livre com poucos dados na literatura sobre sua eficácia. Esta revisão foi feita para determinar a eficácia dos agentes clareadores de venda livre predominantes de 2006 a 2018, onde foi feita uma comparação de cada agente com um placebo, sem tratamento ou com outros agentes clareadores de venda livre. As principais categorias de agentes clareadores de venda livre, como dentifrícios, tiras branqueadoras e géis. Estudos em que o dentista prescreveu clareamento caseiro e em consultório, e estudos que demonstraram os agentes clareadores para os participantes. Os artigos foram pesquisados ​​nas bases de dados do Medline (Ovid), PubMed, Cochrane Library e Cochrane Central Register of Controlled Trials. Vinte e quatro artigos foram incluídos na revisão sistemática e a qualidade dos estudos foi determinada pelo critério de classificação GRADE (Classificação de Recomendações, Avaliação, Desenvolvimento e Avaliações). Em comparação com outros clareadores de venda livre, as tiras são relatadas como eficazes. Dois estudos determinaram que as tiras de clareamento são eficazes. As tiras de clareamento mostraram-se eficazes quando comparadas com placebos e outros agentes clareadores de venda livre. Os dentifrícios são eficazes na mudança da tonalidade do dente "removendo manchas extrínsecas" quando comparados a dentifrícios com placebo e sem clareamento, mas não são tão eficazes em comparação com as tiras de clareamento. Há uma falta de evidência com relação à eficácia dos géis de tinta. Embora exista alguma evidência de que os clareadores de venda livre possa alterar a tonalidade no curto prazo, há necessidade de estudos melhor projetados.

Penetración en la cámara pulpar del blanqueamiento dental con peróxido de carbamida a diferentes concentraciones / Penetration in the pulp chamber of dental whitening with carbamide peroxide to different concentrations / Penetração na câmara pulpar do clareamento dental com peróxido de carbamida a diferentes concentrações

Los agentes utilizados en blanqueamiento dental provocan una respuesta inflamatoria de la pulpa, que de-pende de la concentración y el tiempo de aplicación de la sustancia empleada. Objetivo: Evaluar el nivel de penetración del blanqueamiento a base de peróxido de carbamida a diferentes concentraciones: 10, 20 y 35% dentro de la cámara pulpar. Materiales y métodos: Se utilizaron 120 terceros molares humanos extraí-dos, divididos aleatoriamente en cuatro grupos (n=30): grupo A: control; grupo B: 10% gel de Peróxido de Carbamida (CP del inglés Carbamide Peroxide); grupo C: 20% gel CP y grupo D: 35% gel CP. Los dientes se cortaron 2 mm por debajo del límite amelocementario con una máquina de corte, se colocó buffer de acetato en la cámara pulpar y se aplicó por 40 minutos el agente clareador una sola vez. Los dientes se mantuvieron a temperatura ambiente (25°C) durante el proceso. La penetración de CP se estimó con cristal violeta y peroxi-dasa de rábano picante, en un espectrofotómetro de absorbancia. Los datos fueron analizados mediante las pruebas estadísticas ANOVA complementada con el Test post Hoc de Tukey con un grado de significancia al 5%. Resultados: Las medias obtenidas para el Grupo B fueron de 0,062 mg (±0,018), para el Grupo C fueron de 0,063 mg (±0,017), y para el Grupo D fueron de 0,086 mg (±0,024). Existiendo diferencia significativa (p= <0.05) del grupo D con relación a los otros grupos. Conclusión: la penetración de CP en la cavidad pulpar depende de la concentración, siendo mayor en concentración al 35%.

The elimination of calcium hydroxide in the root canal is decisive for the success of endodontic treatment, the remnants can interact negatively with endodontic sealants increasing filtrations and decreasing the quality of the seal. Objective: To evaluate the effect of intra-duct medication with calcium hydroxide paste on the pen-etration of the sealing cement inside the dentinal tubules. Materials and methods: 20 distal roots of upper molars were instrumented using the Wave One Large 40 / .08 System. They were randomly divided into two groups: one sealed with a single cone technique and Ah plus cement with rhodamine-B and another sealed with the same technique and Ah plus cement with rhodamine B, previous placement for 15 days and removal by recapping the paste calcium hydroxide. Subsequently, the teeth were cut transversely and photomicro-graphs of the cervical, middle and apical third were performed using the laser scanning confocal microscopy technique. The maximum depth of penetration was determined through the Image J program. Results: The Ah plus sealing cement had lower penetration values when the calcium hydroxide paste was previously used as an intra-channel medication (p <0.01). The third of the duct with the highest penetration was the cervical third followed by the middle third and finally the apical (p <0.01). Conclusion: Remaining calcium hydroxide decreases the penetration of the sealing cement Ah plus in the dentinal tubules in all thirds of the root canal.

Os agentes utilizados no clareamento dos dentes estimulam uma resposta inflamatória da polpa, o que de-pende da concentração e do tempo de aplicação da substância utilizada. Objetivo: Avaliar o nível de pe-netração do clareamento à base de peróxido de carbamida em diferentes concentrações: 10, 20 e 35% no interior da câmara pulpar. Materiais e métodos: foram utilizados 120 terceiros molares humanos extraídos, divididos aleatoriamente em quatro grupos (n = 30): grupo A: controle; grupo B: gel de peróxido de carbamida a 10% (CP do inglês carbamide peroxide); grupo C: gel CP de 20% e grupo D: gel CP de 35%. Os dentes foram cortados 2 mm abaixo do limite amelocementário com uma máquina de corte, tampão acetato foi colo-cado na câmara pulpar e o clareador foi aplicado por 40 minutos apenas uma vez. Os dentes foram mantidos à temperatura ambiente (25 °C) durante o processo. A penetração de CP foi estimada com cristal violeta e peroxidase de rábano picante, em espectrofotômetro de absorvância. Os dados foram analisados por meio dos testes estatísticos ANOVA, complementados com o teste post hoc de Tukey, com um grau de significância de 5%. Resultados: As médias obtidas no grupo B foram de 0,062 mg (± 0,018), no grupo C foram de 0,063 mg (± 0,017) e no grupo D foram de 0,086 mg (± 0,024). Existe uma diferença significativa (p = <0,05) do grupo D em relação aos demais grupos. Conclusão: a penetração da PC na cavidade pulpar depende da concentração, sendo maior na concentração em 35%.

Effect of violet LED light on in-office bleaching protocols: a randomized controlled clinical trial

Abstract Objective This study evaluated the clinical effect of violet LED light on in-office bleaching used alone or combined with 37% carbamide peroxide (CP) or 35% hydrogen peroxide (HP). Methodology A total of 100 patients were divided into five groups (n=20): LED, LED/CP, CP, LED/HP and HP. Colorimetric evaluation was performed using a spectrophotometer (ΔE, ΔL, Δa, Δb) and a visual shade guide (ΔSGU). Calcium (Ca)/phosphorous (P) ratio was quantified in the enamel microbiopsies. Measurements were performed at baseline (T 0 ), after bleaching (T B ) and in the 14-day follow-up (T 14 ). At each bleaching session, a visual scale determined the absolute risk (AR) and intensity of tooth sensitivity (TS). Data were evaluated by one-way (ΔE, Δa, ΔL, Δb), two-way repeated measures ANOVA (Ca/P ratio), and Tukey post-hoc tests. ΔSGU and TS were evaluated by Kruskal-Wallis and Mann-Whitney, and AR by Chi-Squared tests (a=5%). Results LED produced the lowest ΔE (p<0.05), but LED/HP promoted greater ΔE, ΔSGU and Δb (T 14 ) than HP (p<0.05). No differences were observed in ΔE and ΔSGU for LED/CP and HP groups (p>0.05). ΔL and Δa were not influenced by LED activation. After bleaching, LED/CP exhibited greater Δb than CP (p>0.05), but no differences were found between these groups at T 14 (p>0.05). LED treatment promoted the lowest risk of TS (16%), while HP promoted the highest (94.4%) (p<0.05). No statistical differences of risk of TS were found for CP (44%), LED/CP (61%) and LED/HP (88%) groups (p>0.05). No differences were found in enamel Ca/P ratio among treatments, regardless of evaluation times. Conclusions Violet LED alone produced the lowest bleaching effect, but enhanced HP bleaching results. Patients treated with LED/CP reached the same efficacy of HP, with reduced risk and intensity of tooth sensitivity and none of the bleaching protocols adversely affected enamel mineral content.

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.

Avaliação dos diferentes protocolos de clareamento dental caseiro (supervisionado) / Evaluation of the different protocols for at-home teeth bleaching (Supervised)

Introdução: A pigmentação dentária é causada por diversos fatores que acarretam prejuízos na estética e autoestima do paciente. A busca por um sorriso esteticamente perfeito acarretou maior demanda por procedimentos clareadores em que diferentes técnicas, tipos e concentrações de agentes clareadores podem ser utilizados na obtenção de um tratamento eficaz. Objetivo: Verificar, através de uma revisão da literatura, a eficácia, as limitações e os efeitos colaterais relacionados aos diferentes protocolos de clareamento dental caseiro. Metodologia: Foi realizada uma revisão da literatura por meio de buscas nas bases de dados PubMed/MEDLINE, LILACS, SciELO e Google Acadêmico, utilizando os seguintes descritores: "tooth bleaching" OR "supervised tooth bleaching" AND "clinical protocol". Apenas estudos experimentais, publicados nos últimos cinco anos, foram incluídos e não houve restrição quanto ao idioma. Resultados: O peróxido de hidrogênio (PH) e o peróxido de carbamida (PC) são eficazes quando administrados em concentrações de 4% a 16% com aplicações diárias que podem variar de 7 a 14 dias. O tempo de aplicação do PH é de 1 a 4 horas e do PC é de 4 a 8 horas. Géis com menores concentrações provocam menos sensibilidade dentária e irritação gengival, porém, o tempo de tratamento é geralmente prolongado. Conclusão: Para um tratamento eficaz, é indispensável um diagnóstico correto, já que o tipo de pigmento influencia sobremaneira no protocolo a ser empregado. Portanto, é fundamental conhecer a etiologia da mancha para assim estabelecer o tipo do gel, a sua concentração, o tempo e o modo de aplicação adequados.

Introduction: Dental pigmentation is caused by several factors that affect the patient's aesthetics and self-esteem. The search for an aesthetically perfect smile has led to a greater demand for bleaching procedures, in which different techniques, types, and concentrations of bleaching agents can be used to do an effective treatment. Objective: to verify, through a literature review, the application, permission, and effects related to different home tooth whitening protocols. Methodology: A literature review was carried out by searching the PubMed/MEDLINE, LILACS, SciELO, and Google Scholar databases, using the following descriptors: "tooth whitening" OR "supervised tooth whitening" AND "clinical protocol". Only experimental studies, which were published in the last five years, were included. There were no language restrictions. Results: Hydrogen peroxide (PH) and carbamide peroxide (PC) are efficient when administered in 4% to 16% with applications that can vary from 7 to 14 days. The PH application time is 1 to 4 hours and the PC is 4 to 8 hours. Gels with smaller concentrations cause less tooth sensitivity and gingival irritation; however, the treatment time is usually prolonged. Conclusion: A correct diagnosis is indispensable for an effective treatment since the type of pigment greatly affects the protocol to be used. Therefore, it is essential to know the etiology of the stain to define the type of gel, its concentration, time, and method of application.

Effect of tooth enamel staining by coffee consumption during at-home tooth bleaching with carbamide peroxide / Efeito da coloração do esmalte dentário pelo consumo de café durante o clareamento dentário caseiro com peróxido de carbamida

Introduction: Obtaining the result expected during tooth bleaching requires a correct diagnosis of the type of staining presented. The causes of tooth staining differ depending on the etiological factor. Objective: To assess the color change caused by the immersion of bovine teeth in coffee solution during at-home tooth bleaching using a 16% carbamide peroxide gel. Material and method: Thirty-three sound bovine teeth were assigned to three groups of eleven teeth each: 1 - Teeth bleached (TB) four hours per day for 21 days; 2 - TB four hours per day for 21 days and immersed in coffee solution immediately after tooth bleaching; 3 - TB four hours per day for 21 days and immersed in coffee solution four hours after the end of tooth bleaching. Immersed in coffee was performed for 15 minutes and tooth color was assessed before the start of the bleaching procedure and after 21 days with an intraoral spectrophotometer. Test Shapiro-Wilk was used to assess homoscedasticity and data were submitted to one-factor Analysis of Variance (ANOVA) and Tukey's test (p <0.05). Result: The color change observed in group 1 (5.76 ± 2.74)A was not statistically different from group 2 (8.83 ±5.11)A, which was immersed in coffee solution immediately after tooth bleaching, and from group 3, which was immersed in coffee solution four hours after tooth bleaching (8.20 ±3.71)A. Conclusion: Coffee did not interfere with the tooth bleaching results, regardless of the time after the procedure. Hence, diet restrictions are not necessary during tooth bleaching.

Introdução: A obtenção do resultado esperado durante o clareamento dental exige um diagnóstico correto do tipo de coloração apresentado. As causas da coloração dos dentes diferem dependendo do fator etiológico. Objetivo: Avaliar a mudança de cor causada pela imersão dos dentes bovinos na solução de café durante o clareamento dentário caseiro, utilizando gel de peróxido de carbamida a 16%. Material e método: Trinta e três dentes bovinos hígidos foram distribuídos em três grupos de onze dentes cada: 1 - Dentes clareados quatro horas por dia durante 21 dias; 2 - Dentes clareados quatro horas por dia durante 21 dias e imerso em solução de café imediatamente após o clareamento dentário; 3 - Dentes clareados quatro horas por dia durante 21 dias e imerso em solução de café quatro horas após o término do clareamento dentário. Imersão em café foi realizada durante 15 minutos e a cor dos dentes foi avaliada antes do início do procedimento do clareamento e após 21 dias com um espectrofotômetro intraoral. O teste Shapiro-Wilk foi utilizado para avaliar a homocedasticidade e os dados foram submetidos à análise de variância de um fator (ANOVA) e ao teste de Tukey (p <0,05). Resultado: A mudança de cor observada no grupo 1 (5,76 ± 2,74)A não foi estatisticamente diferente do grupo 2 (8,83 ± 5,11)A, imerso em solução de café imediatamente após o clareamento dentário, e do grupo 3, imerso em café quatro horas após o clareamento dental (8,20 ± 3,71). Conclusão: O café não interferiu nos resultados do clareamento dental, independentemente do tempo após o procedimento. Portanto, restrições alimentares não são necessárias durante o clareamento dental.

Initial and pulp chamber concentration of hydrogen peroxide using different bleaching products / Concentração de peróxido de hidrogênio na câmara pulpar utilizando diferentes produtos clareadores

Objective: This study's aim was to quantify the hydrogen peroxide (HP) penetration into the pulp chamber of teeth submitted to different protocols of bleaching. Material and Methods: Ninety premolars were randomly divided into nine groups according to the bleaching agent protocol (n = 10): control (no bleaching), carbamide peroxide 10% [10% CP], carbamide peroxide 16% [16% CP], carbamide peroxide 22% [22% CP], hydrogen peroxide 4% [4% HP], hydrogen peroxide 6% [6% HP], hydrogen peroxide 7.5% [7.5% HP], hydrogen peroxide 10% [10% HP] and hydrogen peroxide 35% [35% HP]. The penetration of HP was measured via spectrophotometric analysis of the acetate buffer solution from the pulp chamber. The absorbance of the resulting solution was determined in a spectrophotometer and converted into equivalent concentration of HP (µg/ mL). To analyze the concentration of HP, the titration of bleaching agents with potassium permanganate was used. Data were subjected to ANOVA and Tukey's test for pairwise comparison (α = 0.05). Results: Higher concentration of HP in the pulp chamber was found in the HP 35% group (p < 0.0001). No significant difference between at-home protocols were observed (p = 0.64). Titration values showed that the concentration of the products was similar to that claimed by the manufacturer. Conclusion: It follows that the amount of HP that reaches the pulp chamber is not proportional to the concentration of whitening gels, but depends on the application time recommended by the manufacturers (AU)

Objetivo: o objetivo deste estudo foi quantificar a penetração do peróxido de hidrogênio (PH) na câmara pulpar dos dentes submetidos a diferentes protocolos de clareamento. Material e Métodos: Noventa pré-molares foram divididos aleatoriamente em nove grupos, de acordo com o protocolo do agente clareador (n = 10): controle (sem clareamento), peróxido de carbamida 10% [PC 10%], peróxido de carbamida 16% [PC 16%], peróxido de carbamida 22% [PC 22%], peróxido de hidrogênio 4% [PH 4%], peróxido de hidrogênio 6% [PH 6%], peróxido de hidrogênio 7,5% [PH 7,5%], peróxido de hidrogênio 10% [PH 10%] e peróxido de hidrogênio 35% [PH 35%]. A penetração de PH foi medida por análise espectrofotométrica da solução de tampão de acetato da câmara pulpar. A absorvância da solução resultante foi determinada em um espectrofotômetro e convertida em concentração equivalente de PH (µg / mL). Para analisar a concentração de PH, foi utilizada a titulação de agentes clareadores com permanganato de potássio. Os dados foram submetidos à ANOVA e teste de Tukey para comparação pareada (α = 0,05). Resultados: Foi encontrada maior concentração de PH na câmara pulpar no grupo PH 35% (p < 0,0001). Não foi observada diferença significativa entre os protocolos domiciliares (p = 0,64). Os valores de titulação mostraram que a concentração dos produtos era semelhante à reivindicada pelo fabricante. Conclusão: Conclui-se que a quantidade de PH que atinge a câmara pulpar não é proporcional à concentração de géis clareadores, porém depende do tempo de aplicação recomendado pelos fabricantes.(AU)

Effects of bleaching using 10% carbamide peroxide with calcium or amorphous calcium phosphate on enamel mineral content and hardness / Asociación entre la severidad de Hipomineralización Incisivo-Molar (HIM) y lesiones cavitadas de caries en escolares

ABSTRACT This study evaluated enamel mineral content and surface microhardness before and after bleaching treatment using 10% carbamide peroxide (CP) containing calcium (Ca) or amorphous calcium phosphate (ACP). Thirty-six bovine slabs were randomly allocated into 3 groups (n = 12) according to bleaching treatment: G1 - Opalescence PF 10% (CP), G2 -NiteWhite ACP (CP+ACP), and G3 - Opalescence PF (10%) with calcium (CP+CA). The bleaching agent was applied on enamel surface for 6 h/day over a period of 21 days. Enamel surface was evaluated by Knoop microhardness (KNH) and micro energy-dispersive X-ray fluorescence spectrometry (p-EDXRF) at baseline and at after bleaching treatment. Data were statistically analyzed by repeated measures ANOVA and Tukey's test (a = 0.05). There was a significant decrease in microhardness after bleaching treatments for all study groups, but no difference between bleaching gels. There was no difference in the Ca/P ratio measured by p-EDXRF for all groups at the study times, but the mean value was lower in group CP+CA than in group CP+ACP. Group CP was similar to both CP+ACP and CP+CA. It can be concluded that enamel microhardness decreased after the bleaching process, regardless of the presence of calcium or ACP, but there was no significant change in the Ca/P ratio of enamel after bleaching for each tested gel. This indicates that the bleaching gels have erosive potential, causing softening of enamel without promoting surface loss, regardless of the presence of calcium of ACP ions.

RESUMO Este estudo avaliou o conteúdo mineral do esmalte e a microdureza superficial antes e após o tratamento clareador, utilizando peróxido de carbamida 10% (PC) contendo cálcio (Ca) ou fosfato de cálcio amorfo (ACP) em sua composigao. Trinta e seis espécimes de esmalte bovino foram alocados aleatoriamente em 3 grupos (n = 12) de acordo com os tratamentos clareadores: G1 - Opalescence PF 10% (CP), G2 -NiteWhite (CP+ACP); e G3 - Opalescence PF (10%) com cálcio (CP + CA). O agente clareador foi aplicado na superficie do esmalte por 6 h/dia por um periodo de 21 dias. A superficie do esmalte foi avaliada por microdureza Knoop (KNH) e espectrometria de fluorescencia de raios X micro-dispersiva (p-EDXRF) no inicio e após o tratamento clareador. Os dados foram analisados estatisticamente pelo teste ANOVA de medidas repetidas e Tukey (a = 0,05). Houve uma diminuigao significativa da microdureza após os tratamentos clareadores para todos os grupos estudados, mas nao houve diferenga entre os diferentes géis. Nao houve diferenga da relagao Ca/P mensurada por p-EDXRF para todos os grupos nos tempos estudados; no entanto, o grupo CP+CA apresentou menor valor comparado ao grupo CP+ACP. O grupo CP foi similar aos grupos CP+ACP e CP+CA. Portanto, pode-se concluir que houve redugao significativa da microdureza do esmalte após o clareamento, independente da presenga de cálcio ou APC na composigao dos géis, embora nao tenha havido alteragao significando na relagao Ca/P do esmalte após o clareamento. Isto indica um potencial erosivo dos géis clareadores, causando o amolecimento sem perda da estrutura do esmalte, independente da presenga dos íons cálcio e ACP.

Influence of Prolonged Tooth Bleaching on Enamel Mass Variation / Influencia del Blanqueo Dental Prolongado en la Variación de Masa del Esmalte Dental

ABSTRACT: The objective evaluate was the influence of prolonged tooth bleaching with 10 % carbamide peroxide (10CP) on tooth enamel mass variation. Ten healthy bovine incisor teeth were divided (n = 5) into G1 - storage in distilled water and G2 - storage in artificial saliva. The samples were weighed in an electronic analytical balance at the following times: T0 - before application of the bleaching gel, T1 - after 14 days of bleaching (the time recommended by the manufacturer), T2 - after 21 days of bleaching (50 % increase in the time recommended by the manufacturer), and T3 - after 28 days of bleaching (100 % increase in the time recommended by the manufacturer). The data were subjected to ANOVA for related samples (p = 0.05). The highest mean was observed in G2 (0.5982 g) and the lowest mean was observed in G1 (0.3074 g) at T2 and T3, respectively. Significant differences were observed between the groups at all times. Overall, 10CP caused variation in the enamel mass after a 100 % increase in the use time recommended by the manufacturer, with a decrease in mass when distilled water was used as the storage medium and an increase when artificial saliva was used.

RESUMEN: El objetivo fue investigar la influencia del blanqueamiento dental prolongado con peróxido de carbamida al 10 % (10CP) sobre la variación de masa del esmalte dental. Las muestras se dividieron en dos grupos: G1, diez dientes sanos de los incisivos bovinos (n = 5) en agua destilada, y G2, almacenamiento en saliva artificial. Las muestras se midieron en una escala analítica electrónica de precisión en los siguientes tiempos: T0-antes de la aplicación del gel blanqueador, T1-después de 14 días de blanqueo (el tiempo recomendado por el fabricante), T2-después de 21 días de blanqueo (aumento de 50 % en el tiempo recomendado por el fabricante), y T3-después de 28 días de blanqueo (aumento de 100 % en el tiempo recomendado por el fabricante). Los datos se presentaron al ANOVA para las muestras relacionadas (P = 0,5). La media más alta se observó en G2 (0,5982 g) y la media más baja se observó en G1 (0,3074 g) en T2 y T3, respectivamente. Se observaron diferencias significativas entre los grupos en todo momento. En general, la 10 CP causó variación en la masa del esmalte después de un aumento de 100 % en el tiempo de uso recomendado por el fabricante, con una disminución en la masa cuando el agua destilada se utilizó como medio de almacenamiento y aumentó cuando se usó saliva artificial.

Effect of dental bleaching on pulp oxygen saturation in maxillary central incisors - a randomized clinical trial

Abstract Objective To assess pulp oxygen saturation levels (SaO2) in maxillary central incisors after dental bleaching. Materials and Methods 80 participants (160 teeth) were randomly allocated to four groups: G1 In-office bleaching with two applications of 35% hydrogen peroxide (HP) (20 minutes), followed by at-home bleaching with 10% carbamide peroxide (CP) (2 hours/day for 16 days); G2 - Same protocol as G1, plus desensitizing toothpaste; G3 - In-office bleaching with 35% HP and one application of placebo gel (20 minutes), followed by at-home bleaching with 10% CP (2 hours/day for 16 days); and G4 - Same protocol as G3, plus desensitizing toothpaste. Pulp SaO2 levels were measured before (T0) and immediately after (T1) in-office bleaching; on the 5th (T2), 8th (T3), 12th (T4), and 16th days of at-home bleaching (T5); and on the 7th (T6) and 30th (T7) days. Mean (SD) pulp SaO2 levels were compared within groups by generalized estimating equations (GEE) and Student's t-test (P<0.05). Results Mean pulp SaO2 at T0 was 84.29% in G1, 84.38% in G2, 84.79% in G3, and 85.83% in G4. At T1, these values decreased to 81.96%, 82.06%, 82.19%, and 81.15% in G1, G2, G3, and G4 respectively, with significant difference in G4 (P<0.05). During home bleaching, pulp SaO2 levels varied in all groups, with 86.55%, 86.60%, 85.71%, and 87.15% means at T7 for G1, G2, G3, and G4, respectively; G2 presented significant difference (P<0.05). Conclusions Pulp SaO2 level in maxillary central incisors was similar at baseline, reducing immediately after in-office bleaching, regardless of using desensitizing toothpaste and increasing at 30 days after dental bleaching.

Effect of at-home bleaching on oxygen saturation levels in the dental pulp of maxillary central incisors

Abstract The present study assessed oxygen saturation (SaO2) levels before, during, and after at-home bleaching treatment in the pulps of healthy maxillary central incisors. SaO2 levels were measured in 136 healthy maxillary central incisors using a pulse oximeter. The bleaching protocol consisted of 10% carbamide peroxide gel placed in individual trays and used for four hours daily for 14 days. SaO2 levels were assessed before bleaching (T0), immediately after the first session (T1), on the 7th day of treatment (T2), on the 15th day (the day following the last session) (T3), and 30 days after completion of the bleaching protocol (T4). Data were statistically analyzed using generalized estimating equations (GEE), Student's t test (p<0.05) and Pearson's correlation. Mean pulp SaO2 levels were 85.1% at T0, 84.9% at T1, 84.7% at T2, 84.3% at T3, and 85.0% at T4. Gradual reductions in SaO2 levels were observed, with significant differences (p<0.001) during the course of home bleaching treatment. However, 30 days after the end of the bleaching protocol, SaO2 levels returned to baseline levels. Home bleaching caused a reversible transient decrease in SaO2 levels in the pulps.

Resumo Este estudo verificou o grau de saturação de oxigênio (SaO2) pulpar antes, durante e após o clareamento dental caseiro em incisivos centrais superiores hígidos. O nível de SaO2 foi verificado em 136 incisivos centrais superiores hígidos usando oxímetro de pulso. A técnica de clareamento empregou peróxido de carbamida 10% em moldeira individual por quatro horas diárias durante 14 dias. Os níveis de SaO2 foram analisados antes do clareamento (T0), imediatamente após a primeira sessão (T1), no sétimo dia de tratamento (T2), no décimo quinto dia (um dia após a última sessão) (T3) e 30 dias após o término do clareamento dental (T4). A análise estatística utilizou o modelo de equações de estimações generalizadas (GEE), teste t de Student (p<0,05) e correlação de Pearson. Os níveis médios de SaO2 pulpar foram 85,1% em T0, 84,9% em T1, 84,7% em T2, 84,3% em T3 e 85,0% em T4. Foi observada uma redução gradual dos níveis de SaO2, com diferenças significantes (p<0,001) durante o clareamento dental caseiro. No entanto, 30 dias após o término do clareamento dental, houve retorno aos valores iniciais. O clareamento dental caseiro provocou uma diminuição transitória reversível no grau de SaO2 pulpar.

Evaluation of color change using CIE LAB coordinates on tooth structure subjected to different concentrations of peroxide carbamide

ABSTRACT: Aim: The aim of this study was to evaluate the optical behavior of tooth color using CIE L*A*B* space; the teeth were subjected to novel bleaching gels containing peroxide carbamide with potassium oxalate. Materials and Method: Three different carbamide peroxide gels were experimentally fabricated. They consisted of 10% (G10), 16% (G16) and 37% (G37) concentrations. Sixty recently extracted premolars were subjected to different bleaching protocols. Color change (ΔE) was assessed using the CIE L*a*b* system after the application of each gel. The data were analyzed using one-way ANOVA with Tukey's post hoc test (α=5%) and a t-test. Results: The G10 and G16 gels exhibited an increase in ΔE*ab parameters from T0 to T1 (T0: application day of the gels. T1: 14th day measurement); a small decrease from T1 to T2 was also noted (T2: control measurement, 28th day). However, no statistically significant differences were found (p=0,22 for G10 and p=0,10 for G16). The G37 gel also exhibited an increase in ΔE*ab parameters, with similar results after the first application of 45 min, the second application of 45 min, and the third application of 45 min (T1, T2 and T3, respectively. T4: control measurement, 14th day). No statistically significant differences were observed between the three times of application (p>0,69), and an appreciable difference was noted between times T3 and T4 (p=0,000). Conclusions: The presented formulations of peroxide carbamide at 10%, 16%, and 37% are clearly effective. The G10 and G16 gels exhibited better effectiveness than the G37 gel.

Aclaramiento Dental con Enjuagues de Libre Venta que Contienen Peróxido de Hidrógeno / Toothbleaching with over the Counter Mouthwashes Containing Hydrogen Peroxide

RESUMEN: El objetivo de este estudio in vitro fue evaluar la eficacia en el aclaramiento dental de tres enjuagues orales que contienen peróxido de hidrógeno en diferentes períodos de inmersión en comparación con el peróxido de carbamida al 10 %. Cuarenta muestras de premolares humanos se dividieron aleatoriamente en cuatro grupos según el agente al que se expuso: G1: Colgate Plax®Whitening, G2: Listerine®Whitening Extreme y G3: Oral B® 3D White™ se sumergieron dos minutos al día durante 28 días y G4: Peróxido de carbamida al 10 %, ocho horas al día durante 14 días. La medición de color se realizó con un espectrofotómetro Vita Easyshade usando la escala CIELab inicialmente, a los 14, 28 y 35 días de evaluación. Las comparaciones entre los grupos se realizaron utilizando las pruebas Kruskal-Wallis y U Mann-Whitney, mientras que entre los tiempos las pruebas Friedman y Signo-Rango de Wilcoxon. Los resultados revelaron que a los 14 días, los cuatro grupos mostraron cambios de color, pero no se evidenció mayor eficacia de alguno sobre el otro (p>0,05). Sin embargo, a los 28 y 35 días se observó una clara eficacia del peróxido de carbamida sobre los enjuagues (p<0,05). Los enjuagatorios orales aclaran los dientes a partir de los 28 días, con los protocolos indicados; sin embargo no llegan a tener resultados similares a un aclaramiento profesional con gel de peróxido de carbamida al 10 %.

ABSTRACT: The objective of this in vitro study was to evaluate the efficacy in dental toothbleaching of three mouthwashes containing hydrogen peroxide in different periods of immersion compared to 10 % carbamide peroxide. Forty samples of human premolars were randomly divided into four groups according to the agent to which they were exposed: G1: Colgate Plax®Whitening, G2: Listerine®Whitening Extreme and G3: Oral B® 3D White ™ were immersed two minutes a day during 28 days and G4: 10 % carbamide peroxide, eight hours a day for 14 days. The color measurement was performed with a Vita Easyshade spectrophotometer using the CIELab scale initially, at 14, 28 and 35 days of evaluation. The comparisons between the groups were made using the Kruskal-Wallis and U Mann-Whitney tests. While between the times the tests Friedman and Sign-Range of Wilcoxon. The results revealed that at 14 days, the four groups showed color changes, but no greater effectiveness was shown of one over the other (p>0,05). However, at 28 and 35 days a clear efficacy of carbamide peroxide was observed on the rinses (p<0,05). Mouthwashes clear the teeth after 28 days, with the indicated protocols; however, they do not reach similar results to a professional clarification with 10 % carbamide peroxide gel.

Comparación Espectrofotométrica de las Sesiones de Blanqueamiento Intracameral con Peróxido de Hidrógeno y Carbamida a Diferentes Concentraciones / Spectrophotometric Comparison of Intracameral Tooth-Bleaching Sessions Using Hydrogen Peroxide, and Carbamide Peroxide at Different Concentrations

RESUMEN: El objetivo del presente trabajo fue comparar espectrofotométricamente el número de sesiones para un cambio efectivo de coloración con peróxido de carbamida al 100 %, 37 % y peróxido de hidrógeno al 35 %, a través de la técnica Walking Bleach. Este fue un estudio experimental, in vitro, en paralelo, con ciego en la medición del efecto y en el análisis de datos. Se utilizaron 88 premolares extraídos por indicación ortodóncica. Estos fueron tratados endodónticamente y artificialmente pigmentados con cromógenos derivados de productos de descomposición de la sangre. Se dividieron aleatoriamente en 4 grupos de 22 dientes (un grupo por cada agente blanqueador, más un grupo control con agua destilada). El régimen de tratamiento para cada grupo fue de 4 sesiones existiendo una separación de 4 días entre cada una. El registro de color previo (baseline) y posterior a cada aplicación fue realizado mediante el espectrofotómetro dental Vita Easyshade V, con el cual se registraron los colores en espacio de color CIE L*a*b*. Se calcularon posteriormente los valores de la variación total de color (DE) entre los parámetros iniciales y los distintos tiempos de evaluación. El análisis de significancia se realizó mediante la prueba Kruskal-Wallis y para comparar las diferencias se usó el test de comparaciones múltiples por pares mediante el procedimiento de Steel-Dwass-Critchlow-Fligner, registrando diferencias estadísticamente significativas en la variación total del color desde la primera sesión de blanqueamiento. En conclusión, utilizando peróxido de carbamida al 100 %, la técnica Walking Bleach no requiere un menor número de sesiones para un cambio efectivo de coloración al compararlo con peróxido de hidrógeno al 35 %, pero si con relación al peróxido de carbamida al 37 %, donde el objetivo se consigue en un menor número de sesiones.

ABSTRACT: The objective of this study was to spectrophotometrically compare the number of sessions for an effective color change using 100 % and 37 % carbamide peroxide, and 35 % hydrogen peroxide, applying the Walking Bleach technique. This was an experimental study, performed in vitro, in parallel, and was a blind study in relation to the measurement of the effect and the analysis of data. 88 premolars extracted by orthodontics indications were used. These were endodontically treated and artificially pigmented with chromogens derived from blood decomposition products. They were randomly divided into 4 groups of 22 teeth (one group for each whitening agent, plus a control group with distilled water). The treatment regime for each group was 4 sessions, with a separation of 4 days between each session. The registration of color before (baseline) and after each application was done using the dental spectrophotometer Vita Easyshade V, with which the colors were registered in the CIE L*a*b* color space. The values of total color variation (DE) were later calculated between the initial parameters and the different stages of evaluation. Significance testing was undertaken using Kruskal-Wallis and to compare the differences the method used was Steel-Dwass-Critchlow- Fligner, registering significant statistical differences in the total color variation from the first bleaching session. In conclusion, using 100 % carbamide peroxide, the Walking Bleach technique does not require fewer sessions for an effective change in coloration when compared to 35 % hydrogen peroxide, however, it does using 37 % carbamide peroxide, where the result is achieved in a lower number of sessions.

Dental fluorosis treatment can improve the individuals' ohrqol? results from a randomized clinical trial

Abstract This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito na qualidade de vida relacionada à saúde bucal (QVRSB) de dois protocolos de tratamento para fluorose dentária, em indivíduos incluídos em um ensaio clínico randomizado. Setenta voluntários, os quais viviam em uma área de fluorose endêmica no Brasil, e que possuíam pelo menos quatro dentes ântero-superiores com índice de Thylstrup e Fejerskov de 1 a 7, foram randomizados em dois grupos de tratamento (n= 35): GI- microabrasão de esmalte; ou GII- microabrasão associada com clareamento caseiro. A microabrasão foi realizada com ácido fosfórico 37% e pedra pomes e, o clareamento caseiro com peróxido de carbamida 10% e uso de moldeira. Os voluntários responderam um questionário antes e 1 mês após o tratamento, visando avaliar mudanças na QVRSB através do instrumento Oral Impact on Daily Performance (OIDP). Diferenças nos escores de impacto geral entre e nos mesmos grupos de tratamento foram analisadas através dos testes Wilcoxon (mesmo grupo) e Mann-Whitney (entre grupos), respectivamente. Alterações no escores dos domínios foram analisadas usando o teste Wilcoxon (a<0.05). Um mês após o tratamento, os indivíduos relataram melhora na QVRSB. Ambos os grupos apresentaram menores escores do OIDP (p<0,001), sem diferença entre eles. Os escores dos domínios comer, limpar os dentes, sorrir e estado emocioal diminuíram após o tratamento para toda a amostra. Concluiu-se que o tratamento com microabrasão melhorou a QVRSB de indivíduos vivendo em uma área de fluorose endêmica independentemente da associação com o clareamento caseiro.