Bleaching efficacy of in-office dental bleaching with different application protocols: a single-blind randomized controlled trial.

OBJECTIVE: This randomized controlled trial aimed to evaluate the equivalence in the color change, adverse effects, self-perception (AS) and the impact on oral condition (IO) of participants submitted to different application protocols of in-office dental bleaching. MATERIALS AND METHODS: 165 participants were bleached with a 35% hydrogen peroxide gel (Total Blanc Office One-Step, DFL), according to the following protocols: (1) 2 applications of 20-min each (2 × 20 min); (2) 1 × 40-min and; (3) 1 × 30-min. The color change was evaluated with the Vita Easyshade spectrophotometer, Vita Classical and Vita Bleachedguide scales. The intensity and risk of tooth sensitivity (TS) and gingival irritation (GI) were recorded using a 0-10 visual analogue scale (VAS). AS and IO was assessed before and after the bleaching procedure using the Orofacial Aesthetic Scale and Oral Health Impact Profile-14, respectively. RESULTS: Equivalent color change were observed (p < 0.001), with no significant difference between groups. The group 2 × 20 min presented the highest risk of TS (76%, 95% CI 63 to 85), compared to the 1 × 30 min (p < 0.04). The intensity of TS and GI and the risk of GI was similar between groups (p > 0.31). Irrespectively of the group (p = 0.32), significant improvements were observed for all items of AS and IO after bleaching (p < 0.02). CONCLUSIONS: The 1 × 30 min protocol produced equivalent color change to the other bleaching protocols with reduced risk of TS and shorter application time. CLINICAL RELEVANCE: A more simplified application regimen of a single application of 30 min yields effective bleaching and patient satisfaction while minimizing undesirable side effects and improving patient satisfaction.

In-office dental bleaching in adolescents using 6% hydrogen peroxide with and without gingival barrier: a randomized double-blind clinical trial.

BACKGROUND: At low concentrations used for in-office bleaching gels, such as 6% HP, gingival barrier continues to be performed. If we take into account that, in the at-home bleaching technique, no barrier is indicated, it seems that the use of a gingival barrier fails to make much sense when bleaching gel in low concentration is used for in-office bleaching. OBJECTIVE: This double-blind, split-mouth, randomized clinical trial evaluated the gingival irritation (GI) of in-office bleaching using 6% hydrogen peroxide (HP) with and without a gingival barrier in adolescents, as well as color change and the impact of oral condition on quality of life. METHODOLOGY: Overall, 60 participants were randomized into which side would or would not receive the gingival barrier. In-office bleaching was performed for 50 minutes with 6% HP in three sessions. The absolute risk and intensity of GI were assessed with a visual analogue scale. Color change was assessed using a digital spectrophotometer and color guides. The impact of oral condition on quality of life was assessed using the Brazilian version of the Oral Health Impact Profile (α=0.05). RESULTS: The proportion of patients who presented GI for the "with barrier" group was 31.6% and for the "without barrier" group, 30% (p=1.0). There is an equivalence for the evaluated groups regarding GI intensity (p<0.01). Color change was detected with no statistical differences (p>0.29). There was a significant impact of oral condition on quality of life after bleaching (p<0.001). CONCLUSIONS: The use or not of the gingival barrier for in-office bleaching with 6% HP was equivalent for GI, as well as for bleaching efficacy, with improvement in the impact of oral condition on quality of life.

Clinical performance of preheating thermoviscous composite resin for non-carious cervical lesions restoration: A 24-month randomized clinical trial.

OBJECTIVES: This 24-month, double-blind, split-mouth randomized clinical trial aimed to compare the retention rates of a preheated thermoviscous composite resin (PHT) compared to a non-heated composite resin (NHT) in non-carious cervical lesions (NCCLs). METHODS: A total of 120 restorations were restored on NCCLs using a preheated (VisCalor bulk, Voco GmbH) and a non-heated (Admira Fusion, Voco GmbH) composite resins with 60 restorations per group. A universal adhesive in the selective enamel conditioning was applied. In the PHT group, composite was heated at 68 °C for using a bench heater. In the NHT group, no heating was employed. Both restorative materials were dispensed into caps and inserted into the NCCLs. The restorations were evaluated at baseline, 6, 12, 18, and after 24 months of clinical service using the FDI criteria. Statistical analysis was performed with Kaplan-Meier estimation analysis for retention/fracture rate and Chi-square test for the other FDI parameters (α=0.05). RESULTS: After 24 months 108 restorations were assessed. Seven restorations were lost (two for PHT group and five for NHT group), and the retention rates (95 % confidence interval [CI]) were 96.7 % (81.5-99.9) for PHT group and 90.8 % (81.1-96.0) for NHT group, with no statistical differences between them (p > 0.05). The hazard ratio (95 % CI) was 0.52 (0.27 to 1.01), with no significant difference within groups. In terms of all other FDI parameters that were assessed, all restorations were deemed clinically acceptable. CONCLUSIONS: Both composites showed high rates of retention rates after 24 months. CLINICAL SIGNIFICANCE: The clinical performance of the new preheated thermoviscous was found to be as good as the non-heated composite after 24-month of clinical evaluation in non-carious cervical lesions. REGISTRATION OF CLINICAL TRIALS: RBR-6d6gxxz.

Evaluation of hydrogen peroxide permeability, color change, and physical-chemical properties on the in-office dental bleaching with different mixing tip.

OBJECTIVE: This study aims to assess hydrogen peroxide (HP) penetration into the pulp chamber, color change (CC), physical-chemical properties, and material wastage (MW) and material used (MU) in mixing tips when using in-office bleaching gels with two different mixing tips. MATERIALS AND METHODS: Forty teeth were divided into five groups (n = 8) based on the bleaching gels used (Pola Office +37.5% [PO+] and Whiteness HP Automixx Plus 35% [AM+]) and the mixing tip types (T-Mixer and Helical). A negative control group was treated with ultra-purified water. HP concentration was measured using UV-Vis, and CC was evaluated with a digital spectrophotometer. Initial concentration, pH, and viscosity were measured through Titration, a Digital pH meter, and Rheometer, respectively. MW and MU were measured using a precise analytical balance. Statistical analysis included two-way ANOVA, Tukey's, and Dunnett's test (α = 0.05). RESULTS: A higher HP concentration was observed with PO+ with the Helical mixing tip in comparison with AM+ (p = 0.01). No significant differences in CC or MU were found for different mixing tips (p = 0.001). The T-mixer mixing tip resulted in significantly less MW (p < 0.00001) and improved mixture homogeneity and viscosity. CONCLUSIONS: Utilizing a T-mixer with self-mixing bleaching gels achieves comparable CC while reducing MW. Moreover, it decreases HP penetration when using PO+. CLINICAL SIGNIFICANCE: For the application of a self-mixing in-office bleaching gel, a T-mixer mixing tip should be recommended, as it reduces the penetration of hydrogen peroxide into the pulp chamber when using PO+, while also minimizing gel wastage.

In-office dental bleaching in adolescents using 6% hydrogen peroxide with and without gingival barrier: a randomized double-blind clinical trial

Abstract At low concentrations used for in-office bleaching gels, such as 6% HP, gingival barrier continues to be performed. If we take into account that, in the at-home bleaching technique, no barrier is indicated, it seems that the use of a gingival barrier fails to make much sense when bleaching gel in low concentration is used for in-office bleaching. Objective This double-blind, split-mouth, randomized clinical trial evaluated the gingival irritation (GI) of in-office bleaching using 6% hydrogen peroxide (HP) with and without a gingival barrier in adolescents, as well as color change and the impact of oral condition on quality of life. Methodology Overall, 60 participants were randomized into which side would or would not receive the gingival barrier. In-office bleaching was performed for 50 minutes with 6% HP in three sessions. The absolute risk and intensity of GI were assessed with a visual analogue scale. Color change was assessed using a digital spectrophotometer and color guides. The impact of oral condition on quality of life was assessed using the Brazilian version of the Oral Health Impact Profile (α=0.05). Results The proportion of patients who presented GI for the "with barrier" group was 31.6% and for the "without barrier" group, 30% (p=1.0). There is an equivalence for the evaluated groups regarding GI intensity (p<0.01). Color change was detected with no statistical differences (p>0.29). There was a significant impact of oral condition on quality of life after bleaching (p<0.001). Conclusions The use or not of the gingival barrier for in-office bleaching with 6% HP was equivalent for GI, as well as for bleaching efficacy, with improvement in the impact of oral condition on quality of life.

In-office dental bleaching in adolescents using 6% hydrogen peroxide with different application tips: randomized clinical trial.

OBJECTIVE: Despite the availability of in-office bleaching gels with a 6% concentration of hydrogen peroxide (HP), these gels have not been evaluated in younger patients. They are commercially available with a tip, associated or not with a brush, where the tip with a brush spreads the gel over the entire surface to have a smaller thickness (thin layer) since the manufacturers indicate the application of a thin layer of gel. This randomized, split-mouth, double-blind clinical trial evaluated the efficacy of in-office bleaching with 6% HP in adolescents using different application tips, as well tooth sensitivity (TS) and aesthetic self-perception. METHODOLOGY: Sixty participants were randomized for 6% HP self-mixing bleaching gel tip design: without brush and with brush. In-office bleaching was performed in 3 sessions of 50 minutes. Color change was evaluated using a digital spectrophotometer (ΔE ab , ΔE 00 , and ΔWI D ) and color guide (ΔSGU), the absolute risk and intensity of TS with a visual analogue scale and aesthetic self-perception with the oral aesthetic scale (a=0.05). RESULTS: The groups achieved similar bleaching regardless of the application tip (p>0.05). However, only for ΔWI D , a significant mean difference (MD) was observed in the third week (MD 2.3; 95% CI 1.2 to 3.3; p < 0.001) and at one month (MD 1.6; 95% CI 0.6 to 2.6; p < 0.03) favoring the tip without brush. Regarding TS, 45% in the tip-without-brush group and 33% in the tip-with-brush group reported TS (odds ratio 0.61; 95% CI 0.29 to 1.28; p<0.02), with low TS intensity (MD 0.05; 95% CI -0.06 to 0.17; p>0.36). All patients reported improved aesthetic self-perception after bleaching (MD -1.3; 95% -1.8 to -0.9; p<0.001). CONCLUSIONS: Regardless of the tip used bleaching with 6% HP achieved a bleaching efficacy and improved the aesthetic self-perception. However, a lower risk of TS for application using the tip with brush was observed.

In-office dental bleaching in adolescents using 6% hydrogen peroxide with different application tips: randomized clinical trial

Abstract Despite the availability of in-office bleaching gels with a 6% concentration of hydrogen peroxide (HP), these gels have not been evaluated in younger patients. They are commercially available with a tip, associated or not with a brush, where the tip with a brush spreads the gel over the entire surface to have a smaller thickness (thin layer) since the manufacturers indicate the application of a thin layer of gel. Objective This randomized, split-mouth, double-blind clinical trial evaluated the efficacy of in-office bleaching with 6% HP in adolescents using different application tips, as well tooth sensitivity (TS) and aesthetic self-perception. Methodology Sixty participants were randomized for 6% HP self-mixing bleaching gel tip design: without brush and with brush. In-office bleaching was performed in 3 sessions of 50 minutes. Color change was evaluated using a digital spectrophotometer (ΔE ab , ΔE 00 , and ΔWI D ) and color guide (ΔSGU), the absolute risk and intensity of TS with a visual analogue scale and aesthetic self-perception with the oral aesthetic scale (a=0.05). Results The groups achieved similar bleaching regardless of the application tip (p>0.05). However, only for ΔWI D , a significant mean difference (MD) was observed in the third week (MD 2.3; 95% CI 1.2 to 3.3; p < 0.001) and at one month (MD 1.6; 95% CI 0.6 to 2.6; p < 0.03) favoring the tip without brush. Regarding TS, 45% in the tip-without-brush group and 33% in the tip-with-brush group reported TS (odds ratio 0.61; 95% CI 0.29 to 1.28; p<0.02), with low TS intensity (MD 0.05; 95% CI -0.06 to 0.17; p>0.36). All patients reported improved aesthetic self-perception after bleaching (MD -1.3; 95% -1.8 to -0.9; p<0.001). Conclusions Regardless of the tip used bleaching with 6% HP achieved a bleaching efficacy and improved the aesthetic self-perception. However, a lower risk of TS for application using the tip with brush was observed.

A new preheating thermoviscous composite for restoration of non-carious cervical lesions: a 6-month randomized clinical trial / Um novo compósito termoviscoso de pré-aquecimento para restauração de lesões cervicais não cariosas: ensaio clínico randomizado de 6 meses

Objetivo: Este ensaio clínico randomizado, duplo-cego e boca dividida avaliou o desempenho clínico de um novo compósito termoviscoso com pré-aquecimento (PHT) em comparação com uma resina composta sem aquecimento (NHT) em restaurações de lesões cervicais não cariosas (LCNCs) durante um período de 6 meses. Material e Métodos: 120 restaurações foram realizadas em LCNCs com dois materiais restauradores (n = 60). Após a profilaxia, os dentes foram isolados com isolamento de fio retrator/rolos de algodão e um adesivo universal foi aplicado na estratégia de condicionamento seletivo do esmalte. Para o grupo PHT o aquecimento foi realizado a 68°C usando um aquecidor de bancada por 3 min. Por outro lado, para o grupo NHT, nenhum aquecimento foi aplicado. Ambos os materiais restauradores foram colocados no dispensador de cápsulas e inseridos nas LCNCs. Após 6 meses, o desempenho clínico das restaurações foi avaliado de acordo com os critérios FDI. A análise estatística foi realizada com teste Qui-quadrado para todos parâmetros da FDI (α = 0,05). Resultados: Apenas três restaurações no grupo NHT foram perdidas/fraturadas após seis meses de acompanhamento. As taxas de retenção (intervalo confiança 95%) por seis meses foram de 97,5% (88,6% - 99,0%) para o grupo NHT e 100% (93,9% - 100%) para o grupo PHT (p > 0,05). Vinte e duas restaurações (8 para NHT e 14 para PHT) apresentaram pequenos defeitos de adaptação marginal aos seis meses de acompanhamento (p > 0,05). Vinte e seis restaurações apresentaram alguma retenção de biofilme aos seis meses de acompanhamento (11 para NHT e 15 para PHT; p > 0,05). Em relação a todos os outros parâmetros de FDI avaliados, todas as restaurações foram consideradas clinicamente aceitáveis. Conclusão: O desempenho clínico do novo compósito termoviscoso de pré-aquecimento mostrou-se promissor após 6 meses de avaliação clínica quando aplicado em LCNCs.(AU)

Objective: This double-blind, split-mouth randomized clinical trial evaluate the clinical performance of a new preheating (PHT) thermoviscous composite compared to a non-heating (NHT) composite resin in restorations of non-carious cervical lesions (NCCLs) over a period of 6-month. Material and Methods: 120 restorations were performed on NCCLs with two restorative materials (n = 60). After prophylaxis, the teeth were isolated with retraction cord isolation/cotton rolls and one universal adhesive was applied in the selective enamel etching strategy. For the PHT group heating was carried out at 68°C using a heater bench for 3 min. On the other side, for the NHT group, no heating was applied. Both restorative materials were placed in the caps dispenser and inserted in the NCCLs. The restorations were evaluated after 6-month of clinical performance according to the FDI criteria. Statistical analysis was performed with Chi-square test for all FDI parameters (α = 0.05). Results: Three restorations only in the NHT group were lost/fractured after six months follow-up. The retention rates (confidential interval 95%) for six months were 97.5% (88.6% - 99.0%) for the NHT group and 100% (93.9% - 100%) for the PHT group (p > 0.05). Twenty-two restorations (8 for NHT and 14 for PHT) presented small marginal adaptation defects at the six-months follow-up (p > 0.05). Twenty-six restorations were found to have biofilm retention in the six-month recall (11 for NHT and 15 for PHT; p > 0.05). Regarding all others FDI parameters evaluated, all restorations were considered clinically acceptable. Conclusion: The clinical performance of the new preheating thermoviscous was found to be promise after 6-month of clinical evaluation when applied in NCCLs (AU)