Staining Power of Natural and Artificial Dyes after At-home Dental Bleaching.

INTRODUCTION: Bleached enamel surfaces may undergo changes and retain more dye, which is a reason to recommend the reduction/suspension of foods with dyes during dental bleaching. AIM: Evaluate the effects of the action of natural and artificial dyes on the bleached enamel of extracted human teeth. MATERIALS AND METHODS: Fifty human premolars were used, which were distributed in 5 groups (n = 10) according to the following staining solutions: GW (distilled water); GB (beet); Gca (caramel); GC (carmine); and GR (red 40). After the removal of the root and pulp section, the teeth were embedded in acrylic resin blocks, stored in artificial saliva, and kept at 37°C. At-home bleaching was performed using 16% carbamide peroxide (CP) for 3 hours daily for 3 weeks. After each daily session of bleaching, the specimens were exposed to the dye solution twice a day for 5 min; one of these exposures was performed immediately after bleaching. The color was recorded using a spectrophotometer according to the CIE Lab system (Δ E) for the following periods: baseline, during bleaching (after 1st, 2nd, and 3rd week) and post-bleaching (after 1 week and 1 month). The color was evaluated by two-way analysis of variance and Tukey's test (α=0.05). RESULTS: There was effective dental bleaching for all groups: GW (18.5 ± 6.1), GB (19.9 ± 4.4), Gca (18.9 ± 6.1), GC (20.2 ± 4.6), and GR (19.3 ± 4.2), p <0.01. No color rebound was observed after 1 week and 1 month (p >0.05). CONCLUSION: The exposure to beet, carmine, caramel, and red 40 dyes did not interfere with the effectiveness of dental bleaching using 16% CP. CLINICAL SIGNIFICANCE: Dyes consumption during bleaching did not affect the effectiveness of dental bleaching.

Does smoking habit increase the micronuclei frequency in the oral mucosa of adults compared to non-smokers? A systematic review and meta-analysis.

OBJECTIVES: A systematic review of clinical studies to evaluate the frequency of micronuclei in the oral mucosa of smokers and non-smokers in adult patients was performed. MATERIALS AND METHODS: A comprehensive search was carried out on MEDLINE via PubMeb, Scopus, Web of Science, LILACS, BBO, and Cochrane Library and SIGLE without restrictions. Dissertations and thesis were searched using the ProQuest Dissertations and Periodicos Capes Thesis Databases. We included only cross-sectional clinical trials that compared the frequency of micronuclei in the oral mucosa of smokers and non-smokers in adult patients. DATA: After the removal of duplicates, 1338 articles were identified. After title and abstract screening, 35 studies remained. Eighteen studies were further excluded, whereas 17 studies remained for qualitative analysis and 16 for the meta-analysis of the primary and secondary outcomes. A significant difference in the frequency of micronuclei in smokers when compared to non-smokers was observed in the present study. CONCLUSIONS: Despite the high variation in the methodology of the assessed studies, this study showed a higher frequency of micronuclei in exfoliated cells of smokers compared to non-smokers. CLINICAL SIGNIFICANCE: The use of tobacco is associated with cytotoxic and genotoxic effects because a higher frequency of micronuclei in exfoliated cells of smokers was observed.

Determination of nicotine content in teeth submitted to prophylaxis and in-office bleaching by gas chromatography-mass spectrometry (GC-MS).

OBJECTIVES: The objective of this study was to evaluate the dental color exposed to acute cigarette smoke treatment and quantify the amount of nicotine in samples exposed to cigarette smoke, after dental prophylaxis and after in-office bleaching. MATERIALS AND METHODS: Sixty-nine healthy human molars were subjected to cigarette smoke in a cigarette machine. The teeth were divided into three groups: positive control, prophylaxis, and bleaching. Forty cycles of smoke exposition with duration of 15 min each were performed using 10 cigarettes (positive control). Dental prophylaxis was performed with a rotating brush and prophylaxis paste; in-office bleaching was performed with 35% hydrogen peroxide, in two sessions of three 15-min applications, with a 1-week interval between sessions. The color was evaluated at the baseline, after exposure to cigarette smoke, after dental prophylaxis, and after in-office bleaching. Teeth from each group were powdered and analyzed by gas chromatography-mass spectrometry in order to measure the amount of nicotine present in each group. Data from quantification of nicotine and color change were analyzed by one-way ANOVA and Tukey's test (α = 0.05). Data for subjective and objective color evaluation, a perceptible dental darkening occurred in teeth after exposure to cigarette smoke. Dental prophylaxis was able to recover the original color of teeth however, only after bleaching teeth became whiter than at the baseline (p < 0.001). The amount of nicotine was significantly different and higher in positive control group (3.3 ± 1.3 µg/g of tooth), followed by the prophylaxis group (2.1 ± 1.4 µg/g) and the bleaching group (0.8 ± 0.3 µg/g) (p < 0.001). CONCLUSIONS: Cigarette smoke penetrates into the dental structure. Dental prophylaxis and bleaching with 35% hydrogen peroxide can partially remove the nicotine from tobacco smoke. However, when in-office bleaching was applied, a more significant nicotine removal was achieved. CLINICAL SIGNIFICANCE: Dental prophylaxis could remove most of the external nicotine-staining on the tooth surfaces while bleaching could further reduce the external and internal nicotine-staining of teeth.

Clinical Evaluation of 10% Hydrogen Peroxide on Tooth Sensitivity and Effectiveness in at Home Dental Bleaching.

AIM: The purpose of this study was to evaluate the dental effect and sensitivity of at-home dental bleaching with 10% hydrogen peroxide (H2O2). MATERIALS AND METHODS: Twenty volunteers with A2 or darker central incisors were selected for this study. Was used 10% H2O2 for thirty minutes twice a day, for two weeks. Shade evaluation was assessed visually by the value-oriented shade guide Vita Classical shade guide, Vita Bleachedguide 3D-MASTER and by the Easyshade spectrophotometer at baseline, during bleaching (first and second weeks), and post-bleaching (one month). The perceptions of sensitivity were recorded by the patients through the numerical rating scale (0 to 4) and 0 to 10 visual analog scales daily. Data from the shade guide units was subjected to a one way repeated measures (RM) analysis of variance (ANOVA) test (a = 5%). The overall AE, absolute risk and intensity of tooth sensitivity were calculated as well as the 95% confidence interval. RESULTS: The absolute risk of tooth sensitivity was 65% and the intensity was mild. Data from ASGU and AE after 1 month of bleaching for H2O2 10% showed significant whitening, 4 units for Vita Classical, 5 units for Vita Bleachedguide and 9.7 units for spectrophotometer. CONCLUSION: At-home bleaching using 10% hydrogen peroxide is effective in 14 days of bleaching. The most common adverse events were mild tooth sensitivity, and no subjects discontinued use early because of a treatment-related adverse event. CLINICAL SIGNIFICANCE: At-home dental bleaching with 10% hydrogen peroxide gel reduces the time of use of the tray, maintaining the effectiveness with low intensity of dental sensitivity. Brazilian clinical trials registry (REBEC) RBR-45xmzj.

Effectiveness of a desensitizing agent before in-office tooth bleaching in restored teeth.

OBJECTIVES: The aim of this clinical trial was to evaluate the effectiveness and tooth sensitivity associated with bleaching in patients with composite restorations in anterior teeth after the application of a desensitizing agent. MATERIAL AND METHODS: Bleaching was performed with 35 % hydrogen peroxide gel in 30 patients with composite restorations in anterior teeth, divided according to the prior application of a desensitizing agent (De), or a placebo (Pl), on maxillary superior teeth. Color was recorded at baseline, 1 week after each session and 6 months after treatment. The experience of tooth sensitivity (TS) was recorded on an NRS (0-4) during bleaching and 24 h after each session. Bleaching effectiveness was evaluated by one-way ANOVA and Tukey's tests (α = 0.05). The percentage of TS was evaluated by Fisher's exact test. For each treatment, periods were compared using the Wilcoxon signed-rank test (α = 0.05), and at each period, treatments were compared using Mann-Whitney U test. RESULTS: Both groups showed similar tooth color enhancement and color stability after 6 months (p < 0.05). No significant difference in prevalence of sensitivity was detected between groups (p < 0.001). Higher TS intensity (median [first/third quartiles]) was observed for Pl (1.5 [1/1.75]) compared with De (0.5 [0/1]) during treatment (p < 0.05). CONCLUSIONS: The use of a desensitizing gel (5 % potassium nitrate, 2 % sodium fluoride) before tooth bleaching in patients with composite restorations did not reduce the prevalence of tooth sensitivity, but reduced the intensity of TS during bleaching. CLINICAL RELEVANCE: Although the use of a desensitizing agent before bleaching, in patients with composite resin restorations, did not reduce the prevalence of TS, a reduction of the TS intensity during the protocol was observed without jeopardizing the whitening outcome.

Perioperative use of an anti-inflammatory drug on tooth sensitivity caused by in-office bleaching: a randomized, triple-blind clinical trial.

OBJECTIVES: The aim of this study was to determine the effect of etoricoxib 60 mg on tooth sensitivity (TS) caused by in-office bleaching. MATERIALS AND METHODS: A triple-blind, parallel design, randomized clinical trial was conducted on 30 healthy, young adults who received either a placebo or etoricoxib. The drugs were administered 1 h before the bleaching process and after 24 h. Treatment was performed with 35 % hydrogen peroxide gel. The TS was recorded on three scales: VAS, 0-4, and 0-100. Shade evaluations were performed before and 30 days after bleaching with a visual shade guide and a spectrophotometer. The percentage of patients who reported TS at least once during treatment and the TS intensity were evaluated by Fisher's exact and Mann-Whitney U tests, respectively. Tooth color changes were evaluated by repeated measures ANOVA. RESULTS: There were no significant differences in the percentage of patients with TS, intensity of TS, and color between the groups. CONCLUSIONS AND CLINICAL SIGNIFICANCE: The anti-inflammatory medication etoricoxib 60 mg was unable to reduce the presence and intensity of TS. NCT01300780 (protocol No. 17838/2010).

Effect of mode of application on the microtensile bond strength of a self-etch and etch-and-rinse adhesive system.

UNLABELLED: This study examined the 24-hour microtensile bond strength (microTBS) of a three-step etch-and-rinse (All Bond 3 [AB3]) and a two-step self-etch system (All Bond Self-Etch [ABSE]) to dentin and ground enamel, varying the application mode. METHODS: AB3 was applied according to the following procedures: A-phosphoric acid + adhesive application. The adhesive was then light-cured before resin buildup. B-similar to Procedure A, except that a thin layer of bonding resin was applied over the cured adhesive; C-similar to Procedure B, however, the adhesive was not light-cured before application of the bonding resin. ABSE was applied according to the following procedures: A--the acidic adhesive was applied and light-cured; B--after the acidic adhesive application and light-curing, a thin layer of ABSE Liner was applied and light cured; C--similar to B, however, the acidic adhesive was not light cured before application of the ABSE Liner. Resin composite buildups (Charisma) were bonded to teeth substrates after adhesive application. The bonded specimens were sectioned into beams 0.9 mm2 after storage in water (24 hours/37 degrees C) and subjected to microTBS with a crosshead speed of 0.5 mm/minute. The average values (MPa) obtained in each substrate were subjected to two-way repeated measures ANOVA and the Tukey's test (alpha=0.05). RESULTS: No significant difference was observed among the experimental groups either in ground enamel or dentin. CONCLUSIONS: The 24-hour microtensile bond strength of All Bond 3 and All Bond Self-Etch was similar, regardless the mode of application of the adhesive systems.

Predictive factors on the efficacy and risk/intensity of tooth sensitivity of dental bleaching: A multi regression and logistic analysis.

OBJECTIVES: The aim of this study was to identify predictor factors associated with the whitening outcome and risk and intensity of bleaching-induced tooth sensitivity from pooled data of 11 clinical trials of dental bleaching performed by the same research group. METHODS: The individual patient data of several published and ongoing studies about dental bleaching was collected and retrospectively analyzed. At the patient-level, independent variables (bleaching techniques [at-home and in-office protocols], sex, age and baseline tooth color in shade guide unit [SGU]) as well as dependent variables (color change in shade guide units (ΔSGU), color change in the CIEL*a*b* system (ΔE), risk and intensity of TS in a visual analog scale) were collected. Multivariable linear regression and multivariable logistic regression models were carried out using backward elimination whenever the p-values were higher than 0.05. RESULTS: A significant relationship between baseline color and age on color change estimates was detected (p<0.001). Every increase of one SGU in the baseline color resulted in an increase of approximate 0.66 in the final ΔSGU and 2.48 for the ΔE. For every increase of one year in the participant's age we observed a decrease of the whitening degree of 0.07 for the final ΔSGU and 0.69 for the ΔE. The bleaching technique was shown to be a significant predictor of ΔSGU (p<0.001) but not of ΔE. In regard to TS, baseline color and bleaching technique are significant predictors (p<0.001). The risk of TS for at-home bleaching was 51% (95% CI 41.4-60.6) and for the in-office 62.9% (95% CI 56.9-67.3). CONCLUSIONS: Younger patients with darker teeth reach a higher degree of whitening. Patient with darker teeth and submitted to at-home bleaching presents lower risk and intensity of TS. CLINICAL SIGNIFICANCE: The baseline color of the teeth and the patient's age is directly related to the effectiveness of dental bleaching and TS.

Pre- and postoperative dexamethasone does not reduce bleaching-induced tooth sensitivity: A randomized, triple-masked clinical trial.

BACKGROUND: Tooth sensitivity (TS) is the most common side effect of dental bleaching therapies. Dexamethasone has been used with tooth bleaching to reduce TS. The efficacy of dexamethasone for this purpose has not been well studied. METHODS: The authors conducted a triple-masked, randomized, clinical trial with a parallel design involving 63 healthy participants who received either a placebo or dexamethasone. The placebo or dexamethasone (8 milligrams) was administered 1 hour before the in-office bleaching (35% hydrogen peroxide) and extra doses of 4 mg were administered every 6 hours for a total of 48 hours. TS was recorded on 2 scales: visual analog scale (0-10) and numeric rating scale (0-4) in different periods. The color evaluations were performed before and 1 month after dental bleaching with visual shade guides VITA Classical (VITA Zahnfabrik) and VITA Bleachedguide 3D-MASTER (VITA Zahnfabrik), and for a shade guide evaluation, the authors used a digital spectrophotometer, VITA Easyshade (VITA Zahnfabrik). The absolute risk of TS was evaluated by a Fisher exact test. Data of TS intensity using the NRS scale for the 2 groups were compared with Mann-Whitney and Friedman tests, whereas data from the visual analog scale were evaluated by 2-way repeated measures analysis of variance. The color changes between groups were compared using a t test (α = .05). RESULTS: In both groups, the authors detected a high risk of TS, which was approximately 90%. No significant difference was observed in terms of TS intensity. A whitening of approximately 3 shade guide units of the VITA Classical was detected in both groups, which were statistically similar. CONCLUSIONS: The use of dexamethasone before bleaching did not reduce the risk and intensity of bleaching-induced TS. PRACTICAL IMPLICATIONS: The use of the steroidal anti-inflammatory agent dexamethasone was not capable of preventing TS arising from in-office dental bleaching.

In-office bleaching with a two- and seven-day intervals between clinical sessions: A randomized clinical trial on tooth sensitivity.

OBJECTIVES: In-office bleaching is usually performed in 2-3 sessions with one-week interval. The impact of shorter interval times on tooth sensitivity has not been evaluated. This study aimed to compare the absolute risk of tooth sensitivity (TS) and colour change after in-office bleaching with a two- and seven-day intervals between sessions. METHODS: We selected for this randomized, single-blind study, 40 patients with colour C2 or darker. We performed two bleaching sessions with a 35% hydrogen peroxide gel with either a 1-week or 2-day interval. We recorded the TS up to 48 h with a VAS scale and the colour at baseline and 30 days after bleaching with a value-oriented shade guide and a spectrophotometer. The risk and intensity of TS were compared with the Fisher's exact test and two-way repeated measures ANOVA. Colour change (ΔSGU and ΔE) were evaluated by Student's t-test (alpha=5%). RESULTS: Approximately 60% of the participants reported TS (65% and 55% for the 7 and 2-day groups). A significant whitening of approximately 6 shade guide units was detected for both groups. No difference was detected between groups. CONCLUSIONS: The reduction of the interval between bleaching sessions from seven to two days reduced the treatment time without increasing the bleaching-induced TS (clinicaltrials.gov identifier: NCT1959789). CLINICAL SIGNIFICANCE: In-office bleaching with a 2-day interval did not increase the risk and intensity of bleaching-induced tooth sensitivity.

Effectiveness of and tooth sensitivity with at-home bleaching in smokers: a multicenter clinical trial.

BACKGROUND: The authors conducted a 2-center controlled clinical study to show the equivalence of at-home bleaching in smokers and nonsmokers at 1 week and 1 month and evaluate tooth sensitivity (TS). METHODS: The authors selected 60 smokers and 60 nonsmokers with central incisors of shade A2 or darker. The participants performed bleaching with 10% carbamide peroxide for 3 hours daily for 3 weeks. The authors evaluated the color by using a shade guide and a spectrophotometer before, during, and after bleaching (1 week and 1 month). Patients recorded TS by using a 0-4 scale and a visual analog scale. The authors used multivariable regression analysis to test factors associated with color change and TS (α = .05). RESULTS: Smokers and nonsmokers showed significant color change statistically equivalent to within ± 2.0 units at 1 week after bleaching. Overall, color shade improved by 4.1 shade guide units (95% confidence interval [CI], 3.7-4.5) and 7.8 units of color change measured with the spectrophotometer (95% CI, 7.1-8.5) at 1 month. None of the factors affected the TS risk. TS absolute risk and intensity were similar between groups (P > .05), with an overall estimate of 47% (95% CI, 38-56%). CONCLUSIONS: The immediate effectiveness of whitening- and bleaching-related TS were not affected by smoking. PRACTICAL IMPLICATIONS: Smoking did not affect the immediate color change (1 week). Effective whitening was achieved regardless of whether the patient was a smoker. However, this equivalence was not apparent 1 month after bleaching, with smokers having slightly darker teeth.

Tooth sensitivity and efficacy of in-office bleaching in restored teeth.

OBJECTIVES: The aim of this clinical trial was to evaluate efficacy (BE) and tooth sensitivity (TS) of in-office bleaching with a 35% hydrogen peroxide (HP) in patients with aesthetic restorations. METHODS: Hydrogen peroxide 35% was applied in two sessions, of three 15 min applications, in 15 patients with upper anterior sound teeth (S) and 15 with aesthetic restorations (R). The colour was recorded at baseline, one week and 6 months after treatment completion. Patients recorded TS on a 0-4 scale. The BE was evaluated by two-way ANOVA and Tukey's tests (α=0.05). The percentage of patients with TS was evaluated by Fisher's exact test and TS intensity of treatments was compared with Mann-Whitney U-test (α=0.05). RESULTS: All participants experienced TS at least once during treatment. Higher TS intensity was observed in R (1.5 [1/1.75]) compared to S (0.5 [0/1.25]) during the bleaching (p<0.05). S and R demonstrated similar tooth colour enhancement compared to baseline (p<0.05) and both presented colour stability after 6 months of evaluation (p>0.05). CONCLUSIONS: The in-office bleaching with 35% HP was effective in patients with aesthetic restorations, however, a higher intensity of TS was observed during the bleaching protocol. CLINICAL RELEVANCE: In-office dental bleaching can be performed in patients with adhesive restorations promoting satisfactory results; however, it can promote higher intensity of sensitivity compared to patients with sound teeth.

Tooth sensitivity and bleaching effectiveness associated with use of a calcium-containing in-office bleaching gel.

BACKGROUND: The authors conducted a study to evaluate tooth sensitivity (TS) and the bleaching effectiveness associated with use of a calcium-containing (CC) in-office bleaching gel. METHODS: The authors used a 35 percent calcium-free (CF) hydrogen peroxide gel and a 35 percent CC hydrogen peroxide gel according to the manufacturer's instructions in 40 caries-free participants 18 years or older. They performed two bleaching sessions with a one-week interval between sessions. The authors registered the color at baseline and after the first and second bleaching sessions by using a shade guide and by gauging the participant's perception of TS as registered on a scale from 0 (none) to 4 (severe). The authors evaluated the bleaching effectiveness at each week's recall visit by means of the Friedman test, and they compared the groups at each assessment point by means of the Mann-Whitney test. They evaluated the percentage of participants with TS and the intensity of the TS by using the Fisher exact and Mann-Whitney tests. RESULTS: Both groups demonstrated equivalent and significant tooth color enhancement compared with color values at baseline (P < .05), with an average bleaching of 7 to 8 shade guide units. Most of the participants from the CF group (80 percent) experienced sensitivity while undergoing the bleaching regimen, whereas only 40 percent of participants from the CC group reported experiencing TS (P = .02). The intensity of TS was significantly higher (P < .01) for the CF group during in-office dental bleaching. CONCLUSIONS: The CC 35 percent hydrogen peroxide gel reduced the TS during in-office dental bleaching without jeopardizing the bleaching effectiveness. CLINICAL IMPLICATIONS: The results of this study support the findings that a CC 35 percent hydrogen peroxide gel can reduce TS during in-office dental bleaching.

Influence of professional prophylaxis on reducing discoloration of different aesthetic restorative materials.

OBJECTIVES: Color match is one of the most important characteristics of aesthetic restorative materials. Integrity of the restoration and color stability throughout its functional duration are of paramount importance to ensure treatment longevity. These features, however, are not consistent among the different dental restorative materials. The purpose of this study was to evaluate the influence of professional prophylaxis on reducing wear discoloration of four aesthetic restorative materials after their immersion in coffee solution for 15 days. METHODS: Seventy-one disc-shaped specimens (17 mm in diameter and 1mm thick) were fabricated and divided into five groups according to each restorative material: direct composite resin (G1: Tetric Ceram(®)), three indirect composite resins (G2: Targis; G3: Resilab Master; G4: belleGlassTM HP) and one ceramic system (G5: control: IPS Empress(®) 2). The specimens were immersed in coffee staining solution for 15 days at 37° ± 1°C in a dark environment. Afterwards, they were subjected to professional prophylaxis using sodium bicarbonate jet. Evaluations were made by means of a reflectance spectrophotometer, at three time-intervals: baseline, immediately after staining (15 days), and after prophylaxis. Data were subjected to two-way ANOVA and post hoc Tukey's test (α=0.05). RESULTS: Significant difference was observed between G1/G3 and the other groups, between G2/G4 and the other groups, and between G5 and all the other groups. CONCLUSIONS: It was concluded that G1 and G3 showed the greatest color changes, followed by G2 and G4, while G5 showed the smallest changes. Professional prophylaxis seemed to minimize the wear discoloration, which might result in increasing aesthetic restoration longevity.

Corantes com e sem açúcar versus efetividade do clareamento dental: estudo ex vivo / Dyes with and without sugar versus effectiveness of dental bleaching: an ex vivo study

As descolorações dos dentes e restaurações podem estar relacionadascom o tipo de corante presente nos alimentos, o pH e a presença de açúcar. Objetivo: Avaliar ex vivo a influência de bebidas contendo corantes, com e sem a adição de açúcar, na efetividade do clareamento dental caseiro em dentes humanos expostos a bebidas contendo corantes com e sem adição de açúcar durante o tratamento clareador. Material e método: Setenta pré-molares humanos foram divididos em 7 grupos (n=10) de acordo com a solução corante: água destilada (A), café (C), café com açúcar (CA), chá preto (CH), chá preto com açúcar (CHA), suco de uva(U) e suco de uva com açúcar (UA). O clareamento dental caseiro foi realizado com peróxido de carbamida (PC) 16% (Whiteness Perfect 16%, FGM) por 3 horas diárias durante 3 semanas, para todos os grupos. A cor foi mensurada com Espectrofotômetro Vita Easyshade, nos períodos: inicial, ao término do clareamento (3ª semana) e pós-clareamento (1 semana). Para a avaliação de cor, os dados foram submetidos à análise não paramétrica de Kruskal-Wallis (?=0,05). Resultados: Não houve diferença estatisticamente significante entre os grupos analisados (p<0,001). Conclusões: O clareamento dental caseiro foi efetivo mesmo napresença dos corantes alimentares durante o tratamento clareador, independentemente da presença do açúcar.

The discoloration of teeth and esthetic restorations may be related to the type of colorant present in food, pH and the presence of sugar. Objective: Evaluate ex vivo the effectiveness of dental bleaching exposed in a dye-containing beverages with and without addition of sugar during the bleaching treatment. Material e Methods: Seventy human premolars were divided into 7 groups (n = 10) according to the dye solution: distilled water (W), coffee (C), coffee with sugar (CS), black tea (T), black tea with sugar(TS), grape juice (G) and grape juice with sugar (GS). The home bleaching was performed with carbamide peroxide (PC) 16% (Whiteness Perfect, FGM) for 3 hours daily during 3 weeks for all groups. The color was measured with spectrophotometer Vita Easyshade in the periods: baseline, at the end of bleaching (3rd week) and post-bleaching (1 week after). Evaluation of color, data were analyzed by nonparametric Kruskal-Wallis test (? = 0.05). Results: There was no statistically significant difference between the groups (p <0.001). Conclusion: It was concluded that the bleaching was effective even in the presence of food colors during the at home dental bleaching, regardless of the presence of sugar.

Clareamento dentário de consultório em paciente com restaurações estéticas / In office dental bleaching in patients with esthetics restorations

Este trabalho teve como objetivo apresentar um caso clínico de clareamento dentário de consultório em paciente com restaurações estéticas. Uma paciente jovem, do sexo feminino, com diversas restaurações Classe III nos dentes anterossuperiores, foi avaliada clínica e radiograficamente quanto à ausência de lesões de cárie, lesões periapicais e sensibilidade dentária. Constatada a normalidade clínica, a paciente foi submetida a tratamento clareador com peróxido de hidrogênio (HP) A 35 POR CENTO (Whiteness HPMaxx, FGM) em duas sessões, com três aplicações de 15 minutos cada. Ao final do tratamento clareador, observou-se efetividade de tratamento em todos os dentes clareados, sem ocorrer mudança visualmente notável nas restaurações. Concluiu-se que a técnica de clareamento dentário de consultório pode ser realizada em pacientes com restaurações estéticas, no entanto, pode haver necessidade de troca das restaurações, pela diferença da cor resultante

This study aimed to present a clinical case of in-offce dental bleaching in a patient with esthetic restorations. A young female patient with several Class III restorations in the maxillary anterior teeth was evaluated, clinical and radiographically, as the absence of caries, periapical lesions and tooth sensitivity. Given the clinical normality, the patient undergone dental bleaching with 35% hydrogen peroxide (HP) (Whiteness HPMaxx, FGM) in two sessions with three applications of 15 minutes each. At the end of bleaching, it was observed effectiveness of treatment in all teeth, there was no visually remarkable changes in restorations. It was concluded that the technique of in-offce dental bleaching can be performed in patients with esthetic restorations, however it may be necessary to replace restorations due to the color differences obtained.

Clareamento dental - efeito da técnica sobre a sensibilidade dental e efetividade / Dental bleaching - technique effect on dental sensivity and effectiveness

O clareamento dental associado parece ser mais estável ao longo do tempo. O objetivo foi avaliar a efetividade do clareamento (ECl, sensibilidade dental (SO) e recidiva de cor (RC) no clareamento de dentes vitais. Foram distribuídos 30 pacientes em 2 grupos (n=15): clareamento associado (CA) e clareamento em consultório (CC). Foram realizadas 2 sessões de CC com PH 35% (Mix One Supreme, Villevie). O clareamento caseiro foi realizado no grupo CA com PH 6% (Mix Oay, Villevie], por 4 semanas. A cor foi registrada com a escala Vita Classical, antes e após as 2 sessões de Cc, durante o clareamento caseiro e pós-clareamento (1 semana, 1 mês e 6 meses). Os pacientes registraram a SO numa escala de 0-4. Utilizou-se os testes ANOVA e de Tukey para avaliar a EC, intensidade SO e RC. A SO foi analisada pelo teste de Fisher (p>0,05). A EC foi simi­lar para as técnicas avaliadas (p>0,05). O grupo Cc, apresentou RC significativa após 1 semana (p=0,008) e 1 mês (p=0,003), fato que não ocorreu em relação ao grupo CA, para estes períodos (p>0,05). Não houve diferença na estabilidade de cor entre os grupos 6 meses pós-clareamento (p>0,05). No CA 73% e no CC 80% dos pacientes apresentaram SO (p>0,05), sendo a maioria de intensidade leve (p>0,05). As técnicas avaliadas foram efetivas, porém o CA apresentou maior estabilidade da cor após 1 semana e 1 mês, mas não diferiu do CC 6 meses pós-clareamento. Não houve diferença de SO e de intensidade SO.

The associated dental bleaching appears to be more stable over time. The objective was to evaluate the effectiveness of bleaching (EB), tooth sensitivity (TS) and recurrence color (RC) in bleaching of vital teeth. Thirty patients were divided into 2 groups (n= 15): bleaching associated (BA) and in-office bleaching (OB). Two sessions of OB with 35 % PH (Mix One Supreme, Villevie) were performed. The home bleaching was carried out in BA with PH 6 % (Mix Oay, Villevie) for 4 weeks. The color was recorded with the Vita Classical scale before and after 2 sessions of OB during home bleaching and post - bleaching (1 week , 1 month, and 6 months) . Patients recorded the SO on a scale of 0-4. We used ANOVA and Tukey tests to assess EB, intensity of SO and RC. The SO was analyzed by Fisher (p>0.05). The EB was similar to the techniques evaluated (p>0.05). The OB group showed significant RC after 1 week (p=0.008) and 1 month (p=0.003), which did not occur in relation to the BA group, for these periods (p>0.05). No differences in color stability between groups at 6 months post-bleaching (p>0.05). In BA 73% and OB 80% of patients had SO (p>0.05), with the majority being mild (p>0.05). The evaluated techniques were effective, but the CA showed greater color stability after 1 week and 1 month, but did not differ from OB 6 months after bleaching. There was no difference in SO and intensity of SO.

Associação de microabrasão e clareamento dental caseiro em paciente com fluorose – relato de caso / Association of microabrasion and home bleaching in patient with fluorosis – case report

A fluorose dental é causada pela exposição do germe dental, em sua fase de formação, a altas concentrações de flúor. A preocupação com a estética do sorriso tem acarretado transtornos para os indivíduos que possuem estas alterações, portanto, o tratamento é indicado quando a autoestima do paciente é afetada. Para esses casos, tratamentos minimamente invasivos, como a microabrasão e o clareamento dental, até tratamentos menos conservadores, como a confecção de restaurações, coroas protéticas e facetas, podem ser indicados. O objetivo deste relato de caso foi demonstrar o procedimento de microabrasão associado ao clareamento dental caseiro com peróxido de carbamida 10% em um paciente com fluorose, minimizando as alterações cromáticas que comprometiam a estética dental. Para isso foram realizadas duas sessões de microabrasão em esmalte, seguidas do clareamento caseiro por um período de três horas diárias três semanas. Após o desenvolvimento das duas técnicas, pôde-se concluir que ambas foram efetivas, obtendo um resultado estético favorável e aprovado pelo paciente.

Dental fluorosis is caused by the exposure of tooth germ, in formative stage, to high concentrations of fluoride. The concern with the aesthetics of the smile has led to disorders in individuals who have these changes, so treatment is indicated when the patient’s self-esteem is affected. In these cases minimally invasive treatments such as microabrasion and dental bleaching, as well as less conservative treatments, such as restorations, prosthetic crowns and veneers may be indicated. The aim of this case report was to demonstrate microabrasion associated with home bleaching using 10% carbamide peroxide in a patient with fluorosis, minimizing chromatic alterations that compromise dental aesthetics. Thereunto were conducted two sessions of enamel microabrasion followed by home bleaching in a period of three hours a day for three weeks. After the development of the two techniques, it was concluded that both were effective, obtaining a favorable aesthetic result approved by the patient

Técnica para remoção do remanescente adesivo após descolagem de braquetes ortodônticos / Technique for removal of remmant adhesive after debonding od orthodontic brackets

A etapa de remoção de aparelhos ortodônticos deve ser realizada tentando preservar, ao máximo, a estrutura dentária. Apesar de existirem vários protocolos e materiais disponíveis no mercado, alguns profissionais desconhecem os efeitos destes materiais na superfície do esmalte, o que pode contribuir para que o esmalte seja permanentemente danificado, ou desconhecem que, quando a resina não for adequadamente removida, pode ocorrer um aumento na agregação de biofilme, tornando o esmalte mais suscetível a doenças cárie e periodontal. / Objetivo / O objetivo desse trabalho foi demonstrar, por meio de um caso clínico, uma sequência de acabamento e polimento pós-terapia ortodôntica. / Métodos / Após a remoção dos braquetes, a resina residual foi evidenciada com pó dourado (Texturmarker, Benzer Dental AG, Suíça). Em seguida, foi utilizada broca multilaminada (Komet), discos Sof-Lex (3M ESPE), borrachas para acabamento Astropol e Astrobrush (Ivoclar Vivadent), escova de pelo de cabra e FlexiBuff com pasta Enamelize (Cosmedent). / Conclusão / Pôde-se concluir que a sequência de materiais utilizados foi efetiva e de fácil execução, preservando a estrutura dentária.

Restaurações estéticas indiretas: relato de caso clínico / Indirect esthetic restorations: case report

As restaurações indiretas metal tiee têm sido amplamente utilizadas por serem capazes de mimetizar as estruturas do dente natural. O sucesso dessas restaurações pode ser atribuído às propriedades do material empregado, o domínio da técnica pelo Cirurgião-Dentista, além de uma estreita relação com o ceramista. Dentre as várias opções cerâmicas metal free existentes no mercado odontológico o dissilicato de lítio tem sido uma grande opção devido principalmente as nuances estéticas permitidas com este sistema (lPS Empress 2 Ivoclar/Vivadent). Assim, este trabalho demonstra clinicamente por meio da realização de um caso clínico, o emprego de uma cerâmica pura para devolver a harmonia de um sorriso comprometido pela alteração de posição e coloração dos dentes anteriores, alcançando um resultado altamente satisfatório proporcionando bem estar ao paciente e um aumento de sua autoestima.

The indirect restorations free metal has been widely used because they are able to mimic the structures of natural tooth. The success of these restorations can be attributed to the properties of the material used, mastery of technique by a dentist, and a close relationship with the potter. Among the ceramics on the market, the IPS Empress2 (Ivoclar/Vivadent) has featured works by providing durable, aesthetic and high marginal accuracy. This study demonstrates clinically by conducting a case study, the use of a ceramic lithium disilicate to restore the harmony of a smile compromised by changing color and position of the anterior teeth. Providing welf are to the patient and increase their self esteem.