Clinical and patient reported outcomes of bleaching effectiveness.

OBJECTIVE: The objective of this study is to evaluate clinical and patient reported outcomes of different bleaching products. MATERIALS AND METHODS: Thirty participants were randomly divided into three bleaching groups (n = 10). Bleaching was performed with high concentrations of hydrogen peroxide (HP) - Boost (40%) and Dash (30%), and with prefabricated splints Bite&White (6% HP). Tooth colour was measured before, immediately after, and 1 and 6 months after the bleaching by using classical shade guide and spectrophotometer. Tooth hypersensitivity was self-rated by patients on the Wong-Baker's face scale. Patient satisfaction was evaluated on a 7-point Likert-type scales that measured perceived performance and importance of different characteristics of bleaching treatment. RESULTS: All products were effective in teeth colour change (ΔE > 3.3), which was significantly higher for Boost (p = .016) and Dash (p = .024) than Bite&White treatment. Perception of hypersensitivity was the highest in Boost group, followed by Dash and Bite&White treatment. Most of the patients were satisfied with final tooth colour, length and comfort during treatment, but were dissatisfied with the stability of bleached tooth colour. CONCLUSION: Materials with the higher concentrations of bleaching agent demonstrated greater bleaching effectiveness than at-home bleaching product, but also a greater hypersensitivity. Lengthening the treatment process, but achieving a more stable tooth colour may improve the perceived value of a bleaching service.

Risk Factors Associated with Black Tooth Stain

The aim of the study was to show whether there is any influence of food, drink or drug intake on the formation of tooth discoloration. A total of 500 patients aged 15-25 years were examined to take part in the study. Of these, 60 patients were selected and divided into two groups of 30 patients each. Group 1 included patients with black pigmentation on vestibular/oral tooth surfaces. Group 2 included patients without discoloration (control). Data were recorded in a questionnaire. Atomic absorption spectrometry was used to determine elements in discoloration samples. The Caries Risk Test (CRT) buffer was used to assess buffer capacity of saliva, while CRT bacteria were used to determine the presence of Streptococcus mutans and Lactobacillus spp. Statistically significant between-group differences were found for the intake of collard greens and beets (p<0.05), but not for other vegetables. As for drink consumption, patients with pigmentation reported less wine intake (p<0.05) than those without pigmentation. There was no difference according to drug intake between patients with and without pigmentation. Patients with pigmentation were older, smoked and had lower saliva pH with lower presence of Streptococcus mutans than those without pigmentation (p<0.05). In tooth discoloration samples, there were traces of calcium, magnesium, iron, copper and zinc. The appearance of tooth discoloration is influenced by many factors, among which diet and saliva seem to be very important. Our study showed that patients with black pigmentation used to take more beets, while patients without pigmentation were taking more collard greens and red wine.

Influence of Ionizing Radiation on Fluoride-Releasing Dental Restorative Materials.

This study aimed to investigate the effects of radiotherapy on the mechanical, chemical, and surface properties of two recently introduced restorative dental materials (a glass hybrid and an alkasite), while two conventional restorative materials served as references. Material specimens of the experimental groups (irradiated) were compared to the specimens of the control groups that underwent the same preparation procedure but without irradiation. The experimental groups of restorative material specimens were irradiated with a total of 70 Gy over 35 days (2 Gy/day × 35 days), while the control groups received no treatment. The following properties were evaluated: surface microhardness (Vickers), surface roughness, color change, flexural strength, flexural modulus, material reliability, and infrared spectra. For the experimental groups, measurements were performed 24 h after specimen preparation, i.e., before radiotherapy and after the completion of the irradiation protocol. For the control groups, measurements were performed after the corresponding periods of no treatment. A statistically significant increase in microhardness (p = 0.001-0.004) and surface roughness (p = 0.013) was observed as a result of material aging/maturation in both the control and experimental groups. However, the only statistically significant difference between the control and experimental groups was observed in the discoloration of the conventional reference material (p < 0.001). In conclusion, no statistically significant negative effects of a therapeutic dose of radiotherapy on any of the tested properties of the alkasite and glass hybrid materials were observed, whereas only a minor negative effect of radiotherapy in terms of discoloration was found for a conventional resin composite that was used as a reference material.

Direct Induced Effects of Standard and Modified Radiotherapy Protocol on Surface Structure of Hard Dental Tissue.

INTRODUCTION: Radiotherapy is used to treat neo plasmatic lesions and the common side effects of this process are pain, swelling and sensitivity of mucous membranes in domain of radiation, reduced salivation, caries, and periodontal disease and, in total, low life quality. The purpose of this research was to estimate the outcome of direct irradiation on physical and surface characteristics of hard dental tissues. MATERIALS AND METHODS: Twenty, caries free third molars were involved in the research. Prior to different submission protocols, tooth halves were randomly assigned to subject and control groups by using a draw method. The first group (n=20) was submitted to conventional irradiation protocol (2 Gy for 35 days), second group (n=20) was submitted to one powerful, exploratory dose of 70 Gy. Each sample served as its own control. Radiation was performed with a linear accelerator radiotherapy unit. The surface microhardness and roughness were measured at the beginning (initially), and upon completion of irradiation procedure. The average change in microhardness and roughness after different treatments was compared by t-test for independent samples. Normality was tested by the Shapiro-Wilk test. RESULTS: Significant differences were found after the standard radiation protocol and the exploratory dose of 70 Gy, with decreased mean microhardness and increased mean roughness (p<0.001) of both hard dental tissues. Enamel and dentin surface microhardness and roughness did not vary notably with regards to different irradiation protocols. CONCLUSION: Head and neck conventional irradiation protocol leads to possible breakdown of enamel and dentin with reduced microhardness and increased surface roughness regardless of used irradiation protocol.

Effect of Conventional Adhesive Application or Co-Curing Technique on Dentin Bond Strength.

The aim of this in vitro study was to assess the effect of two different adhesive application methods on shear dentin bond strength (ISO 29022) using three various adhesive systems. A mid-coronal section of 77 intact third human molars with fully developed apices was made to create flat bonding substrates. The materials used in the study were Excite F (Ivoclar Vivadent), Prime&Bond Universal (Dentsply Sirona) and G-Premio Bond (GC). The application of each adhesion system was performed in two different ways. In the first group, the bonding agent was light cured immediately after the application (conventional method), while in the second group the adhesive and composite were cured concurrently ("co-curing" method). A total of 180 specimens were prepared (3 adhesives × 2 method of application × 30 specimens per experimental group), stored at 37 °C in distilled water and fractured in shear mode after 1 week. Statistical analysis was performed using ANOVA and Weibull statistics. The highest bond strength was obtained for Prime&Bond conventional (21.7 MPa), whilst the lowest bond strength was observed when co-curing was used (particularly, Excite F 12.2 MPa). The results showed a significant difference between conventional and co-curing methods in all materials. According to reliability analysis, the co-curing method diminished bond reliability. Different application techniques exhibit different bond strengths to dentin.

Estimating Attribute-Specific Willingness-to-Pay Values from a Health Care Contingent Valuation Study: A Best-Worst Choice Approach.

BACKGROUND: Willingness-to-pay (WTP) studies frequently use a contingent valuation (CV) method to determine the economic value of a good or service. However, a typical CV study is able to estimate the WTP for a good as a whole, but provides no information about the marginal WTP for different attributes of a good. OBJECTIVE: The aim was to estimate marginal WTP for different attributes of a CV scenario. METHODS: By using the data from an additional best-worst choice (BWC) experiment, we disaggregated the holistic WTP values for dental care, estimated using the CV method, into attribute-specific WTP values. The study was conducted at the School of Dental Medicine, University of Zagreb, Croatia. Dental school patients were surveyed from March 2016 to January 2017, and their WTP for dental care was estimated using either a CV survey (n = 242), which also included a BWC task, or a discrete choice experiment (DCE) survey (n = 275). RESULTS: The largest marginal welfare estimate (€13.5) was obtained for the improvement in treatment explanation, followed by the improvements in staff behavior (€8.1) and waiting time in the office (€7.2), and by the changes in dental care provider (€3.4). These estimates were generally highly similar to the traditional marginal WTP estimates obtained with a traditional multi-profile DCE, after adjusting DCE estimates for non-attendance to the cost attribute. CONCLUSION: Our BWC-CV framework may serve as a valuable alternative for estimating marginal WTP values for health care attributes when the choice behavior of respondents raises concerns for the validity of DCE estimates.

Effects of bleaching agent on physical and aesthetic properties of restorative materials.

To investigate the effects of bleaching agent on microhardness, color and light transmission of different restorative materials. Specimens (n=20) of Tetric EvoCeram (TEC), Tetric EvoCeram Bulk Fill (TECBF) and Equia Fill (EQUIA) were treated with either 40% hydrogen peroxide Opalesence Boost or destilled water for 45 min. Specimens were stained in tea solution or stored in deionized water for one and two weeks. Color, microhardness and light transmission were monitored at the baseline, after the bleaching and after the tea immersion or storage in deionized water. After the bleaching a significant reduction in surface microhardness (p<0.001) was recorded for all materials. Clinically visible color change (ΔE>3) was observed after the bleaching and after treatment in tea solution, but only in EQUIA samples. The absorption coefficient was the largest for the samples stained in tea solution. Bleaching can affect the microhardness and color of fillings; therefore, they should be sometimes replaced.