Efficacy of a buccal and lingual at-home bleaching protocol-A randomized, split-mouth, single-blind controlled trial.

OBJECTIVE: To compare the color change, the risk and intensity of tooth sensitivity (TS), and gingival irritation (GI) of at-home bleaching applied on the buccal surface only or the buccal and lingual surfaces. MATERIALS AND METHODS: Sixty patients with canines A2 or darker were selected and their superior arches were randomized in two groups: at-home bleaching on the buccal-only or on the buccal and lingual surfaces, with 7.5% hydrogen peroxide, for 1 h daily/2 weeks. The color change was evaluated at baseline, 7, 14 days, and 1 month after bleaching using shade guides scales (ΔSGU) and a spectrophotometer (ΔEAB, ΔE00, and ΔWID). Risk and intensity of TS and GI were recorded daily using visual analogic scale (0-10). Patient satisfaction was evaluated with the orofacial esthetics. Paired t-test, McNemar's, and Wilcoxon signed-rank test were used for data analysis (α = 5%). RESULTS: Neither the color change nor the risk/intensity of TS was statistically different between groups (p > 0.05). Patient satisfaction increased after bleaching for both groups (p < 0.05). CONCLUSION: The addition of one contact surface does not result in an increased whitening degree compared to bleaching applied solely on the buccal surface. CLINICAL SIGNIFICANCE: Understanding the influence of surfaces interacting with the bleaching agent is crucial for comprehending the bleaching mechanism and avoiding unnecessary material expenses. Notably, employing the buccal-only technique is sufficient to achieve the desired efficacy.

One-year follow-up evaluation of reservoirs in bleaching trays for at-home bleaching.

OBJECTIVE: To evaluate the color change stability and patient satisfaction after one-year of at-home bleaching with 10% carbamide peroxide (CP) in trays with or without reservoirs. MATERIALS AND METHODS: Forty-six patients were subjected to bleaching with CP (3 h/daily; 21 days) with a bleaching tray with or without reservoirs. The color was measured one-month and one-year after the completion of bleaching using the spectrophotometer (ΔEab, Δ00 and ΔWi), and shade guide units (ΔSGU). Patients' satisfaction were assessed using a 5-point Likert Scale questionnaire. Data were submitted to paired t-test (α = 0.05). RESULTS: No significant difference between color change after one-month and one-year was observed (VITA Classical shade guide unit and the ΔWi; p > 0.53). Significant differences were observed for the VITA Bleachedguide 3D-MASTER shade guide, ΔEab and ΔE00 (p < 0.03). The level of patient satisfaction was similar between groups (p = 1.00). CONCLUSIONS: Bleaching tray design did not have any influence on the bleaching stability for the 10% CP (Opalescence PF, Ultradent). Patients were very satisfied with the bleaching outcomes regardless of the bleaching tray design. CLINICAL RELEVANCE: Placement of reservoirs in bleaching trays does not increase longevity of dental bleaching. No clinically important color rebound was observed 1 year after bleaching with 10% CP.

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

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.

Influence of simplified, higher-concentrated sodium ascorbate application protocols on bond strength of bleached enamel.

BACKGROUND: Bleaching procedures performed before restorative procedures, due to the oxygen released, affects the quality of bonding restorations. The application of an lower-concentrated antioxidant for one-hour or more can reversal the compromised bonding to bleached enamel, but it was not effective according to the bleaching concentrations applied. The aim of the present study was to evaluate simplified protocol of higher-concentrated sodium ascorbate (35%SA) in bond strength values of enamel bleached with 10%, 16%, 22% carbamide peroxide (CP) or 35% hydrogen peroxide (HP). MATERIAL AND METHODS: Three hundred and forty enamel surfaces of 85 human third molars were used, divided into 17 groups (n=20), according to the following groups: control = no bleaching and no ascorbic acid application; bleaching (CP10%, CP16%, CP22% at-home and HP 35% in-office) and 35%SA application (no application; 35%SA applied twice for 1-min each [SA2×1], twice for 5-min each [SA2×5] and; twice for 10-min each [SA2×10]). After that, adhesive was applied and composite cylinders were made with Filtek Z350 composite. Microshear test was performed in a universal testing machine. BS values were statistically evaluated using ANOVA and Tukey's and Dunnet's (against control) tests, with 5% level of significance. RESULTS: All bleaching concentrations significantly decrease the enamel bond strength results when compared to control group (p<0.05). More concentrated PC (PC22% and PH35%) showed lower enamel bond strength results when compared to lower concentrated PC (PC10% and PC16%; p<0.05). A significant increase of the enamel bond strength results were only observed when SA2×5 and SA2×10 were applied (p<0.05). CONCLUSIONS: The application of 35% sodium ascorbate for twice 5- and 10-min each was an efficient protocol to reverse the bond strength in bleached enamel at the same level as the no bleaching enamel, independently of the bleaching concentration used. Key words:Tooth bleaching, hydrogen peroxide, sodium ascorbate, bond strength.

Effect of an experimental desensitizing agent on reduction of bleaching-induced tooth sensitivity: A triple-blind randomized clinical trial.

BACKGROUND: In this randomized study, split-mouth, triple-blind clinical trial, the authors evaluated the efficacy of a desensitizing gel that contained 5% potassium nitrate and 5% glutaraldehyde applied before in-office bleaching with 35% hydrogen peroxide (HP). METHODS: Treatment with the desensitizing or placebo control gels was randomly assigned to one-half of the maxillary teeth of 42 patients in a split-mouth design. The desensitizing gels were applied and maintained in contact with the tooth enamel for 10 minutes, followed by 2 HP bleaching sessions separated by 1 week. The primary outcome variable was pain intensity assessed with a numeric rating scale and a visual analog scale. Color was evaluated by means of a digital spectrophotometer and a value-oriented shade guide. RESULTS: The difference in risk of developing tooth sensitivity between the desensitizing gel group (31.7%, 95% confidence interval [CI], 19.6 to 46.9) and the control group (70.7%; 95% CI, 55.5 to 82.3%) was statistically significant (P < .0001), as well as the difference in pain intensity in the first 24 hours (P < .001). No statistically significant difference was found in color change between teeth that received the desensitizing gel and those that received the placebo gel. CONCLUSIONS: Application of desensitizing gel that contained 5% potassium nitrate and 5% glutaraldehyde before HP whitening reduced the risk and severity of dental sensitivity, without altering the effectiveness of whitening. PRACTICAL IMPLICATIONS: A single application of desensitizing gel that contained 5% potassium nitrate and 5% glutaraldehyde can reduce tooth sensitivity after dental bleaching systems.

Nasolabial Cyst Associated with Odontogenic Infection.

The nasolabial cyst or Klestadt cyst is a relatively uncommon nonodontogenic cyst that develops in the nasal alar region; it has uncertain pathogenesis. This lesion has slow growth and variable dimensions and is characterized clinically by a floating tumefaction in the nasolabial fold area around the bridge of the nose, causing an elevation of the upper lip and relative facial asymmetry. Diagnosis is primarily made clinically; if necessary, this is complemented by imaging. This paper reports the case of a 39-year-old male patient who complained of pain in the right upper premolar region and poor aesthetics due to a firm tumor in the right wing of the nose. Initially, this was thought to be due to an odontogenic abscess; however, the differential diagnosis was that a nasolabial cyst was communicating with the apex of teeth 14 and 15. Surgical treatment was carried out, followed by histopathological examination and concomitant endodontic treatment of the teeth involved.

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.

Análise da capacidade de remoção de pigmentos da resina composta pelo peróxido de hidrogênio 35% / Capacity analysis of pigment removal of composite resin by hydrogen peroxide 35%

Objetivo: Avaliar in vitro a capacidade de remoção de pigmentos ocasionados em resina composta após aplicação de peróxido de hidrogênio 35%. Material e método: Confeccionaram-se 20 amostras de resina composta Opallis (FGM), cor A1, em matriz metálica circular. As amostras foram divididas em quatro grupos (n=5) dos seguintes agentes corantes: água destilada (controle), café, vinho tinto e Coca-Cola®. No manchamento, as amostras ficaram imersas nas soluções durante 72 horas, com troca diária das bebidas. Procedeu-se à aplicação do gel de peróxido de hidrogênio 35% (Whiteness HP Blue Calcium, FGM) em três sessões, sendo uma aplicação do gel por sessão, o qual permaneceu nas amostras durante 40 minutos. Medidas de cor foram feitas inicialmente, após manchamento, após aplicação do peróxido e por mais 21 dias, usando espectrofotômetro Vita Easyshade. Os dados foram submetidos à análise de variância de dois fatores (tempo vs. corante) e ao teste de Tukey, para o contraste das médias (alfa=0,05). Resultado: Apresentaram alteração de cor (delta E - média/desvio padrão de L*) o café (15,7 ± 2,0) e o vinho (15,2 ± 4,6), quando comparados à Coca-Cola® (4,8 ± 1,9). O peróxido de hidrogênio removeu a pigmentação das amostras, porém, para nenhum dos corantes, houve retorno à coloração inicial, principalmente no grupo manchado por café (12,9 ± 1,5); este mostrou diferença significativa quando comparado ao controle (1,6 ± 0,6), diferentemente do vinho (3,3 ± 0,6) e da Coca-Cola® (2,1 ± 0,9), que se aproximaram do grupo controle. Conclusão: As soluções corantes pigmentaram a resina composta, principalmente o café. A aplicação do peróxido de hidrogênio 35% foi eficaz na remoção de pigmentos das amostras, porém, em nenhum dos grupos, com diferentes corantes, houve retorno à coloração inicial (p> 0,005).

Objective: Evaluate in vitro the ability to removal pigments of composite resin after application of hydrogen peroxide 35%. Material and method: Concocted to-20 resin samples composed Opallis (FGM), A1 color, in circular metal matrix. The samples were divided into 4 groups (n = 5) the following coloring agents: distilled water (control), coffee, red wine and Coca-Cola®. In the staining, the samples were immersed in the solutions for 72 hours, with daily change of beverages. Proceeded to the application of 35% hydrogen peroxide gel (Whiteness HP Blue Calcium, FGM) in 3 sessions, one application of gel per session that remained in the samples for 40 minutes. Color measurements were made initially after staining after application of the peroxide and for 21 days using Vita Easyshade spectrophotometer. The data were submitted to two-way ANOVA and Tukey's test (alfa = 0.05). Result: Significant color change was observed in specimens after immersion in the solutions, except the control group. Hydrogen peroxide was capable of removing the stains, however the color did not return to the baseline in any of the staining groups, especially for the groups immersed in coffee. Conclusion: Staining solutions can stain the composite resin. The application of 35% hydrogen peroxide can remove partially the staining, minimizing the color change produced by the staining solutions. However, the bleaching gel was not capable of removing all staining, especially for the coffee group.

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.