Effects of enamel moistening and repositioning guide color on tooth whitening outcomes: A clinical trial.

This clinical trial investigated the effects of pre-application enamel moistening on the impact of a 37% carbamide peroxide whitener on tooth color changes and the influence of repositioning guide colors. Forty participants were randomly assigned to in-office tooth bleaching with either moistened enamel (experimental) or dry enamel (control). The whitener was applied for 45 min over two sessions. Tooth color was visually measured or assessed using a spectrophotometer with purple or green silicone guides. Tooth bleaching was assessed using CIE76 (ΔEab ) and CIEDE2000 (ΔE00 ) formulas and by whitening and bleaching index score changes. Moistening the enamel did not significantly affect tooth color. However, the guide color choice only impacted tooth color when measured instrumentally. At baseline, the green guide resulted in statistically significantly whiter teeth than the purple guide. Less pronounced differences in the b* coordinate between baseline and final measurements were found using the green guide. The green guide also produced lower ΔEab values and less change in indexes. In conclusion, moistening the enamel did not significantly impact tooth color changes. However, the repositioning guide color influenced the tooth bleaching measured instrumentally, except for ΔE00 .

Effect of laser irradiation during in-office tooth bleaching on surface properties of resin-based restorative materials.

This study evaluated the changes in surface properties of three resin-based restorative materials after two laser-assisted, in-office tooth bleaching protocols using erbium, chromium: yttrium-scandium-gallium-garnet (Er,Cr:YSGG) or diode (980 nm) lasers. A nanohybrid composite (Enamel Plus HRi), a Bis-GMA-free composite (Enamel Plus HRi Bio Function), and a resin-matrix CAD-CAM ceramic (Shofu Block HC) were tested. Forty specimens for each material were prepared and divided into four groups (n = 10/group). The control specimens did not undergo any bleaching treatment, whereas group 2 received bleaching with 40% hydrogen peroxide (H2O2), while groups 3 and 4 underwent the same bleaching procedure with the use of diode (980 nm) or Er,Cr:YSGG lasers, respectively. Surface microhardness and roughness measurements were conducted using a Vickers tester and an optical profilometer. Microhardness was lower in bleached specimens, with the nanohybrid composite exhibiting the largest difference from the no bleaching group. For the Bis-GMA-free composite the microhardness difference between no bleaching and laser-assisted bleaching were smaller than seen for the conventional bleaching technique. Surface roughness was higher in bleached specimens, with nanohybrid composite showing the largest differences from the control specimens. The examined laser-assisted tooth bleaching protocols were found not to impact surface microhardness and roughness of the tested resin-based specimens and they are deemed suitable for clinical use.

Effect of peroxide-free and peroxide-based in-office bleaching on the surface and mechanical properties of CAD/CAM esthetic restorative materials.

The study aimed to investigate the influence of H2O2-based and H2O2-free in-office bleaching on the surface and mechanical attributes of CAD/CAM composite blocks. CAD/CAM composite blocks from five different composite materials (CC1, CC2, CC3, CC4, and CC5) were randomly divided into two groups according to bleaching application (H2O2-based and H2O2-free). The surface topography, morphology, nanohardness, elastic modulus, flexural strength, and fracture toughness were measured. A paired and unpaired sample t-tests gauged the effect of pre- and post-bleaching on the substrates. The estimated mean differences (before-after bleaching) suggested an increase in surface roughness for two materials CC2 and CC4, and a significant decrease in nanohardness for material CC4 and in elastic modulus for materials CC2 and CC4 with H2O2-based bleaching, whereas H2O2-free bleaching resulted in changes compatible with no change in these properties. Flexural strength and fracture toughness showed no evidence of changes, irrespective of the bleaching gel used. Scanning electron microscopic analysis revealed erosive effects and micropore formation due to H2O2-based bleaching. H2O2-based bleaching deteriorates the surface of CAD/CAM composite materials while H2O2-free bleaching gel had an insignificant effect on both surface and bulk properties. The clinician should carefully evaluate the potential effects of H2O2-based bleaching on the surface properties of CAD/CAM composites.

Effects of alpha-tocopherol antioxidant on fracture strength and adhesion of endodontically treated teeth restored after dental bleaching.

This study evaluated the effect of different concentrations of alpha-tocopherol in gel form on fracture strength, hybrid layer formation, and microtensile bond strength of endodontically treated teeth bleached with 40% hydrogen peroxide (H2 O2 ). Sixty bovine incisors were randomized into one of six groups (n = 10 incisors per group) defined by the interventions carried out after endodontic treatment. In the control group, no additional intervention was carried out, while all teeth in the five intervention groups were bleached with 40% H2 O2 and subsequently treated with alpha-tocopherol at concentrations of 15% (15AT), 20% (20AT), or 25% (25AT), with 10% sodium ascorbate (10SA), or with nothing (40HP). Fracture strength was evaluated in a mechanical testing machine, hybrid layer formation was assessed using scanning electron microscopy, and bond strength was determined using microtensile bond-strength testing. Data were analyzed using Kruskal-Wallis and Dunn's tests. No statistically significant difference regarding fracture strength was observed among groups. Hybrid layer formation was greater in the 15AT group than in groups 40HP and 10SA. Teeth in groups 15AT, 20AT, and 25AT demonstrated higher bond strength than teeth in groups 40HP and 10SA. Alpha-tocopherol, preferably at 15%, effectively reverses the deleterious effects, of bleaching, on hybrid layer formation and bond strength to dentin.

Influence of dental bleaching on the pulp tissue: A systematic review of in vivo studies.

BACKGROUND: Although several studies indicate the harmful effects of bleaching on pulp tissue, the demand for this procedure using high concentrations of hydrogen peroxide (HP) is high. OBJECTIVES: To investigate the influence of bleaching on the pulp tissue. METHODS: Electronic searches were conducted (PubMed/MEDLINE, Scopus, Cochrane Library and grey literature) until February 2021. Only in vivo studies that evaluated the effects of HP and/or carbamide peroxide (CP) bleaching gels on the inflammatory response in the pulp tissue compared with a non-bleached group were included. Risk of bias was performed according to a modified Methodological Index for Non-Randomized Studies scale for human studies and the Systematic Review Centre for Laboratory Animal Experimentation's RoB tool for animal studies. Meta-analysis was unfeasible. RESULTS: Of the 1311 studies, 30 were eligible. Of these, 18 studies evaluated the inflammatory response in animal models. All these studies reported a moderate-to-strong inflammatory response in the superficial regions of pulp, characterized by cell disorganization and necrotic areas, particularly during the initial periods following exposure to 35%-38% HP, for 30-40 min. In the evaluation of human teeth across 11 studies, seven investigated inflammatory responses, with five observing significant inflammation in the pulp of bleached teeth. In terms of tertiary dentine deposition, 11 out of 12 studies noted its occurrence after bleaching with 35%-38% HP in long-term assessments. Additionally, three studies reported significant levels of osteocalcin/osteopontin at 2 or 10 days post-treatment. Other studies indicated an increase in pro-inflammatory cytokines ranging from immediately up to 10 days after bleaching. Studies using humans' teeth had a low risk of bias, whereas animal studies had a high risk of bias. DISCUSSION: Despite the heterogeneity in bleaching protocols among studies, High-concentrations of HP shows the potential to induce significant pulp damage. CONCLUSIONS: High-concentrations of bleaching gel increases inflammatory response and necrosis in the pulp tissue at short periods after bleaching, mainly in rat molars and in human incisors, in addition to greater hard tissue deposition over time. However, further well-described histological studies with long-term follow-up are encouraged due to the methodological limitations of these studies. REGISTRATION: PROSPERO (CRD42021230937).

Clinical comparison of whitening efficacy and tooth sensitivity of different concentrations of hydrogen peroxide photoactivated with violet or blue LEDs.

This study evaluated the photoactivation of hydrogen peroxide gels at different concentrations using blue or violet LED in terms of whitening efficacy and tooth sensitivity. Forty patients were randomly divided into 4 groups: HP6V (violet LED and 6% hydrogen peroxide), HP6B (blue LED and 6% hydrogen peroxide), HP35V (violet LED and 35% hydrogen peroxide), and HP35B (blue LED and 35% hydrogen peroxide). The L*, a* and b* values were measured before, 1 week and 3 months after treatment, and the ΔE and ΔWID values were calculated. Tooth sensitivity was measured using a visual analogue scale (VAS) before, immediately after, and 24 h after bleaching. The ΔE, ΔWID and bleaching sensitivity values were subjected to the ANOVA test and Bonferroni post-test. HP35V and HP35B showed higher whitening efficacy than HP6VL, while HP6V did not show statistical differences compared to the other groups. Regarding bleaching-related sensitivity, the HP6V and HP6B groups presented the lowest values when compared to HP35V and HP35B. HP6V showed whitening efficacy comparable to HP35V and HP35B but with reduced tooth sensitivity. TRIAL REGISTRATION NUMBER: NCT06165458; registration date: 12/09/2023.

Influence of using different toothpaste during bleaching with violet LED light (405 nm) on the colour and roughness of dental enamel: an in vitro study.

This in vitro study aimed to investigate potential changes in the color and roughness of dental enamel resulting from the use of different toothpaste formulations during bleaching with violet LED light (405 nm). Sixty specimens of bovine incisors, each measuring 6 × 6 × 3 mm, were segregated into six distinct experimental groups based on their respective treatments (n = 10): C + VL: Brushing with Colgate® Total 12 + bleaching with violet LED; LB + VL: Brushing with Colgate® Luminous White Brilliant + bleaching with violet LED; LI + VL: Brushing with Colgate® Luminous White Instant + violet LED bleaching; C: Brushing with Colgate® Total 12; LB: Brushing with Colgate® Luminous White Brilliant; LI: Brushing with Colgate® Luminous White Instant. The examined variables included alterations in color (∆L*, ∆a*, ∆b*, ∆Eab, and ∆E00), surface roughness (Ra), and scanning electron microscopy observations. No statistically significant distinctions emerged in total color variations (∆E00 and ∆E) among the groups under scrutiny. Notably, the groups that employed Colgate® Luminous White Instant displayed elevated roughness values, irrespective of their association with violet LED, as corroborated by scanning electron microscopy examinations. It can be concluded that whitening toothpastes associated to violet LED do not influence the color change of dental enamel in fifteen days of treatment. Toothpastes with a higher number of abrasive particles showed greater changes in enamel roughness, regardless of the use of violet LED.

Low and high hydrogen peroxide concentrations of in-office dental bleaching associated with violet light: an in vitro study.

OBJECTIVES: This study aims to assess hydrogen peroxide (HP) penetration within the pulp chamber, color change (CC), physical-chemical properties, and temperature using in-office different concentration bleaching gels with or without violet light. MATERIALS AND METHODS: Fifty teeth were divided into five groups (n = 10) based on the HP concentration bleaching gels used (6% and 35%) and the used violet light (with or without). HP penetration within the pulp chamber was measured using UV-Vis. The CC was evaluated with a digital spectrophotometer. Initial and final concentration, and pH were measured through titration, and a Digital pHmeter, respectively. Temperature analyses were measured through a thermocouple. Statistical analysis included two-way ANOVA, Tukey's, and Dunnett's test (α = 0.05). RESULTS: The presence of violet light did not affect the amount of HP within the pulp chamber, or the CC (p > 0.05). Greater penetration of HP was observed within the pulp chamber, as well as CC when using 35% HP (p < 0.05). The final concentration of both gels was lower than the initial concentration, regardless of the use of violet light (p < 0.05). The initial and final pH levels remained neutral and stable (p > 0.05). The pulp temperature increased when the gels were used in conjunction with violet light (p < 0.05). CONCLUSIONS: Using violet light in conjunction with 6% or 35% HP does not alter the physical properties of the bleaching agents, the penetration of HP or enhance color change. However, an increase in temperature was observed when violet light was applied associated with bleaching gels. CLINICAL RELEVANCE: While the simultaneous use of violet light with hydrogen peroxide 6% or 35% does not alter the material's properties, it also does not bring benefits in reducing hydrogen peroxide penetration and improving color change. Furthermore, the use of violet light increases pulp temperature.

At-home bleaching with carbamide peroxide with concentrations below 10%: bleaching efficacy and permeability in the pulp chamber.

OBJECTIVES: To evaluate the bleaching efficacy and permeability of hydrogen peroxide (HP) in the pulp chamber of human teeth bleached with lower concentrations of carbamide peroxide gel (4%, 5% and 7% CP). MATERIALS AND METHODS: Bleaching gels with lower concentrations were formulated and a commercial standard gel, 10% CP, was used as a reference. Fifty-six human premolars were randomly divided into four groups. Applications of the bleaching gel were made for 3 h for 21 days. The bleaching efficacy was evaluated by digital spectrophotometry on 1, 7, 14 and 21 days, with analysis in the ∆Eab, ∆E00 and WID color spaces. The concentration of HP in the pulp chamber was measured in the same periods by UV-Vis spectrophotometry (µg/mL). Two-way repeated analysis of variance (ANOVA) examined bleaching efficacy and HP permeability, followed by Tukey's post-hoc test (α = 0.05). RESULTS: All groups showed significant color changes, with no statistical differences after the second and third week of bleaching (p > 0.05). The 'time' factor was statistically different (p < 0.05), increasing the bleaching efficacy throughout the treatment. The 4% CP group had lower HP levels in the pulp chamber (p < 0.05). CONCLUSIONS: The results seem promising, revealing that low concentration gels are as effective as 10% CP with the benefit of reducing the amount of HP in the pulp chamber. CLINICAL RELEVANCE: Low concentration 4% PC and 5% PC maintains bleaching efficacy, reduces the penetration of HP peroxide into the pulp chamber, and may reduce tooth sensitivity.

The decomposition rate and bleaching efficacy of in-office bleaching gels with different pHs: a randomized controlled trial.

BACKGROUND: To evaluate the decomposition rate of active hydrogen peroxide (HP) and bleaching efficacy during in-office bleaching using high-concentration HP gels with different pHs. METHOD: A randomized, parallel, double-blind controlled trial was conducted with 40 volunteers randomized into four groups (pH 5.4; pH 7.0; pH 7.7, and pH 8.0). During the first session in-office bleaching, approximately 0.01 g of the gel was collected and titrated with potassium permanganate to obtain the concentration of active HP and pH values were measured using an electrode. Bleaching efficacy was assessed using a spectrophotometer [∆Eab, ∆E00, and WID], Vita Classical and Vita Bleachedguide scales [∆SGU]. The decomposition rate of HP concentration and pH values change were calculated using ANOVA one-way. The bleaching efficacy was assessed using two-way repeated measures ANOVA. Tukey's test was applied as a post-hoc test (p < 0.05). RESULTS: All gels experienced decreasing HP concentration over time. pH 5.4 gel showed greatest reduction after 50 min (p < 0.001). pH 8.0 and 7.7 gels remained stable; pH 5.4 remained acidic, while pH 7.0 turned acidic (p < 0.001). No significant difference in bleaching degree was observed among gels. They all showed a similar and clinically important color change after two clinical sessions, remained stable 1-month post-treatment (p > 0.05). CONCLUSIONS: All bleaching gels kept at least 70% of their HP content after 50 min, suggesting that there is a surplus of HP. They provided similar whitening efficacy 1-month after bleaching. PRACTICAL IMPLICATIONS: It is possible that lower HP concentrations may be equally effective in achieving desired results while reducing the potential for side effects. CLINICAL TRIAL REGISTRY NAME: RBR-35q7s3v.

Efficacy of topical drug application to manage in-office bleaching sensitivity: a systematic review and meta-analysis of randomized clinical trials.

OBJECTIVES: To answer whether the topical drug application can reduce in-office tooth bleaching sensitivity without impairing the color change. MATERIALS AND METHODS: This review was registered on PROSPERO (CRD42024524171). Two reviewers screened PubMed, Web of Science, Scopus, Embase, and clinicaltrials.gov in March 2024 independently for randomized clinical trials investigating the efficacy of topical drug application to manage in-office tooth bleaching sensitivity. The risk of bias was assessed using Cochrane's Risk of Bias tool (RoB2). Certainty of the evidence was assessed using the Grading of Recommendations: Assessment, Development, and Evaluation tool (GRADE). The meta-analyses evaluated the bleaching sensitivity and color change with RevMan 5.4 software. RESULTS: 334 articles were retrieved. The final sample was composed of four articles. Tested drugs were Otosporin, Eugenol, Ibuprofen with arginine, and Dipyrone. The meta-analysis evidenced no difference in bleaching sensitivity up to 1 h (MD, -0.39; 95% CI, -0.89, 0.11), 24 h (MD, -0.26, 95% CI, -0.71, 0.18), or 48 h (MD, 0.00, 95% CI, -0.16, 0.16). Meta-analysis for color change evidenced no difference for color change (MD, 0.03; 95% IC, -0.56, 0.61). The risk of bias was low. The certainty of the evidence was rated moderate for bleaching sensitivity and high for color change. CONCLUSIONS: Although topical drug application did not impair color change, it was ineffective in reducing in-office tooth bleaching sensitivity. CLINICAL RELEVANCE: topical drug application on dental enamel is not an effective approach in reducing bleaching sensitivity, but several modifications can be made in future studies to possibly achieve a better outcome.

Assessment of color changes and adverse effects of over-the-counter bleaching protocols: a systematic review and network meta-analysis.

OBJECTIVES: To assess color change efficacy and the adverse effects of varied over-the-counter (OTC) bleaching protocols. METHODOLOGY: The study included randomized clinical trials evaluating color changes from OTC bleaching agents. Nine databases were searched, including the partial capture of the grey literature. The RoB2 tool analyzed the individual risk of bias in the studies. Frequentist network meta-analyses compared treatments through common comparators (∆Eab* and ∆SGU color changes, and tooth sensitivity), integrating direct and indirect estimates and using the mean and risk differences as effect measures with respective 95% confidence intervals. The GRADE approach assessed the certainty of the evidence. RESULTS: Overall, 37 remaining studies constituted the qualitative analysis, and ten composed the meta-analyses. The total sample included 1,932 individuals. ∆Eab* was significantly higher in groups 6% hydrogen peroxide (HP) strips (≥ 14 h). ∆SGU was significantly higher in groups at-home 10% carbamide peroxide (CP) (≥ 14 h), followed by 6% HP strips (≥ 14 h) and 3% HP strips (≥ 14 h). At-home 10% CP (7-13 h) and placebo showed lower risks of tooth sensitivity without significant differences between these treatments. CONCLUSION: Considering the low level of evidence, OTC products presented satisfactory short-term effects on tooth bleaching compared to the placebo, with little to no impact on dentin hypersensitivity and gingival irritation. CLINICAL RELEVANCE: OTC products are proving to be practical alternatives for tooth whitening. However, patients should be advised about the possible risks of carrying out such procedures without professional supervision.

Bleaching versus color change resistant adhesive in the discoloration of bracket-bonded tooth surfaces: an in vitro study.

OBJECTIVES: The aim of this study was to compare the effect of office bleaching of teeth bonded with Transbond XTTM (3M Unitek, Monrovia, CA, USA) (TRXT) and the use of color change resistant Orthocem (FGM, Joinville, Brazil) in bracket bonding on coffee-induced enamel discoloration. MATERIALS AND METHODS: Eighty premolars were distributed in equal numbers (n = 20) to group 1 (TRXT + distilled water), group 2 (TRXT + coffee solution), group 3 (TRXT + coffee solution + bleaching), and group 4 (Orthocem + coffee solution). Color was measured using a SpectroShade Micro (MHT, International, Verona, Italy) device at the beginning (T0), after coloring (T1), after bleaching (T1B), and after debonding (T2). ΔE color change values were calculated as T1-T0, T1B-T0 and T2-T0 differences. The conformity of the data to the normal distribution was examined with the Shapiro-Wilk test. Multiple comparisons were made with Tamhane's T2 test and Tukey's HSD test using one-way analysis of variance in the comparison of normally distributed data, and multiple comparisons were made with Dunn's test using the Kruskal-Wallis H test for comparison of non-normally distributed data. The significance level was set at p < 0.050. RESULTS: A statistically significant (p < 0.001) difference was found between the T1-T0 and T2-T0 stages for group 1-4 ΔE values. A statistically significant (p < 0.001) difference was also found when the T1B-T0 ΔE values of group 3 were compared with the T1-T0 ΔE values of groups 1, 2, and 4. CONCLUSIONS: After coffee-induced enamel discoloration, bleaching of teeth bonded with TRXT produced acceptable color difference of the incisal, middle, and gingival regions of the crown. In teeth bonded with Orthocem, acceptable color difference was seen only in the middle of the crown. CLINICAL RELEVANCE: The presented study will guide the clinician on how enamel discoloration side effect of fixed orthodontic appliance can reduce.

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.

Whitening toothpastes with hydrogen peroxide concentrations vs. at-home bleaching.

OBJECTIVES: To evaluate the effect of whitening toothpastes with different hydrogen peroxide (HP) concentrations on HP permeability, color change, and physicochemical properties, compared to at-home bleaching treatment. MATERIALS AND METHODS: Forty-nine premolars were randomized into seven groups (n = 7): untreated (control); at-home bleaching with 10% carbamide peroxide gel (AH; 10% CP) with 14 and 28 applications of 180 min each (AH [14 × 180 min] and AH [28 × 180 min]); three whitening toothpastes (3% HP; 4% HP and 5% HP) and 10% CP brushed 28 times for 90 s each (TB [28 × 90 s]). HP permeability was measured using a UV-VIS spectrophotometer and color change by a digital spectrophotometer (ΔEab, ΔE00, and ΔWID). Initial concentration, pH, and viscosity were measured through titration, digital pH meter, and rheometer, respectively. Statistical analysis included one-way ANOVA, Tukey's test, and Dunnett's test (α = 0.05). RESULTS: 4% HP group showed acidic pH, the lowest viscosity and the highest HP concentration into the pulp chamber (p < 0.05). The 10% CP groups had lower HP in the pulp chamber and greater color change than other groups (p < 0.05), except the 5% HP group in ΔEab and ΔE00. For ΔWID, the 10% CP AH groups showed greater whitening than other groups (p < 0.05). CONCLUSIONS: Whitening toothpaste with up to 5% HP resulted in higher HP permeability and less color change compared to 10% CP. Higher HP commercial concentrations in toothpaste increased whitening effect; however, acidic pH toothpastes exhibited greater HP permeability. CLINICAL RELEVANCE: Whitening toothpastes with high hydrogen peroxide concentrations were less effective than at-home bleaching, resulting in less color change and greater permeability of hydrogen peroxide, potentially increasing the risk of tooth sensitivity.

Effectiveness of desensitizing toothpastes in reducing tooth sensitivity after tooth bleaching: a systematic review.

OBJECTIVE: To evaluate the effectiveness of desensitizing toothpastes in reducing post-bleaching tooth sensitivity. MATERIALS AND METHODS: A systematic review of randomized clinical trials was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Electronic searches were conducted in the PubMed/MEDLINE, Scopus, Web of Science, The Cochrane Library and Embase databases, using the following terms: (dentifrices OR toothpaste) AND (sensitive OR sensitivity OR dental sensitivity) AND (dental bleaching OR tooth bleaching OR dental whitening OR tooth whitening). RESULTS: Five studies involving 387 individuals undergoing in-office or at-home teeth bleaching were reviewed. Desensitizing toothpastes reduced sensitivity effectively after home bleaching with 22% carbamide peroxide and single-session in-office bleaching with 35% hydrogen peroxide. However, they were ineffective for home bleaching with 16% carbamide peroxide and in-office bleaching across two sessions with 35% or 38% hydrogen peroxide. CONCLUSION: Desensitizing toothpastes are effective for home bleaching with high concentration carbamide peroxide and single-session in-office bleaching with highly concentrated hydrogen peroxide, but ineffective for home bleaching with low concentration carbamide peroxide and two-session in-office bleaching with concentrated hydrogen peroxide.

Co-doped titanium dioxide nanoparticles decrease the cytotoxicity of experimental hydrogen peroxide gels for in-office tooth bleaching.

OBJECTIVE: To evaluate the efficacy and cytotoxicity of experimental 6% and 35% hydrogen peroxide gels (HP6 or HP35) incorporated with titanium dioxide nanoparticles (NP) co-doped with nitrogen and fluorine and irradiated with a violet LED light (LT). METHODS: Bovine enamel-dentin disks adapted to artificial pulp chambers were randomly assigned to bleaching (n = 8/group): NC (negative control), NP, HP6, HP6 + LT, HP6 + NP, HP6 + NP + LT, HP35, HP35 + LT, HP35 + NP, HP35 + NP + LT, and commercial HP35 (COM). Color (ΔE00) and whiteness index (ΔWID) changes were measured before and 14 days after bleaching. The extracts (culture medium + diffused gel components) collected after the first session were applied to odontoblast-like MDPC-23 cells, which were assessed concerning their viability, oxidative stress, and morphology. The amount of HP diffused through the disks was determined. Data were analyzed by generalized linear models or Kruskal Wallis Tests (α = 5%).  RESULTS: HP6 + NP + LT exhibited ΔE00 and ΔWID higher than HP6 (p < 0.05) and similar to all HP35 groups. HP6 + NP + LT showed the lowest HP diffusion, and the highest cell viability (%) among bleached groups, preserving cell morphology and number of living cells similar to NC and NP. HP6 + LT, HP6 + NP, and HP6 + NP + LT exhibited the lowest cell oxidative stress among bleached groups (p < 0.05). HP35, HP35 + LT, and HP35 (COM) displayed the lowest cell viability. CONCLUSION: HP6 achieved significantly higher color and whiteness index changes when incorporated with nanoparticles and light-irradiated and caused lower cytotoxicity than HP35 gels. The nanoparticles significantly increased cell viability and reduced the hydrogen peroxide diffusion and oxidative stress, regardless of HP concentration. CLINICAL SIGNIFICANCE: Incorporation of co-doped titanium dioxide nanoparticles combined with violet irradiation within the HP6 gel could promote a higher perceivable and acceptable efficacy than HP6 alone, potentially reaching the optimal esthetic outcomes rendered by HP35. This approach also holds the promise of reducing cytotoxic damages and, consequently, tooth sensitivity.

Coffee-stained tooth enamel color restoration and surface abrasion with whitening and regular toothpaste.

PURPOSE: To evaluate the effectiveness of whitening toothpaste in restoring tooth color after coffee staining and its potential impact on enamel surfaces compared with regular toothpaste. METHODS: Bovine tooth enamel specimens were prepared and stained with coffee solutions before undergoing brushing simulation with different toothpaste slurries (whitening, regular, reference). For precise evaluation, spectrophotometric measurements were taken at intervals to assess color changes using the CIELAB (Commission Internationale de l'Éclairage Lab*) color space. Additionally, profilometric measurements were taken to determine the impact of toothpaste type on the roughness and abraded depth of the enamel surface. To understand the effects of toothpaste and brushing on color change, surface roughness, and abraded depth, while also considering correlations between these factors, the findings were analyzed using mixed-effects models. RESULTS: The whitening toothpaste group demonstrated the highest recovery rate (71%) after 10,000 brushstrokes, followed by the regular toothpaste group (48%) and the reference slurry group (43%). The mixed-effects model analysis revealed that the reference group had a smaller change in lightness (ΔL) than those in the regular toothpaste group. The whitening toothpaste group showed a greater change in lightness on average than those in the regular toothpaste group, with an increase in lightness as the number of brushstrokes increased. According to the roughness and abraded depth data, the whitening toothpaste group was least affected by brushing, while the reference and regular toothpaste groups showed higher levels of roughness and abraded depth at all intervals. CLINICAL SIGNIFICANCE: Gaining a thorough understanding of the effectiveness of whitening toothpaste and its impact on the enamel surface plays a crucial role in refining toothpaste formulations and advancing tooth whitening techniques in dental care.

Effect of toothbrushing with conventional and whitening dentifrices on monolithic zirconia after finishing procedures.

PURPOSE: To evaluate the effect of toothbrushing with conventional and whitening dentifrices on the color difference (ΔE00), gloss (Δgloss), and surface roughness (SR) of stained stabilized zirconia with 5 mol% of yttrium oxide (5Y-TZP) after polishing or glazing. METHODS: Specimens were divided into four groups (n=20): C (control), S (staining), SG (staining and glazing) and SP (staining and polishing). 50,000 toothbrushing cycles were performed with conventional (n=10) and whitening (n= 10) dentifrice slurries. The ΔE00 and Δgloss were measured using a spectrophotometer and CIEDE2000 system while SR was measured by laser confocal microscope. The ΔE00 and Δgloss data were analyzed using 2-way ANOVA, and SR data were analyzed using the linear repeated measures model, with Bonferroni's complementary test (α= 0.05). RESULTS: The ΔE00 values were beyond the acceptability threshold and no differences were found among the groups. There was no difference among groups to Δgloss after toothbrushing with conventional dentifrice while SP presented the highest values of Δgloss after toothbrushing with whitening dentifrice. Conventional dentifrice decreased the SR of stained groups and whitening dentifrice decreased SR of S and SG. The toothbrushing with conventional and whitening dentifrices promoted color difference, but did not impair gloss and surface roughness of stained 5Y-TZP. CLINICAL SIGNIFICANCE: Monolithic zirconia has been routinely used for esthetic restorations, however the type of finishing procedures that is carried out on it must be taken into consideration, in addition to the fact that brushing can influence the color difference of the material as well as interfere with surface roughness and gloss.

Effect of fluoride or chitosan toothpaste and at-home bleaching in enamel roughness, tooth color, and staining susceptibility.

PURPOSE: To evaluate how fluoride- or chitosan-based toothpaste used during at-home bleaching affects enamel roughness, tooth color, and staining susceptibility. METHODS: Bovine enamel blocks were submitted to a 14-day cycling regime considering a factorial design (bleaching agent x toothpaste, 2 x 3), with n=10: (1) bleaching with 16% carbamide peroxide (CP) or 6% hydrogen peroxide (HP), and (2) daily exposure of a fluoride (1,450 ppm F-NaF) toothpaste (FT), chitosan-based toothpaste (CBT), or distilled water (control). Then, 24 hours after the last day of bleaching procedure the samples were exposed to a coffee solution. Color (ΔEab, ΔE00, L*, a*, b*) and roughness (Ra, µm) analyses were performed to compare the samples initially (baseline), after bleaching, and after coffee staining. The results were evaluated by linear models for repeated measures (L*, a*, b*, and Ra), 2-way ANOVA (ΔEab, ΔE00) and Tukey's test (α= 0.05). RESULTS: After the at-home bleaching procedure (toothpaste vs. time, P< 0.0001), the toothpaste groups presented a statistically lower Ra than the control (CBT 0.05). After coffee exposure, CBT presented lower ΔEab and ΔE00 values in the HP groups (toothpaste, P< 0.0001), and lower b* and a* values in the CP groups (toothpaste vs. time, P= 0.004). CLINICAL SIGNIFICANCE: Fluoride or chitosan delivered by toothpaste can reduce surface alterations of the enamel during at-home bleaching, without affecting bleaching efficacy.