Effect of Bleaching Treatments on the Mechanical Properties of the Dentin Matrix and on Collagen Biodegradation by Endogenous Protease.

This study evaluated the mechanical properties of demineralized dentin matrix submitted to different bleaching treatments, as well as the changes in mass and collagen biodegradation brought about by endogenous protease. Dentin collagen matrices were prepared to receive the following treatments (n=12): no bleaching treatment (C-control), 10% carbamide peroxide (CP-Opalescence PF, Ultradent, South Jordan, UT, USA) 10%/8 hours/ day/14 days, and 40% hydrogen peroxide (HP-Opalescence Boost, Ultradent), 40 minutes per session/3 sessions. The dentin matrices were evaluated for elastic modulus and mass before and after treatments and ultimate tensile strength after treatments. The solution collected during storage was evaluated for hydroxyproline release. There was no statistically significant difference between CP and C in terms of the elastic modulus (p=0.3697) or mass variation (p=0.1333). Dentin beams treated with HP and C presented significant mass loss after the first session (p=0.0003). HP treatment led to complete degradation of collagen matrices after the second bleaching session. After the second session, CP showed higher hydroxyproline concentration than C (p<0.0001). Ultimate tensile strength was lower for CP than C (p=0.0097). CP did not affect the elastic modulus or the dentin collagen matrix mass but did promote hydroxyproline release by endogenous protease and reduce the ultimate tensile strength. HP significantly affected the mechanical properties of dentin and promoted complete degradation of the demineralized dentin collagen matrix.

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).

Effect of incorporation of calcium polyphosphate sub-microparticles in low-concentration bleaching gels on physical properties of dental enamel.

AIM: To evaluate the bleaching efficacy and effects on enamel properties of experimental gels with carbamide peroxide (CP; 10%) or hydrogen peroxide (HP; 6%) containing calcium polyphosphate sub-microparticles (CaPPs). METHODS: A total of 216 bovine tooth specimens were divided for microhardness and color analyses (n = 108) and block randomized into nine groups (n = 12): (G1) commercial CP (Whiteness Perfect, FGM; Brazil); (G2) experimental CP; (G3) CP-0.5%CaPPs; (G4) CP-1.5%CaPPs; (G5) commercial HP (Potenza Bianco, PHS; Brazil); (G6) experimental HP; (G7) HP-0.5%CaPPs; (G8) HP-1.5%CaPPs; (G9) artificial saliva. The gels' pH values were determined with a bench pH meter. Color (ΔE, ΔE00, ΔWID) and microhardness variation were evaluated before and after the therapy. Part of the specimens used for microhardness was submitted to the scanning electron microscopy (SEM) (n = 3) and energy-dispersive X-ray spectroscopy EDX (n = 3) analyses. Statistical analyses were performed in the R statistical software (α = 0.05). Linear mixed models for repeated measures in time were used to analyze microhardness and L* values. Generalized linear models were used to analyze the a*, b*, ΔE, ΔE00, and ΔWID, considering a group effect. The EDX data were analyzed using a one-way ANOVA with Tukey's test. RESULTS: The gels' pH remained over 6,0. All gels effectively bleached the specimens and did not differ significantly. When compared to the control group, the hardness was significantly lower in the G1, G2, G6, and G7 groups. The G3, G4, G5, and G8 groups did not differ significantly (p > 0.05). CONCLUSION: The incorporation of CaPPs in low-concentration whitening gels reduces its negative effects on microhardness without interfering with their bleaching efficacy.

Effectiveness of changing the color of darker teeth is potentiated by association with violet LED light.

BACKGROUND: The effectiveness of in-office bleaching protocols performed with violet LED light either combined with a bleaching agent containing 37% carbamide peroxide, or not, was determined by comparing teeth with different degrees of darkening. METHODOLOGY: Eighty bovine incisors were separated into groups of "light" teeth (luminosity greater than or equal to B3) and "dark" teeth (less than or equal to A3.5) to receive the protocols: HP - 35% hydrogen peroxide (Whiteness HP), CP - 37% carbamide peroxide (Whiteness SuperEndo), LED - violet LED light (Bright Max Whitening), CPLED - CP associated with the LED. For color analysis the CIEL*a*b* e WID, ΔEab, ΔE00 e ΔWID parameters were used. Data were analyzed using Mann-Whitney, Kruskal-Wallis, Dunn, Friedman or Nemenyi tests (α = 5%). RESULTS: HP and CP resulted in similar color change values (ΔEab, ΔE00 e ΔWID) for light and dark teeth (p > 0.05). Dark teeth showed better bleaching effectiveness (ΔEab, ΔE00 e ΔWID) than light teeth when CPLED was used (p < 0.05). LED showed color change that were below the limits of acceptability and perceptibility for ΔWID. CONCLUSION: light teeth are effectively bleached with the use of HP or CP, whereas dark teeth respond better to treatment with the CPLED protocol. Violet LED used alone did not show a satisfactory result.

Hybrid light applied with 37% carbamide peroxide bleaching agent with or without titanium dioxide potentializes color change effectiveness.

BACKGROUND: The effectiveness of dental color change was assessed by incorporating titanium dioxide (TiO2) into 37% carbamide peroxide bleaching agent associated with hybrid light. METHODOLOGY: Fifty bovine incisors were selected to receive the bleaching treatment, and separated into five groups (n = 10): 35% hydrogen peroxide (HP) (Whiteness HP, FGM/HP); 37% carbamide peroxide (CP) (Whiteness SuperEndo, FGM/CP); CP + hybrid light (HL) (CP HL); CP + 1% TiO2 (CP TiO2); CP TiO2 + hybrid light (CP TiO2 HL). The bleaching gels were applied to the dental surface for 30 min. Hybrid light (Whitening Plus, DMC/infrared laser diodes + blue LEDs +violet LEDs) was applied with 1 min of active light, alternating with 1 min of pause. A spectrophotometer (VITA Easyshade® Advance, Vita) was used to determine the color of the dental elements at baseline and time points after the 1st, 2nd and 3rd bleaching sessions. Color change effectiveness was evaluated using Vita Classical, CIEL*a*b*, WID and ΔEab, ΔE00 and ΔWID parameters. RESULTS: Generalized mixed linear models for repeated measures (α = 5%) showed significant decrease in Vita Classical scores and a* and b* values, as well as an increase in L* and ∆WID values for all the groups. Higher color change values for ΔEab were observed for CP HL and CP TiO2 HL, while those of ΔE00 and ΔWID were higher for CP TiO2 HL at the end of the bleaching treatment. CONCLUSION: Hybrid light applied with TiO2 incorporated into CP potentiated the effectiveness of the color change in the tooth structure.

Effect of experimental bleaching gels with polymers Natrosol and Aristoflex on the enamel surface properties.

Natrosol and Aristoflex® AVC polymers are widely applied in the cosmetic industry and have recently been applied as a thickener option in the composition of dental bleaching gels, with the purpose to reduce the adverse effects on enamel mineral components. The aim of this study was to evaluate the color variation (ΔE* ab, ΔE00, ∆WID), surface roughness (Ra), and mineral content quantification (Raman Spectroscopy) of dental enamel after bleaching treatment with experimental gel-based on 10% carbamide peroxide (CP), containing Carbopol, Natrosol, and Aristoflex® AVC. Sixty bovine teeth were randomly divided into 6 groups (n=10): Negative Control (NC) - no treatment; Positive Control (PC) - Whiteness Perfect 10% - FGM; CP with Carbopol (CPc); CP with Natrosol (CPn); CP with Aristoflex® AVC (CPa); NCP - no thickener. Data were analyzed, and generalized linear models (∆WID -T0 x T1) were used for repeated measurements in time for Ra and with a study factor for ΔE* ab and ΔE00. For the evaluation of the mineral content, data were submitted to one-way ANOVA and Tukey tests. For enamel topographic surface analysis the Scanning Electron Microscope (SEM) was performed. A significance level of 5% was considered. ΔE* ab and ΔE00 were significantly higher for CPc, CPn, CPa, and NCP groups. (∆WID) showed a significantly lower mean than the other groups for NC in T1. After bleaching (4-hour daily application for 14 days), Ra was higher in the CPc, CPn, and PC groups. For CPa, Ra was not altered. No significant difference was found in the quantification of mineral content. CPa preserved the surface smoothness more effectively. Aristoflex® AVC is a viable option for application as a thickener in dental bleaching gels, presenting satisfactory performance, and maintaining the whitening efficacy of the gel, with the advantage of preserving the surface roughness of tooth enamel without significant loss of mineral content.

Efficacy of natural, peroxide-free tooth-bleaching agents: A systematic review, meta-analysis, and technological prospecting.

The aim of this study is to analyze the efficacy of natural bleaching agents and the current technological development in this research field. Two reviewers performed a literature search up to July 2019 in 15 databases. Five laboratory studies and 25 patents were included. Data regarding natural bleaching agent used, application protocol, and the main findings of studies were analyzed. Laboratory studies that evaluated natural bleaching agents' peroxide-free or associated to peroxides and patents related to natural bleaching agents were included. The studies evaluated papain, bromelain, chlorine dioxide, sodium chloride plus vinegar and sodium bicarbonate as peroxide-free agents; and sweet potato extract, lactoperoxidase, and peroxidase associated to peroxide used were included. Twenty-five patents were included; among the most cited are the papain and the chlorine. The addition of non-peroxide agents into peroxide showed improvement in bleaching effect with the incorporation of these non-peroxide agents (p < .05). On the other hand, peroxide-free agents did not show an improvement in bleaching effect (p < .05). The evidence in literature suggested that natural bleaching agents incorporated to peroxide may improve the bleaching. Therefore, the current literature does not support the use of natural agents as dental bleaching.

Effects of bleaching using 10% carbamide peroxide with calcium or amorphous calcium phosphate on enamel mineral content and hardness / Asociación entre la severidad de Hipomineralización Incisivo-Molar (HIM) y lesiones cavitadas de caries en escolares

ABSTRACT This study evaluated enamel mineral content and surface microhardness before and after bleaching treatment using 10% carbamide peroxide (CP) containing calcium (Ca) or amorphous calcium phosphate (ACP). Thirty-six bovine slabs were randomly allocated into 3 groups (n = 12) according to bleaching treatment: G1 - Opalescence PF 10% (CP), G2 -NiteWhite ACP (CP+ACP), and G3 - Opalescence PF (10%) with calcium (CP+CA). The bleaching agent was applied on enamel surface for 6 h/day over a period of 21 days. Enamel surface was evaluated by Knoop microhardness (KNH) and micro energy-dispersive X-ray fluorescence spectrometry (p-EDXRF) at baseline and at after bleaching treatment. Data were statistically analyzed by repeated measures ANOVA and Tukey's test (a = 0.05). There was a significant decrease in microhardness after bleaching treatments for all study groups, but no difference between bleaching gels. There was no difference in the Ca/P ratio measured by p-EDXRF for all groups at the study times, but the mean value was lower in group CP+CA than in group CP+ACP. Group CP was similar to both CP+ACP and CP+CA. It can be concluded that enamel microhardness decreased after the bleaching process, regardless of the presence of calcium or ACP, but there was no significant change in the Ca/P ratio of enamel after bleaching for each tested gel. This indicates that the bleaching gels have erosive potential, causing softening of enamel without promoting surface loss, regardless of the presence of calcium of ACP ions.

RESUMO Este estudo avaliou o conteúdo mineral do esmalte e a microdureza superficial antes e após o tratamento clareador, utilizando peróxido de carbamida 10% (PC) contendo cálcio (Ca) ou fosfato de cálcio amorfo (ACP) em sua composigao. Trinta e seis espécimes de esmalte bovino foram alocados aleatoriamente em 3 grupos (n = 12) de acordo com os tratamentos clareadores: G1 - Opalescence PF 10% (CP), G2 -NiteWhite (CP+ACP); e G3 - Opalescence PF (10%) com cálcio (CP + CA). O agente clareador foi aplicado na superficie do esmalte por 6 h/dia por um periodo de 21 dias. A superficie do esmalte foi avaliada por microdureza Knoop (KNH) e espectrometria de fluorescencia de raios X micro-dispersiva (p-EDXRF) no inicio e após o tratamento clareador. Os dados foram analisados estatisticamente pelo teste ANOVA de medidas repetidas e Tukey (a = 0,05). Houve uma diminuigao significativa da microdureza após os tratamentos clareadores para todos os grupos estudados, mas nao houve diferenga entre os diferentes géis. Nao houve diferenga da relagao Ca/P mensurada por p-EDXRF para todos os grupos nos tempos estudados; no entanto, o grupo CP+CA apresentou menor valor comparado ao grupo CP+ACP. O grupo CP foi similar aos grupos CP+ACP e CP+CA. Portanto, pode-se concluir que houve redugao significativa da microdureza do esmalte após o clareamento, independente da presenga de cálcio ou APC na composigao dos géis, embora nao tenha havido alteragao significando na relagao Ca/P do esmalte após o clareamento. Isto indica um potencial erosivo dos géis clareadores, causando o amolecimento sem perda da estrutura do esmalte, independente da presenga dos íons cálcio e ACP.

Dental enamel bleached for a prolonged and excessive time: Morphological changes.

This work aimed to evaluate the roughness, microhardness, ultrastructure, chemical composition and crystalline structure in submitted teeth to a prolonged home bleaching regimen with 10% carbamide peroxide (10% PC) for different periods. The specimens were divided into the following groups: G1: negative control (application of water-soluble gel); G2: tooth whitening group (positive control), under application time recommended by the manufacturer (4h/14 days); G3: prolonged whitening 50%, under prolonged time recommended by the manufacturer in 50% (4h/21 days); G4: excessive whitening 100%, under exceeded manufacturer recommended time by 100% (4h/ 28 days). The results were evaluated descriptively and analytically. There were no changes in the roughness in any of the evaluated groups. However, the microhardness decreased in the G4 group. Scanning electron microscopy showed changes in the enamel surface of groups G2, G3 and G4. Dispersive X-ray spectroscopy identified changes in the concentration of chemical elements O, Mg, P, K in all groups. Thus, this study showed that prolonged home bleaching could cause changes in the ultrastructure, chemical composition and microhardness of the enamel.

Effects of bleaching using 10% carbamide peroxide with calcium or amorphous calcium phosphate on enamel mineral content and hardness.

This study evaluated enamel mineral content and surface microhardness before and after bleaching treatment using 10% carbamide peroxide (CP) containing calcium (Ca) or amorphous calcium phosphate (ACP). Thirtysix bovine slabs were randomly allocated into 3 groups (n = 12) according to bleaching treatment: G1 Opalescence PF 10% (CP), G2 NiteWhite ACP (CP+ACP), and G3 Opalescence PF (10%) with calcium (CP+CA). The bleaching agent was applied on enamel surface for 6 h/day over a period of 21 days. Enamel surface was evaluated by Knoop microhardness (KNH) and micro energydispersive Xray fluorescence spectrometry (µEDXRF) at baseline and at after bleaching treatment. Data were statistically analyzed by repeated measures ANOVA and Tukey's test (α = 0.05). There was a significant decrease in microhardness after bleaching treatments for all study groups, but no difference between bleaching gels. There was no difference in the Ca/P ratio measured by µEDXRF for all groups at the study times, but the mean value was lower in group CP+CA than in group CP+ACP. Group CP was similar to both CP+ACP and CP+CA. It can be concluded that enamel microhardness decreased after the bleaching process, regardless of the presence of calcium or ACP, but there was no significant change in the Ca/P ratio of enamel after bleaching for each tested gel. This indicates that the bleaching gels have erosive potential, causing softening of enamel without promoting surface loss, regardless of the presence of calcium of ACP ions.

Este estudo avaliou o conteúdo mineral do esmalte e a microdureza superficial antes e após o tratamento clareador, utilizando peróxido de carbamida 10% (PC) contendo cálcio (Ca) ou fosfato de cálcio amorfo (ACP) em sua composição. Trinta e seis espécimes de esmalte bovino foram alocados aleatoriamente em 3 grupos (n = 12) de acordo com os tratamentos clareadores: G1 Opalescence PF 10% (CP), G2 NiteWhite (CP+ACP); e G3 Opalescence PF (10%) com cálcio (CP + CA). O agente clareador foi aplicado na superfície do esmalte por 6 h/dia por um período de 21 dias. A superfície do esmalte foi avaliada por microdureza Knoop (KNH) e espectrometria de fluorescência de raios X microdispersiva (µEDXRF) no início e após o tratamento clareador. Os dados foram analisados estatisticamente pelo teste ANOVA de medidas repetidas e Tukey (α = 0,05). Houve uma diminuição significativa da microdureza após os tratamentos clareadores para todos os grupos estudados, mas não houve diferença entre os diferentes géis. Não houve diferença da relação Ca/P mensurada por µEDXRF para todos os grupos nos tempos estudados; no entanto, o grupo CP+CA apresentou menor valor comparado ao grupo CP+ACP. O grupo CP foi similar aos grupos CP+ACP e CP+CA. Portanto, podese concluir que houve redução significativa da microdureza do esmalte após o clareamento, independente da presença de cálcio ou APC na composição dos géis, embora não tenha havido alteração significando na relação Ca / P do esmalte após o clareamento. Isto indica um potencial erosivo dos géis clareadores, causando o amolecimento sem perda da estrutura do esmalte, independente da presença dos íons cálcio e ACP.

Effect of At-Home Bleaching on Oxygen Saturation Levels in the Dental Pulp of Maxillary Central Incisors.

The present study assessed oxygen saturation (SaO2) levels before, during, and after at-home bleaching treatment in the pulps of healthy maxillary central incisors. SaO2 levels were measured in 136 healthy maxillary central incisors using a pulse oximeter. The bleaching protocol consisted of 10% carbamide peroxide gel placed in individual trays and used for four hours daily for 14 days. SaO2 levels were assessed before bleaching (T0), immediately after the first session (T1), on the 7th day of treatment (T2), on the 15th day (the day following the last session) (T3), and 30 days after completion of the bleaching protocol (T4). Data were statistically analyzed using generalized estimating equations (GEE), Student's t test (p<0.05) and Pearson's correlation. Mean pulp SaO2 levels were 85.1% at T0, 84.9% at T1, 84.7% at T2, 84.3% at T3, and 85.0% at T4. Gradual reductions in SaO2 levels were observed, with significant differences (p<0.001) during the course of home bleaching treatment. However, 30 days after the end of the bleaching protocol, SaO2 levels returned to baseline levels. Home bleaching caused a reversible transient decrease in SaO2 levels in the pulps.

Effect of at-home bleaching on oxygen saturation levels in the dental pulp of maxillary central incisors

Abstract The present study assessed oxygen saturation (SaO2) levels before, during, and after at-home bleaching treatment in the pulps of healthy maxillary central incisors. SaO2 levels were measured in 136 healthy maxillary central incisors using a pulse oximeter. The bleaching protocol consisted of 10% carbamide peroxide gel placed in individual trays and used for four hours daily for 14 days. SaO2 levels were assessed before bleaching (T0), immediately after the first session (T1), on the 7th day of treatment (T2), on the 15th day (the day following the last session) (T3), and 30 days after completion of the bleaching protocol (T4). Data were statistically analyzed using generalized estimating equations (GEE), Student's t test (p<0.05) and Pearson's correlation. Mean pulp SaO2 levels were 85.1% at T0, 84.9% at T1, 84.7% at T2, 84.3% at T3, and 85.0% at T4. Gradual reductions in SaO2 levels were observed, with significant differences (p<0.001) during the course of home bleaching treatment. However, 30 days after the end of the bleaching protocol, SaO2 levels returned to baseline levels. Home bleaching caused a reversible transient decrease in SaO2 levels in the pulps.

Resumo Este estudo verificou o grau de saturação de oxigênio (SaO2) pulpar antes, durante e após o clareamento dental caseiro em incisivos centrais superiores hígidos. O nível de SaO2 foi verificado em 136 incisivos centrais superiores hígidos usando oxímetro de pulso. A técnica de clareamento empregou peróxido de carbamida 10% em moldeira individual por quatro horas diárias durante 14 dias. Os níveis de SaO2 foram analisados antes do clareamento (T0), imediatamente após a primeira sessão (T1), no sétimo dia de tratamento (T2), no décimo quinto dia (um dia após a última sessão) (T3) e 30 dias após o término do clareamento dental (T4). A análise estatística utilizou o modelo de equações de estimações generalizadas (GEE), teste t de Student (p<0,05) e correlação de Pearson. Os níveis médios de SaO2 pulpar foram 85,1% em T0, 84,9% em T1, 84,7% em T2, 84,3% em T3 e 85,0% em T4. Foi observada uma redução gradual dos níveis de SaO2, com diferenças significantes (p<0,001) durante o clareamento dental caseiro. No entanto, 30 dias após o término do clareamento dental, houve retorno aos valores iniciais. O clareamento dental caseiro provocou uma diminuição transitória reversível no grau de SaO2 pulpar.

Comparación Espectrofotométrica de las Sesiones de Blanqueamiento Intracameral con Peróxido de Hidrógeno y Carbamida a Diferentes Concentraciones / Spectrophotometric Comparison of Intracameral Tooth-Bleaching Sessions Using Hydrogen Peroxide, and Carbamide Peroxide at Different Concentrations

RESUMEN: El objetivo del presente trabajo fue comparar espectrofotométricamente el número de sesiones para un cambio efectivo de coloración con peróxido de carbamida al 100 %, 37 % y peróxido de hidrógeno al 35 %, a través de la técnica Walking Bleach. Este fue un estudio experimental, in vitro, en paralelo, con ciego en la medición del efecto y en el análisis de datos. Se utilizaron 88 premolares extraídos por indicación ortodóncica. Estos fueron tratados endodónticamente y artificialmente pigmentados con cromógenos derivados de productos de descomposición de la sangre. Se dividieron aleatoriamente en 4 grupos de 22 dientes (un grupo por cada agente blanqueador, más un grupo control con agua destilada). El régimen de tratamiento para cada grupo fue de 4 sesiones existiendo una separación de 4 días entre cada una. El registro de color previo (baseline) y posterior a cada aplicación fue realizado mediante el espectrofotómetro dental Vita Easyshade V, con el cual se registraron los colores en espacio de color CIE L*a*b*. Se calcularon posteriormente los valores de la variación total de color (DE) entre los parámetros iniciales y los distintos tiempos de evaluación. El análisis de significancia se realizó mediante la prueba Kruskal-Wallis y para comparar las diferencias se usó el test de comparaciones múltiples por pares mediante el procedimiento de Steel-Dwass-Critchlow-Fligner, registrando diferencias estadísticamente significativas en la variación total del color desde la primera sesión de blanqueamiento. En conclusión, utilizando peróxido de carbamida al 100 %, la técnica Walking Bleach no requiere un menor número de sesiones para un cambio efectivo de coloración al compararlo con peróxido de hidrógeno al 35 %, pero si con relación al peróxido de carbamida al 37 %, donde el objetivo se consigue en un menor número de sesiones.

ABSTRACT: The objective of this study was to spectrophotometrically compare the number of sessions for an effective color change using 100 % and 37 % carbamide peroxide, and 35 % hydrogen peroxide, applying the Walking Bleach technique. This was an experimental study, performed in vitro, in parallel, and was a blind study in relation to the measurement of the effect and the analysis of data. 88 premolars extracted by orthodontics indications were used. These were endodontically treated and artificially pigmented with chromogens derived from blood decomposition products. They were randomly divided into 4 groups of 22 teeth (one group for each whitening agent, plus a control group with distilled water). The treatment regime for each group was 4 sessions, with a separation of 4 days between each session. The registration of color before (baseline) and after each application was done using the dental spectrophotometer Vita Easyshade V, with which the colors were registered in the CIE L*a*b* color space. The values of total color variation (DE) were later calculated between the initial parameters and the different stages of evaluation. Significance testing was undertaken using Kruskal-Wallis and to compare the differences the method used was Steel-Dwass-Critchlow- Fligner, registering significant statistical differences in the total color variation from the first bleaching session. In conclusion, using 100 % carbamide peroxide, the Walking Bleach technique does not require fewer sessions for an effective change in coloration when compared to 35 % hydrogen peroxide, however, it does using 37 % carbamide peroxide, where the result is achieved in a lower number of sessions.