Photothermal-Enhanced Fenton-like Catalytic Activity of Oxygen-Deficient Nanotitania for Efficient and Safe Tooth Whitening.

The growing demand for charming smiles has led to the popularization of tooth bleaching procedures. Current tooth bleaching products with high-concentration hydrogen peroxide (HP, 30-40%) are effective but detrimental due to the increased risk of enamel destruction, tooth sensitivity, and gingival irritation. Herein, we reported a less-destructive and efficient tooth whitening strategy with a low-concentration HP, which was realized by the remarkably enhanced Fenton-like catalytic activity of oxygen-deficient TiO2 (TiO2-x). TiO2-x nanoparticles were synthesized with a modified solid-state chemical reduction approach with NaBH4. The Fenton-like activity of TiO2-x was optimized by manipulating oxygen vacancy (OV) concentration and further promoted by the near-infrared (NIR)-induced photothermal effect of TiO2-x. The TiO2-x sample named BT45 was chosen due to the highest methylene blue (MB) adsorption ability and Fenton-like activity among acquired samples. The photothermal property of BT45 under 808 nm NIR irradiation was verified and its enhancement on Fenton-like activity was also studied. The BT45/HP + NIR group performed significantly better in tooth whitening than the HP + NIR group on various discolored teeth (stained by Orange II, tea, or rhodamine B). Excitingly, the same tooth whitening performance as the Opalescence Boost, a tooth bleaching product containing 40% HP, was obtained by a self-produced bleaching gel based on this novel system containing 12% HP. Besides, negligible enamel destruction, safe temperature range, and good cytocompatibility of TiO2-x nanoparticles also demonstrated the safety of this tooth bleaching strategy. This work indicated that the photothermal-enhanced Fenton-like performance of the TiO2-x-based system is highly promising in tooth bleaching application and can also be extended to other biomedical applications.

In vitro evaluation of visible light-activated titanium dioxide photocatalysis for in-office dental bleaching.

The evaluation of the photocatalysis of visible light activated titanium dioxide employed in hydrogen peroxide (H2O2) was carried using seven H2O2 solutions (3.5 and 35%) and/or methylene blue (MB), with or without light irradiation (LI); the absorbance of MB was the bleaching indicator. Color analysis was performed on bovine teeth (n=12) using two different concentrations of H2O2, 6 and 35% associated with titanium dioxide (TiO2). Data were analyzed with one and two-way ANOVA, and significance level of p<0.05. Solutions containing MB, H2O2 at 3.5 or 35%, and TiO2, followed by LI, showed significant difference when compared with other groups. Greater MB reduction was found in 35% concentration. H2O2 35%+TiO2 gel showed no difference in comparison to control group. All groups for the color analysis assay showed ΔE higher than 3.3. In conclusion, TiO2 and H2O2 association is a promisor alternative for reducing the clinical time of in-office dental bleaching.

In-office dental bleaching with light vs. without light: A systematic review and meta-analysis.

OBJECTIVE: A systematic review and meta-analysis were performed to answer the following research question: Does light-activated in-office vital bleaching have a greater whitening efficacy and higher tooth sensitivity (TS) in comparison with in-office vital bleaching without light when used in adults? DATA AND SOURCE: Only randomized clinical trials (RCTs) involving adults who had in-office bleaching with and without light activation were included. Controlled vocabulary and keywords were used in a comprehensive search for titles and abstracts in PubMed, and this search was adapted for Scopus, Web of Science, LILACS, BBO, Cochrane Library, and SIGLE without restrictions in May 2016 and was updated in August 2017. IADR abstracts (1990-2016), unpublished- and ongoing-trial registries, dissertations, and theses were also searched. The risk-of-bias tool of the Cochrane Collaboration was used for quality assessment. The quality of the evidence was rated using the Grading of Recommendations: Assessment, Development, and Evaluation approach. Through the use of the random effects model, a meta-analysis with a subgroup analysis (low and high hydrogen peroxide concentration) was conducted for color change (ΔE*, ΔSGU) as well as the risk and intensity of TS. STUDY SELECTION: We retrieved 6663 articles, but after removing duplicates and non-relevant articles, only 21 RCTs remained. No significant difference in ΔE*, ΔSGU, and risk and intensity of TS was observed (p > .05). For ΔE and risk of TS, the quality of the evidence was graded as moderate whereas the evidence for ΔSGU and intensity of TS was graded as very low and low, respectively. CONCLUSION: Without considering variations in the protocols, the activation of in-office bleaching gel with light does not seem to improve color change or affect tooth sensitivity, regardless of the hydrogen peroxide concentration. (PROSPERO - CRD42016037630). CLINICAL RELEVANCE: Although it is commercially claimed that in-office bleaching associated with light improves and accelerates color change, this study did not confirm this belief for in-office bleaching gels with either high or low levels of hydrogen peroxide.

Hydrogen peroxide diffusion with and without light activation.

OBJECTIVE: The aim of this study was to assess the dental bleaching efficacy of 37.5% hydrogen peroxide (HP), with and without light activation, in HP-exposed and unexposed areas. METHOD: 28 bovine teeth were selected and divided into two groups (n = 14). Crowns were detached and stained with tea. The gingival half was covered with a gingival barrier. In the incisal half, 37.5% HP (Pola Office+, SDI) was applied three times, with a 1-week interval between applications. In HP-A group, the bleaching agent was activated for 3 min with a LED lamp. No light activation was applied in HP-N group. Dental color variation was determined through a spectrophotometer in both halves. Statistical analysis between groups was performed with an ANOVA test, and intragroup differences were evaluated, with an ANOVA test for paired data, with a significance level of P < 0.05. RESULTS: An increase in lightness and a decrease in chroma were found in both groups and halves. No significant differences in ΔE between groups (P > 0.5) were detected in the incisal half. After treatment, a significantly higher ΔE was found in the gingival half for HP-A group (P < 0.05). For the same group, a significantly higher bleaching effect was found in the gingival half, compared with the incisal half (P < 0.05). CONCLUSIONS: LED activation did not have a significant effect in terms of bleaching in the incisal half, but increased clearance in the gingival half. CLINICAL RELEVANCE: HP light activation does not significantly increase the whitening effect, but it can improve the bleaching diffusion to areas where it has not been directly applied.

Clinical comparison between the bleaching efficacy of light-emitting diode and diode laser with sodium perborate.

The aim of this clinical study was to test the efficacy of a light-emitting diode (LED) light and a diode laser, when bleaching with sodium perborate. Thirty volunteers were selected to participate in the study. The patients were randomly divided into two groups. The initial colour of each tooth to be bleached was quantified with a spectrophotometer. In group A, sodium perborate and distilled water were mixed and placed into the pulp chamber, and the LED light was source applied. In group B, the same mixture was used, and the 810 nm diode laser was applied. The final colour of each tooth was quantified with the same spectrophotometer. Initial and final spectrophotometer values were recorded. Mann-Whitney U-test and Wicoxon tests were used to test differences between both groups. Both devices successfully whitened the teeth. No statistical difference was found between the efficacy of the LED light and the diode laser.

Light-activated bleaching: effects on surface mineral change on enamel.

AIM: This study evaluated the in vitro effect of 35% hydrogen peroxide (HP) on surface enamel change when activated with different light curing units (LCUs). MATERIALS AND METHODS: Enamel blocks (4 × 4 × 2 mm) were obtained from bovine incisors. The initial microhardness of the enamel was determined for each specimen. After this enamel blocks were randomly divided into four groups (n = 10) and treated as follows: Control, no bleaching procedure performed; HP - LCU, application of 35% HP gel without light activation; HP + QTH, application of 35% HP gel and light activation with a Quartz Tungsten-Halogen (QTH); and HP + Light Emitting Diode, application of 35% HP gel and light-activation with a LED. New microhardness measurements were obtained, immediately, 7 and 14 days after treatment. The percentage of surface mineral change was calculated according to the baseline and post-treatment microhardness values. Additionally, six samples from each group were randomly selected and prepared for scanning electron microscopy (SEM) characterization. The data were analyzed using an analysis of variance (ANOVA) to detect differences between the three time periods, and an ANOVA and Tukey's test with a confidence level of 95%. RESULTS: There was no significant difference between the initial hardness values and hardness values after treatment in any of the groups or time periods (p > 0.05). No major surface alterations were detected with SEM when comparing control groups to those undergoing bleaching treatments. CONCLUSION: The use of 35% HP in combination to QTH or LED light curing units LCU does not have detrimental effect on the enamel surface topography or in the mineral content, when compared with unbleached enamel or enamel submitted to 35% HP treatment alone.

Effect of light activation on tooth whitening efficacy and hydrogen peroxide penetration: an in vitro study.

OBJECTIVES: To determine the effect of light activation on tooth whitening efficacy and hydrogen peroxide penetration into the pulp cavity and correlate tooth color change with penetration levels. METHODS: Extracted human canines (40) were randomized into four groups, Group A: placebo gel, Group B, placebo gel with light activation, Group C: 40% hydrogen peroxide gel, and Group D: 40% hydrogen peroxide gel with light activation. Treatment was performed three times, at 1-week intervals. Hydrogen peroxide penetration (HPP) was estimated spectrophotometrically and specimen color measured using the Vita Easy Shade Compact at baseline, after whitening, 1-h, 1-day, 1-, 4-, 8-, 12-, 16-, 20-, and 24-week post-whitening. Color change was measured per Commission Internationale de l'Eclairage methodology. ANCOVA was performed to compare color change and HPP level among the four groups. Partial nonparametric correlations between color change and HPP levels were performed with rank transformations. Tests of hypotheses were two-sided with alpha level of 0.05. RESULTS: Greater HPP was observed in Groups C and D compared to Groups A and B (p<0.001). Highest overall color change (ΔE*ab) values after treatment were observed in Group D and remained higher than Groups A-C (p<0.01). Changes in lightness and in the yellow-blue dimension (ΔL* and Δb*) were higher in Groups C and D compared to Groups A and B from post-whitening until 24 weeks (p<0.05). HPP levels were not correlated to color change (p>0.05). CONCLUSIONS: Light activation enhanced whitening efficacy without affecting hydrogen peroxide penetration levels.

Efficacy of tooth bleaching with and without light activation and its effect on the pulp temperature: an in vitro study.

The aim of this in vitro study was to evaluate the colour stability of bleaching after light activation with halogen unit, laser, LED unit or chemical activation up to 3 months after treatment. Four groups of teeth (n = 20) were bleached with Opalescence Xtra Boost (38% hydrogen peroxide) using four different methods: activation with halogen, LED, laser or chemical activation only. All teeth were bleached in one session for four times (4 × 15 min) and the colour was evaluated using a spectrophotometer at the following time points: before bleaching, immediately after bleaching, 1 day, and 1 and 3 months after the end of bleaching. Between the tested time points, the teeth were stored in 0.9% NaCl solution. Additionally, the temperature increase in the pulp chamber was measured using a measuring sensor connected to a computer. Bleaching with the halogen unit showed the highest colour change. Halogen unit, laser and chemical activation resulted in whiter teeth after 1 and 3 months compared to the colour after the end of the bleaching procedure (p ≤ 0.05). Three months after the end of bleaching, the shade changes observed were-halogen: 7.1 > chemical activation: 6.2 > LED: 5.4 > laser: 5.2. Halogen showed the highest temperature increase (17.39°C ± 1.96) followed by laser (14.06°C ± 2.55) and LED (0.41°C ± 0.66) (p < 0.0001). Chemical activation did not affect the temperature in the pulp chamber. The use of light activation did not show any advantages compared to chemical bleaching. Although halogen unit showed the higher shade's change, its use resulted also in the higher pulp temperature. According to the present findings, light activation of the bleaching agent seems not to be beneficial compared to bleaching without light activation, concerning the colour stability up to 3 months after bleaching and the pulp temperature caused during the bleaching procedure.

A study of hydrogen peroxide chemistry and photochemistry in tea stain solution with relevance to clinical tooth whitening.

OBJECTIVE: Tooth whitening using hydrogen peroxide is a complex process, and there is still some controversy about the roles of pH, temperature, chemical activators, and the use of light irradiation. In this work the basic interactions between whitening agents and stain molecules are studied in simple solutions, thus avoiding the physics of diffusion and light penetration in the tooth to give clarity on the basic chemistry which is occurring. METHOD: The absorbance of tea stain solution at 450 nm was measured over a period of 40 min, with various compositions of whitening agent added (including hydrogen peroxide, ferrous gluconate and potassium hydroxide) and at the same time the samples were subjected to blue light (465 nm) or infra-red light (850 nm) irradiation, or alternatively they were heated to 37°C. RESULTS: It is shown that the reaction rates between chromogens in the tea solution and hydrogen peroxide can be accelerated significantly using ferrous gluconate activator and blue light irradiation. Infra red irradiation does not increase the reaction rate through photochemistry, it serves only to increase the temperature. Raising the temperature leads to inefficiency through the acceleration of exothermic decomposition reactions which produce only water and oxygen. CONCLUSION: By carrying out work in simple solution it was possible to show that ferrous activators and blue light irradiation significantly enhance the whitening process, whereas infra red irradiation has no significant effect over heating. The importance of controlling the pH within the tooth structure during whitening is also demonstrated.

The effectiveness of low-intensity red laser for activating a bleaching gel and its effect in temperature of the bleaching gel and the dental pulp.

STATEMENT OF THE PROBLEM: The effectiveness of low-intensity red laser for activating a bleaching gel and its effect in pulp temperature was not investigated in dental literature. PURPOSE: The objective of this study was to assess the effectiveness of low-intensity red laser for activating a bleaching gel, as well as its effect in temperature of the bleaching gel and the dental pulp. MATERIALS AND METHODS: Forty extracted bovine teeth were immersed in a solution of coffee 14 days for darkening. The initial colors were recorded by spectrophotometric analysis. The specimens were randomly distributed into two groups (N = 20): the control, which did not receive light and the experimental group that received light from an appliance fitted with three red light-emitting laser diodes (λ = 660 nm). A green-colored, 35% H(2) O(2) -based bleaching gel was applied for 30 minutes, and changed three times. After bleaching, the colors were again measured to obtain the L*a*b* values. Color variation was calculated (ΔE) and the data submitted to the non-paired t-test (5%). To assess temperature, 10 human incisors were prepared, in which one thermocouple was placed on the bleaching gel applied on the surface of the teeth and another inside the pulp chamber. RESULTS: There was a significant difference between the groups (p = 0.016), and the experimental group presented a significantly higher mean variation (7.21 ± 2.76) in comparison with the control group (5.37 ± 1.76). There was an increase in pulp temperature, but it was not sufficient to cause damage to the pulp. CONCLUSION: Bleaching gel activation with low-intensity red laser was capable of increasing the effectiveness of bleaching treatment and did not increase pulp temperature to levels deleterious to the pulp.

The effects of light on bleaching and tooth sensitivity during in-office vital bleaching: a systematic review and meta-analysis.

OBJECTIVE: To evaluate the influence of light on bleaching efficacy and tooth sensitivity during in-office vital bleaching. DATA SOURCES: We performed a literature search using Medline, EMBASE and Cochrane Central up to September 2011. STUDY SELECTION: All randomised controlled trials (RCTs) or quasi-RCTs comparing the light-activated bleaching system with non-activation bleaching system were included. Reports without clinical data concerning bleaching efficacy or tooth sensitivity were excluded. RESULTS: Eleven studies were included in the meta-analysis. A light-activated system produced better immediate bleaching effects than a non-light system when lower concentrations of hydrogen peroxide (15-20% HP) were used (mean difference [MD], -1.78; 95% confidence interval [CI]: [-2.30, -1.26]; P<0.00001). When high concentrations of HP (25-35%) were employed, there was no difference in the immediate bleaching effect (MD, -0.39; 95% CI: [-1.15, 0.37]; P=0.32) or short-term bleaching effect (MD, 0.25; 95% CI: [-0.47, 0.96]; P=0.50) between the light-activated system and the non-light system. However, the light-activated system produced a higher percentage of tooth sensitivity (odds ratio [OR], 3.53; 95% CI: [1.37, 9.10]; P=0.009) than the non-light system during in-office bleaching. CONCLUSIONS: Light increases the risk of tooth sensitivity during in-office bleaching, and light may not improve the bleaching effect when high concentrations of HP (25-35%) are employed. Therefore, dentists should use the light-activated system with great caution or avoid its use altogether. Further rigorous studies are, however, needed to explore the advantages of this light-activated system when lower concentrations of HP (15-20%) are used.

Effect of light activation on tooth sensitivity after in-office bleaching.

This clinical study evaluated the effects of light-emitting diode (LED)/laser activation on bleaching effectiveness (BE) and tooth sensitivity (TS) during in-office bleaching. Thirty caries-free patients were divided into two groups: light-activated (LA) and non-activated (NA) groups. A 35% hydrogen peroxide gel (Whiteness HP Maxx, FGM Dental Products, Joinville SC, Brazil) was used in three 15-minute applications for both groups. For the LA group, LED/laser energy (Whitening Lase Light Plus, DMC Odontológica, São Carlos SP, Brazil) was used, in accordance with the manufacturer's directions. Two sessions of bleaching were performed at one-week intervals. Color was registered at baseline and after the first and second bleaching sessions using a Vita shade guide. Patients recorded TS on a 0 to 4 scale during bleaching and within the next 24 and 48 hours of each session. BE at recall each week and intensity of TS were evaluated by repeated measures analysis of variance (ANOVA) and Tukey tests (α=0.05). Tooth sensitivity was compared using the Friedman repeated measures analysis of variance by rank and the Wilcoxon sign-ranked test. Faster bleaching was observed for the LA group than for the NA group after the first session (4.8 and 3.8 shade guide units [SGUs]; p=0.0001). However, both techniques were capable of bleaching the same number of SGUs after the second bleaching session (p=0.52). Most of the LA group (53.3%) had sensitivity even 24 hours after each bleaching session, but only 26.6% from the NA group reported TS. The intensity of TS was similar for both groups immediately after bleaching but significantly higher for the LA group 24 hours after each bleaching session (p=0.001). After two bleaching sessions, the use of LED/laser light activation did not improve bleaching speed. Persistent tooth sensitivity and higher tooth sensitivity after 24 hours of bleaching were observed when light activation was used.

Shear bond strength to enamel after power bleaching activated by different sources.

The purpose of the present study was to evaluate enamel bond strength of a composite resin material after hydrogen peroxide bleaching, activated by a diode laser (LaserSmile), an ozone device (HealOzone), a light-emitting diode (BT Cool whitening system), and a quartz-Plus. Fifty extracted caries-free permanent incisors were used in this study. Thirty-eight percent hydrogen peroxidegel was applied to sound, flattened labial enamel surfaces and activated by different sources. Enamel surfaces that had received no treatment were used as control samples. Bonding agent was applied according to the manufacturer's instructions and the adhesion test was performed according to ISO/TS 11405. Statistical analysis showed significant influence of the different activation technique of hydrogen peroxide on shear bond strength to enamel (ANOVA, LSD, P < 0.05). The data in this vitro explorative study suggest the activation of hydrogen peroxide by different sources may further affect the shear bond strength of subsequent composite resin restoration to enamel. Within the limitations of this in vitro study, further studies examining the structural changes of activated hydrogen peroxide-treated enamel are needed. Due to the different activation methods; duration of light irradiation effects, longer time periods may be needed before application of adhesive restorations to enamel, compared with non-activated bleaching.

Nonvital tooth bleaching with halogen light-activated agents: case reports and discussion.

Esthetic dentistry has received increased attention in recent years, as people are more aware of the esthetic appearance of their teeth, including alignment and whiteness. This development, combined with a decrease in the incidence and severity of caries, has directed some clinicians toward conservative and non-invasive treatments such as tooth bleaching. A number of methods for nonvital tooth bleaching are described in the literature; these procedures rely on the bleaching agent used, the agent's concentration, product format, and the source of light activation. This article presents two case reports in which dental bleaching with halogen light-activated agents was used to treat a nonvital discolored incisor. The advantages and disadvantages of the technique are discussed.