Effect of whitening toothpastes with different hydrogen peroxide concentrations: Penetration into the pulp chamber and color change.

OBJECTIVES: This study evaluated the efficacy of simulated brushing with toothpastes containing different concentrations of hydrogen peroxide (HP) in pulp chamber penetration and color change. Also, physical-chemical properties (concentration, pH and viscosity) were evaluated. METHODS: Forty-nine premolars were divided into seven groups (n = 7): untreated (control); whitening gel (White Class 6 %, 6 %BG) with one 90  min application (6 %BG 90  min) and 14 applications of 90  min (6 %BG 14×90 min); toothpastes (Colgate Luminous White Glow 3 %, 3 %TP; Crest 3D White Brilliance 4 %, 4 %TP; Colgate Optic White Pro-Series 5 %, 5 %TP) and 6 %BG toothbrushing for 14 applications of 90 s. HP penetration into the pulp chamber was measured through UV-Vis spectrophotometry and color change with a spectrophotometer (ΔEab, ΔE00, and ΔWID). Initial concentration, pH, and viscosity were measured through Titration, Digital pH-meter, and Rheometer, respectively. Statistical analysis used one-way ANOVA and Tukey's test (α = 0.05). RESULTS: 6 %BG (14×90 min) and 4 %TP groups showed acidic pH and higher concentrations of HP in the pulp chamber compared to the other groups (p < 0.05). On the other side, 3 %TP and 5 %TP groups showed alkaline pH, higher viscosity between the toothpastes and lower HP penetration (p < 0.05). The 6 %BG AH (14×90 min) group exhibited the most significant color change (ΔEab, ΔE00, and ΔWID) (p < 0.05). CONCLUSIONS: Brushing with whitening toothpaste with an acidic pH leads to greater HP penetration into pulp chamber; but, even when a high concentrated HP whitening toothpaste was used, a lower whitening effect was observed when compared to a two-week at-home bleaching. CLINICAL SIGNIFICANCE: Whitening toothpastes containing up to 5 % HP produced lower whitening effect than two-week at-home bleaching. Additionally, HP was detected within the pulp chamber which can potentially impact in tooth sensitivity.

Time Frame Analysis of Potassium Nitrate and Hydrogen Peroxide Diffusion into the Pulp Chamber.

OBJECTIVES: The primary objective of this study was to evaluate the effect of an innovative double-layer, single-application desensitizing/whitening technique of potassium nitrate (PN) and hydrogen peroxide (HP) diffusion at different time points. METHODS AND MATERIALS: Specimens were prepared from extracted caries-free human molars (n=90). Teeth were randomly assigned into four groups: Group A (HP CTRL) treated with 25% HP for 45 minutes, group B (PN CTRL) received a single-layer treatment of 5% PN for 45 minutes, group C received the double-layer treatment of 5% PN and 25% HP for 45 minutes, and group D received a 3% PN incorporated in a 40% HP gel for 45 minutes. PN and HP concentrations were measured at 5, 15, 30, and 45 minutes using standard chemical kits. Group comparisons were made using a repeated measures analysis of variance (ANOVA) test. Pairwise tests for differences in diffusion were done, using the Tukey adjustment of p values for multiple comparisons. A significance level of 5% was used. RESULTS: Group A showed no significant difference in HP diffusion rates between the 5- and 15-minute, 15- and 30-minute, or 30- and 45-minute time points; group D showed a similar trend; however, group C differed significantly at the 5-and 15-minute time points (p=0.0004), at the 15-and 30-minute time points (p=0.0026), and the 30- and 45-minute time points (p=0.0014). For PN diffusion, groups B and C had significantly different levels at the 15-, 30-, and 45-minute time points (p=0.0005, p=0.0002, and p<0.0001, respectively); and at the 15-, 30-, and 45-minute time points, groups D and C had significantly different PN diffusion (p=0.0327, p=0.0004, and p< 0.0001, respectively). Group C had significantly different PN diffusion at the 5- and 15-minute time points (p=0.0004), the 15- and 30-minute time points (p=0.0026), and at the 30- and 45-minute time points (p=0.0014). CONCLUSION: The double-layer technique showed superior diffusion of PN into the pulp chamber and did not affect the diffusion of HP when compared to other techniques. The double-layer technique may be suggested as an alternative tooth-whitening treatment to minimize tooth sensitivity.

Effect of Bleaching Gel Viscosity on Tooth Whitening Efficacy and Pulp Chamber Penetration: An In Vitro Study.

OBJECTIVES: Whitening efficacy has been related to hydrogen peroxide (HP) diffusion into tooth structure. However, little information is available relating rheological properties to whitening efficacy. The purpose was to evaluate the whitening efficacy and HP penetration level of a 10% HP gel at three different viscosities and to compare them to a strip delivery system. METHODS AND MATERIALS: Extracted molars (n=120) were randomly assigned into five groups (n=24/ group): NC_MED (negative control; median): medium viscosity gel without HP; LOW: 10% HP gel (low viscosity experimental gel, Ultradent Products Inc); MED: 10% HP gel (medium viscosity experimental gel, Ultradent); HIGH: 10% HP gel (high viscosity gel, Ultradent); and CWS: Crest 3D Whitestrips 1-Hour Express (Procter & Gamble). All teeth were subjected to five 60-minute whitening sessions. Instrumental color measurements were performed at baseline (T0), and 1-day after each application (T1-T5), and 1-month after whitening (T6). HP penetration was estimated with leucocrystal violet and horseradish peroxidase. A Kruskal-Wallis test and post hoc Bonferroni test were performed to assess the difference in tooth color change and HP penetration among the groups (α=0.05). RESULTS: Hydrogen peroxide penetration levels and overall color changes at T6 were 0.24 µg/mL / 2.80; 0.48 µg/mL / 8.48; 0.44 µg/mL / 7.72; 0.35 µg/mL / 8.49; 0.36 µg/mL / 7.30 for groups NC, LOW, MED, HIGH, and CWS, respectively. There was a significant difference for HP penetration, while there was no significant difference among the four experimental groups for tooth color change. CONCLUSION: Rheological properties should be considered when developing new whitening formulations.

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.

Penetration of hydrogen peroxide and degradation rate of different bleaching products.

This study's aim was to evaluate the degradation rate of hydrogen peroxide (H2O2) and to quantify its penetration in tooth structure, considering the residence time of bleaching products on the dental enamel. For this study, bovine teeth were randomly divided according to the bleaching product received: Opalescence Xtra Boost 38%, White Gold Office 35%, Whiteness HP Blue 35%, Whiteness HP Maxx 35%, and Lase Peroxide Sensy 35%. To analyze the degradation of H2O2, the titration of bleaching agents with potassium permanganate was used, while the penetration of H2O2 was measured via spectrophotometric analysis of the acetate buffer solution, collected from the artificial pulp chamber. The analyses were performed immediately as well as 15 minutes, 30 minutes, and 45 minutes after product application. The data of degradation rate of H2O2 were submitted to analysis of variance (ANOVA) and Tukey tests, while ANOVA and Fisher tests were used for the quantification of H2O2, at the 5% level. The results showed that all products significantly reduced the concentration of H2O2 activates at the end of 45 minutes. It was also verified that the penetration of H2O2 was enhanced by increasing the residence time of the product on the tooth surface. It was concluded that the bleaching gels retained substantial concentrations of H2O2 after 45 minutes of application, and penetration of H2O2 in the dental structure is time-dependent.

Effects of the concentration and composition of in-office bleaching gels on hydrogen peroxide penetration into the pulp chamber.

UNLABELLED: In tooth whitening, the hydrogen peroxide (HP) diffuses in the enamel and dentin, reaching the pulp. This in vitro study aimed to quantify the penetration of HP in the pulp chamber in teeth submitted to bleaching agents of different concentrations of HP without calcium (HP 20% [20CF], HP 35% [35CF]) and with calcium (HP 20% [20CC], HP 35% [35CC]). METHOD: Fifty human premolars were sectioned 3 mm from the cemento-enamel junction and the pulp tissue was removed. The teeth were divided into five groups according to treatment and with a control group (n=10). An acetate buffer solution was placed in the pulp chamber of all teeth. The control group was exposed only to distilled water, while the other groups were treated with a bleaching procedure, according to the manufacturer's recommendations. After treatment, the acetate buffer solution was transferred to a glass tube in which leuco-crystal violet and peroxidase solutions were added, resulting in a blue solution. The optical density of this blue solution was determined spectrophotometrically and converted into micrograms equivalent to the HP. Data were analyzed using analysis of variance and Tukey tests (α=0.05). RESULTS: The HP concentration did not affect the HP inside the pulp chamber, but the presence of calcium significantly reduced it (p<0.0001). CONCLUSION: The amount of HP that reaches the pulp chamber depends on the bleaching protocol and the product employed, and it seems to be less affected by HP concentration.

Transenamel and Transdentinal Penetration of H2O2 in Restored Bovine Teeth.

PURPOSE: To quantify hydrogen peroxide (H2O2) penetration into restored bovine teeth subjected to whitening treatment. MATERIALS AND METHODS: Seventy-five enamel/dentin disks were divided into 5 groups (n = 15): intact disks (G1); cavity preparation only (G2); conventional adhesive system and composite resin (G3); resin-modified glass-ionomer cement (G4); and self-etching adhesive only (G5). After 24 h, the disks were placed into artificial pulp chambers containing an acetate buffer solution, and the first whitening session was performed using a 35% H2O2 (hydrogen peroxide) product. The disks were submitted to 10,000 thermal cycles and then stored for 1 year in deionized water. After this period, a second whitening session was performed. After each whitening procedure, the buffer solutions were analyzed for optical density in a spectrophotometer to assess the amount of H2O2 that had diffused. ANOVA and Tukey's test were used to compare the different groups and a Student's t-test was used to compare the different times (p ≤ 0.05). RESULTS: Prior to aging, group 2 had the highest penetration of H2O2; the other groups showed similar, lower penetration. After thermocycling and aging, all groups showed a significant increase in H2O2 penetration. The greatest penetration of H2O2 into the pulp chamber was found in groups 2 and 5. CONCLUSION: Aged restorations allowed greater H2O2 permeation through the tooth structure.

Transenamel and transdentinal penetration of hydrogen peroxide applied to cracked or microabrasioned enamel.

The present study evaluated transenamel and transdentinal penetration of hydrogen peroxide during tooth whitening recognized in altered enamel by the presence of cracks or microabrasion. We used 72 experimental units (n=20) obtained from bovine incisors: GI-sound enamel; GII-teeth showing visible enamel cracks (4 mm to 5.7 mm in length); and GIII-microabrasioned enamel. The 12 remaining specimens were used to analyze the enamel surface morphology using scanning electron microscopy. The specimens were cylindrical and 5.7 mm in diameter and 3.5 mm thick. A product based on 35% hydrogen peroxide was used for bleaching, following the manufacturer's recommendations for use. To quantify the H2O2 penetration, the specimens were placed in artificial pulp chambers containing an acetate buffer solution. After bleaching, the solution was collected and adequately proportioned with leucocrystal violet, peroxidase enzyme, and deionized water. The resulting solution was evaluated using ultraviolet visible reflectance spectrophotometer equipment. The data were analyzed by analysis of variance (ANOVA) and Fisher's PLSD at a significance level of 0.05, and significant differences in the penetration of peroxide in different substrate conditions were observed (p<0.0001). The penetration of hydrogen peroxide was more intense in cracked teeth. The group in which the enamel was microabraded showed intermediate values when compared to the control group. Microabrasion and the presence of cracks in the enamel make this substrate more susceptible to penetration of hydrogen peroxide during in-office whitening.

Effective tooth-bleaching protocols capable of reducing H(2)O(2) diffusion through enamel and dentine.

OBJECTIVES: To evaluate the effects of experimental protocols on bleaching effectiveness and hydrogen peroxide (HP) diffusion through enamel and dentine. METHODS: Enamel/dentine discs were subjected to six bleaching sessions, consisting of 1 or 3 applications of 17.5% or 35%-HP gel for 5/15min, or 37% carbamide peroxide (CP) gel for 10/20min. Discs undergoing the regular protocol (35%-HP; 3×15min) constituted the positive control group. Colour change (ΔE) was assessed (CIE L*a*b* system) after each session. HP diffusion was quantified (sessions 1, 3, and 6) in enamel/dentine discs adapted to artificial pulp chambers. Data were analysed by Pillai's Trace and Bonferroni test, or by one-way ANOVA and SNK/Tamhane's test (α=5%). RESULTS: All tooth-bleaching protocols significantly increased the ΔE values. A reduction in HP diffusion and no significant difference in ΔE compared with the positive control were observed for the following bleaching protocols: 17.5%-HP 3×15min, at the 4th session; and 35%-HP 1×15 and 3×5min, at the 5th session. HP diffusion in the 37%-CP 3×20min bleaching protocol was statistically similar to that in the positive control. The other experimental bleaching protocols significantly decreased HP diffusion through enamel/dentine discs, but the ΔE values were statistically lower than those observed in the positive control, in all sessions. CONCLUSION: Shortening the contact time of a 35%-HP gel or reducing its concentration produces gradual tooth colour change and reduced HP diffusion through enamel and dentine. CLINICAL SIGNIFICANCE: A reduction in HP concentration, from 35% to 17.5%, in a bleaching gel or shortening its application time on enamel provides a significant tooth-bleaching improvement associated with decreased HP diffusion across hard dental tissues. Therefore, these protocols may be an interesting alternative to be tested in the clinical situation.

Hydrogen peroxide diffusion dynamics in dental tissues.

The aim of this study was to investigate the diffusion dynamics of 25% hydrogen peroxide (H2O2) through enamel-dentin layers and to correlate it with dentin's structural alterations. Micro-Raman Spectroscopy (MRS) and Fourier Transform Infrared Photoacoustic Spectroscopy (FTIR-PAS) were used to measure the spectra of specimens before and during the bleaching procedure. H2O2 was applied to the outer surface of human enamel specimens for 60 minutes. MRS measurements were performed on the inner surface of enamel or on the subsurface dentin. In addition, H2O2 diffusion dynamics from outer enamel to dentin, passing through the dentin-enamel junction (DEJ) was obtained with Raman transverse scans. FTIR-PAS spectra were collected on the outer dentin. MRS findings revealed that H2O2 (O-O stretching µ-Raman band) crossed enamel, had a more marked concentration at DEJ, and accumulated in dentin. FTIR-PAS analysis showed that H2O2 modified dentin's organic compounds, observed by the decrease in amides I, II, and III absorption band intensities. In conclusion, H2O2 penetration was demonstrated to be not merely a physical passage through enamel interprismatic spaces into the dentinal tubules. H2O2 diffusion dynamics presented a concentration gradient determined by the chemical affinity of the H2O2 with each specific dental tissue.

Hydrogen peroxide penetration into the pulp chamber and dental permeability after bleaching.

This study sought to quantify the concentration of hydrogen peroxide (HP) in the pulp chamber and evaluate changes on dental permeability after bleaching with 3 HP concentrations (10%, 35%, and 50%). This study was divided into 2 experiments and the bleaching treatments consisted of 3 applications of HP for 30 minutes during a single session. The first experiment tested HP penetration into the pulp chamber of 4 experimental groups (n = 10) of bovine crowns, which were divided by HP concentration: an unbleached control group (0% HP), 10% HP, 35% HP, and 50% HP. Acetate buffer solution was placed into the pulp chamber and after each application of HP. This solution was collected to determine spectrophotometrically the concentration of HP that reached the pulp chamber. The second experiment evaluated dental permeability. Bovine crowns were divided into 3 groups (n = 10). The crowns were connected to a permeability device and the initial permeability was measured at 10 psi. Three different concentrations of HP gels (10%, 35% and 50%) were applied to the buccal enamel surfaces and the dental permeability was measured after the first, second, and third applications of HP. The data were analyzed by 2-way ANOVA and Tukey test (P ≤ 0.05). All concentrations of HP reached the pulp chamber, although no significant differences were noted between the 3 concentrations tested (P > 0.05). However, the increase of dental permeability in the group that received 50% HP was significantly higher than the 10% HP group (P < 0.05). The results indicate that the HP bleaching treatments increased dental permeability.

Low toxic effects of a whitening strip to cultured pulp cells.

PURPOSE: To assess the trans-enamel and trans-dentin toxicity of a 10% hydrogen peroxide (HP) whitening strip to odontoblast-like cells (MDPC-23). METHODS: Enamel surfaces of enamel/dentin discs adapted to artificial pulp chambers were subjected to two 30-minute whitening strip applications to obtain indirect extracts (DMEM + bleaching components that diffused across enamel and dentin). The extracts were applied for 1 hour to the cells for 1 or 5 days. A bleaching gel with 35% HP was used as the positive control. Cell viability (MTT assay) and morphology (SEM) as well as the quantity of HP in the extracts were assessed. RESULTS: Discrete cell viability reduction (21.9%) associated with slight alterations in cell morphology occurred after application of the extracts for 5 days to the MDPC-23 cells (Tukey's test; P < 0.05). Lower enamel/dentin diffusion of HP was observed after the use of the whitening strip compared with the bleaching gel (Mann-Whitney; P < 0.05).

The relationship of hydrogen peroxide exposure protocol to bleaching efficacy.

The purpose of this study was to compare two in-office bleaching methods with respect to tooth color change and level of hydrogen peroxide penetration into the pulp cavity and to evaluate relationships between penetration level and color change. Eighty extracted canines were exposed to two different bleaching regimens (conventional vs sealed bleaching technique). After exposure to 38% hydrogen peroxide gel for one hour, hydrogen peroxide amount was estimated spectrophotometrically. Color change was measured per Commission Internationale de l'Eclairage methodology. Linear regression was used to evaluate factors affecting color change, including bleaching technique. The conventional and sealed bleaching groups showed no difference for any color change parameters (ΔL, Δa, Δb, ΔE); however, there was significantly greater hydrogen peroxide penetration in the conventional bleaching group (p<0.05). Linear modeling of the change in lightness (ΔL) showed that the increase in lightness tended to be greater for teeth with lower initial L* values (r=-0.32, p<0.05). After adjustment for initial L*, there was no evidence that ΔL differed with hydrogen peroxide penetration levels (p>0.05) or bleaching technique (mean group difference in ΔL=0.36; p>0.05).

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.

Influence of in-office whitening gel pH on hydrogen peroxide diffusion through enamel and color changes in bovine teeth.

PURPOSE: To assess the influence of in-office whitening gel pH on whitening efficiency. METHODS: Hydrogen peroxide diffusion and color changes on bovine teeth were assessed. Three gels with close hydrogen peroxide concentrations but with various pH levels were tested: Zoom 2 (Discus Dental), Opalescence Endo and Opalescence Boost (Ultradent). The pH levels were respectively: 3.0, 5.0 and 7.0. Thirty enamel slices and tooth crowns were used for both studies (n = 10 per group per study). Hydrogen peroxide diffusion through the enamel slices and the tooth crowns was spectrophotometrically recorded every 10 minutes for 1 hour to calculate the diffusion coefficients. Color changes were spectrophotometrically recorded every 10 minutes for 1 hour and quantified in term of CIE-Lab. RESULTS: The hydrogen peroxide diffusion coefficient through enamel ranged from 5.12 +/- 0.82 x 10(-9) cm2 s(-1) for pH 3 to 5.19 +/- 0.92 x 10(-9) cm2 S(-1) for pH 7. Through tooth crowns it ranged from 4.80 +/- 1.75 x 10(-10) cm2 s(-1) for pH 5 to 4.85 +/- 1.82 x 10(-10) cm2 s(-1) for pH 3. After 1 hour, the deltaE varied from 5.6 +/- 4.0 for pH 7 to 7.0 +/- 5.0 for pH 3 on enamel slices and from 3.9 +/- 2.5 for pH 5 to 4.9 +/- 3.5 for pH 7 on tooth crowns. There was no statistically significant difference between groups for both parameters.

Dielectrophoresis: a model to transport drugs directly into teeth.

The article describes an innovative delivery system based on the principles of dielectrophoresis to transport drugs directly into site-specific intraoral targets. The hypothesis that a drug can be driven into tooth enamel during the application of an applied electrical potential difference was tested by the authors in in vitro studies comparing dielectrophoresis to diffusion to transport carbamide peroxide and fluoride. The studies showed that these agents can be transported directly into teeth using an alternating current (AC) electric field more effectively than diffusion. It was found that a 20-min bleaching treatment on human teeth with dielectrophoresis increased carbamide peroxide absorption by 104% and, on average, improved the change in shade guide unit 14 times from 0.6 SGU to 9 SGU. After applying a 1.23% acidulated phosphate fluoride gel to bovine incisors for 20 min by dielectrophoresis or diffusion, analysis with wavelength dispersive spectrometry determined that dielectrophoresis doubled fluoride uptake in the superficial layers compared to diffusion, and drove the fluoride significantly deeper into enamel with an uptake 600% higher than diffusion at 50 µm depth. Finally, dielectrophoresis promises to be a viable model that can potentially be used clinically to deliver other targeted drugs of variable molecular weight and structure.

Hydrogen peroxide release kinetics into saliva from different whitening products: a double-blind, randomized clinical trial.

The objective of this study is to compare salivary hydrogen peroxide (HP) release kinetics and potential toxicity of systemic exposure of four different whitening products. A double-blind, randomized controlled trial was conducted in a Portuguese dental faculty clinic. Two hundred forty volunteers were randomized to eight intervention groups. Participants were randomly assigned to receive active or placebo applications of one of four different products: Opalescence 10% PF™ (OPL), Vivastyle® 10%™ (VS10%), Vivadent Paint On Plus™ (PO+), and Trés White Supreme™ (TWS). Saliva collection was obtained by established methods at different times. The HP salivary content was determined by a photometric method. Salivary HP variations, total amount of salivary HP, and counts of subjects above the safe daily HP dose were the main outcome measures. All whitening systems significantly released HP to the saliva when compared to placebo, and all showed different release kinetics. The adaptable tray system (TWS) presented a risk increase of 37% [20-54%, 95% confidence interval] when compared to the other systems. The use of an adaptable tray whitening system with higher concentration of HP increases the toxicity potential.

Effect of postbleaching application of an antioxidant on enamel bondstrength of three different adhesives

Objectives: The aim of this study was to compare the shear bond strength (sbs) of three different adhesives on bleached enamel imm ediately after bleaching, bleached/delayed for 1 week, and bleached/applied antioxidizingagent. Study Design: The enamel surfaces of 144 freshly extracted incisors without any caries and restorations were flattened and divided into 12 groups. The following adhesives were investigated: Optibond FL (OFL) (three-stepetch&rinse), Optibond Solo Plus (OSP) (two-step etch&rinse), Optibond All-in-One (OA) (one-step self-etch),(Kerr, Orange, USA ). Unbleached enamel groups were prepared as negative controls. The remainder surfaces were bleached with 20% Opalescent PF (Ultradent, USA ) 6 h/d for 5 consecutive days. Specimens were bondedimm ediately after bleaching, after 1 week or after using 10% sodium ascorbate gel for 6 hours. After 500 rounds of thermocycling, sbs was measured and data was analyzed with Kruskall-Wallis and Mann-Whitney U-tests (á= 0.05).Results: The sbs decreased for the adhesives after bleaching except for OFL. The effect of applying sodium ascorbatesubsequent to bleaching was not equal for the studied adhesives. While for OFL, sbs of the sodium ascorbategroup was significantly higher than the unbleached control group, for OSP, the sodium ascorbate group had nostatistically significant difference with the unbleached control group and for OA, sbs was significantly lower thanthe unbleached control group.Conclusions: Different adhesives demonstrate different degrees of reversed bond strength subsequent to applyingantioxidant. It seems the method of application and the chemical composition of the adhesives could affect the antioxidant as a reducing agent (AU)

Microleakage comparison of glass-ionomer and white mineral trioxideaggregate used as a coronal barrier in nonvital bleaching

Objectives: There is some evidence that the pH at the root surface is reduced by intracoronal placement of bleaching pastes, which is known to enhance osteoclastic activity. Therefore, it is recommended that a protective barrierbe used over the canal filling to prevent leak age of bleaching agents. Glass-ionomer (GI) is commonly used asa coronal barrier before nonvital bleaching. Because mineral trioxide aggregate (MTA) creates high alkalinityafter mixing with water, using MTA as a protective barrier over the canal filling may not only prevent leakage of bleaching agents and microorganisms, but may prevent cervical resorption. The aim of this study was to evaluates ealing ability of white mineral trioxide aggregate (WMTA) as a coronal barrier before nonvital bleaching.Study design: Root canals of one hundred thirty human maxillary incisors were instrumented and filled withgutta-percha without sealer. Gutta-percha was removed up to 3 mm below the cementoenamel junction (CEJ). Theteeth were randomly divided into six experimental groups of 20 teeth each and two control groups of 5. In three experimental groups, WMTA was packed into the canal to the level of CEJ. In the remaining experimental groups,glass-ionomer (GI) was used as a coronal barrier. After a 24-hour incubation period, one of the following threebleaching agents was placed in the access cavity of each of the WMTA or GI groups. These three bleaching agentswere 30% hydrogen peroxide, sodium perborate mixed with 30% hydrogen peroxide, and sodium perborate mixedwith distilled water. The bleaching agents were replaced every 3 days for three times. In the positive controls, no (..) (AU)

In vitro evaluation of the efficacy of two bleaching procedures

Objective: In vitro comparison of the efficacy of two bleaching procedures, one based on carbamide peroxide (CP)and the other on hydrogen peroxide (HP), simulating clinical conditions.Study Design: Two groups of 20 teeth in each group were selected. Group A: 22% CP, one hour a day for 21 consecutivedays. Group B: 37.5% HP, in 2 treatment sessions with an one week interval between each session. At eachsession the product was applied three successive times for eight minutes. Colour was recorded before treatment,when it was finished and one week after finishing it, with the Vita EasyShade spectrophotometer. CIEL*a*b* andΔE were established at each moment in the study. Intra-group data was compared using the paired t-test and intergroupdata with the independent groups t-test. Scores from the Vita Classical guide provided with the device wererecorded and the colour improvement percentage was calculated.Results: In both groups significant whitening was achieved by the end of treatment. Lightness remained significantlyhigh when treatment was finished and one week after in both groups. The percentage of bleaching wassignificantly higher in group A.Conclusions: Both 22% CP and 37.5% HP were effective for bleaching teeth. Bleaching effect was greater in CPgroup (AU)

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