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).

Can different agents reduce the damage caused by bleaching gel to pulp tissue? A systematic review of basic research.

Objectives: This study aimed to investigate the effectiveness of different topical/systemic agents in reducing the damage caused by bleaching gel to pulp tissue or cells. Materials and Methods: Electronic searches were performed in July 2023. In vivo and in vitro studies evaluating the effects of different topical or systemic agents on pulp inflammation or cytotoxicity after exposure to bleaching agents were included. The risk of bias was assessed. Results: Out of 1,112 articles, 27 were included. Nine animal studies evaluated remineralizing/anti-inflammatories agents in rat molars subjected to bleaching with 35%-38% hydrogen peroxide (HP). Five of these studies demonstrated a significant reduction in inflammation caused by HP when combined with bioglass or MI Paste Plus (GC America), or following KF-desensitizing or Otosporin treatment (n = 3). However, orally administered drugs did not reduce pulp inflammation (n = 4). Cytotoxicity (n = 17) was primarily assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay on human dental pulp cells and mouse dental papilla Cell-23 cells. Certain substances, including sodium ascorbate, butein, manganese chloride, and peroxidase, were found to reduce cytotoxicity, particularly when applied prior to bleaching. The risk of bias was high in animal studies and low in laboratory studies. Conclusions: Few in vivo studies have evaluated agents to reduce the damage caused by bleaching gel to pulp tissue. Within the limitations of these studies, it was found that topical agents were effective in reducing pulp inflammation in animals and cytotoxicity. Further analyses with human pulp are required to substantiate these findings. Trial Registration: PROSPERO Identifier: CRD42022337192.

Zoledronic Acid Modulates Cytokine Expression and Mitigates Bone Loss during the Development of Induced Apical Periodontitis in a Mice Model.

INTRODUCTION: Bisphosphonates are antiresorptive drugs used worldwide to treat systemic bone pathologies. This study aimed to assess the impact of zoledronic acid on the progression of induced apical periodontitis and the expression of cytokines interleukin (IL)-1ß, IL-10, IL-6, and tumor necrosis factor alpha (TNF-α) in a mouse model. METHODS: Sixteen female isogenic BALB/c mice 6 weeks of age were distributed into 2 groups: mice with induced apical periodontitis (the AP group, n = 8) and mice with induced apical periodontitis treated with zoledronic acid (the AP-ZA group, n = 8). The AP-ZA group received a dose of 125 µg/kg zoledronic acid diluted in sterile saline solution administered intraperitoneally once a week for 4 weeks before pulp exposure, whereas the AP group received only saline solution. Pulp exposures were performed on the maxillary first molars for the induction of apical periodontitis, and mice were euthanized after 7 and 21 days. The jaws were collected; scanned using micro-computed tomographic imaging; and processed for polymerase chain reaction analysis of IL-1ß, IL-10, IL-6, and TNF-α. The Student t test was performed for parametric data, and Mann-Whitney U tests were used for nonparametric data. The level of significance was set at 5%. RESULTS: Micro-computed tomographic imaging revealed higher bone resorption in the AP group compared with the AP-ZA group at both time points (P < .05). Real-time polymerase chain reaction demonstrated higher TNF-α expression in the AP group at both time points and higher IL-6 and IL-1ß expression in the AP group at the 7- and 21-day time points, respectively, compared with the AP-ZA group (P < .05). No differences were observed regarding IL-10 expression between the groups. CONCLUSIONS: Zoledronic acid had significant anti-inflammatory and antiresorptive effects on apical periodontitis in mice.

Photobiomodulation reduces inflammation but does not influence the hypoxia-inducible factor-1α in pulp tissue of rats after bleaching.

OBJECTIVES: To evaluate the influence of photobiomodulation with infrared laser (IRL) in the rat pulp tissue after bleaching, considering the immunolabeling of interleukin (IL)-23 and hypoxia-inducible factor (HIF)-1α. METHODOLOGY: The right and left molars of forty rats were divided into groups: Control - with placebo gel and Bleached - with 35% hydrogen peroxide (H2O2). Half of the rats received one IRL application on both sides, establishing a split-mouth design, which resulted in 4 groups with 20 hemi-maxillae each: Control, Bleach, IRL, and Bleached-IRL. Rats (n=10) from each group were euthanized, at 2- and 30-days mark, and the pulp tissue was evaluated using inflammation and immunolabeling scores. Wilcoxon and Mann-Whitney statistical tests were performed (p<0.05). RESULTS: At the 2-days mark, the Bleached group had severe inflammation and necrosis in the occlusal thirds of the pulp, and moderate to severe inflammation in cervical third, whereas the Bleached-IRL had mild to moderate inflammation (p<0.05). At the 30-days mark, there was no inflammation, but tertiary dentine formation in the bleached groups. Regarding IL-23, severe immunolabeling was observed in the Bleached group (p<0.05) at the 2-days mark; at the 30-days mark, there was a reduction in immunolabeling, in which the Bleached group had moderate and the Bleached-IRL group had mild immunolabeling (p>0.05). HIF-1α was more evident at the 2-days mark in the Bleached group, without significant difference with the Bleached-IRL (p>0.05). The difference was observed between the bleached and control groups, without immunolabeling (p<0.05); at the 30-days mark, the Bleached group had reduction in HIF-1α immunolabeling, while the Bleached-IRL had an increase; the difference remained between the bleached and the controls groups (p<0.05). CONCLUSION: Photobiomodulation using IRL minimized the inflammation and IL-23 immunolabeling in the pulp tissue of rats after dental bleaching, but did not influence significantly the HIF-1α immunolabeling.

Resposta pulpar em molares de camundongos após capeamento pulpar direto com novas formulações de biovidros / Pulp response in mice molars after direct pulp capping with new bioglasses formulations

Quando a polpa dentária é exposta ao meio bucal, cria-se uma ferida no tecido pulpar, cujo tratamento deve ser imediatamente instituído através da limpeza e desinfecção da área, seguida da cobertura pulpar com um material bioativo. O objetivo desse trabalho foi avaliar a resposta do tecido pulpar frente aos biovidros F18 e F18 dopado com cobalto (F18Co) em comparação ao hidróxido de cálcio (HC), após capeamento pulpar direto. Para tanto, 48 camundongos Balb/C machos (8 semanas) tiveram os primeiros molares superiores direito e esquerdo divididos aleatoriamente em grupos: F18, F18Co, HC e controle. Os molares dos grupos experimentais tiveram as polpas coronárias expostas e receberam os materiais, e foram selados com ionômero de vidro. O grupo controle não recebeu nenhuma intervenção. Após 7 e 15 dias, os animais (n = 6) foram eutanasiados e os espécimes processados para avaliação do processo inflamatório e da desorganização tecidual, por meio da coloração de Hematoxilina-Eosina, e da expressão de citocinas, por meio da técnica de PCR em tempo real, onde as interleucinas (IL)-1ß, IL-6 e IL-10 foram avaliadas. Aos 7 e 15 dias, houve inflamação leve a moderada no grupo HC, e principalmente moderada a severa em F18 e F18Co, porém, a diferença significativa foi observada apenas entre o grupo controle, sem inflamação, e os grupos F18 e F18Co (p < 0,05). Em relação à desorganização tecidual, aos 7 dias, observou-se desorganização moderada para o HC e para a maioria dos espécimes F18 e F18Co; aos 15 dias, houve desorganização leve a moderada para HC e moderada a severa para F18 e F18Co; a diferença foi observada entre os grupos controle e F18 e F18Co (p < 0,05), em ambos os períodos de análise. Observou-se a formação de dentina terciária apenas aos 15 dias em todos os grupos experimentais, entretanto, mais intensamente no grupo do HC. Aos 7 dias, não houve diferença significativa entre os grupos quanto às expressões de IL-6 e IL-10. Em relação à expressão de IL1ß, foi possível observar um aumento significativo nos grupos HC e F18. Já aos 15 dias, houve maior expressão de IL-6 nos grupos F18 e F18Co em relação ao controle; aumento significativo na expressão de IL-1ß foi observado neste período nos grupos F18 e F18Co em relação aos grupos HC e controle. Não houve expressão significativa da IL-10 nos diferentes grupos. Conclui-se que os biovidros F18 e F18Co podem ter um desempenho inferior ao HC quando utilizados em contato direto com o tecido pulpar.

When the dental pulp is exposed to the oral environment, a wound is created in the pulp tissue, whose treatment must be immediately instituted by cleaning and disinfecting the area, followed by pulp coverage with a bioactive material. The objective of this study was to evaluate the response of pulp tissue to bioglasses F18 and F18 doped with cobalt (F18Co) compared to calcium hydroxide (CH), after direct pulp capping. For that, 48 male Balb/C mice (8 weeks old) had their right and left maxillary first molars randomly divided into groups: F18, F18Co, CH and control. The molars of the experimental groups had the coronal pulps exposed and received the materials, and were sealed with glass ionomer. The control group received no intervention. After 7 and 15 days, the animals (n = 6) were euthanized and the specimens processed to evaluate the inflammatory process and tissue disorganization, using Hematoxylin-Eosin staining, and cytokine expression, using the PCR technique in real time, where interleukins (IL)-1ß, IL-6 and IL-10 were evaluated. At 7 and 15 days, there was mild to moderate inflammation in the CH group, and mainly moderate to severe in F18 and F18Co, however, a significant difference was observed only between the control group, without inflammation, and the F18 and F18Co groups (P < 0.05). Regarding tissue disorganization, at 7 days, moderate disorganization was observed for the CH and for most specimens F18 and F18Co; at 15 days, there was mild to moderate disorganization for CH and moderate to severe for F18 and F18Co; the difference was observed between the control and F18 and F18Co groups (P < 0.05), in both analysis periods. Tertiary dentin formation was observed only at 15 days in all experimental groups, however, more intensely in the CH group. At 7 days, there was no significant difference between the groups in terms of IL-6 and IL-10 expressions. Regarding the expression of IL-1ß, was possible to observe a significant increase in the CH and F18 groups. At 15 days, there was greater expression of IL-6 in groups F18 and F18Co compared to control; a significant increase in IL-1ß expression was observed in this period in the F18 and F18Co groups compared to the CH and control groups. There was no significant expression of IL-10 in the different groups. It is concluded that the bioglasses F18 and F18Co may have a lower performance than CH when used in direct contact with the pulp tissue.

Minimally invasive treatment of an extruded deciduous tooth - Case report.

When a traumatic dental injury affects the deciduous teeth, the main management is to regularly review the patient until the successor permanent tooth erupts to avoid further consequences to the affected tooth and, especially, sequelae in the tooth germs of the successor permanent tooth. This report describes a case of a tooth extrusion in a 4-year-old male treated with a minimally invasive approach. After 4 years of follow-up, there was a mild disturbance (demarcated opacity in the vestibular surface) and a satisfactory result with normal eruption of the permanent successor tooth.