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

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

Prevention efficacy of dentin tubule sealing with Nd:YAG laser against tooth discoloration induced by vital pulp treatment.

BACKGROUND: The discoloration potential of dental materials and applications such as vital pulp therapy also cause discoloration due to the presence of blood. Dentin tubule sealing methods could be used for the prevention of discoloration. AIM: The purpose of this study was to evaluate the effect of sealing pulp chamber walls with Nd:YAG laser against discoloration caused by tricalcium silicate-based materials in the presence and absence of blood contamination. DESIGN: Eighty-one extracted human maxillary incisors were prepared and randomly divided into nine groups according to the Nd:YAG laser application, the cement to be used (NeoMTA Plus/Biodentine), and the presence or absence of blood. The color measurements were obtained with a spectrophotometer at baseline and then at the sixth (T1) and 12th (T2) months thereafter. RESULTS: Sealing with Nd:YAG laser and placing NeoMTA Plus or Biodentine on human blood significantly increased discoloration at T1 and T2 (p < .05). Similarly, without sealing the cavity and placing NeoMTA Plus or Biodentine on human blood significantly increased discoloration at T1 and T2 (p < .05). CONCLUSION: Regardless of sealing the dentin tubules with Nd:YAG laser, NeoMTA Plus and Biodentine caused more discoloration in the presence of blood contamination.

Inhibition of Silver Diamine Fluoride-induced Tooth Discoloration by Using Natural Antioxidant: In Vitro Study.

AIM: Silver diamine fluoride (SDF) is a well-known caries preventive aid capable of arresting carious lesions and preventing secondary caries formation. Despite having the caries prevention potential, the clinical use of SDF is limited due to the tooth discoloration caused by SDF. The objective of this study was to evaluate the efficiency of natural antioxidants to inhibit SDF-induced tooth discoloration. MATERIALS AND METHODS: A total of 32 bovine teeth were polished to create a 6 mm circular window on the middle 1/3 (for enamel) or on the cervical 1/3 (for dentin) of the labial surface. Specimens were treated either with SDF alone or SDF followed by ascorbic acid (AA)/alpha lipoic acid (ALA)/7th generation bonding materials. The color parameters Lightness (L*), Chroma (C*), and Hue (H*) of the tooth window were measured at pretreatment, 1-hour, 1-week, and 1-month posttreatment using a digital color chromometer. RESULTS: Repeated measure ANOVA showed a significant tooth color alteration at 1-hour posttreatment. The L* and H* values dropped and C* value elevated significantly in 1-hour posttreatment measurement. All experimental groups showed significant tooth color alteration after treatment (p < 0.05) and were unable to reverse the discoloration even after 1-month period except the ALA group which did not show any significant (p > 0.05) color alteration compared with the pretreatment value. CONCLUSIONS: Within the limitation of the in vitro model and according to the results of this study, it can be concluded that ALA has the potential to prevent SDF-induced tooth discoloration; however, AA was unable to prevent the discoloration. CLINICAL SIGNIFICANCE: SDF induces discoloration of enamel and dentin can be reversed by applying Alpha lipoic acid immediacy after SDF application.

Evaluation of the effectiveness of different treatment approaches in preventing coronal discoloration caused by regenerative endodontic treatment.

OBJECTIVES: This study aimed to evaluate the effectiveness of Teethmate desensitizer, a dentin bonding agent (DBA), Nd:YAG laser, and Er:YAG laser, which provides dentin tubule occlusion in the pulp chamber with different mechanisms, in preventing tooth discoloration due to regenerative endodontic treatment. MATERIALS AND METHODS: One hundred five extracted maxillary human incisors with single roots and single canals were included in the study. The apical third of each tooth was resected below the enamel-cementum junction (CEJ) to obtain a standard root length as 10 ± 1 mm. Root canal preparation was performed using the ProTaper Next files up to X5. Root canals were prepared with Gates Glidden (# 2-4) burs to simulate the immature root apex and an apical diameter of 1.1 ± 0.1 mm was obtained. The teeth were randomly divided into 7 groups (n = 15): DBA, Teethmate, Nd:YAG, Er:YAG, Biodentine, Blood, and Negative Control. Relevant dentin tubule occlusion methods were applied to DBA, Teethmate, Nd:YAG, and Er:YAG groups. Following dentin tubule occlusion procedures, Biodentine was placed on the blood clot after filling the root canals with blood up to 4 mm below the CEJ. No dentin tubule occlusion procedure was applied for Blood and Biodentine groups. Color measurement was performed with the spectrophotometer Vita Easyshade Advance before treatment, immediately after treatment, and at days 7, 30, and 90. Data were converted to L*a*b color values of Commission International de I'Eclairage (CIE L*a*b) and ΔE values were calculated. Two-way ANOVA and post hoc Tukey test (p = 0.05) were performed for statistical analysis. RESULTS: A clinically detectable color change was observed in all groups except for the negative control (ΔE ≥ 3,3). It was observed that Biodentine used alone has a potential for discoloration. It was determined that as the contact time with blood increased, tooth discoloration increased. However, no significant difference was found between dentin tubule occlusion methods in preventing color change (p > 0.05). CONCLUSIONS: It was determined that no dentin tubule occlusion method could 100% prevent discoloration caused by RET. CLINICAL RELEVANCE: DBA and Teethmate, which do not have a significant difference in terms of preventing color change, are considered to be suitable for dentin tubule occlusion due to their ease of application and low cost compared to Nd:YAG laser and Er:YAG laser.

Microencapsulación de peróxido de hidrógeno para la elaboración de un caramelo de goma blanqueador dental y evaluación in vitro mediante un método colorimétrico / Microencapsulation of hydrogen peroxide for the development of a dental whitening gummy candy and in vitro evaluation using a colorimetric method

INTRODUCCIÓN: La apariencia y el color de los dientes es una preocupación común para los pacientes por lo que hay una creciente necesidad de contar con tratamientos que mejoren la estética dental. Por esa razón, en los últimos 20 años la ciencia dental ha buscado nuevas técnicas y materiales capaces de reducir la discoloración dental. MÉTODO: Se prepararon pastillas de goma fantasía, caramelos de goma o gominolas que contenían dos concentraciones diferentes (7% y 14% m/v) de peróxido de hidrógeno microencapsulado por gelificación iónica. Durante 30 días se realizó un tratamiento diario de blanqueamiento dental in vitro para evaluar la acción blanqueadora de las dos formulaciones. La medición del color de la superficie de los dientes tratados se llevó a cabo utilizando una técnica colorimétrica. RESULTADOS: Se encontraron diferencias significativas entre los tratamientos de blanqueamiento con las dos formulaciones elaboradas en comparación con un grupo de control, siendo el esquema de dos procedimientos diarios con la formulación al 7% de peróxido de hidrógeno más efectivo que el de un único procedimiento diario con la formulación al 14%. CONCLUSIONES: Las dos formulaciones desarrolladas en este estudio tuvieron un mayor efecto de blanqueamiento in vitro en comparación con un grupo de control, y además se encontró que se logran mejores resultados al disminuir la concentración de peróxido si el número de aplicaciones aumenta para dosis diarias iguales

INTRODUCTION: The appearance and color of the teeth are common concerns for patients and are associated with an increased need for treatments that can improve dental aesthetics. For this reason, in the past 20 years, dental science has been searching for new techniques and materials able to reduce dental discoloration. METHOD: Gummy candies containing two different concentrations (7% and 14% w/v) of hydrogen peroxide microencapsulated by ionic gelation were prepared. In vitro tooth whitening treatment was carried out for 30 days to test the bleaching action of these formulations. The surface color of the treated teeth was measured using a colorimetric technique. RESULTS: Significant differences were found on comparing the whitening treatments for the two formulations with a control group, with two daily treatments using the formulation with 7% hydrogen peroxide being more effective for whitening than a daily single treatment using the formulation with 14 %. CONCLUSIONS: The two formulations developed had an in vitro higher bleaching effect in comparison with the control group, and in addition, better results were achieved if the daily dose was provided by more applications at a lower concentration of hydrogen peroxide

Pre-application of dentin bonding agent prevents discoloration caused by mineral trioxide aggregate.

BACKGROUND: To evaluate tooth discoloration by newly developed calcium silicate-based materials, and to examine the pre-application of dentin bonding agent (DBA) for preventing discoloration caused by mineral trioxide aggregate (MTA). METHODS: The roots of 50 premolars were randomly divided into five groups (n = 10) and cavities were prepared from resected root surfaces. MTA was placed in the cavities of teeth belonging to the ProRoot MTA (MTA) and RetroMTA (RMTA) groups. For teeth belonging to the ProRoot + DBA (MTA-B) and RetroMTA + DBA (RMTA-B) groups, DBA was first applied to the cavities prior to the addition of MTA. Teeth in the control group were restored with composite resin only (i.e., without MTA). After 12 weeks, MTA was removed from the MTA and RMTA groups and bleaching agents were applied for 3 additional weeks. Color assessments were recorded at baseline, and 1, 4, and 12 weeks, as well as after bleaching. A one-way ANOVA was performed to assess the differences between the two types of MTAs and color changes following DBA pre-application in each MTA group. A p-value of < 0.05 was considered indicative of statistical significance. RESULTS: Following 12 weeks of MTA treatment, there was a significant difference between the discoloration in the MTA and RMTA groups (p < 0.05). However, no significant difference was observed between the RMTA and RMTA-B groups (p > 0.05). Following bleaching, the color changes (ΔE values) of the MTA group were not significantly different from those of the MTA-B group (p > 0.05). The difference of ΔE between the RMTA group after internal bleaching and the RMTA-B group was also not significant (p > 0.05). CONCLUSIONS: RetroMTA caused significantly less discoloration than ProRoot MTA. Pre-application of DBA reduced discoloration caused by ProRoot MTA. MTA discoloration was improved equally well between DBA pre-application and post-bleaching.

Hipomineralización en dentición temporal: ¿factor predictivo de him? / No disponible

La terminología hipomineralización incisivo-molar (HIM) fue descrita por primera vez en 2001 para explicar los defectos de desarrollo cualitativos demarcados del esmalte, que afectan a uno o más molares permanentes, con o sin participación de los incisivos per-manentes1. En los últimos años, las investigaciones han dado lugar a informes de lesiones comparables en segundos molares temporales hipomineralizados, sin embargo, se desconoce si la presencia de opacidades demarcadas en los caninos temporales también puede asociarse con el HIM1-3. Da Silva y cols., en 2017, son los únicos autores hasta el momento que relacionan hipomineralizaciones en segundos molares temporales (HSPM) y caninos temporales (HPC)3. La prevalencia de HSPM varía dependiendo de los países entre 2,9% a un 21,8% 3,7.Se puede esperar que las causas de los defectos de hipomineralización en los segundos molares temporales sean las mismas que en los dientes permanentes, si ocurren conco-mitantemente a la calcificación de su corona, la cual comienza alrededor de la decimooctava semana de gestación 4-7. Se presenta el caso de un paciente infantil, de 6 años, que acudió a consulta para revisión odontológica. Tras la exploración, se observó la presencia de anomalías del color y estructura en: todos los segundos molares y caninos temporales, así como en los primeros molares temporales superiores y primer molar temporal inferior izquierdo (Figuras 1-6). La posterior exploración radiográfica mostró hallazgos patológicos localizados en 54, 64, 65, 74, 75, 84, 85 (Figuras 7-9). El tratamiento supone un desafío ya que es frecuente que los dientes afectados presenten afectación pulpar, además de hipersensibilidad y descomposición post*eruptiva. Esta relación podría sugerir como factor predictivo de aparición de HIM, la presencia HSPM y HPC, así podrían implementarse las medidas de prevención y control con intervalos más frecuentes en estos pacientes

No disponible

Design and characteristics of new experimental chlorhexidine dental gels with anti-staining properties.

BACKGROUND: Chlorhexidine-based products are often used in medicine and dentistry as dental hygiene and therapeutic products, especially by patients with various oral tissue diseases. However, these products have disadvantages, such as low stability, as well as discoloration of the teeth and dental reconstruction materials. OBJECTIVES: The aim of this study was to create and evaluate experimental chlorhexidine (CHX) gels with anti-staining properties and to compare them with 3 commercially available products. MATERIAL AND METHODS: For this study, 4 new formulations containing 1% CHX and different anti-staining agents were developed. The properties of these gels were compared with 3 commercial CHX-based dental products. The pH, viscosity, disintegration in water, and anti-staining properties were evaluated. RESULTS: The pH level of the 4 new CHX gels ranged from 5.92 to 6.33. The viscosity of the experimental gels was higher (85.7÷217.7 Pa∙s) than the commercial ones (11.6÷72.7 Pa∙s). Among the experimental formulations with 1% CHX, the formulation with 5% polyvinylpyrrolidone (PVP) and 0.2% citric acid and the formulation with 1% citric acid were the most stable in terms of pH and viscosity. The disintegration times of the experimental gels were longer (50-70 min) as compared with the commercial products (approx. 20 min). These 2 CHX gels caused less color change of glass ionomer cements in black tea solution. CONCLUSIONS: To conclude, 2 new experimental dental gels based on 1% CHX, one with 1% citric acid and the second with 5% PVP and 0.2% citric acid, had the most favorable physicochemical properties. Further research is needed to evaluate their therapeutic potential in the treatment of diseases of the oral cavity.

Nine prophylactic polishing pastes: impact on discoloration, gloss, and surface properties of a CAD/CAM resin composite.

OBJECTIVES: To investigate discoloration reduction and changes of surface properties of a CAD/CAM resin composite after 14 days´ storage in red wine and polishing with nine different prophylactic polishing pastes (PPPs). MATERIALS AND METHODS: Rectangular discs (N = 172) were fabricated and polished (P4000) using GC Cerasmart (GC Europe) to investigate different polishing protocols with 1-4 related descending PPPs (22 in total): Cleanic/CLE-Kerr, CleanJoy/CLJ-Voco, Clean Polish/Super Polish/SPO-Kerr, Clinpro Prophy Paste/CPP-3M, Détartrine/DET-Septodont, Nupro/NUP-Dentsply Sirona, Prophy Paste CCS/CCS-Directa, Proxyt/PXT-Ivoclar Vivadent, and Zircate/ZIR Prophy Paste-Dentsply Sirona. Surface properties (roughness values (RV)/Ra, Rz, Rv, surface free energy (SFE), surface gloss (G), and discoloration (ΔE)) were analyzed before and after storage and additional polishing. Data were examined using Kolmogorov-Smirnov test, three-way ANOVA followed by Tukey-B post hoc, Mann-Whitney U, and Kruskal-Wallis H tests (α < 0.05). RESULTS: Regarding RV, CLE, followed by CCS, and CPP showed the highest values; the lowest presented SPO and DET (p < 0.001). No impact of PPP was observed on ΔE values (p = 0.160). The lowest SFE presented DET, followed by SPO; highest showed CCS followed by NUP and CPP (p < 0.001). Within G, lowest values were observed for CLE and NUP, followed by CCS, ZIP, and CLJ (p < 0.001); the highest presented SPO (p < 0.001). Polishing showed generally a positive impact on SFE values (p < 0.001-p = 0.007), except ZIP (p = 0.322) and CLE (p = 0.083). G increased and RV decreased after polishing (p < 0.001), except SPO, with no significant change for G (p = 0.786). CONCLUSIONS: Polishing with PPPs improves the surface properties and is generally recommended. The choice of PPP has a minor role in removing discolorations. Multi-step systems should be carried out conscientiously. CLINICAL RELEVANCE: The proper selection of PPP is essential for the clinical outcome of surface properties of prosthetic restorations. Not every polishing paste leads to the same final surface quality.

Alternative to Avoid Tooth Discoloration after Regenerative Endodontic Procedure: A Systematic Review.

This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.

Protection Against Discolouration by Two Over-the Counter Desensitising Products.

PURPOSE: To determine in vitro the protection potential against discolouration of two OTC (over-the-counter) desensitising products on enamel and dentin in comparison to a standard toothpaste and water by means of a spectrophotometer. MATERIALS AND METHODS: A total of 96 samples of bovine enamel-dentin complex and 48 of bovine dentin were alternatively immersed in red wine, tea, coffee or water after having been treated by a sodium monofluorophosphate- and calcium phosphate-based product (Curodont Protect), an amine fluoride-based toothpaste (Elmex Red), a stannous chloride-based toothpaste (Elmex Protection Erosion) or distilled water (negative control). Initial (T0) and final colour (T1, after 4 weeks of immersion in staining solutions) of each specimen were assessed by a spectrophotometer. Statistical analysis was done by means of repeated measures ANOVA followed by Fisher's LSD post-hoc test. Differences between T0 and T1 were considered stastistically significant at p ≤ 0.05. RESULTS: When enamel samples were measured over a black background, ΔE00 values (T0-T1) varied from 2.2 (SD 0.7) for amine fluoride-based product/water to 53.9 (SD 7.6) for amine fluoride-based-product/red wine. When dentin samples were measured over a black background, ΔE00 values (T0-T1) varied from 5.4 (SD 0.9) stannous chloride based product/water to 61.6 (SD 3.7) amine fluoride-based product/red wine. CONCLUSION: Specifically, the application of the sodium monofluorophosphate was able to statistically significantly (p ≤ 0.05) reduce discolouration induced by the staining solutions tested only on the enamel-dentin complex, while distilled water and the stannous fluoride-based product were able to statistically significantly (p ≤ 0.05) reduce discolouration induced by the staining solutions tested in pure dentin samples.

Alternative to avoid tooth discoloration after regenerative endodontic procedure: a systematic review

Abstract This systematic review aimed to evaluate whether alternative materials to conventional triple antibiotic paste (TAP - metronidazole, ciprofloxacin, and minocycline) and grey mineral trioxide aggregate (GMTA) could avoid tooth discoloration in teeth submitted to Regenerative Endodontic Procedure (REP). It was also investigated if dental bleaching is able to reverse the color of darkened teeth due to REP. The search was conducted in four databases (Medline via PubMed, Scopus, ISI Web of Science and BVS - Virtual health library), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The retrieved papers were uploaded in the software EndNoteTM and two reviewers independently selected the studies and extracted the data. Only studies in humans (case reports, case series, clinical trials) were included in the review. From 1,122 potentially eligible studies, 83 were selected for full-text analysis, and 38 were included in the review. The included studies were mainly case reports (76.3 %). The studies described a total of 189 teeth submitted to REP. From these, about 54% of teeth presented some degree of discoloration. Most teeth presenting color alteration were treated with TAP, especially when combined with GMTA. Only three studies performed dental bleaching to restore the color of teeth and neither bleaching technique was able to restore the original color of the crowns. The use of alternative materials to TAP and GMTA, such as double antibiotic paste or Ca(OH)2 pastes and white mineral trioxide aggregate or BiodentineTM, reduces the occurrence of tooth discoloration.

Resumo Esta revisão sistemática teve como objetivo avaliar se materiais alternativos à pasta tri-antibiótica convencional (TAP, em Inglês - metronidazol, ciprofloxacina e minociclina) e ao agregado trióxido mineral cinza (MTA cinza) poderiam evitar a descoloração dentária em dentes submetidos ao procedimento endodôntico regenerativo (REP, em Inglês). Também foi investigado se o clareamento dental é capaz de reverter a cor dos dentes escurecidos devido ao REP. A busca foi realizada em quatro bases de dados (Medline via PubMed, Scopus, ISI Web of Science e BVS - Biblioteca Virtual de Saúde), seguindo os Principais Itens para Relatar Revisões Sistemáticas e Meta-análises. Os artigos obtidos foram carregados no software EndNoteTMe dois revisores independentes selecionaram os estudos e extraíram os dados. Apenas estudos em humanos (relatos de casos, séries de casos, ensaios clínicos) foram incluídos na revisão. De 1.122 estudos potencialmente elegíveis, 83 foram selecionados para análise do artigo completo, e 38 foram incluídos na revisão. Os estudos incluídos foram principalmente relatos de casos (76,3%). Os estudos descreveram um total de 189 dentes submetidos ao REP. Destes, cerca de 54% dos dentes apresentaram algum grau de descoloração. A maioria dos dentes com alteração de cor foi tratada com TAP, principalmente quando combinada com MTA-cinza. Apenas três estudos realizaram o clareamento dental para restaurar a cor dos dentes e nem a técnica de clareamento conseguiu restaurar a cor original das coroas. O uso de materiais alternativos à TAP e ao MTA cinza, como a pasta bi-antibiótica, pasta de Ca(OH)2e MTA branco ou BiodentineTM, reduz a ocorrência de descoloração dentária.

Clinical efficacy of a chlorhexidine-based mouthrinse containing hyaluronic acid and an antidiscoloration system in patients undergoing flap surgery: A triple-blind, parallel-arm, randomized controlled trial.

OBJECTIVES: To evaluate the postsurgery gingival healing as well as plaque, gingival inflammation and staining levels following the use of a 0.2% chlorhexidine (CHX) solution with or without antidiscoloration system (ADS) and 0.2% hyaluronic acid (HA). METHODS: Patients undergoing flap surgery at sites with an intact or reduced but healthy periodontium participated in a parallel-arm RCT. After surgery, patients used the assigned mouthrinse (CHX + HA + ADS or CHX) for 21 days. At days 7 and 21, the healing process was evaluated at experimental teeth using a composite index, namely the Gingival Healing Index (GHI). GHI score was obtained as the sum of the scores related to the severity of wound dehiscence (score 1-3) and the profile of the buccal and oral aspects of the papilla (score 1-3). Therefore, GHI ranged from 2 (worst quality of healing) to 6 (optimal quality of healing). Plaque Index (PlI), Gingival Index (GI), angulated bleeding score (AngBS), and tooth and tongue staining were also assessed. RESULTS: In both groups, GHI assumed values of 5 or 6 at both days 7 and 21 in ≥50% of patients, and low median values of PlI, GI, AngBS and staining were observed during the 21-day period. Except for a significantly lower GI in CHX group at day 7, no other significant intergroup differences were found. CONCLUSIONS: Postsurgery plaque control based on either CHX or CHX + HA + ADS mouthrinses results in optimal plaque control and quality of early gingival healing along with limited tooth and tongue staining.

Randomized controlled trial evaluating concurrent gingivitis and stain effects of a two-step dentifrice/gel sequence.

PURPOSE: A randomized controlled trial was conducted to evaluate the clinical efficacy of a two-step dentifrice/whitening gel oral hygiene sequence on natural gingivitis and extrinsic stain. METHODS: The population consisted of healthy adults with clinical evidence of gingivitis and extrinsic stain. Consent, demographic information and clinical measurements were collected, after which subjects were randomized to treatment. Eligible subjects were dispensed blinded test kits containing over-labeled two-step 0.454% SnF2 dentifrice then 3% H2O2 whitening gel sequence or a regular 0.76% NaMFP dentifrice control (Colgate Cavity Protection), plus a regular soft manual toothbrush and instructions for use. Efficacy was assessed blind-to-treatment using the Gingivitis Bleeding Index (GBI) measured whole-mouth and the composite Lobene Stain Index (LSI) measured on the anterior dentition. Treatments were compared at Week 1 and Week 3 versus baseline for ΔGBI and ΔLSI using a two-sided 5% level of significance. RESULTS: A total of 61 subjects with a mean (SD) age of 33.4 (12.0) years were enrolled. Overall baseline means (SD) were 0.16 (0.05) for GBI and 1.30 (0.94) for LSI. After 1 week, only the two-step 0.454% SnF2 dentifrice then 3% H2 O2 whitening gel sequence demonstrated significant (P< 0.0001) reductions in both gingivitis and stain. Adjusted means for the changes with the dentifrice/gel sequence and control were -0.055 and -0.001 for ΔGBI, and -0.619 and -0.095 for ΔLSI, with groups differing significantly (P< 0.0001) on gingivitis and stain improvement. Outcomes at Week 3 were generally similar, with groups differing on bleeding and stain. Treatments were generally well-tolerated. CLINICAL SIGNIFICANCE: In a randomized controlled trial, use of a two-step 0.454% SnF2 dentifrice then 3% H2 O2 whitening gel sequence yielded concurrent improvements in gingivitis and stain compared to regular oral hygiene.

Clinical and microbiological effects of the use of a cetylpyridinium chloride dentifrice and mouth rinse in orthodontic patients: a 3-month randomized clinical trial.

Objective: To assess the clinical, microbiological, and patient-based effects of using a cetylpyridinium chloride (CPC) toothpaste and mouth rinse in orthodontic patients. Design: Parallel randomized controlled, triple-blinded trial (participants, examiners, outcomes' assessors). A computer-generated list was used to allocate treatments. Central allocation was used for concealment. Participants: Thirty-one placebo (10 males, 21 females; mean age 15.2 ± 2.1) and 32 test patients (15 males, 17 females; mean age 15.0 ± 1.8) with fixed orthodontic appliance were included in the study. Interventions: Patients were randomly assigned to both brush and rinse with placebo or with CPC-based products. Products were purposely prepared in white opaque bottles. After screening and professional prophylaxis, patients received a baseline examination, and started to use the assigned products. Patients were monthly assessed during a 3-month period. Main outcome measures: Plaque (PlI) and gingival (GI) indexes. Secondary outcome variables: Calculus index, tooth staining, subgingival microbiological samples, patient-based variables (questionnaire, compliance, and remaining mouth rinse), side-effects (debonded braces or mucosal injuries). Results: Sixty-three patients were randomized, 13 patients were excluded from analysis because of early dropout, leaving 50 patients for intention to treat analysis. PlI in the upper jaw diminished (0.18; SD = 0.82) after 1 month in the test group, while it increased (0.26; SD = 0.62) in the placebo group (P = 0.024). Statistically significant higher GI values were observed in the placebo group at 1 month (mean increase = 0.05; SD = 0.33 versus mean decrease = 0.03; SD = 0.38) and 3 months (mean = 0.05; SD = 0.43 versus mean = 0.02; SD = 0.34). The taste of the test product was rated higher than the placebo at 2- and 3-month visits (P < 0.05). Non-significant changes were observed in microbiological parameters, overgrowth of opportunistic species or remaining secondary outcome variables, including side-effects. Conclusion: The use of CPC-based toothpaste and mouth rinse in orthodontic patients had limited effect in reducing plaque accumulation and gingival inflammation. Effects were little and highly variable. The use of the test products was not associated with relevant adverse effects. Trial registration: Trial registration: Local internal reference: P07/133.

Can Coloured Fluoride Gel Stain Demineralised Enamel?

PURPOSE: This study evaluated the colour changes of demineralized enamel after treatment with coloured fluoride gel. MATERIALS AND METHODS: Enamel blocks obtained from bovine incisors were submitted to artificial caries induction by pH cycling followed by fluoride gel applications (2% sodium fluoride, pH 6.8) using a colourless gel (control group), pink or blue gels. The enamel optical properties were evaluated by spectrophotometry, using the CIE L*a*b* system at baseline (sound enamel), after artificial caries induction (demineralised enamel) and after each of the five fluoride gel applications (weekly intervals). Changes in enamel optical properties (ΔE) were analysed by two-way ANOVA and Tukey's test (α = 0.05). RESULTS: No significant differences were found among fluoride gels (p = 0.476) regardless of the presence of pigments in the gel. ΔE values were significantly different (p < 0.001) between baseline evaluation and treated enamel (after fluoride gel application). CONCLUSION: This in vitro study demonstrated that colour changes in enamel do not occur during fluoride gel treatment, regardless of the presence or absence of coloured pigments in the gel.

Crossover Clinical Trial of Tablets Containing Sodium Tripolyphosphate on Dental Stain Formation.

OBJECTIVES: The purpose of this clinical investigation was to evaluate the effectiveness of sugar-free tablets containing sodium tripolyphosphate 2% or sodium tripolyphosphate 0.65%, compared to a no-tablet control in preventing the formation of extrinsic stains over a 12- week period of regular unsupervised use preserving daily oral hygiene with dentifrice and usual tooth brushing. METHODS: This was a single-center, examiner-blind, randomized, 12-week crossover clinical trial. Sixty-six adult participants were enrolled in the study and were submitted to a professional cleaning to have a stain-free baseline. They either consumed two sugar-free tablets four times per day or not for 12 weeks. At the crossover, all procedures were repeated and subjects were assigned to another group. Extrinsic stain was measured at each 12-week period by the Modified Lobene Stain Index (MLSI). RESULTS: After the three legs of 12 weeks, 60 subjects completed the trial, their MLSI stain scores showed a significant 35.5% reduction (p < 0.001) in new stain formation for those using the sodium tripolyphosphate 2% tablets, and a significant 23.3% reduction (p < 0.001) in new stain formation for those using the sodium tripolyphosphate 0.65% tablets versus the control group. CONCLUSIONS: This clinical study showed that regular use of sugar-free tablets added with sodium tripolyphosphate 2% or 0.65% can reduce stain formation on the anterior teeth respectively by 35.5% (p < 0.001) or 23.3% (p < 0.001), both on facial and lingual/palatal surfaces.

Whitening dentifrice and tooth surface discoloration-a systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic review was to assess the effect of a whitening dentifrice (WDF) relative to a regular dentifrice (RDF) on the reduction of natural extrinsic tooth surface discoloration (ETD). MATERIALS AND METHODS: The MEDLINE-PubMed, Cochrane-CENTRAL and EBSCO-Dentistry and Oral Sciences databases were searched, up to April 2017. The inclusion criteria were as follows:(randomized)controlled clinical trials, healthy subjects ≥18 years of age, studies comparing WDF with RDF, a follow-up period of at least 6 weeks and studies scoring ETD as the stain area/extent, stain intensity or a composite score. Studies using an induced staining model were excluded. RESULTS: Independent screening of 851 unique papers resulted in 21 eligible publications, which included 32 comparisons. The descriptive analysis illustrated that the majority of comparisons showed a significant effect on ETD, in favour of WDF over RDF. The meta-analysis substantiated this observation and revealed that the difference of means (diffM) comparing WDF and RDF was a reduction for stain area of -0.44 [(95% CI: -0.55; -0.339) (P<.00001)] according to the original Lobene Stain Index; this result is in favour of the WDF. For the modified Lobene Stain Index, the diffM was -0.41 [(95% CI: -0.71; -0.10) (P=.009)]. For overall stain intensity, the diffM was -0.35 [(95% CI: -0.44; -0.25) (P<.00001)], and the composite score was -0.39 [(95% CI: -0.57; -0.21) (P<.0001)] and -0.54 [(95% CI: -0.66; -0.43) (P<.00001)]. Subgroup analysis differentiating between products that contained added chemical antidiscoloration agents showed a similar pattern. CONCLUSION: In this review, nearly all dentifrices that are specifically formulated for tooth whitening were shown to have a beneficial effect in reducing ETD, irrespective of whether or not a chemical discoloration agent was added.

Assessment of efficacy of two chlorhexidine mouthrinses on oral hygiene and gingival health in adolescents wearing two types of orthodontic brackets.

OBJECTIVE: To investigate the efficacy of two formulations of chlorhexidine 0.2% (CHX) mouthrinses in terms of oral hygiene and gingival health status in adolescents with fixed orthodontic appliances wearing two different types of brackets during 18 weeks. STUDY POPULATION AND METHODOLOGY: Eighty subjects were randomly divided into two equal groups according to brackets type: (i) metal-stainless steel, (ii) ceramic. Four weeks after the placement of the fixed orthodontic appliances the subjects from each group were randomly allocated into two equal subgroups and were provided with two different mouthrinses for 14 days: (i) alcohol-free CHX, (ii) CHX with antidiscoloration system (CHX-ADS). Assessment was carried out according to gingival index (GI) and oral hygiene index-simplified (OHI-S) performed prior to the placement of the appliance (t1 ), 6 weeks (t2 ), and 18 weeks (t3 ) after the placement. To analyse the data, two-way mixed model MANOVA. Pearson correlations, one-way ANOVA and Independent Samples t test were conducted. RESULTS: Statistically significant decrease in GI and OHI-S indices after 6 weeks and then increase after 18 weeks for all groups was found. Both GI and OHI-S values were lower in subjects wearing ceramic brackets, with statistically significant difference for GI after the usage of the mouthrinse for 14 days, at t2 (P<.05). CONCLUSION: The results revealed that the ceramic brackets as well as usage of CHX-ADS resulted in improved gingival status.