Tooth Bleaching

Introduction: Residual oxygen-free radicals of bleaching agents before composite restorations can increase microleakage in enamel and dentin margins, and also various bleaching techniques are being developed using light sources. The present study was conducted to compare the effect of diode laser bleaching and LED activated bleaching on the microleakage of composite restorations.
Materials & Methods: This in-vitro study was conducted on 84 extracted human premolars in three groups: In group one, class-V cavities were prepared and the teeth (n=12) were restored with composite ten days after bleaching with 35% hydrogen peroxide with no activator. In groups two and three (n=36 each), the teeth were bleached with a Diode laser activator and LED, respectively. Thereafter, each group was divided into three subgroups (n=12), cavities were prepared and restored with composite three, five, and ten days after bleaching. Digital photographs were used to assess microleakage in the enamel and dentin margins. Data were analyzed using Friedman and Wilcoxon Signed Ranks tests (p<0.05).
Results: The lowest amount of microleakage in the enamel margin pertained to the diode laser ten-day subgroup (0.17±0.38) and the diode laser ten-day subgroup in the dentin margin (0.50±1.03). Also, the highest amount of microleakage in the LED group was in the three-day subgroup of the dentin margin (2.78±0.42). Five-day subgroup of diode laser-activated bleaching had a lower amount of microleakage compared to the control group (P=0.042).
Conclusion: It may be concluded that diode laser-activated bleaching with 35% hydrogen peroxide has a better effect on reducing microleakage with an interval of five to ten days, compared to the control and LED activated bleaching group.

The dentist is faced with a daunting task in application of clinical skills to achieve maximum cosmetic results when it comes to the management of discoloured and/or hypoplastic dentition. In this paper, an overview is made of the diagnosis and the management of these broadly termed conditions and the cost-effectiveness of the various modalities discussed.

This article reviews the efficacy of a new 6.5% hydrogen peroxide tooth-whitening gel strip for bleaching teeth that have been intrinsically stained from tetracycline. Given the severity of staining in the cases presented during a recently conducted clinical trial, the resulting efficacy is dramatic. Additionally, the continuous use of these strips for 30 minutes per day, twice daily for 2 months with no meaningful adverse effects is noteworthy.

Rapid innovation in vital bleaching continues to expand the number of treatment options available to patients, particularly in the area of at-home whitening. The development of bleaching strips represented a new paradigm in the delivery of peroxide. The efficacy and safety of bleaching strip systems delivering up to 6.5% hydrogen peroxide has been established in numerous randomized clinical trials. In 2003, a novel bleaching strip with 14% hydrogen peroxide (Crest Whitestrips Supreme) was introduced. This advanced system carries a thinner but more concentrated gel on each strip, resulting in a relatively similar total amount of peroxide as compared to other strip systems. This 2-variable change, higher concentration gel with lowered gel volume translates to improved whitening without adversely affecting oral soft tissue tolerability and irritation. This paper provides an integrated review of 9 comparative clinical trials evaluating the whitening response (six trials) and safety (nine trials) of this novel vital bleaching system. Efficacy results for the 14% hydrogen peroxide strips were significantly (p<0.05) better than the placebo or pooled positive controls evaluated in the clinical trials assessing tooth color or shade. Adverse events were similar in type to the other vital bleaching systems. Overall, the research of 408 patients showed generally better efficacy and similar to or better tolerability for the 14% hydrogen peroxide strips compared to a selected group of marketed positive bleaching controls.

This clinical trial tested the efficacy and safety of a professional strip-based whitening system (Crest Whitestrips Supreme) using the manufacturer&#39;s recommended 3-week treatment regimen. These strips have a higher concentration, but a similar amount of hydrogen peroxide relative to Crest Professional Whitestrips, because the thickness of the gel on strips is reduced. Tooth whitening was measured using the value-oriented VITA Classic Shade Guide before and after treatment. Twenty-nine subjects were treated with either Crest Whitestrips Supreme or placebo strips that did not contain hydrogen peroxide. Participants in the experimental group achieved a mean lightening of nearly eight VITA shades relative to placebo, with minimal side effects.

ABSTRACTPurpose:: This study was performed to evaluate the influence of accelerated aging on the color and translucency parameter (TP) of bleaching-shade resin composites.This study was performed to evaluate the influence of accelerated aging on the color and translucency parameter (TP) of bleaching-shade resin composites.Materials and Methods: Thirty-three bleaching shades and two control conventional shades of microhybrid (MH) and microfill (MF) resin composite specimens (n = 5) were aged in an accelerated aging chamber set to standard CAM 180 cycles. One side of each specimen was evaluated for surface color and TP changes compared with baseline in increments of 150 kJ/m2 for intervals up to 450 kJ/m2 using a spectrophotometer. A ΔE* 3.7 was considered to be a poor match, and the total TP range was divided into three equal parts representing low, medium, and high translucency. Data were analyzed with analysis of variance.Thirty-three bleaching shades and two control conventional shades of microhybrid (MH) and microfill (MF) resin composite specimens (n = 5) were aged in an accelerated aging chamber set to standard CAM 180 cycles. One side of each specimen was evaluated for surface color and TP changes compared with baseline in increments of 150 kJ/m2 for intervals up to 450 kJ/m2 using a spectrophotometer. A ΔE* 3.7 was considered to be a poor match, and the total TP range was divided into three equal parts representing low, medium, and high translucency. Data were analyzed with analysis of variance.Results: Compared to the baseline, ΔL*, Δa*, Δb*, and ΔE* ranges at 450 kJ/m2 were -0.8 to 5.0, -0.6 to 1.2, -8.3 to 0.0, and 0.7 to 8.6 for MH and 0.2 to 1.3, 0.1 to 1.3, -2.5 to 1.1, and 1.7 to 2.7 for MF composites. Scheffé's S intervals (p < =.05) for comparisons of ΔL*, Δa*, Δb*, and ΔE* values of MH composites between baseline and 450 kJ/m2 were 1.6, 0.6, 1.7, and 1.5, respectively. Corresponding Tukey-Kramer intervals for MF composites were 0.7, 0.3, 0.6, and 0.6, respectively. TP values at baseline ranged from 0.9 to 4.3 for MH and from 1.4 to 2.2 for MF composites, whereas ΔTP for baseline minus 450 kJ/m2 ranged from -1.1 to 1.7 for MH and from -0.1 to 0.3 for MF composites. Scheffé's S interval (p < =.05) for comparisons of ΔTP values of MH composites for baseline minus 450 kJ/m2 was 1.0. Corresponding Tukey-Kramer interval for MF composites was 0.4.Conclusions: Aging-dependent color changes at 450 kJ/m2 were above the limit that indicated a poor match for 18/26 MH, while corresponding values for microfills were within acceptable range. Accelerated aging generally caused decreases in L* (specimens became darker) and a* values (specimens became redder), while b* values increased (specimens became more chromatic) for both MH and MF composites. TP was relatively stable during aging for both MH and MF composites.Compared to the baseline, ΔL*, Δa*, Δb*, and ΔE* ranges at 450 kJ/m2 were -0.8 to 5.0, -0.6 to 1.2, -8.3 to 0.0, and 0.7 to 8.6 for MH and 0.2 to 1.3, 0.1 to 1.3, -2.5 to 1.1, and 1.7 to 2.7 for MF composites. Scheffé's S intervals (p < =.05) for comparisons of ΔL*, Δa*, Δb*, and ΔE* values of MH composites between baseline and 450 kJ/m2 were 1.6, 0.6, 1.7, and 1.5, respectively. Corresponding Tukey-Kramer intervals for MF composites were 0.7, 0.3, 0.6, and 0.6, respectively. TP values at baseline ranged from 0.9 to 4.3 for MH and from 1.4 to 2.2 for MF composites, whereas ΔTP for baseline minus 450 kJ/m2 ranged from -1.1 to 1.7 for MH and from -0.1 to 0.3 for MF composites. Scheffé's S interval (p < =.05) for comparisons of ΔTP values of MH composites for baseline minus 450 kJ/m2 was 1.0. Corresponding Tukey-Kramer interval for MF composites was 0.4.Conclusions: Aging-dependent color changes at 450 kJ/m2 were above the limit that indicated a poor match for 18/26 MH, while corresponding values for microfills were within acceptable range. Accelerated aging generally caused decreases in L* (specimens became darker) and a* values (specimens became redder), while b* values increased (specimens became more chromatic) for both MH and MF composites. TP was relatively stable during aging for both MH and MF composites.

The popular media&#39;s influence on social norms with respect to people&#39;s appearance is likely to have played a part in the recent growth of cosmetic dentistry. This study was designed to investigate the manner in which the popular media have affected the perception and delivery of aesthetic dentistry in New Zealand. A nationwide survey was posted to a random sample of 600 general dental practitioners (GDPs) requesting sociodemographic details and information on the types of aesthetic dental procedures provided and the demand for those. Information was also sought on GDPs&#39; awareness of television programmes and reality &quot;makeover&quot; television shows (such as &quot;Extreme Makeover&quot;) covering issues related to aesthetic dentistry, together with the impact of such programmes (and that of different print media) on their patients&#39; perceptions of, and demand for, aesthetic dentistry. The response rate was 81.2 percent. A majority of participants perceived an incr...

The esthetic treatment of darkened anterior teeth represents a great challenge to dentists, because dental materials ideally should match the natural teeth. The optical behavior of the final restoration is determined by the color of the underlying tooth structure, the color of the luting agent, and the thickness and opacity of the ceramic material used. This article reports a case in which veneers and full crowns made of heat-pressed, lithium disilicate glass-ceramic were used for the esthetic rehabilitation of anterior discolored teeth. The patient was referred for treatment with defective anterior composite resin restorations, provisional acrylic resin crowns, darkening of the gingival margins, and uneven gingival contours. The multidisciplinary treatment plan included dental bleaching, periodontal plastic surgery to create gingival symmetry, and indirect all-ceramic restorations using high-opacity lithium disilicate glass-ceramic ingots. The treatment was successful and an excell...

Clinical indications for direct composite restorations have expanded in the last decade, primarily due to improved physical, aesthetic, and handling properties. As a consequence, their increased predictability has encouraged clinicians to progressively abandon amalgam. This article presents a clinical protocol to reconstruct severely damaged endodontically treated and bleached anterior teeth with particular emphasis on placement and curing techniques. Common complications encountered during the bonding of teeth that have undergone endodontic and bleaching treatments are also analyzed.

Discrepancies in tooth size and shape can interfere with smile harmony. Composite resin can be used to improve the esthetics of the smile at a low cost while offering good clinical performance. This article presents an approach for restoring and correcting functional, anatomic, and esthetic discrepancies with minimal intervention, using composites and a direct adhesive technique. This conservative restorative procedure provided the patient with maximum personal esthetic satisfaction.

Dental fluorosis manifests itself as white stains on the enamel of teeth exposed to excessive doses of fluoride during their formation. Fluorosis usually occurs as a result of the ingestion of dentifrices, gels and fluoridated solutions. It may be diagnosed as mild, moderate or severe, and in some cases, it may cause the loss of the surface structure of dental enamel. The aim of this study was to report the clinical case of a female patient of 18 years with moderate fluorosis, whose smile was reestablished by the use of an enamel microabrasion technique, followed by in-office bleaching. A microabrasion technique with 6% hydrochloric acid associated with silica carbide showed to be a safe and efficient method for removing white fluorosis stains, while dental bleaching was useful for obtaining a uniform tooth shade. The association of these techniques presented excellent results and the patient was satisfied. Both techniques are painless, fast and easy to perform, in addition to prese...

To examine the whitening efficacy of three whitening agents in combination with six different photoactivation systems. Bleaching techniques have achieved significant advances using photoactivation with coherent or incoherent radiation sources. Quick White, Ena White Power, and Opalescence Endo bleaching agents, all containing 35% hydrogen peroxide, were stimulated with halogen lamp, light-emitting diode (LED), low-power diode laser, and neodymium: yttrium-aluminum-garnet (Nd:YAG), second harmonic of Nd:YAG, and Er:YAG lasers. One hundred twenty-six extracted human incisors were treated, and color change, pulpal temperature, and enamel morphological alterations were evaluated. Only the groups that were photoactivated using a diode laser, halogen lamp, and LED showed statistically significant differences (p &amp;amp;amp;amp;amp;amp;amp;lt; 0.005) in color change when compared with the control group (without photoactivation). All whitening protocols were safe with regard to the increase in pulpal temperature. Scanning electron microscopy showed no evidence of effects on the integrity of enamel. The source of irradiation is more relevant than the bleaching agent for efficient tooth whitening. In addition, photoactivation with LED was found to be the best choice: it yielded significant change in color with only a minor increase in pulpal temperature.

The aim of this study was to determine the pH of several commercially available in-office and at-home dental bleaching products stored at room temperature and refrigerated. The products were divided into in-office (n=09) and at-home (n=12) bleaching gels and submitted to two different temperatures, namely, room temperature (23 degrees C +/- 1 degree C) and refrigeration temperature (4 degrees C +/- 1 degree C). The pH was measured using a portable pH meter with a direct electrode, which was calibrated with standard buffer solutions at pH 4.0 and 7.0 and recalibrated for each new product. The pH of the dental bleaching products tested ranged from 2.39 +/- 0.10 to 6.52 +/- 0.09, and was found to vary significantly both with temperature and between bleaching agents. Most of the bleaching gels were found to be acidic, especially the in-office bleaching products, and the refrigerated at-home gels had the highest pH values. Thus, we conclude that the storage temperature affected the pH of...

The search for esthetic treatment has persisted in the routine of dental professionals. Following this trend, dental patients have sought treatment with the primary aim of improving smile esthetics. The aim of this article is to present a protocol to assess patient&#39;s smile: The 10 Commandments of smile esthetics.

This study describes a preclinical investigation with laser-activated bleaching agent for discolored teeth. Bleaching techniques involve a broad-spectrum approach utilizing hydrogen peroxide (3-38%) with or without heat or laser, carbamide peroxide (10-30%), or a mixture of sodium perborate and hydrogen peroxide. Extracted human maxillary central incisors were selected. In the bleaching experiment, 38% hydrogen peroxide was used. Two different laser

This study evaluates the effect of calcium hydroxide dressing on microleakage of composite restorations following non-vital bleaching. A total of 45 sound extracted human maxillary central incisors underwent endodontic treatment. The teeth were randomly divided into three groups (n=15). In group 1, access cavities were restored with composite. In group 2, the teeth underwent a bleaching procedure for one week before being restored with composite. In group 3, following a bleaching procedure, calcium hydroxide paste was placed in the pulp chamber for one week. The teeth were then restored with composite. The specimens were subjected to a dye leakage test. The data was analyzed using Kruskal-Wallis and Mann-Whitney U tests. There were significant differences between the groups (P&lt;0.0005). No statistically significant differences were found between groups 2 and 3, while the differences between other groups were significant. The bleaching agent increased microleakage of composite rest...

Purpose: To evaluate the tooth whitening benefit through stain removal delivered by a marketed whitening dentifrice (Crest Vivid White) used twice a day or a combination regimen of two marketed dentifrices (Crest Vivid White Night used at night and Crest Cavity Protection used in the morning) relative to a positive control over a 2-week period. Methods: Both studies were randomized, two treatment, parallel group, examiner-blind, 2-week clinical trials involving 22 and 30 healthy adults with longstanding visible extrinsic stain on the facial surfaces of at least six anterior teeth. In each study, subjects were randomized to one of two treatments: a sodium fluoride/sodium hexametaphosphate whitening dentifrice used alone (Study 1) or in combination with a cavity protection dentifrice (Study 2) with an ADA reference manual toothbrush versus a control power toothbrush with a cavity protection dentifrice (both studies). Results: In both studies, all treatment groups statistically significantly (P < 0.001) reduced baseline stain scores following 1 and 2 weeks of brushing. After 2 weeks, the whitening dentifrice used twice daily had a median percent stain removal of 90% and the night-time whitening dentifrice (used once a day) in combination with the cavity protection dentifrice had a median percent stain removal of 85% while powered toothbrush groups showed median percent stain removal of 88-89% in both studies. Stain removal scores after 1 and 2 weeks of brushing did not differ significantly between the two treatment groups in either study.

Invasive cervical root resorption is an uncommon external root resorption which initiates at the cervical aspect of the tooth. This case report involves a case of cervical root resorption which was initially misdiagnosed and managed as cervical root caries. It was later diagnosed with cone beam CT and the lesion microsurgically removed and restored with resin modified glass ionomer cement. The importance of increasing awareness of this uncommon pathology and the role of cone beam CT in mapping the extent of the lesion is emphasised.

Tray bleaching of vital teeth performed at home by the patient under the dentist s supervision, whether alone or in combination with any of the in-office techniques, provides an interesting alternative to other methods employed in this type of dental treatment. This bleaching procedure applies low-concentration peroxides to the enamel by means of a custom-made mouth tray specifically designed for this purpose. The aim of this study is to examine and compare two commercially-available bleaching products, at equivalent concentrations, for use in this technique: VivaStyle (Vivadent) and FKD (Kin); the former is a 10% carbamide peroxide and the latter a 3.5% hydrogen peroxide formulation. It examines the parameters that must be monitored during the application of this type of procedure and presents 6 cases (3 treated with one of the above-mentioned products and the other 3 with the other), establishing the bleaching power of the products and the appearance and intensity of post-operator...

To measure the efficacy of the whitening effect of non-oxidizing and non-acidic nano- and micro-hydroxyapatite materials on the enamel surface and to evaluate the surface changes after treatment. Three hydroxyapatite suspensions and two hydroxyapatite mixtures in dissolvable polymer films were applied to a total of 30 extracted caries-free human premolars. After the last material application, a hydrodynamic shear force was generated and applied for 2 minutes to all teeth to simulate mechanical loading of the surface. The tooth color was measured with a dental spectrophotometer. The mean changes of the L*a*b* values between different measurements in each group were expressed as delta E and were analyzed with ANOVA and the Tukey&#39;s post-hoc test. The groups of the nano-hydroxyapatite, the hydroxyapatite-nanocrystals and the tricalcium-phosphate exhibited significant delta E values between baseline and after hydrodynamic shear force application (P&lt;0.05). In conclusion, the materi...