In-office dental bleaching in adolescents using 6% hydrogen peroxide with and without gingival barrier: a randomized double-blind clinical trial

Abstract At low concentrations used for in-office bleaching gels, such as 6% HP, gingival barrier continues to be performed. If we take into account that, in the at-home bleaching technique, no barrier is indicated, it seems that the use of a gingival barrier fails to make much sense when bleaching gel in low concentration is used for in-office bleaching. Objective This double-blind, split-mouth, randomized clinical trial evaluated the gingival irritation (GI) of in-office bleaching using 6% hydrogen peroxide (HP) with and without a gingival barrier in adolescents, as well as color change and the impact of oral condition on quality of life. Methodology Overall, 60 participants were randomized into which side would or would not receive the gingival barrier. In-office bleaching was performed for 50 minutes with 6% HP in three sessions. The absolute risk and intensity of GI were assessed with a visual analogue scale. Color change was assessed using a digital spectrophotometer and color guides. The impact of oral condition on quality of life was assessed using the Brazilian version of the Oral Health Impact Profile (α=0.05). Results The proportion of patients who presented GI for the "with barrier" group was 31.6% and for the "without barrier" group, 30% (p=1.0). There is an equivalence for the evaluated groups regarding GI intensity (p<0.01). Color change was detected with no statistical differences (p>0.29). There was a significant impact of oral condition on quality of life after bleaching (p<0.001). Conclusions The use or not of the gingival barrier for in-office bleaching with 6% HP was equivalent for GI, as well as for bleaching efficacy, with improvement in the impact of oral condition on quality of life.

Estética y color en dientes calcificados: Informe de tres casos clínicos con blanqueamiento / Esthetics and shade in calcified teeth. Report of three clinical cases with whitening

Objetivo: El objetivo de este informe es presentar tres casos clínicos de piezas dentarias anterosuperiores calcificadas y con decoloración, resueltos según tres protocolos clínicos de blanqueamiento diferentes, con un mismo fin: devolver la estética al sector anterior. Casos clínicos: Cada una de las tres situaciones clínicas de decoloración dentaria se trató siguiendo un protocolo diferente. A partir del análisis clínico y radiográfico, se estableció un diagnóstico y un plan de tratamiento acorde. Todos los casos evolucionaron de manera favorable y siguen siendo controlados periódicamente. Conclusiones: En casos clínicos como los que se muestran en este trabajo, en los que el conducto y la cámara pulpar están calcificados u obliterados totalmente, sería posible realizar blanqueamiento interno y externo para recuperar la armonía óptica de forma conservadora. Este tipo de tratamientos permitiría responder a la alta prevalencia de demanda estética debido a traumatismos y cambios de coloración (AU)

Aim: To present three clinical cases of discoloration in calcified upper anterior teeth, that were resolved following different clinical protocols for teeth whitening to return the aesthetics of the anterior teeth. Clinical cases: Each clinical case of discoloration was treated following a different treatment protocol based on a correct clinical and radiographic diagnosis. All cases had a favourable outcome and have no regular review. Conclusion: In clinical cases as those presented in this article where the canal and pulp chamber are totally calcified or obliterated, it was possible to perform internal and or external whitening to restore optical harmony in a conservative way. This type of treatment would allow responding to the high prevalence of aesthetic demand due to trauma and colour changes (AU)

Over-the-counter tooth whitening agents: a review of literature

Abstract There is an increased accessibility of over-the-counter (OTC) whitening agents with very little data in the literature regarding their effectiveness. This review was done to determine their effectiveness of the predominant OTC whitening agents from 2006 until 2018 where a comparison of each agent was made with a placebo, no treatment or with other OTC whitening agents. The major categories of OTC whitening agents such as dentifrices, whitening strips and paint on gels. Dentist prescribed bleaching applied at home and in-office bleaching studies and studies that demonstrated whitening products to participants were excluded. Articles were searched for in the databases of Medline (Ovid), PubMed, the Cochrane Library and Cochrane Central Register of Controlled Trials. Twenty-four articles were included in the systematic review and the quality of studies was determined by the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) ranking criteria. Compared to other OTC, strips are reported to be effective. Two studies determined whitening strips to be effective. Whitening strips have been shown to be effective when compared with placebos and other OTC whitening agents. Dentifrices are effective in changing the shade of the tooth "by removing extrinsic stains" when compared to a placebo and non-whitening dentifrices, but they are not as effective in comparison to whitening strips. There is a lack of evidence with regards to the effectiveness of paint-on gels. While there is some evidence that OTC can alter shade in the short term, there is a need for better-designed studies.

Resumo Há um aumento da acessibilidade dos agentes clareadores de venda livre com poucos dados na literatura sobre sua eficácia. Esta revisão foi feita para determinar a eficácia dos agentes clareadores de venda livre predominantes de 2006 a 2018, onde foi feita uma comparação de cada agente com um placebo, sem tratamento ou com outros agentes clareadores de venda livre. As principais categorias de agentes clareadores de venda livre, como dentifrícios, tiras branqueadoras e géis. Estudos em que o dentista prescreveu clareamento caseiro e em consultório, e estudos que demonstraram os agentes clareadores para os participantes. Os artigos foram pesquisados ​​nas bases de dados do Medline (Ovid), PubMed, Cochrane Library e Cochrane Central Register of Controlled Trials. Vinte e quatro artigos foram incluídos na revisão sistemática e a qualidade dos estudos foi determinada pelo critério de classificação GRADE (Classificação de Recomendações, Avaliação, Desenvolvimento e Avaliações). Em comparação com outros clareadores de venda livre, as tiras são relatadas como eficazes. Dois estudos determinaram que as tiras de clareamento são eficazes. As tiras de clareamento mostraram-se eficazes quando comparadas com placebos e outros agentes clareadores de venda livre. Os dentifrícios são eficazes na mudança da tonalidade do dente "removendo manchas extrínsecas" quando comparados a dentifrícios com placebo e sem clareamento, mas não são tão eficazes em comparação com as tiras de clareamento. Há uma falta de evidência com relação à eficácia dos géis de tinta. Embora exista alguma evidência de que os clareadores de venda livre possa alterar a tonalidade no curto prazo, há necessidade de estudos melhor projetados.

Ação de dentifrício com peróxido de hidrogênio sobre resina composta nanoparticulada / Action dentifrices whit hydrogen peroxide in composite resin nanoparticulate

Introdução: O peróxido de hidrogênio é o agente químico mais utilizado no clareamento dental. Além do uso em consultório, também está associado a agentes branqueadores presentes nos dentifrícios. Objetivo: Avaliar in vitro a ação de diferentes dentifrícios branqueadores sobre a cor, rugosidade e massa de uma resina composta nanoparticulada após escovação simulada por 6, 12 e 24 meses. Metodologia: Foram confeccionados 40 corpos de prova da resina composta nanoparticulada FILTEK Z350 XT, divididos em 04 grupos (n=10): grupo de controle (GC-água deionizada) e grupos de teste (GT1- Colgate Total 12, GT2- Colgate Luminous White Instant e GT3- Colgate Luminous White Advanced). Os corpos de prova foram escurecidos com café solúvel e submetidos a escovação simulada por 6,12 e 24 meses. Avaliações de cor, rugosidade e massa foram realizadas após cada período de escovação. Resultados: Houve diferença significativa na alteração de cor nos grupos de teste, contudo o GT2 apresentou diferença estatística quando comparado com o GT1 e GT3. Os dentifrícios não promoveram alterações significativas na rugosidade e na massa dos corpos de prova de resina nanoparticulada, após os períodos de escovação simulada nos grupos de teste. Conclusão: A escovação simulada com dentifrícios de uso convencional e branqueadores foi eficaz na remoção da pigmentação extrínseca em resina composta nanoparticulada, tornando-a mais clara, sem causar danos à sua estrutura. Contudo, a presença do agente químico clareador peróxido de hidrogênio não melhorou a percepção visual da cor da resina quando comparado ao dentifrício branqueador que continha a associação de agentes branqueadores mecânicos e óptico.

Introduction: Hydrogen peroxide is the most commonly used chemical agent in tooth whitening. In addition to office use, it is also associated with whitening agents present in toothpastes. Objective: To evaluate in vitro the action of different whitening dentifrices on the color, roughness and mass of nanoparticulate composite resin after simulated brushing for 6, 12 and 24 months. Methodology: Forty specimens of FILTEK Z350 XT nanoparticulate composite resin were made, divided into 04 groups (n = 10): control group (GC-deionized water) and test groups (GT1- Colgate Total 12, GT2- Colgate Luminous White Instant and GT3- Colgate Luminous White Advanced). The specimens were darkened with instant coffee and submitted to simulate brushing for 6, 12 and 24 months. Color, roughness and mass evaluations were performed after each brushing period. Results: There was a significant difference in color change in the test groups and GT2 showed statistical difference compared to GT1 and GT3. The dentifrices did not promote significant changes in the roughness and mass of the nanoparticulate resin specimens after the simulated brushing periods in the test groups. Conclusion: Simulated brushing with conventional toothpastes and bleaches was effective in removing extrinsic pigmentation in nanoparticulate composite resin, making it clearer without causing damage to its structure. However, the presence of the hydrogen peroxide bleaching agent did not improve the visual perception of resin color when compared to the bleaching dentifrice that contained the combination of mechanical and optical bleaching agents.

Técnica modificada de blanqueamiento de dientes vitales empleando DMC peróxido de hidrógeno al 35% / Modified technique for vital teeth whitening using DMC 35% hydrogen peroxide

RESUMEN Introducción: Los fabricantes de DMC peróxido de hidrógeno al 35% proponen una técnica de blanqueamiento de dientes vitales que malgasta el producto y el tiempo de tratamiento, por lo que una técnica modificada traería beneficios materiales y económicos para operadores y pacientes. Objetivo: Describir la aplicación de una técnica modificada de blanqueamiento dental en dientes vitales utilizando DMC peróxido de hidrógeno al 35%. Presentación del caso: Paciente femenina de 44 años a quien se le realiza un tratamiento de blanqueamiento dental con una modificación de la técnica propuesta por el fabricante del producto. La modificación consistió en el empleo de una sola aplicación del gel blanqueador, en lugar de tres aplicaciones, y aumento del tiempo de exposición a 40 min, en lugar de los 10-15 min recomendados por el fabricante. Las variables empleadas para evaluar el tratamiento y sus resultados fueron definidas por el registro del color inicial y posterior al tratamiento, y por la satisfacción de la paciente con el resultado del mismo. Los dientes expuestos al tratamiento se encontraban con tejidos de esmalte sanos sin exposición de la dentina en ninguna de las superficies. Conclusiones: La modificación descrita de la técnica de blanqueamiento propuesta por el fabricante con DMC Lase Peroxide Sensy (peróxido de hidrógeno al 35%) consistente fundamentalmente en el empleo de una sola aplicación y aumento del tiempo de exposición en una sola sesión de tratamiento, aportó un ahorro del producto sustancial y condujo al cambio de la coloración final de los dientes, con la plena satisfacción de la paciente y protegido el esmalte superficial de sus dientes tratados.

ABSTRACT Introduction: The manufacturers of DMC 35% hydrogen peroxide propose a whitening technique of vital teeth that waste the product and the time of treatment, so a modified technique would bring material and economic benefits for operators and patients. Objective: To describe the application of a modified technique in vital teeth whitening using DMC 35% hydrogen peroxide. Case presentation: A 44-year-old female patient undergoing a whitening treatment with a modification of the technique proposed by the product manufacturer. The modification consisted in the use of a single application of the bleaching gel instead of three applications, and an increase in the exposure time to 40 min instead of the 10-15 min recommended by the manufacturer. The variables used to evaluate the treatment and its results were defined by the registration of the color before and after treatment and also by the satisfaction of the patient with the result. The teeth exposed to treatment were found with healthy enamel tissues without dentine exposure on any of the surfaces. Conclusions: The described modification of the whitening technique proposed by the manufacturer with DMC Lase Peroxide Sensy (35% hydrogen peroxide) consisting mainly on the use of a single application and the increase of the exposure time in a single treatment session contributed to a considerable saving of the product and led to the change of the final coloring of the teeth, which resulted in the full satisfaction of the patient and the protection of her exposed teeth and tissues.

Efecto del Extracto de Maíz Morado "Chicha Morada" durante el blanqueamiento Dental. In vitro / Effect of Purple Corn Beverage "Chicha Morada" During Dental Bleaching. In vitro

RESUMEN: El resultado del tratamiento de blanqueamiento dental puede verse afectado en pacientes que consumen bebidas pigmentantes durante el tratamiento. El objetivo de este trabajo consistió en valuar el efecto in vitro de la exposición al extracto de maíz morado (chicha morada) sobre el color del esmalte humano, durante y después del tratamiento del blanqueamiento dental con peróxido de hidrógeno al 35 %. Se utilizaron 48 dientes humanos, divididos en grupos según la bebida a la que se expuso: Extracto de maíz morado peruano (MM), té verde (T) y agua destilada (A); la mitad de los especímenes expuestos a cada bebida fueron sometidos a blanqueamiento dental con peróxido de hidrógeno al 35 % durante los primeros días de exposición a la pigmentación, resultando en los siguientes grupos: Grupo A: Sin blanqueamiento + maíz morado, Grupo B: Sin blanqueamiento + té verde, Grupo C: Sin blanqueamiento + agua destilada, Grupo D: Con blanqueamiento + maíz morado, Grupo E: Con blanqueamiento + té verde, Grupo F: Con blanqueamiento + agua destilada. Los cambios de color se midieron con un espectrofotómetro digital (VITA Easyshade Advance 4.0, VITA, Alemania) antes del blanqueamiento, durante el blanqueamiento, finalizado el blanqueamiento y al final de los 36 días de exposición a los pigmentos. Según el ∆E, el extracto de maíz morado difiere significativamente con el agua destilada (p < 0,05). Con respecto al grado de luminosidad, el extracto de maíz morado con blanqueamiento presentó los menores valores de luminosidad (p < 0,05). En cuanto al croma, no hubo diferencias entre los grupos (p > 0,05). La exposición al extracto de maíz morado pigmenta los dientes, durante el blanqueamiento el extracto de maíz morado no afecta el tratamiento, pero si la exposición continúa luego del blanqueamiento dental, el color de los dientes se verá afectado.

ABSTRACT: The result of tooth whitening treatment may be affected in patients who consume staining drinks during treatment. The aim of this work was to evaluate the in vitro effect of the exposure to purple corn extract (chicha morada) on human enamel color, during and after the treatment of teeth whitening with 35 % hydrogen peroxide. Forty-eight human teeth were used, divided into groups according to the drink to which it was exposed: Peruvian purple corn extract (MM), green tea (T) and distilled water (A); half of the specimens exposed to each drink were subjected to tooth whitening with 35 % hydrogen peroxide during the first days of exposure to pigmentation, resulting in the following groups: Group A: Without bleaching + purple corn, Group B: Without whitening + green tea, Group C: No whitening + distilled water, Group D: With whitening + purple corn, Group E: With whitening + green tea, Group F: With whitening + distilled water. The color changes were measured with a digital spectrophotometer (VITA Easyshade Advance 4.0, VITA, Germany) before bleaching, during whitening, after whitening and at the end of 36 days of exposure to pigments. According to the ∆E, the purple corn extract differs significantly with the distilled water (p <0.05). Regarding the degree of luminosity, the purple corn extract with whitening presented the lowest luminosity values (p <0.05). As for the chroma, there were no differences between the groups (p> 0.05). Exposure to purple corn extract pigments the teeth, during whitening the purple corn extract does not affect the treatment, but if the exposure continues after tooth whitening, the color of the teeth will be affected.

Avaliação in vitro do efeito de dentifrícios branqueadores contendo blue covarine sobre o esmalte dentário bovino / In vitro evaluation of the effect of bleaching dentifrices containing blue covarine on bovine dental enamel

Introdução: O blue covarine é um agente branqueador que promove mudanças ópticas na superfície dos dentes, associado aos abrasivos dos dentifrícios, colaborando para o branqueamento dentário. Objetivo: Determinar as alterações de cor, rugosidade e massa do esmalte bovino, após escovação simulada com dentifrícios branqueadores contendo blue covarine nos tempos 6, 12 e 24 meses. Material e método: 80 corpos de prova (CP) foram divididos em 8 grupos (n = 10): grupo controle (GC-água) e 7 grupos teste (GT1-Colgate Total 12, GT2-Oral-B 3D White Perfection, GT3-Colgate Luminous Instant White, GT4-Close Up White Diamond Attraction, GT5-Close Up White-Glacier Fresh, GT6-Sorriso Xtreme White, GT7-Colgate Luminous White Advanced). Os CP foram escurecidos com café e submetidos à escovação simulada por 6, 12 e 24 meses. As avaliações de cor, rugosidade e massa foram realizadas após cada período de escovação. Resultado: Nenhum dentifrício teste promoveu alterações significativas na rugosidade e massa dos CP, contudo, quando comparados ao GC todos promoveram branqueamento significativo. A comparação dos grupos teste não demonstrou diferença significativa na variação de cor entre GT1, GT2, GT3, GT5, GT6 e GT7 nos tempos estudados. O GT4 apresentou comportamento variável de acordo com o tempo, não diferindo estatisticamente de GT3 aos 6, 12 e 24 meses, de GT6 aos 6 e 12 meses e de GT7 aos 12 meses. Conclusão: O efeito branqueador dos dentifrícios contendo blue covarine , após 2 anos de escovação, parece estar relacionado principalmente com a sua associação aos agentes branqueadores mecânicos, que promoveram o polimento das superfícies dentárias.

Introduction: Blue covarine is a bleaching agent that produces optical changes on the surface of the teeth, associated with the abrasives of the dentifrice leading to tooth whitening. Objective: To determine the changes in colour, roughness and mass of the bovine enamel, after simulated brushing with dentifrices - containing blue covariate bleaching - for 6, 12 and 24 months. Material and method: 80 specimens were divided into 8 groups (n = 10): Control group (CG-water) and 7 test groups (TG1-Colgate Total 12, TG2-Oral-B 3D White Perfection, TG3 -Colgate Luminous Instant White, TG4-Close Up White Diamond Attraction, TG5-Close Up White Now-Glacier Fresh, TG6-Sorriso Xtreme White, TG7-Colgate Luminous White Advanced). The specimens were stained with coffee and subjected to simulated brushing for 6, 12 and 24 months. The colour, roughness and mass evaluations were performed after each brushing period. Result: No dentifrice test produced significant alterations in the roughness and mass of the specimens, however, when compared to CG, all of themproduced significant whitening. The comparison of the test groups did not show a significant difference in the colour variation between TG1, TG2, TG3, TG5, TG6 and TG7 in the study. The TG4 presented a variable behavior according to time, not statistically differing from TG3 at 6, 12 and 24 months, neither from TG6 at 6 and 12 months nor from TG7 at 12 months. Conclusion: The whitening effect of dentifrices containing blue covarine, after long periods of brushing, seems to be related mainly to association with mechanical bleaching agents, which, despite abrasives, did not damage the dental structure.

Adhesión posclareamiento y el efecto de la aplicación de antioxidantes / Postbleaching bonding and the effect of applying antioxidants

Con el avance en las técnicas de blanqueamiento dental, el advenimiento de nuevos biomateriales capaces de lograr resultados estéticos aceptables por los pacientes; sabiendo que en la operatoria dental muchos autores priorizan iniciar dicho tratamiento restaurador con el aclareamiento dental. Como consecuencia de este último, se ha demostrado que puede producir alteraciones en la adhesión de las resinas compuestas al esmalte dental, proceso dependiente de la concentración residual de radicales libres de oxígeno en la superficie y subsuperficie del esmalte por la degradación del peróxido de hidrogeno. Existe reducción en la fuerza de adhesión del esmalte blanqueado cuando el procedimiento adhesivo se realiza inmediatamente después de un blanqueamiento dental. Sin embargo, se sabe que los antioxidantes ayudan a inactivar los radicales libres de oxígeno residual para tratar de revertir las consecuencias físicoquímicas indeseables que producen los blanqueadores sobre la estructura dental y la adhesión. El objetivo de este trabajo de divulgación es analizar conceptos sobre la interacción entre adhesión posaclaramiento y de qué manera controlar esas interacciones (AU)

With the advancement in teeth whitening techniques, the advent of new biomaterials able to achieve aesthetic results acceptable to patients; knowing that in dental surgery many authors prioritize initiating said restorative treatment with dental clarification, and as a consequence of the latter it has been demonstrated that it can produce alterations in the adhesion of composite resins to dental enamel, a process dependent on the residual concentration of radicals free of oxygen on the surface and subsurface of the enamel by the degradation of hydrogen peroxide. There is a reduction in the adhesion strength of the bleached enamel when the adhesive process is performed immediately after tooth whitening. However, it is known that antioxidants help to inactivate free radicals of residual oxygen to try to reverse the undesirable physico-chemical consequences that bleaches produce on tooth structure and adhesion. The objective of this dissemination work is to analyze concepts on the interaction between post-clarification adhesion and treatments to control these interactions (AU)

Mouthwashes with hydrogen peroxide are carcinogenic, but are freely indicated on the internet: warn your patients!

It all began in Ancient Egypt where people used to bleach their teeth with antiseptic mouthwashes made of urea from human urine. Teeth harmony is promoted by expression of feelings, communication, a real window of the brain and its content! Tooth bleaching products are medicines, not cosmetics! Mouth washing with hydrogen peroxide is an illogical and dangerous procedure! Hydrogen peroxide must be used in one's mouth only when employed by a dentist who has been properly instructed to protect the mucosa, preventing it from receiving these products. How and for how long these products are going to be used require caution in order to avoid or decrease any adverse effects on the tissues. Many websites instruct people on how to purchase and prepare hydrogen peroxide so that it is used as an antiseptic mouthwash and tooth bleaching agent. Some websites even refer to dentists as "exploiters", accusing them of not instructing patients properly. In this article, we aim at providing evidence and information upon which dentists and assistants may base their thinking as well as their opinion and procedures regarding "the indiscriminate and free use of hydrogen peroxide in the mouth, on teeth and oral mucosa". Those websites, blogs and social network profiles trespass the limits of public trust and should be immediately sued by the government for committing a crime against public health.

Tudo começou no Egito antigo, onde procurava-se clarear os dentes com bochechos antissépticos com ureia da urina humana. Os dentes se harmonizam com expressões de sentimentos, na comunicação, como uma verdadeira vitrine do cérebro e seus conteúdos! Clareadores dentários são medicamentos, e não cosméticos! Bochecho com água oxigenada representa um procedimento improcedente e perigoso! O uso do peróxido de hidrogênio ou água oxigenada na boca deve ser feito diretamente pelo profissional da Odontologia, treinado para proteger as mucosas contra o contato desses produtos. O tempo e a forma de uso requerem cuidados, para se proteger ou diminuir os efeitos indesejáveis sobre os tecidos. Vários websites "ensinam" como adquirir e preparar água oxigenada para fazer bochechos antissépticos e clarear os dentes. Alguns websites se referem ao profissional da Odontologia como um "explorador", por não ensinar isso ao paciente. No presente artigo, procuraremos informar e dar fundamentos para que os profissionais da Odontologia e auxiliares possam embasar suas reflexões, opiniões e condutas relacionadas ao tema "uso indiscriminado e livre de peróxido de hidrogênio na boca sobre os dentes e mucosa bucal". Esses websites, blogs e perfis em redes sociais abusam da fé pública e deveriam ser acionados judicialmente, imediatamente, pelas autoridades públicas, pelo crime contra a saúde das pessoas.

Clarifications, guidelines and questions about the dental bleaching "associated" with orthodontic treatment

With regard to the best moment for carrying out or recommending dental bleaching to orthodontic patients, some explanations and orientations are given in order to answers the following questions: 1) Why orthodontic treatment completion is considered the best opportunity for carrying out the procedure? 2) Why dental bleaching should not be performed immediately before orthodontic treatment? 3) If that would be possible at any special case, what would that be? 4) Why dental bleaching should not be performed during orthodontic treatment? 5) If that would be possible at any special case, what would that be? This article highlights why it is essential to protect both the mucosa and the cervical region, regardless of the moment when dental bleaching is performed, whether associated with orthodontic treatment or not. The "how", "why" and "if" of whether or not it is convenient to perform dental bleaching before orthodontic treatment are still a matter of clinical suggestion, as it is a procedure that is under analysis, empirical knowledge waiting for scientific proof or disproof! Although tooth enamel has adamantine fluid flowing within it, providing a specific metabolism that is peculiar to its own and which could scientifically explain and base the option of carrying out teeth whitening before and during orthodontic treatment, we must still be very careful.

Quanto ao melhor momento para se aplicar ou recomendar a clareação dentária aos pacientes ortodônticos, alguns esclarecimentos e orientações são explanados para responder questionamentos como: 1) Por que depois do tratamento ortodôntico se constitui a melhor oportunidade para tal procedimento?; 2) Por que não realizar a clareação dentária imediatamente antes do tratamento ortodôntico?; 3) Se poderia realizá-la em alguma condição especial, e qual seria?; 4) Por que não se deveria clarear os dentes durante o tratamento ortodôntico?; 5) Se possível em algumas situações especiais, quando seriam essas situações especiais? No presente artigo, se destacará porque é fundamental sempre proteger a mucosa e a região cervical, independentemente do momento em que se fizer uma clareação dentária relacionada ou não ao tratamento ortodôntico. O mecanismo de como, por que e se é ou não conveniente clarear os dentes antes da finalização dos tratamentos ortodônticos ainda representa uma sugestão clínica, um procedimento em análise e um conhecimento empírico à espera de sua comprovação ou desmitificação científica. Apesar do esmalte dentário ter uma circulação do líquido adamantino, que propicia um metabolismo próprio e específico, que pode vir a ser, cientificamente, a base para explicar e fundamentar a clareação dentária antes e durante o tratamento ortodôntico, ainda assim devemos ser muito cautelosos.

Adhesión posaclaramiento e intervalos de tiempo: revisión de tema / Post-whitening adhesion and time intervals: a topic review

A pesar del tan alto éxito clínico de los procedimientos de aclaramiento dental, no todas las dudas sobre su uso han sido explicadas, mucho menos los efectos adversos sobre la resistencia de unión de restauraciones adhesivas en esmalte/dentina, los cuales todavía siguen siendo muy controvertidos. Esta revisión de tema tiene como objetivo analizar conceptos sobre la interacción entre adhesión posaclaramiento y tratamientos para controlar esas interacciones. Con base en la literatura revisada se puede concluir que un tiempo de espera entre aclaramiento y procedimiento restaurativo debe ser por lo menos de 7 días para que todo el oxígeno residual remanente pueda ser liberado de la estructura dental y, en los casos que sea necesario hacer una restauración inmediata al proceso de aclaramiento, el uso de agente antioxidante como ascorbato de sodio 10% en la forma de gel es una alternativa viable para disminuir los efectos del aclaramiento en el procedimiento adhesivo.

Despite the enormous clinical success of dental whitening procedures, not all the questions about their use have been fully explained, especially in relation to the adverse effects on bond strength of adhesive restorations in enamel and dentin, which still remain controversial. This topic review pretends to analyze some of the issues on the interaction between post-whitening adhesion and the treatments to control such interactions. Based on the revised literature, we may conclude that a time delay of at least 7 days between whitening and the restorative procedure is advisable, so that all the remaining residual oxygen can be released from the tooth structure and, where necessary, immediately restore the whitening process, using an antioxidant such as 10% sodium ascorbate (as a gel) is a viable alternative to reduce the effects of whitening on the adhesive process.

Clareamento dentário associado à facetas Indiretas em cerâmica: abordagem minimamente invasiva. / Tooth bleaching associated with ceramic veneers: a conservative approach.

O objetivo deste trabalho é relatar um caso clínico, demostrando protocolo conservador para reabilitação estética com facetas indiretas de cerâmica associadas ao clareamento dental. Paciente do gênero masculino insatisfeito em relação à estética do seu sorriso apresentou ao exame clínico restaurações em resina composta nos dentes anteriores com pigmentação e fraturas marginais. Foi realizada remoção das restaurações para avaliação dos diastemas. Inicialmente, foi realizado clareamento externo em consultório com peróxido de hidrogênio a 38%. Após uma semana, foram feitos preparos minimamente invasivos na superfície vestibular e moldagem. Os laminados foram confeccionados com cerâmica feldspática e cimentados adesivamente ao substrato dentário. Feita a cimentação, foi feito ajuste oclusal mantendo os contatos oclusais fisiológicos. A associação entre o clareamento dentário e laminados cerâmicos, com preparos conservadores, mostrou-se eficaz para a reabilitação estética e funcional do sorriso contribuindo para a satisfação do paciente.

The aim of this study is to describe a clinical case, showing conservative approach for aesthetic rehabilitation with ceramic veneers associated with tooth bleaching. A male patient presented dissatisfaction with smile was submitted to clinical examination and showing composite resin restorations on anterior teeth with marginal fractures and pigmentation. Restoration removal was performed for diastemata evaluation. Initially, was performed in-office tooth bleaching with hydrogen peroxide 38%. After one week, preparations were made with minimally removal of tooth structure at buccal surface and the impression was made. The veneers were fabricated with feldspathic ceramic and cemented adhesively to the tooth substrate. Once the luting procedure was performed, occlusal adjustment was made keeping the physiological occlusal contacts. The association between tooth bleaching and ceramic veneers with conservative approach was effective for the esthetic and functional rehabilitation of the smile contributing to patient satisfaction.