Effects of bleaching agents and adhesive systems in dental pulp: a literature review

The dental pulp may be exposed to several irritants that are potentially noxious to the health and functions of this tissue. Each type of irritant or injury has different effects on the pulp, which are generally characterized by acute inflammation, chronic inflammation or necrosis. Common examples of irritants are dental caries, cavity preparation procedures, traumatic injuries, and chemical substances like bleaching agents and adhesive systems. The present study aimed to review the current knowledge about the effect of bleaching agents and adhesive systems in the human dental pulp. The review covered literature from 2004 to 2009, and only relevant manuscripts were included. Hand search of the references completed the review. Based on literature review, it may be concluded that all dental procedures associated with bleaching agents or adhesive systems involve risks to cause pulp damage. However, these risks can be minimized if the causal factors were known and avoided.

Effect of high-concentrated bleaching agents on the bond strength at dentin/resin interface and flexural strength of dentin

This study evaluated the effect of bleaching agents on bond strength at the dentin/resin interface and the flexural strength of dentin. Forty maxillary canines were selected for the study. In the shear strength test, 40 slabs of intracoronary dentin (5 x 5 mm) obtained from buccal surfaces of the crowns were included in acrylic resin. In the flexural strength test, 40 dentin bars (8 x 2 x 2 mm) were obtained from the roots. The 40 hemi-sections of the lingual surface were prepared for scanning electron microscopy (SEM). The specimens were divided into 4 groups according to the bleaching protocol (n=10): Unbleached (control), Sodium perborate + 20 percent hydrogen peroxide (SP + 20 percent HP), 37 percent carbamide peroxide (37 percent CP) and 38 percent hydrogen peroxide (38 percent HP). After 7 days, the bond strength specimens were restored and tested. Dentin bars were bleached and subjected to a three-point bending test. Data (MPa) were analyzed by ANOVA and Tukey's test (α=0.05). In the shear test, the control group was superior (p<0.05) to the bleached groups, which, in turn, were statistically similar (p>0.05). In the flexural strength test, the control group also had the highest values and differed significantly from the other groups (p<0.05). SEM revealed smear layer in all groups, with fissures in the bleached specimens. SP + 20 percent HP and 38 percent HP showed discontinuous interfaces with few tags. In conclusion, bond strength of restorative material to dentin and flexural strength of dentin were reduced after the use of high-concentration bleaching agents.

Este estudo avaliou o efeito de agentes clareadores na resistência de união da interface dentina/resina e resistência à flexão da dentina. Quarenta caninos superiores foram selecionados para o estudo. No teste de cisalhamento, 40 fragmentos de dentina intracoronária (5 x 5 mm) obtidos a partir de superfícies vestibulares das coroas foram incluídos em resina acrílica. No teste de flexão, 40 barras de dentina (8 x 2 x 2 mm) foram obtidas a partir das raízes. As 40 hemi-seções da superfície lingual foram preparadas para microscopia eletrônica de varredura (MEV). Os espécimes foram divididos em 4 grupos de acordo com o protocolo de clareamento (n=10): Não clareados (controle), perborato de sódio + peróxido de hidrogênio 20 por cento (PS + PH 20 por cento), peróxido de carbamida 37 por cento (PC37 por cento) e peróxido de hidrogênio 38 por cento (PH 38 por cento). Após 7 dias, as amostras destinadas à resistência de união foram restauradas e submetidas ao teste. As barras de dentina foram clareadas e submetidas ao teste de flexão de 3 pontos. Os dados (MPa) foram analisados por ANOVA e teste de Tukey (α=0,05). No teste de cisalhamento, o controle foi superior (p<0,05) aos grupos clareados, que foram semelhantes entre si (p>0,05). Na resistência à flexão, o grupo controle também exibiu os maiores valores, diferente dos demais (p<0,05). SEM revelou camada de smear em todos os grupos, com fissuras nos espécimes clareados. PS + 20 por cento PH e PH 38 por cento apresentaram interfaces de descontínuas com poucos tags. A resistência de união do material restaurador à dentina e a resistência à flexão da dentina foram reduzidas após o uso de agentes clareadores de alta concentração.