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.

Tetraciclinas y esmalte dental / Tetracyclines and dental enamel

Las tetraciclinas son antibióticos de amplio espectro frecuentemente usadas en dermatología por sus acciones antiinflamatorias en acné vulgar y en rosácea. Uno de los efectos secundarios más temidos es la alteración del esmalte dental, por lo que no se recomienda su uso en menores; sin embargo, la edad exacta no ha sido claramente determinada. Las tetraciclinas provocan manchas permanentes en el esmalte dental definitivo por su gran afinidad con el calcio y el hierro, aunque el mecanismo exacto esta en discusión. La odontogénesis para la dentadura definitiva termina a los ochos años, excepto para los terceros molares, y es durante la odontogénesis donde se produce la alteración del esmalte, secundario a estas drogas. Por ende, se puede emplear las tetraciclinas con seguridad en pacientes mayores de ocho años. Numerosos otros agentes pueden causar daños similares al esmalte. Existen diversos tratamientos de resorte odontológico para blanquear el esmalte.

Tetracyclines are broad spectrum antibiotics that are frequently used in dermatology because of their anti-inflammatory effects in acne vulgaris and rosacea. One of their worst side effects is the alteration in dental enamel, which is why it is not recommended for children; nevertheless, the exact age has not been clarified. Tetracyclines can stain permanent dental enamel for life due to their great affinity with calcium and iron; however, that exact mechanism is still under discussion. Odontogenesis for permanent teeth finishes at age 8, except for 3rd molars, and it during the odontogenesis that these drugs cause the aforementioned effects. Therefore, tetracyclines can be used in patients older than 8 years without fear of damaging the enamel. Numerous other agents can cause similar damage. There are many whitening treatments and procedures carried out by dentists.

Comparison of two methods for eliminating the bleached enamel surface roughness

Vital bleaching technique is an effective method for reducing the teeth discolorations. The results of previous studies have shown that carbamide peroxide causes enamel surface roughness, so the enamel stain susceptibility increases. The purpose of this study was to compare two methods for elimination of the bleached enamel surface roughness. In this Parallel interventional study, 60 sound bovine insicors, [5x5x10mm] were selected. After 14 days of vital bleaching with 20% opalescence gel, the specimens were randomly divided into three groups of 20; i Bond group: the enamel surface was covered by a self etch adhesive [i Bond]; Fluoride group: the enamel surface was polished by a rubber cap and was treated by 2.7% Acidulated phosphate fluoride; Control group: no surface treatment was done. In order to evaluate the lasting of each method, half of the specimens in each group were thermocycled. Data were analyzed using Kruskal-WaIlis and Mann-Whitney tests [alpha=0.05]. The control group revealed a higher degree of roughness than i bond and fluoride groups before thermo cycling [P<0.05]. No significant difference was observed in roughness degree between i Bond and fluoride group before thermocycling [P>0.05].The fluoride group revealed a lower roughness degree than the other groups after thermocycling [P<0.05]. For prevention of enamel stain susceptibility after vital bleaching, polishing with rubber cap and fluoride is an effective method for elimination of the enamel surface roughness