Influence of Viscosity and Thickener on the Effects of Bleaching Gels.

OBJECTIVE: This study investigated the influence of the viscosity and kind of thickener of 35% hydrogen peroxide bleaching gels on the tooth (color change, demineralization of enamel, and permeation) and on the gel [reactive oxygen species (ROS), pH, and peroxide concentration]. METHODS AND MATERIALS: Two hundred forty specimens were divided into groups of bleaching gels with different thickeners (CAR, carbomer; ASE, alkali swellable emulsion; MSA, modified sulfonic acid polymer; SSP, semisynthetic polysaccharide; PAC, particulate colloids) in three viscosities (low: 50,000 cP; medium: 250,000 cP; high: 1,000,000 cP). Color change (ΔEab), demineralization of enamel by Knoop microhardness (KHN) reduction analysis, and peroxide permeation (PP) were analyzed in the specimens, while pH, peroxide concentration (PC), and ROS were evaluated in the gels. Data were analyzed by two-way ANOVA (α=0.05). RESULTS: The higher viscosity gels reduced ΔEab, PP, enamel softening, and ROS in relation to the lower viscosity gels. However, the drop in pH and PC were higher in the more viscous gels. Gels with MSA produced higher ΔEab compared with SSP and ASE. The PP was higher for PAC, and smaller for SSP and CAR. The KHN reduction was higher for CAR and smaller for PAC. The higher pH reduction was seen for ASE and CAR, and the smaller for SSP. The PC reduction was higher for SSP and smaller for CAR. More ROS were observed for MSA and fewer for ASE. CONCLUSIONS: Increased gel viscosity was associated with reduced color change, permeation, demineralization of enamel, and ROS, and led to increased peroxide decomposition and pH alteration during the treatment. The kind of thickener significantly interfered with the treatment effects.

Glass Ionomer Versus Self-adhesive Cement and the Clinical Performance of Zirconia Coping/Press-on Porcelain Crowns.

OBJECTIVE: This split-mouth clinical study investigated the effect of luting cement on the performance of veneered yttrium-stabilized tetragonal zirconia polycrystal (Y-TZP) zirconia crowns. METHODS AND MATERIALS: A total of 60 crowns prepared with Y-TZP coping and press-on porcelain were made with a split-mouth design in 30 participants. The crowns were cemented either with glass ionomer cement (GIC) (Meron, Voco) or with self-adhesive resin cement (Bifix-SE, Voco). The restorations were assessed immediately after treatment and after 6, 12, 24, 36, and 48 months using the modified United States Public Health Service criteria. The parameters analyzed were retention, color stability, marginal discoloration, marginal adaptation, surface roughness, anatomic form, and secondary caries. The differences between the groups were analyzed by the Fisher exact test in each period of evaluation. The survival rate was analyzed with the Kaplan-Meier and log-rank test (α=0.05). RESULTS: After 48 months, 20 participants attended the recall. During the period of evaluation, 1 crown cemented with glass ionomer cement and 1 crown cemented with resin cement lost retention. Color match, marginal discoloration and adaptation, surface roughness, and anatomic form did not change in any of the periods evaluated, and no secondary caries was observed. No significant differences were found between the 2 luting cements for any of the clinical parameters analyzed, nor for the survival rates during the study. CONCLUSIONS: The type of cement did not influence the performance of the crowns after 48 months of clinical use. Both cements resulted in adequate retention rates, aesthetic and functional outcomes, and biological response.

Efficacy and Safety of Bleaching Gels According to Application Protocol.

OBJECTIVES: This study evaluated bleaching efficacy, enamel microhardness, and roughness of highly concentrated hydrogen peroxide (HP) gels (35%-40%) using different application protocols. Gel decomposition and pH alteration were also analyzed. METHODS AND MATERIALS: Bovine enamel/dentin specimens were divided into groups according to the bleaching gel-Pola Office Plus (POP-SDI, 37.5% HP), Opalescence Boost (OPB-Ultradent, 40% HP), Whiteness HP (WHP-FGM, 35% HP)-and application protocol-single application (SA) and multiple application (MA) during the in-office session. Deionized water was used in control group (no bleaching). Thus, seven final groups were obtained (n=15/group). Color (CIE L*a*b*), surface microhardness (SMH), and roughness (Ra) were assessed before/after treatments. The pH of gels was measured, and HP concentration was determined with potassium permanganate titration method in different times. Data were submitted to analysis of variance and Tukey tests (5%). RESULTS: All gels presented similar and clinically acceptable bleaching efficacy (ΔE>2.7) for both SA and MA, as well as no significant differences for SMH and Ra comparing the two protocols in the same gel. Peroxide decomposition significantly increased with time, but final gel concentrations were still high after 45 minutes (32.29% POP; 38.45% OPB; and 32.74% WHP). The pH decreased over time (initial - after 45 min) for WHP (6.83±0.07 - 5.81±0.06), but minimal alterations were observed for POP (8.09±0.09 - 7.88±0.07) and OPB (7.82±0.11 - 7.87±0.07). CONCLUSIONS: Peroxide decomposition was very low for all gels tested, and pH remained stable for POP and OPB gels. Bleaching protocol did not influence whitening efficacy and hazardous effects over enamel, thus potentially there was no clinical significance. Therefore, for the products tested, there is no evidence for recommending the gel change during the bleaching session.

Assessment of Peroxide in Saliva During and After At-home Bleaching With 10% Carbamide and Hydrogen Peroxide Gels: A Clinical Crossover Trial.

CLINICAL RELEVANCE: This study suggests that at-home bleaching systems are safe in relation to toxicity based on peroxide levels in saliva since the amount of peroxide potentially ingested is much lower than the estimated toxic dose.

Pure Ormocer vs Methacrylate Composites on Posterior Teeth: A Double-blinded Randomized Clinical Trial.

CLINICAL RELEVANCE: The clinical behavior of pure ormocer composite is reliable when used in class II restorations after 24 months of evaluation.

Effect of Calcium and Fluoride Addition to Hydrogen Peroxide Bleaching Gel On Tooth Diffusion, Color, and Microhardness.

OBJECTIVES: The aim of this study was to evaluate the effect of calcium and fluoride addition to a 35% hydrogen peroxide (HP) bleaching gel with regard to its diffusion through the tooth structure, enamel microhardness, and bleaching efficacy. METHODS AND MATERIALS: Eighty specimens (6 mm in diameter and 2 mm in height; 1 mm/enamel and 1 mm/dentin) were obtained from bovine incisors that were polished and divided into four groups (n=20) according to the remineralizing agent added to the gel: Ca = 0.5% calcium gluconate; F = 0.2% sodium fluoride; Ca+F = 0.5% calcium gluconate and 0.2% sodium fluoride; and control = no agent. Initial microhardness and color were assessed. The samples were positioned over simulated pulpal chambers filled with acetate buffer solution to capture the HP. Gels were applied over enamel for 30 minutes, and HP diffusion was assessed by spectrophotometry two hours after bleaching. Microhardness was measured immediately after bleaching and then the specimens were immersed into artificial saliva for seven days for final color assessment. Data were analyzed by one-way analysis of variance followed by Tukey test. RESULTS: Bleaching reduced microhardness for all groups (p=0.0001), but the Ca+F and F groups showed lower reductions after bleaching. The addition of Ca, F, and Ca+F decreased the peroxide penetration through the tooth structure (p=0.0001), but there were no differences in color change for ΔL (p=0.357), Δa (p=0.061), Δb (p=0.823), and ΔE (p=0.581). CONCLUSION: The addition of calcium and fluoride in the gel did not affect bleaching efficacy, but it was able to reduce both the peroxide diffusion and the bleached enamel microhardness loss.

Effect of Remineralizing Gels on Microhardness, Color and Wear Susceptibility of Bleached Enamel.

OBJECTIVES:: To evaluate the effect of a remineralizing gel combining fluoride and calcium silicate/phosphate or a sodium fluoride gel on bleached enamel microhardness, color, and wear susceptibility. METHODS AND MATERIALS:: Two hundred forty bovine enamel-dentin samples were prepared. Baseline analysis of Knoop microhardness, color coordinates (L*a*b*), and surface profile were performed. According to the baseline microhardness values, specimens were stratified into six groups (n=40): NC (negative control)-no treatment; BL (positive control)-bleaching with 40% hydrogen peroxide gel (Opalescence Boost, Ultradent); BL/Rs-bleaching + application of calcium silicate/phosphate gel (Regenerate Serum, Unilever - Rs); Rs/BL-Rs + bleaching; Rs/BL/Rs-Rs + bleaching + Rs; and BL/F-bleaching + 2% sodium fluoride gel. After the treatment described for each group, color change (ΔE) and microhardness were evaluated again. To evaluate abrasion susceptibility, samples were randomly divided into two subgroups, according to the toothpaste used (Cp-Close Up or Rt-Regenerate), and underwent 100,000 brushing strokes. The profile of each sample was evaluated and the mean wear calculated. The data were analyzed by ANOVA and Tukey tests. RESULTS:: All bleached groups showed a significant reduction of microhardness in relation to the negative control. The groups treated with remineralizing gels showed a significantly higher microhardness and less wear than the positive control, although nonsignificant differences were observed among them. Nonsignificant differences in ΔE were found among bleached groups. The groups brushed with Regenerate toothpaste showed significantly less wear than those brushed with Close Up toothpaste. CONCLUSIONS:: The remineralizing gels did not interfere with bleaching efficacy. However, all the treatments minimized the surface hardness reduction caused by the bleaching procedure and enamel loss after abrasion. Regenerate toothpaste resulted in less enamel abrasion.

Bond Stability of a Universal Adhesive System to Eroded/Abraded Dentin After Deproteinization.

OBJECTIVE: Erosive/abrasive challenges can potentially compromise bonding to dentin. Aiming to improve the quality and stability of bonding to this substrate, this study investigated the combined effect of erosion and toothbrush abrasion on the microtensile bond strength (µTBS) stability to dentin using a universal adhesive system in total and self-etching modes, associated or not associated with deproteinization. METHODS: Bovine dentin specimens were divided into five groups according to the organic matrix condition (n=20): control (C); erosion (E); erosion + abrasion (EA); erosion + sodium hypochlorite (EH); erosion + abrasion + sodium hypochlorite (EAH). The groups were further divided (n=10) according to the mode of application (total or self-etching) of a universal adhesive. After the bonding procedure, composite blocks were built up, and the samples were cut to obtain sticks for µTBS testing. For each specimen, one-half of the sticks was immediately tested, and the other one-half was tested after artificial aging (5000 thermocycles, 5°C and 55°C). RESULTS: Three-way analysis of variance (α=5%) showed a significant difference for the triple interaction ( p=0.0007). Higher µTBS means were obtained for the EH and EAH groups compared with the E and EA groups. The control group showed immediate µTBS values similar to that of the E and EA groups for both bond strategies. CONCLUSIONS: Erosion and erosion/abrasion did not significantly influence the immediate µTBS to dentin. Artificial aging reduced µTBS values for the groups C, E, and EA using the total-etching mode. Deproteinization maintained the bond stability to artificially aged eroded and eroded/abraded dentin.

Microleakage and Shear Bond Strength of Composite Restorations Under Cycling Conditions.

OBJECTIVES: The aim of this study was to evaluate microleakage and shear bond strength of composite restorations under different cycling conditions. METHODS AND MATERIALS: Class V cavities were prepared in the buccal and lingual surfaces of 30 human molars (n=60). A further 60 molars were used to prepare flat enamel and dentin specimens (n=60 each). Cavities and specimens were divided into six groups and pretreated with an adhesive (self-etch/Clearfil SE Bond or etch-and-rinse/Optibond FL). Composite was inserted in the cavities or adhered to the specimens' surfaces, respectively, and submitted to cycling (control: no cycling; thermal cycling: 10,000 cycles, 5°C to 55°C; thermal/erosive cycling: thermal cycling plus storage in hydrochloric acid pH 2.1, 5 minutes, 6×/day, 8 days). Microleakage was quantified by stereomicroscopy in enamel and dentin margins after immersion in silver nitrate. Specimens were submitted to shear bond strength testing. Statistical analysis was done by two-way analysis of variance and Kruskal-Wallis tests (p<0.05). RESULTS: Microleakage in enamel margins was significantly lower in the control group compared with thermal cycling or thermal/erosive cycling. Erosive conditions increased microleakage compared with thermal cycling (significant only for Clearfil SE Bond). No significant differences were observed in dentin margins. Bond strength of enamel specimens was reduced by thermal cycling and thermal/erosive cycling when Clearfil SE Bond was used and only by thermal/erosive cycling when Optibond FL was used. No differences were observed among dentin specimens. CONCLUSIONS: Thermal/erosive cycling can adversely affect microleakage and shear bond strength of composite resin bonded to enamel.

Color stability of resin used for caries infiltration after exposure to different staining solutions.

PURPOSE : The aim of this study was to investigate the staining behavior of demineralized enamel infiltrated by low-viscosity resin. METHODS AND MATERIALS : Bovine enamel/dentin cylindrical samples (3 × 2 mm) were assigned into four groups (n=45) according to the enamel treatment: sound enamel (control), demineralization + artificial saliva, demineralization + daily application of 0.05% NaF, demineralization + resin infiltration (Icon, DMG). Artificial white spot lesions were produced in groups with demineralization. After the treatments, color was assessed by spectrophotometry, using the CIE L*a*b* system. The specimens (n=15) were then immersed in deionized water, red wine, or coffee for 10 minutes daily for eight days. Color was measured again, and the specimens were repolished with sandpaper discs. The final color was assessed. Data were analyzed by two-way analysis of variance and Tukey tests (α=0.05). A paired t-test was used for comparison between staining and repolishing conditions. RESULTS : There were significant differences for surface treatment and dye after staining and repolishing. Immersion in wine and coffee resulted in significantly increased color alteration (ΔE) compared with water (p=0.001). The resin-infiltrated group exhibited the highest staining values (p=0.001). The repolishing procedures resulted in significantly decreased color change. CONCLUSION: The exposure of specimens to colored solutions resulted in significant color alteration. The demineralized enamel treated with resin infiltration showed significantly higher staining than all other tested groups; however, the repolishing of the specimens minimized the staining effect.