Over-the-counter products in tooth bleaching: A scoping review.

OBJECTIVE: To map and summarize the current scientific evidence concerning the active ingredients, effectiveness, and adverse effects of over-the-counter (OTC) bleaching products. DATA AND SOURCE: This study was conducted according to the PRISMA-ScR guidelines for scoping reviews and registered on the Open Science Framework platform. STUDY SELECTION: Database searches were conducted in PubMed/MEDLINE, Embase, and Scopus up to January 2024. All in vitro, in situ, and clinical studies evaluating the effectiveness and adverse effects of OTC bleaching products were included. A descriptive analysis of the included studies was performed. RESULTS: A total of 88 studies were included. Most of them were in vitro studies (n = 49), followed by randomized clinical trials (n = 28). The main OTC bleaching products identified were whitening or stain-removing toothpastes (n = 42), followed by whitening strips (n = 39). Most clinical studies indicate that whitening strips are effective in improving tooth color and providing whitening benefits. In contrast, the bleaching effectiveness of toothpastes, mouth rinses and whitening trays was mainly supported by in vitro studies. The main adverse effects associated with OTC bleaching agents were tooth sensitivity and gingival irritation. CONCLUSION: A wide variety of OTC bleaching products is available for consumer self-administered use. Clinical studies have mainly confirmed the bleaching effectiveness of whitening strips, while the validation for toothpastes, mouth rinses and whitening trays has mainly relied on in vitro studies. Nevertheless, the use of OTC bleaching products may result in adverse effects, including tooth sensitivity, gingival irritation, and enamel surface changes. CLINICAL SIGNIFICANCE: Some over-the-counter bleaching products may have whitening properties supported by clinical studies, particularly those containing hydrogen or carbamide peroxide. Nonetheless, clinicians must be aware of the potential risks associated with excessive self-administration of these products, which may result in adverse effects.

At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis.

OBJECTIVES: This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. METHODOLOGY: A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. RESULTS: CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. CONCLUSIONS: CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

At-home bleaching versus whitening toothpastes for treatment of tooth discoloration: a cost-effectiveness analysis

Abstract Objectives This study aimed to analyze the cost-effectiveness of whitening toothpastes and at-home bleaching for the treatment of tooth discoloration. Methodology A cost-effectiveness economic analysis was conducted, and eight randomized clinical trials were selected based on the whitening agent product used: blue covarine dentifrices (BCD), hydrogen peroxide dentifrices (HPD), dentifrices without bleaching agents (CD, negative control), and 10% carbamide peroxide (CP10, positive control) for at-home bleaching. The consumer/patient perspective was adopted, macro-costing techniques were used and a decision tree model was performed considering the costs in the American and Brazilian markets. The color change evaluation (ΔE*ab) was used to calculate the effectiveness of tooth bleaching. A probabilistic analysis was performed using a Monte Carlo simulation and incremental cost-effectiveness ratios were obtained. Results CP10 resulted in the highest cost-effectiveness compared to the use of dentifrices in both markets. In Brazil, HPD was more cost-effective than BCD and CD. In the US, the increased costs of HPD and BCD did not generate any whitening benefit compared to CD. Conclusions CP10 was more cost-effective than BCD and HPD for tooth bleaching from the perspectives of the Brazilian and American markets. Decision-making should consider the use of CP10 for treating tooth discoloration.

The influence of smoking on the effectiveness of at-home bleaching: A prospective clinical study.

OBJECTIVES: To evaluate the effect of smoking on tooth whitening and color change after at-home bleaching. MATERIALS AND METHODS: This prospective clinical study evaluated two groups of participants: NS-non-smokers (n = 24) and S-smokers (n = 16). All subjects were treated with at-home bleaching using 22% carbamide peroxide (CP) for 1 h/day for 14 days. Color coordinates (L*-luminosity, a*-red-green axis and b*-yellow-blue axis) were obtained before bleaching (D0-baseline), 1 day (D1), 15 days (D15), and 1 month (D30) after bleaching. The whiteness index (WID ) and CIEDE2000 color differences (ΔE00 ) were calculated for S and NS. Color changes between S and NS subjects for specific teeth (CI-Central Incisors, LI-Lateral Incisors, and C-Canines) were analyzed using the Mann-Whitney test (α = 0.05). RESULTS: There was no significant difference in WID between S and NS subjects at baseline. NS participants showed higher WID than S at D1, D15, and D30 (p < 0.05). NS showed higher ΔWID for CI and C between D0 and the other evaluation times (D1, D15, and D30) compared to S. Smokers showed higher darkening of CI than NS in ΔWID D30-D1 (p < 0.05). Color changes showed similar overall behavior for ΔWID . For all evaluation times, ΔWID and ΔE00 values were below the corresponding acceptability thresholds. CONCLUSION: At-home bleaching was effective on smokers and nonsmokers. Smoking negatively affected color stability after bleaching. ΔE00 and ΔWID were acceptable for both groups. CLINICAL SIGNIFICANCE: Although smoking negatively affected color stability after bleaching, the observed changes were clinically acceptable.

Topical application of Otosporin® before in-office bleaching: a split mouth, triple-blind, multicenter randomized clinical trial.

OBJECTIVES: To evaluate if the topical application of Otosporin® before in-office bleaching with a 35% hydrogen peroxide (HP) gel reduces the risk and intensity of tooth sensitivity (TS), as well as the bleaching effectiveness. MATERIALS AND METHODS: Twenty participants were selected for this split mouth, triple-blind, multicenter randomized clinical trial. Before each bleaching session, the placebo was applied in the patient's hemi-arch and the other half received the Otosporin®, according to the randomization procedure. Both products were applied topically for 10 min. The 35% HP was applied in two sessions with a 1-week interval. The risk and intensity of TS were assessed using the Numerical Scale (NRS) and the Visual Analog Scale (VAS). The bleaching effectiveness were evaluated with the visual scales and with a digital spectrophotometer. The absolute risk of TS was compared by McNemar's test. To compare the intensity of TS, the Wilcoxon signed-rank test was used to evaluate the NRS, while the paired t test was used to evaluate VAS. Bleaching effectiveness (ΔSGUs and ΔEab, ΔE00, and ΔWID) was compared between groups using the paired t-test (α = 0.05). RESULTS: No significant difference at risk (p = 1.0) and intensity of TS (p > 0.59; VAS and p = 1.00 for NRS) was detected between groups. For both groups, a significant bleaching was observed after 30 days of evaluation (p < 0.39). CONCLUSIONS: The previous application of Otosporin® in the in-office bleaching did not reduce the risk and intensity of TS and did not affect the effectiveness of the bleaching. CLINICAL RELEVANCE: The application of Otosporin® before in-office bleaching with 35% HP was not able to reduce the risk and intensity of TS.

Efficacy and tooth sensitivity of at-home bleaching in patients with esthetic restorations: a randomized clinical trial.

OBJECTIVES: This study aims to evaluate the color change and tooth sensitivity (TS) caused by at-home bleaching in patients with sound and with restored teeth. METHODS: Forty patients were selected according to the inclusion and exclusion criteria and divided into two groups: So (patients with six caries-free maxillary anterior teeth) and Re (patients with at least one restoration in the six maxillary anterior teeth). Both groups were bleached with 10% carbamide peroxide (CP) at-home bleaching. The color change (CIELab [ΔE*ab], CIEDE00 [ΔE00], and whiteness index [∆WID]) were assessed using a spectrophotometer at baseline, 2 weeks, and 1 and 3 months after bleaching. Patients recorded their TS using a numeric rating scale (0-4). Data of color change were submitted to Student's T-test. The absolute risk and intensity of TS were compared using Fisher's and the Mann-Whitney tests, respectively (α = 0.05). RESULTS: Higher ΔE*ab, ΔE00, and ∆WID values were observed for So in relation to Re after all recall rate (p < 0.0001). No significant differences were observed regarding of bleaching-induced TS (p > 0.9). CONCLUSIONS: At-home dental bleaching with 10% CP generated the same pattern of TS in patients with or without restorations. However, in patients with restored teeth, it produced a lower color change after 2 weeks of bleaching. CLINICAL SIGNIFICANCE: After 2 weeks of at-home bleaching, a lower whitening effect was observed in patients with anterior restorations when compared with patients with sound teeth. TRIAL REGISTRATION: ClinicalTrials.gov identifier RBR-52j6gmg.

Effects of a reduced in-office bleaching protocol with 37.5% hydrogen peroxide on effectiveness and tooth sensitivity: A double-blind randomized clinical trial.

OBJECTIVE: This randomized clinical trial evaluated the effectiveness and tooth sensitivity (TS) of 37.5% hydrogen peroxide (37.5HP) in-office bleaching with reduced protocol. MATERIALS AND METHODS: Forty participants with shade mean C2 or darker for the six maxillary anterior teeth were randomly allocated into two treatment groups (n = 20): two (37.5HP2) or three (37.5HP3) 8 min applications/clinical session. Three clinical sessions were performed with a 1 week interval. Color evaluations were done with a spectrophotometer at baseline and 1 week post-bleaching. TS was measured during and up to 48 h after bleaching using a five-point numeric rating scale. Color change was evaluated by Student's t-test for independent samples. The absolute risk and intensity of TS were analyzed by Fisher's and Mann-Whitney/Friedman tests (p < 0.05). RESULT: Both treatment groups resulted in a significant tooth whitening 1 week post-bleaching (p < 0.001). There were no significant differences between 37.5HP2 and 37.5HP3 for ΔE*ab , ΔE00 and ∆WID . Also, there were not differences between groups regarding high absolute risk (p = 1.0) and low intensity of TS at all time assessments (p > 0.7). CONCLUSIONS: The in-office bleaching with two 37.5% HP applications produced the same whitening degree, risk and intensity of TS to that performed with three gel applications. CLINICAL SIGNIFICANCE: Clinicians should opt to use a neutral 37.5% HP in-office bleaching gel for two 8 min applications/clinical session because produces the same whitening effectiveness, risk and low intensity of TS as the protocol proposed by manufacturer (three 8 min applications).

Efficacy of whitening toothpaste containing blue covarine: A double-blind controlled randomized clinical trial.

OBJECTIVE: This randomized clinical trial evaluated the efficacy and safety of a blue-covarine whitening toothpaste on tooth bleaching. SUBJECTS AND METHODS: Seventy-five subjects with shade mean C1 or darker were randomized into three groups (n = 25): CT-conventional toothpaste, WT-whitening toothpaste, and CP10-10% carbamide peroxide. Subjects from CT and WT brushed their teeth twice/day for 2 weeks. CP10 used bleaching gel for 4 hours/night for 2 weeks. Tooth shade and CIELab parameters were measured at baseline, after the first application, 2- and 4-week. ΔE*ab and ΔE00 were calculated. Subjects' perception about tooth color appearance, tooth sensitivity (TS), and gingival irritation (GI) were also assessed. RESULTS: At all evaluation periods, it was not observed differences between WT and CT considering tooth shade (P > 0.7) or CIELab parameters (P > 0.3). At 2- and 4-week, ΔE*ab and ΔE00 were higher for CP10 than WT or CT (P = 0.001). WT and CT reported major dissatisfaction with tooth color appearance than CP10 (P = 0.001). At 1- and 2-week, WT experienced GI and TS similar to CT, both lower than CP10 (P < 0.01). CONCLUSION: There were no significant differences in the whitening efficacy between whitening and conventional toothpastes. Neither of the dentifrices was as effective as at-home bleaching. CLINICAL SIGNIFICANCE: The silica-based toothpaste containing blue covarine evaluated in this study did not give significant tooth whitening benefits over 2 weeks of use.

Bond strength of universal adhesive applied to dry and wet dentin: one-year in vitro evaluation

Aim: This study evaluated the influence of dentin wettability on the immediate and extended microtensile bond strength (mTBS) of a universal adhesive system used in the etch-and-rinse strategy. Methods: Twenty human third molars were selected and divided into four groups according to the adhesive system and dentin wettability. The mTBS values of each group were registered 24 h and one year after adhesive system application and resin composite block build-up (n=30). Data were analyzed by the t-test (p<0.05). Results: When both adhesive systems were compared, there was no statistically significant difference when they were applied following wet bonding (p>0.05). However, the dry bonding reduced µTBS values of the Adper Single Bond 2 adhesive (p<0.05). Regarding storage time, both groups presented similar µTBS values at 24 h and one year (p>0.05). Conclusions: Therefore, the Scotchbond Universal Adhesive can be applied to dry or wet dentin without compromising the etch-and-rinse bonding quality and the durability of the restorations

Effect of ionizing radiation on the properties of restorative materials.

AIM: The aim of this study is to evaluate the effect of different doses of the ionizing radiation (0 Gy, 10 Gy, 30 Gy, and 60 Gy) on the physical properties of dental materials. METHODOLOGY: Disc-shaped samples from each material (Ketac Molar Easymix, Vitro Molar, Vitremer, Vitro Fil Lc, Filtek Z 250 and Filtek Z 350) were made for water solubility, sorption analysis (n = 20), microhardness (n = 20), and surface roughness analysis (n = 24). Specimens were divided into four groups, according to radiation dose: control group (0 Gy), 10 Gy, 30 Gy, and 60 Gy. For water solubility and sorption analysis, the specimens were irradiated and were stored for 21 days to calculate the water solubility and sorption values. Microhardness analysis was carried out before and after irradiation doses. For surface roughness analysis, the specimens were submitted to brushing test, and after 24 h, initial surface roughness analysis was made in a rugosimeter. Subsequently, the samples were irradiated and final surface roughness analysis was made. The original water solubility and sorption, surface roughness, and microhardness values were subjected to ANOVA two-way statistical analysis and Paired t-test and Tukey post hoc test (α = 0.05), respectively. RESULTS: Water solubility and sorption values, and surface roughness values presented statistical difference between groups (0, 10, 30 e 60 Gy) for all materials. CONCLUSIONS: High doses of ionizing radiation (30 Gy and 60 Gy) increased the surface roughness, sorption, and solubility for the most materials.

Influence of three treatment protocols for dental fluorosis in the enamel surface: an in vitro

Introduction: Dental fluorosis is an enamel alteration characterized with opaque stains caused by high exposures to fluoride during the dentition development. Aim : This in vitro study aimed to evaluate changes in the enamel surface of sound human teeth after three treatment protocols for dental fluorosis: microabrasion with 37% phosphoric acid and pumice, home bleaching with 10% carbamide peroxide, and a combination of these techniques. Methods : Thirty-eight specimens (5×5×2 mm) with enamel surface were obtained from 19 third molars. Thirty six specimens were randomized into three treatment groups (n= 12): MAB- enamel microabrasion; CP10- home bleaching; MAB+CP10- a combination of these techniques and two specimens not received treatment. Surface roughness and microhardness analyses were performed before and after treatment protocols. Two representative specimens from each group were evaluated by scanning electron microscopy (SEM). Analysis of variance and Tukey's tests were used for data analysis (p< 0.05). Results : All treatment protocols promoted an increased in enamel surface roughness (p< 0.02). MAB and MAB+CP10 showed a significant increase in the enamel microhardness (p< 0.04), while CP10 showed a microhardness lower than MAB and MAB+CP10 (p< 0.05). SEM images demonstrated a smoother surface from MAB and MAB+CP10 and, an irregular pattern of enamel erosion from CP10. Conclusions : The treatment protocols for dental fluorosis tested significantly changed the enamel roughness, microhardness and micromorphology.

Introdução: A fluorose dentária é uma alteração do esmalte caracterizada por manchas opacas causadas pela alta exposição aos íons fluoreto durante o desenvolvimento dentário. Objetivo : Este estudo in vitro objetivou avaliar mudanças na superfície do esmalte em dentes humanos hígidos após três protocolos de tratamento para a fluorose dentária: microabrasão com ácido fosfórico a 37% e pedra-pomes, clareamento caseiro com peróxido de carbamida a 10% e a associação destas técnicas. Métodos : Trinta e oito espécimes (5×5×2 mm) com superfície em esmalte foram obtidos a partir de 19 terceiros molares, sendo que dois não receberam tratamento e, trinta e seis foram randomizados em três grupos (n= 12): MAB- microabrasão do esmalte; CP10- clareamento caseiro; e MAB+CP10- associação destas técnicas. A rugosidade superficial e microdureza foram realizadas antes e após os protocolos de tratamento. Dois espécimes representativos de cada grupo foram avaliados por microscopia eletrônica de varredura (MEV). A análise de variância e teste de Tukey foram utilizados para análise dos resultados (p< 0,05). Resultados : Todos os protocolos de tratamento promoveram um aumento da rugosidade superficial do esmalte (p< 0,02). MAB e MAB+CP10 mostraram um aumento significativo da microdureza do esmalte (p< 0,04), enquanto que CP10 mostrou uma menor microdureza comparado ao MAB e ao MAB+CP10 (p< 0,05). As imagens de MEV demonstraram uma superfície mais lisa do MAB e MAB+CP10 e um padrão irregular do esmalte erodido para o CP10. Conclusão : Os protocolos testados para tratamento da fluorose dentária testados modificaram significativamente a rugosidade, microdureza e micromorfologia do esmalte.

The Impact of Radiotherapy in the in Vitro Remineralization of Demineralized Enamel

Objective: To evaluate the impact of radiotherapy on enamel around restorations of glass ionomer cement (GIC) and fluoride tooth paste (FTP). Material and Methods: Eighty enamel blocks were made and randomly distributed into two groups, according to the fluoride therapy, non-fluoride tooth paste (NFTP) and FTP (n=40) and in subgroups in conformity with radiation dose (0, 10, 30 and 60 Gy). Roughness and microhardness enamel analyses were conducted before radiotherapy. Enamel cavities were made and restored with two GIC (Ketac Molar Easy Mix or Vitremer). Enamel blocks were submitted to 10, 30 and 60 Gy. Then, artificial enamel caries lesions were created by a pH-cycling procedure and FTP or NFTP were used as treatment. The restored enamel blocks were submitted to final roughness and microhardness analyses. Roughness increase (ΔR) and hardness loss (ΔH) values of enamel were submitted to ANOVA and Tukey test (p=0.05). Results: The irradiated enamel group showed statistically higher ΔR (0.44 ±0.2) and ΔH (99.26±7.0) values compared to non-irradiated group (ΔR = 0.051±0.02; ΔH=66.16±12.7) when a resin-modified GIC and NFTP were used. Conclusion: Higher radiation dose increased dissolution of bovine enamel. The use of GIC associated with FTP decreased roughness and increased enamel hardness after radiotherapy.

Effect of temperature and storage time on dental bleaching effectiveness.

OBJECTIVE: To evaluate the effect of storage time and temperature on the effectiveness of bleaching agents. METHODS: Enamel slabs were randomly allocated according to the concentration of carbamide peroxide (CP): 10% (CP10) and 16% (CP16). Shade evaluations were conducted at baseline and then after 3 and 12 months of storage at 3 different temperatures: 10°C (±2°C), 25°C (±2°C), and 35°C (±2°C). Objective color evaluation was performed (spectrophotometer CIEL*a*b* system and CIEDE2000) to calculate the color change (ΔE00 ). Subjective evaluation was performed using the VITA classical shade guide followed by shade variation (ΔS). RESULTS: The bleaching effect of different CP concentrations (10% and 16%) at baseline showed no differences with regard to objective (ΔE00 ) and subjective parameters (ΔS) (P > .05). No differences were observed between CP concentrations stored for the same length of time and at the same temperature for either parameter (P > .05). In terms of objective measurement (ΔE00 ), a reduction in the bleaching effect was shown for both CP concentrations (10% and 16%) when stored for 12 months at 35°C, and compared with the baseline (P < .05). As regards the subjective parameters (ΔS), after 12 months, both CP concentrations (10% and 16%) stored at 35°C showed a decrease in bleaching capacity compared to baseline (P < .05). CP10 and CP16 stored at 10°C and 25°C did not suffer any loss in bleaching ability, even after 12 months (P > .05). CONCLUSIONS: The storage of bleaching agents for long periods at high temperatures can reduce the bleaching effectiveness of CP at 10% and 16%. CLINICAL SIGNIFICANCE: Clinicians must be made aware that they should store their bleaching products under proper temperature conditions and use them within an appropriate time frame; otherwise, the bleaching effect could be lost.

The effect of a bleaching agent on the pigment removal and the bond strength of bulk-fill resin composites: an in vitro study / Efeito dos agentes clareadores na remoção de pigmentos e na resistência de união de resinas compostas bulk-fill: um estudo in vitro

Introduction: In order to simplify the technique, reduce the time required for direct adhesive restorations, bulk-fill resin composites have been developed be applied in bulk placement up to 4 mm increments. Objective: Evaluating the color change (ΔE) and the microtensile bond strength (μTBS) of bulk fill resin composites (BFRC) to dentin after the immersion in regular beverages and the application of bleaching systems. Method: Forty-five human molar teeth were randomly distributed in three groups according to the filling material (n=15): Filtek Bulk Fill, Tetric N Ceram Bulk Fill and Filtek Z100. The restored teeth were immersed in coffee, wine and distilled water (n=5) for 72 hours. The color parameters were measured using a spectrophotometer, having as basis the CIE L*a*b*, before and after tooth staining and application of bleaching processes. Subsequently, the teeth were sectioned to obtain the specimens for the microtensile testing. The ΔE values were analyzed applying the Kruskal-Wallis and the Wilcoxon tests, and the μTBS values were analyzed applying the ANOVA and the Bonferroni tests (p<0.05). Result: There were no significant differences in the ∆E values when comparing the BFRCs to the conventional resin composite (CRC) in most of the experimental groups. The ∆E values did not present significant differences before and after the application of bleaching processes for all the tested resin composites. The BFRCs presented higher μTBS values than the CRC after exposure to distilled water, wine and bleaching agent. Conclusion: The studied BFRCs presented similar color stability to the CRC. The BFRCs presented higher bond strength to the dentin than the CTC in most of the evaluated conditions. The bleaching agent was not effective in whitening the stained restored teeth.

Introdução: Em busca de simplificar a técnica, reduzir o tempo requerido para as restaurações adesivas, resinas compostas bulk-fill (RCBF) estão sendo desenvolvidas para serem aplicadas em incrementos com espessura de até 4 mm. Objetivo: Avaliar a alteração de cor (ΔE) e resistência de união (μTBS) de RCBF a dentina após imersão em bebidas e aplicação de um sistema clareador. Método: Foram utilizados 45 dentes molares humanos que foram distribuídos aleatoriamente em três grupos de acordo com o material restaurador (n=15): Filtek Bulk Fill, Tetric N Ceram Bulk Fill e Filtek Z100. Os dentes restaurados foram imersos em café, vinho e água destilada (n=5) durante 72 horas. Os parâmetros de cor foram mensurados utilizando um espectrofotômetro, tendo como base o CIE L*a*b*, antes e após o manchamento e aplicação dos agentes clareadores. Consequentemente, os dentes foram seccionados para a obtenção de espécimes para o teste de microtração. Os valores de ΔE foram analisados aplicando os testes de Kruskal-Wallis e Wilcoxon e os valores de μTBS foram analisados aplicando ANOVA e o teste de Bonferroni (p<0,05). Resultado: Não houve diferença significante nos valores de ∆E quando as RCBFs foram comparadas a resina composta convencional (RCC) na maioria dos grupos experimentais. Os valores de ∆E não apresentaram diferença estatística antes e após a aplicação do agente clareador para todas as resinas testadas. As RCBFs demonstraram maiores valores de μTBS comparado a RCC após exposição a água destilada, vinho e agente clareador. Conclusão: As RCBFs demonstraram uma similar estabilidade de cor quando comparado a RCC. As RCBFs apresentaram maior resistência de união a dentina que a RCC na maioria das condições avaliadas. O agente clareador não foi efetivo no clareamento dos dentes restaurados.

Dental Fluorosis Treatment Can Improve the Individuals' OHRQoL? Results from a Randomized Clinical Trial.

This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Dental fluorosis treatment can improve the individuals' ohrqol? results from a randomized clinical trial

Abstract This study aimed to evaluate the effect on oral health-related quality of life (OHRQoL) of two treatment protocols for dental fluorosis in individuals enrolled in a randomized clinical trial. Seventy volunteers, who lived in a fluorosis endemic area in Brazil, and had at least four maxillary anterior teeth showing fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n= 35): GI- enamel microabrasion; or GII- microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice, and at-home tooth bleaching with 10% carbamide peroxide in a tray. Volunteers completed a questionnaire at baseline and 1-month post treatment to assess changes in OHRQoL, using the Oral Impact on Daily Performance (OIDP). Differences in overall impact scores between and within treatment groups were analyzed with Wilcoxon (within) and Mann-Whitney (between) tests. Changes in performance scores were analyzed using Wilcoxon tests (a< 0.05). One month after treatment, subjects reported improvement in OHRQoL. Both groups showed lower OIDP scores (p< 0.001), but there was no difference between them. Eating, cleaning teeth, smiling and emotional state performance scores were lower after treatment for the whole sample. In conclusion, the treatment with microabrasion improved the OHRQoL in this sample of individuals living in a fluorosis endemic area regardless of the addition of at-home bleaching.

Resumo Este estudo teve como objetivo avaliar o efeito na qualidade de vida relacionada à saúde bucal (QVRSB) de dois protocolos de tratamento para fluorose dentária, em indivíduos incluídos em um ensaio clínico randomizado. Setenta voluntários, os quais viviam em uma área de fluorose endêmica no Brasil, e que possuíam pelo menos quatro dentes ântero-superiores com índice de Thylstrup e Fejerskov de 1 a 7, foram randomizados em dois grupos de tratamento (n= 35): GI- microabrasão de esmalte; ou GII- microabrasão associada com clareamento caseiro. A microabrasão foi realizada com ácido fosfórico 37% e pedra pomes e, o clareamento caseiro com peróxido de carbamida 10% e uso de moldeira. Os voluntários responderam um questionário antes e 1 mês após o tratamento, visando avaliar mudanças na QVRSB através do instrumento Oral Impact on Daily Performance (OIDP). Diferenças nos escores de impacto geral entre e nos mesmos grupos de tratamento foram analisadas através dos testes Wilcoxon (mesmo grupo) e Mann-Whitney (entre grupos), respectivamente. Alterações no escores dos domínios foram analisadas usando o teste Wilcoxon (a<0.05). Um mês após o tratamento, os indivíduos relataram melhora na QVRSB. Ambos os grupos apresentaram menores escores do OIDP (p<0,001), sem diferença entre eles. Os escores dos domínios comer, limpar os dentes, sorrir e estado emocioal diminuíram após o tratamento para toda a amostra. Concluiu-se que o tratamento com microabrasão melhorou a QVRSB de indivíduos vivendo em uma área de fluorose endêmica independentemente da associação com o clareamento caseiro.

Resistência de união de compósitos do tipo Bulk Fill: análise in vitro / Microtensile bond streght of Bulk Fill resin composites: in vitro analysis

Introdução: A classe dos compósitos Bulk-Fill tem obtido popularidade com a promessa de ser fotopolimerizado efetivamente em camadas de até quatro milímetros, fato que contrasta com os dois milímetros requisitados para os compósitos convencionais para manutenção da adesividade da restauração. Objetivo: O objetivo deste estudo foi analisar a resistência de união à dentina de restaurações confeccionadas com compósitos do tipo Bulk-Fill. Material e método: Foram utilizados 15 terceiros molares humanos, cuja superfície oclusal foi cortada e a dentina foi exposta. Esses elementos dentários foram divididos em três grupos conforme o material restaurador utilizado. O sistema adesivo usado foi o mesmo para todos os grupos. Posteriormente, os dentes restaurados foram cortados para originar palitos de aproximadamente 1 mm de largura, 1 mm de profundidade e 8 mm de altura, que foram fixados às garras do dispositivo de microtração. Foram utilizados dez palitos de cada dente, totalizando 50 palitos por grupo. Os dados de resistência de união à microtração foram expressos em megapascal (MPa). As fraturas foram analisadas em microscópio óptico. Os dados foram analisados através dos testes ANOVA e Tukey (p<0,05). Resultado: Os três compósitos estudados diferiram estatisticamente entre si (p<0,000). Os compósitos Bulk-Fill apresentaram resistências de união semelhantes e superiores ao convencional (p<0,000). A fratura mais encontrada foi a mista, em todos os grupos. Conclusão: Os compósitos Bulk-Fill apresentaram maiores valores de resistência de união com a técnica restauradora utilizada.

Introduction: The class of the Bulk Fill composites has gotten popularity with the promise of been cured effectively of layers up to 4 mm, a fact with contrasts with the 2 mm required for the convencional composites for maintance of the restoration’s adhesion. Objective: The aim of this study was evaluate the microtensile bond strength to dentine of restorations made with Bulk Fill composites. Material and method: 15 thirds molars teeth were utilized, whose occlusal layer was cut, exposing the teeth dentine. The teeth were divided in three groups according to the type of restoration materials. All groups were treated with the adhesive system Adper Single Bond 2. Subsequently they were cut in sticks with approximately 1 mm wide, 1 mm depth and 8 mm high, that were fixated at a universal microtensile maching. 10 sticks of each tooth were used in the experiment totaling 50 sticks per group. The data of bond strength microtensile were expressed in MPa. The failures mode was evaluated at an optical microscope. The Data were statistically analyzed through ANOVA and Tukey test (p<0.05). Result: The three composites studied differed statistically among themselves (p<0.000). The Bulk Fill composites had microtensile bond strength similar and higher than the convencional (p<0.000). The pattern failure mode found in all groups studied was the mixed. Conclusion: The Bulk Fill composites showed the highest values of microtensile bond strength with the restorative technique used.

The effect of drinks on color stability and surface roughness of nanocomposites.

OBJECTIVE: The aim was to evaluate the color and surface roughness of nanoparticle (C1) and nanohybrid (C2) composites after immersion in distilled water, acai juice, grape juice and red wine and repolishing. MATERIALS AND METHODS: After recording the initial surface roughness and color, the specimens were divided into four groups according to the storage solution. The specimens were reassessed after immersion for 1, 2, 4, 8, and 12 weeks and after repolishing. RESULTS: The results showed that after 2 weeks, there were statistically significant changes in color of both resins in all groups, with the exception of the specimens stored in distilled water (P > 0.05). Only 12 weeks of immersion in red wine changed the roughness of composite C1 (P = 0.009). CONCLUSIONS: Red wine produced the greatest color change in nanocomposites, followed by grape juice. Acai juice made the color unacceptable clinically only after 12 weeks. Repolishing reduced the color change in all groups.

Acceptability, efficacy and safety of two treatment protocols for dental fluorosis: a randomized clinical trial.

OBJECTIVES: This parallel randomized clinical trial evaluated the efficacy of two treatments for removing fluorosis stains. METHODS: Seventy individuals living in an area endemic for fluorosis, with at least four maxillary anterior teeth presenting fluorosis with a Thylstrup and Fejerskov index from 1 to 7, were randomized into two treatment groups (n=35): GI - enamel microabrasion or GII - microabrasion associated with at-home bleaching. Microabrasion was performed using 37% phosphoric acid and pumice and, at-home tooth bleaching was performed with 10% carbamide peroxide. Areas of enamel opacities were recorded by digital camera at baseline and 1-month (1M) after treatment. Two blinded examiners evaluated the reduction in the area (mm(2)) of opacity using software. Two visual analogue scales were used: one for recording tooth sensitivity and/or gingival irritation ranging from 1 (none) to 5 (severe) and the other to evaluate participant satisfaction with the treatment used ranging from 1 (no improvement) to 7 (exceptional improvement). RESULTS: 1M after treatment, both groups showed a significant reduction in the area of enamel opacity (p=0.0001) and there was no difference between groups (p=0.1). Most of the participants from both treatment groups reported no or mild tooth sensitivity and gingival irritation (p>0.05). Participants reported that they were happy with the improvement in dental appearance, however, individuals from GII reported that they were happier than those from GI (p=0.004). CONCLUSIONS: Both treatment protocols were effective in reducing fluoride stains, however, when home bleaching was associated to enamel microabrasion, patients reported a major satisfaction with dental appearance.

Changes in oral health related quality of life after dental bleaching in a double-blind randomized clinical trial.

OBJECTIVES: This study aimed to assess changes in oral health-related quality of life (OHRQoL) in individuals enroled in a double-blind randomized clinical trial conducted to evaluate the efficacy and safety of two carbamide peroxide concentrations used in at-home vital bleaching in the city of Pelotas, Southern Brazil. METHODS: Ninety-two volunteers with a shade mean of C1 or darker for the six maxillary anterior teeth were randomized into two balanced groups (n=46) according to bleaching agent concentration: 10% or 16% carbamide peroxide. The patients were instructed to use the whitening agent in a tray for 2h once a day for three weeks. To assess changes in OHRQoL, participants completed the oral impact on daily performance (OIDP) at the start and one week after the completion of treatment. Because there was no difference with regard to whitening effect or tooth sensitivity during or after treatment the two groups were merged for the analyses of the current article. Before-and-after changes in OIDP scores were assessed by chi-square and McNemar tests (p<0.05). RESULTS: Mean pre- and post-treatment OIDP scores varied from 0.42 to 0.60. When the frequency of impacts for different activities were compared, there was an increase in difficulty in cleaning teeth (p=0.02) and a significant reduction in smiling and showing teeth with embarrassment (p=0.03). Regarding the symptoms and main oral conditions that generated impact, there was higher number of participants reporting pain (p=0.05) after treatment. In opposite, significant decrease was observed in individuals reporting being unhappy with their appearance (p=0.03). On the contrary, it was showed a decrease in impacts resulting from dental colour was observed after bleaching (p=0.03). CONCLUSION: Quality of life is complex and encompasses different domains. Although positive impact of the dental bleaching was detected, with patients showing more their teeth without embarrassment, difficult in dental hygiene and pain resulting from the treatment were also reported, and this can negatively impact daily performances. Dentists must consider these aspects when performing aesthetics procedures.