In vitro efficacy of sodium perborate preparations used for intracoronal bleaching of discolored non-vital teeth

Abstract Bleaching materials containing 30% hydrogen peroxide have been used successfully for the treatment of discolored non–vital teeth. Intracoronal application of these materials was occasionally associated with the development of external root resorption. Extracted human teeth with intact crowns were discolored in vitro and bleached with three preparations of sodium perborate. These preparations included: sodium perborate with 30% hydrogen peroxide, sodium perborate with 3% hydrogen peroxide and sodium perborate with water. The bleaching materials were placed in the pulp chamber of the discolored teeth and sealed with IRM for 14 days. They were replaced with fresh preparations after 3 and 7 days. The coronal tooth shades were evaluated after 3, 7 and 14 days and a comparison of the bleaching success of the groups was made at each interval. It was found that after 14 days and three bleachings there was no significant difference in success between the groups. It is therefore recommended that sodium perborate be used in combination with water rather than with hydrogen peroxide to reduce the risk of post-bleaching external root resorption.     

Influence of post-bleaching time intervals on dentin bond strength

It has been reported that bond strength of resin to tooth structure can be reduced when the bonding procedure is carried out immediately after the bleaching treatment. This study evaluated the effect of bleaching of non-vital teeth bleaching on the shear bond strength (SBS) of composite resin/bovine dentin interface and the influence of delaying the bonding procedures for different time intervals following internal bleaching. According to a randomized block design, composite resin cylinders (Z100/Single bond - 3M) were bonded to the flattened dentin surface of two hundred and fifty-six teeth which had previously been subjected to four different treatments: SPH - sodium perborate + 30% hydrogen peroxide; SPW - sodium perborate + distilled water; CP - 37% carbamide peroxide; and CON - distilled water (control), each one followed by storage in artificial saliva for 0 (baseline), 7, 14, and 21 days after bleaching (n = 16). The bleaching agents in the pulp chambers were replaced every 7 days, over 4 weeks. The SBS test of the blocks was done using a universal testing machine. The ANOVA showed that there was no significant interaction between time and bleaching agents, and that the factor time was not statistically significant (p > 0.05). For the factor bleaching treatment, the Student's t-test showed that [CON = CP] > [SPW = SPH]. The bleaching of non-vital teeth affected the resin/dentin SBS values when sodium perborate mixed with 30% hydrogen peroxide or water was used, independently of the elapsed time following the bleaching treatment.     

In vitro efficacy of sodium perborate preparations used for intracoronal bleaching of discolored non-vital teeth

Bleaching materials containing 30% hydrogen peroxide have been used successfully for the treatment of discolored non-vital teeth. Intracoronal application of these materials was occasionally associated with the development of external root resorption. Extracted human teeth with intact crowns were discolored in vitro and bleached with three preparations of sodium perborate. These preparations included: sodium perborate with 30% hydrogen peroxide, sodium perborate with 3% hydrogen peroxide and sodium perborate with water. The bleaching materials were placed in the pulp chamber of the discolored teeth and sealed with IRM for 14 days. They were replaced with fresh preparations after 3 and 7 days. The coronal tooth shades were evaluated after 3, 7 and 14 days and a comparison of the bleaching success of the groups was made at each interval. It was found that after 14 days and three bleachings there was no significant difference in success between the groups. It is therefore recommended that sodium perborate be used in combination with water rather than with hydrogen peroxide to reduce the risk of post-bleaching external root resorption.     

Effect of bleaching agents on bonding to pulp chamber dentine

AIM: To determine the effect of intracoronal bleaching agents on adhesion of bonding agents to pulp chamber dentine. METHODOLOGY: Forty extracted human maxillary anterior teeth were randomly divided into four groups of 10 teeth each. Bleaching agents were sealed in pulp chambers for 7 days, as in clinical use. Group 1 (control): distilled water, group 2: 35% hydrogen peroxide, group 3: sodium perborate mixed with water, and group 4: sodium perborate mixed with 35% hydrogen peroxide. Teeth were stored in saline at 37 degrees C for 7 days. After the bleaching agent was removed, teeth were leached in water for a further 7 days prior to bonding. The crown was cut vertically from mesial to distal and the labial pulp chamber dentine was prepared for bonding with Clearfil SE-Bond and filled with resin composite (Clearfil AP-X). The bonded specimens were kept moist at 37 degrees C for 24 h. Microtensile bond strengths were determined using a universal testing machine. Additional teeth were prepared using the same bleaching procedures to investigate the scanning electron microscopic appearance of the dentine surface. RESULTS: Mean values (+/-SD) of microtensile bond strength for the experimental groups were: group 1: 5.29 +/- 2.21 MPa, group 2: 5.99 +/- 1.51 MPa, group 3: 9.17 +/- 1.65 MPa and group 4: 3.99 +/- 1.31 MPa. Dentine treated with sodium perborate in water (group 3) had significantly higher mean bond strength when compared with the other three groups (P < 0.05, Tukey's test). Mean bond strength was lowest when dentine was treated with sodium perborate plus hydrogen peroxide (group 4). CONCLUSIONS: In terms of subsequent bond strength during restoration, sodium perborate mixed with distilled water appears to be the best intracoronal bleaching agent.     

In vitro comparison of different types of sodium perborate used for intracoronal bleaching of discoloured teeth

AIM: To compare the bleaching efficacy of three different types of sodium perborate (SP) commonly used for intracoronal bleaching of discoloured non-vital teeth. METHODOLOGY: Sixty-five extracted human maxillary central incisors with intact crowns were used. Following obturation with gutta-percha and a root canal sealer using a lateral condensation technique, the coronal aspects of the root canal fillings were covered with a 1-mm thick protective base placed to a level 1 mm apical to the labial cemento-enamel junction (CEJ). The teeth were than stained artificially with fresh blood over a period of 18 days. One or other of the bleaching materials (group 1: SP monohydrate + water, group 2: SP trihydrate + water, group 3: SP tetrahydrate + water, group 4: SP monohydrate + hydrogen peroxide (HP), group 5: SP trihydrate + HP, group 6: SP tetrahydrate + HP) were placed in the pulp chamber of the discoloured teeth and sealed with Cavit for 21 days. They were replaced with fresh preparations after 3, 7 and 14 days. The shades of the tooth crowns were evaluated at baseline and at 7, 14 and 21 days. Comparison of tooth shades was completed at each interval and analysed statistically using the chi-squared test. RESULTS: There was no statistically significant difference between the groups at 7, 14, 21 days. Period of bleaching significantly affected the outcome (P < 0.01). No colour changes were noted in the control teeth. CONCLUSION: The data obtained from this study demonstrate that sodium perborate can be used mixed with water rather than with hydrogen peroxide for bleaching discoloured teeth.     

Effect of traditional and alternative intracoronal bleaching agents on microhardness of human dentine

The purpose of this study was to compare the effect of traditional and alternative bleaching agents on microhardness of human dentine when used intracoronally. Thirty-six premolars were divided into six groups and bleaching agents were sealed into the pulp chambers as follows: group 1--distilled water (control), group 2--30% hydrogen peroxide solution, group 3--sodium perborate mixed with distilled water, group 4--sodium perborate mixed with 30% hydrogen peroxide solution, group 5--35% carbamide peroxide gel, group 6--35% hydrogen peroxide gel. Access cavities were sealed and the teeth were stored in distilled water at 37 degrees C. After 7 days, each tooth was sectioned at the cemento-enamel junction level and microhardness testing was carried out on dentine. The results showed that treatment with 35% hydrogen peroxide gel, 30% hydrogen peroxide solution and 35% carbamide peroxide gel reduced the microhardness of outer dentine to a small extent while treatment with sodium perborate mixed with water and sodium perborate mixed with 30% hydrogen peroxide solution did not significantly alter the microhardness of dentine.     

An in vitro comparison of the bleaching efficacy of 35% carbamide peroxide with established intracoronal bleaching agents

AIM: To evaluate the bleaching efficacy of 35% carbamide peroxide, 35% hydrogen peroxide and sodium perborate for intracoronal bleaching of root filled discoloured teeth. METHODOLOGY: Extracted premolars were artificially stained using whole blood then root canal treatment was performed. After obturation, a 2 mm intermediate base was placed 1 mm below the buccal amelo-cemental junction. Intracoronal bleaching was performed in 11 teeth per group, using either 35% carbamide peroxide gel (group CP), 35% hydrogen peroxide gel (group HP) or sodium perborate mixed with distilled water (group SP). The bleaching agents were replaced after 7 days. The shade of the teeth was evaluated at day 0, 7 and 14. The results were analysed using Kruskal-Wallis one-way analysis of variance and Mann-Whitney U-test. RESULTS: At the end of 7 days, both groups CP and HP lightened by 8 +/- 3 Vita tab positions, respectively, whereas group SP lightened by 5 +/- 3 tab positions (P < 0.05). At the end of the second bleaching period at day 14, group CP and HP lightened by a further 2 +/- 2 and 2 +/- 3 tab positions, respectively, whereas group SP lightened by a further 3 +/- 4 tab positions. There were no statistical differences between groups at day 14. CONCLUSIONS: Thirty-five per cent carbamide peroxide and 35% hydrogen peroxide were equally effective for intracoronal bleaching, and significantly better than sodium perborate after 7 days. After 14 days, there were no significant differences between the groups. Thirty-five per cent carbamide peroxide can be recommended as an equally effective alternative to hydrogen peroxide for intracoronal bleaching.     

Microtensile bond strength of a nanofilled composite resin to human dentin after nonvital tooth bleaching

PURPOSE: The purpose of this in vitro study was to measure the microtensile bond strength of a nanofilled composite resin to human dentin after nonvital bleaching at different post-bleaching time intervals, and to analyze the fracture mode under SEM. MATERIALS AND METHODS: Thirty-six sound human maxillary premolars extracted for orthodontic reasons were prepared in a standardized manner, and randomly assigned to four groups (n = 9): non bleached (control) (NB); bleached with sodium perborate and 35% hydrogen peroxide (SP-HP); bleached with 35% hydrogen peroxide (HP); and bleached with 37% carbamide peroxide (CP). Each group was subdivided into 3 subgroups (n = 3): restored immediately (RO); restored after 7 days (R7); and restored after 14 days (R14). The teeth were stored in distilled water for 24 h, sectioned 4 mm below cementoenamel junction, and the crown was serially sectioned to obtain sticks (0.9 mm2 cross section) for microtensile bond strength testing. The microTBS samples were attached to a universal testing machine (Instron, model 4444), using a Geraldeli's device. The test was performed until the fracture of the specimens, and all specimens were analyzed under a scanning electron microscope (Philips XL-30). RESULTS: Two-way ANOVA (p = 0.05) revealed that there were no statistically significant differences of bond strength values for the bleaching agents used, or at different post-bleaching time intervals. CONCLUSION: It was concluded that the definitive restoration can be accomplished immediately after nonvital bleaching treatment.     

Ex vivo evaluation of the effectiveness of bleaching agents on the shade alteration of blood-stained teeth

Aim To evaluate ex vivo effectiveness of the three formulations of bleaching materials for intracoronal bleaching of root filled teeth using the walking bleach technique. Methodology Extracted premolar teeth were stained artificially with human blood. After biomechanical preparation, the root canals were filled and a 3‐mm thick intermediate base of zinc phosphate cement was placed at the level of the cementoenamel junction. The teeth were divided into four groups (n = 12): C (control, without bleaching material), A1 (sodium perborate + distilled water), A2 (sodium perborate + 10% carbamide peroxide) and A3 (sodium perborate + 35% carbamide peroxide). The bleaching materials were changed at 7 and 14 days. Evaluation of shade was undertaken with aid of the VITA Easyshade? (ΔE*ab) and was performed after tooth staining and at 7, 14 and 21 days after bleaching, based on the CIELAB system. Data were analysed by anova for repeated measurements, Tukey and Dunnett tests (α = 0.05). Results The Tukey test revealed that group A1 (10.58 ± 4.83 ΔE*ab) was statistically different from the others (A2, 19.57 ± 4.72 ΔE*ab and A3, 17.58 ± 3.33 ΔE*ab), which were not different from each other. At 7 days: A1 was significantly different from A2; at 14 and 21 days: A2 and A3 were significantly better than A1; the Dunnett test revealed that the control group was different from A1, A2 and A3 at all periods (P < 0.05). Conclusion Sodium perborate associated with both 10% and 35% carbamide peroxide was more effective than when associated with distilled water.     

In vitro microleakage of composite restorations after nonvital bleaching.

OBJECTIVE: After bleaching treatment, esthetic restorations often need to be replaced due to color changes. Some papers have shown alterations in the bond of adhesive restorations to bleached teeth. The purpose of this study was to evaluate tooth and resin composite adhesion when submitted to nonvital dental bleaching. METHOD AND MATERIALS: One hundred and twenty bovine teeth were assigned to 3 groups (n = 40); paste of sodium perborate and water; 37% carbamide peroxide gel; and no bleaching (control). After 3 weeks of continuous bleaching treatment, standardized Class V cavities were prepared at the cementoenamel junction and restored with Single Bond adhesive system and Z100 resin composite. The samples were thermocycled 1,500 times (5 +/- 1/55 +/- 1 degrees C) with a 1-minute dwell time. Then, they were immersed in a 2% methylene blue solution (pH 7) for 4 hours, sectioned, and analyzed by stereomicroscopy. Microleakage analyses were done, using scores from 0 to 4, considering leakage on the incisal wall (enamel) and the cervical wall (dentin). Data were analyzed by Kruskal-Wallis and Mann-Whitney tests (alpha = 0.05). RESULTS: The results showed that sodium perborate and carbamide peroxide gel significantly increase the microleakage in Class V resin composite restorations to dentin but not to enamel margins. CONCLUSION: The risk of microleakage in dentin margins is increased soon after bleaching treatment.     

The effect of nonvital bleaching on the shear bond strength of composite resin using three adhesive systems

PURPOSE: To evaluate the effect of nonvital bleaching on the shear bond strength of composite resin using three adhesive systems. MATERIALS AND METHODS: Two hundred seventy bovine teeth were assigned to 3 groups (n = 90): SP, paste of sodium perborate and water; CP, 37% carbamide peroxide; CO, control group (no treatment). After the bleaching treatment, the teeth in each group were cut into enamel (E) and dentin (D) sections. The teeth were embedded in polyester resin and polished in order to obtain a flat E or D surface. Each group was divided into 6 subgroups (n = 15) according to substrate (E and D) and adhesive system: SB, Single Bond (solvent: water/alcohol); PB, Prime & Bond NT (solvent: acetone); CLF, Clearfil SE Bond (solvent: water). The adhesive system was applied on each flat surface according to the manufacturer's instructions and a cylinder of composite resin Z-250 was overlaid. The specimens were stored in distilled water for 7 days at 37 degrees C. The SBS test was performed in a universal testing machine with crosshead speed of 0.5 mm/min. The data obtained (in MPa) were statistically analyzed with two-way ANOVA and Tukey's test (p < or = 0.05). RESULTS: The bleaching treatment influenced the SBS, regardless of the adhesive system used. On enamel, the SP and CP bleaching treatments reduced the SBS values. On dentin, the SP bleaching agent reduced the SBS values, but the CP bleaching did not. CONCLUSION: Nonvital bleaching treatment with sodium perborate may adversely affect shear bond strength of composite resin for both enamel and dentin. Similar effects can be expected from 37% carbamide peroxide bleaching agent on enamel but not dentin bonding strength. The use of water/alcohol and acetone-based adhesive systems cannot reverse the effects of bleaching treatments on bond strengths.     

Microleakage in endodontically treated teeth: influence of calcium hydroxide dressing following bleaching

AIM: The purpose of the present study was to evaluate microleakage of a fourth generation dentine-bonding agent and composite restoration during a walking bleach treatment. METHODOLOGY: Thirty extracted non-carious incisors were selected and conventional root canal treatment was performed. Teeth were randomly divided into 3 groups (n = 10): group A (control), access cavities were restored with a fourth generation dentine-bonding agent, and incrementally restored with composite resin; group B, a paste composed of sodium perborate and hydrogen peroxide was placed into the pulp chamber and sealed with glass ionomer cement for 7 days, teeth were then restored in the same manner as group A; group C, a paste of sodium perborate and hydrogen peroxide was placed in the pulp chamber for 7 days and then after removal of the bleaching mixture, pulp chambers were filled with a calcium hydroxide paste and cavities sealed with glass ionomer for 1 week. The cavities were then restored with bonded restorations as in groups A and B. Teeth were subjected to thermal cycling and immersed in methylene blue for 8 h. Teeth were sectioned from buccal to lingual, through the centre of the restoration, using a diamond disk. Leakage was assessed using a standard scheme, under magnification (x20). Data were submitted to statistical analysis using nonparametric Kruskal-Wallis test. RESULTS: Groups A and C exhibited similar leakage patterns, and both demonstrated less leakage values than group B (P < 0.05). CONCLUSIONS: It was concluded that bleaching with sodium perborate and hydrogen peroxide increases microleakage; short-term use of a calcium hydroxide medicament did not increase microleakage.     

Effect of smear layer removal on bleaching of human teeth in vitro

The purpose of this study was to evaluate objectively in vitro the effectiveness of bleaching artificially discolored teeth with or without the smear layer present using sodium perborate mixed with sterile water or 35% hydrogen peroxide (H2O2). Seventy fully developed maxillary anterior teeth were artificially stained with human hemoglobin and separated into one control and four experimental groups. After the smear layer was removed on half the experimental teeth and left intact on the other half, all of the teeth were bleached intracoronally with sodium perborate and 35% H2O2 or sodium perborate plus water. The bleaching agents were applied twice over a 6-day period. The changes in tooth shade were objectively analyzed using a SP78 sphere spectrophotometer at 1, 30, and 60 days postbleaching. The presence or absence of the smear layer did not significantly influence the outcome of bleaching (p > 0.05). The teeth bleached with sodium perborate and 35% H2O2 were significantly lighter than the teeth bleached with sodium perborate and sterile water (p < 0.0001) at each experimental period. Based on the findings of this study, it is not advantageous to remove the smear layer before intracoronal bleaching.     

Effect of hydrogen peroxide and sodium perborate on biomechanical properties of human dentin

This study compared the ultimate tensile strength, micropunch shear strength, and microhardness of bleached and unbleached human dentin. Forty-four intact premolars were root canal treated and randomly divided into four groups. Bleaching agents were sealed in pulp chambers, as in clinical use. Group 1 (control) was treated with water, group 2 with 30% hydrogen peroxide, group 3 with sodium perborate mixed with water, and group 4 with sodium perborate mixed with 30% hydrogen peroxide. The teeth were stored in saline at 37 degrees C for 7 days. The teeth were then sectioned and biomechanical tests were carried out on dentin specimens that were obtained from all teeth. Intracoronal bleaching with 30% hydrogen peroxide and sodium perborate used either alone or in combination weakened dentin. Hydrogen peroxide alone tended to be more damaging than sodium perborate used alone or sodium perborate mixed with hydrogen peroxide.     

The effects of internal tooth bleaching regimens on composite-to-composite bond strength

BackgroundThe authors conducted an in vitro study to investigate the influence of several internal bleaching regimens on the composite-to-composite shear bond strength of a dental core buildup material.MethodsThe authors fabricated 72 specimens from a resin-based composite core buildup and assigned them randomly to six groups (four experimental and two control groups) (n = 12 per group), according to the following bleaching agents: sodium perborate mixed with distilled water (SP/W); sodium perborate mixed with 3 percent hydrogen peroxide (SP/HP-3); sodium perborate mixed with 30 percent hydrogen peroxide (SP/HP-30); 35 percent hydrogen peroxide (HP-35). After the 12-day bleaching procedures, the authors applied a calcium hydroxide dressing for two weeks. The two control groups consisted of unbleached specimens that either did not receive (C1) or did receive (C2) the calcium hydroxide dressing. The authors cleaned and silanized the resin-based composite specimens and coated them with an intermediate adhesive resin before applying fresh composite material. They measured composite surface roughness and shear bond strength and performed statistical analyses of the data.ResultsUnbleached specimens in groups C1 and C2 exhibited significantly lower composite-to-composite bond strength and significantly lower surface roughness than did specimens in groups SP/W and SP/HP-3. Bond strength in group HP-35 was significantly lower than that in group SP/W.ConclusionInternal bleaching regimens that involve the use of sodium perborate mixed with water or 3 percent hydrogen peroxide might increase the composite-to-composite interfacial bond strength.Clinical ImplicationsNone of the internal bleaching regimens in this study had an adverse effect on the composite-to-composite interfacial bond strength.     

Considerations in intracoronal bleaching

Intracoronal bleaching is a simple, useful procedure for restoring the colour of discoloured root-filled teeth that are not extensively restored. It is important to minimise the extraradicular diffusion of hydrogen peroxide, as excessive levels of hydrogen peroxide in conjunction with existing inflammatory changes in the periodontium predispose the tooth to external root resorption. To keep the levels of extraradicular diffusion of hydrogen peroxide below the safety limit, it is imperative that an effective intermediate base cement of at least 2 mm be placed at the level of the buccal cemento-enamel junction over the root-filling prior to bleaching. The use of 35% carbamide peroxide as the intracoronal bleaching agent seems to combine the safety of sodium perborate together with the efficacy of 35% hydrogen peroxide. As bleaching agents may reduce the composite-tooth bond of some adhesive systems, the post-bleaching composite restoration should be delayed for at least three weeks.     

Radicular penetration of hydrogen peroxide during intra-coronal bleaching with various forms of sodium perborate

The development of external cervical root resorption following internal bleaching of discoloured pulpless teeth is associated with the use of hydrogen peroxide. The aim of the study was to determine radicular penetration of hydrogen peroxide following intracoronal bleaching with various forms of sodium perborate, 63 extracted human incisors were root filled and stained artificially. Standardized cementum defects were created on the mesial and distal aspects of the root directly below the cemento-enamel junction (CEJ). Using the walking bleach technique all teeth were bleached for a 6-day period, with replacement of the bleaching paste after days 1 and 3. Sodium perborate monohydrate (MH), trihydrate (TRH) or tetrahydrate (TH) was mixed with H₂O₂ or H₂O and subsequently placed intracoronatly 1 mm below the labial CEJ. The teeth were divided into six groups:

• I. MH + H₂O₂(30%)(n=12);
• II. TRH + H₂O₂(30%)(n=12);
• III. TH + H₂O₂(30%)(n=12);
• IV. TH + H₂O(n=12);
• V. TH + H₂O gel(n=12);
• VI. no bleaching paste (n= 3).

At baseline and at days 1, 3 and 6 the amount of H₂O₂ taken up from the surrounding medium of each root was indirectly recorded and calculated as p.p.m. Almost all teeth of the experimental groups showed leakage of hydrogen peroxide compared to those of the control group. The radicular penetration of hydrogen peroxide was significantly higher in teeth of groups I and III than in those of groups IV and V (P≤ 0.001). In conclusion, the amount of hydrogen peroxide leakage depends, among other factors, on the form of sodium perborate used. The risk of post-bleaching cervical root resorption may be diminished by using sodium perborate tetrahydrate in conjunction with H₂O.     

The effect of propolis on the bond strength of composite resin to enamel after intracoronal bleaching with different bleaching agents

This study evaluated the effect of propolis as an antioxidant agent on bond strength to enamel after intracoronal bleaching. A total of 160 incisors were endodontically treated. Sixteen teeth were served as control, and the remaining teeth were randomly divided into three main groups according to the bleaching agent used; group 1: Sodium perborate (SP); group 2: Carbamide peroxide (CP); group 3: Hydrogen peroxide (HP). After bleaching, the samples were divided into three subgroups; subgroup A: no antioxidant agent application, subgroup B: sodium ascorbate (SA), subgroup C: propolis (PP). After the antioxidant agents application, the sample's surfaces were washed and dried. After adhesive application, composite resin cylinders were applied to enamel surfaces using tygon tubes and a shear bond strength test was performed. The use of PP significantly decreased the bond strength of composite resin to the enamel (p < 0.05). Using propolis as an antioxidant agent adversely affects the bond strength to enamel after intracoronal bleaching.     

Intracoronal bleaching of discolored non-vital teeth

This clinical study compared the effectiveness of bleaching non-vital teeth with an open pulp chamber during bleaching using 10% carbamide peroxide compared to the modified walking bleach technique and extracoronal bleaching. Sixty discolored, non-vital teeth were treated. They were divided into three groups. Each group was treated with one of the bleaching materials and methods: extracoronally using 10% carbamide peroxide for two weeks as negative control (Group A), intracoronally using sodium perborate mixed with 3% hydrogen peroxide (modified walking bleach technique) (Rotstein, Mor & Friedman, 1993) for four weeks (Group B) and intracoronally and extracoronally using 10% carbamide peroxide for two weeks (Group C) (Liebenberg, 1997). Tooth color was measured at baseline, (BL), immediately post-bleaching (IP) and six months post-bleaching (SP) with a colorimeter (Castor, Sigma, Germany) using a tooth-positioning jig. The color was determined according to the CIELAB system, which records lightness as L* and chromaticity coordinates as a* and b*. The difference in L* and b* among the three groups was significant between BL and IP examination. The post-bleaching, whitening effect in Group C was significantly better, but after six months, in Group C, it was as effective as in Group B.     

Extraradicular diffusion of hydrogen peroxide and pH changes associated with intracoronal bleaching of discoloured teeth using different bleaching agents

AIM: To evaluate the extraradicular pH and hydrogen peroxide (HP) diffusion when either 35% carbamide peroxide (CP), 35% HP or sodium perborate (SP) is used for intracoronal bleaching of artificially discoloured teeth. METHODOLOGY: Single rooted extracted human premolars were stained with whole blood cells. After shaping and cleaning, they were root filled and a base cement placed 1 mm below the buccal cementoenamel junction (CEJ). Four cemental defects were prepared just below the CEJ on each root surface. The teeth were randomly divided into four groups of 11 specimens, and intracoronally bleached using CP, HP, SP or distilled water (CL). Each tooth was suspended in a vial of distilled water and bleached for 7 days. The pH of the extraradicular distilled water was tested at 0, 1, 2 and 7 days and the HP that diffused through the root quantified using the Ferrous Oxidation-Xylenol Orange 2 Assay. The results were analysed using the one-way anova and Scheffe tests. RESULTS: Carbamide peroxide produced the greatest increase and HP the least pH change (P < 0.05 except day 1), SP was intermediate. From day 1 onwards, radicular diffusion of HP was greatest with HP and least with CP (P < 0.01), again SP was intermediate. There was no significant difference between CP and SP. CONCLUSIONS: Carbamide peroxide had very low levels of extraradicular diffusion of HP, in the presence of cemental defects. It could be an alternative to the other intracoronal bleaching agents.