High-concentrated carbamide peroxide bleaching agents effects on enamel surface

Concern has been expressed regarding the adverse effects of peroxide-containing tooth bleaching agents on enamel surface. This study examined enamel average surface roughness before (baseline) and after an in-office bleaching protocol and investigated the influence of high concentrations of carbamide peroxide gels on its surface staining and morphology. Flat enamel surfaces were submitted to 35 and 37% carbamide peroxide or to no bleaching treatment (n = 10) and evaluated with a profilometer. Eight specimens from each group were randomly selected and immersed in a 2% methylene blue solution. Afterwards, specimens were ground into powder and prepared for the spectrophotometric analysis. Two remained specimens of each group were examined using a scanning electron microscope. Data were subjected to analysis of variance and Tukey test (P > 0.05). Baseline roughness average was statistically similar for all groups, however, 35% carbamide peroxide produced the roughest enamel surfaces. Different concentrations of carbamide peroxide produced similar staining means and enamel surface morphological alterations.     

过氧脲素漂白剂对牙釉质表面特性的影响

目的：观察１０％～３０％过氧脲素漂白剂对牙釉质表面特性的影响。方法：选用正畸拔除的健康前磨牙，经１０％、１５％、３０％过氧脲素漂白剂处理１５ｄ后，采用显微硬度测定仪、电子显微镜等手段检查。结果：１０％、１５％、３０％过氧脉素漂白剂对牙釉质表面硬度无降低作用，与对照组（ＨＶ：５８１．９±１１７．５）无明显差异；扫描电镜显示，牙釉质经漂白显现较光滑外观，无腐蚀、溶解现象。结论：１０％～３０％过氧脉素漂白剂对牙釉质表面结构无破坏作用。     

Clinical trial of three 10% carbamide peroxide bleaching products

BACKGROUND: A profusion of commercial bleaching systems exists on the market today, but there are few clinical comparisons of these systems. METHODS: In this study, three different commercial 10% carbamide peroxide bleaching systems were used by 24 patients in an overnight protocol for two weeks. Each patient used two of the bleaching products simultaneously in a side-by-side comparison. RESULTS: The mean onset of tooth whitening was 2.4 +/- 1.7 days. Tooth sensitivity was the most frequent side effect, as 64% of the patients reported tooth sensitivity occurring after 4.8 +/- 4.1 days and lasting for 5.0 +/- 3.8 days. Although intrapatient differences were recorded for the three commercial 10% carbamide peroxide bleaching systems by the patients, there were no statistical differences in the time of onset of subjective tooth whitening and the onset, frequency and duration of tooth sensitivity among the three commercial bleaching systems when compared pairwise or independently (p < 0.05). CONCLUSION: Selection of which bleaching product to use should be based on the concentration of the active ingredient, the viscosity of the product and other marketing features. Further research is needed to investigate the causes of tooth sensitivity and methods to reduce its severity and frequency.     

Effect of 10% carbamide peroxide bleaching gel on enamel microhardness, microstructure, and mineral content

The effect of 10% carbamide peroxide on human enamel subsurface layers was examined. Microhardness, microstructure, and mineral content were studied in such a manner that control and test side were located on the same tooth. Longitudinally sectioned samples were obtained from six teeth and Vickers microhardness of the enamel was measured. Enamel microstructure was analyzed using a scanning electron microscope and subjected to electron probe microanalysis for chemical analysis of calcium (Ca) and phosphorus (P). The concentration of Ca in the bleaching gel was measured spectrophotometrically and the concentration of P was measured photometrically. Results showed that a bleaching gel of 10% carbamide peroxide did not significantly affect the microhardness of the enamel. Scanning electron microscopic analysis showed local changes in enamel microstructure similar to those of initial caries. Electron probe microanalysis showed lowered concentrations of Ca and P; in addition the Ca:P ratio was lowered. There was some Ca and P in the bleaching gel after use. It is concluded that 10% carbamide peroxide causes local microstructural and chemical changes in enamel that are likely not clinically significant.     

The efficiency of 10% carbamide peroxide gel on dental enamel

This study investigated the effect of 10% carbamide peroxide gel on human tooth color, vibrational mode, and mineral loss. The exposed enamels were bleached for two weeks (six hours' bleaching and 18 hours' storage in distilled water per day). Color change was calculated from the CIE L*a*b* color values. Vibrational mode in Fourier transform Raman spectrum and mineral content were also estimated. The bleached enamels showed an apparent color change (deltaE* = 5.35). Within the test period, their whiteness increased linearly as the period increased. A slight decrease in Raman peak at 1068 cm(-1)--compared with the peak at 430 cm(-1)--was observed after bleaching. The total mineral content was decreased from 90.39 to 86.01 after bleaching. Also, the calculated Ca/P ratio decreased from 2.10 to 2.07. However, these changes were negligibly different from the enamels stored in distilled water except for a color change.     

Shear bond strength after dentin bleaching with 10% carbamide peroxide agents

This in vitro study evaluated the shear bond strength (SBS) of dentin treated with two 10% carbamide peroxide bleaching agents 15 days after bleaching and storage in artificial saliva. Dentin fragments were randomly divided into 3 groups (n = 20) for the treatment with the two different bleaching agents (Rembrandt 10% or Opalescence 10%) or with a placebo agent, applied to the tooth surface for 8 hours a day. During the remaining time, the specimens were stored in artificial saliva. After 42 days, the fragments were stored in artificial saliva for 14 days. Another group (n = 20) was exposed to distilled and deionized water for 56 days. An adhesive system and microhybrid composite resin were used to prepare specimens for the SBS test. SBS tests were performed and the fractured surfaces were visually examined using a stereoscope at 30 x magnification. The analysis of variance (ANOVA) and SIDAK tests showed higher SBS values for dentin treated with Opalescence 10% than for dentin treated with Rembrandt 10% or placebo. Groups treated with Rembrandt 10%, Opalescence 10% or placebo did not differ from the group treated with distilled and deionized water. Ten percent carbamide peroxide agents or a placebo agent caused no differences in SBS of dentin after 15 days of storage in artificial saliva.     

The effect of 10% carbamide peroxide bleaching material on microhardness of sound and demineralized enamel and dentin in situ.

This in situ study evaluated the microhardness of sound and demineralized enamel and dentin submitted to treatment with 10% carbamide peroxide for three weeks. A 10% carbamide peroxide bleaching agent--Opalescence/Ultradent (OPA)--was evaluated against a placebo agent (PLA). Two hundred and forty dental fragments--60 sound enamel fragments (SE), 60 demineralized enamel fragments (DE), 60 sound dentin fragments (SD) and 60 demineralized dentin fragments (DD)--were randomly fixed on the vestibular surface of the first superior molars and second superior premolars of 30 volunteers. The volunteers were divided into two groups that received bleaching or the placebo agent at different sequences and periods at a double blind 2 x 2 crossover study with a wash-out period of two weeks. Microhardness tests were performed on the enamel and dentin surface. The SE and DE submitted to treatment with OPA showed lower microhardness values than the SE and DE submitted to treatment with PLA. There were no statistical differences in microhardness values for SD and DD submitted to the treatment with OPA and PLA. The results suggest that treatment with 10% carbamide peroxide bleaching material for three weeks alters the enamel microhardness, although it does not seem to alter the dentin microhardness.     

The effect of a 10% carbamide peroxide home bleaching system on the gingival health

Esthetics plays an important role in dentistry today. Because of an increased emphasis on beauty and health, cosmetic dentistry has been the thrust to the forefront of many practices. Many health products are used for bleaching teeth, but all side effects are not known. Tooth sensitivity and gingival irritation are the most common side effects, but they are typically mild and transient in nature. The aim of this investigation was to evaluate objectively the effect of 10% carbamide peroxide gel (Opalescence Utradent Inc, USA) on gingival health by measuring changes in Bleeding Index, Plaque Index, and Gingival Index. Eighteen subjects, 11 female and 7 male, age range 15-30 years (mean 24 years), were selected for the study as a convenient sample. Their teeth had either fluorosis, dental stains, smoking, or tetracycline staining. The Opalescence system was used as office monitored, at-home bleaching for three weeks. There was a statistically significant reduction in bleeding on probing (1% - 37%, p < or = 0.003), Plaque Index (4% - 50%, p < or = 0.000), and Gingival Index (2.5% - 34%, p < or = 0.002). Only two subjects reported tooth hypersensitivity, and none of the subjects complained about gingival irritation. There was a positive change in tooth color as far as staining was concerned. Further research including randomized controlled, double blind clinical trials is needed to confirm these findings and to examine other factors related to bleaching of teeth.     

The effect of a 10% carbamide peroxide bleaching agent on the phosphate concentration of tooth enamel assessed by Raman spectroscopy

Abstract –  The study assessed changes in phosphate concentrations of surface enamel treated with a proprietary bleaching agent (' PEROXIDE ') containing 10% carbamide peroxide over a 28-day period using Raman spectroscopy. Six non-carious human molar teeth (age range 12–21 years), extracted for orthodontic reasons, were used. From the enamel face of each half tooth, a near flat enamel section, approximately 2 × 2 mm, was cut, providing 12 specimens. Each specimen was treated with 10% carbamide peroxide for 8 h day⁻¹ for 28 consecutive days, with Raman spectra being obtained prior to bleaching and after 7, 14, 21 and 28 days. Raman spectra were acquired on a confocal LabRam 300 spectrometer fitted with an Olympus B microscope (Olympus, Middlesex, UK).The difference in the maximum peak values for phosphate group concentrations were tested using the Friedman test (non-parametric anova ) and Dunn's multiple comparison test. An intense broad band at 980 cm⁻¹, characteristic of phosphate groupings, was always observed. At 7 and 14 days, and again at 28 days, there was a significant decrease in the phosphate group concentration compared with base-line measurements ( P  < 0.05) but not at 21 days ( P  > 0.05). Ideally, bleaching should not be continued to a point where surface enamel is lost, and the present study suggests that a regime using 10% carbamide peroxide should not extend to 7 days.     

Extended at-home bleaching of tetracycline-stained teeth with different concentrations of carbamide peroxide.

OBJECTIVE: The degree of color change and the dental sensitivity associated with the use of different concentrations (10%, 15%, and 20%) of carbamide peroxide every night for 6 months was evaluated in tetracycline-stained teeth. METHOD AND MATERIALS: Fifty-nine subjects were shown how to place two different concentrations of carbamide peroxide in the custom trays with reservoirs. For a period of 6 months, the patients were to insert the tray every evening before retiring. Patients returned in 1 and 2 weeks and at 1, 2, 3, 4, 5, 6, 7, 8, and 9 months for evaluation of the degree of color change by subjective shade matching and by photographic means. Sensitivity of hard or soft tissues was self-reported. RESULTS: Fifty-two subjects attended more than 90% of the recalls. A colorimeter was used to convert shade guide tabs to Commission Internationale de l'Eclairage color spaces (CIELAB). The most rapid whitening occurred in the first month. At 3 and 9 months, 91% and 85% of the subjects, respectively, were at least "a little pleased" with the results of the bleaching. In the professional evaluation, 90% of the teeth were deemed to have an excellent or satisfactory esthetic result. The higher the concentration of carbamide peroxide, the more rapidly the lightness value and color difference changed. There was no difference among the three concentrations in resulting gingival sensitivity. Patients experienced less tooth sensitivity with 10% gel than they did with 15% and 20% gels. CONCLUSION: Bleaching with 10%, 15%, and 20% carbamide peroxide is effective for removing tooth staining caused by tetracycline. The 10% concentration has the most advantages and the fewest disadvantages.     

Effect of CPP-ACP on efficacy and postoperative sensitivity associated with at-home vital tooth bleaching using 20% carbamide peroxide

Clinical Oral Investigations - To evaluate CPP-ACP effect on colour change and tooth sensitivity (TS) associated with at-home vital tooth bleaching using 20% carbamide peroxide (CP). A randomised...     

不同增稠载体的过氧化脲漂白剂对釉质表面形态的影响

目的:研究不同载体和浓度的过氧化脲(carbamide peroxide,CP)漂白剂对釉质表面形态的影响。方法:分别以Carbopol、PVP、Poloxamer为凝胶增稠载体,配制含100g/L、150g/L和200g/LCP的CP漂白剂(pH6.5)和不含CP的凝胶制剂,利用近期拔除的离体前牙牙冠分组观察CP漂白剂对釉质表面形态的影响。结果:以Carbopol,PVP或Poloxamer作为增稠载体的漂白剂,随着CP浓度的增高,釉质表面从轻度溶解、脱矿,蜂窝状改变,直至正常釉质层消失,"鱼鳞状"的釉柱结构清晰可辨。其中以Poloxamer为增稠载体的漂白剂较之更甚。结论:以Carbopol,PVP或Poloxamer作为增稠载体的漂白剂,随着CP浓度的增高,釉质表面出现不同程度的形貌改变。     

Microcomputerised tomography evaluation of 10% carbamide peroxide applied to enamel

OBJECTIVES: There is still some controversy in the dental literature whether carbamide peroxide bleaching causes demineralization of teeth. One of the reasons for this controversy is that there is as yet no reliable, non-destructive in vitro method for assessing mineral loss in bleached teeth. The objective of this study was to investigate the possible demineralization effect of 10% carbamide peroxide bleaching agent on enamel and dentine non-destructively. METHODS: microCT images were obtained of 12 human molar tooth sections. These sections had 10% carbamide peroxide applied for eight hours a day over a period of 15 days. Further tomographic images were obtained and the mineral content prior to and post bleaching assessed. RESULTS: A total of 144 regions were evaluated using the image processing language available in the work station. The application of 10% carbamide peroxide was found to cause demineralization of the enamel extended to a depth of 50 microm below the enamel surface (Paired t-test, p<0.05). CONCLUSIONS: This study confirmed that microCT was indeed a highly suitable method for assessing mineral content of dental enamel after bleach application. It is recommended that application of bleaching agents should be carefully considered in patients susceptible to caries and tooth wear.     

The influence of chemical activation on tooth bleaching using 10% carbamide peroxide

The aim of this study was to assess the influence of manganese gluconate, a chemical activator of bleaching agents, at a concentration of 0.01% on the efficiency of a 10% carbamide peroxide-based bleaching agent. Forty bovine incisors were immersed in a 25% instant coffee solution for seven days and randomly divided into two groups. Group 1 was the control group and consisted of 10% carbamide peroxide-based bleaching gel only. Group 2 consisted of 10% carbamide peroxide-based bleaching gel and 0.01% manganese gluconate. Three readings of color were taken using the Vita Easyshade spectrophotometer: the initial reading, a reading at seven days, and a reading at 14 days. Total color variation was calculated by ΔE*Lab. Data were submitted to the statistical t-test (5%), which showed that after seven days group 2 had a significant increase in the degree of tooth bleaching compared with group 1. The mean values (±SD) were 16.33 (±3.95) for group 1 and 19.29 (±4.97) for group 2. However, the results for group 1 and group 2 were similar after 14 days. Adding 0.01% manganese gluconate to 10% carbamide peroxide bleaching gel increased the degree of tooth bleaching after a seven-day treatment and did not influence the resulting shade after 14 days.     

Comparison of 10% carbamide peroxide and sodium perborate for intracoronal bleaching

The purpose of this study was to compare 10% carbamide peroxide to the combination of sodium perborate and water as intracoronal bleaching agents. Forty-four extracted teeth were discolored in vitro. Bleaching agents were placed intracoronally to the level of the cemento-enamel junction for 12 days; solutions were replaced after four and eight days. Standardized slides were used to rank color changes; a colorimeter was used to quantify color change. After 12 days, 65% of the discolored teeth in the 10% carbamide peroxide group and 67% of the discolored teeth in the sodium perborate group had lightened to their original shade or lighter. While there was no statistical difference between the two treatments, sodium perborate was easier to use.