Effect of bleaching on restorative materials and restorations--a systematic review.

OBJECTIVE: Internal and external bleaching procedures utilizing 3-35% hydrogen peroxide solutions or hydrogen peroxide releasing agents, such as carbamide peroxide or sodium perborate, can be used for whitening of teeth. The purpose of the review article was to summarize and discuss the available information concerning the effects of peroxide releasing bleaching agents on dental restorative materials and restorations. SOURCES: Information from all original scientific full papers or reviews listed in PubMed or ISI Web of Science (search term: bleaching AND (composite OR amalgam OR glass ionomer OR compomer OR resin OR alloy) were included in the review. DATA: Existing literature reveals that bleaching therapies may have a negative effect on physical properties, marginal integrity, enamel and dentin bond strength, and color of restorative materials as investigated in numerous in vitro studies. However, there are no reports in literature indicating that bleaching may exert a negative impact on existing restorations requiring renewal of the restorations under clinical conditions. CONCLUSION: Bleaching may exert a negative influence on restorations and restorative materials. Advice is provided based on the current literature to minimize the impact of bleaching therapies on restorative materials and restorations.     

漂白剂对玻璃离子水门汀类材料充填Ⅴ类洞边缘微渗漏的影响

目的评估漂白凝胶和洁白牙贴对3种不同的玻璃离子水门汀类材料边缘微渗漏的影响。方法在45颗离体健康前磨牙的颊舌侧制备Ⅴ类洞,随机分为A、B、C组,分别使用加强型玻璃离子水门汀KetacTM Molar Easymix、复合体F2000、复合体Dyract AP充填,每个大组再分为3个亚组,第1组和第2组分别使用质量分数14％过氧化氢（HP）洁白牙贴和10％过氧化脲（CP）凝胶进行漂白,第3组为对照组。所有样本置入37 ℃蒸馏水中保存7 d后冷热循环500次,然后进行漂白。漂白21 d后置于碱性品红溶液中染色24 h,沿牙体长轴通过充填体中央颊舌向剖开牙齿,体视显微镜下观察并测量染料渗入窝洞壁的深度。结果2种漂白方式对充填体边缘微渗漏的影响没有明显差异（P>0.05）;与对照组相比,2种漂白方式对B、C组的微渗漏均没有产生明显影响（P>0.05）,但均可使A组的微渗漏增加（P<0.05）。结论10％CP凝胶和14％HP洁白牙贴对充填体边缘微渗漏的影响无明显差异;漂白不会影响复合体的微渗漏,但会增加加强型玻璃离子水门汀的微渗漏。     

Post-operative bleaching: effect on microleakage.

The effect of a carbamide peroxide bleaching gel on the microleakage of Class V resin composite restorations with two dentin bonding agents was evaluated using extracted human teeth. Class V cavity preparations were placed at the cementoenamel junction of the facial and lingual surfaces of 20 teeth for a total of 40 preparations. Half of the teeth were restored with Scotchbond 2/Silux Plus and half were restored with Prisma Universal Bond 3/AP.H. Five teeth were randomly selected from each of the two groups and were stored in water at 37 degrees C to serve as controls. The remaining teeth were exposed to a carbamide peroxide gel for three 2-hour periods per day for 9 days. The specimens were stored in distilled water at 37 degrees C except during treatment periods. All teeth were then thermally stressed for 100 cycles. Microleakage was assessed by dye penetration. The results demonstrated that the carbamide peroxide agent adversely affected the marginal seal of both restorative systems.     

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 effects of high concentration tooth whitening bleaches on microleakage of Class V composite restorations

OBJECTIVE: To explore the effects of high-concentration hydrogen peroxide bleaching agents on the microleakage of composite restorations. METHODS: In 60 extracted human molars, Class V restorations were prepared with Scotchbond 1/Filtek Z250 composite. Teeth were randomly divided into four groups: (1) no bleaching; (2) bleaching with 14% hydrogen peroxide gel from Crest Whitestrips; (3) bleaching with 20% carbamide peroxide gel from Opalescence PF 20; and (4) bleaching with 38% hydrogen peroxide gel Opalescence Xtra Boost. Bleaching procedures were carried out at 37 degrees C for 21 days/42 hours (2); seven days/42 hours (3); one day/45 minutes (4). Varnish was applied on the apical portion of the teeth only, excluding the restoration, prior to immersion in a 0.1% rhodamin-B-isothiocyanate solution for 24 hours at 37 degrees C. After rinsing, specimens were embedded in methacrylate blocks, and sectioned with a water-cooled microtome with three restoration cuts positioned centrally parallel to the long axis of the tooth. Microleakage was evaluated at the occlusal margins of the Class V restorations using a stereo microscope, separate for dentin and enamel margins. RESULTS: Over 90% of enamel margins exhibited no microleakage following cycling. Bleaching agents had almost no effect on numerical averages. Eighty-eight percent of the dentin margins were free of microleakage for the non-treated control group. Bleaching treatments collectively had slight numerical reductions to around 80%. The statistical evaluation (Kruskal-Wallis-test) showed no significant difference in microleakage between groups for enamel or dentin. CONCLUSION: Bleaching with the materials tested had no influence on microleakage of Filtek Z250 composite bonded with Scotchbond 1.     

Clinical evaluation of a combined in-office and take-home bleaching system

BACKGROUND: Tooth whitening is one of the fastest growing areas in cosmetic and restorative dentistry. An increasing number of patients are demanding faster ways to bleach their teeth. Therefore, clinicians are being pushed to seek quicker and easier means to bleach their patients' teeth, while maintaining safety in bleaching procedures. METHODS: The authors included in the clinical trial 10 subjects 18 years of age or older, each of whom had six caries-free maxillary anterior teeth without restorations on the labial surfaces and no tooth sensitivity. For each subject, one-half of the maxillary arch received a 35 percent hydrogen peroxide (Group 1) gel application for 30 minutes, and the other one-half of the maxillary arch received a 38 percent hydrogen peroxide (Group 2) gel application for 30 minutes. The in-office bleaching treatment was maintained and reinforced using a 10 percent carbamide peroxide at-home bleaching agent for 60 minutes. Subjects repeated both the in-office and take-home bleaching treatments for three consecutive days. RESULTS: The shade change was 8.5 for Group 1 and 9 for Group 2. There was no statistically significant difference between the two groups (P = .3434). An average shade rebound of two shades was recorded at seven days for both treatment systems. No sensitivity was reported during or after the bleaching treatment. CONCLUSIONS: When combined with 10 percent carbamide peroxide at-home applications, use of the Group 1 and Group 2 bleaching materials resulted in significant tooth lightening. CLINICAL IMPLICATIONS: By using the clinical technique presented, clinicians can reduce the time required to complete tooth-whitening treatment. Using the correct tray design and improved chemical formulations of tooth whiteners may reduce gingival and tooth sensitivity, thus increasing safety.     

Protective effect of resin coating on the microleakage of Class V restorations following treatment with carbamide peroxide in vitro

This in vitro study evaluated the effects of a resin coating on the microleakage of Class V restorations due to bleaching. One-hundred and sixty Class V cavities were randomly restored with one of four different restorative materials (n = 40): a compomer (Dyract AP), a conventional glass-ionomer cement (Ketac Molar Easymix), a resin modified glass-ionomer cement (Fuji II LC) and a resin composite (Filtek Z350). For each kind of material, 40 restorations were divided into four subgroups: bleached with resin coating (group BC), bleached without resin coating (group B), immersed in artificial saliva with resin coating (group SC), immersed in artificial saliva without resin coating (group S). In groups B and BC, the specimens were bleached with 10% carbamide peroxide gel for eight hours daily, while groups SC and S were stored in artificial saliva instead. After 28-day treatment, all the samples were subjected to a dye penetration test using the multiple-sectioning technique. In addition, one more test was performed to investigate the color difference between the coated and uncoated tooth surface after bleaching. There was a statistically significant increase in cervical microleakage in the group B specimens of Fuji II LC and Ketac Molar Easymix compared to their respective control specimen (group S). These effects on microleakage were not found in the bleached specimens with resin coating (group BC). There was also no visually-detectable color difference between the coated and uncoated tooth surface. In conclusion, resin coating is an effective method for avoiding the bleaching-induced microleakage of glass-ionomer cement.     

The benefits of glass ionomer self-adhesive materials in restorative dentistry

Bonded, resin-based composite restorative materials have potential advantages. If the dentin bond achieved is not greater than the polymerization stress, loss of retention is likely, resulting in areas of microleakage and postoperative sensitivity. Class 5 lesions restored with no preparation have been used for testing the clinical performance of new adhesive restorative systems. Laboratory studies have demonstrated that bond strength varies according to the depth of dentin and the degree of calcification. Until the later generations of dentin bonding agents, retention rates for bonded, resin-based composites were typically more erratic and lower than glass ionomer (GI) and resin-modified glass ionomer (RMGI) restorative materials. Providing stress relief during setting is inherent in GI and RMGI materials, which helps to explain their good retention rates, despite their low bond strengths. GI and RMGI liners and lightly filled resin bonding agents provide similar stress relief. Current evidence supports the use of both RMGI and composite restorations placed with a liner of lightly filled resin in adhesive Class 5 restorations. Bonded, resin-based composite has the advantage of finishing to a high-gloss surface, making it more acceptable in areas of the mouth that are highly visible.     

The marginal seal of a flowable composite, an injectable resin modified glass ionomer and a compomer in primary molars--an in vitro study

The present study was carried out to compare the marginal microleakage of some newer materials viz. a flowable composite, an injectable resin modified glass-ionomer and a compomer in Class I cavities of 30 non carious primary molars. After 0.5% basic fuchsin dye penetration and sectioning, the teeth were studied under stereomicroscope. The results obtained revealed that flowable composite showed significantly lower microleakage (p<0.05) as compared to injectable resin-modified glass ionomer and compomer. However, no significant difference was observed when injectable resin modified glass-ionomer cement was compared to compomer. This concludes that flowable composite materials adhere better to the primary teeth than resin modified glass ionomer and compomer.     

Effect of water storage and intrapulpal pressure on microleakage of three restorative materials

Three different restorative materials, Z100 composite, F2000 compomer and Vitremer glass ionomer cement are currently proposed for Class V restorations. The aim of this in vitro study was to evaluate the influence of water storage and the simulated intrapulpal pressure (sIP) on the quality of the margins of class V restorations located both in enamel and dentin. The water resorption of restorative materials containing hydrophilic groups (compomers and glass ionomer cements) can favourably modify the marginal sealing ability by hydroscopic expansion. The influence of the sIP was specific to the material. While F2000 compomer and Vitremer glass ionomer cement were un-influenced by sIP, with Z100 composite a significant difference could be observed. It was concluded that F2000 compomer and Vitremer glass ionomer cement showed significantly less microleakage, which means a better marginal sealing ability than Z100 composite.     

Prerestorative bleaching: effect on microleakage of Class V cavities.

The effect of bleaching extracted teeth on the microleakage of subsequently placed Class V composite resin restorations was evaluated. Ten extracted premolars were stored in water at 37 degrees C to serve as controls. Ten premolars were exposed to a carbamide peroxide gel for three 2-hour periods per day for 9 days. These specimens were stored in water at 37 degrees C except during treatment periods. Class V cavity preparations were then placed at the cementoenamel junction of the facial and lingual surfaces of all teeth. Half of the teeth of each group were restored with Scotchbond 2/Silux Plus and half were restored with Prisma Universal Bond 3/AP.H. After 24 hours of storage in 37 degrees C water, the teeth were thermally stressed for 100 cycles. Microleakage was assessed by dye penetration. The results demonstrated that prerestorative bleaching did not affect the marginal seal of subsequently placed restorations.     

漂白处理对树脂充填体边缘微渗漏的影响

目的:评价35%过氧化氢凝胶对树脂充填体边缘微渗漏的影响。方法:选择离体上颌第三磨牙40颗,在颊面制备Ⅴ类洞复合树脂分层充填,光照固化抛光后按处理时间随机分为4组(n=10):A(对照组)、B(10 min)、C(20 min)、D(30min)。将凝胶涂布于充填体表面进行漂白处理后冷热循环500次,再用2%亚甲蓝溶液染色24 h,沿颊舌纵向剖开,体式显微镜观察并记录染料渗入深度。用Kruskal-Wallis法进行数据分析;Mann-Whitney法组间两两比较,检验水准均为α=0.05。结果:不同漂白处理时间对树脂充填体边缘微渗漏的影响有统计学意义(P<0.05);组间比较显示A与C、A与D、B与D、C与D间差异有统计学意义。结论:35%过氧化氢凝胶漂白处理使复合树脂充填体的边缘微渗漏程度增加。     

Effect of peroxide bleaches on resin-enamel bonds.

Human third molar teeth were divided into three groups: untreated control; enamel treated with 35% hydrogen peroxide for 2 hours; and enamel treated with 10% carbamide peroxide gel for 14 days. All teeth were ground to present a flat enamel surface, to which cylinders of light-cured composite resin were bonded. Shear bond strengths were determined for each specimen. The mean shear bond strengths of resin-enamel bonds after pretreatment with both 35% hydrogen peroxide and 10% carbamide peroxide were significantly lower than those for untreated controls. External bleaching with these materials prior to resin bonding procedures may reduce the quality of resin-enamel bonds.     

过氧化氢酶对外漂白后树脂充填体边缘微渗漏的影响

目的： 观察过氧化氢酶对10%过氧化脲外漂白后复合树脂充填体边缘微渗漏的影响。方法： 选取牙体健康完整的人离体前磨牙40颗,随机分为4组,第1组不漂白直接进行树脂充填,第2组外漂白后立即树脂充填,第3组外漂白后将牙在人工唾液中浸泡3周再进行树脂充填,第4组外漂白后先用过氧化氢酶处理窝洞再进行树脂充填。然后将4组样本进行2000个周期的冷热循环,应用2%亚甲基蓝染色24 h,体视显微镜下观察剖面树脂充填体的微渗漏程度,采用SPSS17.0软件包对数据进行统计学分析。结果： 第1组微渗漏值最低,第2组微渗漏值最高,第3组微渗漏值显著高于第1组但与第2组相比无显著差异（P>0.05）;第4组微渗漏值较第2组显著下降（P<0.05）。结论： 10%过氧化脲外漂白致树脂充填体边缘微渗漏明显增加,树脂充填前应用过氧化氢酶处理窝洞,可有效减少微渗漏,延迟充填不能有效改善微渗漏。     

10%抗坏血酸钠对外漂白后复合树脂充填体微渗漏的影响

目的观察10%抗坏血酸钠与含表面活化剂(Tween,0.2%)的10%抗坏血酸钠对经10%过氧化脲外漂白后复合树脂充填体微渗漏的影响。方法选取牙体完整健康的人离体前磨牙50颗,随机分为5组,第1组不漂白直接树脂充填,第2组用10%过氧化脲漂白后立即树脂充填,第3组漂白后将牙齿浸泡在人工唾液中3周再进行树脂充填,第4组漂白后先用10%抗坏血酸钠处理窝洞后再充填树脂,第5组漂白后先用含0.2%Tween的10%抗坏血酸钠处理窝洞后再进行树脂充填。然后,将5组样本进行2000个周期的冷热循环,2%亚甲基蓝染色24h,体视显微镜下观察剖面充填体的微渗漏情况。结果第1组微渗漏值最低,第2组微渗漏值最高,第3、4组微渗漏值显著高于第1组但与第2组无显著性差异(P>0.05);第5组渗漏值较第2组及第4组显著下降(P<0.05)。结论 10%过氧化脲外漂白致复合树脂充填体边缘微渗漏明显增加,含0.2%Tween的10%抗坏血酸钠处理窝洞可以有效减少该微渗漏的增加,延迟充填和单纯使用抗坏血酸钠均不能有效减少微渗漏。     

Effect of non-vital tooth bleaching on microleakage of coronal access restorations

This study evaluated the effect of non-vital tooth bleaching on microleakage of composite resin/bovine tooth interface at different post-bleaching times. A total of 320 teeth were cleaned. A pulp chamber access cavity was made at the lingual surface of each tooth. The teeth were randomly divided into four groups: SPH - sodium perborate + 30% hydrogen peroxide; SPW - sodium perborate + distilled water; CP-37% carbamide peroxide; and CON-distilled water (control). The bleaching agents were replaced every 7 days, over 4 weeks. Following bleaching procedures, the groups were divided into four subgroups (n = 20), according to the post-bleaching times: 0 (baseline), 7, 14 and 21 days. After that, the cavities were restored with an adhesive system (Single Bond; 3M Co., St Paul, MN, USA) and a composite resin (Z100/3M). The specimens were thermocycled, stained with 2% methylene blue solution (pH 7), and sectioned longitudinally. The teeth were evaluated blind and independently by three previously calibrated examiners, to provide representative scores. The data were submitted to Kruskal-Wallis and multiple comparison tests (alpha=0.05). At baseline and 7 days, the SPH group showed a higher degree of dye penetration than the CON (P=0.04). At 14 and 21 days, there were no differences among groups. The association of sodium perborate with 30% hydrogen peroxide or with water may affect the sealing ability of composite resin restorations performed up to 7 days after bleaching procedures.     

The effect of bleaching agents on the microhardness of dental aesthetic restorative materials

This study investigated the effects of three home bleaching agents on the microhardness of various dental aesthetic restorative materials. The restorative materials were: feldspatic porcelain, microfilled composite resin and light-cured modified glass-ionomer cement and the bleaching agents Nite-White (16% carbamide peroxide), Opalescence (10% carbamide peroxide and carbapol jel) and Rembrandt (10% carbamide peroxide jel). A total of 90 restorative material samples were prepared 1 cm diameter and 6 mm thick and kept in distilled water for 24 h before commencing bleaching which was carried out for 8 h day-1 for 4 weeks. Microhardness measurements were then made using a Tukon tester. Statistically significant differences with respect to unbleached controls were found only for the feldspatic porcelain and microfilled composite resins (P <0.05) for Nite-White and Opalescence. All the bleaching agents decreased the microhardness of the porcelain and increased that of the light cured modified glass-ionomer cement. For the composite resin, whereas Nite-White increased its microhardness, the other bleaching agents decreased it. There were no significant differences between the bleaching agents for any of the restorative materials.     

Direct materials for restoring caries lesions: Systematic review and meta-analysis—a report of the American Dental Association Council on Scientific Affairs

BackgroundThe goal of restoring caries lesions is to protect the pulp, prevent progression of the disease process, and restore the form and function of the tooth. The purpose of this systematic review was to determine the effect of different direct restorative materials for treating cavitated caries lesions on anterior and posterior primary and permanent teeth.Type of Studies ReviewedThe authors included parallel and split-mouth randomized controlled trials comparing the effectiveness of direct restorative materials commercially available in the United States placed in vital, nonendodontically treated primary and permanent teeth. Pairs of reviewers independently conducted study selection, data extraction, and assessments of risk of bias and certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation approach. The authors conducted pair-wise meta-analyses to summarize the evidence and calculated measures of association and their 95% CIs.ResultsThirty-eight randomized controlled trials were eligible for analysis, which included data on Class I and Class II restorations on primary teeth and Class I, Class II, Class III, Class V, and root surface restorations on permanent teeth. Included studies assessed the effect of amalgam, resin composite, compomer, conventional glass ionomer cement, resin-modified glass ionomer cement, and preformed metal crowns. Moderate to very low certainty evidence suggested varying levels of effectiveness across restorative materials.Conclusions and Practical ImplicationsOwing to a relatively low event rate across various outcomes indicating restoration failure, there was limited evidence to support important differences between direct restorative materials used in practice.     

漂白剂对复合树脂的影响

临床上常需要对存在复合树脂修复体的牙进行漂白,或者对漂白后的牙进行复合树脂修复。由于漂白剂具有较强的氧化性及反应活性,在一定程度上影响了复合树脂的性能如微硬度、表面粗糙度等;因此,研究漂白剂对复合树脂的影响有重要的临床意义。本文就漂白剂对复合树脂表面性能、与釉质和牙本质粘接强度、微渗漏、颜色等的影响作一综述。     

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.