Determination of peroxides in saliva--kinetics of peroxide release into saliva during home-bleaching with Whitestrips and Vivastyle

Aim of the study was to determine peroxides in saliva, released during bleaching procedures. Upper incisors of five subjects were bleached with Whitestrips (5% H2O2) and Vivastyle (10% carbamide peroxide, tray charged with 225mg) for 30min, each on different days. Saliva was collected before and during the whole period of bleaching at different intervals. The amount of peroxide in the salivary samples was assessed with peroxidase, phenol and 4-aminoantipyrin in a photometric assay. Additionally the amount of peroxides in the bleaching material was determined before and after the bleaching, so that the peroxide release into saliva could be balanced. The amount of peroxides released into saliva was related to the bleaching system and only partially influenced by the individual salivary flow rate. Bleaching with Vivastyle led to lower release of peroxides into saliva compared to Whitestrips (Vivastyle: 0.8+/-0.17mg; Whitestrips: 1.5+/-0.84mg). Salivary flow rate was not correlated to release of peroxides from the bleaching products. It can be concluded that the enzymatic method adopting 4-aminoantipyrin and peroxidase is valid for the determination of peroxides in saliva. Furthermore distinctly more peroxides are released into the oral cavity from Whitestrips than from trays charged with Vivastyle .     

Recovery of peroxides in saliva during home bleaching--influence of smoking

The study aimed at determining hydrogen peroxide recovery in saliva during use of different home bleaching products by smokers and non-smokers. Peroxide recovery was evaluated with respect to the safe level reported in the literature. Determination of peroxide levels in saliva was performed with peroxidase, phenol and 4-aminoantipyrin in a photometric method. Four different bleaching regimens were used by 10 smokers and 10 non-smokers: Whitestrips, Vivastyle (tray-based) and two paint-on products (Crest Night Effects, Colgate Simply White). Whole saliva was collected and total amount of peroxide (mg) released during the 60 min bleaching period was determined: Colgate Simply White: 2.67 +/-0.88 (non-smokers); 2.66 +/- 1.17 (smokers); Crest Night Effects: 0.23 +/- 0.13 (non-smokers); 0.25 +/-0.16 (smokers); Vivastyle: 2.47 +/- 0.82 (non-smokers), 2.44 +/- 1.31 (smokers); Whitestrips: 1.39 +/- 0.62 (non-smokers), 2.02 +/- 1.86 (smokers). In terms of amount of peroxide kg(-1) body weight the bleaching systems led to a single exposure of 0.004-0.046 mg kg(-1), which is distinctly less than safe daily dose of 0.26 mg kg(-1) day(-1), if calculated for a small person (58 kg). The criterion smoker versus non-smokers had no influence on peroxide levels in the oral cavity. Conclusion: Smoking did not appear to impact the anti-oxidant defence capacity of the oral cavity with respect to degrading peroxides released from bleaching products. Significantly lower amounts of peroxides were detected in saliva during application of the paint-on product Crest Nights Effects compared with the other bleaching systems.     

Influence of different bleaching systems on fracture toughness and hardness of enamel

This study evaluated the influence of different bleaching procedures on the fracture toughness and microhardness of enamel. The labial aspects of 72 bovine incisors were prepared for microhardness determination. At baseline, Knoop hardness (KH) determination was conducted on each specimen. Moreover, the fracture toughness (FT) of enamel was assessed using Vickers hardness indentations with a load of 9.8 N. The length of both indentations and enamel cracks were recorded and used for calculation of FT. The samples were divided among six (A-F) groups (n = 12) and sectioned, resulting in a control and an experimental half. The samples were stored in artificial saliva for 10 days. The experimental halves were removed from the saliva and subjected to bleaching according to manufacturers' instructions (A: Opalescence Xtra, B: Opalescence Quick, C: Rapid White, D: Whitestrips, E: Opalescence 10%, F: Opalescence PF 15%). Bleaching with C-F was conducted daily (C: twice per day for 10 minutes, D: twice per day for 30 minutes, E: 8 hours, F: 4 hours), systems A-B were applied on the first and fifth day (A: twice for 10 minutes, B: 1 hour). Finally, Knoop hardness and FT were assessed and statistically compared to baseline values using Wilcoxon-tests (p < 0.05). KH and FT of the controls remained stable during storage in saliva. All bleaching regimens resulted in a statistically significant percentage loss of KH (mean + standard error of means): A: 17.3 +/- 2.8%, B: 8.6 +/- 3.3%; C: 83.5 +/- 0.61%, D: 29.0 +/- 1.9%, E: 9.0 +/- 2.91%, F: 5.4 +/- 2.2%. The percentage changes (mean + standard error of means) of FT in the experimental specimens were as follows: A: 3.9 +/- 9.5%, B: 0.1 +/- 4.7%; D: -8.2 +/- 7.1%, E: -18.9 +/- 4.7%, F: -12.0 +/- 4.7%. Due to severe surface softening, FT could not be determined for the samples in Group C. Applying Opalescence 10% resulted in a significant reduction in FT compared to baseline. In the remaining groups, changes in FT were not statistically significant.     

The effect of 2 different bleaching regimens on the surface roughness and hardness of tooth-colored restorative materials.

OBJECTIVE: The purpose of this in vitro study was to evaluate the effects of 10% carbamide peroxide (Vivastyle/Vivadent) and 6.5% hydrogen peroxide strip bands (Crest Professional Whitestrips) on the surface roughness and hardness of the 3 different tooth-colored restoratives: an ormocer (Definite), a packable composite (Filtek P60), and a flowable composite (Filtek Flow). METHOD AND MATERIALS: A total of 48 specimens (10 mm in diameter and 2 mm thick) of each material were fabricated against a mylar surface. After being polished with Sof-Lex discs, they were randomly divided into 3 groups of 16 and treated as follows: group I was stored in distilled water at 37 degrees C for 2 weeks (control), group II was treated with Vivastyle for 2 hours per day for 2 weeks, and group III was treated with Whitestrips for 30 minutes twice a day for 2 weeks. For groups II and III, the specimens were stored in distilled water at 37 degrees C during the hiatus period. At the end of the test period, the specimens were first subjected to surface roughness and then to microhardness tests. The data were analyzed by Kruskal-Wallis and Mann-Whitney U tests. RESULTS: Both bleaching regimens increased the surface roughness of the materials (P <.05), but Whitestrips significantly increased the roughness of materials more than did Vivastyle (P <.05). Both bleaching regimens decreased significantly the hardness of tested materials except Filtek P60 (P <.05). CONCLUSION: Bleaching agents may affect the surface of existing restorations; therefore, they should not be used indiscriminately when tooth-colored restorations are present.     

Efficacy, side-effects and patients' acceptance of different bleaching techniques (OTC, in-office, at-home)

This clinical study compared the efficacy of three different bleaching techniques with respect to the bleaching times required in order to achieve six grades of whitening in human teeth. Any side effects that were noted and the patients' acceptance of the method were recorded by a visual analog scale ranging from 0 to 10. Moreover, epoxy casts from the study teeth were analyzed by scanning electron microscopy in order to detect any potential changes in the enamel surface due to treatments. Thirty-nine volunteers participated in the study and were allocated randomly to one of three different bleaching treatments: Group A (n=13) used Whitestrips (over-the-counter technique; one cycle=30 minutes), Group B (n=13) used Opalescence PF 10% (at-home bleaching technique; one cycle=8 hours) and Group C (n=13) used Opalescence Xtra Boost (in-office bleaching technique; one cycle=15 minutes) until a defined whitening of six tabs compared to the baseline were reached (assessed by the VITA shade guide). All three methods achieved six grades of whitening. The mean treatment time required to reach the defined level of whitening was 31.85 +/- 6.63 cycles in Group A, 7.15 +/- 1.86 cycles in Group B and 3.15 +/- 0.55 cycles in Group C. All products differed significantly from each other in terms of treatment cycles and required treatment time (p<0.001 by ANOVA and Mann-Whitney-U-test). Using the VA scale, side effects noted within the three groups were minimal. Tooth hypersensitivity ranged from 2.62 (Whitestrips) to 3.38 (Opalescence PF), and gingival irritation ranged between 0.23 (Opalescence Xtra Boost) and 0.85 (Whitestrips). The most accepted method was the at-home bleaching technique. None of the teeth studied showed detectable enamel surface changes in the subsequent SEM analysis using 200x and 2000x magnification.     

In-use peroxide kinetics of 10% hydrogen peroxide whitening strips

OBJECTIVE: Clinical research was conducted to establish the peroxide degradation profile of a very thin 10% hydrogen peroxide bleaching gel delivered on a flexible polyethylene strip. METHODS: Sixteen subjects participated in this study of Crest Whitestrips Premium, a thin layer of 10% hydrogen peroxide gel. Application was supervised, and strips were removed after five, 10, 30, and 60 minutes. Samples were collected from the strips, teeth, gingiva, and saliva, and peroxide levels were derived using a colorimetric peroxide assay. RESULTS: At five minutes, median peroxide concentrations were 7.3%, 6.4%, and 0.7% for strips, teeth, and gingiva, respectively, declining to 4.6%, 2.9%, and 0.1% at 30 minutes. Salivary samples never exceeded a median concentration of 0.014% at any time point. Samples differed significantly (p < 0.01) with respect to the 30- and 60-minute area-under-the-curve calculations, with the highest concentrations on the strip and teeth, and the lowest on the gingiva and in saliva. Median peroxide concentrations on strips and teeth remained above 2% over 60 minutes. At all post-treatment time points, the gingival peroxide concentration was an order of magnitude lower than the teeth samples. CONCLUSION: Use of 10% hydrogen peroxide whitening strips yielded appreciable peroxide on teeth over a 60-minute period, with rapid peroxide degradation on the gingiva, and exceedingly low accumulation in saliva anytime during use.     

Effect of bleaching on subsurface micro-hardness of composite and a polyacid modified composite.

OBJECTIVE: To investigate the influence of different bleaching techniques on subsurface physical properties of composite and polyacid modified composite tested via determination of micro-hardness. METHODS: Specimens of Tetric Flow, Tetric EvoCeram and Compoglass were light cured (2.5mm thickness) and stored in artificial saliva for 2 weeks (n=12/group). The samples were only removed for application of the following bleaching agents in a humid atmosphere: Either Vivastyle (1h/d), Whitestrips (30min/d), sodium-perborate-water mixture (once for 72h), Simply White (1h/d), or Opalescence XtraBoost (1st and 5th day for 15min) were applied on the surfaces of the samples. Untreated specimens served as negative controls, samples treated with ethyl alcohol for 1h acted as positive controls. After the bleaching period, samples were cross-sectioned and the micro-hardness (Knoop) of different subsurface levels (0.1mm-2.0mm) was determined. RESULTS: All bleaching techniques significantly reduced the Knoop-hardness of the restoratives compared to untreated controls. Thereby, bleaching significantly affected not only superficial but also the deep layers of the specimens: in superficial layers (0.1mm, 0.2mm) lowest micro-hardness values amounted to 69.5% and 76.3% of the respective untreated controls (Compoglass/Vivastyle). In deeper subsurface levels, the lowest hardness was observed with Opalescence/Tetric EvoCeram (0.3mm: 78.3%; 0.4mm: 80%; 0.5mm: 80.5%; 1.0mm: 84.2%; 2.0mm: 84.4%). SIGNIFICANCE: Bleaching with the tested bleaching agents softens the adhesive restorative materials examined. Due to the fact that subsurface layers are also affected, polishing of the surface may not suffice for re-establishing the physical properties of the surface of the fillings.     

Diffusion of peroxides through dentine in vitro with and without prior use of a desensitizing varnish

Different bleaching regimens are used in dentistry possibly penetrating the dentine and affecting the pulp. The aim of the present study was to investigate peroxide diffusion through dentine pre-treated with a desensitizing varnish (Vivasens®) in a standardized in vitro setup during application of different bleaching materials. The penetration was tested using 1.3-mm-thick bovine dentine slabs. The following bleaching materials were tested with and without prior application of the desensitizing varnish on the external side of the dentine slabs: Vivastyle, Whitestrips, Simply White, Opalescence (external bleaching), and sodium perborate (internal bleaching, only tested without varnish; n?=?8 samples per subgroup). The penetration of peroxides was measured photometrically using 4-aminoantipyrin as a substrate, the penetration of peroxides was monitored over 240 min. All bleaching agents yielded a diffusion of peroxides through the dentine, the kinetics of penetration were approximately linear for all materials tested. The significantly highest diffusion of peroxides was observed with Opalescence, the lowest with sodium perborate. The adoption of the desensitizing varnish reduced the diffusion of peroxides significantly for all external bleaching materials. Peroxides penetrated the dentine during application of bleaching materials; the penetration of peroxides can be reduced by application of a desensitizing agent.     

In vitro evaluation of toothbrushing abrasion of differently bleached bovine enamel

PURPOSE: To evaluate in vitro, the effect of different external bleaching agents on the susceptibility of enamel against toothbrushing abrasion. METHODS: 96 bovine enamel specimens were embedded in acrylic resin, polished and covered with tape except for a 1.4 x 10 mm window. The samples were divided into eight groups (A-H), 12 specimens each (A-G) were treated with seven different home-bleaching (A: Whitestrips, B: Rapid White, C: Opalescence 10%, D: Opalescence PF 15%) and in-office-bleaching agents (E: Opalescence Extra, F: Opalescence Quick, G: Opalescence Extra Boost) according to manufacturers' instructions. Before and after each individual bleaching treatment the samples were brushed 40 times in an automatic brushing machine using a slurry containing artificial saliva and fluoridated toothpaste. The control group (Group H) was not bleached, but also brushed. After each cycle the specimens were stored in artificial saliva for 24 hours. RESULTS: After 20 cycles loss of enamel was determined by profilometry, resulting in the following values (mean +/- standard deviation) which were statistically analyzed: Group A: (0.169 microm +/- 0.035), Group B (11.108 microm +/- 0.655), Group C (0.207 microm +/- 0.042), Group D (0.154 microm +/- 0.028), Group E (0.081 microm +/- 0.015), Group F (0.084 microm +/- 0.018), Group G (0.087 microm +/- 0.014), Group H (0.076 microm +/- 0.012). Group B differed significantly from the other groups (r = 0.001). Samples of Groups C, D and A showed a significant difference compared to the control H (r = 0.001). Statistical analysis revealed no significant difference between enamel loss of Groups E, F, G and the Control H. It could be proven that toothbrushing abrasion of bleached enamel may be increased depending on the bleaching agent and application form used. Nevertheless, with the exception of bleaching treatment with Rapid White, toothbrushing abrasion of bleached enamel seems to be clinically less relevant.     

Effect of carbamide peroxide bleaching agents on tensile strength of human enamel.

OBJECTIVES: The aim of this study was to evaluate the effects of low concentrations of carbamide peroxide bleaching agents (CP) on the ultimate tensile strength of enamel (UTS). METHODS: Resin composite structure was built-up on the bonded occlusal surface of 12 sound third molars to facilitate specimen preparation for microtensile testing. The bonded teeth were sectioned in a bucco-lingual direction in slices approximately 0.7 mm thick. Each slice was trimmed with a fine diamond bur to reduce the buccal, internal slope enamel of the cusps to a dumb-bell shape with a cross-sectional area at the 'neck' of less than 1 mm2. The sample was randomly divided into six groups of 10 specimens each: Control (C-untreated); Opalescence 10% (O10), Opalescence 15% (O15), Opalescence 20% (O20), Whiteness 10% (W10) and Whiteness 16% (W16). Specimens in each group received the application of the CP for 6 h/day, at 37 degrees C, during 14 days and were stored in artificial saliva in between each application. After the bleaching regimen, specimens were tested with the microtensile method at 0.5 mm/min. Data were analyzed by ANOVA and Tukey test (5%). RESULTS: Mean tensile strengths were (MPa): C = 47.5 +/- 6.2a; O10 = 37.6 +/- 5.8b; O15 = 33.2 +/- 6.0b; O20 = 31.2 +/- 3.5b; W10 = 32.5 +/- 6.1b; W16 = 30.6 +/- 7.7b. Specimens subjected to the bleaching regimen presented significantly lower UTS than the control group. No differences were found among the type and concentration of the bleaching agents. SIGNIFICANCE: Results suggested that bleaching enamel with CP could significantly reduce its UTS within a 14 days treatment.     

In vitro penetration of the pulp chamber by three brands of carbamide peroxide

PURPOSE: Vital tooth bleaching has become a popular procedure for whitening teeth. Most home bleaching products contain 10% carbamide peroxide. The purpose of this in vitro study was to measure the quantity of hydrogen peroxide that reaches the pulp chamber from three carbamide peroxide products: Opalescence, Sparkle, and Rembrandt. MATERIALS AND METHODS: Seventy roots of extracted premolars were amputated approximately 3 mm apical to the cementoenamel junction, and the pulp tissues were removed. They were divided into three experimental groups (n = 20) and a control group of 10 teeth. An acetate buffer solution was placed in the pulp chamber before the crown was exposed to the bleaching agent at 37 degrees C for 25 minutes. The buffer solution was removed and reacted with leukocrystal violet and horseradish peroxidase. The optical density of blue color that developed was measured at a wavelength of 596 nm and read from a standard curve for hydrogen peroxide quantity. RESULTS: The measured amounts of hydrogen peroxide were 3.605 +/- 1.405, 1.282 +/- 0.762, and 0.339 +/- 0.251 micrograms for the Opalescence, Sparkle, and Rembrandt groups, respectively. A statistically significant difference in the hydrogen peroxide levels was observed by analysis of variance (p < .05) among the three groups. It was concluded that the penetration of commercial bleaching products was different even though the products were labeled as having the same 10% carbamide peroxide. CLINICAL SIGNIFICANCE: Carbamide peroxide penetration to the pulp varies significantly for various commercial bleaching products. This may result in different levels of tooth sensitivity or bleaching efficacy.     

Degradation of bleaching gels in vivo as a function of tray design and carbamide peroxide concentration

This study determined the degradation of nine bleaching agents with different concentrations after two hours in vivo following the manufacturers' recommendations. The nine carbamide peroxide products are 10%, 15% and 20% Opalescence, 10%, 15% and 22% Rembrandt and 10%, 16% and 22% Nite White Excel 2. Each subject wore the tray with the bleaching agent for two hours on three separate occasions. The amount of remaining carbamide peroxide was determined after each use. Evaluation of remaining amount of carbamide peroxide was calculated by the US Pharmacopeia method. The study showed that the total carbamide peroxide percent recovered was significantly higher for Opalescence products (47% to 54%) compared to Nite White (22% to 25%) and Rembrandt bleaching gels (15% to 16%). It concluded that this difference was mostly due to the use of facial reservoirs with Opalescence products, and also that whitening gel in trays with reservoirs and trays without reservoirs degraded at the same rate.     

Effects of new formulas of bleaching gel and fluoride application on enamel microhardness: an in vitro study

This in vitro study evaluated the new formulas of bleaching products and the effect of subsequent applications of fluoride on the hardness of enamel during and after tooth bleaching. The crowns of 60 extracted intact human molars were sectioned longitudinally; the buccal part was embedded in acrylic resin, the occlusal part was ground flat, exposing enamel and dentin, and then polished. Baseline Knoop microhardness (KHN) of enamel was determined. The specimens were then randomly divided into six groups of 10 specimens, and each group was assigned to a specific 10% carbamide peroxide (CP) bleaching agent. A: Opalescence, B: Opalescence PF (3% potassium nitrate and 0.11% fluoride), C: Nite White Excel 3 (ACP), D: Opalescence + F (acidulated phosphate fluoride 1.23%), E: Opalescence PF + F, F: Nite White Excel 3 + F. The teeth were bleached for eight hours; after each procedure, the specimens were stored in artificial saliva at 37 degrees C. Immediately after day 21 of bleaching, the specimens in groups D, E and F received fluoride 1.23% for five minutes. KHN tests w ere performedbefore (baseline = control), during (14, 21) and two weeks (35 days) after the bleaching procedure and were statistically compared using ANOVA/Tukey's t-test (alpha < 0.05). The statistical analysis revealed no significant difference among the bleaching materials (p = 0.123). A significant enamel KHN reduction (p < 0.001) was observed for all bleaching materials, with no difference among them. Two weeks after bleaching, all the groups that received fluoride showed a significant increase in microhardness. For the new bleaching formulas, the enamel was restored to a value similar to baseline.     

Efficacy and tolerability of two home bleaching systems having different peroxide delivery

The aim of this study was to investigate tooth whitening efficacy and oral side effects during bleaching with Whitestrips (WS) (6% hydrogen peroxide H(2)O(2) gel) and Vivadent Vivastyle (VS) (10% carbamide peroxide gel). Forty-seven subjects were included in this single blind, randomized, parallel group study. Application of WS was performed twice a day for 30 min. Trays filled with VS were worn for 60 min once a day. Tooth color was evaluated by measuring L*a*b* values before the study and after completion of the bleaching. Treatment tolerability was monitored throughout bleaching with an 8-week follow-up after completion of therapy. After 2 weeks both treatment groups demonstrated significant improvements in tooth color compared to baseline. A shift toward less yellow (-Deltab) and brighter (+DeltaL) tooth color was observed. Deltab amounted to -1.69 +/- 0.38 for WS and -1.20 +/- 0.34 for VS (mean value +/- SE). DeltaL was +1.55 +/- 0.41 for WS and +1.20 +/- 0.37 for VS. There was no significant difference between the two systems. No significant differences between the two bleaching systems were recorded for clinically observed signs or reported symptoms. Gingival irritation was observed in 13%, reported tooth hypersensitivities in 22% and reported gum irritation in 20% of the total study population. At an 8-week follow-up visit no adverse effects were observed. Both WS and VS demonstrated significant and comparable levels of tooth color improvement after 2 weeks. Each treatment caused similar levels of transient oral side effects.     

Influence of bleaching agents and desensitizing varnishes on the water content of dentin

This in vitro study investigated the possible dehydration of dentin caused by bleaching agents. Furthermore, it tested whether protective dentin varnishes can maintain the physiological moisture of dentin during bleaching treatment. Fifty-five standardized dentin cylinders were prepared from freshly extracted bovine incisors under constant water irrigation. Prior to bleaching, the treatment specimens were conditioned at room temperature in a hygrophor for 14 days. The samples were divided into 11 groups. The Group A specimens, which were completely dehydrated, and Group B, which was stored for 2 weeks in a hygrophor, served as controls (A, B n=5). The other samples (n=10 each group) were coated with Vivasens [VS] (C), Bilfuorid [BF] (D) and Seal&Protect [SP] (E). Five specimens from each group (C-E) were subsequently treated with an experimental bleaching gel (Exp BG) (20% carbamide peroxide [CP], glycerine-based gel): Cb, Db, Eb. The remaining specimens were bleached with Exp BG (F) only, Vivastyle (G: 16% CP, glycerine-based gel) or Vivastyle Paint On (H: 6% CP-varnish) for 7 days (n=5 each group) with bleaching time for gels: 2 hours/day, paint on: 20 minutes/day. After the respective treatments, the overall water content of each specimen was determined using the analytical method of Karl-Fischer-titration. The water content of bovine dentin (Group B, mean%+/-SD) obtained in this study amounted to 15.24+/-0.4. All bleaching products significantly reduced the water content compared to the controls (exp BG: 13.32+/-0.47, Vivastyle 13.2+/-0.27, paint on 13.72+/-0.54; p<0.05). Also, application of SP before bleaching resulted in reduced water content (14.06+/-0.12; p=0.0005). However, bleaching with exp BG following use of VS (14.99+/-0.42) or SP (13.85+/-0.26) did not result in a reduction of water content in dentin. Pretreatment with BF did not protect dentin from water loss during bleaching (12.44+/-0.38; bi p=0.0009). All glycerine-based bleaching products used in this study had a significant dehydrating effect on dentin. The application of protective varnishes prior to bleaching treatment may reduce or even prevent dentin dehydration.     

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.     

A clinical study of the effect of pellicle on the degradation of 10% carbamide peroxide within the first hour.

OBJECTIVE: The purpose of this study was to determine the degradation of 10% carbamide peroxide within the first hour of use and the effect of pellicle on the degradation of carbamide peroxide in vivo. METHOD AND MATERIALS: Fifteen subjects were assigned to wear nightguard trays filled with bleaching gel for 0.5, 2.5, 5.0, 10.0, 20.0, 40.0, and 60.0 minutes under 2 conditions: (1) subjects did not receive a prophylaxis before each bleaching treatment (pellicle was assumed to be present on the tooth surface); and (2) subjects received prophylaxis to remove pellicle from the tooth surface. At each evaluation time, 3 types of sample were collected: (1) a "grab sample," a sample of gel taken with a spatula from the reservoir of the tray on the maxillary right central incisor; (2) the remaining gel from the tray; and (3) the remaining gel scraped from the teeth. The collected gel samples were analyzed for the amount of peroxide using the United States Pharmacopeia-accepted method. Subjects were asked not to swallow the saliva during treatment but to expectorate into a beaker. The collected saliva was analyzed to determine the amount of peroxide. This sample represented the approximate amount of peroxide that subject would ingest during treatment. RESULTS: Pellicle did not affect the degradation of carbamide peroxide for the teeth or grab samples. The degradation of carbamide peroxide was exponential, except during the first 5 minutes, when the degradation rate was much higher. The saliva collected from subjects during use of the bleaching tray revealed an average of 2.1 mg of carbamide peroxide for 1 hour of bleaching treatment. CONCLUSION: The degradation rate is not affected by the removal of the pellicle.     

Tooth bleaching and pit and fissure stain

PURPOSE: To investigate if tooth whitening had any effect on the shade of occlusal pit and fissure stains and whether reservoirs in bleaching trays affected bleaching of occlusal pit and fissure stains. METHODS: 96 extracted molars were randomly divided into three paired groups for whitening using a 10% carbamide peroxide solution (Opalescence) or a 22% carbamide peroxide solution (Nite White Excel 3), or tap water for a control. One of each pair utilized reservoirs in their custom bleaching trays. Three dentists evaluated the shade of a specified occlusal area of pit and fissure stain twice before bleaching and twice after bleaching. RESULTS: Pit and fissure stain showed significant lightening of shade for either of the bleaching systems (P < 0.0005) but not the control (P = 0.816). There was no significant difference in pit and fissure stain shade lightening following treatment between those groups utilizing reservoirs in the custom trays and those without reservoirs (P = 0.658).     

Subsurface microhardness of enamel and dentin after different external bleaching procedures

PURPOSE: To evaluate the influence of various bleaching systems on subsurface microhardness of enamel and dentin. METHODS: 60 bovine crowns were distributed among seven groups (A: Opalescence Xtra Boost, B: Opalescence Quick, C: Rapid White, D: Whitestrips, E: Opalescence 10%, F: Opalescence PF 15%). The crowns were sectioned and baseline hardness (Knoop) of enamel and dentin was assessed on the sectioned surface at various distances from the enamel surface. The sectioned surface was covered with wax and the enamel was treated for 10 days with the bleaching agents A-F according to manufacturers' instructions. Bleaching with C-F was conducted each day (C: twice per day for 10 minutes, D: twice per day for 30 minutes, E: 8 hours, F: 4 hours), systems A-B were applied on first and fifth days (A: twice for 10 minutes, B: 1 hour). Finally, hardness was re-assessed. Data were statistically analyzed to compare baseline hardness and final hardness in the respective groups (P< 0.05). RESULTS: Analysis showed that in Group C, hardness was significantly reduced in both enamel and dentin. In the remaining groups, significant reduction of hardness was observed up to the following depths [microm] in enamel; A: 250, B: 700, D: 300, E: 150, F: 150. In these groups no significant hardness changes were recorded in subsurface dentin.     

The effect of tooth bleaching on the shear bond strength of orthodontic brackets

INTRODUCTION: The purpose of this study was to determine the effect of enamel bleaching on the shear bond strength of orthodontic brackets bonded with a composite adhesive. METHODS: Two protocols were used on 60 human molars. In the at-home bleaching group (n = 30), Opalescence bleaching agent (Ultradent, South Jordan, Utah), which contains 10% carbamide peroxide, was brushed onto the teeth daily for 14 days and left for 6 hours each day. Teeth in the in-office group (n = 30) were treated with Zoom! (Discus Dental, Culver City, Calif), which contains 25% hydrogen peroxide gel, and then exposed to a light source for 20 minutes; these teeth were treated twice. After bleaching, the specimens were randomly divided into equal subgroups and stored in artificial saliva at 37 degrees C for 7 or 14 days before bonding. Shear bond strength testing was performed on all teeth. The Kruskal-Wallis test for nonparametric means was used to determine whether significant differences existed between the various subgroups and an unbleached control group. RESULTS: The mean shear bond strength for the control group was 5.6 +/- 1.8 MPa. Means for the at-home groups were 5.2 +/- 3.6 MPa and 7.2 +/- 3.2 MPa for the 7- and 14-day waiting periods, respectively. Means for the in-office groups were 5.1 +/- 5.3 MPa and 6.6 +/- 2.6 MPa for the 7- and 14-day waiting periods, respectively. The Kruskal-Wallis test (X(2) = 8.089) indicated no significant differences between the 5 subgroups (P = .088). CONCLUSIONS: The results showed that in-office and at-home bleaching did not affect the shear bond strength of orthodontic brackets to enamel.