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This study assessed the effectiveness and predictability of a readily available protocol to treat peri-implantitis utilizing mechanical debridement, chemical antiseptic surface detoxification, and osseous grafting. Nine patients (7 women, 2 men; mean age: 56.5 years) with 15 implants with peri-implantitis were included. Pocket probing depth (PPD), bleeding on probing (BOP), and standardized digital periapical radiographic measurements were taken. Surgical flaps were elevated, and the implant threads were cleaned with a plastic curette. Chemical decontamination was performed by scrubbing solutions of 0.25% sodium hypochlorite (NaClO) and 1.5% hydrogen peroxide (H2O2) around the exposed implant using cotton pellets. Bony defects were filled with a 50/50 mixture of bovine hydroxyapatite and nanocrystalline calcium sulfate (CaSO4). A porcine collagen membrane was placed over the grafted bony defect. Follow-up appointments were scheduled 1 week, 2 weeks, 3 months, 6 months, 9 months, and 1 year posttreatment. Clinical and radiographic parameters were assessed and compared. At baseline, PPD ranged from 5 to 7.5 mm (mean: 6 ± 0.7 mm). At 12 months, PPD ranged from 1.5 to 4.2 mm (mean: 2.5 ± 0.8 mm). The mean PPD reduction of 3.6 mm (59.2%) was statistically significant (P < .001). The number of bleeding sites around each test implant decreased significantly from 4 to 0.4 sites between baseline and 12 months (P < .001). Mean radiographic bone loss decreased from 4.8 ± 1.3 mm to 2.7 ± 1.2 mm (P < .001). The proposed method of mechanical decontamination, chemical detoxification, and bone regeneration is clinically effective and reproducible. Clinical peri-implant parameters and radiographic bone levels were improved and maintained their stability for 1 year using this peri-implantitis treatment protocol.

Purpose: To evaluate the effects of desensitizing MI Varnish (GC America) applied before or after bleaching on the mineral component of enamel and surface topography., Materials and Methods: The coronal portions of 10 freshly extracted bovine teeth were segmented for a total of 40 specimens. Enamel specimens obtained from each tooth were randomly divided into four groups (n = 10): Group A = no bleaching; Group B = bleaching with 40% hydrogen peroxide (HP); Group C = MI Varnish applied before bleaching; and Group D = MI Varnish applied after bleaching. The calcium (Ca) and phosphorus (P) levels of the specimens in each group were determined by energy dispersive spectroscopy (EDS). Morphologic changes were observed using scanning electron microscopy (SEM). One-way ANOVA and Tukey HSD tests were used for statistical analyses (α = .05)., Results: The mean Ca content of Group B was significantly lower than those of Groups A, C, and D (P < .05). The mean Ca content of Group C was significantly lower than that of Group A (P < .05). There was no significant difference in Ca content between the other groups (P > .05). The mean P content of Group A was significantly higher than those of Groups B to D (P < .05). There was no significant difference in P content between Groups B to D (P > .05)., Conclusions: Application of MI Varnish before or after in-office bleaching was effective in reducing mineral loss. However, applying MI Varnish after bleaching was more effective.

The objective of this split-mouth clinical study was to compare a combination of in-office and at-home dental bleaching with at-home bleaching alone. Two applications of in-office bleaching were performed, with one appointment per week, using 38% hydrogen peroxide. At-home bleaching was performed with or without in-office bleaching using 10% carbamide peroxide in a custom-made tray every night for 2 weeks. The factor studied was the bleaching technique on two levels: Technique 1 (in-office bleaching combined with home bleaching) and Technique 2 (home bleaching only). The response variables were color change, dental sensitivity, morphology, and surface roughness. The maxillary right and left hemiarches of the participants were submitted to in-office placebo treatment and in-office bleaching, respectively (Phase 1), and at-home bleaching (Phase 2) treatment was performed on both hemiarches, characterizing a split-mouth design. Enamel surface changes and roughness were analyzed with scanning electron microscopy and optical interferometry using epoxy replicas. No statistically significant differences were observed between the bleaching techniques for either the visual or the digital analyses. There was a significant difference in dental sensitivity when both dental bleaching techniques were used, with in-office bleaching producing the highest levels of dental sensitivity after the baseline. Microscopic analysis of the morphology and roughness of the enamel surface showed no significant changes between the bleaching techniques. The two techniques produced similar results in color change, and the combination technique produced the highest levels of sensitivity. Neither technique promoted changes in morphology or surface roughness of enamel.

Purpose: This double-blind randomized controlled trial assessed the effect of subgingival ozone (O3, gaseous ozone, HealOzone MK II, KaVo) and/or hydrogen peroxide (H2O2) on the development of peri-implant mucositis., Materials and Methods: Twenty subjects (mean age, 60 ± 7.7 years) with 80 implants (4 implants each) were recruited. First, a 2-week pretrial phase took place to achieve healthy gingiva. Subsequently, partial gum shields were constructed for the experimental area (around the 4 implants); subjects were asked to refrain from brushing in that area by wearing the gum shield. The following treatments were randomly applied (for 60 seconds) to implant sites on days 0, 7, and 14: (1) air (O2) and saline (0.9% NaCl) (control group), (2) O2 and H2O2 (3%), (3) O3 and saline, and (4) O3 and H2O2. Plaque, gingival, and bleeding indices were recorded on days 0, 7, 14, and 21., Results: Significant differences were seen among the treatments (P < .01) in plaque (F = 16.68), modified gingival (F = 7.86), and bleeding (F = 18.42) indices. O3 + saline and O3 + H2O2 produced optimum gingival health scores and were equally effective and the most effective in controlling bleeding (mean score = 0.05), while O2 + saline was the least effective (mean score = 0.56)., Conclusion: Ozone showed great potential for management of peri-implant mucositis.

The aim of this study was to assess the color alteration and sensitivity of teeth throughout and following in-office bleaching. Twenty-two volunteers participated in this clinical trial of bleaching treatment (35% hydrogen peroxide bleaching gel and placebo) applied on maxillary incisors and canines. According to a split-mouth design, the volunteers' maxillary hemi-arches received either the bleaching or placebo agent, applied four times, at 1-week intervals. Color alteration and tooth sensitivity were assessed throughout and following bleaching. Statistical calculations were performed using gamma distribution and repeated-measures ANOVA. There was a statistically significant difference between teeth submitted to a bleaching agent and placebo (P < .001). At the end of the first, second, third, and fourth sessions, the bleached teeth presented color scores statistically lower than those observed immediately before bleaching. There was no difference in the color scale scores of the bleached teeth between bleaching sessions. The sensitivity data test showed a significant difference among treatments (P < .0001). Color alteration and dental sensitivity were altered by the bleaching agent.

The aims of this in vivo study were to compare the effectiveness and color stability of at-home and in-office bleaching techniques and to evaluate whether the use of light sources can alter bleaching results. According to preestablished criteria, 40 patients were selected and randomly divided into four groups according to bleaching treatment: (1) at-home bleaching with 10% carbamide peroxide, (2) in-office bleaching with 35% hydrogen peroxide (HP) without a light source, (3) in-office bleaching with 35% HP with quartz-tungsten-halogen light, and (4) in-office bleaching with 35% HP with a light-emitting diode/laser. Tooth shade was evaluated using the VITA Classical Shade Guide before bleaching as well as after the first and third weeks of bleaching. Tooth shade was evaluated again using the same guide 1 and 6 months after the completion of treatment. The shade guide was arranged to yield scores that were used for statistical comparison. Statistical analysis using the Kruskal-Wallis test showed no significant differences among the groups for any time point (P > .01). There was no color rebound in any of the groups. The bleaching techniques tested were equally effective. Light sources are unnecessary to bleach teeth.

The aim of this study was to assess the durability of bleaching results achieved with (1) 15% carbamide peroxide home bleaching and (2) 38% hydrogen peroxide in-office bleaching. A total of 231 extracted anterior teeth were randomly divided into three groups (n = 77 in each group) with comparable mean baseline L*-values (68.24 ± 0.8): a non-bleached control group A, a 15% carbamide peroxide group B (5 bleaching intervals of 8 hours), and a 38% hydrogen peroxide group C (3 intervals of 15 minutes). Durability of bleaching was assessed by comparing CIE-L*a*b* data after intervals of 2, 4, 12, and 26 weeks from baseline. Both bleaching regimes initially produced a highly significant increase in lightness parameter L*, with no significant difference between the respective bleaching regimes (B: 68.23 / 72.48; C: 68.32 / 73.25). Six months after starting the trial, L*-values for group B yielded no significant differences compared to baseline (69.55), whereas L*-values for group C were still significantly raised (69.91), despite a highly significant decrease when compared to initial bleaching results. In both treatment groups, there was a lasting response to bleaching in terms of CIE-a* and -b* value decreases. Results for both home- and in-practice regimes were found to be similar for about 12 weeks. However, in-office results were longer lasting, despite the shorter treatment intervals. Summarized bleaching effects, in terms of delta E values, revealed no significant differences between treatment groups and the control group after 6 months, indicating an abatement of the bleaching results achieved.

Objective: To evaluate the effects of a commercial bleaching agent containing 36% hydrogen peroxide on the clinical plaque index and Streptococcus mutans and Lactobacilli counts in dental plaque and saliva in vivo., Methods: Twenty volunteers were recruited in the present study. Evaluation of plaque index and bacteria counts in plaque and saliva was performed before bleaching the teeth, and 3 days, 2 weeks and 4 weeks post-treatment., Results: Quigley-Hein Plaque Index and Modified Navy Plaque Index were significantly lower on day three after bleaching compared to that before bleaching and the other time points after bleaching. The total number of bacteria in the plaque on day three after bleaching was also less than that before bleaching and the other time points after bleaching. The Streptococcus mutans counts in the plaque and saliva four weeks after bleaching were decreased significantly compared to that before bleaching., Conclusion: Hydrogen peroxide bleaching can decrease plaque accumulation and cariogenic bacteria for a short period of time.

The purpose of the present study was to evaluate enamel bond strength of a composite resin material after hydrogen peroxide bleaching, activated by a diode laser (LaserSmile), an ozone device (HealOzone), a light-emitting diode (BT Cool whitening system), and a quartz-Plus. Fifty extracted caries-free permanent incisors were used in this study. Thirty-eight percent hydrogen peroxidegel was applied to sound, flattened labial enamel surfaces and activated by different sources. Enamel surfaces that had received no treatment were used as control samples. Bonding agent was applied according to the manufacturer's instructions and the adhesion test was performed according to ISO/TS 11405. Statistical analysis showed significant influence of the different activation technique of hydrogen peroxide on shear bond strength to enamel (ANOVA, LSD, P < 0.05). The data in this vitro explorative study suggest the activation of hydrogen peroxide by different sources may further affect the shear bond strength of subsequent composite resin restoration to enamel. Within the limitations of this in vitro study, further studies examining the structural changes of activated hydrogen peroxide-treated enamel are needed. Due to the different activation methods; duration of light irradiation effects, longer time periods may be needed before application of adhesive restorations to enamel, compared with non-activated bleaching.

Objective: The aim of this study was to evaluate the in vitro color stability of bleached teeth by means of a 6-day staining procedure., Material and Methods: 20 caries-free randomly divided into two groups. Test group: a bleaching agent (Zoom 2, Discus Dental) was applied to the labial surfaces following the manufacturer's instructions., Control Group: no bleaching treatment. using a thermo-cycling device, all teeth were alternately immersed in a 0.9% saline solution at 37 °C for 1 hour, and in a coffee solution at 55 °C for another hour, in order to simulate the natural tooth-staining process. This procedure was repeated 12 times a day for 6 days. Teeth were polished once a day with a rubber cup and polishing paste. CIELAB color variables (L, a, b) were assessed by means of a spectrophotometer (VITA Easyshade®) and a custom alignment device at baseline, after bleaching, and once a day throughout the 6-day staining treatment. The bleaching result and the color stability of bleached and control group teeth were assessed by matched pair t test and MANOVA., Results: The bleaching agent had a significant whitening effect. The staining treatment did not produce any significant color change on bleached teeth, which maintained the same whiteness achieved after the bleaching treatment. The staining treatment did not produce any significant color change on control teeth. The two groups showed significant differences in both whiteness and lightness changes as a result of the polishing treatment., Conclusions: The Zoom 2 whitening agent produced immediate and long-lasting bleaching results, even if the reduction of b value mainly occurred 24 and 48 hours after the bleaching treatment.

The objective of the present study was to assess the clinical efficacy of a dental bleaching system based on hydrogen peroxide with or without light activation. This randomized controlled trial evaluated the effect of the light when applied to the hydrogen peroxide by using a split-mouth design with 21 patients, with light activation in one hemi-arch but not in the other. The bleaching agent was QuickWhite 35% hydrogen peroxide and activation was conducted with a diode lamp (Luma Cool). The Classic Vita Guide was used to score tooth shades. Two consecutive applications of hydrogen peroxide were made to one hemi-arch, each light-activated for 10 min. The other hemi-arch was then identically treated but without light activation. After removal of the bleaching agent, the shade was re-scored and the Wilcoxon signed ranks test was used to compare differences in tooth shade values. The bleaching treatment produced significant shade changes (P < 0.01) in both hemi-arches. After treatment, there were no statistically significant differences between light-treated and non-light-treated tooth types (central incisors, lateral incisors, and canines). However, taking central incisor, lateral incisor, and canine as a group, comparison between each hemi-arch showed a significant effect in the hemi-arch with light activation (P < 0.05). The use of diode light with a 35% hydrogen peroxide gel slightly improved the dental bleaching.

This study sought to develop treatment strategies for managing percutaneous infection around craniofacial implants. The present general pathogen situation together with a bacterial resistance were determined in 57 infected peri-implant sites. Forty-four implants were randomly assigned for wound cleaning and split into three groups-two with local antibiotics of proven efficacy and one with 3% hydrogen peroxide (H2O2). The pathogen spectrum differed depending on the severity of the infection, with Staphylococcus aureus clearly correlated with the degree of inflammation (positive correlation: R = 0.72). It was observed that the use of additional local antibiotics was not superior to conventional wound cleaning with 3% H2O2. It is suggested that sulcus fluid flow rate measurements could serve as a simple and reliable objective parameter for recall examinations.

Purpose: This study aimed to determine whether gender, age, and initial tooth hue impacted the effect of laser tooth whitening., Materials and Methods: Ninety-one subjects were enrolled in a laser tooth whitening study at Kaohsiung Medical University. Sensitivity was evaluated by asking the patients about any tooth sensitivity they experienced after the whitening procedures were performed. The LaserSmile tooth whitener, containing 35% hydrogen peroxide, was applied to the tooth surfaces of both arches from the central incisor to the second premolar, and the LaserSmile Twilite diode laser was applied to the same maxillary and mandibular teeth. After removal of the whitening gel, shade matching was immediately performed with the ShadeEye NCC Dental Chroma Meter. Patients were classified into the following groups: tetracycline stain, gender, age, and initial tooth hue. Only 5 of the 91 individuals had tetracycline staining., Results: The initial tooth shade and the amount of shade change showed no significant differences between female and male patients, but a significant difference was found between hue and age group., Conclusions: Teeth with hue A showed greater shade improvement than teeth with hue C and hue D. Whitening response was better in younger individuals, and gender was not a factor that affected the whitening response. Sensitivity is common during the whitening procedure but can be tolerated by the patients.

Porcelain laminate veneers are widely accepted as the treatment of choice to noninvasively restore the esthetics and function of anterior teeth, provided there is a sufficient amount of tooth structure to support the reconstruction. However, there are certain esthetic limitations if the underlying tooth structure is discolored, which may occur in cases of nonvital roots. This article describes how to manage this esthetic challenge. Internal bleaching, tooth-colored internal buildups, and preparation guidelines are discussed via clinical case presentations.

This paper describes the rationale and procedures for noninvasive treatment of discolored nonvital teeth using the walking bleach technique. The limitations of this procedure and, in particular, the unpredictable color stability following non-vital bleaching are discussed and illustrated with two cases of rapid discoloration relapse. The possible reasons for treatment failure are examined and show that current knowledge regarding the origin and prevention of discoloration is limited.

In-office techniques for bleaching vital teeth are effective and expedient, but because they require the use of elevated concentrations of hydrogen peroxide-based agents, which are caustic and potentially toxic, they are found to be less appealing by practitioners compared with home whitening procedures. In this article we propose a new technique for in-office whitening of vital teeth using a 6% hydrogen peroxide paint-on whitening varnish, which enables the whitening procedure to be more economic and user-friendly, as well as less toxic and time consuming, compared with traditional in-office bleaching. A total of six patients with no caries or restorations in the maxillary and mandibular anterior teeth were selected for this study. Ten-minute applications of the paint-on whitening varnish were performed repeatedly with each patient for up to 1 hour and then repeated 1 week later. Initial shades were recorded with a Vita scale guide, and photographs were taken at the beginning and end of the study. A questionnaire assessing clinical parameters and patient satisfaction was performed. A change of 7 to 13 values on the Vita scale was observed in all cases. There were no reports of tooth sensitivity, and overall patient satisfaction was achieved. In-office bleaching with the use of paint-on varnishes seems to be effective, safe, and well accepted by patients, offering a viable alternative to high-peroxide-concentration in-office procedures.