Search

Purpose: Sodium bicarbonate (NaHCO3) in toothpaste can enhance the removal of biofilms involved in the development of gingivitis. To examine this over an extended time period, this study compared the efficacy and tolerability of twice-daily brushing for 24 weeks with 67% or 0% NaHCO3-containing toothpastes in subjects with moderate gingivitis., Materials and Methods: 247 adults with bleeding after brushing and ≥ 20 gingival bleeding sites were randomized to twice-daily brushing with a 67% NaHCO3 or 0% NaHCO3 toothpaste. The primary efficacy variables were between-treatment differences in number of bleeding sites and the Modified Gingival Index (MGI) score after 24 weeks' use. Secondary efficacy variables included Bleeding Index (BI) and Turesky modification of Quigley-Hein Plaque Index (TPI) (overall and only interproximal sites)., Results: The 67% NaHCO3 toothpaste produced statistically significant improvements compared with the 0% NaHCO3 toothpaste in number of bleeding sites (-17.5; 95% CI -20.32, -14.66; p < 0.0001) and MGI score (-0.2; 95% CI -0.24, -0.17; p < 0.0001) at week 24. These significant differences were also found at 6 and 12 weeks for these measures and at 6, 12, and 24 weeks for BI and TPI scores (including at only interproximal sites) (all p < 0.0001). No treatment-related adverse events were reported., Conclusion: Twice-daily brushing with 67% NaHCO3 toothpaste was generally well tolerated and significantly improved indices of gingival bleeding and plaque compared with 0% NaHCO3 toothpaste in subjects with moderate gingivitis.

Objective: To evaluate the efficacy of in-office tooth bleaching following application of either ozone (O3) or hydrogen peroxide (H2O2)., Method and Materials: 32 participants were randomly distributed into two groups (n = 16 each). Participants' maxillary anterior teeth were treated with ozone (produced via a healOzone X4 device; Curozone) for 60 seconds in Group 1, or with 38% H2O2 for 20 minutes in Group 2. Tooth shades were evaluated by means of a colorimeter (CR-400, Minolta) measuring Vita classic shades in addition to L*a*b* shade values before and following bleaching in each group. A visual analog scale was used to evaluate tooth sensitivity before and after bleaching. Statistically significant differences were identified at P < .05., Results: Teeth obtained lighter shades (increased L* and reduced a* and b* values) following bleaching in both groups (P < .001). Both groups revealed comparable bleaching outcomes (P > .05). However, bleaching with ozone did not result in tooth sensitivity, whilst using H2O2 was accompanied with significantly increased bleaching sensitivity (P < .001)., Conclusion: Similar bleaching outcomes and lighter tooth shades (both for Vita shades and L*a*b* values) were obtained following in-office bleaching with either 60 seconds of ozone or 20 minutes of 38% H2O2. Notwithstanding, tooth sensitivity was significantly increased following bleaching with H2O2 in comparison to ozone. Ozone obviously does reduce the regularly clinically observed inconveniences of bleaching by means of H2O2; thus, ozone would seem worth considering for patients asking for in-office tooth bleaching.

Esthetic treatment of stained arrested caries lesions (ACLs) has mostly been done using invasive restorative techniques. The aim of this paper was to propose and report the efficacy of a conservative approach based on dental bleaching to esthetically treat these lesions, both experimentally (extracted teeth) and clinically. In a laboratory experiment, ten extracted human teeth with stained ACLs in either pit and fissure or smooth surface were selected and treated with 15% carbamide peroxide gel, 4 h per day, for a total of 6 days. The second part of the paper reports a clinical case of pit and fissure-stained ACLs in four posterior teeth, which were treated with 40% hydrogen peroxide in-office bleaching. Digital photographs were taken in both parts to document the efficacy of the treatment. The lesions showed noticeable increase in color lightness indicating the efficacy and suitability of the proposed approach. By using the conservative clinical technique presented, the esthetics of most stained ACLs could be improved, eliminating the need for invasive restorative treatments.

Objective: The aim of this clinical study was to compare tooth shade, color rebound, and tooth sensitivity after using either a combined bleaching technique (CBT) or a deep bleaching technique (DBT) to lighten stained teeth. CBT is a two-stage bleaching process consisting of an initial in-office bleaching treatment session using 35% hydrogen peroxide (HP) followed by a 7-day at-home bleaching session with 6% HP. DBT involves a 7-day at-home bleaching session with 6% HP prior to the initiation of a two-stage CBT process., Method and Materials: Thirty-six volunteers were recruited in this split-mouth design randomized clinical trial. Tooth shade was objectively evaluated by using a spectrophotom-eter and shade guide tabs. Tooth and gingival tissue sensitivity were self-evaluated by recording any tooth or gingival sensitivity on a daily basis., Results: Both CBT and DBT presented satisfactory whitening effects. Although DBT resulted in a better shade change, the two bleaching techniques had a similar rebound effect. CBT was associated with a lower frequency of tooth sensitivity, but both bleaching techniques can be considered safe from a clinical standpoint., Conclusion: The results indicate that CBT might potentially be preferred to whiten teeth, thus promoting the shade change, and avoiding gingival and tooth sensitivity.

Objective: To investigate the efficacy, tolerability, and long-term color stability of tooth whitening using two different bleaching techniques: an at-home tray technique (5.0% H2O2) and an over-the-counter strip technique (5.3% H2O2)., Method and Materials: Thirty subjects were included in this two-cell, parallel, examiner-blinded, randomized clinical trial. Shade evaluations were performed with a value-oriented VITA shade guide. The null hypothesis was that there would be no differences between the groups and no improvements from baseline with regard to tooth shade. Bleaching sensitivity, gingival irritation, and patient acceptance were recorded on a visual analog scale (VAS). Scanning electron microscopy (SEM) was performed to detect any enamel surface changes., Results: After bleaching, both treatments demonstrated significant improvements in tooth shade (P < .001 for both groups). At the 18-month recall, tooth shade remained significantly lighter than at baseline (P = .006 for tray group; P = .001 for strip group). However, a relapse of the tooth shade was observed compared with the immediate postbleaching result (P < .05). VAS data yielded no significant differences between groups regarding bleaching sensitivity and gingival irritation. None of the teeth studied showed detectable enamel surface changes. Patient acceptance was statistically significantly higher in the tray group compared with the strip group (P < .05)., Conclusion: Both techniques demonstrated significant and comparable levels of tooth shade improvement after 2 weeks and 18 months. Each treatment caused similar, transient oral adverse effects.

Enamel white spot lesions in anterior teeth that compromise esthetics are common. Microabrasion is indicated, since it affects enamel superficially. An acid-abrasive slurry with 37% phosphoric acid with pumice was used on the enamel for a controlled time period. Home bleaching with hydrogen peroxide was then used, further improving the final result. The method is safe, easy, and conservative and provides good esthetic results.

Summary: This case report is of a rare occurrence of necrotic ulcerative changes in a female patient with Fanconi's anaemia and its successful periodontal management., Background: The response of the periodontium to certain genetic and haematological disorders may vary from bleeding, ulcerations and necrosis to a more severe form of periodontitis. Periodontal management in such conditions still remains an enigma with respect to the timing of the periodontal intervention with regard to the systemic wellbeing of the patient., Methods: Necrotising ulcerative lesions in a patient with Fanconi's anaemia (FA) progressed rapidly in a week's time necessitating early preliminary periodontal care, which included scaling and root planning using ultrasonic equipment supplemented with hydrogen peroxide irrigation, in conjunction with systemic antibiotics and blood transfusion., Results: Following 1 unit (500ml) of fresh whole blood transfusion 24 hours preoperatively, basic periodontal therapy, comprising of removal of necrotic slough and thorough scaling was done. There was marked resolution of the necrotic ulceration and related symptoms when the patient was followed up for a period of 1 month., Conclusion: This report reconfirms most oral manifestations of Fanconi's anaemia and is the first of its kind to associate necrotic ulcerative changes of the gingiva with FA. It also goes a step further to emphasise the clinical significance of multidisciplinary approach towards successful patient management, which was the primary objective.

Objective: Various bleaching modalities are now offered to patients, either monitored by the dental office or self-directed, for which relative efficiency is unknown. The aim of this in vitro study was to evaluate the ability of bleaching products and protocols to lighten enamel and dentin., Method and Materials: Bovine tooth specimens of standardized thickness (2.5 +/- 0.025 mm with similar dentin and enamel thickness) were prepared and stained with whole blood and hemolysate before being submitted to seven supervised or self-directed bleaching regimens: tray-based bleaching using 10% (Opalescence, Ultradent; Nite White, Discus Dental) or light-activated 30% (Metatray, Metatray) carbamide peroxide (CP); 6% (Zoom, Discus Dental) or 9% (TresWhite, Ultradent) hydrogen peroxide (HP); strips (Whitening Strips, Oral B-Rembrandt); and paint-on gel (Paint on Plus, Ivoclar Vivadent) containing 8.1% and 6% HP, respectively. Colorimetric measurements were performed on each specimen side, according to the CIE L*a*b* system, before and after staining, as well as after 5, 10, and the recommended number of bleaching applications., Results: Color change after recommended number of applications (DEr) varied from 15.72 (Metatray) to 29.67 (Nite White) at enamel and 14.91 (Paint on Plus) to 41.43 (Nite White) at dentin side; Nite White (10% CP) and TresWhite (9% HP) were more effective than Metatray (30% CP) and Paint on Plus (6% HP) after 5 or the recommended number of applications., Conclusion: In this in vitro study based on bovine teeth, tray-based systems produced the faster and better bleaching effect, regardless of the product and concentration used, at both enamel and dentin sides.

Objectives: To determine in vitro the effect of prophylaxis before tooth whitening and to evaluate a paint-on home whitening product using two methods of color analysis., Method and Materials: Ninety extracted human maxillary anterior teeth were randomly separated into a prophylaxis group or nonprophylaxis group of 45 teeth. The prophylaxis group received debridement and polishing before whitening. The two groups were randomly separated into three subgroups of 15 teeth each: placebo group, test group (Easy White, Dental Kosmetik), and positive control group (Colgate Simply White, Colgate-Palmolive). The 2-week whitening treatment consisted of applying one of the three gels twice daily according to the manufacturers' instructions. In vitro measurements included tooth color assessment using digital imaging analysis and evaluation of tooth shade by a colorimeter. Measurements were taken at baseline, after prophylaxis, and after whitening., Results: While whitening was effective with or without prophylaxis, prior prophylaxis contributed to improved posttreatment outcomes. Both test gel and positive control gel resulted in greater shade reductions and tooth color improvements compared to placebo gel (P<.05). The positive control gel was not superior to test gel., Conclusions: Prophylaxis is highly recommended before use of paint-on home whitening gels. Colorimetric measurements and digital imaging analysis with a gray card are options to record the efficacy of whitening products. Digital imaging analysis has advantages: Numeric data can be evaluated, and an image of the outcome of the whitening procedure is available.

Objective: The purpose of this clinical trial was to evaluate the efficacy of 2 over-the-counter whitening systems: a liquid whitening gel (5.9% hydrogen peroxide, twice a day for 15 minutes), and a sodium chlorite-based whitening gel applied in a tray system (10 minutes twice a day)., Method and Materials: Sixty volunteers (minimum shade A3 on 1 maxillary tooth) were selected to participate in this single-blind (examiner-blinded), single-center, 2-group trial. The subjects were randomly divided into 2 groups (n = 30 each) and instructed to bleach their teeth for 2 weeks. Efficacy was measured using the Vita Classical shade guide and a spectrophotometer at baseline, as well as after 2 weeks and 6 months., Results: For the subjectively measured tooth shades, improvement for maxillary canines was 2.03 +/- 3.67 tooth shades in group 1 and 1.08 +/- 2.19 tooth shades in group 2 after 2 weeks; the maxillary incisors revealed a tooth shade improvement of 0.83 +/- 1.71 tabs in group 1 and 0.73 +/- 2.22 tabs in group 2 (P < .05, except maxillary incisors in group 2; t test). Objectively measured tooth shade scores revealed a change of 0 +/- 0.25 tooth shade tabs (P > .05)., Conclusions: The bleaching gel containing hydrogen peroxide achieved a slight improvement, and the sodium chlorite-based bleaching gel achieved only a small tooth color improvement. Moreover, subjectively and objectively measured tooth shades revealed considerably different results in the clinical situation.

Objective: The aim of this study was to evaluate the clinical efficacy of home-administered vital bleaching procedures and possible adverse effects derived from their use. One gel containing 3.5% hydrogen peroxide with a 5% potassium nitrate component (FKD, Kin Lab) was compared with a carbamide peroxide-based gel with a concentration of 10% (Opalescence, Ultradent)., Method and Materials: Two sample groups were designed, each composed of 8 patients. All patients employed both bleaching products, 1 in the maxillary arch and the other in the mandibular arch on a random basis. The treatment was applied for 3 hours a day for 4 weeks. The degree of bleaching was evaluated using the Vita guide arranged by brightness. Dental sensitivity was measured with a specially designed 4-point scale. Gingival irritation was registered by the presence or absence of lesions in the marginal gingiva related to treatment., Results: The degree of bleaching was similar with both products (4.8 Vita shade tabs). The hydrogen peroxide product with potassium nitrate provoked less dental sensitivity, although the difference between the 2 products was insignificant (P = .063). Gingival irritation appeared in 6 subjects, but was unrelated to the applied product., Conclusion: Under the conditions of this study, no statistically significant differences were detected between 3.5% hydrogen peroxide containing 5% potassium nitrate (FKD) and the 10% carbamide peroxide-based product (Opalescence).

The effects of four bleaching agents (Opalescence, HiLite, 30% hydrogen peroxide, and 30% hydrogen peroxide mixed with sodium perborate) and 37% phosphoric acid on the external surface of human enamel were examined with the scanning electron microscope. The materials were applied to the enamel surfaces of 60 specimens obtained from 10 teeth. Each test agent was applied to one specimen from each tooth. One specimen of each tooth was left untreated. Comparison to the untreated control surfaces revealed that enamel exposed to the bleaching agents underwent slight morphologic surface alterations. The enamel surfaces treated with phosphoric acid, in contrast, showed severe morphologic alterations.

The combination of intracoronal and extracoronal bleaching represents a conservative treatment to restore esthetics to darkened or stained nonvital teeth. Notwithstanding the eventual risks and difficulties accompanying such technique, nonvital teeth often can be successfully lightened. This article presents a few guidelines for bleaching nonvital teeth as well as a clinical case to illustrate the indications and clinical protocol for the technique.

Exodontia of extremely carious teeth leads to a significant risk of osteoradionecrosis in patients who have undergone radiotherapy. In these patients, endodontic treatment could be an alternative. Successful root canal therapy in a girl who had been irradiated for head and neck neoplasms is reported. The results indicated that use of calcium hydroxide to obturate the root canals is a viable method of postirradiation endodontics in primary teeth.

This article reviews the literature on the use of hydrogen peroxide in three professionally administered bleaching techniques from historical, technique, and safety viewpoints. Safety over time, absolute safety, and relative safety of nonvital bleaching, in-office vital bleaching, nightguard vital bleaching, and over-the-counter bleaching kits are compared. The advantages and disadvantages of different bleaching options, as well as indications for individual or combined use of the techniques, are discussed. In addition, specific indications for the use of the nightguard vital bleaching technique are presented.

Since 1985, 534 severely discolored teeth have been treated with intentional endodontics and internal bleaching; of these, 258 were treated with the conventional technique and 276 were treated with the modified technique. Six years of clinical and radiographic evaluation revealed that the results obtained with the first group (conventional technique) remain stable and that a very noticeable improvement has been achieved with the second group of teeth, treated with the modified technique.

Many clinicians advocate etching the teeth before vital bleaching as a way to enhance the permeability of the tooth surface to hydrogen peroxide and thus to enhance the bleaching effect. However, no studies have been published to date to document the effect of etching on vital bleaching. In this study, ten patients received a bleaching treatment regimen of several appointments. Half of the teeth in one arch of each patient were etched with phosphoric acid for 20 seconds before they were bleached with 35% hydrogen peroxide. The teeth in the other half of the same arch were treated with tap water prior to bleaching. Evaluations of the patients after 3 and 6 weeks failed to confirm any enhanced lightening effect from etching.