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Aim: This study compared the effectiveness of several techniques in restoring compromised bonding to recently bleached enamel., Methods: Seventy-five healthy bovine incisors were divided into five groups (n = 15). Fifteen teeth (Group 1) remained intact, whereas 60 (Groups 2 to 5) underwent at-home bleaching with 16% carbamide peroxide. The bonding procedures were as follows: Group 1: Bonding of resin composite to unbleached enamel; Group 2: Bonding immediately after bleaching; Group 3: Application of a 10% sodium ascorbate solution for 10 min before bonding; Group 4: Enamel removal to the depth of 0.5 mm; and Group 5: Increased curing time of the bonding agent to 80 instead of 20 s. After 24 h, the specimens were subjected to micro-shear testing, and the failure mode was determined., Results: ANOVA revealed a significant difference in bond strength among the groups (P < 0.001). The mean bond strength was significantly lower in group 2 than in other groups (P < 0.05), which showed comparable bond strength to each other (P > 0.05). Adhesive failure was the most predominant failure type in all groups. The mixed failure occurred with a frequency of 26.7% in groups 3 and 5. The Fisher's exact test revealed a significant difference in failure modes among the groups (P = 0.047)., Conclusions: The three experimental procedures used in this study, including the application of 10% sodium ascorbate before bonding, enamel removal to the depth of 0.5 mm, and increasing the curing time of the bonding agent to 80 s, were effective in restoring the compromised bonding to recently bleached enamel., (© 2024. The Author(s).)

Background: A reduction in bond strength of bleached enamel has been confirmed in the literature. Although limited information is available, it is conceivable that the veneer preparation process may remove the impacted enamel and further eliminate the compromised bond strength between the composite resin and bleached enamel. This study aimed to evaluate the effect of surface removal following bleaching on the micro-shear bond strength (μSBS) of bleached enamel., Methods: Forty-eight specimens were prepared from bovine incisors and were randomly divided into 2 groups (n = 24): group B (bleaching with 40% hydrogen peroxide for 2 × 45 min with a 1-week interval) and group C (control group without bleaching treatment). Immediately after receiving the treatments, 0.5 mm of the enamel was removed from the specimen surface, followed by bonding of composite resin to the enamel surface. Each group was further divided into 2 subgroups of 12 specimens each: subgroup T (with 5000 thermocycles in water baths at 5 °C and 55 °C), and subgroup N (without thermocycling). The μSBS values were measured using a universal testing machine and subjected to two-way analysis of variance (α = 0.05). The fracture modes of the specimens were observed using a stereomicroscope., Results: The μSBS values of the different groups ranged from 21.42 to 25.21 MPa. Following a surface reduction of 0.5 mm, bleaching treatment and thermocycling did not significantly affect the μSBS values (P = 0.348 and P = 0.507, respectively). No significant interaction was found between the bleaching treatment and thermocycling (P = 0.514). All the groups exhibited a high percentage of mixed failures. Compared with group C, group B exhibited higher percentage of adhesive failure., Conclusion: The results suggested that the bonding procedure could be performed on the bleached enamel following a surface reduction of 0.5 mm immediately after the bleaching treatment.

Context: The effect of home bleaching on surfaces of dental cements is controversial., Aim: The aim of this study was to microscopically evaluate and compare the effect of different concentrations of carbamide peroxide (CP) home bleaching agents on the surface of zinc phosphate cement., Materials and Methods: Forty 10 mm × 2 mm specimens of zinc phosphate cement were prepared following the manufacturer's directions. All specimens were immersed in artificial saliva at 37°C for 24 h. The specimens were equally divided into four groups (n = 10). One control group received no CP bleaching. Three experimental groups were exposed to 10%, 16%, and 22% of CP home bleaching agents. The bleaching agents were applied daily for 4 h for 14 days. Specimens were stored in artificial saliva at 37°C for 24 h and then examined under a scanning electron microscope. The surface micromorphology of the specimens was carefully evaluated and compared., Results: The zinc oxide particles in the specimens of the control group were tightly packed with well-defined plate-like crystals. When specimens were exposed to 10% CP gels, the particles became flat and irregular with few areas of eroded matrix. When 16% CP gel was used, the crystals became flatter and irregular with rounded edges. Bleaching with 22% CP gel showed little more erosion of the surface of the matrix of the cement. Fewer flat and irregular crystals were observed on the surface of the cement., Conclusions: At-home bleaching using 10%, 16%, and 22% CP may be safely used in the presence of zinc phosphate-luted crown restorations without adverse effects., Competing Interests: There are no conflicts of interest

Background: The effects of HP-based products upon dental enamel and dentin are inconclusive., Aim: To evaluate changes in micromorphology and composition of calcium (Ca) and phosphate (P) in enamel and dentin after the application of 37.5% hydrogen peroxide (HP) and 35% carbamide peroxide (CP) METHODS: Crowns of 20 human teeth were divided in two halves. One half was used as control specimen and the other as experimental specimen. The control specimens were kept in artificial saliva, and the experimental specimens were divided into four groups (n=5 each): group 1 (enamel HP for 45min); group 2 (dentin HP for 45min); group 3 (enamel CP for 90min); and group 4 (dentin CP for 90min). The morphological changes were evaluated using confocal laser scanning microscopy (CLSM), while the changes in the composition of Ca and P were assessed using environmental scanning electron microscopy combined with a microanalysis system (ESEM+EDX). The results within each group and between groups were compared using the Wilcoxon test and Mann-Whitney U-test, respectively (p<0.05)., Results: Similar morphological changes in the enamel and no changes in dentin were assessed with both products. Ca and P decreased in enamel and dentin, without significant differences between them or with respect to their control specimens (p>0.05)., Conclusions: When bleaching products with a neutral pH are used in clinical practice, both, the concentration and the application time should be taken into account in order to avoid possible structural and mineral changes in enamel and dentin., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Aim: To evaluate the structural-morphological changes in enamel surface roughness and Streptococcus mutans adhesion after tooth bleaching using plasma in combination with a low concentration of 15% carbamide peroxide (CP)., Methodology: Sixty pairs of premolars were randomly assigned to the treatment groups (n = 30; buccal surface, groups 1A/2A) or controls (n = 30; palatal surface, Groups 1B/2B). Group 1A received a low concentration of 15% CP and low-temperature plasma. Premolars in group 1B were placed in phosphate-buffered saline and served as controls. The buccal surface of Groups 2A was subjected to 15% CP alone, whilst the palatal surface was subsequently immersed in PBS (group 2B). After bleaching, all teeth were soaked for 1 h in artificial saliva at 37 °C. Subsequently, teeth were placed in brain-heart infusion with S. mutans at 37 °C for 24 h. The assessment of the structural-morphological changes was carried out using a biofilm assay, scanning electron microscopy and atomic force microscopy. Statistical analysis of the data was performed with the SPSS (SPSS Inc., Version 18.0, Chicago, IL, USA). The Student's t-test was used to determine whether there was a significant difference in the structural-morphological effects with and without plasma., Results: Significantly less S. mutans adhesion was observed in group 1A compared with the other groups (P < 0.05). Moreover, the surface roughness was significantly greater in group 2A compared with the other groups (P < 0.05)., Conclusions: The application of plasma did not result in any structural-morphological and topographic changes in the enamel. The combined bleaching method using plasma and a low concentration of 15% CP was less destructive, particularly with respect to tooth surface changes., (© 2017 International Endodontic Journal. Published by John Wiley & Sons Ltd.)

The aim of this in vitro study was to evaluate the long-term effect of bleaching on human enamel. Four groups of enamel specimens were prepared (n = 20): group 1: bleaching with Opalescence Boost [40% hydrogen peroxide (H 2 O 2 ), 3 × 20 min/week]; group 2: control group (the specimens were stored in human saliva); group 3: beaching with Vivastyle Paint on Plus (6% H 2 O 2 , 2 × 10 min/day), and group 4: bleaching with Opalescence PF 16% [16% carbamide peroxide (CP), 6 h/day]. After each bleaching session the specimens were stored in human saliva. Knoop microhardness and surface roughness were measured: before bleaching, after 2-week and after 8-week bleaching. After 2-week treatment, surface roughness was significantly increased in all experimental groups (p < 0.05), while among them no significant difference was found (p > 0.05). The roughness changes exerted after 8-week bleaching were not significantly higher than the ones after 2 weeks (p > 0.05). After 8-week treatment, the increase in roughness caused by 16% CP was significantly higher (p < 0.05) than the one caused by 40% H 2 O 2 . Microhardness increased in all groups including control; however, only 40% H 2 O 2 increased the microhardness significantly (p < 0.05). The effect of bleaching on enamel was not shown to be dependent on the method or the H 2 O 2 concentration. Bleaching with CP 16% resulted in higher roughness than bleaching with H 2 O 2 , while 40% H 2 O 2 caused the higher microhardness increase. The present study showed that in-office bleaching with 40% H 2 O 2 seems to be at least as safe as home bleaching as far as their effects on human enamel are concerned.

Several studies have investigated the effect of bleaching on dental tissues. The evaluation of the effect of home bleaching with 10% carbamide peroxide is important for assessing alterations in enamel microhardness that may affect dental health in terms of resistance to masticatory forces. This meta-analysis was performed in order to determine scientific evidence regarding the effects of home vital bleaching with 10% carbamide peroxide gel on the microhardness of human dental enamel. A systematic electronic literature search was conducted in the PubMed and Web of Science databases using search terms. Two independent researchers evaluated the information and methodological quality of the studies. Inclusion and exclusion criteria were established for article selection; further, only studies published in English were selected. Thirteen studies that met all of the inclusion and exclusion criteria were selected and underwent statistical analysis. The results of this meta-analysis showed no significant changes in enamel microhardness when using the 10% carbamide peroxide bleaching gel over periods of 7, 14 and 21 days., (© 2016 Australian Dental Association.)

Aims and Objectives: This study aimed to evaluate the effects of at-home and in-office bleaching on the shear bond strength (SBS) of metal, ceramic, and composite orthodontic brackets and to compare their SBSs., Subjects and Methods: A total of 96 human lower premolar teeth were used for this study. Six teeth were used for scanning electron microscopic study while the remaining ninety were divided into three equal groups. Each group was further subdivided into three subgroups with ten samples each. Three protocols were used. In the at-home bleaching group (n = 30), opalescence non-PF (potassium nitrate and fluoride) bleaching agent (10% carbamide peroxide) was applied onto the teeth daily for 14 days and left for 8 h each day. Teeth in the in-office group (n = 30) were treated twice in consecutive days with Opalescence boost PF (40% hydrogen peroxide). After bleaching, the specimens were stored in distilled water for 1 day before bonding. SBS testing was performed on all teeth using Instron universal testing machine., Results: Analysis of variance indicated a significant difference (P < 0.005) among the groups. Maximum SBS was shown by ceramic brackets in control group (Ib) and minimum was shown by composite brackets of in-office bleached group (IIIc)., Conclusions: The results showed that at-home bleaching did not affect the SBS significantly whereas in-office bleaching reduced SBS of metal, ceramic, and composite brackets significantly. It is preferable to use metal or ceramic brackets than composite brackets for bonding 24 h after bleaching.

Objectives: The aim of this study was to compare the effectiveness of whitening mouth rinses on teeth previously whitened or not, exposed to food dyes., Methods and Materials: One hundred twenty enamel-dentin specimens, 3 mm in diameter, were obtained from bovine incisors. The specimens were stained for 14 days in staining broth. After staining, the initial color reading was performed via a spectrophotometer CM-2600d (Konica Minolta). Half of specimens were submitted to whitening (10% carbamide peroxide [CP]) for 14 days. They were then divided into three groups and were submitted to cycles of staining (five minutes) and mouth rinses (two minutes) for 12 weeks, with the following: CP-LI, Listerine Whitening; CP-PL, Plax Whitening; CP-BP, bromelain + papain; CP-DW, deionized water. LI, PL, BP, and DW groups were submitted to the same cited cycles but with no prior bleaching. The color measurements were performed after four, eight, and 12 weeks of treatment with mouth rinses. Data were submitted to repeated measures analysis of variance (ANOVA) and Tukey's test for multiple comparisons, with significance level at 5%., Results: The results showed that the CP-LI, CP-PL, LI, and PL groups had greater color change than did the others. The CP-BP and BP groups were similar to CP-DW and DW., Conclusions: We therefore conclude that Listerine Whitening mouth rinse presented the highest bleaching effect, followed by Plax Whitening mouth rinse. Both maintained CP bleaching effect after 12 weeks of dye-rinse cycles. However, none of these rinses were able to produce whitening similar to CP. Bromelain- and papain-containing mouth rinses did not show bleaching effect, being similar to the control groups.

Objectives: The aims of the study are to prepare novel stain removal gel-based formulations containing papain or bromelain and to investigate their stain removal effect when applied to enamel., Materials and Methods: Experimental bromelain- and papain-based stain removal gels were prepared. Next, enamel/dentin tooth samples (6 × 6 mm 2 , 4 mm in thickness) were obtained from bovine teeth, stained in coffee solution for 1 week, and measured with a digital spectrophotometer (Easyshade, Vita Zahnfabrik) for color assessment (baseline). The samples were then randomly allocated into four groups (n = 7), according to the stain removal agent applied: ContrastPM+ (Discus Dental, LLC), which is based on 20 wt.% carbamide peroxide (positive control); bromelain-based; papain-based; and no agent (negative control). The materials were applied once a week, three times per day, during 4 weeks, and following the directions of use from positive control. The samples were measured again with the Easyshade and using the CIEL * a * b * color system. The color change (ΔE * ) results were obtained by subtracting the baseline values from the final color values obtained at each time point. The data were statistically analyzed using two-way repeated-measures analysis of variance and Student Newman Keuls's test as a post hoc test (α = 5 %)., Results: All stain removal agents produced greater color change than the negative control (p < .001), with the positive control demonstrating greater ΔE * values when compared to the experimental gels (p ≤ .004). The second application of all gels resulted in greater ΔE * values compared to the first application (p ≤ .025), although no color change was observed after the third application (p ≥ .051), regardless of the material evaluated., Clinical Significance: The proposed gels containing proteolytic enzymes (bromelain or papain) of vegetal origin may hold significant clinical potential as active agents for the preparation of stain removal agents free of hydrogen/carbamide peroxide.

Aim: The study aims to evaluate the effect of the application of two antioxidants on the bond strength of composite resin to bleached enamel., Materials and Methods: Eighty enamel surfaces were obtained from forty human extracted premolars. Specimens were randomly divided into four groups (n = 20). Group 1: No bleaching (control); Group 2a: Bleaching with 15% carbamide peroxide gel; Group 2b: Bleaching, followed by application of 10% sodium ascorbate gel; Group 2c: Bleaching, followed by application of 5% proanthocyanidin agent. Surfaces were etched followed by application of total etch bonding system, and composite resin cylinders were bonded. Specimens were tested for shear bond strength., Statistical Analysis Used: One-way analysis of variance was used for multiple group comparison and post hoc Tukey's test for individual group-wise comparison., Results: Significantly higher shear bond strength values were observed in Group 2c and 2b as compared with Group 1 and 2a (P < 0.05). Among the antioxidants, Group 2c showed significantly higher shear bond strength values than Group 2b (P < 0.05)., Conclusion: It can be concluded that the use of antioxidant before bonding procedures on bleached enamel completely neutralizes the deleterious effects of bleaching and increases the bond strength significantly.

Objectives: Dental microhardness experiments are influenced by unobserved factors related to the varying tooth characteristics that affect measurement reproducibility. This paper explores the appropriate analytical tools for modeling different sources of unobserved variability to reduce the biases encountered and increase the validity of microhardness studies., Materials and Methods: The enamel microhardness of human third molars was measured by Vickers diamond. The effects of five bleaching agents-10, 16, and 30 % carbamide peroxide, and 25 and 38 % hydrogen peroxide-were examined, as well as the effect of artificial saliva and amorphous calcium phosphate. To account for both between- and within-tooth heterogeneity in evaluating treatment effects, the statistical analysis was performed in the mixed-effects framework, which also included the appropriate weighting procedure to adjust for confounding. The results were compared to those of the standard ANOVA model usually applied., Results: The weighted mixed-effects model produced the parameter estimates of different magnitude and significance than the standard ANOVA model. The results of the former model were more intuitive, with more precise estimates and better fit., Conclusions: Confounding could seriously bias the study outcomes, highlighting the need for more robust statistical procedures in dental research that account for the measurement reliability. The presented framework is more flexible and informative than existing analytical techniques and may improve the quality of inference in dental research., Clinical Relevance: Reported results could be misleading if underlying heterogeneity of microhardness measurements is not taken into account. The confidence in treatment outcomes could be increased by applying the framework presented.

Unlabelled: Objective Peripheral enamel staining is often noticed after removal of long-term veneer or crown provisional restorations. Application of carbamide peroxide (CP) easily removes the stain, but the potential for immediate bonding with a resin-based cement is questionable. This project tested the short-term, shear bond strength of a commercial, photo-curable, resin cement to bovine enamel after application of a 10% concentration of CP placed for different exposure times., Materials and Methods: Bovine enamel was flattened and polished. Surfaces had either no CP application (control), or 10% CP applied for 10, 20, or 30 seconds. Teeth were acid-etched, rinsed, dried, and controlled sized stubs of a commercial resin cement were photocured onto the treated surfaces. The shear bond strength of each specimen was determined using a universal testing machine, and results were compared using an analysis of variance at a preset alpha of 0.5 (n = 10/group)., Results: No significant differences (p = 0.819) in shear bond strength were found among any CP cleaning treatments or the experimental (nontreated) control., Conclusions: Short-term application of 10% carbamide peroxide prior to acid etching, to remove enamel stains in teeth prepared to receive ceramic veneers or crowns, does not reduce immediate shear bond strength of resin-based cement to enamel., Clinical Significance: Clinicians can confidently apply 10% CP for short-term, localized stain removal on enamel and not be concerned about affecting subsequent bond strength of a resin-based cement to enamel. (J Esthet Restor Dent, 2016)., (© 2016 Wiley Periodicals, Inc.)

Objective: To evaluate the effect of home-use bleaching agent containing 16% Carbamide Peroxide (CP) and in-office bleaching agent containing 38% Hydrogen Peroxide (HP) on enamel micro-hardness., Study Design: An in vitroexperimental study., Place and Duration of Study: Department of Operative Dentistry and Science of Dental Materials at Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences and Material Engineering Department of NED University of Engineering and Technology, Karachi, from July to December 2014., Methodology: Atotal of 90 enamel slabs from 45 sound human 3rd molar were randomly divided into 3 groups. Each group contained 30 specimens (n=30). Group 1 was kept in artificial saliva at 37°C in incubator during the whole experiment. However, Groups 2 and 3 were treated with power whitening gel and tooth whitening pen respectively. After bleaching session, specimens were thoroughly rinsed with deionized water again for 10 seconds and then stored in artificial saliva at 37°C in incubator. Artificial saliva was changed after every 2 days. The Vickers hardness tester (Wolpert 402 MVD, Germany) was adjusted to a load of 0.1 kg (100 gm) and dwell time of 5 seconds. Three Vickers were performed on each specimen using a hardness tester according to the ISO 6507-3:1998 specification. Micro-hardness measurements were performed before and after bleaching at day 1, 7 and 14., Results: In the control group, the baseline micro-hardness was 181.1 &plusmn;9.3 which was reduced after the storage on day 1, 7 and 14 (p = 0.104). In Group 2, baseline micro-hardness was 180.4 &plusmn;10.1 which was reduced to 179.79 &plusmn;10.0 units after day 1. Whereas, on day 7 and 14, the values of micro-hardness were 179.8 &plusmn;10 and 179.7 &plusmn;10.29, respectively (p=0.091). Furthermore, the baseline micro-hardness in Group 3 was 174.0 &plusmn;22.9 units which was reduced to 173 &plusmn;23 on day 1, 170 &plusmn;30 on day 7 and 173 &plusmn;23 on day 14 (p = 0.256). The statistically insignificant difference was found among micro-hardness values of different bleaching agents (p = 0.118)., Conclusion: Bleaching with 38% Hydrogen Peroxide (HP) and 16% Carbamide Peroxide (CP) resulted in insignificant effect on surface micro-hardness of enamel.

Objective: To evaluate the effect of home-use bleaching agent containing 16% Carbamide Peroxide (CP) and in-office bleaching agent with 38% Hydrogen Peroxide (HP) on surface micro-morphology of enamel., Study Design: An experimental study., Place and Duration of Study: The discs were prepared at Material Engineering Department of NED University of Engineering and Technology, Karachi, and surface morphology was analyzed at Centralized Science Laboratory of Karachi University, Pakistan. Duration of study was one year from January to December 2012., Methodology: Forty five sound human third molar crowns, extracted for periodontal reason, were included in the study. Longitudinal sections were made using diamond disks (0.2 mm) under water lubrication to obtain enamel slabs measuring (3 mm x 3 mm). The slabs were embedded in polystyrene resin by using 2.0 cm diameter PVC molds, leaving the outer enamel surface uncovered by the resin. Ninety dental enamel slabs were prepared. The slabs were then randomly divided into 3 groups. Each group contained thirty specimens (n=30). Group 1 was kept in artificial saliva at 37&deg;C in incubator (Memart, Germany) during whole experiment. Group 2 was treated with power whitening gel (White Smile 2011, Germany). Group 3 was treated with tooth whitening pen (White Smile 2011, Germany). The most central region or the region that was most representative of the entire surface area was used. The SEM (Jeol-Japan-JSM6380A, JAPAN) micrographs were examined to determine the type of surface presented. The enamel changes were classified as no or mild alteration, moderate alteration and severe altered surface., Results: Regarding micro-morphology, the enamel surface of control groups showed smooth surface in general with some scattered clear scratches due to the polishing procedure. The specimens bleached in group 2 and group 3, represented areas of mild erosion., Conclusion: Bleaching with 38% Hydrogen Peroxide (HP) and 16% Carbamide Peroxide (CP) resulted in mild changes in surface micro-morphology of enamel.

This study investigated the effect of two bleaching agents, 16% carbamide peroxide (CP) and 35% hydrogen peroxide (HP), on the mechanical properties and protein content of human enamel from freshly extracted teeth. The protein components of control and treated enamel were extracted and examined on sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE). Marked reduction of the protein matrix and random fragmentation of the enamel proteins after bleaching treatments was found. The mechanical properties were analyzed with Vickers indentations to characterize fracture toughness, and nanoindentation to establish enamel hardness, elastic modulus and creep deformation. Results indicate that the hardness and elastic modulus of enamel were significantly reduced after treatment with CP and HP. After bleaching, the creep deformation at maximum load increased and the recovery upon unloading reduced. Crack lengths of CP and HP treated enamel were increased, while fracture toughness decreased. Additionally, the microstructures of fractured and indented samples were examined with field emission gun scanning electron microscopy (FEG-SEM) showing distinct differences in the fracture surface morphology between pre- and post-bleached enamel. In conclusion, tooth bleaching agents can produce detrimental effects on the mechanical properties of enamel, possibly as a consequence of damaging or denaturing of its protein components., (Copyright © 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.)

This study evaluated the effects of several low-concentration bleaching products on microtensile bond strength (µTBS) to enamel at different elapsed times after the bleaching treatment. One hundred and fifty bovine incisors were divided into five groups: No treatment, 10% carbamide peroxide (Opalescence), 10% hydrogen peroxide (Opalescence Treswhite Supreme), 3% carbamide peroxide plus lactoperoxidase (WhiteKin), or 3% carbamide peroxide plus 2.7% carbamide peroxide (Clysiden Kit Express). All treatments lasted 4 weeks. After bleaching treatment or non-treatment, teeth were restored immediately, at 1, 3, 7, or 14 days after bleaching and submitted to µTBS test. Data were analyzed by ANOVA and Tukey's test (p<0.05). For WhiteKin and Clysiden, µTBS to enamel was significantly reduced immediately, at 1, 3 and 7 days after bleaching. At 14 days after bleaching, similar µTBS values were obtained regardless of bleaching product. Therefore, while over-the-counter (OTC) products might affect bond strength to enamel, this effect was no longer observed after 14 days.

This study evaluated the effect of green tea application time on the bond strength of enamel after enamel bleaching. Enamel samples were obtained from 80 third molars and randomly divided into 7 experimental groups (G1-G7) and 1 group without treatment (G8): G1, bleached with 10% carbamide peroxide (CP); G2, CP + 10% sodium ascorbate gel (SA) for 15 min; G3, CP + SA for 30 min; G4, CP + SA for 60 min; G5, CP + 10% green tea gel (GT) for 15 min; G6, CP + GT for 30 min; G7, CP + GT for 60 min. The CP was applied onto the enamel surface for 8 h for 14 days. The SA was applied in groups 2, 3 and 4, and the GT was applied in groups 5-8 according to the above described application times. Immediately after treatment, the specimens were bonded with Adper Single Bond 2 and Filtek Z350XT. The specimens were prepared to microtensile bond strength analysis. Fracture mode analysis was performed using a stereoscopic loupe. The data were statistically analyzed by two-way analysis of variance, the Tukey's and Dunnett's tests (=5%). The means (standard deviation) were: G1, 23.3 (3.2); G2, 25.2 (3.9); G3, 26.4 (5.4); G4, 30.2 (4.5); G5, 26.6 (3.4); G6, 22.0 (5.4); G7, 31.4 (3.3); G8, 31.4 (3.2). All groups had a high percentage of adhesive failures. In conclusion, the bond strength values were higher than the value in the bleached group only when the antioxidants were applied for 60 min.

Background and Objective: Carbamide peroxide bleaching has been implicated in adversely affecting the bond strength of composite to enamel. The objective of this in vitro study was to evaluate the effect of ethanol-based (Clearfil S 3 bond, Kuraray, Adper Single bond 2, 3M ESPE dental products) and acetone-based (Prime and Bond NT, Dentsply, One Step, Bisco) bonding agents on the shear bond strength of composite to enamel treated with 10% carbamide peroxide bleaching agent., Materials and Methods: A total of 120 extracted human noncarious permanent incisors were randomly divided into two groups (control and experimental). Experimental group specimens were subjected to a bleaching regimen with a 10% carbamide peroxide bleaching system (Opalescence; Ultradent Products Inc, South Jordan, USA). Composite resin cylinders were bonded to the specimens using four bonding agents and shear bond strength was determined with universal testing machine., Results: There was no statistically significant difference in the shear bond strength between control and experimental groups with both ethanol-based (Clearfil S 3 Bond and Adper Single Bond 2) and acetone-based bonding agent (Prime and Bond NT and One Step)., Interpretation and Conclusion: The adverse effect of bleaching on bonding composite to enamel can be reduced or eliminated by using either ethanol- or acetone-based bonding agent. Clinical Significances: Immediate bonding following bleaching procedure can be done using ethanol- or acetone-based bonding agent without compromising bond strength.

Aim: The aim of this study was to investigate the Influence of simulated pulpal pressure on efficacy of bleaching gels., Materials and Methods: Cylindrical enamel-dentin specimens from bovine teeth (3 mm diameter, enamel and dentin layer each 1 mm thick) were divided into 4 groups, according to the bleaching treatment: negative control (non-bleached), bleached with 10% carbamide peroxide (CP), bleached with 7.5% hydrogen peroxide (HP) and bleached with 35% hydrogen peroxide. Ten percent CP gel was applied for 8 h/day and 7.5% HP for 1 h/day, during 14 days. For 35% HP treatment, two sessions of 45 minutes each were employed. In intermediate periods specimens were stored in artificial saliva. Experimental groups (n = 19) were subdivided according to the simulation of pulpal pressure (25 mm Hg) during bleaching treatment. Initial color measurement and after bleaching treatment were assessed by spectrophotometry, using CIE L*a*b* system. The data were statistically analyzed by ANOVA and Dunnett's post-hoc tests (p < 0.05)., Results: There was significant difference of ΔE for all experimental groups compared to negative control group, according to Dunnett's test (p < 0.0001). There were no significant difference for total color variation (ΔE) among experimental groups (p > 0.05)., Conclusion: It was concluded that all bleaching gels showed bleaching efficacy compared to non-bleached group and that the simulated pulpal pressure did not Influence the bleaching outcomes of the tested gels., Clinical Significance: Although numerous in vitro studies investigating the efficacy of bleaching agents have been performed, they do not properly simulate the pulpal pressure. In order to make these studies closer to clinical conditions, it is important to reproduce these conditions in laboratory, so the results can be more reliable. This in vitro study was performed under simulated pulpal pressure, aiming to investigate its Influence on dental bleaching outcomes.

Objectives: This study aimed to compare the effects of two 10% carbamide peroxide (CP) agents with or without desensitizers on tooth sensitivity, colour and enamel morphological changes., Methods: Twenty subjects used a 10% carbamide peroxide gel with or without fluoride and potassium nitrate for 2 weeks. Sensitivity, spectrophotometric evaluation of colour and morphological analyses of replicas with scanning electron microscope (SEM) were performed before and after treatment. All data were analysed statistically., Results: Both bleaching agents induced sensitivity; however, the 10% CP bleaching agent with fluoride and potassium nitrate produced significantly lower sensitivity (P < 0.05) than the bleaching product without desensitizing agents. In spectrophotometric evaluation, no difference in bleaching effectiveness was found between the tested bleaching gels, and the SEM analysis confirmed the absence of relevant alterations of the enamel surface in both groups., Conclusion: The use of 10% carbamide peroxide gel with fluoride and potassium nitrate reduced the incidence of sensitivity during the bleaching treatment compared to a bleaching agent that did not contain desensitizing agents. The bleaching effectiveness of the tested products was comparable., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To evaluate the effects of experimental protocols on bleaching effectiveness and hydrogen peroxide (HP) diffusion through enamel and dentine., Methods: Enamel/dentine discs were subjected to six bleaching sessions, consisting of 1 or 3 applications of 17.5% or 35%-HP gel for 5/15min, or 37% carbamide peroxide (CP) gel for 10/20min. Discs undergoing the regular protocol (35%-HP; 3×15min) constituted the positive control group. Colour change (ΔE) was assessed (CIE L*a*b* system) after each session. HP diffusion was quantified (sessions 1, 3, and 6) in enamel/dentine discs adapted to artificial pulp chambers. Data were analysed by Pillai's Trace and Bonferroni test, or by one-way ANOVA and SNK/Tamhane's test (α=5%)., Results: All tooth-bleaching protocols significantly increased the ΔE values. A reduction in HP diffusion and no significant difference in ΔE compared with the positive control were observed for the following bleaching protocols: 17.5%-HP 3×15min, at the 4th session; and 35%-HP 1×15 and 3×5min, at the 5th session. HP diffusion in the 37%-CP 3×20min bleaching protocol was statistically similar to that in the positive control. The other experimental bleaching protocols significantly decreased HP diffusion through enamel/dentine discs, but the ΔE values were statistically lower than those observed in the positive control, in all sessions., Conclusion: Shortening the contact time of a 35%-HP gel or reducing its concentration produces gradual tooth colour change and reduced HP diffusion through enamel and dentine., Clinical Significance: A reduction in HP concentration, from 35% to 17.5%, in a bleaching gel or shortening its application time on enamel provides a significant tooth-bleaching improvement associated with decreased HP diffusion across hard dental tissues. Therefore, these protocols may be an interesting alternative to be tested in the clinical situation., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Purpose: To analyze the efficacy of Colgate Plax Whitening mouthwash containing 1.5% hydrogen peroxide., Methods: 30 enamel fragments, obtained from the proximal surfaces of human third molars were darkened with Orange II methyl orange. The fragments were divided into three groups according to the type of bleaching agent applied (n = 10): (1) 10% carbamide peroxide gel (positive control, PC) was applied for 2 hours/day for 28 days; (2) a solution containing 1.5% hydrogen peroxide (Plax) was applied for 4 minutes once a day for 28 days, and (3) no bleaching agent, kept in artificial saliva (negative control, AS). The specimens were kept in artificial saliva between treatment intervals. The specimens were photographed before darkening (baseline), after darkening and before lightening and on the 28th day of whitening. Afterwards, they were analyzed with color measurement software using the CIELab system. The data for the L*, a* and b* parameters were submitted to two-way ANOVA with repeated measures. The values of deltaL *, deltaa *, deltab * and deltaE* were calculated using two procedures: (1) darkened versus original, and (2) bleached versus darkened. This data was submitted to the one-way ANOVA test. Multiple comparisons were conducted using the Tukey test (alpha = 0.05)., Results: When the specimens were subjected to bleaching agents, there was a significant increase in the brightness (L* parameter) of the enamel exposed to the gel and also to the bleaching solution. However, higher brightness was observed for the PC (gel) group. As for the axis a* parameters, there were no significant differences between the bleaching products. Regarding the axis b* parameters, the PC group underwent major changes (indicating a color change toward blue chroma), statistically greater than those of the Plax group. After bleaching, there was a significantly greater color change (deltaE*) in the PC group. Although the Plax solution caused a color change, it was less than that produced by the gel. The slightest color change was observed in the control group, in which no bleach was used. The mouthwash containing hydrogen peroxide was able to lighten the darkened human enamel, but to a lesser degree than the lightening produced by 10% carbamide peroxide.

Pigments of food and beverages could affect dental bleaching efficacy. The aim of this investigation was to evaluate color change and mineral loss of tooth enamel as well as the influence of staining solutions normally used by adolescent patients undergoing home bleaching. Initial hardness and baseline color were measured on enamel blocks. Specimens were divided into five groups (n=5): G1 (control) specimens were kept in artificial saliva throughout the experiment (3 weeks); G2 enamel was exposed to 10% carbamide peroxide for 6 h daily, and after this period, the teeth were cleaned and stored in artificial saliva until the next bleaching session; and G3, G4, and G5 received the same treatments as G2, but after bleaching, they were stored for 1 h in cola soft drink, melted chocolate, or red wine, respectively. Mineral loss was obtained by the percentage of hardness reduction, and color change was determined by the difference between the data obtained before and after treatments. Data were subjected to analysis of variance and Fisher's test (α=0.05). G3 and G5 showed higher mineral loss (92.96 ± 5.50 and 94.46 ± 1.00, respectively) compared to the other groups (p ≤ 0.05). G5 showed high-color change (9.34 ± 2.90), whereas G1 presented lower color change (2.22 ± 0.44) (p ≤ 0.05). Acidic drinks cause mineral loss of the enamel, which could modify the surface and reduce staining resistance after bleaching.

The aim of this study was to compare the effect of a 16% carbamide peroxide (CP) gel and a 10% CP gel on mineralized enamel content and morphology. Enamel blocks from bovine incisors were subjected to a 14-day treatment (8 h/day) with 10% or 16% CP gels. Knoop microhardness was evaluated before bleaching and at 1, 7 or 14 days after this treatment (50 g/15 s). Mineral content (energy-dispersive x-ray spectroscopy), surface roughness and topography (atomic force microscopy) were evaluated at the 14-day period. Data were analyzed statistically by two-way ANOVA and Tukey's test (α=0.05). Significant microhardness reduction was observed at the 7 th and 14 th days for 10% CP gel, and for all bleaching times for 16% CP gel (p<0.05). At the 14-day period, a significant decrease in Ca and P content, increase on surface roughness (p<0.05) as well as on picks and valleys distance were observed when both bleaching gels were used. These enamel alterations were more intense for 16% CP gel. It was concluded that both CP-based gels promoted loss of mineral structure from enamel, resulting in a rough and porous surface. However, 16% CP gel caused the most intense adverse effects on enamel.

Aim: The goal of this study was to fnd a method to eliminate bond strength reduction after vital bleaching., Materials and Methods: Sixty fat surfaces of enamel central human incisors were prepared by diamond disks. In the frst group, the samples immediately bonded to the tooth after bleaching. For the second group, the bleached samples were treated by sodium ascorbate for 1 hours. In the third and fourth groups the treatment was down using a new antioxidant agent for 1 hour and 15 minutes respectively. For the ffth group no bleaching was done. Cylindrical composite resin (Z 100) with a Single Bond adhesive system was bonded to the enamel with a special metal mold. After thermocycling, the samples were loaded at a crosshead speed of 0.5 mm/min. The mode of failures was inspected by the Dino Lite microscope and the microstructure of the debonding surfaces was observed by SEM. Considering normal data, statistical analysis was conducted by ANOVA and Tukey tests (p = 0.05)., Results: The fourth group had maximum (21.82), while the frst group had the least (9.0971) shear bond strength. The ANOVA test showed a signifcant difference among the fve groups (p = 0.0002). There was not any signifcant statistical difference between the three types of debonding (p = 0.165)., Conclusion: The usage of sodium ascorbate or sodium ascorbate with detergent after vital bleaching are effective methods for reducing the damaging effects of bleaching agents on the shear bond strength of composite resin restoration to enamel. CLINICAL SIGNIFCANCE: Using antioxidants is necessary post bleaching and before resin bonding.

The objective of this study was to evaluate the antioxidant effect of green tea on microtensile bond strength (μTBS) to bleached enamel. Forty-two human third molars were randomly divided into six experimental groups (n = 7 each group): group 1, no treatment; group 2, bleaching (10% carbamide peroxide); group 3, bleaching + 10% sodium ascorbate gel (SA); group 4, bleaching + 10% green tea gel (GT); group 5, SA; and group 6, GT. In groups 2, 3, and 4, bleach was applied onto the enamel surface for 6 h, every day for 14 d. In groups 3 and 5, SA was applied for 1 h; and in groups 4 and 6, GT was applied for 1 h. Immediately after treatment, the specimens were bonded with Adper Single Bond 2 and Filtek Z350 XT. The μTBS of the specimens was tested using a universal testing machine. Fracture mode analysis of the bonded enamel surface was performed using scanning electron microscopy. The mean μTBS values for each group were: group 1, 33.2 ± 5.8 MPa; group 2, 22.6 ± 5.5 MPa; group 3, 30.0 ± 5.2 MPa; group 4, 31.6 ± 3.8 MPa; group 5, 29.1 ± 4.2 MPa; and group 6, 32.2 ± 4.5 MPa. All groups had a higher percentage of mixed failures. In conclusion, green tea can be used as an alternative antioxidant on bleached enamel before bonding procedures., (© 2013 Eur J Oral Sci.)

This study investigated the effect of peroxide bleaching gel on the durability of the adhesive bond between composite material, enamel, and dentin created with the etch-and-rinse adhesive Gluma Comfort Bond (GLU) and with the self-etch adhesives Clearfil SE Bond (CLE), Adper Prompt (ADP), and iBond (IBO). The adhesives were applied to flattened enamel and dentin of extracted human molars and built up with a microhybrid composite (Charisma). After 25 eight-hour cycles of bleaching with a 20% carbamide peroxide bleaching gel (Opalescence PF 20), the shear bond strength was measured and compared with one-day and two-month control specimens stored in water. The data were analyzed using nonparametric Mann-Whitney and Kruskal-Wallis statistics (p<0.05). Detailed fractographic analysis was performed using scanning electron microscopy. The bleaching gel significantly decreased the bond strength on both enamel and dentin for the simplified single-step self-etch adhesives ADP and IBO and markedly affected a fracture pattern of ADP specimens at the periphery of their bonded area. The results of our study indicate that the durability of adhesive restorations can be detrimentally influenced by carbamide peroxide bleaching and that different adhesives show varying sensitivity levels to the bleaching gel.

Background: The resistance of bleached enamel to demineralization has not been elucidated fully. In this study, the authors aimed to examine the level of in vitro demineralization of human tooth enamel after bleaching by using two common bleaching regimens: home bleaching (HB) and office bleaching (OB) with photoirradiation., Methods: The authors bleached teeth to equivalent levels by means of the two bleaching regimens. They used fluorescence spectroscopy to measure the reduction in enamel density and the release of calcium into solution after storing the treated teeth in a demineralizing solution for two weeks. They also visualized and quantified mineral distribution in demineralized bleached enamel over time by using a desktop microcomputed-tomographic analyzer., Results: Enamel subjected to HB or to photoirradiation without bleaching showed increased demineralization. In contrast, enamel treated with OB was more resistant to demineralization. This resistance to demineralization in teeth treated with OB presumably is due to peroxide's permeating to deeper layers of enamel before being activated by photoirradiation, which enhances mineralization., Conclusions: The mineral distribution pattern of enamel after treatment plays a critical role in providing resistance to demineralization in whitened teeth., Practical Implications: OB confers to enamel significant resistance to in vitro demineralization. Dentists should supervise the nightguard HB process.

The objective of this study was to evaluate the color, translucency and fluorescence of bovine enamel and dentin submitted to different bleaching modalities. Pairs of enamel and dentin discs (3 mm in diameter) were obtained from 150 bovine teeth. In 75 of the pairs, one specimen had the enamel removed (Dentin Group). The dentin was removed from one specimen of the remaining 75 pairs (Enamel Group) and the other specimen was left unaltered (Enamel + Dentin). The evaluation of color, translucency and fluorescence was performed with a spectrophotometer using the CIE L* a* b*. Each group was subdivided into three subgroups: Control, composed of specimens that were not bleached, and two experimental subgroups, bleached with either 10% carbamide peroxide (CP10%) or 35% hydrogen peroxide (HP35%). The CP10% bleaching gel was applied 2 h/day for 14 days. The HP35% bleaching agent was applied using two applications of 30 min each, with a one week interval between each application. When not being bleached, the specimens were immersed in artificial saliva. The color, translucency and fluorescence ratings were assessed using spectrophotometry 7 days after the treatment. Regarding color, significant differences were found between bleaching techniques in the groups Enamel and Enamel + Dentin, with a higher color difference for HP35%. Bleaching did not change the translucency of the dental tissues. There were significant differences for fluorescence for the HP35% subgroups of Dentin and Enamel + Dentin, and for the CP10% subgroup of Enamel. Dental bleaching changed the color and fluorescence of the dental tissues, however translucency was not affected.

Objective: The aim of this laboratory study was to investigate the effect of three commercial bleaching agents and Tooth Mousse(™) containing 10% w/w casein phosphopeptide-amorphous calcium phosphate on the hardness of tooth enamel., Methods: Sixteen human enamel specimens were exposed to one of three commercial bleaching agents with or without subsequent exposure to Tooth Mousse(™) . Nanoindentation was used to measure the hardness and reduced modulus before and after treatments., Results: When bleaching materials were applied for a short period of time following the manufacturers' instructions, there was an increase in enamel hardness and reduced modulus for some bleaching groups, with no statistically significant difference from the baseline values. After extended bleaching periods a statistically significant decrease in enamel hardness and reduced modulus was found and after applying Tooth Mousse(™) post-bleaching, the hardness and reduced modulus returned to close to baseline values., Conclusion: The application of bleaching agents for an extended period of time significantly decreases enamel hardness and the reduced modulus. The application of Tooth Mousse(™) after bleaching was able to reestablish the baseline enamel hardness and reduced modulus, decreasing the adverse effects of bleaching enamel., (© 2012 Wiley Publishing Asia Pty Ltd.)

This study aimed to evaluate the effect of toothbrushing on enamel surface roughness at three different intervals after daily bleaching treatment. Eighty enamel slabs were initially evaluated for surface roughness and then randomly divided into four groups. The bleaching procedure was carried out for 21 days, six hours daily. In the control group (group 1), the specimens were not brushed after bleaching, but in groups 2-4, they were brushed with toothpaste immediately, one hour, or two hours after bleaching, respectively. Then the specimens were stored in artificial saliva. Enamel surface roughness was reevaluated at the end of the period. Kruskal-Wallis and Mann-Whitney U tests showed statistically significant differences in the means of surface roughness values between the immediately brushed group and the three other groups (p<0.001). Daily toothbrushing immediately after bleaching increased enamel surface roughness; however, postponing the procedure for one or two hours after daily bleaching and exposing the specimens to artificial saliva during the study period resulted in enamel surface roughness comparable to that of the control group.

The aim of this study was to evaluate the possibility of fluoride solutions applied to enamel to protect pulp cells against the trans-enamel and transdentinal cytotoxicity of a 16% carbamide peroxide (CP) bleaching gel. The CP gel was applied to enamel/dentin discs adapted to aicial pulp chambers (8 h/day) during 1, 7 or 14 days, followed by fluoride (0.05% or 0.2%) application for 1 min. The extracts (culture medium in contact with dentin) were applied to MDPC-23 cells for 1 h, and cell metabolism (MTT assay), alkaline phosphatase (ALP) activity and cell membrane damage (flow cytometry) were analyzed. Knoop microhardness of enamel was also evaluated. Data were analyzed statistically by ANOVA and Kruskal-Wallis tests (α=0.05). For the MTT assay and ALP activity, significant reductions between the control and the bleached groups were observed (p<0.05). No statistically significant difference occurred among bleached groups (p>0.05), regardless of fluoride application or treatment days. Flow cytometry analysis demonstrated 30% of cell membrane damage in all bleached groups. After 14 days of treatment, the fluoride-treated enamel presented significantly higher microhardness values than the bleached-only group (p<0.05). It was concluded that, regardless of the increase in enamel hardness due to the application of fluoride solutions, the treated enamel surface did not prevent the toxic effects caused by the 16% CP gel to odontoblast-like cells.

Unlabelled: The purpose of the study was to compare two different commercial bleaching agents, Opalescence with Colgate Platinum, and 30% phosphoric acid used as aggressive agent on the morphology of human enamel., Materials and Methods: Ten freshly extracted, noncarious, human maxillary central incisors extracted for periodontal reasons were used in this study. The labial surface of the disinfected teeth were polished using a polishing paste with the help of rubber cup and a slow speed handpiece. Each tooth was sectioned at cement-enamel junction and the crown was separated into four specimens, all taken from labial surface. Group 1 was treated with Colgate Platinum for 7 hours, group 2 with Opalescence for 7 hours, group 3 was treated with 30% phosphoric acid for 30 seconds and group 4 was untreated and used as control. After the treatment period, the specimens were washed with normal saline and stored in sterile bottle and sealed. Photomicrographs obtained from the scanning electron microscopy (SEM) after surface treatments were examined for no alteration, slight alteration, moderate alteration and severe alterations., Results: The specimens treated with commercial bleaching agents revealed no enamel surface morphologic alterations compared to control group. The specimen treated with phosphoric acid showed severe alterations., Conclusion: Ten percent carbamide peroxide evaluated in this study does not etch tooth enamel or alter enamel surface morphology as do conventional etching techniques., Clinical Relevance: Carbamine peroxide is a safe and effective tooth whitening agent even when used for extended period of time. The enamel surface remains smooth which reduces caries due to plaque collection.

This study evaluated the influence of fluoride-containing carbamide peroxide (CP) bleaching agents and adhesive systems on bonded enamel interfaces that are part of the dynamic pH cycling and thermal cycling models. The buccal surfaces of 60 bovine incisors were restored with a composite resin and bonded with three- and two-step, etch-and-rinse, fluoride-containing adhesives, Optibond FL (FL) and Optibond Solo Plus (SP), respectively. Restored teeth were subjected to thermal cycling to age the interface. Both SP and FL adhesive-restored teeth were bleached (n = 10) with 10% CP (CP) and 10% CP + fluoride (CPF) or were left unbleached (control). Bleaching was performed for 14 days simultaneously with pH cycling, which comprised of 14 h of remineralization, 2 h of demineralization and 8 h of bleaching. The control groups (FL and SP) were stored in remineralizing solution during their bleaching periods and were also subjected to carious lesion formation. Parallelepiped-shaped samples were obtained from the bonded interface for microtensile bond strength (μTBS) testing. The enamel μTBS of the FL and SP groups (control, not bleached) were higher (p < 0.05) than those of the bleached interfaces (FL > FL + CPF = FL + CP and SP > SP + CPF = SP + CP). The groups subjected to treatment with the fluoride-containing bleaching agents exhibited similar μTBS compared to regular bleaching agents. Bleaching agents, regardless of whether they contained fluoride, decreased enamel bond strength.

Aim: The aim of this in vitro study was to evaluate the surface roughness and hardness of both unbleached and bleached (opalescence; 10% carbamide peroxide) human enamel brushed with water (without dentifrice), fluoride abrasive dentifrice (Colgate Total) and whitening dentifrice (Natural White)., Materials and Methods: Human enamel samples were obtained from third molars and randomly divided into five groups (n = 8): G1 - Control (brushed with water without dentifrice), G2 - Colgate Total (fluoride abrasive dentifrice), G3 - Natural White (whitening dentifrice), G4 - Opalescence (10% carbamide peroxide) and then brushed with Colgate Total, G5 - Opalescence (10% carbamide peroxide) and then brushed with Natural White. Bleaching regimen was applied according to manufacturers' instructions. The brushing process was performed with a modified Nyffenegger's brushing machine. Surface roughness was analyzed with a profilometer. Microhardness testing was performed with a Brinell hardness tester., Results: Results were statistically analyzed by Kruskal-Wallis, one-way ANOVA analysis and Mann-Whitney U, Wilcoxon matched-pairs signed-ranks tests. There were significant differences in surface roughness values for all groups, which showed an increase in roughness (p < 0.05). When the bleaching treatment combined with brushing with whitening dentifrice was performed (G5), there was a significant decrease in hardness values (p < 0.05). The other groups (G1, G2, G3, G4) showed no significant hardness differences (p > 0.05)., Conclusion: It was concluded that toothbrushing procedures increased the enamel surface roughness, and that bleaching regimen performed with cleaning treatment, through brushing with whitening dentifrice decreased hardness values., Clinical Significance: When applied together, bleaching and cleaning treatments may alter the enamel surface roughness and hardness values.

Purpose: To compare shear bond strengths of three different self-etching adhesive systems of different pH values to enamel bleached with carbamide peroxide, treated with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), or treated with CPP-ACP subsequent to bleaching with carbamide peroxide., Materials and Methods: Thirty-six human third molars were cut into 4 sections and randomly assigned to 4 groups (n = 36): group I: no treatment; group II: bleaching; group III: CPP-ACP; group IV: bleaching and CPP-ACP. After surface treatments, the samples of each group were further divided into three subgroups (n = 12) based on the adhesive used. The adhesives Clearfil SE Bond (CSE), AdhesE (ADE), and Adper SE Plus (ADP) were applied, and resin composite cylinders with a diameter of 2 mm and a height of 4 mm were bonded to the enamel. Then the specimens were subjected to shear bond strength testing. Two-way ANOVA and a post-hoc Tukey's test were used for statistical analysis (α = 0.05)., Results: There were significant differences between the adhesive systems (p < 0.001) and surface treatments (p < 0.001), but no significant interactions were observed between these variables (p = 0.78). The CSE adhesive system showed the highest bond strength, and the bleaching procedure reduced bond strengths (p = 0.001). Furthermore, there were no significant differences in shear bond strength values between the control and CPP groups. However, the differences between other groups were statistically significant (p < 0.05)., Conclusion: Bleaching reduced shear bond strength to enamel, but CPP-ACP application did not affect the bond strength to intact and previously bleached enamel. The bond strength of adhesives with different pH values to enamel was material dependent.

Objectives: The aim of this in vitro study was to investigate the efficacy of in-office bleaching technique combined with the application of a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) paste (MI Paste-MI) at different moments and its influence on enamel surface properties., Methods: Eighty bovine dental crowns were randomly allocated into eight groups (n = 10), and bleached with either 35% hydrogen peroxide (HP) or 37% carbamide peroxide (CP). Four different protocols of application of MI were considered: without MI, MI applied before bleaching, MI applied after bleaching, and MI applied both before and after bleaching. Bleaching effectiveness was measured by the VITA EasyShade spectrophotometer utilizing the CIEL*a*b* system (ΔE, ΔL*, Δa*, and Δb*). Color readings were measured at baseline, 7, 14, and 21 days. Hardness and roughness were measured at baseline (T0) and immediately after bleaching (T14). Data were subjected to the two-way ANOVA for repeated measurements and Tukey's test at 5%., Results: HP groups achieved the greatest color change. The application of a CPP-ACP paste did not reduce the efficacy of bleaching peroxides. Samples bleached with CP showed decreased hardness at T14. Samples bleached with HP that received the application of MI before and before/after bleaching did not present hardness decrease at T14. Samples bleached with peroxides only and received MI after bleaching showed increased roughness at T14., Conclusions: The use of CPP-ACP was able to prevent negative changes in roughness and hardness of bovine enamel when associated to hydrogen peroxide, and might be applied before/after the bleaching protocol., (Copyright © 2012 Wiley Periodicals, Inc.)

Objectives: To evaluate the influence of tooth bleaching on the opalescence properties of enamel., Methods: Color of 38 specimens was determined by colorimetric analysis before and after bleaching in the reflectance and transmittance modes. The results were described as CIELab color coordinates. The Opalescent Parameter (OP) was calculated as the difference in yellow-blue color coordinate (CIE Δb*) and red-green color coordinate (CIE Δa*) between the reflected and transmitted colors., Results: Mean OP value of the specimens was 18.9 (±1.6) before bleaching and 16.1 (±1.0) after bleaching., Conclusions: Bleaching decreases the OP of the specimens (p>0.001). OP decrease was correlated with differences in b* color coordinate in the transmittance mode., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: This study evaluated the impact of bleaching teeth using blends of a CPP-ACP paste (MI Paste; MI) and carbamide/hydrogen peroxides in different proportions on surface properties of bleached enamel., Methods: Ninety bovine incisors were bleached with 7.5% hydrogen peroxide (HP), 16% carbamide peroxide (CP), MI and blends of HP or CP:MI at three proportions (1:1, 2:1, 1:2). Hardness and roughness were measured at baseline and after bleaching. Enamel morphology was evaluated by Scanning Electron Microscopy (SEM). The data were analyzed by two-way ANOVA for repeated measurements and Tukey's test., Results: Most of the samples bleached with MI in combination with peroxides presented increased hardness and roughness which were associated to mineral deposition, as observed by SEM images. Blends with higher fractions of MI did not offer superior benefits., Conclusions: The use of a CPP-ACP paste mixed to carbamide/hydrogen peroxides can decrease adverse side-effects from tooth bleaching on an enamel surface.

Background: Because the effects of dental bleaching on enamel needs to be clarified in vivo, the authors conducted a study to determine calcium and phosphorus concentrations in enamel after the application of different bleaching treatments., Methods: The authors applied four agents (10 percent and 20 percent carbamide peroxide [both recommended for home use], 38 percent and 35 percent hydrogen peroxide [both applied in the dental office]) to the enamel of 80 participants, who were divided into four groups of 20. The authors collected enamel microbiopsy specimens from incisors before (baseline), during (seven, 14 and 21 days) and after (seven and 14 days) the bleaching treatments. They analyzed calcium and phosphorus concentrations by using a spectrophotometer., Results: The authors analyzed data by using the Friedman test and the Kruskal-Wallis test, followed by the Dunn test (α= .05). There were no statistical differences between the evaluation results, regardless of which bleaching gel was used, for determining the concentration of either calcium or phosphorus., Conclusions: Home-use and in-office bleaching gels did not alter the concentrations of calcium and phosphorus concentrations on the enamel surface in vivo., Clinical Implications: In vivo, different dental bleaching techniques did not alter the inorganic composition of enamel.

Objective: To investigate the effects of three differently concentrated at-home bleaching agents on the structure and the structure-related mechanical properties of human enamel., Methods: Sixty enamel specimens were randomly divided into four groups and treated with 10% carbamide peroxide (CP), 15% CP, 20% CP and distilled water, respectively. The bleaching process was 8 h/day for 14 consecutive days. Baseline and final atomic force microscopy (AFM) surface detection, Raman spectroscopy, attenuated total reflectance-infrared spectroscopy (ATR-IR), microhardness and fracture toughness (FT) measurements were carried out before and after bleaching experiments., Results: CP didn't change the morphology of enamel. Meanwhile, the three bleached groups and the control group had no significant difference in root mean square detection (P = 0.774), ν(2)CO(3)(2-) : ν(1)ν(3)PO(4)(3-) (P = 0.263) and microhardness (P = 0.829). The percentage of relative Raman intensity in the three bleached groups and the control group were (105.74 ± 11.34)%, (104.46 ± 8.83)%, (99.52 ± 9.32)% and (97.62 ± 7.46)%, respectively. There was no significant difference among them (P = 0.062). However, the percentage of laser-induced fluorescence in the three bleached groups and the control group were (20.86 ± 7.23)%, (22.14 ± 7.34)%, (21.10 ± 7.59)% and (100.78 ± 3.70)%, respectively. There was significant difference between either of the bleached groups and the control group (P < 0.001). Moreover, FT declined significantly in the three groups (P = 0.024, P = 0.005, P = 0.013) when compared with the control group., Conclusions: Under in vitro condition, three differently concentrated at-home bleaching agents wouldn't induce the demineralization and the decline of microhardness on enamel. However, the decrease of FT on enamel seemed to be inevitable after bleaching.

Objective: The purpose of this study was to evaluate, using scanning electron microscopy (SEM), the morphological and structural changes of the enamel induced by three bleaching agents namely old McInnes solution, modified McInnes solution and 10% carbamide peroxide gel at different time intervals., Materials and Methods: Fifteen freshly extracted noncarious human central incisors with intact enamel surface were selected. The teeth were sectioned at the cementoenamel junction separating the crown portion from the root using a diamond separating disk. Following this, the samples were subjected to three different bleaching agents: Group 1: Old McInnes solution, group 2: modified McInnes solution and group 3: 10% carbamide peroxide for a period of 15, 30 and 60 minutes, 24 and 30 hours time interval. The sample stubs were subjected to scanning electron microscope and were photographed at 2000 and 10,000 magnifications., Conclusion: The present study revealed no indication of either etching or significant change in surface morphology of enamel when evaluated under scanning electron microscope after 6 weeks treatment with various bleaching agents., Clinical Significance: Morphological alterations in bleached enamel are both concentration and time dependent.

The aim of this study was to evaluate the effects of bleaching and delayed bonding on the shear bond strengths of metal and ceramic brackets bonded with light and chemically cure composite resin to human enamel. One hundred and twenty extracted human premolar teeth were randomly divided into three groups of 40 each. The first two groups were bleached with 20 per cent carbamide peroxide (CP) at-home bleaching agent. No bleaching procedures were applied to the third group and served as control. The first two and control groups were divided into equal subgroups according to different adhesive-bracket combinations. Specimens in group 1 (n = 40) were bonded 24 hours after bleaching process was completed while the specimens in group 2 (n = 40) were bonded 14 days after. The specimens in all groups were debonded with a Universal testing machine while the modified adhesive remnant index was used to evaluate fracture properties. No statistically significant differences were found between the shear bond strengths of metal and ceramic brackets bonded to bleached enamel after 24 hours, 14 days, and unbleached enamel with light or chemical cure adhesives (P > 0.05). The mode of failure was mostly at the bracket/adhesive interface and cohesive failures within the resin were also observed. Our findings indicated that at-home bleaching agents that contain 20 per cent CP did not significantly affect the shear bond strength of metal and ceramic orthodontic brackets to enamel when bonding is performed 24 hours or 14 days after bleaching.

The safety of at-home tooth bleaching, based upon carbamide peroxide (CP) or hydrogen peroxide (HP) as the active agent, has been questioned. The aim of the present study was to investigate the effects of three differently concentrated home-applied bleaching agents on human enamel under in situ conditions. Sixty specimens were divided randomly into four groups and treated with 10% CP, 15% CP, 20% CP, and distilled water, respectively. Raman spectroscopy, attenuated total reflectance-infrared (ATR-IR) spectroscopy, atomic force microscopy (AFM), microhardness, and fracture toughness (FT) measurements were conducted to determine variations on enamel structure and mechanical properties before and after the bleaching process. Raman revealed little variation of Raman relative intensity after treatment with CP, which was consistent with the results of ATR-IR, AFM, and microhardness analyses. In addition, laser-induced fluorescence (LIF) intensity, and FT showed significant decreases on CP-treated specimens. These findings suggested there were minimal demineralization effects of the three at-home bleaching agents on enamel in situ. However, the decrease of LIF intensity and FT on enamel seemed to be inevitable., (© 2012 Society of Photo-Optical Instrumentation Engineers (SPIE).)

Purpose: This study analyzed the influence of 10% sodium ascorbate (SA) on tag formation in bleached enamel., Materials and Methods: Five groups were tested: G1 - control; G2 - bleaching with 10% carbamide peroxide (CP) + restoration; G3 - CP + SA + restoration; G4 - bleaching with 35% hydrogen peroxide (HP) + restoration; and G5 - HP + SA + restoration. The teeth were sectioned and decalcified, and the resin tags were analyzed at 400X magnification using an optical light microscope and Axiovision software., Results: The resin tag lengths in µm for each group were as follows: G1 - 36.1A; G2 - 5.8C; G3 - 14.4B; G4 - 1.7D; G5 - 6.5C. Different letters indicate statistically significant differences., Conclusion: Tooth bleaching with CP or HP impairs the formation of resin tags, and the utilization of sodium ascorbate increases tags length.

The aim of this study was to assess in vitro the surface roughness (Ra) of human enamel exposed or not exposed to the action of a bleaching agent containing 10% carbamide peroxide (CP) after brushing with different dentifrices. Ninety-six human enamel specimens were divided into 2 groups: GI--exposed to the action of 10% CP; GII--not exposed. These were subdivided into 4 brushing subgroups: (CEW) Close-Up Extra Whitening, (CUB) Colgate Ultra Branco, (CCP) Crest Cavity Protection and (DW) Deionized Water. The specimens from Group GI were exposed to 10% CP for 6 hours/14 days and those from Group GII were stored in artificial saliva for 14 days. Then they were submitted to 35.600 brushing cycles. Ra was measured before and after brushing. Ra difference was compared by two-way ANOVA. Ra was compared between subgroups using ANOVA and Tukey's test. Ra was compared between groups using T-test (alpha = 0.05). Final and initial Ra were compared by Paired t-test; using SPSS (15.0). Two-way ANOVA difference in the outcome revealed that the use of bleaching agent did not affect the difference in Ra (p = 0.45). Brushing significantly influenced the difference in Ra (p < 0.001), but the interaction between the two factors was not significant (p = 0.20). Among the brushing subgroups, a significant increase in Ra was observed for Subgroup CEW--GI: Rai 0.691 (0.112)a, Raf 0.993 (0.264)a; Raf-Rai: 0.303a (43. 7%)--G2: Rai 0.794 (0.167)a, Raf 1.006 (0.488)a; Raf-Rai: 0.212a (26.7%) with a statistical difference for Subgroup CUB--GI: Rai 0.639 (0.163)a, Raf 0.506 (0.113)b; Raf-Rai: -0.133b (-20.8%)--GII: Rai 0.647(0.166)a, Raf 0.472b (0.260); Raf-Rai: -0.134b (-0.27%). Regardless of whether or not the enamel had been exposed to 10% CP, Ra values varied according to the abrasives in the composition of the different dentifrices.

Changes in enamel surface microhardness as a result of bleaching with carbamide peroxide in various in vitro conditions have been reported. The present study evaluated the effect of oral hygiene procedures on enamel microhardness at three time intervals following bleaching with 15% carbamide peroxide. Although this was an in vitro study, the purpose was to address whether or not a patient's toothbrushing following at-home bleaching might affect surface changes in tooth enamel. Eighty enamel slabs were prepared from impacted human third molars that had been extracted surgically. Subsequent to placing the specimens in acrylic resin, their surfaces were smoothed, and they were randomly divided into four equal groups. The specimens were initially evaluated for microhardness by Vickers test. The bleaching procedure was carried out for 21 days for 6 hours daily. In each group, the surfaces of specimens were brushed with toothpaste immediately, 1 hour, and 2 hours after bleaching except for the control group. The specimens were stored in artificial saliva. Enamel microhardness was again measured at the end of the bleaching period. Then the differences in enamel microhardness between the two periods were calculated. Data were analyzed with a nonparametric Kruskal-Wallis test at a significance level of p<0.05. The differences in the microhardness values before and after intervention between the groups were not significant (p=0.59). Daily oral hygiene procedures either immediately or 1 or 2 hours after daily bleaching procedures and exposing the specimens to artificial saliva during the study period produced no significant differences in enamel microhardness values.

Objectives: The aim of this study was to evaluate the separate contribution of enamel (E) and dentine (D) to the colour change of tooth which subjected to 10% carbamide peroxide (CP) gels using a novel recombined enamel-dentine (Recombined-ED) study model., Methods: 120 enamel-dentine (ED) samples (four homogeneous premolar ED from each patient; total=30×4 ED) were involved in the present study. Two homogeneous ED samples were bleached with 10% CP and the other two ones were stored in artificial saliva for one, two or four weeks. After treatment, four kinds of layers were prepared from each four homogeneous ED samples by removing enamel or dentine part: bleached-enamel (BE), bleached-dentine (BD), control-enamel (CE) and control-dentine (CD). Initial and final colour records of samples were taken with a spectrophotometer in CIELab system. The contribution of enamel/dentine to the colour change of tooth (CTCC) was calculated by measuring the colour difference ΔE between two different enamel-dentine combinations (ΔE between BE/BD and CE/BD for enamel; ΔE between BE/BD and BE/CD for dentine). Translucency parameter (TP) was obtained by calculating the colour difference between enamel on black and white backings., Results: ED and recombined-ED were significantly correlated in L(*)a(*)b(*) values both for unbleached samples and bleached samples. Bleaching resulted in a significant colour change (ΔE) of E, D and ED samples. The TP of BE was significantly lower than that of CE. The CTCC of enamel was significantly higher than that of dentine all through the time points., Conclusions: Enamel played a more important role than dentine in tooth bleaching due to the changes in translucency and colour., (Copyright © 2011 Elsevier Ltd. All rights reserved.)