Restorative Dentistry & Endodontics

Can carbamide peroxide be as effective as hydrogen peroxide for in-office tooth bleaching and cause less sensitivity? A systematic review: Patrick Wesley Marques de Boa, Kaiza de Sousa Santos, Francisca Jennifer Duarte de Oliveira, Boniek Castillo Dutra Borges; Restor Dent Endod 2024;49(2):e14. Published online March 20, 2024; DOI: https://doi.org/10.5395/rde.2024.49.e14

Abstract PDF PubReader ePub: This study aimed to answer the question through a systematic review: Can carbamide peroxide be as effective as hydrogen peroxide and cause less in-office bleaching sensitivity? A literature survey was performed in PubMed/MEDLINE, Embase, Scopus, ISI Web of Science, and gray literature. Primary clinical trials that compared the efficacy or the in-office bleaching sensitivity between carbamide and hydrogen peroxides were included. The risk of bias was evaluated using the RoB2. The certainty of the evidence was assessed using the GRADE approach. DPI training significantly improved the mean scores of the dental undergraduates from 7.53 in the pre-DPI-training test to 9.01 in the post-DPI-training test (p < 0.001). After 6 weeks, the mean scores decreased marginally to 8.87 in the retention test (p = 0.563). DPI training increased their confidence level from 5.68 pre-DPI training to 7.09 post-DPI training. The limited evidence suggests that the 37% carbamide peroxide may be similarly effective to the 35% hydrogen peroxide for bleaching teeth in-office and causes less bleaching sensitivity. However, more well-designed split-mouth clinical trials are necessary to strengthen the evidence.

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Impact of combined at-home bleaching and whitening toothpaste use on the surface and color of a composite resin: Carolina Meneghin Barbosa, Renata Siqueira Scatolin, Waldemir Francisco Vieira-Junior, Marcia Hiromi Tanaka, Laura Nobre Ferraz; Restor Dent Endod 2023;48(3):e26. Published online July 26, 2023; DOI: https://doi.org/10.5395/rde.2023.48.e26

Abstract PDF PubReader ePub: Objective
This in vitro study aimed to evaluate the effects of different whitening toothpastes on a composite resin during at-home bleaching with 10% carbamide peroxide.
Materials and Methods
Sixty samples (7 mm × 2 mm) were used for color and roughness analyses, while another 60 samples (3 mm × 2 mm) were utilized to assess microhardness. The factors analyzed included toothpaste, for which 5 options with varying active agents were tested (distilled water; conventional toothpaste; whitening toothpaste with abrasive agents; whitening toothpaste with abrasive and chemical agents; and whitening toothpaste with abrasive, chemical, and bleaching agents). Brushing and application of whitening gel were performed for 14 days. Surface microhardness (SMH), surface roughness (Ra), and color (∆L*, ∆a*, ∆b, ∆E*_ab, and ∆E₀₀) were analyzed. The Ra and SMH data were analyzed using mixed generalized linear models for repeated measures, while the color results were assessed using the Kruskal-Wallis and Dunn tests.
Results
Between the initial and final time points, all groups demonstrated significant increases in Ra and reductions in SMH. No significant differences were found between groups for SMH at the final time point, at which all groups differed from the distilled water group. Conventional toothpaste exhibited the lowest Ra, while whitening toothpaste with abrasive agent had the highest value. No significant differences were observed in ∆L*, ∆a*, and ∆b.
Conclusions
While toothpaste composition did not affect the color stability and microhardness of resin composite, combining toothbrushing with whitening toothpaste and at-home bleaching enhanced the change in Ra.

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2 Web of Science

Effects of applying antioxidants on bond strength of bleached bovine dentin: Hyo-Jin Whang, Dong-Hoon Shin; Restor Dent Endod 2015;40(1):37-43. Published online October 13, 2014; DOI: https://doi.org/10.5395/rde.2015.40.1.37

Abstract PDF PubReader ePub: Objectives
Some antioxidants are believed to restore dentin bond strength after dental bleaching. This study was done to evaluate the influence of antioxidants on the bond strength of bleached bovine dentin.
Materials and Methods
Thirty incisors were randomly assigned to 10 groups (two unbleached control and eight bleached groups: immediate bonding IB, 4 wk delayed bonding DB, 10% sodium ascorbate treated SA, 10% α-tocopherol treated TP groups). Teeth in half of groups were subjected to thermal stress, whereas the remaining groups were not. Resin-dentin rods with a cross-sectional area of 2.25 mm² were obtained and microtensile bond strength was determined at a crosshead speed of 1 mm/min. Fifteen specimens were prepared for SEM to compare the surface characteristics of each group. The change in dentin bond strength from thermal stress and antioxidant treatment was evaluated using two-way analysis of variance (ANOVA) and Sheffe's post hoc test at a significance level of 95%.
Results
The control group exhibited the highest bond strength values, whereas IB group showed the lowest value before and after thermocycling. The DB group recovered its bond strength similar to that of the control group. The SA and TP groups exhibited similar bond strength values with those of the control and DB groups before thermocycling. However, The TP group did not maintain bond strength with thermal stress, whereas the SA group did.
Conclusions
Applying a 10% sodium ascorbate solution rather than 10% α-tocopherol solution for 60 sec is recommended to maintain dentin bond strength when restoring non-vitally bleached teeth.

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Effect of vital tooth bleaching agent on dentin bonding: Na-Young Jeong, Myoung-Uk Jin, Young-kyung Kim, Sung Kyo Kim; J Korean Acad Conserv Dent 2006;31(2):79-85. Published online March 31, 2006; DOI: https://doi.org/10.5395/JKACD.2006.31.2.079

Abstract PDF PubReader ePub

To evaluate the effect of vital tooth bleaching agent and alcohol pretreatment on dentin bonding, flat dentin windows were produced on the buccal side of the crowns of fifty-five extracted, human premolars. A bleaching gel, Opalescence® with 10% of carbamide peroxide (Ultradent Product, USA) was daily applied on the teeth of three experimental groups for six hours for 10 consecutive days, while teeth of a control group were not bleached. After 6 hours of bleaching gel application, the specimens were washed and stored in saline until the next day application. After application of One-step® dentin bonding agent (Bisco, USA), Z-250® resin (3M-ESPE, USA) was bonded to dentin with a mount jig. Shear bond strength was measured with an Instron machine (Type 4202, Instron Corp., USA) after 24 hours. The results were analyzed using one-way ANOVA and Duncan's multiple range test at p < 0.05.

Immediate bonding group showed significantly lower bond strength than un-bleached control group (p < 0.05).

Ethanol-treated group showed significantly higher bond strength compared to immediate bonding group (p < 0.05). However, the bond strength of the ethanol treatment group was lower than that of the un-bleached control group (p < 0.05).

There were no significant difference in shear bond strength between the 2-week delayed bonding group and the ethanol-treated group (p > 0.05) and between delayed bonding group and un-bleached control group (p > 0.05).

In the condition of the present study, it seems that alcohol pretreatment after bleaching procedure can reduce the adverse effect of vital bleaching agent on dentin bonding.

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Bleaching effect of carbamide peroxide gel on discolored nonvital teeth: Sun-Ah Park, Sun-Ho Kim, Yun-Chan Hwang, Byung-Ju Oh, Chang Youn, Yeong-Joon Park, Sun-Wa Jeong, In-Nam Hwang, Won-Mann Oh; J Korean Acad Conserv Dent 2002;27(4):441-447. Published online July 31, 2002; DOI: https://doi.org/10.5395/JKACD.2002.27.4.441

Abstract PDF PubReader ePub

The bleaching of discolored nonvital teeth is conservative treatment that satisfy the cosmetic desire. The most common method for this treatment, walking bleaching, is using 30% hydrogen peroxide and sodium perborate.

Many alternatives are suggested for preventing the external cervical root resorption that is the common complication of the nonvital teeth bleaching with 30% hydrogen peroxide.

The same extent of oxidation reactions as that resulted by the bleaching with the application of 30% hydrogen peroxide and sodium perborate can also be acquired more safely by materials that contain 10% carbamide peroxide, used primarily for the bleaching of vital teeth. Therefore, this study was performed to evaluate the efficacy of 10% and 15% carbamide peroxide bleaching gel in nonvatal teeth bleaching.

The internal bleaching of intentionally discolored teeth was performed in vitro with 10% carbamide peroxide (Group 1), 15% carbamide peroxide (Group 2), mixture of distilled water and sodium perborate (Group 3), and mixture of 30% hydrogen peroxide and sodium perborate (Group 4). The bleaching materials were refreshed following 3, 6, 9 and 12 days. To evaluate the bleaching effect, the color change of the crowns was measured at 1, 2, 3, 4, 7 and 15 days of bleaching using the colorimeter.

The results were as follows :

1. L* and ΔE* values were increased with time in all bleaching agents(p<0.01).

2. There was no significant difference in L* and ΔE* value among bleaching agents.

3. ΔE* value higher than 3 was shown after 3 days of bleaching with 10% carbamide peroxide gel, 1 day with 15% carbamide peroxide gel, 4 days with mixture sodium perborate and distilled water and 4 days with mixture sodium perborate and 30% hydrogen peroxide, respectively.

These results revealed that the use of 10% and 15% carbamide peroxide bleaching gel in non-vital teeth bleaching is as effective as mixture of distilled water and sodium perborate and mixture of 30% hydrogen peroxide and sodium perborate. Accordingly, carbamide peroxide could be used clinically to bleach discolored non-vital teeth.

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