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ObjectiveThis in vitro study aims to evaluate of hydrogen peroxide (HP) diffusion into the pulp chamber, bleaching efficacy (BE), and pH stability (pH) of single-application high concentrated in-office bleaching gels.Materials and methodsEighty-eight healthy premolars were randomly into eleven groups (n = 8) according to the in-office dental bleaching: DSP White Clinic 35% calcium (DW), Nano White 35% (NW), Opalescence XTra Boost 40% (OB), Pola Office + 37.5% (PO), Potenza Bianco Pro SS 38% (PB), Total Blanc 35% (TB), Total Blanc One-Step 35% (TO), Whiteness Automixx 35% (WA), Whiteness Automixx Plus 35% (WP), and Whiteness HP Blue 35% (WB). A group not exposed to bleaching agents was the control group (CG). All bleaching agents were applied in one session with a single application. After the bleaching procedure, the concentration of HP diffusion (μg/mL) into the pulp chamber was assessed using UV-Vis spectrophotometry. The BE (ΔEab and ΔE00) was evaluated before and 1 week after the bleaching procedure using a digital spectrophotometer. The pH of each bleaching gel was evaluated by digital pHmeter. The one-way ANOVA and Tukey’s was used for a statistical analysis (α = 0.05).ResultsThe concentration of HP diffusion into the pulp chamber was higher in all in-office bleaching gels when compared to CG (p < 0.0000001). However, there are a significant difference between them (p = 0.0001). A significant BE was observed in all in-office bleaching gels (p < 0.0001 for ΔEab and ΔE00), with a significant difference between them (p < 0.0001). PO, OB, TB, WP, and WB showed a higher BE when compared to DW, PB, and WA (p < 0.0001). Most bleaching gels were slightly acidic or alkaline during the total application time, while DW, PB, TB, and WA showed a high acidic behavior after 30 min of application.ConclusionsA single application was able to produce a bleaching efficacy. However, usually, gels with slightly acidic or alkaline pH during the application time reduces the HP diffusion into the pulp chamber.Clinical relevanceThe single-application of bleaching gels with slightly acidic or alkaline and stable pH decreased the penetration of hydrogen peroxide into the pulp chamber in in-office bleaching and maintained the bleaching efficacy.

ObjectivesTo evaluate in vitro two high concentration self-mix bleaching gels (35% or 37.5%) with different application tips (with or without an applicator brush) during in-office bleaching.Materials and methodsHealthy premolars were randomly assigned to five groups (n = 8): no treatment; 35% HP without applicator brush, 35% HP with applicator brush, 37.5% HP without applicator brush, and 37.5% HP with applicator brush. After the procedures, the concentration of HP transferred into the pulp chamber was evaluated using UV–Vis. The amount of gel used in each group was measured on a precision analytical balance. Color change (ΔEab, ΔE00, and ΔWID) was evaluated with a digital spectrophotometer. Initial concentration was measured by titration with potassium permanganate. The pH was evaluated using a digital pH meter. The data from each test were submitted to nonparametric tests (α = 0.05).ResultsUsing a tip with an applicator brush expended less gel and left a lower amount of HP inside the pulp chamber compared to the tip without a brush for both bleaching gels (p < 0.0003), although no significant difference in color change was observed (p < 0.05). The 37.5% HP showed a more stable and less acidic pH and a lower amount of HP in the pulp chamber than the 35% HP (p < 0.00001).ConclusionThe HP penetration into the pulp chamber was lower when using an applicator with a brush tip than when using one with a conventional tip. As for the color, both tips were considered to lighten teeth.Clinical significanceFor the application of a self-mixing high concentration in-office bleaching gel, a brush tip should be recommended because its use diminishes the penetration of HP into the pulp chamber and wastes less bleaching gel.

Objectives This study aimed to compare the efficacy of two non vital whitening techniques, In-office and Walking Bleach, using 35% hydrogen peroxide. The primary research question was to determine which technique achieves greater tooth color improvement. Materials and methods Fifty non-vital anterior teeth with discoloration were randomly assigned to either the In-office ( n  = 25) or Walking Bleach ( n  = 25) groups. Tooth color was measured using a Vita EasyShade V ® spectrophotometer and visual scales (Vita Classical and Bleachguide) before treatment, after each bleaching session, and at a one-month follow-up. ΔE00, Whiteness Index (WID), and Shade Guide Unit (ΔSGU) values were calculated. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney tests. Results Both techniques improved tooth color, with final ΔE00 values of 10.08 for In-office and 8.12 for Walking Bleach. WID values were significantly higher in the In-office group, indicating greater whitening efficacy. Significant differences favoring the In-office method were seen after the first bleaching ( p  = 0.0337), and one-month follow-up ( p  = 0.0327). Conclusions Both the In-office and Walking Bleach techniques effectively improve the color of non-vital teeth, with the In-office method showing slight advantages at certain times. Clinicians can choose either technique based on safety, patient needs, and clinical context to achieve optimal results. Clinical relevance This study provides evidence that both bleaching techniques are viable options for non-vital teeth whitening. The findings help clinicians choose the most appropriate technique based on biological safety and patient needs and desired outcomes, with the In-office technique being preferable for faster results.

Purpose Intracoronary bleaching is a minimally invasive, alternative treatment that addresses aesthetic concerns related to non-vital teeth discoloration. However, to the best of our knowledge, no studies have assessed the psychosocial impacts of such procedures on patients' aesthetic perceptions. The aim of this study was to evaluate aesthetic perceptions and the psychosocial impact of patients up to 3 months after their teeth had been bleached with hydrogen peroxide (35%) and carbamide peroxide (37%) using the walking bleach technique. Methods The patients were randomly divided into two groups according to the bleaching agent used: G1 = hydrogen peroxide 35% (n=25) and G2 = carbamide peroxide 37% (n=25). Non-vital bleaching was performed in four sessions. Color was objectively (ΔE) and subjectively (ΔSGU) evaluated. Aesthetic perception and psychosocial factors were evaluated before, 1 week and 1 month after the bleaching using the Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires. Results The color change (ΔE) values at 1 month were G1 = 16.80±6.07 and G2= 14.09±4.83. These values remained stable until the third month after treatment (p>0.05). There was a decrease in the values of OHIP-aesthetics and PIDAQ after treatment versus baseline (p<0.05). This status was maintained through the third month after treatment. Conclusions Both agents were highly effective and had a positive impact on the aesthetic perception and psychosocial impact of patients, values that also remained stable over time. Non-vital bleaching yields positive and stable impacts on aesthetic perception and psychosocial factors. ClinicalTrials.gov identifier NCT02718183.

Objective This randomized controlled trial aimed to evaluate the equivalence in the color change, adverse effects, self-perception (AS) and the impact on oral condition (IO) of participants submitted to different application protocols of in-office dental bleaching. Materials and methods 165 participants were bleached with a 35% hydrogen peroxide gel (Total Blanc Office One-Step, DFL), according to the following protocols: (1) 2 applications of 20-min each (2 × 20 min); (2) 1 × 40-min and; (3) 1 × 30-min. The color change was evaluated with the Vita Easyshade spectrophotometer, Vita Classical and Vita Bleachedguide scales. The intensity and risk of tooth sensitivity (TS) and gingival irritation (GI) were recorded using a 0–10 visual analogue scale (VAS). AS and IO was assessed before and after the bleaching procedure using the Orofacial Aesthetic Scale and Oral Health Impact Profile-14, respectively. Results Equivalent color change were observed ( p  < 0.001), with no significant difference between groups. The group 2 × 20 min presented the highest risk of TS (76%, 95% CI 63 to 85), compared to the 1 × 30 min ( p  < 0.04). The intensity of TS and GI and the risk of GI was similar between groups ( p  > 0.31). Irrespectively of the group ( p  = 0.32), significant improvements were observed for all items of AS and IO after bleaching ( p  < 0.02). Conclusions The 1 × 30 min protocol produced equivalent color change to the other bleaching protocols with reduced risk of TS and shorter application time. Clinical relevance A more simplified application regimen of a single application of 30 min yields effective bleaching and patient satisfaction while minimizing undesirable side effects and improving patient satisfaction.

The clinical efficacy regarding bleaching sensitivity and tooth shade lightening using a standard hydrogen peroxide (H 2 O 2 ) bleaching gel was compared with the additional use of ozone either before or after application of H 2 O 2 . Using computer-generated tables, 45 participants were randomly allocated into three groups (n = 15 each) in this investigator-driven, single-centre trial. In Group 1, upper anterior teeth were bleached using ozone (produced via a healOzone X4 device) for 60 seconds, then 38% H 2 O 2 for 20 minutes; in Group 2, 38% H 2 O 2 application (20 min) was followed by ozone (60 s); air produced by the healOzone machine (60 s) followed by 38% H 2 O 2 (20 min) was used in Group 3 (control). Bleaching sensitivity was evaluated via visual analogue scales, and a treatment-blinded reader objectively recorded tooth shades using a colorimeter before and 24 hours after bleaching (at α = 0.05). The H 2 O 2 /ozone combination did not result in pain sensations, while both ozone/H 2 O 2 and H 2 O 2 alone increased bleaching sensitivity (p < 0.001). Teeth achieved lighter shades (higher L*/lower b* values) after bleaching in all groups (p < 0.001), while Ozone boosted lighter tooth shades, irrespective of its use before or after H 2 O 2 (p < 0.05). Due to the complimentary effects, applying ozone after H 2 O 2 seems preferable for bleaching.

Objectives To evaluate the effect of whitening toothpastes with different hydrogen peroxide (HP) concentrations on HP permeability, color change, and physicochemical properties, compared to at-home bleaching treatment. Materials and methods Forty-nine premolars were randomized into seven groups ( n  = 7): untreated (control); at-home bleaching with 10% carbamide peroxide gel (AH; 10% CP) with 14 and 28 applications of 180 min each (AH [14 × 180 min] and AH [28 × 180 min]); three whitening toothpastes (3% HP; 4% HP and 5% HP) and 10% CP brushed 28 times for 90 s each (TB [28 × 90 s]). HP permeability was measured using a UV-VIS spectrophotometer and color change by a digital spectrophotometer (ΔE ab , ΔE 00 , and ΔWI D ). Initial concentration, pH, and viscosity were measured through titration, digital pH meter, and rheometer, respectively. Statistical analysis included one-way ANOVA, Tukey’s test, and Dunnett’s test (α = 0.05). Results 4% HP group showed acidic pH, the lowest viscosity and the highest HP concentration into the pulp chamber ( p  < 0.05). The 10% CP groups had lower HP in the pulp chamber and greater color change than other groups ( p  < 0.05), except the 5% HP group in ΔE ab and ΔE 00 . For ΔWI D , the 10% CP AH groups showed greater whitening than other groups ( p  < 0.05). Conclusions Whitening toothpaste with up to 5% HP resulted in higher HP permeability and less color change compared to 10% CP. Higher HP commercial concentrations in toothpaste increased whitening effect; however, acidic pH toothpastes exhibited greater HP permeability. Clinical relevance Whitening toothpastes with high hydrogen peroxide concentrations were less effective than at-home bleaching, resulting in less color change and greater permeability of hydrogen peroxide, potentially increasing the risk of tooth sensitivity.

This study evaluated the photoactivation of hydrogen peroxide gels at different concentrations using blue or violet LED in terms of whitening efficacy and tooth sensitivity. Forty patients were randomly divided into 4 groups: HP6V (violet LED and 6% hydrogen peroxide), HP6B (blue LED and 6% hydrogen peroxide), HP35V (violet LED and 35% hydrogen peroxide), and HP35B (blue LED and 35% hydrogen peroxide). The L*, a* and b* values were measured before, 1 week and 3 months after treatment, and the ΔE and ΔWID values were calculated. Tooth sensitivity was measured using a visual analogue scale (VAS) before, immediately after, and 24 h after bleaching. The ΔE, ΔWID and bleaching sensitivity values were subjected to the ANOVA test and Bonferroni post-test. HP35V and HP35B showed higher whitening efficacy than HP6VL, while HP6V did not show statistical differences compared to the other groups. Regarding bleaching-related sensitivity, the HP6V and HP6B groups presented the lowest values when compared to HP35V and HP35B. HP6V showed whitening efficacy comparable to HP35V and HP35B but with reduced tooth sensitivity.Trial registration numberNCT06165458; registration date: 12/09/2023.

Objective The study aimed to evaluate the whitening efficacy and removal of extrinsic tooth stain of sodium phytate-containing whitening toothpaste, as well as to evaluate participant satisfaction. Methods A total of eighty participants were recruited for this randomized, triple-blind controlled trial and were randomly assigned to either the test group (toothpaste containing 0.875% sodium phytate, ST) or the control group (toothpaste without sodium phytate, CT). Tooth color was assessed using a VITA spectrophotometer and changes in exogenous tooth stains were evaluated using the Lobene Index, which were conducted at baseline, as well as at 2, 3, and 4 weeks. Additionally, participants’ self-assessment of tooth color were evaluated through an aesthetic numerical analogue scale. Statistical tests were conducted appropriately, and the significance level was established at α = 0.05. Results This study demonstrates that the b-value of the index teeth in the ST group was significantly lower ( p  < 0.05) than that of the CT group, while the △WI D values were significantly higher ( p  < 0.05) at both the 3-week and 4-week time points. Additionally, the a-value of the index teeth in the ST group was significantly lower ( p  < 0.05) compared to the CT group, and the L-value of the index teeth in the ST group was significantly higher ( p  < 0.05) than that of the CT group after 4 weeks. The differences in color between the two treatments, as analyzed by the CIELAB (ΔE), were not statistically significant. Similarly, no significant differences were observed in the changes of the Lobene Index or in participant satisfaction regarding tooth color between the two groups. A comparative analysis of the subjects in the ST group at the 3-week and 4-week marks revealed that the L-value of the index tooth at 4 weeks was significantly higher than that at 3 weeks ( p  < 0.001), while the b-value was significantly lower at 4 weeks compared to 3 weeks ( p  < 0.001). Conclusion Brushing teeth with sodium phytate-containing whitening toothpaste for a duration of three weeks demonstrates notable whitening effects, which significantly increase over time. However, after four weeks, the sodium phytate-containing toothpaste shows minimal efficacy in removing extrinsic tooth stains. Clinical significance Sodium phytate may be incorporated into toothpaste as a whitening agent.

Objective This clinical study evaluated an experimental pregabalin (PG) gel in reducing dental sensitivity (DS) and color change after dental bleaching. Materials and methods Seventy-five volunteers were selected and randomized into three groups: GPG (10% pregabalin gel), GKF (5% potassium nitrate and 2% sodium fluoride), and GP (placebo gel). Prior to the bleaching treatment, GPG and GKF received applications of the respective desensitizing gels for 10 min. The GP group received an application of placebo gel, similar to the other groups. The bleaching was performed with 35% hydrogen peroxide in 3 sessions, with a 7-day interval between sessions. Post-bleaching DS was assessed using the visual analog scale (VAS) over 21 days of follow-up. Color Assessment (ΔE00, ΔWID, and ΔEab) and luminosity (L) were measured at baseline (T0) and 7 days after the third session (T1). Friedman, Kruskal-Wallis, one-way ANOVA, and Tukey tests were used, with α = 5%. Results Intergroup analysis showed that on the 1st, 8th, and 15th days, DS was higher for GP ( p  < 0.006; p  = 0.004; p  < 0.001) and did not differ between GKF and GPG ( p  = 0.203; p  = 0.178; p  = 0.09). In the intragroup analysis, GP showed a significant increase in DS on the 15th day ( p  < 0.001). Conclusions The experimental 10% pregabalin gel reduced dental sensitivity and did not interfere with bleaching results. Clinical significance The topical application of 10% pregabalin gels and NKF was effective in reducing tooth sensitivity 24 hoursafter whitening with 35% hydrogen peroxide. Trial registration ClinicalTrials.gov trial registry with the identifier NCT06180707.