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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.

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.

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.

The purpose of this study is to evaluate the use of infrared photobiomodulation with low-level laser therapy (PBM) to reduce bleaching-induced tooth sensitivity (TS) after in-office bleaching. Eighty-three participants were randomized in blocks into two groups. In the experimental group, the patients received an application after each session of in-office bleaching (35% hydrogen peroxide, 1 × 50 min; 2 sessions with 1-week interval), while the laser application was simulated in the control group. The PBM system was operated in continuous mode, using 3 J of energy. A dose of 100 J/cm2 was applied for 30 s with 808 nm (100 mW of power) in the middle third of the crown. The risk and intensity of TS were recorded immediately after bleaching, 1 h, 24 h, and 48 h after each bleaching session, with a visual scale analog (0–10) and a five-point numerical scale (0–4). The color was recorded at the beginning, weekly, and 1 month after the end of the bleaching (VITA Classical, VITA Bleachedguide, and digital spectrophotometer). The risk of TS was 98% (95% CI 88 to 99%) for the laser group and 95% (95% CI 83 to 99%) for the control (RR = 1.03; 95% CI 0.94 to 1.12; p = 1.0). Similarly, no difference in the intensity of TS was detected for both pain scales (p > 0.65). Improvement in color change, regardless of the group, was observed (p > 0.15). The application of an PBM did not reduce the risk and intensity of TS when applied after the procedure using the parameters recommended by the manufacturer.Trial registration number and date of registration: RBR-4HCVSG—04/06/2019.

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.

Hydrogen peroxide (H 2 O 2 )-based products are effective in tooth whitening; however, their safety is controversial as they may harm patient tissues/cells. These effects are suggested to be concentration-dependent; nonetheless, to date, there are no reports on H 2 O 2 -mediated oxidative damage in the gingival tissue, and neither whether this can be detected in gingival crevicular fluid (GCF) samples. We hypothesize that H 2 O 2 whitening products may cause collateral oxidative tissue damage following in office application. Therefore, H 2 O 2 and nitric oxide (NO) levels were investigated in GCF samples obtained from patients undergoing dental bleaching with H 2 O 2 at different concentrations, in a randomized, double-blind, split-mouth clinical trial. A proteomic analysis of these samples was also performed. H 2 O 2 -based whitening products promoted inflammation which was detected in GCF samples and lasted for longer following 35% H 2 O 2 bleaching. This included time-dependent changes in NO levels and in the abundance of proteins associated with NO synthesis, oxidative stress, neutrophil regulation, nucleic acid damage, cell survival and/or tissue regeneration. Overall, H 2 O 2 -based products used in office promote inflammation irrespective of their concentration. As the inflammation caused by 35% H 2 O 2 is longer , patients may benefit better from using lower concentrations of this bleaching product, as they may result in less tissue damage.

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 clinical trial evaluated the effect of 1.5% potassium oxalate (PO) in controlling sensitivity and color change after at-home tooth whitening. It also evaluated the influence of PO on health-related quality of life (HRQoL) and the degree of patient satisfaction after bleaching treatment. Fifty volunteers were randomized into two groups (n = 25): At-home bleaching gel with 22% carbamide peroxide for 45 min + placebo gel (GP) or 1.5% PO (GPO) for 10 min. The intensity of tooth sensitivity was assessed daily through the visual analog scale. The color analysis was performed three times: baseline, 21 days, and 1 month after the last application of the whitening gel. The impact of the oral condition on the patient's quality of life (OIDP) was used to measure the impact caused by the whitening treatment in relation to the individuals' ability to carry out their daily activities and its influence on HRQOL. No difference in tooth sensitivity was observed (p > 0.05). In addition, there was no difference in color change between groups (p > 0.05). However, there was an intragroup statistical difference throughout the evaluation period (p <0.05). The OIDP analysis showed a statistical difference between the groups (p > 0.05) and there was no difference between the groups regarding the degree of satisfaction with the bleaching (p > 0.05). The 1.5% PO was effective in preventing sensitivity and did not interfere with tooth whitening. Desensitizing therapy had a positive impact on quality of life and 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 assess color change efficacy and the adverse effects of varied over-the-counter (OTC) bleaching protocols. Methodology The study included randomized clinical trials evaluating color changes from OTC bleaching agents. Nine databases were searched, including the partial capture of the grey literature. The RoB2 tool analyzed the individual risk of bias in the studies. Frequentist network meta-analyses compared treatments through common comparators (∆Eab* and ∆SGU color changes, and tooth sensitivity), integrating direct and indirect estimates and using the mean and risk differences as effect measures with respective 95% confidence intervals. The GRADE approach assessed the certainty of the evidence. Results Overall, 37 remaining studies constituted the qualitative analysis, and ten composed the meta-analyses. The total sample included 1,932 individuals. ∆Eab* was significantly higher in groups 6% hydrogen peroxide (HP) strips (≥ 14 h). ∆SGU was significantly higher in groups at-home 10% carbamide peroxide (CP) (≥ 14 h), followed by 6% HP strips (≥ 14 h) and 3% HP strips (≥ 14 h). At-home 10% CP (7-13 h) and placebo showed lower risks of tooth sensitivity without significant differences between these treatments. Conclusion Considering the low level of evidence, OTC products presented satisfactory short-term effects on tooth bleaching compared to the placebo, with little to no impact on dentin hypersensitivity and gingival irritation. Clinical Relevance. OTC products are proving to be practical alternatives for tooth whitening. However, patients should be advised about the possible risks of carrying out such procedures without professional supervision.