Bleaching Of Non-vital Teeth Research Articles

Effectiveness of Three Bleaching Techniques for Endodontically Treated Teeth: A Randomized Clinical Trial.

Various techniques, products, and protocols are used for the bleaching of non-vital teeth. The walking bleach technique involves sealing the bleaching agent in the pulp chamber. In the inside/outside technique, a low-concentration bleaching agent is applied at home using a custom tray. In the in-office technique, a high-concentration bleaching agent is applied by a dental professional. Limited research has compared the effectiveness of these techniques. This clinical trial aimed to evaluate the effectiveness of the walking bleach, the inside/outside, and the in-office bleaching techniques. Fifty-four discolored teeth were selected according to eligibility criteria, randomized, and assigned to three treatment groups (n=18): walking bleach (sodium perborate - SP), inside/outside bleaching (7.5% hydrogen peroxide -HP7.5), and in-office bleaching (35% hydrogen peroxide - HP35). A cervical seal was placed in all the teeth, and nonvital bleaching was performed according to each technique. The CIELab color coordinates were measured using a clinical spectrophotometer at baseline, weekly, and at the 1-week follow-up. ΔE00 and ΔWID were calculated between the baseline and each evaluation time point. The ANOVA, Fisher exact, and Kruskal-Wallis tests were used to compare the quantitative variables, and the Fisher exact test, to determine the association among categorical variables. Bleaching effectiveness was interpreted by 50:50% perceptibility and acceptability thresholds. As the treatment progressed, all techniques presented a significant increase in L* and WID (p<0.001), and a significant decrease in a* and b* (p<0.001). HP7.5 and HP35 presented greater increases in WID mean values, in comparison with SP (p=0.006). No significant differences were observed among the techniques for ΔE00 after treatment completion (p=0.383). There were no statistical differences in bleaching effectiveness among the techniques after treatment completion (p=0.098). All techniques presented excellent effectiveness after treatment completion. However, HP7.5 and HP35 techniques provided a more rapid whitening response.

Management of Discoloured Maxillary Central Incisor with Intracoronal Bleaching

Abstract Dentistry has an array of treatment options to harmonise a smile with discoloured teeth. Bleaching is an extremely promising option. Bleaching is a safe and conservative approach to tackle discolorations, hence gaining wider acceptance. Intracoronal bleaching of non-vital teeth involves the use of oxidising agents within the coronal portion of an endodontically treated tooth to remove tooth discolouration. The objectives of treatment are to reduce or eliminate discolouration, improve the degree of coronal translucency and alleviate present and prevent future adverse clinical signs or symptoms. The successful outcome depends mainly on the cause, correct diagnosis, case selection and proper application of bleaching technique.

Clinical Testing of Walking Bleach, In-Office, and Combined Bleaching of Endodontically Treated Teeth.

Objective. The causes of internal posteruptive discoloration of teeth are bleeding, necroses, infections, and endodontic filling materials. The aim of this study was to establish the results of bleaching endodontically treated teeth using walking bleach, in-office, and combined techniques, using 30% carbamide peroxide and 35% hydrogen peroxide, as well as the effect of etiological factors, and the time elapsed after endodontic treatment on the success of bleaching. Materials and Methods. The research involved 30 endodontically treated teeth in healthy patients. Retroalveolar X-rays were taken to check the quality of root canal obturation. Endodontic treatment and obturation were carried out on the discolored non-vital teeth without any previous endodontic treatment. Before bleaching, two millimeters of the filling were removed from the root canal and the very entry into the canal was protected with glass ionomer cement. The teeth were divided into three groups, depending on the bleaching technique: walking bleach technique (10 patients), in-office technique (10 patients), and combined technique (10 patients). The teeth were bleached with 30% carbamide peroxide and 35% hydrogen peroxide. The bleaching procedure was repeated in all the patients three times. The color of all teeth was determined based on the Vita Classic guide before and after bleaching. The Χ2 square and Kruskal−Wallis tests were used to identify differences in teeth bleaching results. Results. A statistically significant difference (p < 0.05) was established between bleaching success and the time elapsed after endodontic treatment. There were no statistically significant differences observed between the bleaching success and etiological factors, bleaching techniques, or bleaching agents. Conclusions. The effectiveness of non-vital tooth bleaching is affected by the time elapsed after endodontic treatment.

INVASIVE CERVICAL RESORPTION DUE TO IONTOPHORETIC INTERNAL BLEACHING WITH HYDROGEN PEROXIDE: TWO CASE REPORTS

Background: Invasive cervical resorption is a localised inflammatory-mediated aggressive form of an external root resorptive process of the tooth. One of the predisposing factors associated with ICR is the internal bleaching of non-vital teeth. The maxillary anterior teeth are highly affected among all tooth types. Case reports: The clinical management and one-year follow-up results of two cases with invasive cervical resorption in maxillary central incisors due to iontophoretic internal whitening with 30% hydrogen peroxide are presented in this study. The complications associated with post-bleaching ICR as well the prevalence and underlying mechanism of this phenomenon and treatment planning, are discussed. Conclusion: Clinicians should be alert to the possibility of ICR, especially following iontophoretic non-vital bleaching. A combined multidisciplinary treatment approach can be applied based on thorough clinical, radiographical and CBCT evaluation.

Attitude of Clinical Dental Students to Bleaching of Vital and Non-Vital Teeth: A Cross-Sectional Study

Aim: To assess the attitudes of clinical dental students towards the various aspects of tooth bleaching in Saudi Arabia Methods: This is an observational cross-sectional study that was carried out across different universities in Saudi Arabia. The study’s questionnaire consisted of questions regarding the demographics and knowledge of dental bleaching procedures, techniques, and materials. Descriptive statistics of frequency distribution and percentages were calculated for categorical variables and the Chi-squared test was applied to assess the relationship between categorical variables. Results: A total of 674 dental students and interns from 14 different governmental and private dental colleges in Saudi Arabia completed the survey. The majority of participants were females, 461 (68.4%), attended governmental universities, 396 (58.8%), and did not use any bleaching techniques (62.8%). Dental interns had a higher level of knowledge (42%) followed by 5th-year students (33.7%), and 6th-year students (22.9%). Furthermore, participants who practiced tooth bleaching during clinical training and private universities’ students showed a significantly better bleaching knowledge Conclusion: Overall, dental schools should be encouraging their students to be involved in bleaching application. Additionally, there is a pressing need to focus more on dental bleaching material and procedures in dental school. Keywords: Tooth bleaching, bleaching, techniques, dental students, attitude.

Attitude of Clinical Dental Students to Bleaching of Vital and Non-Vital Teeth

Background: Bleaching is considered the most conservative and cost-effective aesthetic procedure. Vital and non-vital bleaching techniques commonly involve at-home, in-office, and over-the-counter techniques and can be internal (within the pulp chamber) or external (on the enamel surface). Aim: To assess the attitudes of clinical dental students towards the various aspects of tooth bleaching in Saudi Arabia Design and settings: This is an observational cross-sectional study that was carried out across different universities in Saudi Arabia. The study’s questionnaire consisted of questions regarding the demographics and knowledge of dental bleaching procedures, techniques, and materials. Results: A total of 674 dental students and interns from 14 different governmental and private dental colleges in Saudi Arabia completed the survey. The majority of participants were females, 461 (68.4%), attended governmental universities, 396 (58.8%), and did not use any bleaching techniques (62.8%). Dental interns had a higher level of knowledge (42%) followed by 5th-year students (33.7%), and 6th-year students (22.9%). Furthermore, participants who practiced tooth bleaching during clinical training and private universities’ students showed a significantly better bleaching knowledge Conclusion: Overall, dental schools should be encouraging their students to be involved in bleaching application. Additionally, there is a pressing need to focus more on dental bleaching material and procedures in dental school. Keywords: Tooth Bleaching, Dental Students, Bleaching Techniques.

Dentists’ preference for Vital and Non-vital Tooth Bleaching Material in Teaching Institutions of Multan

Objective: The objective of this study was three fold; to investigate the preference of dentists regarding the technique for vital and non-vital tooth bleaching, to find out the materials used for vital and non-vital tooth bleaching and to evaluate the influence of post-graduate training, working place and clinical experience on techniques and material used. Methodology: A cross sectional study was carried out using a questionnaire with dentists working in three teaching institutes of Multan, Nishtar Institute of Dentistry (NID), Bakhtawar Amin Medical &amp; Dental College (BAMDC) and Multan Medical &amp; Dental College (MMDC). A total of 170 questionnaires were distributed and 154 recovered, at a response rate of 90.5%. Information about post-graduate training, working place and clinical experience was obtained. The information regarding technique and material used for vital and non-vital tooth bleaching was also collected. Data were analyzed using SPSS version 22 and frequencies and percentages were calculated along with association between the treatment options and other variables. Results: Majority of the dentists 81.8% and 75.3% preferred in-office technique for vital and non-vital tooth bleaching respectively. For vital tooth bleaching, 31.8% selected HP 6% and 28.4% opted CP10-22%. For non-vital tooth bleaching, 34.8% selected SP mixed with water/HP and 26.6% opted HP37%. Conclusion: Clinical experience and working place significantly influenced the bleaching technique for vital teeth not for the non-vital. No significant influence of post-graduation, clinical experience and working place was found on material used for vital or non-vital bleaching. Key Words: Vital tooth bleaching, Non-vital tooth bleaching, Hydrogen peroxide, Carbamide peroxide, Sodium perborate

Dentist’s preferences on vital and nonvital tooth bleaching

Aim: The present study aimed to investigate if the Guatemalan dentist’s options on tooth bleaching could be influenced by their time in clinical practice, the level of specialization or their working place. Methods: A representative sample of dentists working in clinical practice in Guatemala was selected. Data were collected using a self-administered questionnaire with information related to gender, professional characteristics (time since graduation in years and working place) and preferences regarding vital (at-home or in-office; type and concentration of bleaching agent) and the nonvital tooth bleaching (bleaching agent used). The analysis was performed and the association between preference for bleaching technique and independent variables were investigated using Fisher’s exact test. Results: 200 dentists were interviewed. More than half of dentists were male (57.0%) with time since graduation between 11 and 20 years (n= 64; 32.3%). Dentists mostly (60.5%) preferred in-office technique for vital bleaching, with 10-20% Carbamide peroxide (CP) as the preferred agent (50%). For nonvital teeth, the preferred agent (46.8%) was 37% Hydrogen Peroxide (HP). About the associations, younger dentists (&lt; 20 years of graduation) selected mostly in-office technique, while those with more than 20 years indicated more the at-home technique. Also, the dentists working in private practice chose more frequently in-office technique. Thus, the in-office technique was more popular among Guatemalan dentists, with 10-20% CP and 37% HP selected as favorite bleaching agents for vital and nonvital techniques, respectively. Conclusion: The time of clinical practice and working place influenced some choices.

Spectrophotometric analysis of the effectiveness of bleaching agents used for non-vital teeth bleaching

Objectives: This study aimed to compare the efficiency of three different substances used for the bleaching of non-vital teeth. Methods: Forty bovine teeth were divided into five groups: three test groups (sodium perborate + 20% hydrogen peroxide – SPG; 37% carbamide peroxide – CPG; 35% hydrogen peroxide – HPG) and two control groups (CG1 and CG2). Teeth of the test groups were stained artificially with blood and bleached using the in-office and walking bleach techniques. The efficiency of the bleaching agents was evaluated objectively by comparing the color variables L*, a*, and b* measured spectrophotometrically according to the CIELab system. The data were analyzed by ANOVA and the Tukey test, adopting a 5% level of significance. Results: The results showed a reduction in lightness (L*) after staining and an increase after the bleaching sessions. The values of a* and b* increased after staining and decreased after the application of the bleaching substances. Conclusions: All substances used for non-vital tooth bleaching exhibited the same bleaching efficiency. No significant differences in this efficiency were observed between the bleaching techniques at the end of the experiment. However, in-office bleaching provided the same bleaching result as the walking bleach technique within a shorter period. Clinical significance: Given the increasing demand for esthetics, the use of different bleaching techniques and the variety of whitening agents, oral health professionals should offer evidence-based treatment, more efficient and in less time.

Management of discolored nonvital tooth by walking bleach technique: A conservative approach

Discoloration of teeth in the anterior region can cause considerable cosmetic impairment. One of the techniques which is commonly used for bleaching of endodontically treated teeth is “walking” bleach techniques, and it provides satisfactory results. Based on the clinical reports with nonvital tooth bleaching, it is a viable, esthetic treatment for the discolored tooth. Its conservative nature makes it an important part of an esthetic dentistry treatment. This case report presents two cases, in which nonvital bleaching was done by walking bleach technique. Regular follow-up after a period of 4 weeks showed a significant reduction in the discoloration of teeth.

Clinical efficiency of a sodium perborate - hydrogen peroxide mixture for intracoronal non-vital teeth bleaching

Introduction/Objective. The aim was to evaluate initial efficiency of sodium perborate (tetrahydrate) and 30% hydrogen peroxide mixture for intracoronal non-vital teeth bleaching (?walking bleach? technique). Methods. Forty patients with discolored teeth were included in the study. Based on their history and clinical examination, causes of discoloration were classified as necrotic pulp, ?endo-sealer? or unknown. The ?walking bleach? technique was performed by applying sodium perborate (tetrahydrate) and 30% hydrogen peroxide mixture intracoronally to cavity dentin walls. The mixture was renewed in seven-day intervals. Tooth color was assessed visually before, during, and after the procedure using the Vita Classical shade guide (Vita Zahnfabrik, Bad Sackingen, Germany). Numerical values or shade guide units (SGU) were assigned to Vita shade tabs on a bright-dark scale. Analysis of variance, t-test, correlation and regression analysis were used to analyze the data (p &lt; 0.05). Results. On average, 26 ? 9 days or 3?4 appointments were required for intracoronal bleaching to achieve the desired or best possible shade. Better clinical efficiency was found in the necrotic pulp group (17 ? 6 days; 8 ? 3 SGU) than in the ?endo-sealer? group (42 ? 13 days; 4 ? 2 SGU) (p &lt; 0.05). Age significantly influenced bleaching efficiency (p &lt; 0.05). There was no significant correlation between bleaching efficiency and initial shade (p &gt; 0.05). Conclusion. Intracoronal, non-vital teeth bleaching (?walking bleach? technique) using sodium perborate (tetrahydrate) and 30% hydrogen peroxide mixture showed satisfactory clinical efficiency. Discoloration caused by pulp necrosis was treated more efficiently than that caused by endodontic sealers. Younger age had a positive effect and discoloration intensity had no effect on bleaching efficiency.

Effect of Er: YAG Laser on Microtensile Bond Strength of Bleached Dentin to Composite.

Introduction: In non-vital tooth bleaching, dentin is in direct contact with the bleaching agent, 1 to 3-week delay is needed to eliminate free radicals from tooth structure. The present study aimed to evaluate the effect of irradiation of Er: YAG laser on immediate microtensile bond strength of bleached dentin to composite. Methods: Sixty sounds human teeth were collected and randomly divided into 4 groups (n=15): no bleaching (NB), opalescence endo hydrogen peroxide (HP) gel bleaching, sodium perborate (SP) bleaching and laser bleaching with heydent gel (LB). The groups were divided into 3 subgroups (n=5): no surface treatment, Er: YAG laser irradiation and 10% sodium ascorbate (SA). All samples were restored and underwent microtensile bond strength testing. Statistical analysis was carried out using one-way and two-way ANOVA. Results: Bond strength in NB-SA group had a significant difference with the NB group (P<0.05) while no significant difference was noted between NB and NB-Er groups (P=0.55). Application of SA and Er: YAG laser after bleaching with SP did not enhance the bond strength (P=0.07). Conclusion: Application of SA and Er: YAG laser after HP gel bleaching significantly enhanced the bond strength. Application of Er: YAG laser after internal bleaching with HP gel could enhance the bond strength.

Deionized water can substitute common bleaching agents for nonvital tooth bleaching when treated with non-thermal atmospheric plasma.

The bleaching efficacy of common bleaching agents and deionized water treated with non-thermal atmospheric pressure plasma in the pulp chamber for nonvital tooth bleaching was evaluated. A total of 120 extracted human maxillary first incisors were stained using human blood. Teeth were randomly divided into eight groups (n = 15). In the first four groups, teeth were bleached using 35% hydrogen peroxide gel, 37% carbamide peroxide gel, 2:1 (w/v) sodium perborate paste, and deionized water for 30 min. In the remaining groups, bleaching agents were treated with non-thermal atmospheric plasma for 5 min inside the pulp chamber. Overall color changes (∆E) were determined using Commission Internationale de L'Eclairage Lab Colour System. The plasma-assisted tooth bleaching has not increased tooth temperature beyond 37°C. Bleaching efficacies of bleaching agents were significantly improved when treated with non-thermal atmospheric plasma compared to their application (P < 0.05). A remarkable bleaching effect was obtained when bleaching agents were substituted with water and when treated with non-thermal atmospheric plasma. Non-thermal atmospheric plasma treatment could be a novel tool for activation of bleaching agents in the pulp chamber for nonvital tooth bleaching procedure. Moreover, water could be used as a novel bleaching agent when treated with the non-thermal atmospheric plasma to eliminate possible risks which might arise from peroxide-containing agents.

Color Regression and Maintenance Effect of Intracoronal Whitening on the Quality of Life: RCT—A One-year Follow-up Study

This randomized clinical study evaluated two parameters: 1) the clinical color rebound of whitening patients' tooth discoloration using the walking bleaching technique and 2) the impact on psychological and aesthetic self-perception at the one-year follow-up of patients who underwent bleaching of nonvital teeth. Fifty study participants with nonvital tooth discoloration were recruited. Teeth were assigned randomly into one of two groups: 1) 35% hydrogen peroxide (n=25) and 2) 37% carbamide peroxide (n=25). Intracoronal bleaching was carried out over the course of four sessions using the walking bleach technique. Tooth color was evaluated after each session in order to measure the total color variation (ΔE). The guide was arranged from highest (B1) to lowest values (C4) for evaluating color, and color changes using Vita Classical Shade (ΔSGUs) units were calculated. Subjective and objective assessments were compared with the counterpart of the tooth. Aesthetic perception and psychosocial factors were evaluated before and after treatment by the Oral Health Impact Profile (OHIP) and Psychological Impact of Dental Impact Questionnaire (PIDAQ) surveys. Color changes (ΔE) were 15.48 ± 5.17 and 14.02 ± 4.85 for carbamide and hydrogen peroxide groups, respectively. There were no significant differences ( p>0.05) between these two groups at the one-year follow-up. There was a decrease in the PIDAQ scores after treatment compared to baseline values ( p<0.05). The majority of OHIP values regressed to baseline values. The technique of walking bleaching was highly effective and showed minimal color rebound in nonvital teeth and had a positive effect on patients' psychological impact at the one-year follow-up.

Effectiveness and effect of non-vital bleaching on the quality of life of patients up to 6 months post-treatment: a randomized clinical trial.

The aim of this study was to evaluate the esthetic perception of patients at 6months after bleaching of non-vital teeth with 35% of hydrogen peroxide and 37% of carbamide peroxide using a walking bleach technique. We also assessed psychosocial impacts as well as the clinical effectiveness and stability of the color change. The teeth bleaching treatment was randomly assigned to two groups according to the bleaching agent used: G1 HP = 35% of hydrogen peroxide (n = 25) and G2 CP = 37% of carbamide peroxide (n = 25). The non-vital bleaching was performed in four sessions using the walking bleach technique. The color was objectively (ΔE) and subjectively (ΔSGU) evaluated. The esthetic perception and psychosocial factors were evaluated before treatment as well as one and 6months post-treatment using Oral Health Impact Profile (OHIP) esthetics and Psychosocial Impact of Dental Esthetics Questionnaire (PIDAQ). The color change (ΔE) at 6months (G1 = 14.53 ± 5.07 and G2 = 14.09 ± 6.61) for both color groups remained stable until the 6-month post-treatment (p > 0.05). There was a decrease in the values of OHIP esthetics and PIDAQ after treatment compared to the baseline (p < 0.05), and this effect was maintained 6months post-treatment. Both agents were highly effective and maintained the color stability at 6months; this positively affected the esthetic perception and psychosocial impact of patients who also remained stable over time. Non-vital bleaching produces a positive and stable impact on the esthetic perception and psychosocial factors at medium-term follow-ups.

Bleaching of non-vital teeth, five-year follow-up: case reports

In 2009, a study was conducted for the purpose of comparing the effectiveness of two bleaching agents: sodium perborate and 37% carbamideperoxide gel. Thirteen patients diagnosed with “non-vital teeth with traumatic dyschromias” were treated at the Universidad Autónoma de Santo Domingo School of Dentistry, Dominican Republic. The findings showed that both bleaching agents were effective; however, 37% carbamideperoxide worked more rapidly and was easier to administer. Because it comes in individualised pre-measured syringes, the gel is immediately ready for application, thereby giving patients the results they desire in a considerably shorter amount of time. After five years, the 13patients previously treated with the non-vital dental bleaching products were recalled to be re-evaluated for possible reversal of tooth discolouration and the development of cervical resorption. Only four patients came to this follow-up dental visit. In all four of the patients’ radiographic findings, there was a complete absence of external cervical resorption. Three of the patients had reversal of tooth discolouration; however, for one patient there were no observable dyschromias. Regardless of the bleaching agent used, if the patient had poor final dental restoration(s) post-bleaching procedure and a lifestyle counter to the maintenance of proper dental health (i.e. smoking, excessive alcohol consumption, and excessive simple sugar consumption), the dyschromias tended to return.

Bleaching of non-vital teeth to remove intrinsic stains

Bleaching of non-vital teeth to remove intrinsic stains

A Survey among Palestinian Dentists Regarding Preferences Over Vital and Non-Vital Teeth Bleaching:A Cross-Sectional Study

Background: With bleaching treatments becoming very popular, assessment was conducted among Palestinian dentists to check their preferences. Objective: To evaluate the preferences of general dentists regarding vital and non-vital tooth bleaching therapies and to investigate whether the time of clinical practice influences these options. MaterialM At home therapies were the least preferred (19.3%). Hydrogen peroxide more than 22% was the preferred treatment of choice for vital bleaching therapy (57.9%), whereas the combination of sodium perborate with water or hydrogen peroxide (46.5%) was the preferred treatment of choice for non-vital bleaching. There was a significant association between the time since graduation and the preference for in-office bleaching (P = 0.01) and no significant association between the time since graduation and the material used. Conclusion: In-office bleaching was preferred over at-home therapies; HP >22% and sodium perborate with water or HP were chosen as first treatment options to manage discolored vital and non-vital teeth, respectively. The time in clinical practice had an effect only on the choice of vital bleaching technique.

Resin Bonding of Self-Etch Adhesives to Bovine Dentin Bleached from Pulp Chamber.

This study evaluated the microtensile bond strength (μTBS) of 1-step self-etch adhesives (1-SEAs) and 2-step self-etch adhesives (2-SEAs) to pulp chamber dentin immediately after bleaching with 2 types of common bleaching techniques. Pulp chamber dentin of bovine teeth was bleached using 30% hydrogen peroxide (H2O2) solution with quartz-tungsten-halogen light-curing unit (Group 1) and 3.5% H2O2-containing titanium dioxide (TiO2) (Pyrenees®) activated with 405-nm violet diode laser for 15 min (Group 2). Unbleached specimens were placed in distilled water for 15 min and used as controls. After treatment, dentin was bonded with resin composite using 1-SEA or 2-SEA and stored in water at 37°C for 24 h. Each specimen was sectioned and trimmed to an hourglass-shape and μTBS was measured. Fractured specimens were examined under a scanning electron microscope to determine fracture modes. All specimens in Group 1 failed before proper bonding tests. In Group 2, the μTBS of 2-SEA was significantly greater (with no failed specimens) than 1-SEA (where 21 out of 36 failed). These results indicate that 2-SEA is a better adhesive system than 1-SEA on bleached dentin. Our results also demonstrated that application of H2O2 significantly decreases bond strength of resin to dentin; however, in the case of nonvital tooth bleaching, Pyrenees® is a better alternative to the conventional 30% H2O2 bleaching.

Walking bleach in primary teeth

Dental bleaching, also known as tooth whitening is a common procedure in dentistry. Dental bleaching in primary teeth has been reported with less frequency when compared to permanent teeth. Various methods are available for bleaching of both vital and nonvital teeth. The present article reports a clinical case of a 4-year-old girl who had discolored tooth 61 following pulpectomy procedure. Intra-coronal bleaching using sodium perborate with walking bleach technique was the treatment of choice. After a follow-up period of 3 weeks, an improvement in the discoloration was noticed.