Si Alqahtani2014

SDENTJ 157 No.
of Pages 14
15 March 2014
The Saudi Dental Journal (2014) xxx, xxx–xxx
1
King Saud University
The Saudi Dental Journal

www.ksu.edu.sa
www.sciencedirect.com
2 REVIEW ARTICLE
4 Tooth-bleaching procedures and their

5 Q1 controversial effects: A literature review
6 Q2 Mohammed Q. Alqahtani *
7 Q3 Restorative Dental Sciences Department, College of Dentistry, King Saud University, Saudi Arabia
8 Dental Biomaterials Research and Development Chair, College of Dentistry, King Saud University, Saudi Arabia
9 Received 5 January 2014; revised 15 February 2014; accepted 26 February 2014

10
12 KEYWORDS Abstract Aim: This review article will help clinicians improve their understanding of the history
13
14 Bleaching; of bleaching procedures, bleaching types, components, mechanisms, and their effects on soft tissue,
15 Pre-bleaching; tooth structures, resin composite, and bonding.
16 Post-bleaching; Methods: The controversial issues about bleaching procedures and their effects are reviewed.
17 Bonding Additionally, the consequences of pre- and post-bleaching on the bonding potential of composite
resin restorations to tooth structure are discussed.
Conclusion: The overall goal of the paper is to help reduce risks for patients.
18 ª 2014 Production and hosting by Elsevier B.V. on behalf of King Saud University.
19 Contents
20 1. History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
21 2. Types of stains/discolorations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
22 2.1. Extrinsic stains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
23 2.2. Intrinsic stains . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
24 3. Composition of commercial bleaching agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
25 4. Mechanism of tooth bleaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
26 4.1. Types of dental bleaching procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
27 4.1.1. Vital tooth bleaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
28 4.1.2. Non-vital tooth bleaching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
29 5. Effects of the bleaching process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
* Address: College of Dentistry, King Saud University, P.O.

Box 60169, Riyadh 11545, Saudi Arabia. Mobile: +966 503486898.
E-mail address: malqathani@ksu.edu.sa
Peer review under responsibility of King Saud University.
Production and hosting by Elsevier
1013-9052 ª 2014 Production and hosting by Elsevier B.V. on behalf of King Saud University.
http://dx.doi.org/10.1016/j.sdentj.2014.02.002
Q1 Please cite this article in press as: Alqahtani, M.Q. Tooth-bleaching procedures and their controversial effects: A literature review. The Saudi Dental
Journal (2014), http://dx.doi.org/10.1016/j.sdentj.2014.02.002
SDENTJ 157 No. of Pages 14
15 March 2014
2 M.Q. Alqahtani
30 5.1. Effects on soft tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

31 5.2. Systemic effects. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
32 5.3. Effects of dental bleaching on tooth structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
33 5.3.1. Effects on Enamel surface morphology and texture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
34 5.3.2. Effects on Enamel surface hardness and wear resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
35 5.3.3. Effects on enamel chemical composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
36 5.3.4. Effects on dentin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
37 5.4. Effects of dental bleaching on composite resin restorations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
38 5.4.1. Surface properties and microhardness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
39 5.4.2. Color changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
40 5.4.3. Effects on marginal quality and microleakage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
41 5.4.4. Effects on the bonding of composite resin restorations to tooth structure . . . . . . . . . . . . . . . . . . . . . . . . . . 00
42 6. Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
43 Ethical statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
44 Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
45 Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
46 References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
47
48
49 1. History a light source was regarded as an acceptable method in dental 89

clinics (Fisher, 1911). 90
50 The history of dentistry is comprised of many efforts under- Furthermore, in the late 1960s, a successful home-bleaching 91
51 taken to achieve an effective tooth-whitening method. Non-vital technique was established when Dr. Bill Klusmier, an ortho- 92
52 tooth bleaching began in 1848 with the use of chloride of lime dontist, instructed his patients to use an ‘‘over-the-counter’’ 93
53 (Dwinelle, 1850), and in 1864, Truman introduced the most oral antiseptic, Gly-Oxide (Marion Merrell Dow, Kansas City, 94
54 effective technique for bleaching non-vital teeth, a method MO, USA), which contained 10% carbamide peroxide deliv- 95
55 which used chlorine from a solution of calcium hydrochlorite ered via a custom-fitting mouth tray at night. Dr. Klusmier 96
56 and acetic acid (Kirk, 1889). The commercial derivative of this, found that this treatment not only improved gingival health 97
57 later known as Labarraque’s solution, was an aqueous solution but also whitened teeth (Haywood et al., 1990). 98
58 of sodium hypochlorite (Woodnut, 1861; M’Quillen, 1868). In Subsequently, Proxigel (a mixture of 10% carbamide per- 99
59 the late nineteenth century, many other bleaching agents were oxide, water, glycerin, and carbopol) was marketed and re- 100
60 also successfully used on non-vital teeth (Haywood, 1992), placed Gly-Oxide for orthodontic patients, because of its 101
61 including cyanide of potassium (Kingsbury, 1861), oxalic acid slow release of carbamide peroxide. Later on, the University 102
62 (Bogue, 1872), sulfurous acid (Kirk, 1889), aluminum chloride of North Carolina clinically approved the clinical effectiveness 103
63 (Harlan, 1891), sodium hypophosphate (Harlan, 1891), pyroz- of Proxigel. Then, Haywood and Heymann (1989) described a 104
64 one (Atkinson, 1892), hydrogen dioxide (hydrogen peroxide home-bleaching technique in their article, ‘‘Nightguard vital 105
65 or perhydrol), and sodium peroxide (Kirk, 1893). All these sub- bleaching’’, and an at-home bleaching product ‘‘White and 106
66 stances were considered as either direct or indirect oxidizers act- Brite’’ (Omni International, Albertson, NY, USA) was intro- 107
67 ing on the organic portion of the tooth, except for sulfurous duced. Later, many other bleaching products and techniques 108
68 acid, which was a reducing agent (Kirk, 1889). Subsequently, have been introduced (Haywood, 1991). 109
69 it became known that the most effective direct oxidizers were The ‘‘over-the-counter’’ (OTC) bleaching agents were first 110
70 Pyrozone, Superoxol, and sodium dioxide, while the indirect launched in the United States in the 1990s, containing lower 111
71 oxidizer of choice was a chlorine derivative (Franchi, 1950). concentrations of hydrogen peroxide or carbamide peroxide 112
72 In fact, when Superoxol was introduced, it became the and sold directly to consumers for home use (Greenwall 113
73 chemical substance used by most dentists, because of its high et al., 2001). 114
74 safety (Pearson, 1951). Pyrozone continued to be used effec- Finally, the current in-office bleaching technique typically 115
75 tively for non-vital teeth in the late 1950s and early 1960s uses different concentrations of hydrogen peroxide, between 116
76 (Pearson, 1958), as was sodium perborate (Spasser, 1961). In 15% and 40%, with or without light and in the presence of 117
77 the late 1970s, Nutting began to use Superoxol instead of rubber dam isolation (Haywood, 2000; Ontiveros, 2011). 118
78 Pyrozone, for safety purposes, and later combined it with

79 sodium perborate to attain a synergistic effect (Nutting, 2. Types of stains/discolorations 119
80 1976). Moreover, he recommended the use of Amosan (Knox
81 Mfg. Co., Tulsa, OK, USA), a sodium peroxyborate mono hy- Many types of color problems may affect the appearance of 120
82 drate, because it is known to release more oxygen than sodium teeth, and the causes of these problems vary, as does the speed 121
83 perborate. Also, he recommended that gutta-percha should be with which they may be removed. Therefore, the causes of 122
84 sealed before any procedure. tooth staining must be carefully assessed for better prediction 123
85 Vital teeth were also bleached as early as 1868, by means of of the rate and the degree to which bleaching will improve 124
86 oxalic acid (Latimer, 1868) or Pyrozone (Atkinson, 1892) and tooth color, since some stains are more responsive to the pro- 125
87 later with hydrogen peroxide (Fisher, 1911). In 1911, the use of cess than others (Haywood and Heymann, 1989; Jordan and 126
88 concentrated hydrogen peroxide with a heating instrument or Boksman, 1984). Discolorations may be extrinsic or intrinsic. 127
15 March 2014
Q1 Tooth-bleaching procedures and their effects 3
128 2.1. Extrinsic stains brown fluorescence are moderately responsive (Haywood 186
et al., 1994; Leonard et al., 2003). 187
129 Extrinsic stains usually result from the accumulation of chro-

130 matogenic substances on the external tooth surface. Extrinsic 3. Composition of commercial bleaching agents 188
131 color changes may occur due to poor oral hygiene, ingestion
132 of chromatogenic food and drinks, and tobacco use. These
Current bleaching agents contain both active and inactive 189
133 stains are localized mainly in the pellicle and are either gener-
ingredients. The active ingredients include hydrogen peroxide 190
134 ated by the reaction between sugars and amino acids or ac-
135 quired from the retention of exogenous chromophores in the or carbamide peroxide compounds. However, the major inac- 191
tive ingredients may include thickening agents, carrier, surfac- 192
136 pellicle (Viscio et al., 2000). The reaction between sugars and
tant and pigment dispersant, preservative, and flavoring. 193
137 amino acids is called the ‘‘Millard reaction’’ or the ‘‘non-enzy-
138 matic browning reaction,’’ and includes chemical rearrange-
(a) Thickening agents: Carbopol (carboxypolymethylene) is 194
139 ments and reactions between sugars and amino acids. The
the most commonly used thickening agent in bleaching 195
140 chemical analysis of stains caused by chromatogenic food dem-
141 onstrates the presence of furfurals and furfuraldehyde deriva- materials. Its concentration is usually between 0.5% 196
and 1.5%. This high-molecular-weight polyacrylic acid 197
142 tives due to this reaction (Viscio et al., 2000).
polymer offers two main advantages. First, it increases 198
143 In addition, the retention of exogenous chromophores in
144 the pellicle occurs when salivary proteins are selectively at- the viscosity of the bleaching materials, which allows for 199
better retention of the bleaching gel in the tray. Second, 200
145 tached to the enamel surface through calcium bridges; conse-
it increases the active oxygen-releasing time of the bleach- 201
146 quently, a pellicle will form. At the early stage of staining,
ing material by up to 4 times (Rodrigues et al., 2007). 202
147 chromogens interact with the pellicle via hydrogen bridges.
148 Most extrinsic tooth stains can be removed by routine prophy- (b) Carrier: Glycerin and propylene glycol are the most 203
commonly used carriers in commercial bleaching agents. 204
149 lactic procedures. With time, these stains will darken and be-
The carrier can maintain moisture and help to dissolve 205
150 come more persistent, but they are still highly responsive to
151 bleaching (Goldstein and Garber, 1995). other ingredients. 206
(c) Surfactant and pigment dispersant: Gels with surfactant 207
152 2.2. Intrinsic stains or pigment dispersants may be more effective than those 208
without them (Feinman et al., 1991). The surfactant acts 209
as a surface-wetting agent which permits the active 210
153 Intrinsic stains are usually caused by deeper internal stains or
bleaching ingredient to diffuse. Moreover, a pigment 211
154 enamel defects. They are caused by aging, ingestion of chroma-
dispersant keeps pigments in suspension. 212
155 togenic food and drinks, tobacco usage, enamel microcracks,
(d) Preservative: Methyl, propylparaben, and sodium ben- 213
156 tetracycline medication, excessive fluoride ingestion, severe
zoate are commonly used as preservative substances. 214
157 jaundice in infancy, porphyria, dental caries, restorations,
They have the ability to prevent bacterial growth in 215
158 and the thinning of the enamel layer.
bleaching materials. In addition, these agents can 216
159 Aging is a common cause of discoloration. Over time, the
accelerate the breakdown of hydrogen peroxide by 217
160 underlying dentin tends to darken due to the formation of sec-
releasing transitional metals such as iron, copper, and 218
161 ondary dentin, which is darker and more opaque than the ori-
magnesium. 219
162 ginal dentin, and when the overlying enamel becomes thinner.
(e) Flavoring: Flavorings are substances used to improve the 220
163 This combination often results in darker teeth.
taste and the consumer acceptance of bleaching prod- 221
164 Excessive fluoride in drinking water, greater than 1–2 ppm,
ucts. Examples include peppermint, spearmint, winter- 222
165 can cause metabolic alteration in ameloblasts, resulting in a
green, sassafras, anise, and a sweetener such as saccharin. 223
166 defective matrix and improper calcification of teeth (Dodson
224
167 and Bowles, 1991).
168 Discoloration from drug ingestion may occur either before
169 or after the tooth is fully formed. Tetracycline is incorporated 4. Mechanism of tooth bleaching 225
170 into the dentin during tooth calcification, probably through

171 chelation with calcium, forming tetracycline orthophosphate, The mechanism of bleaching by hydrogen peroxide is not well- 226
172 which causes discoloration. Moreover, intrinsic stains are also understood. In-office and home bleaching gels contain hydro- 227
173 associated with inherited conditions (e.g., amelogenesis imper- gen peroxide or its precursor, carbamide peroxide, as the active 228
174 fecta and dentinogenesis imperfecta) (Nathoo, 1997; Viscio ingredient in concentrations ranging from 3% to 40% of 229
175 et al., 2000). Blood penetrating the dentinal tubules and met- hydrogen peroxide equivalent. Hydrogen peroxide bleaching 230
176 als released from dental restorative materials also cause generally proceeds via the perhydroxyl anion (HO2 ). Other 231
177 stains. conditions can give rise to free radical formation, for example, 232
178 Intrinsic stains cannot be removed by regular prophylactic by homolytic cleavage of either an O–H bond or the O–O bond 233
179 procedures. However, they can be reduced by bleaching with in hydrogen peroxide to give H + OOH and 2OH (hydroxyl 234
180 agents penetrating enamel and dentin to oxidize the chromo- radical), respectively (Kashima-Tanaka et al., 2003). Under 235
181 gens. Tooth stains caused by aging, genetics, smoking, or cof- photochemical reactions initiated by light or lasers, the forma- 236
182 fee are the fastest to respond to bleaching: Yellowish aging tion of hydroxyl radicals from hydrogen peroxide has been 237
183 stains respond quickly to bleaching in most cases (Haywood, shown to increase (Kashima-Tanaka et al., 2003). Hydrogen 238
184 2000), whereas blue–gray tetracycline stains are the slowest peroxide is an oxidizing agent that, as it diffuses into the tooth, 239
185 to respond to bleaching (Haywood, 1991), while teeth with dissociates to produce unstable free radicals which are hydro- 240
15 March 2014
4 M.Q. Alqahtani
241 xyl radicals (HO), perhydroxyl radicals (HOO), perhydroxyl by the patients themselves, but it should be supervised by den- 300
242 anions (HOO–), and superoxide anions (OO–), which will at- tists during recall visits. The bleaching gel is applied to the teeth 301
243 tack organic pigmented molecules in the spaces between the through a custom-fabricated mouth guard worn at night for at 302
244 inorganic salts in tooth enamel by attacking double bonds of least 2 weeks. This technique has been used for many decades 303
245 chromophore molecules within tooth tissues (Dahl and Palle- and is probably the most widely used (Sulieman, 2005a). 304
246 sen, 2003; Joiner, 2006; Minoux and Serfaty, 2008). The The at-home technique offers many advantages: self- 305
247 change in double-bond conjugation results in smaller, less administration by the patient, less chair-side time, high degree 306
248 heavily pigmented constituents, and there will be a shift in of safety, fewer adverse effects, and low cost. Despite the fact 307
249 the absorption spectrum of chromophore molecules; thus, that patients are able to bleach at their own pace, this at-home 308
250 bleaching of tooth tissues occurs. bleaching technique, with its various concentrations of bleach- 309
251 In the case of tetracycline-stained teeth, the cause of discol- ing materials and regimens, has become the gold standard by 310
252 oration is derived from photo-oxidation of tetracycline which other techniques are judged. However, it is by no means 311
253 molecules available within the tooth structures (Mello, 1967). without disadvantages, since active patient compliance is man- 312
254 The bleaching mechanism in this case takes place by chemical datory and the technique suffers from high dropout rates 313
255 degradation of the unsaturated quinone-type structures found (Leonard et al., 2003). In addition, color change is dependent 314
256 in tetracycline, leading to fewer colored molecules (Feinman on diligence of use, and the results are sometimes less than 315
257 et al., 1991). Vital bleaching via a long-term night guard can ideal, since some patients do not remember to wear the trays 316
258 sometimes improve the color of tetracycline-stained teeth every day. In contrast, excessive use by overzealous patients 317
259 (Leonard et al., 2003). is also possible, which frequently causes thermal sensitivity, re- 318
260 More recently, amorphous calcium phosphate (ACP) has ported to be as high as 67% (Haywood, 1992). 319
261 been added to some of the tooth whitening products, to reduce A 35% concentration of hydrogen peroxide is recommended 320
262 sensitivity, reduce the demineralization of enamel through a by some clinicians for in-office dental bleaching, followed by 321
263 remineralization process after whitening treatments, and add at-home bleaching with gels containing 10%, 15%, or 20% 322
264 a lustrous shine to teeth. A study proved that the bleaching carbamide peroxide (Langsten et al., 2002). Bailey and Swift 323
265 treatments promoted increased sound enamel demineraliza- (1992) showed that higher-concentration bleaching agents can 324
266 tion, while the addition of Ca ions or ACP did not prevent/re- produce more peroxide radicals for bleaching, resulting in a fas- 325
267 verse the effects caused by the bleaching treatment in both ter whitening process. However, this rapid process of bleaching 326
268 conditions of the enamel. Early artificial caries induced by may increase the side-effects of tooth sensitivity, gingival irrita- 327
269 pH cycling model were not affected by the bleaching treatment, tion, throat irritation, and nausea (Broome, 1998). 328
270 regardless of the type of bleaching agent. (Berger et al., 2012). Finally, over-the-counter (OTC) bleaching products have 329
increased in popularity in recent years. These products are 330
271 4.1. Types of dental bleaching procedures composed of a low concentration of whitening agent (3–6% 331
hydrogen peroxide) and are self-applied to the teeth via gum 332
272 4.1.1. Vital tooth bleaching shields, strips, or paint-on product formats. They are also 333
available as whitening dentifrices, pre-fabricated trays, whiten- 334
273 There are three fundamental approaches for bleaching vital ing strips, and toothpastes (Zantner et al., 2007). They should 335
274 teeth: in-office or power bleaching, at-home or dentist-super- be applied twice per day for up to 2 weeks. OTC products are 336
275 vised night-guard bleaching, and bleaching with over-the- considered to be the fastest growing sector of the dental mar- 337
276 counter (OTC) products (Kihn, 2007). ket (Kugel, 2003). However, these bleaching agents may be of 338
277 First, in-office bleaching utilizes a high concentration of highly questionable safety, because some are not regulated by 339
278 tooth-whitening agents (25–40% hydrogen peroxide). Here, the Food and Drug Administration. 340
279 the dentist has complete control throughout the procedure
280 and has the ability to stop it when the desired shade/effect is
281 achieved. In this procedure, the whitening gel is applied to 4.1.2. Non-vital tooth bleaching 341
282 the teeth after protection of the soft tissues by rubber dam There are numerous non-vital bleaching techniques used to- 342
283 or alternatives (Powell and Bales, 1991), and the peroxide will day, for example, walking bleach and modified walking bleach, 343
284 further be activated (or not) by heat or light for around one non-vital power bleaching, and inside/outside bleaching. The 344
285 hour in the dental office (Sulieman, 2004). Different types of walking bleach technique involves sealing a mixture of sodium 345
286 curing lights including; halogen curing lights, Plasma arc perborate with water into the pulp chamber of the affected 346
287 lamp, Xe–halogen light (Luma Arch), Diode lasers (both 830 tooth, a procedure that is repeated at intervals until the desired 347
288 and 980 nm wavelength diode lasers), or Metal halide (Zoom) bleaching result is achieved. This technique is modified with a 348
289 light can be used to activate the bleaching gel or accelerate the combination of 30% hydrogen peroxide and sodium perborate 349
290 whitening effect. The in-office treatment can result in signifi- sealed into the pulp chamber for one week; this is known as 350
291 cant whitening after only one treatment, but many more modified walking bleach. In internal non-vital power bleach- 351
292 may be needed to achieve an optimum result (Sulieman, ing, hydrogen peroxide gel (30–35%) is placed in the pulp 352
293 2005b). chamber and activated either by light or heat, and the temper- 353
294 Second, at-home or dentist-supervised night-guard bleach- ature is usually between 50 and 60 C maintained for five 354
295 ing basically involves the use of a low concentration of whiten- minutes before the tooth is allowed to cool for a further 355
296 ing agent (10–20% carbamide peroxide, which equals 3.5–6.5% 5 min. Then, the gel is removed, the tooth is dried, and the 356
297 hydrogen peroxide). In general, it is recommended that the 10% ‘walking bleach technique’ is used between visits until the 357
298 carbamide peroxide be used 8 h per day, and the 15–20% car- tooth is reviewed 2 weeks later to assess if further treatment 358
299 bamide peroxide 3–4 h per day. This treatment is carried out is needed. Finally, the inside/outside bleaching technique is a 359
15 March 2014
360 combination of internal bleaching of non-vital teeth with the depth of enamel grooves (Abouassi et al., 2011; Azrak et al., 412
361 home bleaching technique (Setien et al., 2008). 2010; Ben-Amar et al., 1995; Bitter, 1992, 1998; Hegedus 413
et al., 1999; Josey et al., 1996; Sa et al., 2013; Titley et al., 414
362 5. Effects of the bleaching process 1992; Xu et al., 2011). 415
In a scanning electron microscopy (SEM) analysis, Hay- 416
363 5.1. Effects on soft tissues wood et al. (1990) reported no morphological changes in the 417
enamel surface after the application of 10% carbamide perox- 418
ide bleaching. Titley et al. (1992) observed a slight increase in 419
364 The more powerful in-office bleaching (30–35% hydrogen per-
surface roughness, whereas Hunsaker et al. (1990) and Gurgan 420
365 oxide) can easily produce soft-tissue burns, turning the tissue
et al. (1997) reported no modification of surface roughness. 421
366 white (Barghi and Morgan, 1997). In general, these tissue
Moreover, Ernst et al. (1996) reported slight, insignificant, or 422
367 burns are reversible with no long-term consequences if the
no changes on enamel surfaces under 3000· magnification 423
368 exposure to the bleaching material is limited in time and quan-
and using 30% solutions of hydrogen peroxide. 424
369 tity. Rehydration and application of an antiseptic ointment
In contrast, other studies have reported that dental bleach- 425
370 quickly return the color to the tissue (Barghi, 1998). Therefore,
ing might induce morphological alteration of enamel surfaces, 426
371 it is very important to protect soft tissues with a rubber dam or
such as increased porosity, shallow depressions, and slight 427
372 other measures to prevent tissue burns. In addition, soft-tissue
erosion. Using atomic force microscopy, Hegedus et al. 428
373 irritation has been reported with at-home bleaching. This irri-
(1999) observed changes in the enamel surface after 28 h of 429
374 tation is most likely due to an ill-fitting tray rather than to the
bleaching with 10% carbamide peroxide and 30% hydrogen 430
375 bleaching agent itself (Li, 1997).
peroxide, and found that the sample’s surface became more 431
irregular and surface grooves became deeper after bleaching 432
376 5.2. Systemic effects treatment. Azrak et al. (2010) conducted an in vitro study to 433
assess the effects of bleaching agents on eroded and sound 434
377 There is more concern about the possible adverse effects of enamel specimens. They used enamel specimens prepared from 435
378 home-bleaching agents, although their concentrations are far human permanent anterior teeth incubated with different 436
379 below those of in-office bleaching agents, because the latter bleaching agents containing active ingredients such as 7.5% 437
380 are controlled by the dentist. Occasionally, patients report gas- or 13.5% hydrogen peroxide or 35% carbamide peroxide, 438
381 trointestinal mucosal irritation, e.g., a burning palate and ranging in pH from 4.9 to 10.8. To induce erosive changes, 439
382 throat, and minor upsets in the stomach or intestines (Howard, enamel specimens were incubated for 10 h with apple juice. 440
383 1992; Pohjola et al., 2002). However, most reports in the liter- Then, pretreated and untreated dental slices were incubated 441
384 ature have concluded that the use of low concentrations of with one of the bleaching agents for 10 h. An optical profilo- 442
385 hydrogen peroxide in tooth bleaching is still safe (Freedman, metric device was used to measure surface roughness of all 443
386 1990; Reddy and Salkin, 1976; Shipman et al., 1971; Stindt enamel specimens. Results indicated that exposure to an acidic 444
387 and Quenette, 1989). bleaching agent (pH = 4.9) led to a higher surface roughness 445
than treatment with a high peroxide concentration 446
388 5.3. Effects of dental bleaching on tooth structure (pH = 6.15), and that bleaching agents with a high concentra- 447
tion of peroxide or an acidic pH can provoke surface rough- 448
389 There is still controversy over the effects of dental bleaching on ness of sound or eroded enamel. Furthermore, Josey et al. 449
390 the physical properties of enamel and dentin. (1996) examined the effect of a night-guard vital bleaching pro- 450
cedure on enamel surface morphology and the shear bond 451
391 5.3.1. Effects on Enamel surface morphology and texture strength (SBS) of a composite resin luting cement to enamel. 452
They used extracted human teeth which were bleached for 453
392 Many studies in the literature have investigated the effects of
1 week with a vital bleaching product. The results of this study 454
393 bleaching on enamel morphology and the surface texture mor-
suggested that bleaching caused changes to the surface and 455
394 phological alteration of the enamel surface – increased poros-
subsurface layers of enamel. However, the SBS of composite 456
395 ity of the superficial enamel structure, demineralization and
resin luting cement to etched bleached enamel appeared to 457
396 decreased protein concentration, organic matrix degradation,
be clinically acceptable. Moreover, Bitter (1992, 1998) con- 458
397 modification in the calcium:phosphate ratio, and calcium loss
ducted two studies, the first of which examined the effects of 459
398 – thereby supporting the hypothesis that bleaching agents are
bleaching agents on the enamel surface using SEM by compar- 460
399 chemically active components potentially able to induce sub-
ison of treated with untreated enamel, and concluded that the 461
400 stantial structural alterations in human dental enamel (Abou-
treated surface showed increased surface change and porosity 462
401 assi et al., 2011; Azrak et al., 2010; Ben-Amar et al., 1995;
after the equivalent of 30 h of exposure to the bleaching agent 463
402 Bitter, 1992, 1998; Cadenaro et al., 2010; Ernst et al., 1996;
(Bitter, 1992). The second study included an in vivo exposure of 464
403 Gurgan et al., 1997; Haywood et al., 1990; Hegedus et al.,
bleaching agents used to evaluate the short- and long-term 465
404 1999; Hunsaker et al., 1990; Sa et al., 2013; Smidt et al.,
effects on the enamel surface; the results were demonstrated 466
405 2011; Sun et al., 2011; Titley et al., 1992; Xu et al., 2011). Some
by scanning electron microscopy (Bitter, 1998). In that study, 467
406 studies have reported that bleaching did not significantly affect
he found that exposure to the bleaching agents for 14 days cre- 468
407 Q4 the enamel surface (Cadenaro et al., 2010; Ernst et al., 1996;
ated an alteration of the enamel surface and caused exposure 469
408 Gurgan et al., 1997; Haywood et al., 1990; Hunsaker et al.,
of enamel prisms. In addition, a 21- to 90-day post-exposure 470
409 1990; Smidt et al., 2011; Sun et al., 2011). However, other
SEM evaluation demonstrated an alteration of the surface 471
410 investigations demonstrated morphological alterations in the
enamel, indicating an exposure of the enamel prismatic layer, 472
411 bleached enamel surface: depressions, porosity, and increased
frequently to the depth of the enamel rods and possibly the 473
15 March 2014
6 M.Q. Alqahtani
474 dentin. However, this study lacked adequate controls, the tooth enamel in terms of chemical structure, mechanical prop- 536
475 patients’ oral hygiene was not monitored, and compliance erties, surface morphology, and tooth color and concluded that 537
476 could have been poor, since the teeth were scheduled for neutral 30% hydrogen peroxide had the same efficiency in tooth 538
477 extraction. Moreover, 35% carbamide peroxide bleaching bleaching and caused less deleterious effects on enamel than did 539
478 agent was used, which is not acceptable because it is considered the acidic 30% hydrogen peroxide. Finally, Sa et al. (2013) dem- 540
479 to be too high for long-term night-guard vital bleaching (Bit- onstrated that in-office bleaching agents with low pH values 541
480 ter, 1998). could induce enamel morphology alterations under in vitro con- 542
481 Ben-Amar et al. (1995) used SEM to conduct an in vitro ditions, and that the presence of natural human saliva could 543
482 study to evaluate the effect of Opalescence home bleaching eliminate the demineralization effect caused by low pH. 544
483 (10% carbamide peroxide) in a mouth guard on enamel
484 surfaces and morphology. They found that bleaching created 5.3.2. Effects on Enamel surface hardness and wear resistance 545
485 some enamel pitting because, since it contains hydroxyl radi- Enamel surface hardness and wear resistance after dental 546
486 cals which are highly reactive, unstable, and will attack most bleaching have also been investigated in the literature. Some 547
487 organic molecules to achieve stability, the agent removed some studies (Araujo Fde et al., 2010; Potočnik et al., 2000; Sasaki 548
488 of the organic components of the enamel, and thus could lead et al., 2009) showed no effects, while others (Azer et al., 549
489 to changes in the mechanical properties of the enamel, such as 2009; de Arruda et al., 2012) showed significant decreases in 550
490 changing the abrasion resistance of the enamel surface (Seghi hardness and fracture resistance. Sasaki et al. (2009) studied 551
491 and Denry, 1992). the effect of home-use bleaching agents containing 10% 552
492 A more recent study, by Smidt et al. (2011), evaluated carbamide peroxide and 7.5% hydrogen peroxide on enamel 553
493 the morphologic, mechanical, and chemical effects of three microhardness and surface micromorphology. They concluded 554
494 carbamide peroxide bleaching agents on human enamel in situ that these bleaching agents may change the surface micromor- 555
495 using Nitewhite (16% carbamide peroxide, Discus Dental, phology of enamel, although no changes in microhardness 556
496 Philips Oral Healthcare, Stamford, CT, USA), Polanight were detected. Potočnik et al. (2000) evaluated the effect of 557
497 (16% carbamide peroxide), and Opalescence (15% carbamide 10% carbamide peroxide on the human enamel subsurface 558
498 peroxide, Ultradent, South Jordan, UT, USA). They found that layer in terms of microhardness, microstructure, and mineral 559
499 enamel surfaces showed no mechanical, morphologic, or chem- content. They found that 10% carbamide peroxide caused clin- 560
500 ical changes after bleaching with any of the three different car- ically insignificant local microstructural and chemical changes 561
501 bamide peroxide agents, and this may be attributed to the in enamel. In contrast, Azer et al. (2009) examined the nanoh- 562
502 protective effects of saliva, which provided dilution, buffering ardness and elastic modulus of human enamel after treatment 563
503 capacity, and a supply of Ca and P ions for tooth remineraliza- with tray and strip bleaching systems. They exposed human 564
504 tion. Using profilometric and SEM analyses of epoxy resin enamel samples to five different bleaching agents. Results 565
505 replicas of upper right incisors at baseline (control), and after showed that the nanohardness and elastic modulus of human 566
506 each bleaching treatment with a 38% hydrogen peroxide whit- enamel were significantly decreased after the application of 567
507 ening agent, applied four times at one-week intervals, Cadenaro home-bleaching systems. 568
508 et al. (2010) conducted an in vivo study to test the effect of a Moreover, Araujo Fde et al. (2010) investigated the effects 569
509 hydrogen peroxide in-office whitening agent on enamel. Results of various light sources on the microhardness of human dental 570
510 demonstrated that the application of a 38% hydrogen peroxide enamel following treatment with an in-office vital bleaching 571
511 in-office whitening agent did not change enamel surface rough- agent (35% hydrogen peroxide) using enamel slabs subjected 572
512 ness, even after multiple applications. However, Xu et al. (2011) to hardness testing after four time periods (baseline and after 573
513 investigated the influence of pH values of bleaching agents on 1, 7 and 14 days). Enamel slabs were then divided into five 574
514 the properties of the enamel surface using four groups treated groups according to the light source treatment: Group LA 575
515 with 30% hydrogen peroxide solutions with different pH val- (35% hydrogen peroxide + argon laser unit); Group HA 576
516 ues: HP3 group (pH = 3.0), HP5 group (pH = 5.0), HP7 group (35% hydrogen peroxide + halogen light-curing unit); Group 577
517 (pH = 7.0), and HP8 group (pH = 8.0). SEM investigation LED (35% hydrogen peroxide + LED-laser unit); Group OX 578
518 and micro-Raman spectroscopy were used to evaluate enamel (35% hydrogen peroxide + no light source unit); and Group 579
519 surface morphological and chemical composition alterations CO (control: saliva only). Results indicated that the different 580
520 and detected obvious enamel surface alterations in the neutral light sources tested did not significantly affect the microhard- 581
521 or alkaline bleaching solutions. ness of human enamel following treatment with 35% hydrogen 582
522 Abouassi et al. (2011) examined changes in the micromor- peroxide. 583
523 phology and microhardness of the enamel surface after bleach- In addition, de Arruda et al. (2012) studied the microhardness 584
524 ing with two different concentrations of hydrogen peroxide and histomorphology of bovine enamel after using 35% hydro- 585
525 and carbamide peroxide, using bleaching gels containing gen peroxide. The specimens in this study were adapted to 586
526 10% or 35% carbamide peroxide, or 3.6% or 10% hydrogen removable devices that were used by individuals undergoing a 587
527 peroxide, respectively, for two hours every second day over a dental caries challenge. It was concluded that 35% hydrogen per- 588
528 period of 2 weeks. They found that application of carbamide oxide enhanced the reduction in hardness and histomorphologic 589
529 peroxide and hydrogen peroxide showed only small quantita- changes in the enamel surfaces exposed to cariogenic challenge. 590
530 tive and qualitative differences. In addition, they found that
531 the influence of the bleaching procedure on the morphology
5.3.3. Effects on enamel chemical composition 591
532 and hardness of the enamel surface depended on the concen-
533 trations of the active ingredients. Regarding the effect of dental bleaching on enamel chemical 592
534 Furthermore, a study by Sun et al. (2011) investigated the ef- composition, many studies examined it by measuring the 593
535 fects of acidic and neutral 30% hydrogen peroxide on human changes in constituent enamel elements (Al-Salehi et al., 2007; 594
15 March 2014
595 Cakir et al., 2011; Düschner et al., 1997; Efeoglu et al., 2005; dentin’s abrasive wear, depending on erosive and abrasive 655
596 Goo et al., 2004; Lee et al., 2006; Rotstein et al., 1996; Tezel challenges. 656
597 et al., 2007). Al-Salehi et al. (2007) found that tooth-bleaching
598 agents might adversely affect tooth structure by demonstrating 5.4. Effects of dental bleaching on composite resin restorations 657
599 that, with increasing hydrogen peroxide concentrations, ion re-
600 lease from both enamel and dentin increased, and that microh- 5.4.1. Surface properties and microhardness 658
601 ardness of enamel decreased significantly with bleaching. Most studies addressing the effects of bleaching agents on the 659
602 Moreover, Efeoglu et al. (2005) used micro-computerized surface properties of composite showed that the effect of 660
603 tomography to evaluate the effect of 10% carbamide peroxide bleaching on the surface texture is material- and time-depen- 661
604 applied to enamel. Results indicated that this was found to dent (Polydorou et al., 2006). In some SEM studies and 662
605 cause demineralization of the enamel extending to a depth of profilometric analyses, it was shown that 10–16% carbamide 663
606 50 lm below the enamel surface. Therefore, they recommended peroxide bleaching gels may lead to a slight, but statistically 664
607 that the application of bleaching agents should be carefully con- significant, increase in surface roughness and numbers of 665
608 sidered in patients susceptible to caries and tooth wear. In an- porosities of microfilled and hybrid composite resins (Bailey 666
609 other two studies, Rotstein et al. (1996) and Tezel et al. (2007) and Swift, 1992; Türker and Biskin, 2003). However, in 667
610 proved that a concentrated bleaching agent caused a significant another SEM study, it was concluded that the application of 668
611 loss of calcium from the enamel surface. In a more recent study, 6% hydrogen peroxide gel to a hybrid composite in a cycling 669
612 Cakir et al. (2011) concluded that the use of home bleaching protocol, with intermittent storage in saliva, could modify or 670
613 agents (10%, 20%, and 35% carbamide peroxide) could affect weaken the impact of the hydrogen peroxide by formation of 671
614 the chemical composition of dental hard tissues, whereas the a surface-protective salivary layer on the restorative material 672
615 change in the chemical composition of enamel and dentin was (Schemehorn et al., 2004). In addition, cracking was also 673
616 not affected by the carbamide peroxide concentration of the observed in microfilled specimens after application of 10% car- 674
617 bleaching systems used. bamide peroxide for a period of four weeks (Bailey and Swift, 675
618 In contrast, Goo et al. (2004) demonstrated that mineral 1992). Also, a study was set to compare the superficial texture 676
619 loss caused by dental bleaching was not a threat to teeth. In of nanocomposites with that of microhybrid composites after 677
620 addition, Lee et al. (2006) showed that the amount of calcium different bleaching protocols (Wang et al., 2011). The authors 678
621 lost from teeth after 12 h of bleaching treatment was similar to used Filtek Supreme, Filtek Z350 (3M ESPE, Dental Products, 679
622 that lost from teeth exposed to a soft drink or juice for a few St. Paul, MN, USA), and Grandio (Voco, Cuxhaven, Ger- 680
623 minutes. These studies concluded that changes in the chemical many) nanocomposites and compared them with Opallis 681
624 composition of enamel were slight and not clinically (FGM Produtos odontológicos, Joinville, SC, Brazil) and Fil- 682
625 significant. tek Z250 (3M ESPE, Dental Products, St. Paul, MN, USA) 683
(control microhybrid composites) using three different bleach- 684
626 5.3.4. Effects on dentin ing agents: 35% hydrogen peroxide Whiteness HP (WHP), 685
627 Little has been published about the influence of dental bleach- 35% Whiteness HP MAXX (WMAXX) and 16% carbamide 686
628 ing on dentin structure compared with enamel. Zalkind et al. peroxide Whiteness Standard (WS). The results showed that 687
629 (1996) used SEM to reveal changes in dentin surface morphol- surface roughness alteration was material- and time-depen- 688
630 ogy. Pecora et al. (1994) found that dentin microhardness de- dent. While WHP treatment significantly altered the Filtek 689
631 creased after the application of a 10% carbamide peroxide Supreme composite over time, when WMAXX was used, 690
632 agent for 72 h. In a study conducted by Basting et al. (2003), Grandio displayed the most significant alterations in surface 691
633 results showed that the thickening agent (carbopol and/or roughness throughout the evaluation period, which was not 692
634 glycerin), not just the 10% carbamide peroxide, caused a de- observed for the other nanocomposites. When WS was used, 693
635 crease in dentin microhardness. In addition, Tam et al. over time, Filtek Z250 presented significant surface alterations 694
636 (2005) concluded that direct exposure to 10% carbamide per- that were not seen in the nanofilled materials. In this context, it 695
637 oxide caused a significant decrease in the flexural strength should also be mentioned that salivary proteins adsorbed onto 696
638 and flexural modulus of bovine dentin. Faraoni-Romano the surfaces of composite materials decrease after bleaching 697
639 et al. (2008) studied the effects of low and highly concentrated with peroxide-containing agents, which is suggested to have 698
640 bleaching agents on microhardness and surface roughness of an influence on bacterial adhesion of cariogenic bacteria, such 699
641 bovine enamel and root dentin and proved that while bleach- as Streptococcus sobrinus and Streptococcus mutans, but not 700
642 ing did not change enamel microhardness and surface rough- Actinomyces viscosus (Steinberg et al., 1999). 701
643 ness, it affected root dentin in terms of microhardness, which As for the effect of bleaching on surface microhardness of 702
644 seems to be dependent on the bleaching agent used. Moreover, composites, there is a controversy about the impact of low-con- 703
645 Lewinstein et al. (1994) showed a decrease in the microhard- centration 10–16% carbamide peroxide gels on surface microh- 704
646 ness of dentin following exposure to a 30% solution of hydro- ardness of restorative composite materials. In some 705
647 gen peroxide at pH 3, while Tam et al. (2007) found that investigations, softening of composite resins was associated 706
648 in vitro fracture resistance of dentin was reduced after the pro- with the application of at-home bleaching gels (Bailey and 707
649 longed use of bleaching products applied directly to dentin. In Swift, 1992; Lima et al., 2008; Türker and Biskin, 2002). Other 708
650 another study, Engle et al. (2010) conducted an investigation investigations revealed no significant changes in hardness (Gar- 709
651 of the effect of the interaction among bleaching, erosion, and cia-Godoy et al., 2002; Nathoo, 1997; Polydorou et al., 2007) or 710
652 dentifrice abrasivity on enamel and dentin. They indicated that even an increase in surface hardness (Campos et al., 2003; 711
653 bleaching with 10% carbamide peroxide did not increase the Türker and Biskin, 2003) due to the application of at-home 712
654 erosive and abrasive wear of enamel. However, it might change bleaching gels. In-office tooth whiteners (35% carbamide per- 713
15 March 2014
8 M.Q. Alqahtani
714 oxide or 35% hydrogen peroxide) were not reported to have Differences in color change between and among different 774
715 significant effects on the hardness and tensile strength of com- materials might be a result of different amounts of resin and 775
716 posite materials (Cullen et al., 1993; Yap and Watt- different degrees of conversion of the resin matrix. For the 776
717 anapayungkul, 2002). Using the Knoop hardness test, Hannig above-mentioned reasons, more color change was found in 777
718 et al. (2007) reported a significant decrease in the surface hard- chemically cured than in light-cured composites, and this dif- 778
719 ness of bleached composite resins (Tetric Flow, TetricEvoCe- ference can be mainly attributed to the composition of the ma- 779
720 ram; Ivoclar Vivadent, Schaan, Liechtenstein), not only on trix phase, especially the activator system (Inokoshi et al., 780
721 superficial surfaces, but also in the deeper layers of the filling 1996). Color stability of light-cured composites can be ex- 781
722 materials. These results were related to the high oxidation plained by the stability of its resin matrix. 782
723 and degradation of the resinous matrix in the composites Yu et al. (2009) found that bleached composite resins stain 783
724 (Taher, 2005). more easily than unbleached ones. The authors suggested that 784
725 Moreover, in 2013, the present author reported the results this staining could be caused by alterations in the surfaces of 785
726 of an in vitro study (Alqahtani, 2013) conducted to assess the the bleached restorations. However, two studies found that 786
727 effect of a 10% carbamide peroxide bleaching agent on the bleaching can remove stains from the external surface of a 787
728 microhardness of four types of direct resin-based restorative composite restoration (Fay et al., 1999; Villalta et al., 2006), 788
729 materials [Microhybrid resin composite (Z250) (3M ESPE, and another showed that bleaching with 10–15% hydrogen 789
730 St. Paul, MN, USA), a nanofilled resin composite (Z350) peroxide is more effective than polishing for removing stains 790
731 (3M ESPE, St. Paul, MN, USA), a silorane-based low-shrink and restoring the original color of the composite resin (Turkun 791
732 resin composite (P90) 3M ESPE, Seefeld, Germany, and a and Turkun, 2004). However, at a minimum, polishing of res- 792
733 hybrid resin composite (Valux Plus) (3M ESPE, St. Paul, torations after bleaching is advisable, since the increased sur- 793
734 MN, USA)]. The author divided specimens from each material face roughness is held to be responsible for increased 794
735 into three groups, selected one group as a control group (non- adherence of certain cariogenic microorganisms to the outer 795
736 treated with bleaching agent), and treated the other two groups surfaces of tooth-colored restorative materials after contact 796
737 with the bleaching agent for 14 days (Group A) and for with different bleaching agents, as assessed by Mor et al. 797
738 14 days followed by immersion in artificial saliva for 14 days (1998). 798
739 (Group B). In addition, the top surfaces of the specimens were
740 exposed to the Vickers hardness test with a load of 300 g. 5.4.3. Effects on marginal quality and microleakage 799
741 Results showed a general reduction of Vickers hardness values Two studies using the dye penetration test reported that, in ex- 800
742 of treated groups compared with the control group for each tracted teeth restored with composite restorations, post-opera- 801
743 material used; however, this reduction was minimal, and there tive contact with 35% hydrogen peroxide or 10–16% 802
744 was no significant difference between groups in Z250, whereas carbamide peroxide gel could adversely affect the marginal seal 803
745 the other three materials (Z350, P90, and Valux Plus) demon- at both dentin and enamel margins (Crim, 1992; Ulukapi et al., 804
746 strated a significant decrease of Vickers hardness of treated 2003). In contrast, another study found no increased micro- 805
747 groups compared with the control group. leakage rates, at least at enamel margins (White et al., 2008). 806
In that study, White et al. found that bleaching teeth with 807
748 5.4.2. Color changes Class I composite restorations with 20% carbamide peroxide 808
749 For standardized and reproducible evaluation of color changes did not affect the occlusal margins of the restorations, and 809
750 of restorative materials, colorimeters are used for analysis of therefore did not cause microleakage. 810
751 L*a*b* values according to the CIELAB system. Under oral Polydorou et al. (2009) studied the amount of monomer re- 811
752 conditions, DE* color differences have been reported to be leased from a bleached composite resin (Ceram X). They indi- 812
753 objectionable only when higher than 3.3 or 3.7 (Buchalla cated that less Bis-GMA (bisphenol A-glycidyl dimethacrylate) 813
754 et al., 2002; Inokoshi et al., 1996). The application of 10% and less UDMA-2 (urethane dimethacrylate) were released 814
755 hydrogen peroxide or heated 30% hydrogen peroxide resulted from composite resin restorations than from unbleached con- 815
756 in composite color changes which were presumably clinically trol samples, while the released concentration of TEGDMA 816
757 detectable with DE* ranging between 2 and 11 for the different (triethylene glycoldimethacrylate) molecules was similar to 817
758 materials and shades tested (Canay and Cehreli, 2003). In that of the control group. In a recent study, Ajami et al. 818
759 contrast, the use of 10% carbamide peroxide gel led to color (2012) evaluated the effects of Oral-B (OB), Listerine (LN), 819
760 changes of composite resins less than DE* 2, and these were and Rembrandt Plus (RM) mouthrinses on microleakage of 820
761 comparable with color changes of unbleached samples stored composite resin restorations bonded with two adhesive systems 821
762 in water only (Monaghan et al., 1992). Using a spectrophotom- (Excite and Clearfil SE Bond) after bleaching with 10% car- 822
763 eter, Li et al. (2009) found significant changes in the color of bamide peroxide. They demonstrated that microleakage with 823
764 nanohybrid and packable composite resins after bleaching with Excite was significantly higher than that with Clearfil SE Bond. 824
765 15% carbamide peroxide. Another study found that this differ- In addition, they found that microleakage with OB was higher 825
766 ence was especially noticeable when a high peroxide concentra- than that with LN. However, there were no significant differ- 826
767 tion (35%) was used on low-density resins such as microfilled ences in microleakage between LN and RM and between 827
768 composite resin (Hubbezoglu et al., 2008). The authors attrib- RM and OB. In addition, with the Excite adhesive system, 828
769 uted these results to the volume of resin matrices and filler type. microleakage with OB was higher than that with LN and 829
770 Generally, alterations in the color of restorative materials RM. They concluded that the use of some mouthrinses, such 830
771 have been attributed to oxidation of surface pigments and as OB, after bleaching can increase post-restoration microleak- 831
772 amine compounds, which have also been indicated as respon- age of resin composite restorations bonded with etch-and-rinse 832
773 sible for color instability of restorative materials over time. adhesive systems. 833
15 March 2014
834 5.4.4. Effects on the bonding of composite resin restorations to the adhesives could affect the efficacy of antioxidant as a 894
835 tooth structure reducing agent (Khoroushi and Aghelinejad, 2011; Khoroushi 895
836 The effects of dental bleaching on the bonding potential of and Saneie, 2012). Khoroushi and Saneie (2012) compared the 896
837 composite resin restorations to tooth structure can be divided SBS of three different adhesives: OptiBond FL (OFL; three- 897
838 into the effects of pre- and post-operative bleaching on the step etch & rinse), OptiBond Solo Plus (OSP; two-step etch 898
839 bonding of composite resin restorations to the tooth structure. & rinse), and OptiBond All-in-One (OA; one-step self-etch) 899
(Kerr, Orange, CA, USA) on bleached enamel immediately 900
after bleaching, bleached then delayed for one week, and 901
840 5.4.4.1. The effects of pre-operative dental bleaching on the bleached then an antioxidizing agent applied. Results showed 902
841 bonding potential of composite resin restorations to tooth that: for OFL, SBS of the sodium ascorbate group was signif- 903
842 structure. The reduction in bond strength of adhesive icantly higher than that of the unbleached control group; for 904
843 restorations to tooth structure after dental bleaching has been OSP, the sodium ascorbate group had no statistically signifi- 905
844 investigated widely in the literature. Some authors attributed cant difference from the unbleached control group; and for 906
845 the decrease in bond strength to the presence of residual perox- OA, the SBS was significantly lower than that of the 907
846 ide on the tooth surface, which interferes with the resin bond- unbleached control group. In addition, it was suggested that, 908
847 ing and prevents its complete polymerization (Dishman et al., in the etch-and-rinse adhesives, the use of sodium ascorbate 909
848 1994). Others mentioned that vital bleaching will alter the pro- is more appropriate than delayed bonding; however, in the 910
849 tein and mineral content of the superficial layers of enamel, self-etching adhesive under study, there was no difference be- 911
850 which may be responsible for reduced bond strength (Perdigão tween the two methods (Khoroushi and Saneie, 2012). More- 912
851 et al., 1998). over, they reported that the chemical composition of some 913
852 Titley et al. (1991) reported that, in the SEM evaluation of adhesives is more compatible with sodium ascorbate, to com- 914
853 bleached specimens, large areas of enamel surface were resin- pensate for the reduced bond strength after bleaching. 915
854 free and tags were poorly defined and fragmented and pene- In many studies, bonding resin composite after home 916
855 trated to a lesser depth when compared with those in the bleaching with 10% carbamide peroxide was compared with 917
856 unbleached control groups. In another study, SEM examina- the use of either etch-and-rinse or self-etch adhesives (Adebayo 918
857 tion of resin and bleached enamel interfaces displayed a porous et al., 2007; Gurgan et al., 2009; Moule et al., 2007). These 919
858 and granular view with a ‘bubbly’ appearance (Titley et al., studies proved that the SBS of bleached enamel was best when 920
859 1992). etch-and-rinse adhesives were used. Furthermore, Sung et al. 921
860 To improve the bond strength of previously bleached teeth, (1999) proposed the use of dental adhesives containing organic 922
861 different methods have been proposed in the literature. Some solvents to enhance bond strength. They suggested that the use 923
862 studies reported the effectiveness of 10% sodium ascorbate of an alcohol-based bonding agent (OptiBond) will result in 924
863 in reversing the compromised bond strength of enamel previ- less-compromised composite bond strength when the restor- 925
864 ously bleached with 10% carbamide peroxide when bonded ative treatment is to be completed immediately after bleaching 926
865 to resin composite (Kaya and Turkun, 2003; Kimyai and Val- (10% carbamide peroxide, Nite White Whitening System), 927
866 izadeh, 2006, 2008; Turkun et al., 2009). Lai et al. (2002) found while Montalvan et al. (2006) concluded that the SBS did 928
867 that surface treatment with an antioxidant (sodium ascorbate) not differ between the acetone- or ethanol-based adhesives 929
868 can immediately reverse the compromised bond strength of 24 h post-bleaching with 35% hydrogen peroxide (Opalescence 930
869 teeth bleached with hydrogen peroxide or teeth treated with Xtra, Ultradent). On the contrary, Niat et al. (2012) indicated 931
870 sodium hypochlorite. that the acetone-based adhesive (One Step) had a higher bond 932
871 Moreover, in a study conducted by Feiz et al. (2011), it was strength than did the alcohol-based adhesive (Single Bond). 933
872 suggested that the application of sodium ascorbate as an anti- Some investigators demonstrated that catalase or catalase- 934
873 oxidant could significantly increase the bond strength of com- like substances can be used as effective adjuncts after bleaching 935
874 posite resin to bleached dentin, while the use of calcium treatment to decrease the residual hydrogen peroxide on the 936
875 hydroxide as a buffering agent did not affect bond strength. bleached teeth (Kum et al., 2004). However, they reported that 937
876 In another study, Dabas et al. (2011) studied the effects of dif- catalase presently is not a practical agent to be used clinically, 938
877 ferent concentrations of hydrogel of sodium ascorbate (10% because of its short shelf life, need for refrigeration, and its 939
878 and 20%) on the bond strength of bleached enamel for various sensitivity to air. Other investigators mentioned that a-tocoph- 940
879 periods of time (30, 60, 120 min) and concluded that sodium erol formulated in solution results in a significant increase in 941
880 ascorbate hydrogel application following bleaching increased the bond strength of bleached enamel (Sasaki et al., 2009). 942
881 the resin-enamel bond strength, and that this was directly pro- However, they mentioned that a period of at least 1 week after 943
882 portional to its duration of application. However, there was no the bleaching treatment is still recommended before bonding 944
883 difference in bond strength with an increase in the concentra- procedures can precede. 945
884 tion of sodium ascorbate hydrogel. Furthermore, Danesh-Sani In addition, Vidhya et al. (2011) concluded that the use of 946
885 and Esmaili (2011) demonstrated that delaying the bonding grape seed extract (oligomeric proanthocyanidin complexes 947
886 procedure by one week after bleaching reduced the compro- [OPCs]), after bleaching with 38% hydrogen peroxide and 948
887 mised SBS of composite resin and resin-modified glass iono- prior to bonding procedures on enamel, completely neutralizes 949
888 mer. Furthermore, applying 10% sodium ascorbate hydrogel the deleterious effects of bleaching and significantly increases 950
889 in the treatment of bleached enamel surfaces reversed the com- bond strength. 951
890 promised SBS and might be an alternative to delayed bonding, Since the reduction in bond strength after dental bleaching 952
891 especially when restoration can be completed immediately has been shown to be reversible, the best method, according to 953
892 after bleaching. In addition, other recent studies found that the literature, is to postpone the bonding procedure for a per- 954
893 the method of application and the chemical composition of iod of time after tooth bleaching, which varies in many studies 955
15 March 2014
10 M.Q. Alqahtani
956 from 24 h to one week, 2 weeks, or even up to 4 weeks (Bulut damage caused to the restoration-dental structure bond 1017
957 et al., 2006; Turkun and Kaya, 2004; Turkun et al., 2009). strength by the bleaching agents is augmented by the increase 1018
in carbamide peroxide concentration, and that the resin com- 1019
958 5.4.4.2. The effects of post-operative dental bleaching on the posite bond to dentin was less sensitive to this adverse effect 1020
959 bonding potential of composite resin restorations to tooth than was the bond to enamel substrate. 1021
960 structure. Most available research in the current literature has In a more recent study, Dudek et al. (2012) investigated the 1022
961 focused on the preoperative influence of bleaching gels on adhe- effect of peroxide bleaching gel on the durability of the adhe- 1023
962 sion of composites to enamel. However, few studies have dealt sive bond among composite material, enamel, and dentin cre- 1024
963 with the influence of bleaching gels on the adhesive bond of pre- ated with the etch-and-rinse adhesive Gluma Comfort Bond 1025
964 viously prepared composite restorations. This effect was ana- (GLU) and with the self-etch adhesives Clearfil SE Bond 1026
965 lyzed by different methods, including measurement of bond (CLE), Adper Prompt (ADP), and iBond (IBO). They used a 1027
966 strength (Barcellos et al., 2010; Cavalli et al., 2005; Dudek microhybrid composite (Charisma). After 25 eight-hour cycles 1028
967 et al., 2012), fracture toughness (Far and Ruse, 2003), and of bleaching with a 20% carbamide peroxide bleaching gel 1029
968 microleakage (Crim, 1992; Polydorou et al., 2009; White et al., (Opalescence PF 20), the SBS was tested and compared with 1030
969 2008). In fact, the oxygen radicals released from peroxide that of one-day and two-month control specimens stored in 1031
970 bleaching materials are known for their high reactivity and non- water. Results demonstrated that the bleaching gel signifi- 1032
971 specific nature and may have side-effects on tooth tissues (in cantly decreased the bond strength on both enamel and dentin 1033
972 terms of affecting tooth chemical structure due to reduction in for the simplified single-step self-etch adhesives ADP and IBO 1034
973 the Ca/P ratio, enamel microhardness, dentin permeability, and markedly affected the fracture patterns of ADP specimens 1035
974 and surface morphology) (Attin et al., 2009; Tam et al., 2007), at the periphery of their bonded area. They concluded that the 1036
975 restorative materials (in terms of affecting their surface microh- durability of adhesive restorations can be detrimentally influ- 1037
976 ardness, color changes, surface properties, and marginal integ- enced by carbamide peroxide bleaching, and that different 1038
977 rity) (Hannig et al., 2007; Türker and Biskin, 2003; adhesives show various levels of sensitivity to the bleaching gel. 1039
978 Wattanapayungkul and Yap, 2003), and the bond between
979 them, which is usually the most susceptible to degradation. It 6. Summary 1040
980 was reported that these peroxide radicals are supposed to dam-
981 age the dental substrate bond to resin tags – in other words, the
982 hybrid layer – which is mainly responsible for the mechanisms of The increasing demand for tooth bleaching has driven many 1041
983 adhesion between teeth and resin composites (Nakabayashi manufacturers and researchers to develop bleaching products 1042
984 et al., 1982). to be used either in the dental office or at home. However, 1043
985 Cavalli et al. (2005) applied a bleaching agent containing as with any dental procedure, bleaching involves risks. For 1044
986 10% carbamide peroxide over composite-tooth interfaces that reason, this review article is provided to help clinicians im- 1045
987 bonded with two adhesive systems applied to enamel and den- prove their information about the bleaching process and their 1046
988 tin with Single Bond (SB) and Clearfil SE Bond (CB). Results understanding of the controversial issues regarding the effects 1047
989 indicated that bleaching significantly affected bond strength of of bleaching on teeth, resin composite, and bonding, to help re- 1048
990 CB to enamel, but no influence on bond strength to dentin was duce the risks to patients. 1049
991 noted for both adhesive systems. Moreover, Far and Ruse To minimize the risks, the involvement of dental profes- 1050
992 (2003) assessed the effects of carbamide peroxide concentra- sionals, the prevention of using of OTC bleaching products 1051
993 tion and length of exposure on fracture toughness of existing and the reduction of overused of bleaching products are neces- 1052
994 composite-dentin interfaces with 11%, 13%, 16%, and 21% sary. In addition to that interval of 2 weeks post-bleaching 1053
995 carbamide peroxide, and conducted tests after 1, 2, and procedure is found to be adequate to avoid adverse effects 1054
996 3 weeks, representing a cumulative exposure of 14, 42, and on the polymerization. 1055
997 70 h. Results suggested that cumulative exposure to a bleach- Finally, Clinicians should inform their patients about the 1056
998 ing agent for 70 h significantly decreased interfacial fracture possible changes that may occur on their dental restorations 1057
999 toughness, regardless of the concentration. For the 16% and during bleaching procedure as well as the possibility of replace- 1058
1000 21% concentrations, a significant reduction was observed after ment of the bleached restorations at the end of bleaching 1059
1001 42 h. It was concluded that bleaching could adversely affect the treatment. 1060
1002 interfacial fracture toughness of dentin-resin composite adhe-

1003 sive interfaces. Ethical statement 1061
1004 Barcellos et al. (2010) evaluated the effect of bleaching gel
1005 containing 10%, 15%, and 20% carbamide peroxide on the This review article does not require ethical approval. 1062
1006 bond strength of dental enamel or dentin and resin composite
1007 restorations. Results showed that carbamide peroxide bleach-
Conflict of interest 1063
1008 ing agents could significantly affect the micro-tensile bond
1009 strength (lTBS) between the restoration and dental structure.
1010 In addition, for groups in which the restoration was placed on The author of this manuscript has no conflict of interest to 1064
1011 enamel substrate, the control subgroup showed higher bond declare. 1065
1012 strength values when compared with subgroups subjected to

1013 bleaching with 15% and 20% carbamide peroxide. For groups Acknowledgments 1066
1014 with restorations in the dentin substrate, the control showed

1015 higher bond strength values compared with the subgroup trea- The author would like to thank Dr. Aminah Elmourad, Dem- 1067
1016 ted with 20% carbamide peroxide. The conclusion was that the onstrator, Restorative Dental Sciences, College of Dentistry, 1068
15 March 2014
1069 King Saud University; for her help in the collection of the lit- Buchalla, W., Attin, T., Hilgers, R.D., Hellwig, E., 2002. The effect of 1133
1070 erature articles for this review. water storage and light exposure on the color and translucency of a 1134
hybrid and a microfilled composite. J. Prosthet. Dent. 87, 264–270. 1135
Bulut, H., Turkun, M., Kaya, A.D., 2006. Effect of an antioxidizing 1136
1071 References agent on the shear bond strength of brackets bonded to bleached 1137
human enamel. Am. J. Orthod. Dentofacial Orthop. 129, 266–272. 1138
1072 Abouassi, T., Wolkewitz, M., Hahn, P., 2011. Effect of carbamide Cadenaro, M., Navarra, C.O., Mazzoni, A., et al, 2010. An in vivo 1139
1073 peroxide and hydrogen peroxide on enamel surface: an in vitro study of the effect of a 38 percent hydrogen peroxide in-office 1140
1074 study. Clin. Oral Investig. 15, 673–680. whitening agent on enamel. J. Am. Dent. Assoc. 141, 449–454. 1141
1075 Adebayo, O.A., Burrow, M.F., Tyas, M.J., 2007. Effects of condi- Cakir, F.Y., Korkmaz, Y., Firat, E., Oztas, S.S., Gurgan, S., 2011. 1142
1076 tioners on microshear bond strength to enamel after carbamide Chemical analysis of enamel and dentin following the application 1143
1077 peroxide bleaching and/or casein phosphopeptide-amorphous cal- of three different at-home bleaching systems. Oper. Dent. 36, 529– 1144
1078 cium phosphate (CPP-ACP) treatment. J. Dent. 35, 862–870. 536. 1145
1079 Ajami, A.A., Bahari, M., Oskoee, S.S., et al, 2012. Effect of three Campos, I., Briso, A.L., Pimenta, L.A., Ambrosano, G., 2003. Effects 1146
1080 different mouthrinses on microleakage of composite resin restora- of bleaching with carbamide peroxide gels on microhardness of 1147
1081 tions with two adhesive systems after bleaching with 10% restoration materials. J. Esthet. Restor. Dent. 15, 175–182, discus- 1148
1082 carbamide peroxide. J. Contemp. Dent. Pract. 13, 16–22. sion 183. 1149
1083 Al-Salehi, S.K., Wood, D.J., Hatton, P.V., 2007. The effect of 24 h Canay, S., Cehreli, M.C., 2003. The effect of current bleaching agents 1150
1084 non-stop hydrogen peroxide concentration on bovine enamel and on the color of light-polymerized composites in vitro. J. Prosthet. 1151
1085 dentine mineral content and microhardness. J. Dent. 35, 845–850. Dent. 89, 474–478. 1152
1086 Alqahtani, M., 2013. The effect of a 10% carbamide peroxide Cavalli, V., de Carvalho, R.M., Giannini, M., 2005. Influence of 1153
1087 bleaching agent on the microhardness of four types of direct resin- carbamide peroxide-based bleaching agents on the bond strength of 1154
1088 based restorative materials. Oper. Dent. 38, 316–323. resin-enamel/dentin interfaces. Braz. Oral Res. 19, 23–29. 1155
1089 Araujo Fde, O., Baratieri, L.N., Araujo, E., 2010. In situ study of in- Crim, G.A., 1992. Post-operative bleaching: effect on microleakage. 1156
1090 office bleaching procedures using light sources on human enamel Am. J. Dent. 5, 109–112. 1157
1091 microhardness. Oper. Dent. 35, 139–146. Cullen, D.R., Nelson, J.A., Sandrik, J.L., 1993. Peroxide bleaches: 1158
1092 Atkinson, C., 1892. Fancies and some facts. Dent. Cosmos 34, 968– effect on tensile strength of composite resins. J. Prosthet. Dent. 69, 1159
1093 972. 247–249. 1160
1094 Attin, T., Schmidlin, P.R., Wegehaupt, F., Wiegand, A., 2009. Dabas, D., Patil, A.C., Uppin, V.M., 2011. Evaluation of the effect of 1161
1095 Influence of study design on the impact of bleaching agents on concentration and duration of application of sodium ascorbate 1162
1096 dental enamel microhardness: a review. Dent. Mater. 25, 143–157. hydrogel on the bond strength of composite resin to bleached 1163
1097 Azer, S.S., Machado, C., Sanchez, E., Rashid, R., 2009. Effect of enamel. J. Conserv. Dent. 14, 356–360. 1164
1098 home bleaching systems on enamel nanohardness and elastic Dahl, J.E., Pallesen, U., 2003. Tooth bleaching––a critical review of 1165
1099 modulus. J. Dent. 37, 185–190. the biological aspects. Crit. Rev. Oral Biol. Med. 14, 292–304. 1166
1100 Azrak, B., Callaway, A., Kurth, P., Willershausen, B., 2010. Influence Danesh-Sani, S.A., Esmaili, M., 2011. Effect of 10% sodium 1167
1101 of bleaching agents on surface roughness of sound or eroded dental ascorbate hydrogel and delayed bonding on shear bond strength 1168
1102 enamel specimens. J. Esthet. Restor. Dent. 22, 391–399. of composite resin and resin-modified glass ionomer to bleached 1169
1103 Bailey, S.J., Swift Jr., E.J., 1992. Effects of home bleaching products enamel. J. Conserv. Dent. 14, 241–246. 1170
1104 on composite resins. Quintessence Int. 23, 489–494. de Arruda, A., Santos, P.D., Sundfeld, R., Berger, S., Briso, A., 2012. 1171
1105 Barcellos, D.C., Benetti, P., Fernandes Jr., V.V., Valera, M.C., 2010. Effect of hydrogen peroxide at 35% on the morphology of enamel 1172
1106 Effect of carbamide peroxide bleaching gel concentration on the and interference in the de-remineralization process: an in situ study. 1173
1107 bond strength of dental substrates and resin composite. Oper. Oper. Dent. 37, 518–525. 1174
1108 Dent. 35, 463–469. Dishman, M.V., Covey, D.A., Baughan, L.W., 1994. The effects of 1175
1109 Barghi, N., 1998. Making a clinical decision for vital tooth bleaching: peroxide bleaching on composite to enamel bond strength. Dent. 1176
1110 at-home or in-office? Compend. Contin. Educ. Dent. 19, 831–838. Mater. 10, 33–36. 1177
1111 Barghi, N., Morgan, J., 1997. Bleaching following porcelain veneers: Dodson, D., Bowles, W., 1991. Production of minocyclines pigment 1178
1112 clinical cases. Am. J. Dent. 10, 254–256. by tissue extracts [abstract]. J. Dent. Res. 70 (Spec Iss), 424. 1179
1113 Basting, R.T., Rodrigues Jr., A.L., Serra, M.C., 2003. The effects of Dudek, M., Roubickova, A., Comba, L., Housova, D., Bradna, P., 1180
1114 seven carbamide peroxide bleaching agents on enamel microhard- 2012. Effect of postoperative peroxide bleaching on the stability of 1181
1115 ness over time. J. Am. Dent. Assoc. 134, 1335–1342. composite to enamel and dentin bonds. Oper. Dent. 33, 394–407. 1182
1116 Ben-Amar, A., Liberman, R., Gorfil, C., Bernstein, Y., 1995. Effect Düschner, H., Götz, H., Øgaard, B., 1997. Fluoride-induced precip- 1183
1117 of mouthguard bleaching on enamel surface. Am. J. Dent. 8, 29– itates on enamel surface and subsurface areas visualised by electron 1184
1118 32. microscopy and confocal laser scanning microscopy. Eur. J. Oral 1185
1119 Berger, S.B., Pavan, S., Dos Santos, P.H., Giannini, M., Bedran- Sci. 105, 466–472. 1186
1120 Russo, A.K., 2012. Effect of bleaching on sound enamel and with Dwinelle, W., 1850. Ninth annual meeting of American Society of 1187
1121 early artificial caries lesions using confocal laser microscopy. Braz. Dental Surgeons-Article X. Am. Dent. Sci., 157–161. 1188
1122 Dent. J. 23, 110–115. Efeoglu, N., Wood, D., Efeoglu, C., 2005. Microcomputerised 1189
1123 Bitter, N.C., 1992. A scanning electron microscopy study of the effect tomography evaluation of 10% carbamide peroxide applied to 1190
1124 of bleaching agents on enamel: a preliminary report. J. Prosthet. enamel. J. Dent. 33, 561–567. 1191
1125 Dent. 67, 852–855. Engle, K., Hara, A.T., Matis, B., Eckert, G.J., Zero, D.T., 2010. 1192
1126 Bitter, N.C., 1998. A scanning electron microscope study of the long- Erosion and abrasion of enamel and dentin associated with at- 1193
1127 term effect of bleaching agents on the enamel surface in vivo. Gen. home bleaching: an in vitro study. J. Am. Dent. Assoc. 141, 546– 1194
1128 Dent. 46, 84–88. 551. 1195
1129 Bogue, E., 1872. Bleaching teeth. Dent. Cosmos, 141–143. Ernst, C.P., Marroquin, B.B., Willershausen-Zönnchen, B., 1996. 1196
1130 Broome, J.C., 1998. At-home use of 35% carbamide peroxide Effects of hydrogen peroxide-containing bleaching agents on the 1197
1131 bleaching gel: a case report. Compend. Contin. Educ. Dent. 19, morphology of human enamel. Quintessence Int. 27, 53–56. 1198
1132 824–829. Far, C., Ruse, N.D., 2003. Effect of bleaching on fracture toughness 1199
of composite-dentin bonds. J. Adhes. Dent. 5, 175–182. 1200
15 March 2014
12 M.Q. Alqahtani
1201 Faraoni-Romano, J.J., Da Silveira, A.G., Turssi, C.P., Serra, M.C., Inokoshi, S., Burrow, M.F., Kataumi, M., Yamada, T., Takatsu, T., 1269
1202 2008. Bleaching agents with varying concentrations of carbamide 1996. Opacity and color changes of tooth-colored restorative 1270
1203 and/or hydrogen peroxides: effect on dental microhardness and materials. Oper. Dent. 21, 73–80. 1271
1204 roughness. J. Esthet. Restor. Dent. 20, 395–402, discussion 403- Joiner, A., 2006. The bleaching of teeth: a review of the literature. J. 1272
1205 394. Dent. 34, 412–419. 1273
1206 Fay, R.M., Servos, T., Powers, J.M., 1999. Color of restorative Jordan, R.E., Boksman, L., 1984. Conservative vital bleaching 1274
1207 materials after staining and bleaching. Oper. Dent. 24, 292–296. treatment of discolored dentition. Compend. Contin. Educ. Dent. 1275
1208 Feinman, R.A., Madray, G., Yarborough, D., 1991. Chemical, 5 (803–805), 807. 1276
1209 optical, and physiologic mechanisms of bleaching products: a Josey, A.L., Meyers, I.A., Romaniuk, K., Symons, A.L., 1996. The 1277
1210 review. Pract. Periodontics Aesthet. Dent. 3, 32–36. effect of a vital bleaching technique on enamel surface morphology 1278
1211 Feiz, A., Khoroushi, M., Gheisarifar, M., 2011. Bond strength of and the bonding of composite resin to enamel. J. Oral Rehabil. 23, 1279
1212 composite resin to bleached dentin: effect of using antioxidant 244–250. 1280
1213 versus buffering agent. J. Dent. (Tehran) 8, 60–66. Kashima-Tanaka, M., Tsujimoto, Y., Kawamoto, K., et al, 2003. 1281
1214 Fisher, G., 1911. The bleaching of discolored teeth with H2O2. Dent. Generation of free radicals and/or active oxygen by light or laser 1282
1215 Cosmos 53, 246–247. irradiation of hydrogen peroxide or sodium hypochlorite. J. 1283
1216 Franchi, G.J., 1950. A practical technique for bleaching discolored Endod. 29, 141–143. 1284
1217 crowns of young permanent incisors. J. Dent. Child. 20, 68–69. Kaya, A.D., Turkun, M., 2003. Reversal of dentin bonding to 1285
1218 Freedman, G.A., 1990. Safety of tooth whitening. Dent. Today 9, 32– bleached teeth. Oper. Dent. 28, 825–829. 1286
1219 33. Khoroushi, M., Aghelinejad, S., 2011. Effect of postbleaching 1287
1220 Garcia-Godoy, F., Garcia-Godoy, A., Garcia-Godoy, F., 2002. application of an antioxidant on enamel bond strength of three 1288
1221 Effect of bleaching gels on the surface roughness, hardness, and different adhesives. Med. Oral Patol. Oral Cir. Bucal 16, e990– 1289
1222 micromorphology of composites. Gen. Dent. 50, 247–250. e996. 1290
1223 Goldstein, R.E., Garber, D.A., 1995. Complete Dental Bleaching, Khoroushi, M., Saneie, T., 2012. Post-bleaching application of an 1291
1224 first ed. Quintessence Publishing Inc, Chicago, 165. antioxidant on dentin bond strength of three dental adhesives. 1292
1225 Goo, D.H., Kwon, T.Y., Nam, S.H., et al, 2004. The efficiency of Dent. Res. J. (Isfahan) 9, 46–53. 1293
1226 10% carbamide peroxide gel on dental enamel. Dent. Mater. J. 23, Kihn, P.W., 2007. Vital tooth whitening. Dent. Clin. North Am. 51, 1294
1227 522–527. 319–331. 1295
1228 Greenwall, L., Fredman, G., Gordan, V.V., 2001. Bleaching Tech- Kimyai, S., Valizadeh, H., 2006. The effect of hydrogel and solution 1296
1229 niques in Restorative Dentistry: An Illustrated Guide. Martin of sodium ascorbate on bond strength in bleached enamel. Oper. 1297
1230 Dunitz. Dent. 31, 496–499. 1298
1231 Gurgan, S., Alpaslan, T., Kiremitci, A., et al, 2009. Effect of Kimyai, S., Valizadeh, H., 2008. Comparison of the effect of hydrogel 1299
1232 different adhesive systems and laser treatment on the shear bond and a solution of sodium ascorbate on dentin-composite bond 1300
1233 strength of bleached enamel. J. Dent. 37, 527–534. strength after bleaching. J. Contemp. Dent. Pract. 9, 105–112. 1301
1234 Gurgan, S., Bolay, S., Alacam, R., 1997. In vitro adherence of Kingsbury, C., 1861. Discoloration of dentine. Dent. Cosmos 3, 57– 1302
1235 bacteria to bleached or unbleached enamel surfaces. J. Oral 60. 1303
1236 Rehabil. 24, 624–627. Kirk, E., 1889. The chemical bleaching of teeth. Dent. Cosmos 31, 1304
1237 Harlan, A., 1891. The dental pulp, its destruction, and methods of 273–283. 1305
1238 treatment of teeth discolored by its retention in the pulp chamber Kirk, E., 1893. Hints, queries, and comments: sodium peroxide. Dent. 1306
1239 or canals. Dent. Cosmos 33, 137–141. Cosmos 35, 1265–1267. 1307
1240 Haywood, V.B., 1991. Overview and status of mouthguard bleaching. Kugel, G., 2003. Over-the-counter tooth-whitening systems. Com- 1308
1241 J. Esthet. Dent. 3, 157–161. pend. Contin. Educ. Dent. 24, 376–382. 1309
1242 Haywood, V.B., 1992. History, safety, and effectiveness of current Kum, K.Y., Lim, K.R., Lee, C.Y., et al, 2004. Effects of removing 1310
1243 bleaching techniques and applications of the nightguard vital residual peroxide and other oxygen radicals on the shear bond 1311
1244 bleaching technique. Quintessence Int. 23, 471–488. strength and failure modes at resin-tooth interface after tooth 1312
1245 Haywood, V.B., 2000. Current status of nightguard vital bleaching. bleaching. Am. J. Dent. 17, 267–270. 1313
1246 Compend. Contin. Educ. Dent. Suppl. 28, S10–S17, quiz S48. Lai, S.C., Tay, F.R., Cheung, G.S., et al, 2002. Reversal of 1314
1247 Haywood, V.B., Heymann, H.O., 1989. Nightguard vital bleaching. compromised bonding in bleached enamel. J. Dent. Res. 81, 477– 1315
1248 Quintessence Int. 20, 173–176. 481. 1316
1249 Haywood, V.B., Leech, T., Heymann, H.O., Crumpler, D., Bruggers, Langsten, R.E., Dunn, W.J., Hartup, G.R., Murchison, D.F., 2002. 1317
1250 K., 1990. Nightguard vital bleaching: effects on enamel surface Higher-concentration carbamide peroxide effects on surface rough- 1318
1251 texture and diffusion. Quintessence Int. 21, 801–804. ness of composites. J. Esthet. Restor. Dent. 14, 92–96. 1319
1252 Haywood, V.B., Leonard, R.H., Nelson, C.F., Brunson, W.D., 1994. Latimer, J., 1868. Notes from the discussion of the Society of Dental 1320
1253 Effectiveness, side effects and long-term status of nightguard vital Surgeons in the city of New York. Dent. Cosmos 10, 257–258. 1321
1254 bleaching. J. Am. Dent. Assoc. 125, 1219–1226. Lee, K.H., Kim, H.I., Kim, K.H., Kwon, Y.H., 2006. Mineral loss 1322
1255 Hannig, C., Duong, S., Becker, K., et al, 2007. Effect of bleaching on from bovine enamel by a 30% hydrogen peroxide solution. J. Oral 1323
1256 subsurface micro-hardness of composite and a polyacid modified Rehabil. 33, 229–233. 1324
1257 composite. Dent. Mater. 23, 198–203. Leonard Jr., R.H., Van Haywood, B., Caplan, D.J., Tart, N.D., 2003. 1325
1258 Hegedus, C., Bistey, T., Flora-Nagy, E., Keszthelyi, G., Jenei, A., Nightguard vital bleaching of tetracycline-stained teeth: 90 months 1326
1259 1999. An atomic force microscopy study on the effect of bleaching post treatment. J. Esthet. Restor. Dent. 15, 142–152, discussion 153. 1327
1260 agents on enamel surface. J. Dent. 27, 509–515. Lewinstein, I., Hirschfeld, Z., Stabholz, A., Rotstein, I., 1994. Effect 1328
1261 Howard, W.R., 1992. Patient-applied tooth whiteners. J. Am. Dent. of hydrogen peroxide and sodium perborate on the microhardness 1329
1262 Assoc. 123, 57–60. of human enamel and dentin. J. Endod. 20, 61–63. 1330
1263 Hubbezoglu, I., Akaoglu, B., Dogan, A., et al, 2008. Effect of Li, Q., Yu, H., Wang, Y., 2009. Colour and surface analysis of 1331
1264 bleaching on color change and refractive index of dental composite carbamide peroxide bleaching effects on the dental restorative 1332
1265 resins. Dent. Mater. J. 27, 105–116. materials in situ. J. Dent. 37, 348–356. 1333
1266 Hunsaker, K., Christensen, G., Christensen, R., 1990. Tooth bleach- Li, Y., 1997. Toxicological considerations of tooth bleaching using 1334
1267 ing chemicals. Influence on teeth and restorations. J. Dent. Res. peroxide-containing agents. J. Am. Dent. Assoc. 128 (Suppl), 31S– 1335
1268 [abstract # 69303]. 36S. 1336
15 March 2014
1337 Lima, D.A., De Alexandre, R.S., Martins, A.C., et al, 2008. Effect of Rotstein, I., Dankner, E., Goldman, A., et al, 1996. Histochemical 1404
1338 curing lights and bleaching agents on physical properties of a analysis of dental hard tissues following bleaching. J. Endod. 22, 1405
1339 hybrid composite resin. J. Esthet. Restor. Dent. 20, 266–273, 23–25. 1406
1340 discussion 274-265. Sa, Y., Sun, L., Wang, Z., et al, 2013. Effects of two in-office 1407
1341 M’Quillen, J., 1868. Elongation and discoloration of a superior bleaching agents with different pH on the structure of human 1408
1342 central incisor. Dent. Cosmos 10, 225–227. enamel: an in situ and in vitro study. Oper. Dent. 38, 100–110. 1409
1343 Mello, H.S., 1967. The mechanism of tetracycline staining in primary Sasaki, R.T., Florio, F.M., Basting, R.T., 2009. Effect of 10% 1410
1344 and permanent teeth. J. Dent. Child. 34, 478–487. sodium ascorbate and 10% alpha-tocopherol in different formu- 1411
1345 Minoux, M., Serfaty, R., 2008. Vital tooth bleaching: biologic lations on the shear bond strength of enamel and dentin 1412
1346 adverse effects––a review. Quintessence Int. 39, 645–659. submitted to a home-use bleaching treatment. Oper. Dent. 34, 1413
1347 Monaghan, P., Lim, E., Lautenschlager, E., 1992. Effects of home 746–752. 1414
1348 bleaching preparations on composite resin color. J. Prosthet. Dent. Schemehorn, B., Gonzalez-Cabezas, C., Joiner, A., 2004. A SEM 1415
1349 68, 575–578. evaluation of a 6% hydrogen peroxide tooth whitening gel on 1416
1350 Montalvan, E., Vaidyanathan, T.K., Shey, Z., Janal, M.N., Caceda, dental materials in vitro. J. Dent. 32 (Suppl), 135–139. 1417
1351 J.H., 2006. The shear bond strength of acetone and ethanol-based Seghi, R.R., Denry, I., 1992. Effects of external bleaching on 1418
1352 bonding agents to bleached teeth. Pediatr. Dent. 28, 531–536. indentation and abrasion characteristics of human enamel 1419
1353 Mor, C., Steinberg, D., Dogan, H., Rotstein, I., 1998. Bacterial in vitro. J. Dent. Res. 71, 1340–1344. 1420
1354 adherence to bleached surfaces of composite resin in vitro. Oral Setien, V.J., Roshan, S., Nelson, P.W., 2008. Clinical management of 1421
1355 Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 86, 582–586. discolored teeth. Gen. Dent. 56, 294–300, quiz 301-294. 1422
1356 Moule, C.A., Angelis, F., Kim, G.H., et al, 2007. Resin bonding Shipman, B., Cohen, E., Kaslick, R.S., 1971. The effect of a urea 1423
1357 using an all-etch or self-etch adhesive to enamel after carbamide peroxide gel on plaque deposits and gingival status. J. Periodontol. 1424
1358 peroxide and/or CPP-ACP treatment. Aust. Dent. J. 52, 133–137. 42, 283–285. 1425
1359 Nakabayashi, N., Kojima, K., Masuhara, E., 1982. The promotion of Smidt, A., Feuerstein, O., Topel, M., 2011. Mechanical, morphologic, 1426
1360 adhesion by the infiltration of monomers into tooth substrates. J. and chemical effects of carbamide peroxide bleaching agents on 1427
1361 Biomed. Mater. Res. 16, 265–273. human enamel in situ. Quintessence Int. 42, 407–412. 1428
1362 Nathoo, S.A., 1997. The chemistry and mechanisms of extrinsic and Spasser, H.F., 1961. A simple bleaching technique using sodium 1429
1363 intrinsic discoloration. J. Am. Dent. Assoc. 128 (Suppl), 6S–10S. perborate. N. Y. State Dent. J., 27332–27334. 1430
1364 Niat, A.B., Yazdi, F.M., Koohestanian, N., 2012. Effects of drying Steinberg, D., Mor, C., Dogan, H., Zacks, B., Rotstein, I., 1999. 1431
1365 agents on bond strength of etch-and-rinse adhesive systems to Effect of salivary biofilm on the adherence of oral bacteria to 1432
1366 enamel immediately after bleaching. J. Adhes. Dent. 14, 511–516. bleached and non-bleached restorative material. Dent. Mater. 15, 1433
1367 Nutting, E., 1976. A new combination for bleaching teeth. Dent. Clin. 14–20. 1434
1368 North Am. 10, 655–662. Stindt, D.J., Quenette, L., 1989. An overview of Gly-Oxide liquid in 1435
1369 Ontiveros, J.C., 2011. In-office vital bleaching with adjunct light. control and prevention of dental disease. Compendium 10, 514– 1436
1370 Dent. Clin. North Am. 55, 241–253, viii. 519. 1437
1371 Pearson, H.H., 1951. Successful bleaching without secondary discol- Sulieman, M., 2004. An overview of bleaching techniques: I. History, 1438
1372 ouration. J. Can. Dent. Assoc. 17, 200–201. chemistry, safety and legal aspects. Dent. Update 31, 608–616. 1439
1373 Pearson, H.H., 1958. Bleaching of the discolored pulpless tooth. J. Sulieman, M., 2005a. An overview of bleaching techniques: 2. Night 1440
1374 Am. Dent. Assoc. 56, 64–68. guard vital bleaching and non-vital bleaching. Dent. Update 32, 1441
1375 Pecora, J.D., Cruzfilho, A.M., Sousaneto, M.D., Silva, R.G., 1994. In 39–46. 1442
1376 vitro action of various bleaching agents on the microhardness of Sulieman, M., 2005b. An overview of bleaching techniques: 3. In- 1443
1377 human dentin. Braz. Dent. J. 5, 129–134. surgery or power bleaching. Dent. Update 32, 101–108. 1444
1378 Perdigão, J., Francci, C., Swift Jr., E.J., Ambrose, W.W., Lopes, M., Sun, L., Liang, S., Sa, Y., et al, 2011. Surface alteration of human 1445
1379 1998. Ultra-morphological study of the interaction of dental tooth enamel subjected to acidic and neutral 30% hydrogen 1446
1380 adhesives with carbamide peroxide-bleached enamel. Am. J. Dent. peroxide. J. Dent. 39, 686–692. 1447
1381 11, 291–301. Sung, E.C., Chan, S.M., Mito, R., Caputo, A.A., 1999. Effect of 1448
1382 Pohjola, R.M., Browning, W.D., Hackman, S.T., Myers, M.L., carbamide peroxide bleaching on the shear bond strength of 1449
1383 Downey, M.C., 2002. Sensitivity and tooth whitening agents. J. composite to dental bonding agent enhanced enamel. J. Prosthet. 1450
1384 Esthet. Restor. Dent. 14, 85–91. Dent. 82, 595–599. 1451
1385 Polydorou, O., Beiter, J., König, A., Hellwig, E., Kummerer, K., Taher, N.M., 2005. The effect of bleaching agents on the surface 1452
1386 2009. Effect of bleaching on the elution of monomers from modern hardness of tooth colored restorative materials. J. Contemp. Dent. 1453
1387 dental composite materials. Dent. Mater. 25, 254–260. Pract. 6, 18–26. 1454
1388 Polydorou, O., Hellwig, E., Auschill, T.M., 2006. The effect of Tam, L.E., Kuo, V.Y., Noroozi, A., 2007. Effect of prolonged direct 1455
1389 different bleaching agents on the surface texture of restorative and indirect peroxide bleaching on fracture toughness of human 1456
1390 materials. Oper. Dent. 31, 473–480. dentin. J. Esthet. Restor. Dent. 19, 100–109, discussion 110. 1457
1391 Polydorou, O., Hellwig, E., Auschill, T.M., 2007. The effect of at- Tam, L.E., Lim, M., Khanna, S., 2005. Effect of direct peroxide 1458
1392 home bleaching on the microhardness of six esthetic restorative bleach application to bovine dentin on flexural strength and 1459
1393 materials. J. Am. Dent. Assoc. 138, 978–984, quiz 1022. modulus in vitro. J. Dent. 33, 451–458. 1460
1394 Potočnik, I., Kosec, L., Gaspersic, D., 2000. Effect of 10% carbamide Tezel, H., Ertas, O.S., Ozata, F., Dalgar, H., Korkut, Z.O., 2007. 1461
1395 peroxide bleaching gel on enamel microhardness, microstructure, Effect of bleaching agents on calcium loss from the enamel surface. 1462
1396 and mineral content. J. Endod. 26, 203–206. Quintessence Int. 38, 339–347. 1463
1397 Powell, L.V., Bales, D.J., 1991. Tooth bleaching: its effect on oral Titley, K.C., Torneck, C.D., Ruse, N.D., 1992. The effect of 1464
1398 tissues. J. Am. Dent. Assoc. 122, 50–54. carbamide-peroxide gel on the shear bond strength of a microfil 1465
1399 Reddy, J., Salkin, L.M., 1976. The effect of a urea peroxide rinse on resin to bovine enamel. J. Dent. Res. 71, 20–24. 1466
1400 dental plaque and gingivitis. J. Periodontol. 47, 607–610. Titley, K.C., Torneck, C.D., Smith, D.C., Chernecky, R., Adibfar, 1467
1401 Rodrigues, J.A., Oliveira, G.P.F., Amaral, C.M.I., 2007. Effect of A., 1991. Scanning electron microscopy observations on the 1468
1402 thickener agents on dental enamel microhardness submitted to at- penetration and structure of resin tags in bleached and unbleached 1469
1403 home bleaching. Braz. Oral Res. 21, 170–172. bovine enamel. J. Endod. 17, 72–75. 1470
15 March 2014
14 M.Q. Alqahtani
1471 Türker, S.B., Biskin, T., 2002. The effect of bleaching agents on the Wang, L., Francisconi, L.F., Atta, M.T., et al, 2011. Effect of 1499
1472 microhardness of dental aesthetic restorative materials. J. Oral bleaching gels on surface roughness of nanofilled composite resins. 1500
1473 Rehabil. 29, 657–661. Eur. J. Dent. 5, 173–179. 1501
1474 Türker, S.B., Biskin, T., 2003. Effect of three bleaching agents on the Wattanapayungkul, P., Yap, A.U., 2003. Effects of in-office bleach- 1502
1475 surface properties of three different esthetic restorative materials. J. ing products on surface finish of tooth-colored restorations. Oper. 1503
1476 Prosthet. Dent. 89, 466–473. Dent. 28, 15–19. 1504
1477 Turkun, L.S., Turkun, M., 2004. Effect of bleaching and repolishing White, D.J., Düschner, H., Pioch, T., 2008. Effect of bleaching 1505
1478 procedures on coffee and tea stain removal from three anterior treatments on microleakage of class I restorations. J. Clin. Dent. 1506
1479 composite veneering materials. J. Esthet. Restor. Dent. 16, 290– 19, 33–36. 1507
1480 301, discussion 301-292. Woodnut, C., 1861. Discoloration of dentine. Dent. Cosmos, 2662. 1508
1481 Turkun, M., Kaya, A.D., 2004. Effect of 10% sodium ascorbate on Xu, B., Li, Q., Wang, Y., 2011. Effects of pH values of hydrogen 1509
1482 the shear bond strength of composite resin to bleached bovine peroxide bleaching agents on enamel surface properties. Oper. 1510
1483 enamel. J. Oral Rehabil. 31, 1184–1191. Dent. 36, 554–562. 1511
1484 Turkun, M., Celik, E.U., Kaya, A.D., Arici, M., 2009. Can the Yap, A.U., Wattanapayungkul, P., 2002. Effects of in-office tooth 1512
1485 hydrogel form of sodium ascorbate be used to reverse compromised whiteners on hardness of tooth-colored restoratives. Oper. Dent. 1513
1486 bond strength after bleaching? J. Adhes. Dent. 11, 35–40. 27, 137–141. 1514
1487 Ulukapi, H., Benderli, Y., Ulukapi, I., 2003. Effect of pre- and Yu, H., Pan, X., Lin, Y., et al, 2009. Effects of carbamide peroxide 1515
1488 postoperative bleaching on marginal leakage of amalgam and on the staining susceptibility of tooth-colored restorative materials. 1516
1489 composite restorations. Quintessence Int. 34, 505–508. Oper. Dent. 34, 72–82. 1517
1490 Vidhya, S., Srinivasulu, S., Sujatha, M., Mahalaxmi, S., 2011. Effect Zalkind, M., Arwaz, J.R., Goldman, A., Rotstein, I., 1996. Surface 1518
1491 of grape seed extract on the bond strength of bleached enamel. morphology changes in human enamel, dentin and cementum 1519
1492 Oper. Dent. 36, 433–438. following bleaching: a scanning electron microscopy study. Endod. 1520
1493 Villalta, P., Lu, H., Okte, Z., Garcia-Godoy, F., Powers, J.M., 2006. Dent. Traumatol. 12, 82–88. 1521
1494 Effects of staining and bleaching on color change of dental Zantner, C., Beheim-Schwarzbach, N., Neumann, K., Kielbassa, 1522
1495 composite resins. J. Prosthet. Dent. 95, 137–142. A.M., 2007. Surface microhardness of enamel after different home 1523
1496 Viscio, D., Gaffar, A., Fakhry-Smith, S., Xu, T., 2000. Present and bleaching procedures. Dent. Mater. 23, 243–250. 1524
1497 future technologies of tooth whitening. Compend. Contin. Educ. 1525
1498 Dent. Suppl. 28, S36–S43, quiz S49.
1526

Si Alqahtani2014

Uploaded by

Copyright:

Available Formats

You might also like

Si Alqahtani2014

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Si Alqahtani2014

Uploaded by

Copyright:

Available Formats

SDENTJ 157 No.

King Saud University

The Saudi Dental Journal

4 Tooth-bleaching procedures and their

9 Received 5 January 2014; revised 15 February 2014; accepted 26 February 2014

* Address: College of Dentistry, King Saud University, P.O.

Production and hosting by Elsevier

30 5.1. Effects on soft tissues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

49 1. History a light source was regarded as an acceptable method in dental 89

78 Pyrozone, for safety purposes, and later combined it with

129 Extrinsic stains usually result from the accumulation of chro-

170 into the dentin during tooth calciﬁcation, probably through

1002 interfacial fracture toughness of dentin-resin composite adhe-

1012 strength values when compared with subgroups subjected to

1014 with restorations in the dentin substrate, the control showed

You might also like