Search Results (76)

Background: The rising demand for aesthetic dental treatments has spurred interest in peroxide-free color correctors as alternatives to traditional hydrogen peroxide formulations, which are associated with tooth sensitivity and potential enamel demineralization. This systematic review evaluates the whitening efficacy and safety profile of hydrogen peroxide-free color corrector (HPFCC) products, focusing on color change metrics, enamel and dentin integrity, and adverse effects. Methods: Following PRISMA guidelines, we searched PubMed, Scopus, and Web of Science throughout January 2025 for randomized controlled trials, observational studies, and in vitro experiments comparing HPFCC to placebo or peroxide-based agents. The data extraction covered study design, sample characteristics, intervention details, shade improvement (ΔE00 or CIE Lab), enamel/dentin mechanical properties (microhardness, roughness, elastic modulus), and incidence of sensitivity or tissue irritation. Risk of bias was assessed using the Cochrane tool for clinical studies and the QUIN tool for in vitro research. Results: Six studies (n = 20–80 samples or subjects) met the inclusion criteria. In vitro, HPFCC achieved mean ΔE00 values of 3.5 (bovine incisors; n = 80) and 2.8 (human molars; n = 20), versus up to 8.9 for carbamide peroxide (p < 0.01). Across studies, HPFCC achieved a mean ΔE00 of 2.8–3.5 surpassing the perceptibility threshold of 2.7 and approaching the clinical acceptability benchmark of 3.3. Surface microhardness increased by 12.9 ± 11.7 VHN with HPFCC (p < 0.001), and ultramicrohardness rose by 110 VHN over 56 days in prolonged use studies. No significant enamel erosion or dentin roughness changes were observed, and the sensitivity incidence remained below 3%. Conclusions: These findings derive from one clinical trial (n = 60) and five in vitro studies (n = 20–80), encompassing violet-pigment serums and gels with differing concentrations. Due to heterogeneity in designs, formulations, and outcome measures, we conducted a narrative synthesis rather than a meta-analysis. Although HPFCC ΔE00 values were lower than those of carbamide peroxide, they consistently exceeded perceptibility thresholds while maintaining enamel integrity and causing sensitivity in fewer than 3% of subjects, supporting HPFCCs as moderate but safe alternatives for young patients. Full article

Tooth bleaching is a widely used esthetic treatment; however, bleaching agents can temporarily alter the surface morphology of enamel, increasing surface roughness and porosity, which may lead to increased susceptibility to discoloration. This in vitro study investigated the effectiveness of fluoride varnish in preventing immediate discoloration of bovine incisors after bleaching. Specimens were bleached with 35% hydrogen peroxide and treated with either Clinpro White Varnish (CW) or Enamelast Fluoride Varnish (EN), whereas control specimens received no treatment after bleaching. The samples were immersed in coffee for 24 h, and the color difference (ΔE₀₀) was calculated using the CIEDE2000 formula. The surface morphology of enamel was examined using SEM. The fluoride varnish groups showed significantly lower color difference values than the control group (p < 0.05), with ΔE₀₀ reduced by approximately two-thirds in both the CW and EN groups. SEM observations showed that the enamel surfaces in the varnish-treated groups exhibited reduced surface irregularities compared to the untreated group, suggesting remineralization. These results suggest that the immediate application of fluoride varnish after bleaching can effectively reduce short-term discoloration by providing physical protection and promoting remineralization. Fluoride varnish may serve as a simple and effective strategy to maintain whitening outcomes and minimize early discoloration. Full article

Background/Objectives: Tooth bleaching is a widely requested aesthetic procedure in modern dentistry. However, the structural effects of high-concentration peroxide-based bleaching agents on enamel remain insufficiently understood. This study aims to evaluate and compare the effects of three in-office bleaching agents—Opalescence Boost (40% hydrogen peroxide [HP]), Opalescence Quick (45% carbamide peroxide [CP]), and BlancOne Ultra + (35% hydrogen peroxide [HP])—on enamel surface characteristics and color change using confocal laser scanning microscopy (CLSM) and spectrophotometric analysis. Methods: Forty-two extracted human teeth were sectioned and divided into experimental and control halves. Each experimental specimen underwent bleaching according to the manufacturer’s protocol. Color measurements were conducted at baseline, immediately post-treatment, at 3 days, 7 days, and 6 months following treatment using the Vita Easyshade^® spectrophotometer. Color differences were calculated using the CIEDE2000 (ΔE₀₀) formula. Enamel surface morphology was assessed by CLSM. Data were analyzed using Wilcoxon and Kruskal–Wallis tests (p < 0.05), performed with SPSS v23. Results: All bleaching agents produced clinically perceptible color changes (ΔE₀₀ > 3.3). Opalescence Boost achieved the highest and most consistent whitening effect (mean ΔE₀₀ > 11), while Opalescence Quick showed moderate efficacy (ΔE₀₀ ~6–8), and BlancOne Ultra+ induced milder changes (ΔE₀₀ ~4–5). CLSM imaging revealed surface alterations in all bleached samples, with more pronounced changes observed in specimens treated with higher peroxide concentrations. Conclusions: All three bleaching systems were effective in improving enamel color, with Opalescence Boost delivering the most substantial and durable effect. CLSM analysis confirmed morphological changes in enamel without evidence of severe damage. These results underscore the importance of selecting bleaching protocols that balance efficacy with enamel safety. Further in vivo studies are recommended to validate long-term structural effects and support clinical decision-making. Full article

Maintaining the cleanliness of orthodontic aligners is crucial for oral hygiene and preserving the optical properties of aligners. In this randomized clinical trial, we compared the effectiveness of different cleaning methods for the maintenance of Invisalign clear aligners. Twelve adult patients received five aligners, each worn for 10 days. The aligners were divided based on the cleaning method: tooth brushing with whitening toothpaste, vinegar, Fittydent Super Cleansing Tablets, Invisalign cleaning crystals, and only water. Scanning electron microscopy (SEM) was used to detect surface morphology changes; color changes (ΔE) were evaluated using a spectrophotometer. Fourier transform infrared spectroscopy (FTIR) with a diamond hemisphere was used to study the aligners’ chemical compositions. Nanoindentation testing was used to assess changes in the elastic modulus. SEM confirmed the effectiveness of Invisalign cleaning crystals in maintaining cleanliness, revealing a surface similar to that of the control group with no adverse effects. Color stability analysis revealed significant ΔE value differences; whitening toothpaste had significantly lower ΔE values than water and Invisalign cleaning crystals. The elastic modulus and FTIR analyses indicated no significant differences between the cleaning methods. Therefore, Invisalign cleaning crystals and whitening toothpaste are safe for aligner maintenance, showing successful and aesthetically pleasing results. Full article

Background: Tooth whitening is a widely sought-after cosmetic procedure, with various at-home and professional treatments available. This study compares the whitening efficacy of an activated charcoal toothpaste and a 6% hydrogen peroxide whitening pen under controlled in vitro conditions. Methods: Twenty freshly extracted human teeth were stained with a coffee solution and divided into two groups. Group A underwent daily applications of activated charcoal toothpaste for 30 days, while Group B received a single 5 min application of a 6% hydrogen peroxide whitening pen. Tooth color was assessed using the VITA Classical A1-D4 Shade Guide at baseline, mid-treatment, and post-treatment for Group A and at baseline and immediately after treatment for Group B. Results: The activated charcoal toothpaste exhibited a gradual whitening effect, with the most significant improvements occurring within the first two weeks (p < 0.01), after which the whitening effect plateaued. In contrast, the hydrogen peroxide whitening pen produced immediate and substantial whitening (p < 0.001). Statistical analysis using the Wilcoxon signed-rank test and Mann–Whitney U test confirmed the superior efficacy of the hydrogen peroxide treatment. Conclusions: The hydrogen peroxide whitening pen was significantly more effective in achieving rapid and substantial whitening compared to the activated charcoal toothpaste, which provided gradual but limited improvements. Further clinical studies are needed to evaluate the long-term color stability. Full article

Background/Objectives: Toothbrushing is a recommended daily practice that helps sustain oral health. However, if performed improperly, it can lead to loss of tooth structure and injury to soft tissues. We explored this topic with an extensive literature search. Methods: A literature search was performed across textbooks and journals for original research and review articles in Scopus, PubMed, PubMed Central, and Cochrane databases, published between 1967 and 2024. Results: The search result yielded 118 articles that were suitable to include in this review. Toothpaste abrasivity plays a major role in combination with toothbrush forces. Therefore, maintaining forces between 2 and 3 N may be gentler on the tissue. Electric toothbrushes are safer. Toothpastes with low RDA values are also less abrasive. Active ingredients in whitening and desensitizing toothpaste can induce tooth wear. Remineralizing agents have the potential to manage the associated lesions. Conclusions: Cervical abrasions and gingival recession occur frequently due to oral hygiene measures. Standards in oral hygiene aid to match patient needs can prevent hard and soft tissue loss. Full article

Background: Micro- and macroabrasion represent a minimally invasive treatment approach for stained teeth in the esthetic zone. Diagnosing the type of stain is crucial for selecting the appropriate treatment approach. These clinical procedures involve several meticulous steps that may be confusing for less experienced clinicians. Methods: The objective of this article is to provide an updated review of the literature on the clinical procedures for micro- and macroabrasion and to present a clinical case in which a minimally invasive macroabrasion procedure was applied to treat a female patient seeking to remove stains from her anterior teeth. Preliminary reviews were conducted of existing case reports and reviews evaluating the clinical procedures and outcomes of micro- and macroabrasion. Results: A review of the literature reveals minor differences in how stains on anterior teeth are addressed. Depending on the depth of the stain, microabrasion is typically used for superficial stains, while macroabrasion is employed for deeper stains. Clinicians often combine micro- or macroabrasion with tooth whitening procedures. Literature reviews agree that micro- and macroabrasion techniques are effective minimally invasive approaches that yield high esthetic results. The case study demonstrated each clinical step of microabrasion, achieving results that fully satisfied the patient’s esthetic demands. Conclusions: Micro- and macroabrasion can be effective and minimally invasive methods for treating stained anterior teeth. Superficial stains can be treated with microabrasion, while deeper stains may require macroabrasion. In some clinical scenarios, tooth whitening can also be combined with these treatments. Full article

Background: There is high demand for white and healthy teeth. Therefore, various whitening toothpastes are commercially available. Hydroxyapatite and blue covarine are two ingredients used in whitening toothpaste formulations. Objectives: This in vitro study analyzed the stain-removing efficacy of two commercial whitening toothpastes: one containing hydroxyapatite and the other containing blue covarine. Methods: The stain-removing efficacy of both toothpastes was analyzed for different brushing times (30 and 180 s) using a staining model on human enamel. Photographic documentation and colorimetric measurements were performed after staining and after each brushing series. Colorimetric measurements were used to determine the stain removal efficacy in percentage. Statistical analysis was performed using one-way analysis of variance (ANOVA) with a post hoc Tukey test and Levene’s test to assess the homogeneity of variances. The significance level α was set at 0.05. Results: The hydroxyapatite toothpaste demonstrated a significantly higher stain-removing efficacy compared to the blue covarine toothpaste after 30 s of brushing. The stain-removing efficacy was comparable between the two toothpastes after 180 s of brushing. Conclusions: Both hydroxyapatite and blue covarine toothpastes effectively cleaned stained enamel, with hydroxyapatite toothpaste showing a significantly higher stain-removing efficacy after 30 s of brushing. Full article

Background/Objectives: The objective of this review is to establish a solid base of information regarding the use of proteolytic enzymes to replace hydrogen peroxide/carbamide in teeth whitening products. The use of proteolytic enzymes, such as bromelain and papain, can provide surprising results for solving two important aspects related to dental aesthetics: tooth whitening and the chemo-mechanical removal of damaged dental tissue. Due to their ability to degrade salivary proteins, these enzymes can be used successfully as active agents in tooth whitening and in the atraumatic treatment of caries without being accompanied by other side effects on dental components. Methods: Random-effects meta-analyses were performed with enzymes (bromelain, papain) used in dentistry. A keyword search of scientific publications was conducted using the Google Academic, Web of Science and PubMed search engines. Results: The results were systematized in the present work in two parts: bromelain and papain effects in tooth whitening and chemo-mechanical/atraumatic removal of damaged dental tissues. Conclusions: The findings from different studies and clinical reports indicate that bromelain and papain could be considered efficient and safe therapeutic agents not only in various medical conditions but also in dental problems. Full article

This study assessed the bleaching and abrasiveness levels of different kinds of toothpaste with various RDA values on nanohybrid and microhybrid composite samples using a novel Press-on Force-Guided brushing simulator. One hundred and forty disc-shaped samples were prepared using two nano-hybrid and three microhybrid composites and divided randomly into four subgroups (n = 7). The samples were immersed in a coffee solution for 144 h and then brushed using R.O.C.S. (Remineralizing Oral Care Systems) brand toothpaste with different RDA values [Sensitive Instant Relief (SIR), Sensation Whitening (SW), and their combination with PRO Polishing (PP) (once a week)] using a brushing simulator for 140, 280 and 560 strokes (140 strokes correspondence to one week of real-time brushing). The level of surface roughness and color change (ΔE) were measured before and after the simulated brushing. Color changes were evaluated in Photoshop CC software through ∆E₀₀* values generated from before and after L, a*, b* parameters on sample photographs taken by a mobile dental photography tool. The surface structure of samples was measured before and after the brushing using a profilometer. The measurements were analyzed in SPSS V23 software by Analysis of Variance and the Bonferroni Test, and the level of significance was set at <0.05. Regarding ΔE values comparisons, there were no significant differences between the toothpastes after 2 weeks of brushing. SW (2.82 ± 1.24), SIR + PP (2.78 ± 0.98), and SW + PP (2.84 ± 1.22) values were found to be similar after one month of brushing (p < 0.007). Regarding surface roughness comparisons between the toothpastes, two-week and one-month brushing values were found to be similar and statistically rougher than the initial values. Using R.O.C.S. PRO Polishing with low-abrasive toothpaste may increase the whitening effect by enhancing color recovery. Full article

Background/Objectives: Whiter teeth are widely accepted as the most beautiful. With the growing demand for whiter teeth, several manufacturers have launched different brands of whitening toothpaste claiming to be effective in removing tooth stains and whitening teeth. The objective of this in vitro study was to evaluate and compare the whitening effect of eight over-the-counter available toothpastes by measuring the changes in color using a digital colorimeter in a simulated staining–brushing cycle model. Methods: A total of 32 extracted bovine enamel were polished with 1000–2000 grit SIC paper and immersed in a tea staining solution for 30 min at 37 °C to create extrinsic staining. The specimens were randomly divided into eight groups (n = 4) and subjected to a staining–brushing cycle for 2 weeks. During this period, the specimens were stained for 5 min twice, brushed for 2 min twice per day, and immersed in artificial saliva for the remaining time. The colors of the enamel surfaces L*, a*, and b* were recorded, and the color difference (ΔE) was measured before the treatment and after 1 and 2 weeks of the staining–brushing cycle. Results: The repeated measures showed a significant reduction of (ΔE) after 1 week of the staining–brushing cycle in all eight experimental groups (p < 0.05). The (ΔE) was significantly reduced after the second week of the staining–brushing cycle in groups 1, 3, and 5 (p < 0.05). However, it was insignificant in groups 2, 6, 7, and 8 (p > 0.05). Among the tested materials, group 1 showed the highest and group 8 showed the lowest teeth-whitening effects. Conclusions: The over-the-counter toothpaste used in this study showed effective teeth-whitening. Charcoal-based toothpaste showed the highest efficiency in teeth whitening. Full article

In-office teeth bleaching is an esthetic dental procedure performed to whiten teeth. A desensitizing procedure often requires prior in-office bleaching to relieve tooth hypersensitivity. The objective of this study was to evaluate the bleaching efficiency of teeth specimens pre-treated with different desensitizing agents by analyzing the color parameters. A total of 25 bovine specimens were stained and divided into five groups (n = 5). The specimens were pre-treated with GLUMA, ICON, bonding, or fluoride varnish according to the manufacturer’s instructions. Subsequently, the samples underwent three consecutive 20 min bleaching sessions using an in-office bleaching product. Color values in the CIE L*, a*, and b* color space were initially recorded, both before any treatment and after each bleaching session. The color difference (ΔE) was then computed. The data were analyzed using SPSS 24.0 software. The color alteration after pre-treatment was analyzed using a one-way ANOVA test, and the color alteration in each bleaching session was compared using a repeated-measure ANOVA test. A one-way ANOVA analysis showed a statistically significant difference in the bleaching efficiency of teeth specimens pre-treated with different desensitizers (p < 0.001). The repeated-measure ANOVA analysis showed no statistically significant difference in additional bleaching sessions (p = 0.133). The ICON and bonding pre-treatment showed the color alteration of teeth specimens before the bleaching procedure. Although the different desensitizer pre-treatments showed significant differences in bleaching efficiency, the differences in color parameters of the teeth specimens at the end of three bleaching sessions were statistically insignificant. Desensitizer pre-treatment influenced the degree of color change during multiple bleaching sessions; however, the outcome of bleaching was not affected by desensitizer pre-treatment. Full article

Background/Objectives: Tooth whitening is a cosmetic dental treatment that improves the color of natural teeth, making them whiter and brighter; this review aimed to evaluate the greater effectiveness of in-office, at-home, and combined bleaching with hydrogen or carbamide peroxide, also in relation to possible relapses and side effects (tooth sensitivity). Methods: A literature search has been carried out through electronic databases, PubMed/MEDLINE, and Cochrane Library, focused on the use of the effectiveness of in-office, at-home, and combined dental bleaching. This review has been registered on PROSPERO (ID613248). Results: 30 articles have been included. Most of the studies did not find any more effective treatment than the proposed treatments; all types of bleaching have been shown to be effective in changing color; in the studies that have compared in-office and at-home bleaching, there was a lower recurrence of treatment with the use of the at-home trays with carbamide peroxide gel. There were no clear positions regarding tooth sensitivity, which would appear to be higher in professional in-office and combined dental bleaching. Conclusions: Bleaching is an effective treatment for the change of color of the tooth regardless of the type used (concentrations, type of gel, and duration of sessions), although, at home, it would seem to be more effective over time. It is, however, a clinical feature that may give a risk of tooth sensitivity after treatment. Full article

Introduction: In everyday life, many people smoke, eat colored foods, and drink coffee, tea, and other beverages. The use of herbal products containing natural ingredients is better accepted by the public because of their safety. The aim of the present study was to develop two formulations of curcumin-based gels and investigate their anti-dyschromic qualities in teeth. Materials and Methods: This is an in vitro therapeutic clinical trial. A series of experiments was carried out on extracted teeth (n = 30). Samples were randomly divided into five subgroups. Readings were taken initially (T1), and then after immersion in a blackening process (T2). The brightening agent was applied for 5 min, three times a day. After 30 days of applications, new measurements were taken using a Vita Classical shade guide. Results: The curcumin and xanthan gum hydrogel that was used topically demonstrated superior efficacy in reducing dental dyschromia. These promising results suggest that this formulation could be an attractive option for the treatment of dental dyschromia. Conclusions: Curcumin-based gel presents itself as a promising candidate for the prevention and/or treatment of dental dyschromia. In addition, it has an excellent safety profile. Full article

The impact of cold atmospheric plasma (CAP) treatment on the enamel of twelve primary teeth (incisors, canines, and molars) collected from six children was examined in order to evaluate the possibility of using the CAP technique in dental applications. A radio-frequency dielectric barrier discharge (DBD) plasma jet operating at a voltage of 3.25 kV using a mixture of helium and oxygen as the working gas was used for the generation of plasma as part of the electro-technological method for the treatment of biological material. The plasma exposure time for the primary teeth was 5, 10, and 20 min. The properties of tooth enamel (color, contact angles, surface roughness, surface topography, elemental composition) were examined before (control) and after the plasma treatment. As shown by the results, the plasma treatment time is a key parameter that can induce desired features, such as whitening or improved wettability. However, with prolonged plasma treatment (20 min), the enamel surface may be permanently damaged. The cold-plasma-treated samples were characterized by a higher value of the brightness L* parameter and thus a lighter color, compared to the CAP-untreated teeth. It was also evidenced that the plasma treatment increased the hydrophilicity of tooth surfaces, and the contact angles effectively decreased with the time of the CAP treatment. The tooth surface also became much more heterogeneous and rough with much greater amplitudes in heights. The surface of the primary teeth after the CAP treatment lost its homogeneity, as evidenced by the SEM micrographs. The analysis of the elemental composition revealed only minor changes after the plasma process, which may suggest that the observed morphological changes in the enamel surface are mainly physical and are not a consequence of chemical reactions between the enamel and the reactive components of the cold plasma. Plasma treatment of teeth opens up new possibilities of using this method as an alternative to whitening or pre-treatment before other dental procedures. Full article