Intraoral scanning has been reported to be preferred by patients over conventional impression making. Nevertheless, information regarding patient-related outcomes for conventional impression making ...and digital scanning is sparse.
The purpose of this systematic review and meta-analysis was to analyze patient-related outcomes of intraoral scanning and conventional impression methods. The primary outcomes evaluated were patient preference and satisfaction, and the secondary outcomes discomfort, nausea, unpleasant taste, breathing difficulty, pain, and anxiety.
Electronic and manual searches were performed for clinical trials that evaluated patient-related outcomes for intraoral scanning and conventional impression making for prosthetic rehabilitation. The Cochrane Collaboration risk of bias tool and Newcastle-Ottawa scale were used to assess the quality of the studies. Random-effects models using mean difference were used for meta-analyses. Heterogeneity was assessed using the Cochran Q test and I2 statistics (α=.05).
The search strategy identified 1626 articles, and 11 studies were included in the meta-analyses. Patients preferred intraoral scanning to conventional impression making. The mean difference for patient preference was 15.02 (95% confidence interval of 8.33 – 21.73; P<.001). Discomfort, absence of nausea, absence of unpleasant taste, and absence of breathing difficulty were also significantly different (P<.05).
Intraoral scanning is a suitable alternative to conventional impression procedures, promoting less discomfort for patients sensitive to taste, nausea, and breathing difficulty than when conventional impression making techniques are used.
Abstract Objectives This randomized, split-mouth, single-blinded trial assessed whether the use of reservoirs in at-home bleaching trays is equivalent to non-reservoir trays. Our choice of an ...equivalence trial was based on the expectation that a non-reservoir tray is sufficient to produce a color change. Secondary outcomes such as tooth sensitivity (TS) and gingival irritation (GI) were also assessed. Methodology Forty-six patients were selected with canines shade A2 or darker. In half of the patient’s arch, bleaching trays were made with reservoirs and the other half, without reservoirs. At-home bleaching was performed with carbamide peroxide (CP) 10% (3 h daily; 21 days). Color change was evaluated with a digital spectrophotometer (ΔE, ΔE00, and Whiteness Index) and shade guide units (ΔSGU) at baseline, during and one-month post-bleaching. TS and GI were assessed with a numeric scale (NRS) and a visual analog scale (VAS). Results After one month, the equivalence of reservoir and non-reservoir groups were observed in all color instruments (p>0.05). Fifteen and sixteen patients presented pain (absolute risk: 33% and 35%, 95%, confidence interval (CI) 21-46% and 23-49%) in the reservoir and non-reservoir side, respectively. The odds ratio for pain was 0.8 (95%CI 0.2-3.0) and the p-value was non-significant (p=1.0). TS intensity was similar between both groups in any of the pain scales (p>0.05). No difference in the GI was observed (p>0.05). Conclusions The protocol with reservoirs is equivalent in color change to the non-reservoir, although no superiority of the latter was observed in terms of reduced TS and GI with at-home 10% carbamide peroxide bleaching. Clinical Relevance The presence of reservoirs in a bleaching tray did not improve color change or affect tooth sensitivity and gingival irritation.
At low concentrations used for in-office bleaching gels, such as 6% HP, gingival barrier continues to be performed. If we take into account that, in the at-home bleaching technique, no barrier is ...indicated, it seems that the use of a gingival barrier fails to make much sense when bleaching gel in low concentration is used for in-office bleaching.
This double-blind, split-mouth, randomized clinical trial evaluated the gingival irritation (GI) of in-office bleaching using 6% hydrogen peroxide (HP) with and without a gingival barrier in adolescents, as well as color change and the impact of oral condition on quality of life.
Overall, 60 participants were randomized into which side would or would not receive the gingival barrier. In-office bleaching was performed for 50 minutes with 6% HP in three sessions. The absolute risk and intensity of GI were assessed with a visual analogue scale. Color change was assessed using a digital spectrophotometer and color guides. The impact of oral condition on quality of life was assessed using the Brazilian version of the Oral Health Impact Profile (α=0.05).
The proportion of patients who presented GI for the "with barrier" group was 31.6% and for the "without barrier" group, 30% (p=1.0). There is an equivalence for the evaluated groups regarding GI intensity (p<0.01). Color change was detected with no statistical differences (p>0.29). There was a significant impact of oral condition on quality of life after bleaching (p<0.001).
The use or not of the gingival barrier for in-office bleaching with 6% HP was equivalent for GI, as well as for bleaching efficacy, with improvement in the impact of oral condition on quality of life.
Light-cured resins are widely used as gingival barriers to protect the gums from highly concentrated peroxides used in tooth bleaching. The impact of barrier brand on clinical outcomes is typically ...considered negligible. However, there is limited evidence on the effects of different brands on operator experience, barrier adaptation, and patient comfort.
This clinical trial assessed the impact of four commercial gingival barrier brands (Opaldam, Topdam, Lysadam, and Maxdam) on operator perception, adaptation quality, and patient comfort.
Twenty-one undergraduate students placed gingival barriers in a randomized sequence using blinded syringes. Photographs of the barriers were taken from frontal and incisal perspectives. After bleaching procedures, operators rated handling features and safety using Likert scale forms. Two experienced evaluators independently assessed barrier adaptation quality on a scale from 1 (perfect) to 5 (unacceptable). The absolute risk of barrier-induced discomfort was recorded. Data were analyzed using Friedman and Chi-square tests (α = 0.05).
Opaldam and Topdam received the highest scores in most handling features, except for removal, which was similar among all brands. No significant difference was observed in barrier adaptation quality between the evaluated brands. Discomforts were mainly reported in the upper dental arch, with Maxdam having the highest absolute risk (35% for this arch and 24% overall).
This study suggests that gingival barrier brands can influence operator perception and patient comfort. Opaldam and Topdam were preferred by operators, but all brands demonstrated comparable adaptation quality.
The study was nested in a randomized clinical trial registered in the Brazilian Clinical Trials Registry under identification number RBR-9gtr9sc.
OBJECTIVEDespite the availability of in-office bleaching gels with a 6% concentration of hydrogen peroxide (HP), these gels have not been evaluated in younger patients. They are commercially ...available with a tip, associated or not with a brush, where the tip with a brush spreads the gel over the entire surface to have a smaller thickness (thin layer) since the manufacturers indicate the application of a thin layer of gel. This randomized, split-mouth, double-blind clinical trial evaluated the efficacy of in-office bleaching with 6% HP in adolescents using different application tips, as well tooth sensitivity (TS) and aesthetic self-perception.METHODOLOGYSixty participants were randomized for 6% HP self-mixing bleaching gel tip design: without brush and with brush. In-office bleaching was performed in 3 sessions of 50 minutes. Color change was evaluated using a digital spectrophotometer (ΔE ab , ΔE 00 , and ΔWI D ) and color guide (ΔSGU), the absolute risk and intensity of TS with a visual analogue scale and aesthetic self-perception with the oral aesthetic scale (a=0.05).RESULTSThe groups achieved similar bleaching regardless of the application tip (p>0.05). However, only for ΔWI D , a significant mean difference (MD) was observed in the third week (MD 2.3; 95% CI 1.2 to 3.3; p < 0.001) and at one month (MD 1.6; 95% CI 0.6 to 2.6; p < 0.03) favoring the tip without brush. Regarding TS, 45% in the tip-without-brush group and 33% in the tip-with-brush group reported TS (odds ratio 0.61; 95% CI 0.29 to 1.28; p<0.02), with low TS intensity (MD 0.05; 95% CI -0.06 to 0.17; p>0.36). All patients reported improved aesthetic self-perception after bleaching (MD -1.3; 95% -1.8 to -0.9; p<0.001).CONCLUSIONSRegardless of the tip used bleaching with 6% HP achieved a bleaching efficacy and improved the aesthetic self-perception. However, a lower risk of TS for application using the tip with brush was observed.
Introduction. Dental bleaching is the first choice to improve smile esthetics, but, in some cases, it needs to be associated with resin composite restoration to obtain a satisfactory result. ...Unfortunately, the bonding of resin-based materials can be impaired due to residual oxygen molecules, which can decrease the durability of the restoration. Objectives. To evaluate the effect of the antioxidant application on the bond strength of bleached enamel after 24 hr and 3 years of water storage. Methods. In total, 84 bovine teeth were used in this study. Of these, 77 were bleached with 35% hydrogen peroxide in a single session for three cycles of 15 min. Then, the specimens were divided into groups (n = 7 each): control (without bleaching), without antioxidant (WA) use; application of 10% sodium ascorbate (SA) gel, grape seed (GS) extract, and aloe vera (AV). The restorative procedure was performed immediately after bleaching, 7 and 14 days after bleaching. Specimens were sectioned and evaluated using microtensile bond strength (μTBS). Half of the resin-enamel sticks were tested after 24 hr, and the remaining half after 3 years of water storage. µTBS data were analyzed using a three-way analysis of variance, Tukey’s test, and Dunnett’s test. Results. The lowest µTBS values were observed when the restoration was performed immediately after bleaching in the AV, GS, and WA groups when compared with the SA group (p<0.005). However, no significant differences were observed among all groups after 3 years of water storage (p<0.001). Conclusions. SA at 10% was the most effective antioxidant agent for improving the immediate bond strength. However, independent of the antioxidant agent used, the bond strength values were maintained or recovered after 3 years of water storage. SA at 10% could be used to avoid delayed bonding procedures after in-office whitening without compromising bond strength over time. Clinical Significance. The use of antioxidants after dental bleaching can be effective in improving the bonding durability of the adhesive restorations.
Evaluate the penetration of hydrogen peroxide (HP) into the pulp chamber, bleaching efficacy (BE) and amount of gel expended during in-office bleaching using an applicator brush tip and conventional ...tip from different commercial brands.
104 human premolars were randomly distributed into thirteen groups (n = 8) according to the commercial brand: DSP White Clinic 35 % Calcium (DW), Nano White 35 % (NW), Total Blanc One-Step 35 % (TS), Whiteness HP Blue 35 % (WB), Potenza Bianco Pro SS 38 % (PB), Opalescence XTra Boost 40 % (OB), no bleaching (negative control), and application method: applicator brush tip and conventional tip for all groups. Initial HP concentration (%) was determined via titration and pH was measured with digital pH meter. Concentration (µg/mL) of HP into the pulp chamber was measured using UV–Vis spectrophotometry, the BE (ΔE*ab, ΔE00 and ΔWID) was evaluated with a digital spectrophotometer, and the amount of gel expended was evaluated using a precision analytical digital balance. Statistical analysis included two-way ANOVA, Tukey's, and Dunnett's test. Comparison between HP into the pulp chamber vs BE was performed with Person's correlation (α = 0.05).
Brush tip demonstrated a low amount of HP in the pulp chamber compared to the conventional method for all bleaching gels (p < 0.0003), as well as lower amount of gel expended (p < 0.002). The brush tip did not result in a significant difference in BE compared to the conventional (p > 0.05). No correlations were found between both factors (p > 0.05).
Brush tip showed lower penetration of HP in the pulp chamber and a reduced volume of spent gel when compared to the conventional tip, for all commercial brands.
Brush tip is recommended for bleaching gels in an attachable syringe due to its ability to reduce the penetration of HP into the pulp chamber and minimize the amount of bleaching gel used.
•Spherical and rod-shaped HAp successfully reduced peroxide permeability.•Both morphologies reduced dental demineralization.•Prior application of HAp did not reduce bleaching efficacy.
This study ...aims to synthesize, characterize, and assess the penetration of hydrogen peroxide (HP), color change (CC), and surface morphology changes after the application of two distinct nano-hydroxyapatite (nano-HAp).
Two nano-HAp were previously synthesized by co-precipitation: one with rod-shaped particles (RS) and the other with spherical-shaped particles (SS). The surface charge of the nano-HAp particles was determined at varying pH levels and characterized by X-ray diffraction patterns and Fourier transform infrared spectroscopy. The morphology of the samples was assessed using scanning electron microscopy (SEM). The nano-HAp particles were applied before the dental bleaching procedure. Forty teeth were divided into four groups (n = 10) according to the bleaching treatment: no treatment, bleaching with 35% HP only, RS application and bleaching with 35% HP, and SS application and bleaching with 35% HP. HP concentration (µg mL−1) was measured using UV-Vis, while CC was evaluated with a digital spectrophotometer (ΔEab, ΔE00 and WID). Additionally, four teeth from each group were selected for SEM analysis. Statistical analysis encompassed one-way ANOVA, Tukey's, and Dunnet's tests.
RS and SS were successfully synthesized by coprecipitation, primarily differing in pH during synthesis. Both variations of nano-HAp morphology significantly reduced HP diffusion into the pulp chamber (p < 0.001). Regarding enamel morphology, groups analyzed post dental bleaching exhibited greater HAp deposition on the enamel surface. Notably, this deposition did not impede CC.
The utilization of different nano-HAp morphologies prior to dental bleaching appears to be a promising strategy for mitigating adverse effects associated with dental bleaching procedures.
To evaluate the bleaching sensitivity and the bleaching effectiveness of in-office bleaching, following a protocol of complete cervical third protection with gingival dam in comparison with a ...traditional manner of applying gingival dam (used only in the gingival sulcus area).
35 participants were selected for this double-blind split-mouth randomized clinical trial. The control group received the gingival barrier in the traditional manner, and in the experimental group the barrier was extended by about 3 mm to include the cervical region. The bleaching agent was applied in two sessions. The risk and intensity of bleaching sensitivity were assessed using two scales. The bleaching effectiveness was evaluated with a digital spectrophotometer with the tip placed in the cervical area. The absolute risk of bleaching sensitivity was compared by the McNemar's test and bleaching effectiveness (ΔEab, ΔE00 and ΔWi) and intensity of bleaching sensitivity was evaluated by Wilcoxon-paired test (α= 0.05).
No significant difference at risk (P= 1.0) and intensity of bleaching sensitivity (P> 0.45) was seen between groups. After 30 days, bleaching effectiveness had no statistical difference between the groups (P> 0.09).
Extending the barrier in the cervical region of teeth did not reduce the risk and intensity of bleaching sensitivity, nor jeopardize the bleaching effectiveness.
Objectives
To evaluate the bleaching efficacy and permeability of hydrogen peroxide (HP) in the pulp chamber of human teeth bleached with lower concentrations of carbamide peroxide gel (4%, 5% and 7% ...CP).
Materials and methods
Bleaching gels with lower concentrations were formulated and a commercial standard gel, 10% CP, was used as a reference. Fifty-six human premolars were randomly divided into four groups. Applications of the bleaching gel were made for 3 h for 21 days. The bleaching efficacy was evaluated by digital spectrophotometry on 1, 7, 14 and 21 days, with analysis in the ∆E
ab
, ∆E
00
and WI
D
color spaces. The concentration of HP in the pulp chamber was measured in the same periods by UV-Vis spectrophotometry (µg/mL). Two-way repeated analysis of variance (ANOVA) examined bleaching efficacy and HP permeability, followed by Tukey’s post-hoc test (α = 0.05).
Results
All groups showed significant color changes, with no statistical differences after the second and third week of bleaching (
p
> 0.05). The ‘time’ factor was statistically different (
p
< 0.05), increasing the bleaching efficacy throughout the treatment. The 4% CP group had lower HP levels in the pulp chamber (
p
< 0.05).
Conclusions
The results seem promising, revealing that low concentration gels are as effective as 10% CP with the benefit of reducing the amount of HP in the pulp chamber.
Clinical relevance
Low concentration 4% PC and 5% PC maintains bleaching efficacy, reduces the penetration of HP peroxide into the pulp chamber, and may reduce tooth sensitivity.
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