|Year : 2013 | Volume
| Issue : 1 | Page : 17-21
Comparison of the bleaching efficacy of three different agents used for intracoronal bleaching of discolored primary teeth: An in vitro study
R Ganesh, S Aruna, M Joyson, Manikandan, Deepa
Department of Pediatric Dentistry, College of Dental Surgery, Saveetha University, Chennai - 600 077, Tamilnadu, India
|Date of Web Publication||27-May-2013|
C/O S. Rajendran, 17/788,10th Sector, 59th Street, K.K.Nagar, Chennai -600078, Tamilnadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Everyone wants whiter teeth to make them feel younger and to provide beautiful smiles with the accompanying increase in self-esteem. Bleaching is an established, simple, cost-effective and conservative method for improving the color of the discolored teeth. Aim: The aim of this in vitro study was to compare the bleaching efficacy of 10% carbamide peroxide, 10% hydrogen peroxide and 2g sodium perborate as bleaching agents on the artificially discolored human primary maxillary central incisors. Materials and Methods: Forty extracted human primary central incisors with intact crowns were selected for the study. Pulpectomy was performed and each tooth was artificially stained with 2 ml of fresh human blood and centrifuged. The teeth were randomly divided into four experimental groups of 10 teeth each and the baseline color evaluation was performed. 0.04 ml of the bleaching agent is syringed into the access cavity of the tooth and, in the control group, 0.04 ml of distilled water was syringed into the access cavity and it was sealed with IRM and placed at 37°C in an incubator throughout the experiment. The color of the bleached teeth was determined at 0, 7 and 14 days. The data obtained were analyzed using ANOVA and Turkey's test. Results: There was statistical significance (P = 0.00) among the carbamide peroxide, sodium perborate, hydrogen peroxide and control groups after 7 and 14 days and a significance of P = 0.013 among the carbamide peroxide, sodium perborate and hydrogen peroxide after two bleaching sessions (day 14) was seen. Conclusions: The bleaching efficacy of 10% hydrogen peroxide gel was more effective than 10% carbamide peroxide and sodium perborate in bleaching the artificially discolored primary teeth.
Keywords: Bleaching, Primaryteeth, Hydrogenperoxide, Carbamide Peroxide, Sodium Perborate
|How to cite this article:|
Ganesh R, Aruna S, Joyson M, Manikandan, Deepa. Comparison of the bleaching efficacy of three different agents used for intracoronal bleaching of discolored primary teeth: An in vitro study. J Indian Soc Pedod Prev Dent 2013;31:17-21
|How to cite this URL:|
Ganesh R, Aruna S, Joyson M, Manikandan, Deepa. Comparison of the bleaching efficacy of three different agents used for intracoronal bleaching of discolored primary teeth: An in vitro study. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2021 Apr 23];31:17-21. Available from: https://www.jisppd.com/text.asp?2013/31/1/17/112394
| Introduction|| |
Everyone wants whiter teeth to make them feel younger and to provide beautiful smiles, with the accompanying increase in self-esteem. It is amazing that an appearance change as simple and noninvasive as tooth whitening has had so much influence on the profession and the people we serve. 
Parents are aware of the cosmetic and esthetics of anterior teeth of the children. Children, too, are becoming more aware of their appearance because they live in an era of acute peer evaluation. Children want to be like everyone else; they want to avoid ridicule and criticism from their peers. Much criticism may be directed toward unsightly teeth and may be psychologically traumatic. Older children express their desires for an esthetic smile to be like their peers. 
Intracoronal bleaching of discolored nonvital teeth in young people offers advantages over more conventional treatment involving partial or complete coverage restorations. Perhaps the most important of these advantages is conservation of tooth structure. The younger teeth are easier to bleach because the tooth substance has relatively greater permeability.  Intracoronal bleaching provides satisfactory results and it is relatively economic and visits are comparatively short, making the technique readily acceptable to children [Table A]. 
| Materials and Methods|| |
Forty extracted human primary central incisors with intact crowns were selected for the study [Figure 1]c. The armamentarium used were airotor, files, burs, zinc oxide eugenol [Figure 1]a, normal saline, IRM [Figure 1]b. The bleaching agents used were 10% hydrogen peroxide [Figure 1]f, 10% carbamide peroxide [Figure 1]e and 10%sodium perborate [Figure 1]d. Teeth were then stored in physiologic saline. Pulpectomy was performed and, the root canal filling was reduced 1 mm apical to the cemento-enamel junction and covered with IRM as protective base.
The teeth were placed in a test tube containing 2 ml of fresh human blood [Figure 1]g and centrifuged at 3200 rpm for 20 min twice daily for 3 days [Figure 1]h. The teeth was placed in incubator [Figure 1]i at 25 0 C .
After artificial staining, the teeth are randomly divided into four experimental groups of 10 teeth each and the baseline color evaluation was performed. 0.04 ml of the bleaching agent is syringed into the access cavity of the tooth and, in the control group, 0.04 ml of distilled water was syringed into the access cavity and it is sealed with IRM and placed at 37°C in an incubator throughout the experiment.
The color of bleached teeth is determined at 0, 7 and 14 days.  The color of each tooth is evaluated using vita lumen shade guide [Figure 1]j under broad daylight conditions. The [Figure 2]a shows the group 1(CP) and [Figure 2]b shows the group2 (HP) before bleaching. The [Figure 2]c and d shows the group 3(SP) and control group before bleaching. The [Figure 3]a shows the group 1(CP) and [Figure 3]b shows the group2 (HP) after bleaching at the end of 14 days. The [Figure 3]c and d shows the group 3(SP) and control group after 14days. The data are collected, tabulated and subjected to statistical analysis.
| Results|| |
The results in [Table 1] showed statistical significance in control group, group 1 (CP), group 2 (HP), group 3 (SP) (mean = -8.40, P-value = 0.00) (P-value <0.05 is statistically significant). The comparison of group 3 (SP) with group 1 (CP) and group 2 (HP) and control group showed significance in relation to the control group (mean = -6.20, P-value = 0.00) (P-value <0.05 is statistically significant).
|Table 1: Multiple comparisons among the carbamide peroxide, sodium perborate, hydrogen peroxide and control groups after two bleaching sessions (day14)|
Click here to view
The comparison of group 2 (HP) with group 1 (CP), group 3 (SP) showed high statistical significance in relation to group 1 (CP) (mean = -2.20, P-value = 0.026) and group 3 (SP) (mean = -2.20, P-value = 0.026). The comparison of group 3 (SP) with group 1 (CP), group 2 (HP) showed significance in relation to group 2 (mean = 2.20, P-value = 0.026) (P-value <0.05 is statistically significant) alone in [Table 2]. This shows that the bleaching efficacy of 10% hydrogen peroxide gel was more effective than 10% carbamide peroxide and sodium perborate in bleaching the artificially discolored primary teeth. [Graph 1[Additional file 1]]shows Comparison of bleaching efficacy of CP, HP, SP and Control group. It shows no significant changes in control group after 14 days. The [Graph 2[Additional file 2]] exhibits the Comparison of bleaching efficacy of CP, HP and SP group after 14days and It also shows that there is marked significance in HP group when compared to other groups.
|Table 2: Multiple comparisons among the carbamide peroxide, sodium perborate and hydrogen peroxide groups after two bleaching sessions (day 14)|
Click here to view
| Discussion|| |
Teeth whitening techniques have seen renewed interest from the dental profession as a result of the public's desire for whiter,  brighter teeth. In children and adolescents, partial or complete coverage restorations are difficult because of the instability of the gingival margin, leading to deterioration in esthetics.  Intracoronal bleaching provides a satisfactory result until gingival maturation is complete. Younger teeth are easier to bleach because the tooth substance has relatively greater permeability and hence a lesser concentration of bleaching agents may be used. 
Discoloration of nonvital teeth can occur through extrinsic and/or intrinsic factors. Among the intrinsic stains, intrapulpal hemorrhage and/or pulpal necrosis, often associated with impact injuries of teeth, can be successfully managed using intracoronal bleaching. 
Stewart Ho and Goerig  reported that deciduous teeth can also be successfully bleached. As young children are accident-prone and have a significant number of anterior teeth that are traumatized,  the pulps become necrotic, causing discoloration of the teeth. Endodontic treatment and bleaching should be a viable treatment option for such teeth. 
Reports on the bleaching of discolored nonvital teeth were first described in the mid-19 th century.  Chlorinated lime was recommended first for whitening of nonvital teeth,  followed later by oxalic acid and agents such as chlorine compounds and solutions. Next, sodium peroxide, sodium hypochlorite or mixtures consisting of 25% hydrogen peroxide in 75% ether were used as bleaching agents. 
In 1961, Spasser  described the intracoronal bleaching method of sealing a mixture of sodium perborate with water into the pulp chamber and leaving it in situ for 1 week. This was known as "walking bleach." Nutting and Poe  modified this by using a combination of 30% hydrogen peroxide and sodium peroxide sealed into the pulp chamber. The most commonly used bleaching agents to produce the desired esthetic color change are hydrogen peroxide and sodium perborate, either used alone or in combination. More recently, 10% carbamide peroxide has also been recommended. 
Hydrogen peroxide is used in dentistry as a whitening material at different concentrations, from 5 to 35%. Because of its low molecular weight, this substance can penetrate the dentin and can release oxygen, which breaks the double bonds of the organic and inorganic compounds inside the dentinal tubule. 
Carbamide peroxide is an organic white crystalline compound and is formed by urea and hydrogen peroxide and is used in different concentrations. In a hydrophilic environment, it breaks down into approximately 3% hydrogen peroxide and 7% urea. 
Sodium perborate is an oxidizing agent available as a powder. It is stable when dry; however, in the presence of acid, warm air or water, it breaks down to form sodium metaborate, hydrogen peroxide and nascent oxygen. 
The results in this study indicate the statistical significance between the control group with group 1 (CP) with group 2 (HP) and group 3 (SP) at day 7 and day 14. With CP and SP, there was a mean improvement of six Vita Lumin shade tabs, whereas group HP had a mean improvement of eight Vita Lumin shade tabs. In contrast, the results from Lim et al study showed eight Vita Lumin shade mean improvement in both the carbamide peroxide and the hydrogen peroxide group and four Vita Lumen shade improvement in the sodium perborate group. In fact, approximately half of all teeth from the groups except the control group underwent further color change, and this was similar to the study by Lim et al. 
Thus, the present study demonstrated that hydrogen peroxide (10%) was better as intracoronal bleaching agent on artificially discolored primary anterior teeth than sodium perborate (2g) and carbamide peroxide (10%) after two bleaching sessions (day 7 and day 14). Hence, the present study and the study by Stewart et al.  showed that intracoronal bleaching can be considered as one of the ideal and conservative methods in treating discolored primary teeth.
| Conclusions|| |
In the present in vitro study, 10% hydrogen peroxide gel was more effective than carbamide peroxide (10%) and sodium perborate (2 g) after two bleaching sessions (day 14) for intracoronal bleaching of artificially discolored primary teeth. There was no color change in the control group after 7 and 14 days.
The study showed statistical significance of hydrogen peroxide in bleaching efficacy to be high when compared with carbamide peroxide and sodium perborate at day 14.
In children, discolored primary teeth secondary to trauma and minor developmental tooth discolorations can be effectively treated with intracoronal bleaching. Hence, the present study concludes that 10% hydrogen peroxide can be used as an ideal and effective intracoronal bleaching agent on discolored primary teeth in children.
"Every child is our treasure and every smile is our pleasure"
| References|| |
|1.||Christensen GJ. The tooth whitening revolution. J Am Dent Assoc 2002;133:1277-9. |
|2.||Curzon ME, Roberts JF, Kennedy DB. Kennedy's Text book of Paediatric operative dentistry. Wright Publishers; 4 th ed; 1997. |
|3.||Mortada A, King NM. A simplified technique for the restoration of severely mutilated primary anterior teeth. J Clin Pediatr Dent 2004;28:187-92. |
|4.||Carrillo A, Arredondo Trevino MV, Haywood VB. Simultaneous bleaching of vital teeth and an open -chamber nonvital tooth with 10% carbamide peroxide. Quintessence Int 1998;29:643-8. |
|5.||Macey-Dare LV, Williams B. Bleaching of a discolored nonvital tooth: Use of a sodium perborate/water paste as the bleaching agent. Int J Paediatr Dent 1997;7:35-8. |
|6.||Attin T, Paqué F, Ajam F, Lennon AM. Review of the current status of tooth whitening with the walking bleach technique. Int Endod J 2003;36:313-29. |
|7.||Sulieman M. An over view of bleaching techniques: History, chemistry, safety and legal aspects. Dent Update 2004;31:608-16. |
|8.||Stewart HO, Goerig AC. An invitro comparison of different bleaching agents in the discolored tooth. J Endod 1989;15:106-11. |
|9.||Waterhouse PJ, Nunn JH. Intracoronal bleaching of nonvital teeth in children and adolescents: Interim results. Quintessence Int 1996;27:447-53. |
|10.||Beer R, Text Book Of Color atlas of dental medicine and endodontology, Elsevier Publishers 1 st ed, 2004. |
|11.||Curtis JW, Dickinson GL, Downey MC, Russell CM, Haywood VB, Myers ML, et al. Assessing the effects of 10 percent carbamide on oral soft tissues. J Am Dent Assoc 1996;127:1218-23. |
|12.||Lenhard M. Assessing tooth color change after repeated bleaching invitro with a 10% carbamide. J Am Dent Assoc 1996;127:1618-24. |
|13.||Settembrini L, Gultz J, Kaim J, Scherer W. A technique for bleaching non-vital teeth: Inside/outside bleaching. J Am Dent Assoc 1997;128:1283-4. |
|14.||Spasser HF. A simplified bleaching technique using sodium perborate. NY State Dent J 1961;27:332-4 (cited from Waterhouse P J, Nunn J H. Intracoronal bleaching of nonvital teeth in children and adolescents: Interim results. Quintessense Int 1996;27:447-53). |
|15.||Nutting EB, POE GS. A new combination for bleaching teeth. J South Calif Dent Assoc 1963;31:289-91 (cited from Waterhouse P J, Nunn J H, Intracoronal bleaching of nonvital teeth in children and adolescents: Interim results. Quintessense Int 1996;27:447-53). |
|16.||Horn DJ, Hicks LM, Brady JB. Effect of smear layer removal on bleaching of human teeth in vitro. J Endod 1998;24:791-5. |
|17.||Haywood VB, Leonard RH. Night guard vital bleaching removes brown discoloration for 7 years: A case report. Quintessence Int 1998;29:450-1. |
|18.||Matis BA, Gaiao U, Blackman D, Schultz FA, Eckert GJ. In vivo degradation of bleaching gel used in whitening teeth. J Am Dent Assoc 1999;130:227-35. |
|19.||Tam L. Clinical trial of three 10% carbamide peroxide products, J Can Dent Assoc 1999;65:201-5. |
|20.||Lim MY, Lum SO, Poh RS, Lee GP, Lim KC. An invitro comparison of the bleaching efficacy of 35% carbamide peroxide with established intracoronal bleaching agents. Int Endod J 2004;37:483-8 |
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2]
|This article has been cited by|
||Aesthetic management of a discoloured non-vital immature maxillary central incisor
| ||R. Srinivasan,T.K. Bandyopadhyay,Nilav Bhagabati,R. Jaya |
| ||Medical Journal Armed Forces India. 2014; |
|[Pubmed] | [DOI]|