Bleaching gel mixed with MI Paste Plus reduces penetration of H2O2 and damage to pulp tissue and maintains bleaching effectiveness
MI Paste Plus remineralizer (Rem) strengthens dental structures after bleaching. We investigated the effect of Rem on the penetration of hydrogen peroxide (H2O2), bleaching effectiveness, and pulp inflammation after bleaching.
Materials and methods
Bovine disks were grouped as follows (n = 10): control (untreated), bleached (Ble; 35% H2O2, 30 min), Ble-Rem (H2O2 followed by Rem, 30 min), Rem-Ble (Rem followed by H2O2), Rem-Ble-Rem (Rem before and after H2O2), and Ble+Rem (mixture of Rem with H2O2, 1:1, 30 min). The penetration of H2O2 was quantified and bleaching efficacy was analyzed. Upper rat molars (n = 10) received the same treatments at random. The rats were euthanized after two days and 30 days, and their jaws were removed for histological analysis. Statistical tests were performed (P < 0.05).
The bleached groups, except Ble+Rem (P > 0.05), showed significant H2O2 penetration compared with control (P < 0.05). Color alteration analysis showed that ΔL and ΔE were significantly higher in the bleached groups than those in control (P < 0.05); the Δb of the bleached groups differed from that of control at 24 h (P < 0.05). At two days, necrosis or inflammation was observed in the bleached groups compared with control (P < 0.05), except Ble+Rem, which was similar to control (P > 0.05). At 30 days, tertiary dentin formation was significant in the bleached groups (P < 0.05), except Ble+Rem (P > 0.05).
The mixture of MI Paste Plus and bleaching gel reduces H2O2 penetration and pulp damage and maintains bleaching effectiveness.
Because bleaching can damage dental tissues, we studied a new bleaching protocol that reduces damage to the pulp tissue while maintaining bleaching efficiency: a single application of 30 min of MI Paste Plus mixed with 35% H2O2 bleaching gel (1:1).
KeywordsCasein phosphopeptide-amorphous calcium phosphate (CPP-ACP) Dental bleaching Hydrogen peroxide MI Paste Plus Pulp inflammation
This study was supported by a grant (2015/10984-3) from the Fundação de Amparo à Pesquisa do Estado de São Paulo, São Paulo, SP, Brazil.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants by any of the authors. The in vitro (CEUA 00568) and in vivo (CEUA 00631) studies using rat molars were approved by the ethics committee of the institution where the study was performed and conducted in accordance with its ethical standards.
For this type of study, informed consent is not required.
- 6.Trindade FZ, Ribeiro AP, Sacono NT, Oliveira CF, Lessa FC, Hebling J, Costa CA (2009) Trans-enamel and trans-dentinal cytotoxic effects of a 35% H2O2 bleaching gel on cultured odontoblast cell lines after consecutive applications. Int Endod J 42(649):516–524. https://doi.org/10.1111/j.1365-2591.2009.01544.x CrossRefGoogle Scholar
- 12.Heshmat H, Ganjkar MH, Jaberi S, Fard MJ (2014) The effect of remin pro and MI paste plus on bleached enamel surface roughness. J Dent (Tehran) 11:131–136Google Scholar
- 17.Loguercio AD, Servat F, Stanislawczuk R, Mena-Serrano A, Rezende M, Prieto MV, Cereño V, Rojas MF, Ortega K, Fernandez E, Reis A (2017) Effect of acidity of in-office bleaching gels on tooth sensitivity and whitening: a two-center double-blind randomized clinical trial. Clin Oral Investig 21:2811–2818. https://doi.org/10.1007/s00784-017-2083-5 CrossRefGoogle Scholar
- 18.Faria-E-Silva AL, Nahsan FP, Fernandes MT, Martins-Filho PR (2015) Effect of preventive use of nonsteroidal anti-inflammatory drugs on sensitivity after dental bleaching: a systematic review and meta-analysis. J Am Dent Assoc 146:87–93. https://doi.org/10.1016/j.adaj.2014.10.007 CrossRefGoogle Scholar
- 19.Cartagena AF, Parreiras SO, Loguercio AD, Reis A, Campanha NH (2015) In-office bleaching effects on the pulp flow and tooth sensitivity - case series. Braz Oral Res 29:1–6. https://doi.org/10.1590/1807-3107BOR-2015.vol29.0026 CrossRefGoogle Scholar
- 22.Mena-Serrano AP, Parreiras SO, do Nascimento EM, Borges CP, Berger SB, Loguercio AD, Reis A (2015) Effects of the concentration and composition of in-office bleaching gels on hydrogen peroxide penetration into the pulp chamber. Oper Dent 40:e76–e82. https://doi.org/10.2341/13-352-L CrossRefGoogle Scholar
- 23.Benetti F, Lemos CAA, de Oliveira Gallinari M, Terayama AM, Briso ALF, de Castilho Jacinto R, Sivieri-Araújo G, Cintra LTA (2017) Influence of different types of light on the response of the pulp tissue in dental bleaching: a systematic review. Clin Oral Investig 22:1825–1837. https://doi.org/10.1007/s00784-017-2278-9 CrossRefGoogle Scholar
- 28.Borges BC, Borges JS, de Melo CD, Pinheiro IV, Santos AJ, Braz R, Montes MA (2011) Efficacy of a novel at-home bleaching technique with carbamide peroxides modified by CPP-ACP and its effect on the microhardness of bleached enamel. Oper Dent 36:521–528. https://doi.org/10.2341/11-013-L CrossRefGoogle Scholar
- 32.Bayrak S, Tunc ES, Sonmez IS, Egilmez T, Ozmen B (2009) Effects of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application on enamel microhardness after bleaching. Am J Dent 22:393–396Google Scholar
- 36.Cunha AG, De Vasconcelos AA, Borges BC, Vitoriano Jde O, Alves-Junior C, Machado CT, Dos Santos AJ (2012) Efficacy of in-office bleaching techniques combined with the application of a casein phosphopeptide-amorphous calcium phosphate paste at different moments and its influence on enamel surface properties. Microsc Res Tech 75:1019–1025. https://doi.org/10.1002/jemt.22026 CrossRefGoogle Scholar
- 46.Benetti F, Gomes-Filho JE, Ferreira LL, Sivieri-Araújo G, Ervolino E, Briso ALF, Cintra LTA (2018) Concentration-dependent effect of bleaching agents on the immunolabelling of interleukin-6, interleukin-17 and CD5-positive cells in the dental pulp. Int Endod J 51:789–799. https://doi.org/10.1111/iej.12891 CrossRefGoogle Scholar
- 47.Benetti F, Briso ALF, Carminatti M, Lopes JMA, Barbosa JG, Ervolino E, Gomes-Filho JE, Cintra LTA (2018) Presence of osteocalcin, osteopontin, and reactive oxygen species-positive cells in pulp tissue after dental bleaching. Int Endod J, in press. https://doi.org/10.1111/iej.13049, 52, 665, 675
- 48.Benetti F, Gomes-Filho JE, Ferreira LL, Ervolino E, Briso ALF, Sivieri-Araújo G, Dezan-Júnior E, Cintra LTA (2017) Hydrogen peroxide induces cell proliferation and apoptosis in pulp of rats after dental bleaching in vivo: effects of the dental bleaching in pulp. Arch Oral Biol 81:103–109. https://doi.org/10.1016/j.archoralbio.2017.04.013 CrossRefGoogle Scholar
- 49.Benetti F, Briso ALF, Ferreira LL, Carminatti M, Álamo L, Ervolino E, Dezan-Júnior E, Cintra LTA (2018) In vivo study of the action of a topical anti-inflammatory drug in rat teeth submitted to dental bleaching. Braz Dent J 29:555–561. https://doi.org/10.1590/0103-6440201802177 CrossRefGoogle Scholar
- 60.Griffiths CE, Bailey JR, Jarad FD, Youngson CC (2008) An investigation into most effective method of treating stained teeth: an in vitro study. J Dent 2008 36:54–62. https://doi.org/10.1016/j.jdent.2007.10.009