This study evaluated the effects of calcium gluconate (CaGlu), sodium fluoride (NaF), sodium trimetaphosphate (TMP), and NaF/TMP added to a 35% hydrogen peroxide (HP) bleaching gel for the reduction in enamel demineralization in vitro, with and without the use of a fluoridated dentifrice.
Enamel blocks (n = 100) were obtained from bovine incisors (n = 200) after flattening and subjected to initial surface hardness (SH) analysis. The blocks were divided according to the bleaching gel (35% HP; 35% HP + 0.05% NaF; 35% HP + 0.25% TMP; 35% HP + 0.05% NaF + 0.25% TMP; 35% HP + 2% CaGlu) and were treated with ether non-fluoridated or fluoridated (1100 ppm) dentifrice. The bleaching gels were applied thrice (40 min/session) at the intervals of 7 days between each application. After 21 days, the final SH for the calculation of the percentage of SH loss (%SH) and cross-sectional hardness for the evaluation of the integrated hardness area (IH) were determined.
Bleaching containing HP + NaF + TMP presented lowest %SH (p < 0.001), regardless of the dentifrice used. HP + NaF + TMP bleaching gel led to lower subsurface enamel mineral loss (IH) compared to the other groups (p < 0.001), and these did not differ from each other (p > 0.05). Daily use of fluoride dentifrice led to higher IH values (p < 0.001), regardless of the bleaching gels.
The addition of NaF/TMP to a 35% HP bleaching gel remarkably reduced the mineral loss compared to the cases of the other bleaching gels, regardless of dentifrice.
The association of TMP/NaF can be used as a strategy for reducing mineral loss during the bleaching procedure, even without the daily use of fluoride dentifrice.
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Samorodnitzky-Naveh GR, Geiger SB, Levin L (2007) Patients’ satisfaction with dental esthetics. J Am Dent Assoc 138:805–808. https://doi.org/10.14219/jada.archive.2007.0269
Kielbassa AM, Maier M, Gieren AK, Eliav E (2015) Tooth sensitivity during and after vital tooth bleaching: a systematic review on an unsolved problem. Quintessence Int 46:881–897. https://doi.org/10.3290/j.qi.a34700
Carey CM (2014) Tooth whitening: what we now know. J Evid Based Dent Pract 14:70–76. https://doi.org/10.1016/j.jebdp.2014.02.006
Auschill TM, Hellwig E, Schmidale S, Sculean A, Arweiler NB (2005) Efficacy, side-effects and patients’ acceptance of different bleaching techniques (OTC, in-office, at-home). Oper Dent 30:156–166. https://doi.org/10.1016/S0084-3717(08)70026-6
Reis A, Tay L, Herrera D, Kossatz S, Loguercio AD (2011) Clinical effects of prolonged application time of an in-office bleaching gel. Oper Dent 36:590–596. https://doi.org/10.2341/10-173-C
Magalhães JG, Marimoto ARK, Torres CRG, Pagani C, Teixeira SC, Barcellos DC (2012) Microhardness change of enamel due to bleaching with in-office bleaching gels of different acidity. Acta Odontol Scand 70:122–126. https://doi.org/10.3109/00016357.2011.600704
Cintra LTA, Benetti F, Ferreira LL, Gomes-Filho JE, Ervolino E, Gallinari MO, Rahal V, Briso ALF (2016) Penetration capacity, color alteration and biological response of two in-office bleaching protocols. Braz Dent J 27:169–175. https://doi.org/10.1590/0103-6440201600329
Zantner C, Beheim-Schwarzbach N, Neumann K, Kielbassa AM (2007) Surface microhardness of enamel after different home bleaching procedures. Dent Mater 23:243–250. https://doi.org/10.1016/j.dental.2006.06.044
Eimar H, Siciliano R, Abdallah MN, Nader SA, Amin WM, Martinez PP, Celemin A, Cerruti M, Tamimi F (2012) Hydrogen peroxide whitens teeth by oxidizing the organic structure. J Dent 40:e25–e33. https://doi.org/10.1016/j.jdent.2012.08.008
White DJ, Kozak KM, Zoladz JR, Duschner H, Götz H (2002) Peroxide interactions with hard tissues: effects on surface hardness and surface/subsurface ultrastructural properties. Compend Contin Educ Dent 23:42–48
Sasaki RT, Arcanjo AJ, Flório FM, Basting RT (2009) Micromorphology and microhardness of enamel after treatment with home-use bleaching agents containing 10% carbamide peroxide and 7.5% hydrogen peroxide. J Appl Oral Sci 17:611–616. https://doi.org/10.1590/S1678-77572009000600014
Basting R, Amaral F, França F, Flório F (2012) Clinical comparative study of the effectiveness of and tooth sensitivity to 10% and 20% carbamide peroxide home-use and 35% and 38% hydrogen peroxide in-office bleaching materials containing desensitizing agents. Oper Dent 37:464–473. https://doi.org/10.2341/11-337-C
Wiegand A, Schreier M, Attin T (2007) Effect of different fluoridation regimes on the microhardness of bleached enamel. Oper Dent 32:610–615. https://doi.org/10.2341/06-171
Chen HP, Chang CH, Liu JK, Chuang SF, Yang JY (2008) Effect of fluoride containing bleaching agents on enamel surface properties. J Dent 36:718–725. https://doi.org/10.1016/j.jdent.2008.05.003
Cavalli V, Rodrigues LK, Paes-Leme AF, Brancalion ML, Arruda MA, Berger SBGM (2010) Effects of bleaching agents containing fluoride and calcium on human enamel. Quintessence Int 41:157–165
da Costa Soares MUS, Araújo NC, Borges BCD, Sales WS, Sobral APV (2013) Impact of remineralizing agents on enamel microhardness recovery after in-office tooth bleaching therapies. Acta Odontol Scand 71:343–348. https://doi.org/10.3109/00016357.2012.681119
Alexandrino L, Gomes Y, Alves E, Costi H, Rogez H, Silva C (2014) Effects of a bleaching agent with calcium on bovine enamel. Eur J Dent 08:320–325. https://doi.org/10.4103/1305-7456.137634
Basting RT, Antunes EV, Turssi CP, do Amaral FL, Franca FM, Florio FM (2015) In vitro evaluation of calcium and phosphorus concentrations in enamel submitted to an in-office bleaching gel treatment containing calcium. Gen Dent 63:52–56
Furlan IS, Bridi EC, Amaral FLBD, França FMG, Turssi CP, Basting RT (2017) Effect of high- or low-concentration bleaching agents containing calcium and/or fluoride on enamel microhardness. Gen Dent 65:66–70
Cavalli V, Rosa DAD, Silva DPD et al (2018) Effects of experimental bleaching agents on the mineral content of sound and demineralized enamels. J Appl Oral Sci 26:26. https://doi.org/10.1590/1678-7757-2017-0589
Vieira-Junior W, Lima D, Tabchoury C, Ambrosano GMB, Aguiar FHB, Lovadino JR (2016) Effect of toothpaste application prior to dental bleaching on whitening effectiveness and enamel properties. Oper Dent 41:E29–E38. https://doi.org/10.2341/15-042-L
Tschoppe P, Neumann K, Mueller J, Kielbassa AM (2009) Effect of fluoridated bleaching gels on the remineralization of predemineralized bovine enamel in vitro. J Dent 37:156–162. https://doi.org/10.1016/j.jdent.2008.11.001
Cruz NVS, Pessan JP, Manarelli MM, Souza MDB, Delbem ACB (2015) In vitro effect of low-fluoride toothpastes containing sodium trimetaphosphate on enamel erosion. Arch Oral Biol 60:1231–1236. https://doi.org/10.1016/j.archoralbio.2015.05.010
Missel EMC, Cunha RF, Vieira AEM, Cruz NVS, Castilho FCN, Delbem ACB (2016) Sodium trimetaphosphate enhances the effect of 250 p.p.m. fluoride toothpaste against enamel demineralization in vitro. Eur J Oral Sci 124:343–348. https://doi.org/10.1111/eos.12277
Manarelli MM, Moretto MJ, Sassaki KT, Martinhon CC, Pessan JP, Delbem AC (2013) Effect of fluoride varnish supplemented with sodium trimetaphosphate on enamel erosion and abrasion. Am J Dent 26:307–312
Pancote LP, Manarelli MM, Danelon M, Delbem ACB (2014) Effect of fluoride gels supplemented with sodium trimetaphosphate on enamel erosion and abrasion: in vitro study. Arch Oral Biol 59:336–340. https://doi.org/10.1016/j.archoralbio.2013.12.007
Burgmaier GM, Schulze IM, Attin T (2002) Fluoride uptake and development of artificial erosions in bleached and fluoridated enamel in vitro. J Oral Rehabil 29:799–804. https://doi.org/10.1046/j.1365-2842.2002.00966.x
Basting RT, Rodrigues AL, Serra MC (2003) The effects of seven carbamide peroxide bleaching agents on enamel microhardness over time. J Am Dent Assoc 134:1335–1342. https://doi.org/10.14219/jada.archive.2003.0047
Vieira AEM, Danelon M, Camara DMD et al (2017) In vitro effect of amorphous calcium phosphate paste applied for extended periods of time on enamel remineralization. J Appl Oral Sci 25:596–603. https://doi.org/10.1590/1678-7757-2016-0513
Amaral JG, Pessan JP, Souza JAS, Moraes JCS, Delbem ACB (2018) Cyclotriphosphate associated to fluoride increases hydroxyapatite resistance to acid attack. J Biomed Mater Res B Appl Biomater 106:2553–2564. https://doi.org/10.1002/jbm.b.34072
Featherstone JDB, ten Cate JM, Shariati M, Arends J (1983) Comparison of artificial caries-like lesions by quantitative microradiography and microhardness profiles. Caries Res 17:385–391. https://doi.org/10.1159/000260692
Kielbassa AM, Wrbas KT, Schulte-Mönting J, Hellwig E (1999) Correlation of transversal microradiography and microhardness on in situ-induced demineralization in irradiated and nonirradiated human dental enamel. Arch Oral Biol 44:243–251. https://doi.org/10.1016/S0003-9969(98)00123-X
Dalpasquale G, Delbem ACB, Pessan JP, Nunes GP, Gorup LF, Neto FNS, de Camargo ER, Danelon M (2017) Effect of the addition of nano-sized sodium hexametaphosphate to fluoride toothpastes on tooth demineralization: an in vitro study. Clin Oral Investig 21:1821–1827. https://doi.org/10.1007/s00784-017-2093-3
Danelon M, Garcia LG, Pessan JP, Passarinho A, Camargo ER, Delbem ACB (2019) Effect of fluoride toothpaste containing nano-sized sodium hexametaphosphate on enamel remineralization: an in situ study. Caries Res 53:260–267. https://doi.org/10.1159/000491555
Delbem ACB, Souza JAS, Zaze ACSF, Takeshita EM, Sassaki KT, Moraes JCS (2014) Effect of trimetaphosphate and fluoride association on hydroxyapatite dissolution and precipitation in vitro. Braz Dent J 25:479–484. https://doi.org/10.1590/0103-6440201300174
This study was supported by FAPESP (The State of São Paulo Research Foundation, grant 2016/26132-9).
Conflict of interest
The authors Alberto Carlos Botazzo Delbem and Mirela Sanae Shinohara and hold a patent request for a product used in the study, by the National Institute of Industrial Property—INPI/SP, on 11 Nov. 2014 under number BR 102013 006761-0 A2.
This paper does not contain any studies with human subjects, so that no ethical approval was required.
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Júnior, R.A.T.P., Danelon, M., Pessan, J.P. et al. Effect of daily use of fluoridated dentifrice and bleaching gels containing calcium, fluoride, or trimetaphosphate on enamel hardness: an in vitro study. Clin Oral Invest (2020). https://doi.org/10.1007/s00784-020-03375-5
- Tooth demineralization
- Dental enamel
- Dental bleaching