Joe C. Ontiveros

In-office Vital Bleaching with Adjunct Light

The use of light as an adjunct to in-office bleaching is a controversial topic in dentistry because of the equivocal outcomes of the research conducted in studies using light compared with no light treatment. The proper diagnosis and treatment planning of discolored teeth is of primary importance when managing the outcomes and setting expectations for patients undergoing in-office bleaching with supplemental light. Although no study is conclusive on all bleaching lights, research evidence provides guidelines for the responsible use of in-office bleaching lights in dentistry.

Clinical effectiveness and sensitivity with overnight use of 22% carbamide peroxide gel

OBJECTIVE To evaluate clinical effectiveness, color rebound and sensitivity of 22% carbamide peroxide (CP) with 3% potassium nitrate. METHODS Twenty-one participants were enrolled and treated overnight for 2 weeks with 22% CP (Venus White, Heraeus Kulzer). Visual color measurement was performed and expressed in shade guide units (SGU) of Vita Classical (VC) and Vita Bleachedguide 3D Master (BG) shade guides. Instrumental color measurements were performed using an intraoral spectrophotometer (Vita Easyshade Compact, EC). Color measurements were taken on a canine and central incisor at baseline, 2, 3, and 4 weeks. Participants documented sensitivity and data were analysed with Wilcoxon and Bonferroni correction at the 0.05 level of significance. RESULTS Mean BG SGU difference immediately, 1 and 2 weeks postbleaching compared to baseline was 4.9 (2.1), 4.5 (2.2) and 4.6 (2.0), respectively. Corresponding VC values were 7.0 (3.5), 6.4 (3.3) and 6.5 (3.4), while corresponding ΔE* values were 8.3 (4.1), 8.1 (4.0) and 7.9 (3.5). For visual shade evaluation there was a significant decrease in SGU from baseline and each subsequent week, p<0.001. There was no difference between week 3 and week 4 using VC or BG. For instrumental color measurements, there was no difference from week 2 to week 3 for canines and generally no difference between week 3 and week 4 for incisors. CONCLUSIONS Visual and instrumental evaluation showed rebound occurred 1 week postbleaching with 22% carbamide peroxide and 3% potassium nitrate. In general, color was stable at 2 weeks postbleaching. Participants reported low sensitivity levels with a mean value of below 2 on a 0-10 scale. CLINICAL SIGNIFICANCE This study demonstrates efficacy with overnight usage of 22% carbamide peroxide with 3% potassium nitrate and demonstrates postbleaching color is stable at two weeks with low tooth sensitivity.

Accelerated aging effects on color and translucency of flowable composites.

OBJECTIVES To evaluate the effect of accelerated aging on color and translucency parameter of composites. MATERIALS AND METHODS Filtek Supreme Ultra Flowable, shades A1, A3, White, Tetric EvoFlow, shades A1, A3, Bleach, and Filtek Z250 shades A1, A3, B1 were evaluated. Color and translucency were recorded using a spectrophotometer after 24-hour storage (baseline) and after accelerated aging. The data were analyzed by analysis of variance. RESULTS Fishers PLSD intervals for comparisons among products and shades were 0.4, 0.1, 0.3, and 0.4 for ΔL*, Δa*, Δb*, and ΔE*, respectively. The data showed significant ΔE* and ΔL* main effects for composite product and shades (p < 0.001) and their interactions (p = 0.008 and p = 0.03), respectively. Tetric EvoFlow displayed the smallest aging-dependent color shift followed by Filtek Z250 and Filtek Supreme Ultra Flowable. Accelerated aging did not significantly affected the composites for translucency (p > 0.05). CONCLUSION The effects of aging on color of resin composites were composite and shade dependent. Translucency was not affected by accelerated aging. CLINICAL SIGNIFICANCE The effects of aging on color of resin composites were composite and shade dependent.

Commentary: Alternative Esthetic Management of Fluorosis and Hypoplasia Stains: Blending Effect Obtained with Resin Infiltration Techniques

Enamel white spots appear on natural teeth in various degrees of demineralization, opacity, and characteristic patterns that may be an esthetic problem for some patients. Research indicates that at least one enamel white spot is expected to occur for 73% of patients undergoing orthodontic treatment. Often, treatment for white-spot lesions is approached like other forms of smooth surface caries using high concentrations of fluoride (greater than or equal to 5,000 ppm) to induce a rapid remineralization of the superficial enamel.The rapid remineralization of superficial enamel can impede the remineralization of the deeper layer of the lesions resulting in white-spot scars or enamel opacities that will not return to the natural opalescence of sound enamel.

Effects of repeated sterilization cycles on primary stability of orthodontic mini-screws.

OBJECTIVE To determine if repeated sterilization has deleterious effects on the clinical stability of mini-screws. MATERIALS AND METHODS Thirty each of the following mini-screws were tested: Aarhus (American Orthodontics, Sheboygan, Wisc), VectorTAS (Ormco Corporation, Orange, Calif), Dual-Top (RMO, Denver, Colo), and Ortho Anchor (KLS Martin, Jacksonville, Fla). Controls were sterilized once using a steam autoclave (Statim 5000, SciCan USA, Canonsburg, Pa). Each group of mini-screws was divided into three groups: the control (n = 10) and two test groups (n  =10, each). Test groups were cycled five and 10 times respectively. All screws were inserted into custom-designed synthetic blocks that simulated mandibular bone. Maximum insertion torque and lateral displacement force data were recorded and subjected to statistical testing. Two-way analysis of variance (ANOVA) and three-way mixed ANOVA were used for statistical analyses for maximum insertion torque data and lateral displacement force data, respectively. Level of significance was established at P < .05. RESULTS Insertion torque values displayed significant differences between both of the groups and sterilization cycles (P < .05). Significant differences were observed between American Aarhus mini-screws and both RMO and KLS Martin mini-screws. Ormco Vector mini-screws also differed significantly from the KLS Martin mini-screws in this comparison (P < .05). For lateral displacement, there was a significant main effect of groups, F(1,36) = 14.5 (P < .05). Significant differences were observed between American Aarhus mini-screws and all three of the other groups (P < .05). CONCLUSIONS The examined groups displayed statistical differences of variable quality that may not affect their clinical stability.

Evaluation of a calcium silicate-based cement as a root reinforcement material for endodontically treated maxillary anterior teeth.

STATEMENT OF PROBLEM Fractures of endodontically treated teeth have been attributed to weakened tooth structure caused by root canal enlargement and post preparation. PURPOSE The purpose of this in vitro study was to evaluate the fracture resistance of roots filled with either gutta percha, composite resin (LuxaCore Dual), or calcium silicate-based cement (Biodentine). MATERIAL AND METHODS One hundred twenty freshly extracted, human, permanent maxillary anterior teeth were sorted by type and assigned to 1 of 4 groups (n=30). The teeth in group NT were not endodontically treated and served as the control. The teeth in groups GP, LC, and, BD were accessed and instrumented to size 40/06. In group GP, the root canals were completely filled with gutta percha. In groups LC and BD, only the apical 5-mm portion of the root canals was filled with gutta percha, and the remaining portion of the root canals was filled with (LuxaCore Dual) in group LC and with (Biodentine) in group BD. Fracture resistance (kN) was assessed at the middle portion of each root, using a 3-point bending test with a universal testing machine exerting a compressive load on a loading pin at a crosshead speed of 0.5 mm/min until fracture occurred. One-way ANOVA was used to compare the mean root fracture resistance among the 4 groups (α=.05). RESULTS The mean ± SD fracture loads were 2.13 ±0.53 kN for group NT, 1.97 ±0.60 kN for group GP, 2.18 ±0.71 kN for group LC, and 2.22 ±0.54 kN for group BD. No statistically significant differences were found among the 4 groups (P>.05). CONCLUSIONS The roots of endodontically treated maxillary anterior permanent incisors filled with gutta percha, Biodentine, or LuxaCore Dual had resistance to fracture similar to that of teeth that were not endodontically treated.

Bond strength comparison of color-change adhesives for orthodontic bonding using a self-etching primer

Background The purpose of this study was to compare the shear bond strengths of two color-change adhesives with a commonly used conventional light-cure adhesive while using a self-etching primer, and to compare any changes in shear bond strengths over time. Methods One hundred and eighty extracted bovine incisors were randomly divided into nine groups of 20 teeth each. The teeth were prepared with a self-etching primer (Transbond™ Plus) Metal lower incisor brackets were bonded directly to each tooth with two different color-change adhesives (TransbondPlus and Grēngloo™) and a control (Transbond XT). The teeth were debonded at three different time points (15 minutes, 24 hours, 1 week) using an Instron at 1.0 mm/min. The teeth that were to be debonded at 24 hours and 1 week were stored in distilled water at 37°C to simulate the oral environment. The data were analyzed by two-way analysis of variance and with Fisher’s protected least-significant difference multiple comparisons test at the P < 0.05 level of significance. Adhesive remnant index (ARI) scores were calculated for each debonded tooth. Results Transbond Plus at 1 week had the highest mean shear bond strength (14.7 mPa). Grēngloo tested at 24 hours had the lowest mean shear bond strength (11.3 mPa). The mean shear bond strengths for the remaining seven groups had a range of 12–14.5 mPa. Grēngloo had >80% samples presenting with an ARI score of 1 at all times. Interestingly, both Transbond groups had ARI scores of 3 in more than 50% of their samples. Conclusion Time had no significant effect on the mean shear bond strength of Transbond XT, Grēngloo, or Transbond Plus adhesive.