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Table of Contents   
ORIGINAL ARTICLE  
Year : 2022  |  Volume : 25  |  Issue : 2  |  Page : 161-165
Comparative study of effects of home bleach and laser bleach using digital spectrophotometer: An in vitro study


Department of Conservative Dentistry and Endodontics, Sri Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India

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Date of Submission09-Nov-2021
Date of Decision03-Jan-2022
Date of Acceptance05-Jan-2022
Date of Web Publication04-May-2022
 

   Abstract 


Background: With the increasing demand for teeth whitening, we have seen a trend in emergence of newer bleaching products. Patients often come to dentists to find a solution in order to address the stains in the oral cavity. Thus, this study was performed to give quality esthetic treatment to patients.
Aim: The aim of this study was to compare if laser bleaching or 3-day home bleaching is effective for paan-stained and tea-stained teeth.
Materials and Methodology: Forty extracted teeth were randomly divided (n = 20 each) into Group 1 laser bleaching and Group 2 for home bleaching and further subdivided into Group 1a and 2a for tea stains and Group 1b and 2b for paan stains. The shade was evaluated with digital spectrophotometer. Pola Office + was applied on tooth and activated using the diode laser for Group 1. The bleaching was carried out with Zoom Nitewhite for Group 2. The second color measurement of the specimens was made.
Statistical Test: ANOVA with Tukey's post hoc analysis was done.
Results: 1. The test results demonstrated that there was no statistically significant difference in shade change on comparing Groups 1a and 2a (laser and home and tea stains). 2. The test results demonstrated that there was a statistically significant difference in shade change on comparing both the groups; Groups 1b and 2b (laser and home and paan stains) and Group 2b showed a lesser change in shade compared to Group 1b (P < 0.05).
Conclusion: Laser bleaching was effective when compared to 3-day home bleach for paan-stained teeth, whereas for tea-stained teeth, both treatments showed similar results.

Keywords: Coloring agents, laser, tooth bleaching

How to cite this article:
Naik PL, Valli K. Comparative study of effects of home bleach and laser bleach using digital spectrophotometer: An in vitro study. J Conserv Dent 2022;25:161-5

How to cite this URL:
Naik PL, Valli K. Comparative study of effects of home bleach and laser bleach using digital spectrophotometer: An in vitro study. J Conserv Dent [serial online] 2022 [cited 2022 May 24];25:161-5. Available from: https://www.jcd.org.in/text.asp?2022/25/2/161/344824



   Introduction Top


With the increasing demand for teeth whitening, we have seen a trend in emergence of newer bleaching products. Among the various esthetic treatments such as restoration with crowns, laminates, and composite veneers, dental bleaching is preferred because it is minimally invasive, easy to accomplish, has low cost, and can satisfy the expectations of both the patients and professionals.[1] The common cause of discoloration of teeth in our country is ascribed to pigmented food and beverages as well as tobacco products such as cigarettes or chewing tobacco.

Bleaching can be further divided into in-office bleaching, home bleaching, or a combination of both. Various sources have been tried and tested to enhance the bleaching efficacy such as lasers and light-emitting diodes (LEDs). The main advantage of in-office bleaching with laser includes 1. Dentist control of laser 2. Avoidance of tissue exposure since it is minimally invasive 3. Reduced treatment time 4. Enhanced patient satisfaction due to visibility of results in lesser number of visits.[2] Patients are often reluctant to undergo laser bleaching because of the higher cost which adds as a disadvantage. Also the type of laser used in the treatment is dependent on the various factors like exposure time, temperature and the wavelength used and that adds to the complexity of the procedure. Since CO2 lasers increased the intrapulpal temperature, they are no longer used.

Home vital tooth bleaching has become popular because it has reduced the chairside time and produced a significant change in tooth color. The optimum time required for home bleach gel to show effective results is approximately 2 weeks, and this has resulted in poor patient compliance. With introduction of newer products that show immediate changes, patients look for faster results. As it is very common for dentists to come across these stained teeth, the need for this study is to compare if laser bleaching or 3-day home bleaching is effective for tea-stained and paan-stained teeth and provide quality esthetics.

Aim

The aim of this in vitro study was to compare and evaluate the impact of laser bleaching on tea-stained teeth and paan-stained teeth with home bleaching on tea-stained teeth and paan-stained teeth using digital spectrophotometer.


   Materials and Methodology Top


An in vitro study was performed following the approval of ethical committee (Ethical Clearance Number – SRGCDS/2018/624).

A total of forty freshly extracted teeth were preserved in a solution of normal saline with 1% thymol crystals and were debrided of any deposits such as plaque and calculus using ultrasonic scaling unit. The specimens (n = 40) were randomly divided into two groups: Group 1 (n = 20) for laser bleaching and Group 2 (n = 20) for home bleaching. They were further subgrouped into tea-stained teeth (Group a) and paan-stained teeth (Group b) in each group. The teeth were then immersed in 200 ml of a freshly prepared tea solution and paan extracts, respectively, for a period of 2 weeks. The solution was changed every 7 days. The temperature of staining solutions was maintained at 37°C.

The samples were evaluated for preshades using VITA Easyshade spectrophotometer.

In order to measure tooth color, a model called CIE L*a*b (Commission Internationale de l'Éclairage), which is a mathematical system for describing the three dimensions of color perceptible to human eyes (red, green, and blue), was used. This system was defined by the International Commission on Illumination in 1967 where L* represents the value (lightness or darkness), a* measures redness or greenness, and b* measures yellowness or blueness. Readings were calculated using the ΔE* values for each individual sample shown on spectrophotometer using the formula – ΔE* = √ [(ΔL*)2+ (Δa*)2 + (Δ b*)2].

For the in-office bleaching procedure, the samples were mounted. 37% hydrogen peroxide Pola Office + was the gel used. A layer of 2-mm thick gel was spread over the samples in Group 1a and Group 1b. The diode laser of 980 nm was used for the activation of the bleaching gel. The laser activation was carried out for 30 s of four sessions on the samples in Group 1a and Group 1b. The excess gel was suctioned, teeth were washed, and shade was evaluated post bleaching.

In order to simulate maxillary and mandibular teeth, the trays were fabricated in the form of arches for the home bleach procedure using the polyvinyl acetate sheets and vacuum molding unit. 22% carbamide peroxide Zoom Nitewhite was used for home bleach. The gel was placed in each tooth compartment in the tray. The tray was placed over the samples in Group 2a and Group 2b. Any excess gel was removed with a cotton swab. The bleaching was carried out for 6 h. Then, the trays were rinsed with cold water. The teeth were rinsed to remove excess gel. The same procedure was carried out for 3 consecutive days. After the end of the bleaching process for the different groups, the color of the teeth was evaluated again. For each specimen, change in the ΔE* values was obtained from spectrophotometer readings.

Statistical analysis

  1. The shade change in each sample was detected using VITA Easyshade spectrophotometer
  2. Comparison of shade change between Group 1 and Group 2 for tea and paan stains was done with mean obtained, and ANOVA test with Tukey's post hoc analysis was done.



   Results Top


  1. Comparison of shade change between the laser bleach and home bleach in tea-stained teeth showed a mean shade change (ΔE-ΔE1 [ΔE- ΔE1 is the value obtained that denotes the change in the shade after bleaching]) of 28.376 for Group 1 and 21.757 for Group 2, respectively. The test results demonstrated that there was no statistically significant difference in shade change on comparing Group 1a and Group 2a (Tukey's HSD P = 0.1062093)
  2. Comparison of shade change between the laser bleach and home bleach in paan-stained teeth showed a mean shade change (ΔE-ΔE1) of 31.88 for Group 1b and 23.104 for Group 2b, respectively. The test results demonstrated that there was a statistically significant difference in shade change on comparing both the groups and Group 2b showed a lesser change in shade compared to Group 1b (Tukey's HSD P = 0.0181777, inference P < 0.05).



   Discussion Top


There is no study in the literature that has been carried out to find the result of bleaching on paan-stained teeth. Thus, this study was done to check if laser bleaching or 3-day home bleaching would be an effective option for patients with tea- and paan-stained teeth using digital spectrophotometer.

Beverages such as tea, coffee, and wine stain the teeth and the resultant stain on the teeth is obtained from the polyphenolic compounds which generate color due to the presence of conjugated double bonds and they interact with the teeth through exchange of ions. Since tea is a commonly consumed beverage causing stain in the Indian population, in this present study, tea was selected as one of the staining agents and the compounds in the tea that are responsible for causing dental stains are tannins.[3]

A study was done to check topographic pattern concerning the consumption of addictive substances in India, and it was found that paan (betel nut leaf) is the fourth highly consumed substance apart from nicotine, ethanol, and caffeine.[4] The scientific name of betel vine is Piper betle. It belongs to the Piperaceae family. The betel leaf is used for wrapping the areca nut/catechu and lime which are responsible for the resultant staining. The staining has been reported to be caused by polymers of orthoquinones.[5] Hence, the study was performed to check the effect of paan stains on teeth before and after bleaching.

There are three distinct phases which bring about a change in perception of teeth color: (a) diffusion of bleaching agent into tooth structure, (b) interaction of the whitening agent with the stain molecules, and (c) the double bonds are broken down and there is a change in the optical properties resulting in alteration of the tooth structure surface such that it reflects light differently. This sequence of events would determine the final color change of teeth after bleaching.[6],[7],[8]

Hydrogen peroxide, the active ingredient, is used in higher concentrations in the in-office bleach technique and lower concentrations in the home bleach technique. This brings about the breakdown of pigmented ring structures to nonpigmented single carbon bonds. Home bleach carried out by patients usually involves more wear time than a single-visit in-office bleach, and since the hydrogen peroxide not only reacts with the teeth but also with the adjacent tooth structures, it is important to maintain the optimal concentration of the bleaching agent. A 10% carbamide peroxide solution breaks down into 3.35% hydrogen peroxide and 6.65% urea. The bleaching agents used in the study were hydrogen peroxide and carbamide peroxide.

Photo-oxidation of the double bonds in the chromophore will result in their disruption and bring about the bleaching process. Hence, LEDs and lasers have been used to heat the bleaching gel. This will increase the penetration of the bleaching gel into the tooth structures and enhance the bleaching efficiency because chemical reactions happen faster at elevated temperature.[9] A 10°C temperature rise can speed hydrogen peroxide decomposition by a factor of 2.2.[9]

Studies have shown that to obtain whiteness from darker to lighter shade across 6 tabs of Vita Classic shade guide, atleast a 3.15 cycle of in-office bleach (each cycle having a time frame of 15 minutes) is required.[10] In the present study, the gel was activated using the diode laser of 980 nm. The laser activation was carried out for 30 s of four sessions each. This is shown to have no detrimental effects on pulp and was thus preferred.

It was found from studies that the patients preferred nightwear than daywear of the trays because it did not hinder with their appearance or daily activities. Unlike the nightwear, it is suggested that for daytime application, the treatment duration should be prolonged from 2 to 3 weeks to achieve stable result because the hours assigned for tray wear are less. Furthermore, if the trays loaded with bleaching agents are removed sooner from the oral cavity, the active material would be wasted and efficient bleaching would not happen.[11] Hence, in this study, it was carried out in the night to simulate the normal conditions and duration was 6 h.

To match the color in dentistry, several methods such as visual method, colorimeter, and spectrophotometer are used. Vita Easyshade provides objective and reliable color measurements of natural teeth. It is efficient and reproducible and helps in digital communication. Various studies have shown that spectrophotometers show significantly accurate results compared to visual method.[12],[13] Hence, Vita Easyshade digital spectrophotometer was used in this study.

In this study, the mean ΔE-ΔE1 was calculated for Group 1a and Group 2a. The mean obtained for Group 1a was ΔE-ΔE1 = 28.376 and for Group 2a was ΔE-ΔE1 = 21.757, suggesting that there was a decrease in the shade post bleaching by both laser bleach and home bleach in tea-stained teeth [Table 1]. On comparing the test results between both the groups (Group 1a and Group 2a), there was no significant difference in shade change in between both the groups [P = 0.1062093, [Table 1]], thus suggesting that both laser bleach and home bleach were equally effective for tea-stained teeth.
Table 1: Comparison of shade change between the laser bleach and home bleach in tea-stained teeth

Click here to view


This is in accordance with the study conducted by Jala et al. who evaluated the efficacy of in-office bleaching with 37.5% hydrogen peroxide using laser and LED light with carbamide peroxide used in home bleaching and concluded that 15% carbamide peroxide was as effective as 37.5% hydrogen peroxide on tea-stained teeth (P < 0.05, significant).[14]

When ΔE-ΔE1 was calculated for Group 1b and Group 2b, the mean obtained for Group 1b was ΔE-ΔE1 = 31.88, suggesting that there was a decrease in the shade post bleaching using laser light in paan-stained teeth with Pola Office+ [Table 2]. The mean obtained for Group 2b was ΔE-ΔE1 = 23.104, suggesting that there was a decrease in the shade post bleaching using home bleach in paan-stained teeth with Zoom Nitewhite [Table 2]. On comparing the test results between both the groups, they demonstrated that there was a significant difference in shade change in between both the groups [P = 0.0181777, inference P < 0.05, [Table 2]], suggesting that in the paan-stained teeth, laser bleach was effective when compared to home bleach.
Table 2: Comparison of shade change between the laser bleach and home bleach in paan-stained teeth

Click here to view


As the use of light source increases the chemical decomposition of hydrogen peroxide, it helps in achieving whiter teeth in a short period of time. This could be the possible reason why laser was effective for paan-stained teeth.[15]

Some studies have shown better results with laser bleaching.[2],[15],[16],[17],[18] Other studies suggest that there was no significant difference with or without the use of laser.[19],[20] In the present study, laser activation of the gel did not enhance the bleaching efficiency when compared to home in tea-stained teeth, however, laser activation showed improved results with home bleach in paan-stained teeth. This could be due to discoloration that is dependent on various factors such as type of stain, number of years of use, and pH of the stain.

From this study, it can be inferred that both the groups (laser bleach and home bleach) produced a significant increase in lightness following bleaching for paan-stained teeth. Diode laser activation of 37% hydrogen peroxide was quick to provide immediate results, had an increased impact, and proved to be efficient, without causing any detrimental effect, and these factors will result in better patient acceptance and satisfaction when compared to home bleach.

Further, it can be concluded that for tea-stained teeth, diode laser activation of 37% hydrogen peroxide gel (Pola Office+) and home bleach with 22% carbamide peroxide (Zoom Nitewhite) both showed effective results, thus allowing patients with tea-stained teeth to consider both the treatment modalities.

Acknowledgment

We specially thank Mr. Chaitanya Naik, the statistician, and IDS Denmed Bangalore for equipment support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Surmelioglu D, Usumez A. Effectiveness of different laser-assisted in-office bleaching techniques: 1-year follow-up. Photobiomodul Photomed Laser Surg 2020;38:632-9.  Back to cited text no. 10
    
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Kalantari MH, Ghoraishian SA, Mohaghegh M. Evaluation of accuracy of shade selection using two spectrophotometer systems: Vita Easyshade and Degudent Shadepilot. Eur J Dent 2017;11:196-200.  Back to cited text no. 12
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Chitrarsu VK, Chidambaranathan AS, Balasubramaniam M. Analysis of shade matching in natural dentitions using intraoral digital spectrophotometer in LED and filtered LED light sources. J Prosthodont 2019;28:e68-73.  Back to cited text no. 13
    
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Jala S, Ahuja R, Singh A, Abraham D. Comparative evaluation of the efficacy of in office bleaching (37.5% Hydrogen Peroxide) and at home bleaching (15% Carbamide Peroxide) using different activation systems. Int J Med Sci Clin Invent 2017;4:2929-40.  Back to cited text no. 14
    
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Wetter NU, Barroso MC, Pelino JE. Dental bleaching efficacy with diode laser and LED irradiation: An in vitro study. Lasers Surg Med 2004;35:254-8.  Back to cited text no. 15
    
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Bhutani N, Venigalla BS, Patil JP, Singh TV, Jyotsna SV, Jain A. Evaluation of bleaching efficacy of 37.5% hydrogen peroxide on human teeth using different modes of activations: An in vitro study. J Conserv Dent 2016;19:259-63.  Back to cited text no. 16
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Mondelli RF, Azevedo JF, Francisconi AC, Almeida CM, Ishikiriama SK. Comparative clinical study of the effectiveness of different dental bleaching methods – Two year follow-up. J Appl Oral Sci 2012;20:435-43.  Back to cited text no. 17
    
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Tavares M, Stultz J, Newman M, Smith V, Kent R, Carpino E, et al. Light augments tooth whitening with peroxide. J Am Dent Assoc 2003;134:167-75.  Back to cited text no. 18
    
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Deliperi S, Bardwell DN, Papathanasiou A. Clinical evaluation of a combined in-office and take-home bleaching system. J Am Dent Assoc 2004;135:628-34.  Back to cited text no. 19
    
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Strobl A, Gutknecht N, Franzen R, Hilgers RD, Lampert F, Meister J. Laser-assisted in-office bleaching using a neodymium: yttrium-aluminum-garnet laser: An in vivo study. Lasers Med Sci 2010;25:503-9.  Back to cited text no. 20
    

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Correspondence Address:
Dr. Priyadarshini L Naik
Department of Conservative Dentistry and Endodontics, Sri Rajiv Gandhi College of Dental Sciences, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcd.jcd_568_21

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