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December 2009

                                                                                                                                   Review Article

Probiotics: Health benefits in the mouth


Iva  Stamatova, md  &  Jukka  H.  Meurman, md, phd


Abstract: Probiotics or health-beneficial bacteria have only recently been introduced in dentistry and oral medicine after years of successful use in mainly gastro-intestinal disorders. The concept of bacteriotherapy and use of health-beneficial micro-organisms to heal diseases or support immune function was first introduced in the beginning of the 20th century. Later the concept lead to the development of modern dairy industry and even today most probiotic strains are lactobacilli or bifidobacteria used in milk fermentation. The mechanisms of probiotic action are mainly unknown but the inter-microbial species interactions are supposed to play a key role in this together with their immuno-stimulatory effects. The introduction of probiotic bacteria in the mouth calls for ascertainment of their particular safety. Since acid production from sugar is detrimental to teeth, care must be taken not to select strains with high fermentation capacity. The first randomized controlled trials have nevertheless shown that probiotics may control dental caries in children due to their inhibitory action against cariogenic streptococci. Less evidence exists on their role in periodontal disease or oral yeast infections. Furthermore the best vehicles for oral probiotic applications need to be assessed. So far mainly dairy products have been investigated but other means such as probiotics in chewing gums or lozenges have also been studied. From the clinical practitioner’s point of view direct recommendations for the use of probiotics cannot yet be given. However, scientific evidence so far indicates that probiotic therapy may be a reality also in dentistry and oral medicine in the future. (Am J Dent 2009;22:329-338)


Clinical significance: From the clinical practitioner’s point of view direct recommendations for the use of probiotics cannot yet be given. However, scientific evidence so far indicates that probiotic therapy may be a reality also in dentistry and oral medicine in the future.


*: Dr. Iva Stamatova, 3 Christo Botev Blvd., Faculty of Dental Medicine, 4000 Plovdiv, Bulgaria. E-*:




                                                                                                                                        Research Article

Effects of tooth bleaching on the color and translucency properties of enamel


Xiao  Ma, dds, phd, Tao  Jiang, dds, phd, Lili  Sun, dds, Zhejun  Wang,  Yi  Zhou, dds, phd  &  Yining  Wang, dds, phd


Abstract: Purpose: To investigate the changes in color and translucency properties of enamel following 14 days treatment with carbamide peroxide. Methods: 24 extracted premolars were used in this study. Two enamel-dentin specimens were prepared from each tooth and randomly assigned to be bleached with carbamide peroxide for 14 days or stored in artificial saliva as control. A spectrophotometer (Spectrascan PR650) was employed to measure the color of specimens according to the CIELab system. Color measurement of enamel-dentin specimens was performed prior to and after bleaching. After 14 days bleaching, enamel slabs were prepared by removing dentin parts using a low-speed saw. Then the color and translucency parameter (TP) of enamel slabs was measured over a black and a white background. Data between the experimental group and the control group were analyzed by paired t-test. Results: After bleaching, the color of enamel slabs and controls differed significantly both over the black and white background in L* and b* values (all P< 0.001). The translucency parameter (TP) of bleached enamel slabs was significantly lower than that of controls (P< 0.01). Both the ∆E values of enamel on the two backgrounds were significantly correlated to that of enamel-dentin specimens (P= 0.003; P= 0.012). (Am J Dent 2009;22:324-328).


Clinical significance: Tooth bleaching may alter not only the color but also the translucency of enamel. The color change of teeth during bleaching may be highly influenced by the color and translucency properties of enamel.


*: Dr. Yining Wang, Key Laboratory for Oral Biomedical Engineering, Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan 430079, PR China. E-*:

Research Article

Treatment of Miller Class I and II localized recession defects

using laterally positioned flaps: A 24-month study


Luiz  Armando  Chambrone, dds, msd, phd  &  Leandro  Chambrone, dds, msd


Abstract: Purpose: To assess the clinical results obtained with laterally positioned flap (LPF) for the treatment of localized gingival recessions (GR). Methods: 32 systemically healthy, non-smoking patients, with one Miller Class I or II buccal GR of ≥ 3 mm, were treated with a LPF. At baseline the following measurements were recorded: (1) recession depth; (2) probing depth; (3) clinical attachment level; and (4) width of keratinized tissue. At 24 months post-surgery, all clinical measurements were repeated. Results: Mean root coverage obtained with the laterally positioned flaps was 93.8%. Complete root coverage was obtained in 62.5% of the recipient sites. The mean recession depth decreased from 4.71 ± 1.30 mm to 0.28 ± 0.42 mm. Statistically significant improvements were found for all clinical parameters from baseline to 24 months (P< 0.05). Patients with maxillary recessions recorded statistically superior gains in the width of keratinized tissue than patients with mandibular recessions. The results of the present study demonstrated that the LPF is an effective procedure to cover localized gingival recession. Moreover, both groups (i.e., patients with maxillary or mandibular recessions) recorded similar significant improvements from baseline to 24-month examination, except for the width of keratinized tissue which was statistically higher for maxillary recessions. (Am J Dent 2009;22:339-344).


Clinical significance: The laterally positioned flap was considered an uncomplicated and effective procedure in the treatment of localized gingival recessions, among patients presenting esthetic demands, treated at a private practice.


*: Dr. Leandro Chambrone, Disciplina de Periodontia, Departamento de Periodontia, Faculdade de Odontologia, Universidade de São Paulo, Av. Prof. Lineu Prestes, 2227 C. Universitária 05508-000, São Paulo –SP, Brazil. E-*:


Research Article

Comparison of rotation/oscillation and sonic power toothbrushes on plaque

and gingivitis for 10 weeks


Karen  Williams, rdh, phd,  Kathy  Rapley, bs,  Jan  Haun, rdh, bs,  Pat  Walters, rdh, msdh, msob,

Tao  He, dds, phd,  Julie  Grender, phd  &  Aaron  R.  Biesbrock, dmd, phd, ms


Abstract: Purpose: Although power toothbrushes provide valuable tools toward improving oral health, contrasting results are discerned in their efficiency. This 10-week study was conducted to compare the safety and efficacy of rotation/oscillation and sonic power toothbrushes in the reduction of plaque and gingivitis. Methods: This two-treatment, parallel group, examiner-blind, randomized study had the subjects brush twice daily at home with their assigned rotation/oscillation or sonic toothbrush following manufacturer’s instructions with center visits at baseline, and at 4 and 10 weeks following the baseline visit, for assessment of oral safety (all visits), plaque (baseline, Weeks 4 and 10), and gingivitis (baseline and Week 10). Gingivitis and number of bleeding sites were measured using the Löe-Silness Gingivitis Index, and plaque was measured using the Turesky Modification of the Quigley-Hein Plaque Index. Results: At Week 10, 171 subjects were evaluable for plaque assessment (85 in Sonic group, 86 in rotation/oscillation group) and 165 subjects were evaluable for gingivitis and bleeding sites assessment (84 in sonic group, 81 in rotation/oscillation group). The rotation/oscillation group had statistically significantly lower gingivitis scores (by 3.5%) and statistically significantly fewer bleeding sites than the sonic group (by 16.1%) with P= 0.038 and 0.028, respectively, at Week 10. Compared to baseline, only the rotation/oscillation group showed a statistically significant improvement in gingivitis (P= 0.003) and bleeding (P< 0.001) at Week 10. At both Weeks 4 and 10, the rotation/oscillation group had directionally lower plaque scores than the sonic group (by approximately 3%), but treatment group differences were not statistically significant (P> 0.1) at either time point.  Both groups showed statistically significantly lower plaque scores at Weeks 4 and 10 relative to baseline. (Am J Dent 2009;22:345-349).



Clinical significance: The rotation/oscillation toothbrush significantly reduced gingivitis over a 10-week period relative to the sonic toothbrush.



*: Dr. Aaron R. Biesbrock, The Procter & Gamble Company, 8700 Mason-Montgomery Rd., Mason , Ohio 45040-9462 , USA .  E-*:


Research Article

Difference in illuminant-dependent color changes of shade guide tabs by the

shade designation relative to three illuminants


Hyun-Suk Cha, dds, phd &  Yong-Keun Lee, dds, phd


Abstract: Purpose: To determine the difference in illuminant-dependent color changes of shade guide tabs of Vita Lumin (VITA), Chromascop (CHRO) and Vita 3D-Master (3D-M) shade guides by the shade designation in each shade guide. Methods: Color of 16 tabs of VITA, 20 tabs of CHRO and 29 tabs of 3D-M was measured according to the CIELAB color scale relative to the CIE standard illuminant D65, A and F2. Color differences (∆E*ab) between the A1 tab and other VITA tabs, between the 110 tab and other CHRO tabs and between the 0M 1 tab and other 3D-M tabs relative to the three illuminants were calculated, and the ratios of ∆E*ab values relative to the different illuminants [∆E*ab(A)/∆E*ab(D65), ∆E*ab(F2)/∆E*ab(D65) and ∆E*ab(F2)/∆E*ab(A)] were calculated. Ratios of the hue angle shifts of each shade tab by the change of illuminant over the corresponding value of the A1, the 110 or the 0M 1 tab were also calculated. Differences in the ratios of color difference and hue angle shift were analyzed with a repeated measures, two-way analysis of variance (α=0.05). Results: Ratios of ∆E*ab values by the illuminant were 0.90-1.17, 0.95-1.07 and 0.99-1.06 for the VITA, the CHRO and the 3D-M shade guide, respectively. Ratios of the hue angle shifts by the illuminant were from -1.6 to 1.8 for the VITA, from -7.3 to 1.2 for the CHRO and from -1.2 to 3.1 for the 3D-M. Changes in color and hue angle of shade tabs were significantly different by the shade tab designation when illuminant was changed (P< 0.01). (Am J Dent 2009;22:350-356).


Clinical significance: Within each brand of shade guide tested, color and hue angle of shade tabs change differently by the shade designation when the illuminant is changed. Therefore, combined with different directions in the hue angle shifts, this differential color change of shade tabs by the illuminant depending on the shade designation can be a strong contributing factor in color mismatch when shade tabs and restorations are matched and viewed under different illuminants.


*: Dr. Yong-Keun Lee, Denforus Co., Ltd., Room 1202, I-B Diosuperium, 3001-2 Bangbae-Dong, Seocho-Gu, Seoul, Korea.  E-*:



Research Article

Microtensile dentin adhesive bond strength under different positive

pulpal pressures


John  H.  Purk, dds, phd,  Vladimir  Dusevich, phd,  Jared  Atwood,  Becca  Dawson  Spencer,

Dustin  Kruse, Tyler  Webb,  Angela  Williams  &  Daniel  Tira, phd


Abstract: Purpose: To measure the in vitro dentin microtensile bond strength of established adhesives under different hydrostatic pulpal pressures. Methods: After IRB approval, 24 human extracted third molars were randomly distributed into four adhesive treatment groups: Clearfil-SE (self-etch, water-based), One-Step Plus (total-etch, acetone-based), Peak-SE (self-etch, ethanol-based) and PQ1 (total-etch, ethanol-based, Ultradent). Additionally each group was assigned to be restored under 0.0, 5.0 or 15.0 cm of water pressure. Coronal enamel was removed using 60, 240 & 320-grit wet sandpaper until only dentin was visible. After adhesive placement Filtek Z250 Universal Restorative was applied in five 1.0 mm increments. All teeth were tested at 24 hours for microtensile bond strength and examined for mode of failure under light microscopy (x40). Results: A two-factor ANOVA found a statistically significant effect for adhesives, water pressures and their interaction (P≤ 0.001). Post hoc pairwise comparisons of simple effects using the Ryan-Einot-Gabriel-Welsch Range procedure showed Clearfil-SE stronger than the other adhesives at 5.0 and at 15.0 cm water pressure (P< 0.07). One-Step Plus was weaker than PQ1 and Peak-SE at 5.0 and at 15.0 cm water pressure (P< 0.07). PQ1 and Peak-SE at 0.0, 5.0 and 15.0 cm were not significantly different from each other (P> 0.07). For water pressure comparisons, Clearfil-SE was stronger at 0.0 vs. 5.0 cm water pressure (P< 0.07), while there was no difference for Clearfil-SE between 5.0 and 15.0 cm water pressure (P> 0.07). One-Step Plus was significantly stronger at 0.0 cm water pressure than at 5.0 and 15.0 cm water pressure (P< 0.07), and at 5.0 cm water pressure it was stronger than at 15.0 cm pressure (P< 0.07). Both Peak-SE and PQ1 at 0.0 cm water pressure were significantly stronger than at 5.0 and 15.0 cm water pressure. There was no difference in strength between 5.0 and 15.0 cm water pressure for either of the two adhesives (P> 0.07). (Am J Dent 2009;22:357-360).


Clinical significance: Microtensile bond strengths of dentin adhesives may be affected by a slight pulpal pressure (5.0 cm) when teeth are restored.


*: Dr. John H. Purk, School of Dentistry, University of Missouri-Kansas City, 650 East 25th Street, Kansas City, Missouri  64108, USA. E-*:


Research Article

Translucency and color change of tooth-colored temporary

coating materials


Shoji  Takenaka, dds, phd,  Rika  Wakamatsu, dds,  Yumiko  Ozoe, dds,  Fumihito  Tomita, dds, phd,

Masayoshi  Fukushima, dds, phd  &  Takashi  Okiji, dds, phd


Abstract: Purpose: To estimate the color-masking ability of two polymer-based paint-on temporary coating materials, White Coat and BeautiCoat. Methods: Three shades (OA1, OB0, OB1) of White Coat and four shades (BW1, BW2, BW3 and BW4) of BeautiCoat were used. Disk specimens (0.25–2.0 mm thick) were prepared, CIELAB coordinates (L*, a*, b*) were measured against white and black backgrounds on a colorimeter, and translucency parameter (TP) was calculated. Masking effect (∆ME*ab) was also calculated as the color difference between a specimen over a black background and black background itself. Measurements were also made on a dentin-shaded resin composite as a substitute for discolored teeth, and color differences (∆E*) were then calculated. Results: The TP value decreased as the thickness of the specimen increased, and non-linear regressions were shown between the specimen thickness and TP value for all materials evaluated (P< 0.01). TP values of BeautiCoat showed significant differences (P< 0.05) between each shade at any thickness evaluated, ranging from 20.0 to 46.4 at 0.25 mm in thickness. White Coat showed narrower-ranging TP values: from 20.0 to 23.5 at 0.25 mm, and differences were often insignificant. ∆ME*ab values correlated with TP values. ∆E* values of 0.25 mm-thick specimens against the dentin-shade composite were above 6.5, which can be evaluated as visually perceptible. (Am J Dent 2009;22:361-365).


Clinical significance: White Coat consists of shades with a higher color-masking ability and thus this is more effective for teeth with considerable discoloration. On the other hand, BeautiCoat has a larger selection of shades with different color-masking abilities, and thus is useful for various tooth discolorations. Regardless of the shades and materials, a clinically perceptible color change is obtained by the application of 0.25 mm in thickness.


*: Dr. Shoji Takenaka, Division of Cariology, Operative Dentistry and Endodontics, Department of Oral Health Science, Niigata University Graduate School of Medical and Dental Sciences, 2-5274, Gakko-cho-dori, Chuo-ku, Niigata 951-8514, Japan. E-*:


Research Article

The influence of storage condition and duration on the resistance

to fracture of different fiber post systems


Michele  Vano, dds,  Carlos  Carvalho, dds,  Maurizio  Sedda, dds,  Mario  Gabriele, md, dds,

Franklin  García-Godoy, dds, ms   &  Marco  Ferrari, md, dds, phd


Abstract: Purpose: To evaluate the effects of storage condition and duration on the resistance to fracture of different fiber post systems (and to morphologically assess the post structure before and after storage. Methods: Three types of fiber posts (DT Light Post, GC Post, FRC Postect Plus) were divided in different groups (n=12) according to the storage condition (dry at 37°C; saline water at 37°C; mineral oil at 37°C and storage inside the roots of extracted human teeth immersed in saline water at 37°C) and duration (6, 12 months). A universal testing machine loading at a 90° angle was employed for the three-point bending test. The test was carried out until fracture of the post. A 3-way ANOVA and Tukey’s test (α= 0.05) were used to compare the effect of the experimental factors on the fracture strength. Two posts of each group were observed before and after the storage using a scanning electron microscope. Results: Storage condition and post type had a significant effect on post fracture strength (P< 0.05). The interaction between these factors was significant (P< 0.05). Water storage significantly decreased the fracture strength, regardless of the post type and the storage duration. Storage inside roots, in oil, and at dry conditions did not significantly affect post fracture strength. SEM micrographs revealed voids between fibers and resin matrix for posts stored in water. Posts stored under the other conditions showed a compact matrix without porosities. (Am J Dent 2009;22:366-370).


Clinical significance: Fiber posts placed inside human root canals immersed in water were not affected by water. Fiber posts stored in direct contact with water showed significantly lower fracture strength values and morphological changes regardless of the post type.


*: Prof. Dr. Marco Ferrari, Department of Restorative Dentistry and Dental Materials, University of Siena, Policlinico Le Scotte, Viale Bracci, 53100 Siena, Italy. E-*:




Research Article

Enamel-resin bond durability of self-etch and etch & rinse adhesives


Raquel  Osorio, dds, phd,  Francesca  Monticelli, dds, msc, phd,  Mario  A.G.  Moreira, dds, phd,

Estrella  Osorio, dds, phd  &  Manuel  Toledano, md, dds, phd


Abstract: Purpose: To evaluate the degradation of resin-enamel interfaces bonded with different adhesive systems. Methods: Flat enamel surfaces were ground buccally on bovine incisors. Two etch & rinse self-priming adhesives (Single Bond, Prime & Bond NT), three two-step self-etch adhesives (Clearfil SE Bond, Resulcin Aquaprime, NRC/Prime & Bond NT) and two all-in-one adhesives (Etch & Prime 3.0, Adper Prompt-L-Pop) were used for bonding. A hybrid resin composite (Tetric Ceram) was selected for coronal build-up. Bonded specimens were stored in water at 37ºC for 24 hours, 6 months and 1 year, respectively, and then sectioned into 1 mm2 beams. Each microtensile stick was loaded in tension until failure (crosshead speed: 0.5 mm/minute). Bond strength data were analyzed with two-way ANOVA and Student Newman Keuls tests (P< 0.05). Etching patterns resulting from phosphoric acid etching and self-etch adhesives application on ground enamel were analyzed under SEM. Results:  All adhesives attained similar bond strengths after 24 hours. All-in-one adhesives and Resulcin Aqua Prime recorded a significant reduction in bond strengths after 6 months and 1 year of water aging. (Am J Dent 2009;22:371-375).


Clinical significance: Etch & rinse systems and the mild two-step self-etch adhesive (CSEB) may ensure durable resin-enamel bonds. The etching pattern was not a determining factor in enamel-resin bond longevity.


*: Prof. Raquel Osorio, Dental School, University of Granada, Colegio Máximo, Campus de Cartuja s/n 18017 Granada, Spain.  E-*:

Research Article

Effect of acid conditioning of root canal dentin on the retention

of adhesively luted glass fiber-reinforced composite (FRC) posts


Zakereyya  S.  Albashaireh, bds, msc, phd,  Muhamad  Ghazal, dds  &  Matthias  Kern, dr med dent, phd


Abstract: Purpose: To assess the retention of glass FRC posts luted with resin cements after conditioning the canal dentin with different acidic treatments. Methods: Post spaces were prepared in six groups of eight endodontically treated extracted teeth. Glass FRC posts were luted after etching the canal dentin with phosphoric acid and/or applying ED-Primer, Clearfil New Bond or XP Bond. The groups with their respective etching time, primer and cement combinations were as follows. ED: ED-Primer only and Panavia 21; ED15: 15 seconds phosphoric acid treatment, ED-Primer and Panavia 21; NB15: 15 seconds phosphoric acid treatment, Clearfil New Bond and Panavia 21; NB30: 30 seconds phosphoric acid treatment, Clearfil New Bond and Panavia 21; XP15: 15 seconds phosphoric acid treatment, XP Bond and Calibra; XP30: 30 seconds phosphoric acid treatment, XP Bond and Calibra. Specimens were stored in water for 30 days and subjected to simulated aging conditions. Post retention was measured in tension at a crosshead speed of 2 mm/minute. Analysis of variance and Bonferroni multiple range tests were conducted for data analysis. Results: The mean (standard deviation) retention values in Newtons (N) were: ED: 180.9 (44.9); ED15: 278.3 (37.7); NB15: 283.8 (84.9); NB30: 187.7 (60.0), XP15: 216.8 (46.8), XP30: 199.6 (34.0). The retention values of ED15 and NB15 were significantly higher than those of ED and NB30 groups respectively. There were no statistically significant differences between XP Bond groups. Micro­scopic evaluation of post surfaces demonstrated that the debonding failure was adhesive at the cement-post and cement-dentin interfaces. (Am J Dent 2009;22:376-380).


Clinical significance: When using ED-Primer and Panavia 21 for cementing glass FRC root canal posts, an additional 15 seconds treatment of the canal dentin with phosphoric acid improves the retention. While, when using Clearfil New Bond and Panavia 21, or XP Bond and Calibra, high retention of same post is achieved by treating dentin with phosphoric acid for 15 seconds.


*: Prof. Zakereyya S.M. Albashaireh, Department of Conservative Dentistry, Faculty of Dentistry, Jordan University of Science & Technology, P.O. Box 3030, Irbid 22110, Jordan. E-*:



Review Article

Curing efficiency of three different curing lights at different distances

for a hybrid composite


Song  Zhu, dds , ms   &  Jeffrey  A.  Platt, dds , ms


Abstract: Purpose: To evaluate the influence of different curing distances with three types of lights in terms of the surface microhardness of a resin composite as a function of power density. Methods: 90 cylindrical light-cured resin composite specimens were polymerized with three light curing units: (a) Mini LED AutoFocus with a fast curing mode (1955 mW/cm2); (b) LEDemetron I (1541 mW/cm2) and (c) Optilux 401 QTH (1294 mW/cm2) for 40 seconds. Polymerization was performed with the curing tip at a distance of 0 mm , 3.0 mm , 6.0 mm , 9.0 mm , 12.0 mm and 15.0 mm from the top surface of the specimen. 15-25 minutes after photocuring, the top and bottom specimen’s surface KHNs were determined. Microhardness values were measured again after 24-hour storage in distilled water in a light proof container at 37ºC. Data were submitted to ANOVA and Multiple Comparisons with a Tukey test. The KHNs before and after storage in distilled water were analyzed using a paired t-test. Linear regression analysis was also performed and all statistical analyses were performed at a significance level of 0.05. Results: There was a linear relationship between the logarithm of the power density and the curing distance. The light curing unit and curing tip distance had a significant effect on the composite microhardness. Specimens cured with the Mini LED AutoFocus light provided higher KHNs than those photoactivated with the LEDemetron I light and Optilux 401 light. There was no statistically significant difference in KHNs between the LEDemetron I group and the Optilux 401 group. The mean Knoop microhardness values decreased significantly as the curing tip distance increased. Fifteen minutes after light cure, effective hardness percent values (> 80%) were achieved in a few experimental groups. A linear correlation was found between the logarithm of the power density and the hardness percent values. Twenty-four hours after light irradiation, most of the experimental groups obtained valid hardness percent values. After storage in distilled water for 24 hours, the KHN of both the top and bottom surfaces in most of the groups increased significantly. There were no significant increases in the mean relative hardness ratios related to surface or light curing device. (Am J Dent 2009;22:381-386).


Clinical significance: For the resin composite tested, the Mini AutoFocus LED light was able to polymerize a 2 mm-thick composite specimen with the light guide tip 15 mm from the top surface of the specimens, 9 mm for the LEDemetron I light and 6 mm for the Optilux 401 light if the specimens were evaluated 24 hours after light exposure. The curing light sources with high power density can fulfill the requirement of sufficient curing of composite at a clinically relevant long distance from light guide tip to the floor of a proximal box in a molar.


*: Dr. Song Zhu, Department of Prosthetic Dentistry, Hospital of Stomatology, JiLin University, ChangChun, JiLin, P.R.China. E-*:




Review Article


Influence of in situ post-bleaching times on resin composite

shear bond strength to enamel and dentin


Cinthia  Maria  Barbosa, dds, ms,  Robson  Tetsuo  Sasaki, dds,  Flávia  Martão  Flório, dds, ms

&  Roberta  Tarkany  Basting, dds, ms, scd, phd


Abstract: Purpose: To evaluate in situ the influence of time after treatment with a 16% carbamide peroxide home-use bleaching agent on the shear bond strength of resin-based composite to human enamel and dentin. Methods: 80 enamel slabs (E) and 80 dentin slabs (D) were obtained, embedded, flattened, sterilized and randomly fixed on the buccal surface of teeth in 20 volunteers. These specimens were submitted to treatment with a 16% carbamide peroxide bleaching agent (Pola Night) for 2 hours a day, for 3 weeks. The control group (C) consisted of slabs that were fixed on buccal tooth faces that did not receive any bleaching treatment. For the experimental groups, three slabs of E and three slabs of D were fixed to teeth of the same volunteers, and after bleaching treatment, the slabs were removed at different times: EI – immediate removal; E7 – removal 7 days after treatment ended; E14 – removal 14 days after treatment ended. After removal, the slabs were again embedded and microhybrid composite resin cylinders (Filtek Z250) were constructed and bonded using a one-bottle adhesive system (Single Bond) for shear bond strength tests. These tests were performed in a universal testing machine, with a speed of 0.5 mm/minute, with the data returned in MPa. The results were submitted to the ANOVA test. Results: There were no significant differences with regards to the timespan for the E and D groups (P> 0.05). For the fracture mode analysis, there was a predominance of adhesive failures for Groups C, EI and E14 in enamel, with the same adhesive failures occurred for all groups in dentin. It was concluded that restorative procedures may be performed immediately after the end of the bleaching treatment. (Am J Dent 2009;22:387-392).


Clinical significance: The influence of bleaching agents on bond strength has been extensively evaluated in laboratory conditions, demonstrating that there is diminished bond strength of resin composites to bleached enamel and dentin. However, this in situ study suggests that adhesive restorations can be made immediately after at-home bleaching treatment with 16% carbamide peroxide agent.


*: Prof. Dr. Roberta Tarkany Basting, Faculty of Dentistry and Dental Research Center São Leopoldo Mandic, Department of Restorative Dentistry - Operative, Rua José Rocha Junqueira, 13 Bairro Swift, Campinas, SP, CEP: 13045-755, Brazil.  E-*:




Review Article


Effects of  casein  phosphopeptide-amorphous calcium phosphate

(CPP-ACP) application on enamel microhardness after bleaching


Sule  Bayrak, dds, phd,  Emine  Sen  Tunc, dds, phd,  Isil  Saroglu  Sonmez, dds, phd,  Turkan  Egilmez, dds &  Bilal Ozmen, dds


Abstract: Purpose: To evaluate the effect of casein phosphopeptide-amorphous calcium phosphate (CCP-ACP) application on the microhardness of bleached enamel and compare it to that of fluoride application. Methods: 10 extracted bovine incisors were cut into four sections (4 x 4 x 3 mm ) that were randomly distributed among five groups (n=8). All groups were bleached three times using 38% hydrogen peroxide (HP), with 5-day intervals between bleaching, according to the following treatment protocols: Group A: bleaching only; Group B: bleaching + daily CCP-ACP paste; Group C: bleaching + daily casein phosphopeptide-amorphous calcium fluoride phosphate (CPP-ACPF) paste; Group D: bleaching + daily 250ppm NaF solution; Group E: bleaching + APF gel (once after final bleaching). Specimens were maintained in artificial saliva throughout the experiment. Baseline and post-treatment Vickers microhardness values were obtained for all specimens. Statistical analysis was performed using one-way ANOVA and post-hoc Tukey tests. Results: Groups B and C showed significant increases in enamel microhardness following treatment (P< 0.001), whereas no statistically significant changes were observed in Groups A, D, or E (P> 0.05). One-way ANOVA of Δ Vickers microhardness numbers (ΔVHN) revealed significant differences among groups (P< 0.001), with Group B showing the highest ΔVHN and Group A the lowest. (Am J Dent 2009;22:393-396).


Clinical significance: Pastes containing CPP-ACP significantly increased enamel microhardness and may be beneficial after bleaching treatment.


*: Dr. Sule Bayrak, Department of Pediatric Dentistry, Faculty of Dentistry, Ondokuz Mayis University , 55139 Samsun , Turkey .  E-*:




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