Immediate Bonding to Bleached Enamel Treated with 10% Sodium Ascorbate Gel: a Case Report with One-Year Follow-Up

CASE REPORT

Immediate Bonding to Bleached Enamel Treated with 10% Sodium Ascorbate Gel: A Case Report with One-Year Follow-up

Eugenio Jose Garcia, DDS, MS PhD student, School of Dentistry, Department of Dental Materials, University of São Paulo, São Paulo, SP, Brazil

Alexandra Mena-Serrano, DDS, MS PhD student, School of Dentistry, Department of Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil

Andrea Mello de Andrade, DDS, PhD Private practice, São Paulo, SP, Brazil

Alessandra Reis, DDS, PhD Adjunctive Professor, School of Dentistry, Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil

Rosa Helena Miranda Grande, DDS, MS, PhD Associate Professor, School of Dentistry, Department of Dental Materials, University of São Paulo, São Paulo, SP, Brazil

Alessandro Dourado Loguercio, DDS, MS, PhD Adjunctive Professor, School of Dentistry, Department of Restorative Dentistry, State University of Ponta Grossa, Ponta Grossa, PR, Brazil

Correspondence to: Prof Dr Alessandro D. Loguercio

State University of Ponta Grossa, Pós-graduação em Odontologia, Rua Carlos Cavalcanti, 4748, Bloco M, Sala 64A,

Uvaranas 84030-900, Ponta Grossa, Paraná, Brazil; E-mail: [email protected]

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Abstract direct resin composite immediately after dental bleaching. Teeth were bleached It is generally not recommended that with a combination of in-office and at- bonded restoration treatment should be home whitening protocols, followed by carried out immediately after bleaching the application of a 10% sodium ascor- treatment. However, the use of antioxi- bate gel for one hour, to allow the im- dants such as sodium ascorbate can mediate reshaping with direct resin be useful to avoid a waiting period. This composite restoration. After one year, article is a brief review about in vitro pro- the clinical performance of the restor- posals to overcome low bond strength ation was successful. The use of sodium values to bleached dental surfaces. It ascorbate gel can help the clinician to shows a one-year follow-up case report perform bonding procedures immedi- of a young female presenting agenesis ately after bleaching treatments. of maxillary lateral incisors reshaped with (Eur J Esthet Dent 2012;7:154–162)

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Introduction to present a case report with a one-year follow-up, using sodium ascorbate gel Several in vitro studies have shown a at 10% as an intermediary step between considerable reduction in the enamel dental bleaching, and immediate direct and dentin bond strength of resin com- composite restorations in a person with posite restorations when the adhesive missing maxillary lateral incisors. procedure is carried out immediately after bleaching.  The related literature explains that this phenomenon occurs Case report because bleaching products may in- terfere with resin infiltration into etched "
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SF- enamel/dentin, or due to the inhibition storative dentistry unit at the State Uni- of resin polymerization by the residual versity of Ponta Grossa in order to solve free-radicals forming the whitening pro- an esthetic problem in the anterior area. cess.3-5 Orthodontic treatment to treat the miss- It has been demonstrated that these ing maxillary lateral incisors was first problems are time and concentration- performed, which involved the closure dependent.6 Some studies claim that a of space in the anterior segment (Fig 1). certain waiting period is needed prior Considering clinical and radiographic to performing any restoration,7,8 in order findings, it was decided to reshape the to allow the leaching of peroxide by- maxillary canines and first premolars in- products and obtain the original bond to lateral incisors and canines respect- strength values.1,9-11 ively with direct resin composite build- Several studies have suggested op- ups, in order to be non-invasive. Due tions to solve the clinical problems re- to the higher saturation of canines and lated to the bonding post-bleaching, in premolars, it was decided to start the es- an effort to avoid an interim dressing and thetic treatment with dental bleaching, facilitate the immediate restoration:8 to using a combination of in-office (three remove the superficial layer of enamel; 45-min sessions of 35% hydrogen per- pre-treat the bleached enamel with alco- oxide, Whiteness HP Maxx, FGM, Join- hol before restoration;13 to use adhesives ville, SC, Brazil) and at-home (two-hour containing organic solvents as alcohol daily regimen of 7% carbamide perox- or acetone;6,14 photopolymerization ide for 4 weeks, Whiteness Class, FGM) with different sources;15 increased poly- bleaching protocols. merization time;16 water rinsing;17,18 and To avoid an elapsed time of approxi- the use of antioxidants such as sodium NBUFMZ

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ascorbate, catalase, sodium ascorbyl treatment and the direct composite res- phosphate, butylated hydroxyanisole, torations, it was decided to use an an- ascorbic acid and vitamin E (Table 1). tioxidant treatment in order to eliminate So far, the use of sodium ascorbate the residual free radicals that compro- is the most studied in vitro alternative, mise bonding procedures. A 10% gel of showing promising results for the clinical sodium ascorbate was prepared, as rec- practice. The objective of this article is ommended by Kimyai and Valizadeh,19

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Table 1 In vitro studies using antioxidants to revert the lower bond strength values of bleached teeth. (Adapted from Garcia et al; An alternative protocol for esthetic restorations immediately after tooth bleach- JOH
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Bleaching product Antioxidants

Author Efficacy Type Application Application time Type % Mode and % time (hour/day) (min/day)

180 min/14 d Da Silva CP 10 6 h/14 d SAP 3 Gel Yes  
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10 No Solution 180 Yes Kimyai CP 10 8 h/7 d 10 31 SA 10 No Gel 180 Yes

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 Yes Turkun et al. CP 10 8 h/7 d SA  5YGel  es

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10 Yes

60 Yes

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 Yes

480 Yes

10 Solution 180 Yes

Kimyai & Valizadeh CP 10 8 h/1 d SA 10 Gel 180 Yes 

 Gel 180 Yes

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Table 1 (continued) In vitro studies using antioxidants to revert the lower bond strength values of bleached teeth. (Adapted from Garcia et al; An alternative protocol for esthetic restorations immediately BGUFS
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Muraguchi Yes HP 35+ et al. IE AsAc 10 Solution 1 SP ) Yes

SA 10 No

CAT 34 mg/ml No

GP 10 mg/ml No Torres et al. HP 35 30 min   Solution AC P.A. No

ET P.A. No

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10 Solution 180 Yes Kimyai & Valizadeh CP 10 8 h/1 d SA 10 Gel 180 Yes 19  Gel 180 Yes

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a b c

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Fig 1 (a) Frontal view before treatment; (b) hydrogen peroxide at 35% reinforcing bleaching treatment on teeth with higher saturation; (c and d) 10% sodium ascorbate gel and trays used for at-home bleach- ing; (e) removing sodium ascorbate excess with a gauze; (f) water rinsing of dental surfaces after 1 hour of antioxidant treatment.

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Fig 2 Frontal and lateral views after treatment. (a to c) Immediately after; (d to f) after one year.

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applied inside the same tray used for the fect of hydrogen peroxide by-products, at-home bleaching. It was used in office such as oxygen and water on the bond only once for 1 hour. Afterwards, the tray strength values. was removed and the dental surfaces Although several methodologies have were rinsed with water for 30 s and air- been proposed to reverse the low bond dried. Dental surfaces were etched with strength values on bleached teeth, the 35% phosphoric acid for 30 s, washed use of antioxidants showed promising with water spray and air-dried. For the results under in vitro conditions (Table 1). restorative procedure, a two-step adhe- Sodium ascorbate has been widely sive system (XP Bond, Dentsply DeTrey, used for in vitro studies.       Konstanz, Germany) and resin compos- However, it is not yet commercially avail- ite were used (Opallis, FGM, Joinville, able for clinical use; it was purchased SC, Brazil). The finishing and polishing from Sigma Chemical (St. Louis, MO, were carried out using fine and extra- USA) and needed to be prepared for fine diamond burs, abrasive disks (Dia- JUT
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mond PRO, FGM, Joinville, SC, Brazil), acquired ready to use from FGM Dental abrasive silicone points (Astropol, Ivo- Products (Neutralize, FGM, Joinville, SC, clar Vivadent, Schaan, Liechtenstein) Brazil), but there are no studies analyz- and cloth disks embedded with polish- ing the effectiveness of this product. Al- ing pastes (Diamond Excel, FGM, Join- though several antioxidants have been ville, SC, Brazil). proposed, more information is needed about efficiency time, antioxidant activ- ity, pH, viscosity (solution or gel), sta- Clinical follow-up bility during different storage conditions (pH and temperature) and shelf life. The evaluation after one year reported that the restorations remained stable, and no signs of pulpal or periodontal Conclusion disease were found. After one year of evaluation, no alter- ations of shape or color were observed. Discussion Thus, this approach can be considered an efficient, user-friendly and less time Nowadays dental bleaching is a widely consuming technique, which enables used treatment that answers people’s immediate direct composite buildups to esthetic demands. Tooth whitening is be used after a bleaching treatment. commonly associated with bonding procedures either for direct, indirect res- toration or even with orthodontic treat- Acknowledgements ment. Whenever adhesive procedures This study was partially supported by the National need to be done immediately after den- Council for Scientific and Technological Devel- tal bleaching, it has to be kept in mind PQNFOU
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References 11. Torneck CD, Titley KC, Smith 19. Kimyai S, Valizadeh H. DC, Adibfar A. The influence The effect of hydrogel and of time of hydrogen peroxide solution of sodium ascor- 1. Barbosa CM, Sasaki RT, Flo- exposure on the adhesion of bate on bond strength in rio FM, Basting RT. Influence composite resin to bleached bleached enamel. Oper Dent of time on bond strength bovine enamel. J Endod o after bleaching with 35% o 
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to enamel bleached with car- 10 % carbamide peroxide. Griggs JA, Wakefield C. bamide peroxide. J Esthet Rev de Clín Pesq Odontol Immediate bonding to %FOU
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o et al. Effects of removing Comparison of the effect of 3. Lai SC, Mak YF, Cheung GS, residual peroxide and other hydrogel and a solution of et al. Reversal of compro- oxygen radicals on the shear sodium ascorbate on dentin- mised bonding to oxidized bond strength and failure composite bond strength etched dentin. J Dent Res modes at resin-tooth inter- after bleaching. J Contemp o face after tooth bleaching. %FOU
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DH. The effect of oxygen 14. Sung EC, Chan SM, Mito R, RO, et al. Effect of sodium inhibition on an unfilled/filled Caputo AA. Effect of carba- ascorbate and the time lapse composite system. J Dent mide peroxide bleaching on before cementation after 3FT
o the shear bond strength of internal bleaching on bond 5. Türkün M, Kaya AD. Effect of composite to dental bonding strength between dentin 10% sodium ascorbate on agent enhanced enamel. and ceramic. J Prosthodont the shear bond strength of J Prosthet Dent o composite resin to bleached o 
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bovine enamel. J Oral Reha- 15. Loretto SC, Braz R, Lyra AM, Suzuki S, Tanaka T. Improve- CJM
o Lopes LM. Influence of pho- ment of bonding to bleached 6. Barghi N, Godwin JM. topolymerization light source bovine tooth surfaces by Reducing the adverse effect on enamel shear bond ascorbic acid treatment. of bleaching on composite- strength after bleaching. %FOU
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#BTU- 7. Kawamoto K, Tsujimoto Y. 16. Cadenaro M, Breschi L, ing RT. Effect of 10% so- Effects of the hydroxyl radi- Antoniolli F, Mazzoni A, Di dium ascorbate and 10% cal and hydrogen peroxide Lenarda R. Influence of -tocopherol in different on tooth bleaching. J Endod whitening on the degree of formulations on the shear o conversion of dental adhe- bond strength of enamel and 8. Liebenberg WH. Intracoronal sives on dentin. Eur J Oral dentin submitted to a home- bleaching of nonvital dis- 4DJ
o use bleaching treatment. colored mandibular incisors. 17. Elkhatib H, Nakajima M, 0QFS
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#PSH- o Tagami J, Nomura S. Surface es AB. The effects of anti- 9. Cavalli V, Reis AF, Gian- pH and bond strength of a oxidant agents as neutral- nini M, Ambrosano GM. self-etching primer/adhesive izers of bleaching agents on The effect of elapsed time system to intracoronal dentin enamel bond strength. Braz following bleaching on after application of hydrogen +
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resin composite. Oper Dent dium perborate. Oper Dent AD, Arici M. Can the hydro- o o gel form of sodium ascor- 10. Kaya AD, Türkün M, Arici M. 18. Torneck CD, Titley KC, bate be used to reverse Reversal of compromised Smith DO, Adibfar A. Effect compromised bond strength bonding in bleached enamel of water leaching the adhe- after bleaching? J Adhes using antioxidant gel. Oper sion of composite resin to %FOU
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enamel bleached with 10% bate on orthodontic bracket- Bulut H, Er O, Ustdal A. Can carbamide peroxide. Gen enamel shear bond strength intra-coronally bleached %FOU
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