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Introduction

Objective

Study design:

The experimental units were 60 human

teeth with stained arrested caries lesions

(pit and fissure surface) embedded in

acrylic blocks (n= 20 per treatment group).

Baseline color was measured

spectrophometrically.

Then, specimens were randomized into 3

groups (n=20) based on the bleaching

protocol used.

Materials and Methods

Color:

At-home bleaching protocol significantly

(p<0.001) improved the color lightness

(ΔE 7.6) of stained arrested caries lesions,

compared to in-office bleaching protocol

(ΔE 3.2) and control (ΔE 3.7).

Re-staining susceptibility:

After staining, both at-home (ΔE 8) and in-

office bleaching groups (ΔE 7.3) produced

a significant (p≤0.009) increase in stains

absorption (darker) compared to the

control group (ΔE 3.1), indicating more

surface stain deposition.

Results

References

[1] P. Schupbach, F. Lutz, B. Guggenheim,

Human root caries: histopathology of arrested

lesions, Caries Res 26 (1992) 153-64.

[2] A. Watts, M. Addy, Tooth discolouration and

staining: a review of the literature, Br Dent J 190

(2001) 309-16.

[3] C. Gonzalez-Cabezas, The chemistry of

caries: remineralization and demineralization

events with direct clinical relevance, Dent Clin

North Am 54 (2010) 469-78.

[4] S.S. Al-Angari, A.T. Hara, A conservative

approach to esthetically treat stained arrested

caries lesions, Quintessence Int 47 (2016) 499-

504.

[5] C.M. Carey, Tooth whitening: what we now

know, J Evid Based Dent Pract 14 Suppl (2014)

70-6.

[6] F. Lippert, R.J. Lynch, G.J. Eckert, S.A.

Kelly, A.T. Hara, D.T. Zero, In situ fluoride

response of caries lesions with different mineral

distributions at baseline, Caries Res 45 (2011)

47-55.

[7] N.V. Penumatsa, R.R. Kaminedi, K. Baroudi,

O. Barakath, Evaluation of remineralization

capacity of casein phosphopeptide-amorphous

calcium phosphate on the carbamide peroxide

treated enamel, J Pharm Bioallied Sci 7 (2015)

S583-6.

[8] S.S. Al-Angari, F. Lippert, J.A. Platt, G.J.

Eckert, C. Gonzalez-Cabezas, Y. Li, A.T. Hara,

Bleaching of simulated stained-remineralized

caries lesions in vitro, Clin Oral Investig (2018).

[9] S.S. Al-Angari, F. Lippert, J.A. Platt, G.J.

Eckert, C. Gonzalez-Cabezas, Y. Li, A.T. Hara,

Dental bleaching efficacy and impact on

demineralization susceptibility of simulated

stained-remineralized caries lesions, Journal of

dentistry (2018).

Acknowledgment

The authors extend their appreciation to

the Deanship of Scientific Research at

King Saud University for funding this

work through the Undergraduate Research

Support Program, Project no.

(URSP – 3 –17 – 32 ).”

To investigate (1) the efficacy of two

different dental bleaching systems on

stained-arrested caries lesions; and

(2) to assess the susceptibility of the

bleached lesions to staining.

1 Dental Student, Collage of Dentistry, King Saud University

2 Assistant Professor, Collage of Dentistry, Department of Dental Restorative Science, King Saud University

Sara Eisa1, Sarah Al-Angari2

Dental Bleaching Efficacy of Stained Arrested Caries

Lesion and their Re-Staining Susceptibility In-Vitro Deanship of Scientific Research

Aesthetic and conservative management of

arrested caries lesions is not well explored in

literature. Bleaching has shown promising

results as an aesthetic and a non-invasive

approach, yet the possibility of re-staining

which may affect the bleaching outcome,

have not been investigated.

Clinical significant

The expected results will help clinicians to

carefully consider selecting appropriate

arrested caries lesions cases as well as the

type of bleaching agent, based on the

effectiveness to manage such lesions in a

conservative and aesthetic approach.

Table 1. Color change (ΔE) means

(standard-deviation) after bleaching and

staining.

- Uppercase letters indicate significant difference within

treatment (row, p<0.05); while lower case among

treatments (column, p<0.05).

+ΔEBleaching: bleaching-baseline, ΔEStaining: staining-

bleaching.

Groups ΔEBleaching+ ΔEStaining+

G1

(control)

3.2 (1.9)

A/a

3.1 (1.7

A/a

G2

(At-home

bleaching)

7.6 (4.1)

A/b

8.0 (3.4)

A/b

G3

(In-office

bleaching)

3.7 (2.3)

A/a

7.3 (5.1)

B/b

Before After

Bleaching

After

staining

G1

G2

G3

A. B.

G1:

No

bleaching

(negative

control)

G2:

Simulated

at-home

bleaching

G3:

Simulated

in-office

bleaching

1. Bleaching test:

A. At-Home bleaching:

15% carbamide peroxide, 4h/d ×7.

B. In-office bleaching:

40% hydrogen peroxide; 20min ×3.

2. Staining test:

Specimens were subjected to staining

(combination of coffee and tea solution;

8h/d×5), in an incubator at 37ºC.

The study outcome was color change (ΔE),

measured spectrophometrically at 3 time

points:

Baseline, after bleaching and after

staining.

Statistical analysis:

Data were analyzed using ANOVA

models followed by Dunnett T3 tests

(α=0.05).

Figure 1. Visual color change for all

groups at baseline, after bleaching and

after staining.

Conclusion

At-home bleaching protocol was

significantly more efficient in color

improvement (lighter color) compared to

in-office bleaching protocol when treating

stained arrested caries lesion; however,

both bleaching protocols resulted in

higher surface stain absorption.

P20