Abst ract
Submitted: October 27, 2016 Accepted: December 29, 2016
Random ized clinical t r ial of t he
effect of NovaMin and CPP- ACPF in
com binat ion w it h dent al bleaching
Ob j ect iv e: Th is r an d om ized , con t r olled , d ou b le- b lin d clin ical st u d y evaluat ed t he effect of calcium sodium phosphosilicat e ( NovaMin) and casein SKRVSKRSHSWLGHDPRUSKRXV FDOFLXP SKRVSKDWH ZLWK ÀXRULGH &33$&3) on t he pr event ion of post - operat ive sensit ivit y and on t he effect s of clinical bleaching t r eat m ent . Mat er ial and Met hods: Sixt y volunt eer s w er e select ed according t o inclusion and exclusion crit eria and were random ly assigned int o t hr ee gr oups ( n= 20) : CG ( cont r ol gr oup) pat ient s, w ho w er e t r eat ed w it h 35% hydrogen peroxide; NOVAG ( NovaMin group) pat ient s, who were t reat ed w it h 35% hydr ogen per oxide follow ed by t he applicat ion of NovaMin; and CPPG ( CPP gr oup) pat ient s, w ho w er e t r eat ed w it h 35% hydr ogen per oxide follow ed by t he applicat ion of CPP- ACPF. Bot h bioact ive agent s w er e applied IRU¿YHPLQXWHV$QHYDSRUDWLYHVWLPXOXVDVVRFLDWHGZLWKDPRGL¿HGYLVXDO scale was used t o analyze sensit ivit y 24 hour s aft er each bleaching session. The color evaluat ion was per for m ed on t he m axillar y cent ral incisor s using a spect r ophot om et er. Associat ions bet w een t he int er vent ion gr oup, bleaching session, and r epor t ed sensit ivit y w er e t est ed using Chi- squar e par t it ioning. 5HVXOWV&RORUFKDQJHYDOXHVƩ(ZHUHDQDO\]HGXVLQJDQDO\VLVRIYDULDQFH $129$7KHVLJQL¿FDQFHOHYHOXVHGIRUERWKWHVWVZDV,QWKHLQWUDJURXS assessm ent , t he Friedm an t est showed t hat only t he CPP-ACPF group showed QR VWDWLVWLFDOO\ VLJQL¿FDQW GLIIHUHQFH S EHWZHHQ EDVHOLQH DQG ¿UVW bleaching session. I n t he int er gr oup assessm ent , t he Kr uskal–Wallis t est VKRZHGWKDWWKH&33*KDGOHVVSRVWRSHUDWLYHVHQVLWLYLW\DIWHUWKH¿UVWVHVVLRQ ZKHQFRPSDUHGWRWKHRWKHUJURXSVS&RORUFKDQJHDQDO\VLVƩ( VKRZHGDVLJQL¿FDQWGLIIHUHQFHEHWZHHQWKHPHDQVREWDLQHGLQWKHGLIIHUHQW EOHDFKLQJVHVVLRQVLQDOOJURXSVS&RQFOXVLRQV7KLVVWXG\VKRZHG WKDWWKHFRPELQDWLRQRI&33$&3)ZLWKK\GURJHQSHUR[LGHVLJQL¿FDQWO\ UHGXFHGSRVWRSHUDWLYHVHQVLWLYLW\LQWKH¿UVWVHVVLRQFRPSDUHGZLWKWKH ot her evaluat ed t r eat m ent s. The associat ion of CPP- ACPF and NovaMin did not affect t he color change induced by t oot h bleaching.
Ke y w or d s: Dent in sensit iv it y. Toot h bleaching. Dent in desensit izing agent s.
Larissa Dias ALEXANDRINO1
Cristiane de Melo ALENCAR1
Ana Daniela Silva da SILVEIRA1
Eliane Bemerguy ALVES1
Cecy Martins SILVA1
http://dx.doi.org/10.1590/1678-7757-2016-0408
1Universidade Federal do Pará, Belém, PA, Brasil.
I nt r oduct ion
Toot h bleaching has becom e a popular appr oach
because it is conser vat ive and capable of changing
t oot h color26.The use of highly concent rat ed agent s is
pr efer r ed by m any dent ist s in clinical pract ice because
it affor ds t he pr ofessional gr eat er cont r ol, ensur es
great er pat ient safet y, and requires fewer applicat ions24.
Bleaching agent s have an oxidizing act ion t hat leads t o
t he form at ion of free radicals, react ive oxygen species,
and hydr ogen per oxide ions. These r eact ive m olecules
at t ack chr om ophor es, causing t heir degradat ion and
r esult ing in a bleaching effect29.
The m ost com m on adver se effect r esult ing fr om
bleaching is dent inal sensit ivit y5,which is charact erized
by t he m anifest at ion of acut e, shor t - t er m , or t ransient
pain16.Mor eover, it is cur r ent ly believed t hat oxygen
bubbles ar e for m ed in t he dent inal t ubules dur ing t he
applicat ion of per oxides and t hat t hese bubbles can PRYH WKH LQWUDWXEXODU ÀXLG DQG DFWLYDWH LQWUDGHQWDO n er v es, ca u si n g p o st - o p er a t i v e sen si t i v i t y7.Th i s
hy pot hesis t her efor e suggest s t hat sensit iv it y aft er
bleaching is a consequence of per oxide penet rat ion
int o t he int er nal t oot h st r uct ur e, causing t he dir ect
act ivat ion of neur onal r ecept or s18.
Alt hough saliva has a known rem ineralizing act ion9,
it alone m ay not be able t o incr ease t he lev els of
available calcium and phosphat e in t he oral cavit y and
pr event t he incidence of sensit ivit y27. To m inim ize or
HOLPLQDWH SRVWRSHUDWLYH VHQVLWLYLW\ ÀXRULGHV DQGRU r em ineralizing solut ions have been used t o m aint ain
a p osit iv e b alan ce b et w een d em in er alizat ion an d
r em ineralizat ion3. Bioact ive agent s cont aining calcium
and phosphor us ions have t hus been used t o t r eat
dent inal hyper sensit ivit y12.I n t he pr esence of saliva
DQGELR¿OPWKHVHLRQVFDQocclude t he dent inal t ubules
and r educe ner ve- ending excit abilit y w it hout affect ing
t he t oot h bleaching pr ocess25.
Calciu m sodiu m ph osph osilicat e ( NovaMin ) an d
casein phosphopept ide- am orphous calcium phosphat e ZLWKÀXRULGH&33$&3)DUHELRDFWLYHSURGXFWVWKDW have been used t o prom ot e enam el rem ineralizat ion17,20,
an d t h ey w er e t h er efor e com bin ed w it h bleach in g
t r eat m ent s in t his st udy.
An inor ganic bioact ive glass, know n com m er cially
as NovaMin, has also been used for t r eat ing dent al
h y p er sen sit iv it y an d f or en am el r em in er alizat ion .
Th is m at er ial w as or ig in ally d ev elop ed t o act on
bone r egenerat ion because it has a ceram ic st r uct ur e
cont aining am or phous calcium and sodium . NovaMin
is t her efor e a highly wat er- r eact ive phosphosilicat e FRPSRVHGRI¿QHSRZGHUSDUWLFOHVWKDWFDQSK\VLFDOO\ obst r uct t he dent inal t ubules11.
Nov aMi n i s co m p o sed o f so d i u m , p h o sp h at e,
calcium , and silica, and it quickly r eleases calcium ,
p h osp h or u s, an d sod i u m i on s w h en f or m i n g t h e
hydr oxyapat it e layer10.NovaMin for m s an am or phous
layer r ich in t he ionic com pound a2+ 3PO4-, w hich is
cr y st allized by t he incor porat ion of OHí and 3COí anions pr esent in t he solut ion, t her eby r em ineralizing
t he t issue30.
Desp it e p r om isin g r esu lt s in ot h er ar eas, it is
believed t hat t he use of rem ineralizing bioact ive agent s
t o accelerat e t he r em ineralizat ion pr ocess m ay im pair
t he enam el’s perm eabilit y and consequent ly im pair t he
qualit y of t he bleaching t r eat m ent . The penet rat ion
of r eact ive oxygen species and fr ee radicals m ay be
pr event ed by t he deposit ion of ionic cr yst als on t he
t oot h sur face6.
The var ious com m er cial bioact ive com pounds var y ZLGHO\LQWKHLUFOLQLFDOHI¿FDF\WKXVFOLQLFDOVWXGLHV DUH QHFHVVDU\ WR FRQ¿UP WKH HIIHFWLYHQHVV RI WKHVH subst ances w hen associat ed w it h bleaching.
This random ized clinical t r ial aim ed t o evaluat e
t he effect of t w o bioact ive agent s, NovaMin and
CPP-ACPF, used aft er t oot h bleaching, on t he pr event ion
of post - operat ive sensit ivit y and on t he qualit y of t he
bleaching t reat m ent . The null hypot heses t est ed in t his
st udy w er e as follow s: H01 – t her e is no differ ence in
post - operat ive sensit ivit y bet w een t he t est ed gr oups
( cont r ol, NovaMin, and CPP- ACPF) at t he differ ent
evaluat ion t im es; H02 – t here is no difference bet ween
t he t est ed gr oups ( cont r ol, NovaMin, and CPP- ACPF) UHJDUGLQJFRORUFKDQJHƩ(DWWKHGLIIHUHQWHYDOXDWLRQ t im es.
Mat er ial and Met hods
Et hical aspect s
The st udy follow ed t he guidelines published by
t h e Con solid at ed St an d ar d s of Rep or t in g Tr ials –
CONSORT22. The Resear ch Et hics Com m it t ee of t he
Healt h Sciences I nst it ut e, Federal Univer sit y of Para,
r ev iew ed and appr oved t he st udy. The clinical t r ial
n u m ber in t h e Br azilian Regist r y of Clin ical Tr ials
Populat ion and sam ple calculat ion
The soft war e BioEst at® ( Civ il Societ y Mam irauá,
AM, Brazil) was used t o calculat e t he sam ple size using
dat a fr om a pilot st udy, w hich was conduct ed w it h t en
volunt eer s and t hat follow ed t he sam e pr ocedur es as WKLVVWXG\$VWDWLVWLFDOSRZHURIDQĮHUURURI 5% , and a sam ple loss pr edict ion of 20% at t he end of
t he st udy w er e consider ed for sam ple size calculat ion.
The sam ple calculat ed for t his st udy was of 20 pat ient s
per gr oup, t ot aling 60 pat ient s.
St udy design
This random ized, cont rolled, double- blind st udy
w it h t hr ee parallel ar m s evaluat ed com parat ively t he
per for m ance of bioact ive agent s r ecent ly pr oposed
f o r r ed u ci n g d en t i n al sen si t i v i t y af t er b l each i n g
t r eat m ent . Sixt y volunt eer s w er e select ed accor ding
t o t he inclusion and exclusion cr it er ia ( Figur e 1) and
were divided int o t hree groups by sim ple random izat ion
( n= 2 0 ) . All gr oups under w ent t he sam e bleaching
t r eat m ent . The gum t issue adj acent t o t he w hit ened
t eet h was isolat ed using a polym er ized r esinous gum
bar r ier ( Top Dan – FGM; Joinville, SC, Brazil) . Thir t y-¿YHSHUFHQWK\GURJHQSHUR[LGH:KLWHQHVV+3±)*0 Joinville, SC, Brazil) was applied t o t he buccal sur faces
of t he incisors, canines, and prem olars of bot h arches of
t he volunt eers for 45 m inut es. The bleaching t reat m ent
was per for m ed over a t ot al of t hr ee sessions, w it h an
int er val of seven days bet w een t hem .
Pat ient s in t he ex per im ent al gr oups r eceived an
ap p licat ion of b ioact iv e ag en t s w it h a d isp osab le
applicat or ( Microbrush – Vigodent ; Joinville, SC, Brazil) IRU¿YHPLQXWHVRQWKHEOHDFKHGWRRWKVXUIDFHVDIWHU
each bleaching session. The bioact ive agent s w er e
lat er r em oved w it h wat er j et s. Pat ient s in t he NOVAG
( NovaMin group) were t reat ed wit h NovaMin Repair and
Prot ect ( GSK Sensodyne; Brent ford, Middlesex, Unit ed
Kingdom ) , and pat ient s in t he CPPG ( CPP gr oup) w er e
t reat ed wit h CPP-ACPF ( GC MI Past e Plus – Recaldent®;
Hasunum a- Cho, I t abashi- Ku, Tokyo, Japan) .
All pat ient s r eceived oral hygiene kit s cont aining
a t oot hbr ush ( Oral B I ndicat or ; São Paulo, SP, Brazil)
DQG WRRWKSDVWH ZLWK SSP ÀXRULGH &ROJDWH
Palm olive Com pany; São Paulo, SP, Brazil) , along w it h
inst r uct ions t o use t hem t hr ee t im es per day.
Th e p ost - op er at i v e sen si t i v i t y ev al u at i on w as
per for m ed 24 hour s aft er each bleaching session. An
evaporat ive t est was per for m ed by applying air j et s
w it h a t r iple syr inge ( Dabi At lant e; Ribeir ão Pr et o, SP,
Brazil) t o t he labial sur face of t he bleached t eet h. The
YROXQWHHUVUHFHLYHGDPRGL¿HGYLVXDOVFDOHSULQWHG cont aining facial expr essions show ing differ ent levels
of sensit ivit y and discom for t caused by t he bleaching
t r eat m ent ( absent , m ild, m oderat e, or sever e) .
Th e co l o r ev al u at i o n w as p er f o r m ed o n each
volunt eer ’s upper incisors using an Easyshade Advance
spect r ophot om et er ( Easyshade; Vit a Zahnfabr ik, Bad
Säckingen, Ger m any) w it h t he CI E L* a* b* syst em ,
ZKHUH WKH FRORU FKDQJH YDOXHV Ʃ( ZHUH REWDLQHG for each gr oup of t eet h using t he follow ing for m ula:
Ʃ( ^Ʃ/2ƩD2ƩE2}1 / 2, ZKHUH Ʃ/ /í/
0;
ƩD DíD0DQGƩE EíE0. The color evaluat ion w as p er f or m ed f ou r t im es: b ef or e t h e b leach in g
t r eat m ent ( baseline) , and 24 hour s aft er each of t he
t hr ee bleaching sessions.
To st andar dize t he color m easur em ent point on
each t oot h, a m old was m ade of each pat ient ’s upper
ar ch, and a plast er m odel was obt ained t o const r uct a
polyet hylene plat e wit h t he aid of a lam inat or. When t he PROGZDVUHDG\¿[HGUHIHUHQFHSRLQWVZHUHHVWDEOLVKHG using a per forat ion in t he cent ral r egion of t he labial
sur face of t he m axillar y cent ral incisor s of each m odel,
w it h a size cor r esponding t o t he spect r ophot om et er
t ip4.
St at ist ical analysis
7KH FRORU FKDQJH YDOXHV Ʃ( IRU HDFK JURXS RI st u died t eet h an d t h e sen sit iv it y r epor t ed by t h e
volunt eer s w er e t abulat ed in an Excel spr eadsheet
( Micr osoft Window s 2 0 0 7 ) and analy zed using t he
p r og r am BioEst at®. Th e associat ion b et w een t h e
int er v ent ion gr oup, t he bleaching session, and t he Inclusion Criteria
ā$JHEHWZHHQDQG
ā*RRGJHQHUDODQGRUDOKHDOWKFRQGLWLRQV ā$OODQWHULRUWHHWKKHDOWK\
ā,QLWLDOFRORURI$RUGDUNHUDFFRUGLQJWRWKH9,7$VFDOH āS+DQGVDOLYDU\ÀRZZLWKLQQRUPDOSDUDPHWHUV
Exclusion Criteria
ā3UHYLRXVWRRWKEOHDFKLQJ ā5HVWRUDWLRQVLQWKHDQWHULRUWHHWK ā3UHJQDQWRUEUHDVWIHHGLQJ
ā7HHWKGDUNHQHGE\WHWUDF\FOLQHVWDLQLQJÀXRURVLVWHHWKWUHDWHG HQGRGRQWLFDOO\
ā%UX[LVPRUH[SRVHGGHQWLQRQWKHLQFLVDOVXUIDFH ā1RQFDULRXVFHUYLFDOOHVLRQV
· Dentinal hypersensitivity.
sen sit iv it y r epor t ed af t er 2 4 h ou r s w as t est ed by
an aly sis of var ian ce ( Fr iedm an or Kr u sk al–Wallis) . 7KH Ʃ( YDOXHV REWDLQHG IRU HDFK LQWHUYHQWLRQ JURXS and each t im e point w er e analy zed using analy sis
of var iance ( ANOVA) follow ed by Tukey ’s t est . The VLJQL¿FDQFHOHYHODGRSWHGLQDOODQDO\VHVZDV
Result s
Of t he 60 random ized volunt eer s, 51 com plet ed
t he t r eat m ent . Ther efor e, at t he end of t he st udy, 17
volunt eer s w er e evaluat ed in each exper im ent al gr oup
( Figur e 2) . Table 1 show s t he r esult s for t he evaluat ion
of sensit ivit y r epor t ed by pat ient s 24 hour s aft er each
bleaching session.
I n t he int ragr oup assessm ent s, t he Fr iedm an t est
show ed t hat only t he CPP- ACPF gr oup pr esent ed no VWDWLVWLFDOO\ VLJQL¿FDQW GLIIHUHQFH S! EHWZHHQ EDVHOLQHDQG¿UVWEOHDFKLQJVHVVLRQ,QWKHLQWHUJURXS assessm ent s, t he Kr uskal–Wallis t est show ed t hat t he
CPP- ACPF gr oup had less post - operat ive sensit iv it y
DIWHUWKH¿UVWVHVVLRQFRPSDUHGZLWKWKHRWKHUJURXSV S
7KHƩ(YDOXHVIRUWKHXSSHULQFLVRUVZHUHXVHGWR
com par e t he color changes bet w een t he exper im ent al
gr oups at each bleaching session ( Table 2) .
Th e d at a an aly sis in Tab le 2 r ev eals t h at t h e YDULDWLRQLQƩ(ZDVKRPRJHQHRXVEHWZHHQWKHJURXSV WKHUH ZDV QR VLJQL¿FDQW GLIIHUHQFH S! ZKHQ com par ing t he exper im ent al gr oups at each t r eat m ent
session. These dat a show t hat , under t he condit ions of
t his st udy, t he gr oups t r eat ed w it h NovaMin and
CPP-ACPF follow ed t he sam e pat t er n of t he cont r ol gr oup, ZLWK Ʃ( LQFUHDVLQJ XS WR WKH WKLUG VHVVLRQ DQG ZLWK color st abilizat ion aft er t his point .
I n addit ion, when analyzing t he groups individually, DFOHDULQFUHDVHZDVREVHUYHGLQWKHƩ(YDOXHDWWKH end of t he exper im ent in all t est ed gr oups. Bot h CG DQG&33*JURXSVVKRZHGDQLQFUHDVHLQƩ(DIWHUWKH VHFRQGEOHDFKLQJVHVVLRQSKRZHYHUWKLVFRORU differ ence was only obser ved aft er t he t hir d bleaching
session in t he NOVAG.
Time/ Group 1 (control) Group 2 (NovaMin) Group 3 (CPP-ACPF)
Groups Md (±IQR) Md (±IQR) Md (±IQR)
Baseline 0.0 (±0.0)A,a 0.0 (±0.0)A,a 0.0 (±0.0)A,a
1st session 1.0 (±0.0)B,a 1.0 (±0.0)B,a 0.5 (±1.0)A,b
2nd session 1.0 (±0.0)B,a 1.0 (±0.0)B,a 1.0 (±0.0)B,a
3rd session 1.0 (±1.0)B,a 1.0 (±1.0)B,a 1.0 (±0.0)B,a
Note¹: Equal letters for similar values (p >0.05) and different letters statistically different values (p <0.05).
1RWHð&DSLWDOL]DWLRQLVWKHFRPSDULVRQLQWKHVDPHFROXPQE\)ULHGPDQWHVWIRUFRPSDULVRQVLQWUDJURXSVORZHUFDVHOHWWHUVUHSUHVHQWLQJ
the comparison on the same line by Kruskal-Wallis test for comparisons intergroup.
Table 1- Median (Md) and interquartile ranges (IQR) of sensitivity described by patients after bleaching treatment, according to experimental group and session
Discussion
Hydrogen peroxide at a 35% concent rat ion has a
high capacit y of penet rat ing t he enam el and dent in
because of it s low m olecular w eight ( 34.0147 g/ m ol) ,
as w ell as it s abilit y t o denat ure prot ein, increase ionic
m ovem ent , and st im ulat e nerve recept ors. These fact ors
t oget her explain t he high incidence of t oot h sensit ivit y2.
Most post- bleaching sensit ivit y prevent ion t reat m ent s
are based on t he use of desensit izing agent s, w here
t he proposed m ode of act ion is nerve inhibit ion and/ or
depolarizat ion23. According t o Paula, et al.19 ( 2013) , t he
use of desensit izing agent s has produced bet t er result s WKDQWKHXVHRISDLQNLOOHUVDQGDQWLLQÀDPPDWRU\DJHQWV Furt herm ore, prior st udies claim t hat bioact ive product s
wit h t ubular occlusion act ivit y can preserve dent al t issue
by form ing a prot ect ive layer over t he enam el14.
The null hypot hesis ( H01) of t his st udy was rej ect ed
because we observed t hat post- operat ive sensit ivit y was VLJQL¿FDQWO\UHGXFHGLQWKH&33*7KHJURXSVGLIIHUHG LQ WRRWK VHQVLWLYLW\ KRXUV DIWHU WKH ¿UVW EOHDFKLQJ session. Only t he CPPG volunt eers report ed a lack of
sensit ivit y, w hile m ost m em bers of t he CG and NOVAG SUHVHQWHGPLOGSDLQQRWGLIIHULQJVLJQL¿FDQWO\IURPHDFK ot her. These result s can be explained by t he act ion of
CPP-ACPF, which act s as a calcium and phosphat e carrier
t hat t ranspor t s t hese m inerals t o t he t oot h sur face,
p r om ot in g t h eir su p er sat u r at ion . Ad d it ion ally, t h e
presence of casein in t his com pound st abilizes calcium
phosphat e by changing t he chem ical st ruct ure of t he
t oot h surface and prom ot ing rem ineralizat ion28.
Rey n old s, et al.2 1 ( 2 0 0 1 ) r ep or t t h at CPP- ACP
at t aches easily t o t he t oot h surface and t o t he plaque
bact eria surrounding t he t oot h. Therefore, t he CPP- ACP
deposit s ar e for m ed in close pr ox im it y t o t he t oot h
sur face. These aut hor s hy pot hesized t hat , in acidic
condit ions, CPP- ACP prom ot es t he form at ion of calcium
ion s an d f r ee ph osph at es, su bst an t ially in cr easin g
calcium phosphat e levels in t he plaque. This effect would
t hus m aint ain a st at e of supersat urat ion t hat inhibit s
enam el dem ineralizat ion and prom ot es rem ineralizat ion,
explaining t he result s of our st udy.
By cont rast , NovaMin only reduced post - operat ive VHQVLWLYLW\ LQ WKH ¿UVW VHVVLRQ 7KLV VKRUWWHUP HIIHFW is due t o t he rapid pr ecipit at ion capacit y of calcium
an d ph osph at e ion s, leadin g t o a m or e im m ediat e
occlusion of dent inal t ubules1. These glasses form an
int egrat ed bond w it h hard t issue t hrough t he form at ion
of a carbonat ed hydroxyapat it e layer on t issue surfaces
follow ing im m er sion in phy siological solut ions13. This
hydroxyapat it e layer, in t urn, is generally t hought t o
help prot ein binding, leading t o t he form at ion of a t ight
bond w it h t he enam el8. Therefore, furt her st udies m ust
be conduct ed t o evaluat e t he dissolut ion m echanism of
NovaMin.
I n st r u m en t al ev al u at i o n i s p r ef er r ed t o v i su al
assessm ent , because t he for m er pr ov ides t he m ost
pract ical an d st at ist ically r eliable pr ocess, en ablin g
an al y si s i n sm al l ar eas. Co l o r ev al u at i o n u si n g a
spect rophot om et er is perform ed under t he I nt ernat ional
Com m ission on I llum inat ion ( CI E) st andardizat ion, in
w hich t he L* , a* , and b* coor dinat e values of each
t oot h, referring t o black and w hit e ( lum inosit y) ,
red-gr een an d blu e- y ellow v ar iat ion s, r espect iv ely, ar e
evaluat ed. These m easurem ent s t hereby allow a t ot al FRORUYDULDWLRQWREHFDOFXODWHGƩ($Ʃ(YDULDWLRQRI 3.3 t o 3.7 is clinically apparent aft er t oot h bleaching,
w hich is in line w it h our result s15.
The second null hy pot hesis ( H0 2 ) w as accept ed
based on t he result s of t his color change evaluat ion
m et h od. Th e color ev alu at ion r esu lt s of t h is st u dy
show ed t hat t he color changes in t he groups t reat ed
w it h NovaMin and CPP- ACPF follow ed a pat t ern sim ilar WRWKDWREVHUYHGLQWKH&*ZLWKDQLQFUHDVHLQƩ(XSWR t he t hird session. These result s show t hat t he subst ances
used t o prevent sensit ivit y did not com prom ise t oot h
Time/Groups Group 1 (control) Group 2 (NovaMin) Group 3 (CPP-ACPF)
(±SD) CI (95%) (±SD) CI (95%) (±SD) CI (95%)
1st session 4.57 (±1.77)A,a 3.66-5.48 4.64 (±3.01)A,a 3.09-6.19 5.13 (±1.35)A,a 4.44-5.83 2nd session 7.63 (±1.55)B,a 6.83-8.43 6.64 (±2.90)B,a 5.15-8.13 7.35 (±2.38)B,a 6.12-8.57 3rd session 10.46 (±1.60)C,a 9.64-11.28 9.60 (±3.24)C,a 7.93-11.27 9.87 (±1.75)C,a 8.97-10.77 24 hours 9.84 (±2.60)C,a 8.50-11.18 10.10 (±3.98)C,a 8.06-12.15 9.85 (±2.17)C,a 8.73-10.96
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1RWHð8SSHUFDVHOHWWHUVUHSUHVHQWFRPSDULVRQVEHWZHHQURZVLQWKHVDPHFROXPQORZHUFDVHOHWWHUVUHSUHVHQWFRPSDULVRQVEHWZHHQ FROXPQVLQWKHVDPHURZE\DQDO\VLVRIYDULDQFH$129$IROORZHGE\7XNH\¶VWHVW
bleaching.
7KH &33$&3 DVVRFLDWHG ZLWK ÀXRULGH ppm ) m ay have prom ot ed not only rem ineralizat ion,
but also t he form at ion of a m ore hom ogeneous enam el
layer, w hich is less perm eable t o pigm ent s derived from
t he diet . By cont rast , t he high solubilit y of t he ionic layer
form ed by t he NovaMin bioact ive likely com prom ised t he
longevit y of t he bleaching t reat m ent in t his experim ent al
group.
Th e r esu lt s su g g est t h at , u n d er t h e ex am in ed
condit ions, t oot h bleaching w it h CPP- ACPF causes less
sensit ivit y in t reat ed t eet h t han a bleaching agent alone
or a bleaching agent plus NovaMin. None of t he bioact ive
agent s affect ed t he t oot h bleaching process.
Conclusion
Th e com b in at ion of CPP- ACPF w it h a b leach in g WUHDWPHQWVLJQL¿FDQWO\UHGXFHGSRVWRSHUDWLYHVHQVLWLYLW\ LQ WKH ¿UVW ZHHN ZKHQ FRPSDUHG ZLWK D EOHDFKLQJ t reat m ent w it hout a bioact ive agent . The com binat ion
of NovaMin w it h bleaching t reat m ent produced result s
sim ilar t o t h ose obt ain ed w it h bleach in g t r eat m en t
w it hout a bioact ive agent , and t he associat ion of eit her
CPP- ACPF or NovaMin w it h 35% hydrogen peroxide did
not affect t he bleaching process.
Acknow ledgm ent s
Th e au t h or s t h an k CNPq – Nat ion al Cou n cil f or 6FLHQWL¿FDQG7HFKQRORJLFDO'HYHORSPHQW
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