Effect of internal bleaching on the reversal of coronal discoloration induced by triple‐antibiotic‐paste or Biodentine use in regenerative endodontic procedures

Abstract

The aim of this study is to measure color changes caused by two regenerative protocols over 3 months, and the effectiveness of internal bleaching. Twenty extracted human maxillary anterior teeth were used. The apex and canal were prepared to reproduce immature teeth. Teeth were divided: group 1: Triple‐antibiotic‐paste was applied for 3 weeks and then changed for blood until 3 months. Group 2: Blood was inoculated and sealed at cemento‐enamel junction level with Biodentine for 3 months. Both groups were subjected to three sessions of internal bleaching. Color assessments were taken at baseline and at 2 and 3 weeks, 2 and 3 months, and 1, 2, and 3 weeks from the beginning the bleaching phase. Statistical significance was considered at P = .05. Both techniques produce color changes above the acceptability limit at 2 weeks. Chromatic variation caused by Triple‐antibiotic‐paste was intense and progressive over time. Replacement of the Triple‐antibiotic‐paste with blood made the color change more intense and progressive, with significant statistical differences at 2 and 3 months (T4 > T3; P = .028). The internal bleaching technique was statistically more effective in the Triple‐antibiotic‐paste group at 1 week (P = .002). Both techniques cause unacceptable color changes, causing Triple‐antibiotic‐paste more staining than Biodentine. Two sessions of internal bleaching recovered clinically perceptible color in both regenerative endodontic procedures without returning the original color.

Effectiveness of Teeth Whitening after Regenerative Endodontics Procedures: An In Vitro Study

“…Human [ 31 , 32 , 34 , 49 , 50 ] and bovine [ 12 , 16 , 39 , 51 ] teeth are used in in vitro studies to evaluate tooth discolouration. Bovine incisors were used as the specimens in the present study.…”

“…It is difficult to directly compare these studies with this study because different materials, specimen types, bleaching agents, and methods were used. Three authors used hydrogen peroxide [ 31 , 34 , 50 ], and one of the authors included the addition of sodium perborate [ 34 ]. Shokouhinejad et al [ 50 ] analysed laser-assisted protocols.…”

“…The bleaching material is placed in the pulp chamber, and the newly created pulp-like tissue in the root canal is protected by a barrier material [ 16 ]. Different types of bleaching agents have been used in previous studies, including hydrogen peroxide [ 31 ], carbamide peroxide [ 30 , 32 ] and sodium perborate [ 11 , 27 , 28 ], or a mixture of these materials [ 33 , 34 ]. Sodium perborate is prohibited in Europe [ 35 ] and is classified as toxic to reproduction, carcinogenic, or mutagenic.…”

“…There is a lack of extensive in vitro studies on large research materials that analyse the whitening of discoloured teeth after single- and two-visit regenerative endodontic procedures in the context of different disinfectant pastes, scaffolds, and barrier materials. Several authors have analysed bleached teeth after single- or two-visit regenerative endodontic procedures in which blood and a selected barrier material are placed into the root canal [ 31 , 32 , 34 ], but no studies have evaluated bleaching after regenerative endodontic procedures during which platelet-rich fibrin is used. Additionally, most of the authors used a high concentration of whitening agents that did not meet the requirements for dental treatment in patients younger than 18 years of age.…”