The Effect of Two Bleaching Techniques On Teeth Discolored with Different calcium silicate-based cements
The Effect of Bleaching Techniques On Teeth Discolored with cements
Abstract
Objectives: The objective of this study was to investigate tooth discoloration caused by different calcium silicate-based cements (CSCs), and assess the efficacy of two bleaching techniques in restoring the original tooth color.
Materials and Methods: In this in vitro study, 54 sound teeth were divided into three groups (n=18) of Endocem, MTA Angelus, and calcium-enriched mixture (CEM) cement. Baseline color assessments were conducted using a spectrophotometer, with subsequent color evaluation after 3 months. Each group was divided into two subgroups of internal bleaching and internal/external bleaching. The bleaching procedure was performed over a 2-week period. Two-way ANOVA was applied to investigate the interaction effect of bleaching technique and time on color change (∆E). The Tukey’s test was used as post-hoc for pairwise comparisons. P≤0.05 was considered significant.
Results: The results indicated noticeable color change in all test groups, surpassing the perceptibility threshold (ΔE>3.3). Endocem exhibited the maximum discoloration, while CEM cement displayed the minimum. Significant differences were observed between Endocem and other groups (P<0.05). Regarding the L*, a*, and b* parameters, no significant differences were found between the two subgroups except in Endocem group, where internal/external bleaching caused a significantly greater increase in color parameters compared to internal bleaching (P=0.001).
Conclusion: Endocem induced more discoloration than MTA Angelus and CEM cement. However, there was no difference in efficacy between the internal and internal/external bleaching techniques (except in Endocem), both proving effective in restoring the original color of discolored teeth.
1. Gürel MA, Kivanç BH, Ekici A, Alaçam T. Evaluation of crown discoloration induced by endodontic sealers and colour change ratio determination after bleaching. Aust Endod J. 2016 Dec;42(3):119-23.
2. Vajrabhaya LO, Korsuwannawong S, Jantarat J, Korre S. Biocompatibility of furcal perforation repair material using cell culture technique: Ketac Molar versus ProRoot MTA. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Dec;102(6):e48-50.
3. Tsatsas DV, Meliou HA, Kerezoudis NP. Sealing effectiveness of materials used in furcation perforation in vitro. Int Dent J. 2005 Jun;55(3):133-41.
4. Phillips RW. Phillips' science of dental materials. 13th, editor: Elsevier/Saunders; 2022.
5. Silva EJ, Carvalho NK, Guberman MR, Prado M, Senna PM, Souza EM, et al. Push-out bond strength of fast-setting mineral trioxide aggregate and pozzolan-based cements: Endocem MTA and Endocem Zr. J Endod. 2017 May;43(5):801-4.
6. Sharma V, Nawal RR, Augustine J, Urs AB, Talwar S. Evaluation of Endosequence Root Repair Material and Endocem MTA as direct pulp capping agents: An in vivo study. Aust Endod J. 2022 Aug;48(2):251-7.
7. Camilleri J. Tricalcium silicate-based cements: properties and modifications. Braz oral res(Online). 2018:e70.
8. Choi Y, Park SJ, Lee SH, Hwang YC, Yu MK, Min KS. Biological effects and washout resistance of a newly developed fast-setting pozzolan cement. J Endod. 2013 Apr;39(4):467-72.
9. Asgary S, Shahabi S, Jafarzadeh T, Amini S, Kheirieh S. The properties of a new endodontic material. J Endod. 2008 Aug;34(8):990-3.
10. Mozayeni MA, Milani AS, Marvasti LA, Asgary S. Cytotoxicity of calcium enriched mixture cement compared with mineral trioxide aggregate and intermediate restorative material. Aust Endod J. 2012 Aug;38(2):70-5.
11. Farhang R, Hekmatfar S, Samadi V, Meraji A, Jafari K. Comparison of tooth discoloration induced by calcium enriched mixture, mineral trioxide aggregate, and Endocem. World J Dent. 2020 Sep;11(5):392-5.
12. Ioannidis K, Mistakidis I, Beltes P, Karagiannis V. Spectrophotometric analysis of coronal discolouration induced by grey and white MTA. Int Endod J. 2013 Feb;46(2):137-44.
13. Khim TP, Sanggar V, Shan TW, Peng KC, Western JS, Dicksit DD. Prevention of coronal discoloration induced by root canal sealer remnants using Dentin Bonding agent: an in vitro study. J Conservative Dent. 2018 Sep;21(5):562-8.
14. Tripathi R, Cohen S, Khanduri N. Coronal tooth discoloration after the use of white mineral trioxide aggregate. Clin Cosmet Investig Dent. 2020 Sep;12:409-14.
15. Mondelli RFL, Francisconi AC, Almeida CMd, Ishikiriama SK. Comparative clinical study of the effectiveness of different dental bleaching methods-two year follow-up. J Appl Oral Sci. 2012;20(4):435-43.
16. Faus-Matoses V, Palau-Martínez I, Amengual-Lorenzo J, Faus-Matoses I, Faus-Llácer VJ. Bleaching in vital teeth: Combined treatment vs in-office treatment. J Clin Exp Dent. 2019;11(8):e754.
17. Demir N, Karci M, Ozcan M. Effects of 16% carbamide peroxide bleaching on the surface properties of glazed glassy matrix ceramics. Biomed Res. Int. 2020;2020(1):1864298.
18. Settembrini L, Gultz J, Kaim J, Scherer W. A technique for bleaching nonvital teeth: inside/outside bleaching. J Am Dent Assoc. 1997 Sep;128(9):1283-4.
19. Akbulut MB, Terlemez A, Akman M, Buyukerkmen B, Guneser MB, Eldeniz AU. Tooth discoloration effects of calcium silicate based barrier materials used in revascularization and treatment with internal bleaching. J. Dent. Sci. 2017 Dec;12(4):347-53.
20. Machado AC, Braga SR, Ferreira D, Jacintho FF, Scaramucci T, Sobral MA. Bleaching of severely darkened nonvital tooth case report—48 months clinical control. J Esthet. Restor. Dent. 2021 Mar;33(2):314-22.
21. Gurel MA, Kivanc BH, Ekici A, Alacam T. Evaluation of crown discoloration induced by endodontic sealers and colour change ratio determination after bleaching. Aust Endod J. 2016 Dec;42(3):119-23.
22. Rao YM, Srilakshmi V, Vinayagam KK, Narayanan LL. An evaluation of the color stability of tooth-colored restorative materials after bleaching using CIELAB color technique. Indian J. Dent. Res. 2009 Jan;20(1):60.
23. Huang M, Ye H, Chen H, Zhou Y, Liu Y, Wang Y, et al. Evaluation of accuracy and characteristics of tooth-color matching by intraoral scanners based on Munsell color system: an in vivo study. Odontology. 2022 Oct;110(4):759-68.
24. Lenherr P, Allgayer N, Weiger R, Filippi A, Attin T, Krastl G. Tooth discoloration induced by endodontic materials: a laboratory study. Int. Endod. J. 2012 Oct;45(10):942-9.
25. Dozić A, Kleverlaan CJ, El‐Zohairy A, Feilzer AJ, Khashayar G. Performance of five commercially available tooth color‐measuring devices. J. Prosthodont. 2007 Mar;16(2):93-100.
26. Partovi M, Al‐Havvaz AH, Soleimani B. In vitro computer analysis of crown discolouration from commonly used endodontic sealers. Aust Endod J 2006 Dec;32(3):116-9.
27. Esmaeili B, Alaghehmand H, Kordafshari T, Daryakenari G, Ehsani M, Bijani A. Coronal discoloration induced by calcium-enriched mixture, mineral trioxide aggregate and calcium hydroxide: a spectrophotometric analysis. Iran. Endod. J. 2015 Dec;11(1):23.
28. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review—part III: clinical applications, drawbacks, and mechanism of action. J. Endod. 2010 Mar;36(3):400-13.
29. Salem-Milani A, Ghasemi S, Rahimi S, Ardalan-Abdollahi A, Asghari-Jafarabadi M. The discoloration effect of white mineral trioxide aggregate (WMTA), calcium enriched mixture (CEM), and portland cement (PC) on human teeth. J Clin Exp Dent. 2017 Dec;9(12):e1397.
30. Asgary S, Parirokh M, Eghbal MJ, Brink F. A comparative study of white mineral trioxide aggregate and white Portland cements using X‐ray microanalysis. Aust Endod J. 2004 Dec;30(3):89-92.
31. Kim RJ, Kim MO, Lee KS, Lee DY, Shin JH. An in vitro evaluation of the antibacterial properties of three mineral trioxide aggregate (MTA) against five oral bacteria. Arch. Oral Bio. 2015 Oct;60(10):1497-502.
32. Jamali Zavare F, Nojehdehian H, Moezizadeh M, Daneshpooy M. Chemical modification of MTA and CEM cement to decrease setting time and improve bioactivity properties by adding alkaline salts. J Dent Res Dent Clin Dent Prospects. 2020 Winter;14(1):1-11.
33. Arman M, Khalilak Z, Rajabi M, Esnaashari E, Saati K. In vitro spectrophotometry of tooth discoloration induced by tooth-colored mineral trioxide aggregate and calcium-enriched mixture cement. Iran. Endod. J. 2015;10(4):226.
34. Carrillo A, Trevino MVA, Haywood VB. Simultaneous bleaching of vital teeth and an open-chamber nonvital tooth with 10% carbamide peroxide. Quintessence Int. 1998 Oct;29(10).
35. Zimmerli B, Jeger F, Lussi A. Bleaching of nonvital teeth. Schweiz Monatsschr Zahnmed. 2010 Jan;120(4):306-13.
36. Shi Z, Chow CW, Fabris R, Liu J, Jin B. Applications of online UV-Vis spectrophotometer for drinking water quality monitoring and process control: a review. Sensors. 2022 Apr;22(8):2987.
37. Pedrollo Lise D, Siedschlag G, Bernardon JK, Baratieri LN. Randomized clinical trial of 2 nonvital tooth bleaching techniques: A 1-year follow-up. J Prosthet Dent. 2018 Jan;119(1):53-59.
38. Saati K, Sheikhi S, Esnaashari E, Valizadeh S. The effects of three bleaching agents on tooth discoloration caused by mineral trioxide aggregate. Iran. Endod. J. 2019;14(4):253-8.
39. Giachetti L, Bertini F, Bambi C, Nieri M, Russo DS. A randomized clinical trial comparing at-home and in-office tooth whitening techniques: a nine-month follow-up. J Am Dent Assoc. 2010 Nov;141(11):1357-64.
40. Mittal R, Sood AG, Singla MG, Dhawan D. A comparative evaluation of efficacy of commercially available bleaching agents in non-vital teeth: An in vitro study. Saudi Endod. J. 2015 Jan;5(1):33.
2. Vajrabhaya LO, Korsuwannawong S, Jantarat J, Korre S. Biocompatibility of furcal perforation repair material using cell culture technique: Ketac Molar versus ProRoot MTA. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006 Dec;102(6):e48-50.
3. Tsatsas DV, Meliou HA, Kerezoudis NP. Sealing effectiveness of materials used in furcation perforation in vitro. Int Dent J. 2005 Jun;55(3):133-41.
4. Phillips RW. Phillips' science of dental materials. 13th, editor: Elsevier/Saunders; 2022.
5. Silva EJ, Carvalho NK, Guberman MR, Prado M, Senna PM, Souza EM, et al. Push-out bond strength of fast-setting mineral trioxide aggregate and pozzolan-based cements: Endocem MTA and Endocem Zr. J Endod. 2017 May;43(5):801-4.
6. Sharma V, Nawal RR, Augustine J, Urs AB, Talwar S. Evaluation of Endosequence Root Repair Material and Endocem MTA as direct pulp capping agents: An in vivo study. Aust Endod J. 2022 Aug;48(2):251-7.
7. Camilleri J. Tricalcium silicate-based cements: properties and modifications. Braz oral res(Online). 2018:e70.
8. Choi Y, Park SJ, Lee SH, Hwang YC, Yu MK, Min KS. Biological effects and washout resistance of a newly developed fast-setting pozzolan cement. J Endod. 2013 Apr;39(4):467-72.
9. Asgary S, Shahabi S, Jafarzadeh T, Amini S, Kheirieh S. The properties of a new endodontic material. J Endod. 2008 Aug;34(8):990-3.
10. Mozayeni MA, Milani AS, Marvasti LA, Asgary S. Cytotoxicity of calcium enriched mixture cement compared with mineral trioxide aggregate and intermediate restorative material. Aust Endod J. 2012 Aug;38(2):70-5.
11. Farhang R, Hekmatfar S, Samadi V, Meraji A, Jafari K. Comparison of tooth discoloration induced by calcium enriched mixture, mineral trioxide aggregate, and Endocem. World J Dent. 2020 Sep;11(5):392-5.
12. Ioannidis K, Mistakidis I, Beltes P, Karagiannis V. Spectrophotometric analysis of coronal discolouration induced by grey and white MTA. Int Endod J. 2013 Feb;46(2):137-44.
13. Khim TP, Sanggar V, Shan TW, Peng KC, Western JS, Dicksit DD. Prevention of coronal discoloration induced by root canal sealer remnants using Dentin Bonding agent: an in vitro study. J Conservative Dent. 2018 Sep;21(5):562-8.
14. Tripathi R, Cohen S, Khanduri N. Coronal tooth discoloration after the use of white mineral trioxide aggregate. Clin Cosmet Investig Dent. 2020 Sep;12:409-14.
15. Mondelli RFL, Francisconi AC, Almeida CMd, Ishikiriama SK. Comparative clinical study of the effectiveness of different dental bleaching methods-two year follow-up. J Appl Oral Sci. 2012;20(4):435-43.
16. Faus-Matoses V, Palau-Martínez I, Amengual-Lorenzo J, Faus-Matoses I, Faus-Llácer VJ. Bleaching in vital teeth: Combined treatment vs in-office treatment. J Clin Exp Dent. 2019;11(8):e754.
17. Demir N, Karci M, Ozcan M. Effects of 16% carbamide peroxide bleaching on the surface properties of glazed glassy matrix ceramics. Biomed Res. Int. 2020;2020(1):1864298.
18. Settembrini L, Gultz J, Kaim J, Scherer W. A technique for bleaching nonvital teeth: inside/outside bleaching. J Am Dent Assoc. 1997 Sep;128(9):1283-4.
19. Akbulut MB, Terlemez A, Akman M, Buyukerkmen B, Guneser MB, Eldeniz AU. Tooth discoloration effects of calcium silicate based barrier materials used in revascularization and treatment with internal bleaching. J. Dent. Sci. 2017 Dec;12(4):347-53.
20. Machado AC, Braga SR, Ferreira D, Jacintho FF, Scaramucci T, Sobral MA. Bleaching of severely darkened nonvital tooth case report—48 months clinical control. J Esthet. Restor. Dent. 2021 Mar;33(2):314-22.
21. Gurel MA, Kivanc BH, Ekici A, Alacam T. Evaluation of crown discoloration induced by endodontic sealers and colour change ratio determination after bleaching. Aust Endod J. 2016 Dec;42(3):119-23.
22. Rao YM, Srilakshmi V, Vinayagam KK, Narayanan LL. An evaluation of the color stability of tooth-colored restorative materials after bleaching using CIELAB color technique. Indian J. Dent. Res. 2009 Jan;20(1):60.
23. Huang M, Ye H, Chen H, Zhou Y, Liu Y, Wang Y, et al. Evaluation of accuracy and characteristics of tooth-color matching by intraoral scanners based on Munsell color system: an in vivo study. Odontology. 2022 Oct;110(4):759-68.
24. Lenherr P, Allgayer N, Weiger R, Filippi A, Attin T, Krastl G. Tooth discoloration induced by endodontic materials: a laboratory study. Int. Endod. J. 2012 Oct;45(10):942-9.
25. Dozić A, Kleverlaan CJ, El‐Zohairy A, Feilzer AJ, Khashayar G. Performance of five commercially available tooth color‐measuring devices. J. Prosthodont. 2007 Mar;16(2):93-100.
26. Partovi M, Al‐Havvaz AH, Soleimani B. In vitro computer analysis of crown discolouration from commonly used endodontic sealers. Aust Endod J 2006 Dec;32(3):116-9.
27. Esmaeili B, Alaghehmand H, Kordafshari T, Daryakenari G, Ehsani M, Bijani A. Coronal discoloration induced by calcium-enriched mixture, mineral trioxide aggregate and calcium hydroxide: a spectrophotometric analysis. Iran. Endod. J. 2015 Dec;11(1):23.
28. Parirokh M, Torabinejad M. Mineral trioxide aggregate: a comprehensive literature review—part III: clinical applications, drawbacks, and mechanism of action. J. Endod. 2010 Mar;36(3):400-13.
29. Salem-Milani A, Ghasemi S, Rahimi S, Ardalan-Abdollahi A, Asghari-Jafarabadi M. The discoloration effect of white mineral trioxide aggregate (WMTA), calcium enriched mixture (CEM), and portland cement (PC) on human teeth. J Clin Exp Dent. 2017 Dec;9(12):e1397.
30. Asgary S, Parirokh M, Eghbal MJ, Brink F. A comparative study of white mineral trioxide aggregate and white Portland cements using X‐ray microanalysis. Aust Endod J. 2004 Dec;30(3):89-92.
31. Kim RJ, Kim MO, Lee KS, Lee DY, Shin JH. An in vitro evaluation of the antibacterial properties of three mineral trioxide aggregate (MTA) against five oral bacteria. Arch. Oral Bio. 2015 Oct;60(10):1497-502.
32. Jamali Zavare F, Nojehdehian H, Moezizadeh M, Daneshpooy M. Chemical modification of MTA and CEM cement to decrease setting time and improve bioactivity properties by adding alkaline salts. J Dent Res Dent Clin Dent Prospects. 2020 Winter;14(1):1-11.
33. Arman M, Khalilak Z, Rajabi M, Esnaashari E, Saati K. In vitro spectrophotometry of tooth discoloration induced by tooth-colored mineral trioxide aggregate and calcium-enriched mixture cement. Iran. Endod. J. 2015;10(4):226.
34. Carrillo A, Trevino MVA, Haywood VB. Simultaneous bleaching of vital teeth and an open-chamber nonvital tooth with 10% carbamide peroxide. Quintessence Int. 1998 Oct;29(10).
35. Zimmerli B, Jeger F, Lussi A. Bleaching of nonvital teeth. Schweiz Monatsschr Zahnmed. 2010 Jan;120(4):306-13.
36. Shi Z, Chow CW, Fabris R, Liu J, Jin B. Applications of online UV-Vis spectrophotometer for drinking water quality monitoring and process control: a review. Sensors. 2022 Apr;22(8):2987.
37. Pedrollo Lise D, Siedschlag G, Bernardon JK, Baratieri LN. Randomized clinical trial of 2 nonvital tooth bleaching techniques: A 1-year follow-up. J Prosthet Dent. 2018 Jan;119(1):53-59.
38. Saati K, Sheikhi S, Esnaashari E, Valizadeh S. The effects of three bleaching agents on tooth discoloration caused by mineral trioxide aggregate. Iran. Endod. J. 2019;14(4):253-8.
39. Giachetti L, Bertini F, Bambi C, Nieri M, Russo DS. A randomized clinical trial comparing at-home and in-office tooth whitening techniques: a nine-month follow-up. J Am Dent Assoc. 2010 Nov;141(11):1357-64.
40. Mittal R, Sood AG, Singla MG, Dhawan D. A comparative evaluation of efficacy of commercially available bleaching agents in non-vital teeth: An in vitro study. Saudi Endod. J. 2015 Jan;5(1):33.
| Issue | Vol 23 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Dental Cements Tooth Bleaching Tooth Discoloration | ||
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How to Cite
1.
Hekmatfar S, Samadi V, meraji A, Jafari K. The Effect of Two Bleaching Techniques On Teeth Discolored with Different calcium silicate-based cements. Front Dent. 2026;23.
