Bleaching gels with 10% HO applied in small teeth for short periods may be an interesting alternative to obtain whitening effectiveness without causing toxicity to pulp cells, which may be able to reduce the tooth hypersensitivity claimed by patients.

Although the chemical activation of H2O2 by adding FeSO4 to the bleaching agent improved the bleaching effectiveness, this metal ion has no significant protective effect against pulp cell cytotoxicity.

SUMMARY Objectives: The aim of this study was to evaluate the effect of horseradish peroxidase (HRP) on the release of free radicals, bleaching effectiveness, and indirect cytotoxicity of a 35% hydrogen peroxide (HP) bleaching gel. Methods and Materials: First, HP degradation rates and free radical release were evaluated for 35% HP in contact or not with HRP (10 mg/mL). The bleaching gel associated or not with HRP was then applied (3 × 15 minutes) to enamel/dentin discs adapted to artificial pulp chambers, and the culture medium in contact with dentin surfaces (extract) was collected and exposed to cultured odontoblast-like cells. Membrane damage and viability of cells as well as oxidative stress were evaluated. Residual HP/free radical diffusion was quantified, and bleaching effectiveness (ΔE) was assessed. Unbleached discs served as negative controls. Results: The addition of HRP to the 35% HP bleaching gel enhanced the release of free radicals in comparison with plain HP gel. The 35% HP-mediated cytotoxicity significantly decreased with HRP in the bleaching gel and was associated with reduced HP/free radical diffusion through the enamel/dentin discs. ΔE values increased every bleaching session for HRP-containing gel relative to positive control, accelerating the whitening outcome. Conclusion: The enzymatic activation of a 35% HP bleaching gel with HRP accelerated HP degradation mediated by intensification of free radical release. This effect optimized whitening outcome as well as minimized residual HP and free radical diffusion through enamel and dentin, decreasing the harmful effects on odontoblast-like cells.

Objective: This study was designed for the chemical activation of a 35% hydrogen peroxide (H 2 O 2) bleaching gel to increase its whitening effectiveness and reduce its toxicity. Methodology: First, the bleaching gel-associated or not with ferrous sulfate (FS), manganese chloride (MC), peroxidase (PR), or catalase (CT)-was applied (3x 15 min) to enamel/dentin discs adapted to artificial pulp chambers. Then, odontoblast-like MDPC-23 cells were exposed for 1 h to the extracts (culture medium + components released from the product), for the assessment of viability (MTT assay) and oxidative stress (H 2 DCFDA). Residual H2O2 and bleaching effectiveness (DE) were also evaluated. Data were analyzed with one-way ANOVA complemented with Tukey's test (n=8. p<0.05). Results: All chemically activated groups minimized MDPC-23 oxidative stress generation; however, significantly higher cell viability was detected for MC, PR, and CT than for plain 35% H2O2 gel. Nevertheless, FS, MC, PR, and CT reduced the amount of residual H2O2 and increased bleaching effectiveness. Conclusion: Chemical activation of 35% H2O2 gel with MC, PR, and CT minimized residual H2O2 and pulp cell toxicity; but PR duplicated the whitening potential of the bleaching gel after a single 45-minute session.

Clinical Relevance Pigments in tooth structures affect the diffusion of H2O2 through enamel and dentin. The bleaching methodology can be impacted.

Evaluate the kinetics of hydrogen peroxide (H 2 O 2 ) degradation, esthetic efficacy and cytotoxicity of a bleaching gel with 35%H 2 O 2 applied on enamel previously covered or not with polymeric nanofibrillar scaffold (SNan), polymeric primer catalyst (PPol), and both. Standardized enamel/dentin discs (n = 128) obtained from bovine teeth were adapted to pulp chambers. After covering enamel with the polymeric products, the bleaching gel was applied for 45 min, establishing the following groups: G1: no treatment (negative control); G2: 35%H 2 O 2 (positive control); G3: SNan; G4: PPol; G5: SNan + PPol; G6: SNan + 35%H 2 O 2 ; G7: PPol + 35%H 2 O 2 ; G8: SNan + PPol + 35%H 2 O 2 . The kinetics of H 2 O 2 degradation (n = 8), bleaching efficacy (ΔE/ΔWI; n = 8), trans-amelodentinal cytotoxicity (n = 8), and cell morphology (n = 4) were assessed (ANOVA/Tukey test; p < 0.05). Greater H 2 O 2 degradation occurred in G7 and G8. Bleaching efficacy (ΔE) was higher in G6, G7, and G8 in comparison with G2 (p < 0.05). However, no difference was observed for ΔWI (p > 0.05). G8 presented the lower level of trans-amelodentinal diffusion of H 2 O 2 , oxidative stress, and toxicity to the MDPC-23 cells (p < 0.05). Polymeric biomaterials increased the kinetics of H 2 O 2 decomposition, as well as maintained the esthetic efficacy and minimized the cytotoxicity caused by a bleaching gel with 35%H 2 O 2 .Clinical Significance: Application of a bleaching gel with 35%H 2 O 2 on enamel previously covered by polymeric biomaterials maintains the esthetic efficacy and reduces the cytotoxicity caused by a single session of in-office dental bleaching.

SUMMARY Objective: This study aimed to evaluate the esthetic efficacy, cytotoxicity, and kinetics of decomposition of hydrogen peroxide (H2O2) present in a commercial bleaching gel with 35% H2O2 (BG35%) chemically activated with manganese oxide (MnO2). Methods and Materials: After incorporating 2 mg/mL, 6 mg/mL, and 10 mg/mL of MnO2 into BG35%, the stability of pH and temperature of the products were analyzed. To assess the esthetic efficacy (ΔE and ΔWI), the BG35%s with MnO2 were applied for 45 minutes on enamel/dentin discs (DiE/D). BG35% or no treatment were used as positive (PC) and negative (NC) controls, respectively. To analyze the cell viability (CV) and oxidative stress (OXS), the same bleaching protocols were performed on DiE/D adapted to artificial pulp chambers. The extracts (culture medium + gel components that diffused through the discs) were applied to pulp cells and submitted to H2O2 quantification. BG35% with MnO2 that showed the best results was evaluated relative to kinetic decomposition of H2O2, with consequent generation of free radicals (FR) and hydroxyl radicals (OH•). The data were submitted to the one-way analysis of variance complemented by Tukey post-test (α=0.05). Data on kinetics of H2O2 decomposition were submitted to the Student’s-t test (α=0.05). Results: All the BG35%s with MnO2 showed stability of pH and temperature, and the gel with 10 mg/mL of this activator had an esthetic efficacy 31% higher than that of the PC (p&lt;0.05). Reduction in OXS and trans-amelodentinal diffusion of H2O2 occurred when all the BG35%s with MnO2 were used. The addition of 6 and 10 mg/mL of MnO2 to BG35% increased the CV in comparison with PC, confirmed by the cell morphology analysis. An increase in FR and OH• formation was observed when 10 mg/mL of MnO2 was added to BG35%. Conclusion: Catalysis of BG35% with MnO2 minimized the trans-amelodentinal diffusion of H2O2 and toxicity of the product to pulp cells. BG35% containing 10 mg/mL of MnO2 potentiated the decomposition of H2O2, enhancing the generation of FR and OH•, as well as the efficacy of the in-office tooth therapy.

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