There is some evidence of tooth discoloration after regenerative endodontic procedures. The aim of this review is to determine which materials used in regenerative procedures induce tooth discoloration. The authors searched six digital databases in February 2018: PubMed, Google Scholar, the Cochrane Library, Scopus, Web of Science, and Lilacs. As a result, 353 studies were found. Eleven studies that met the established criteria were selected. Analysis of the selected studies showed that most materials used in regenerative endodontic procedures have the potential to stain tooth tissues. To decrease tooth discoloration, sealing dentin with a dentinbonding agent before the placement of a disinfectant paste and barrier materials should be considered. Only a small number of in vitro studies have been performed; therefore, further studies on this topic are warranted.
The aim of this review is to evaluate of effectiveness of bleaching procedures used to treat discolored teeth subsequent to regenerative endodontic procedures (REPs) based on the review of in vitro and in vivo studies. This literature review was carried out according to the PRISMA guidelines. Four databases (PubMed, Scopus, the Cochrane Library, and Web of Science databases) were searched electronically, until 30 January 2020 without a year limit. The quality of studies was assessed using a modified methodological index for non-randomized studies. After analyzing 1405 studies, 6 in vitro and 9 in vivo studies were eligible for this review. In in vitro studies, effectiveness of bleaching was assessed in teeth discolored by antibiotic pastes, blood, and barrier materials in various combinations. In all analyzed studies, bleaching was effective in teeth discolored by antibiotic pastes as well as by blood and barrier materials. Of 26 treated teeth in the in vivo studies, 17 teeth were bleached successfully. In six cases, there was improvement of the shade. In three cases, bleaching was not sufficient. Bleaching material, techniques, and times differed between studies. Whitening of discolored teeth after REPs is achievable. However, to establish precise guidelines, further long-term clinical studies should be performed.
The aim of the present in vitro study was to investigate the effects of 10% and 40% citric acid (CA) on the color of calcium silicate–based cements (CSCs) in comparison to the effects of common root canal irrigants. Samples of six CSCs (n = 6)—ProRootMTA (Dentsply, Tulsa, OK, USA, Biodentine (Septodont, Saint Maur des Fosses, France), MTA Plus (Avalon Biomed Inc, by Prevest Denpro Limited, Jammu, India), MTA Repair HP (Angelus, Londrina, PR, Brazil), Ortho MTA (BioMTA, Seoul, Korea), and Retro MTA (BioMTA, Seoul, Korea)—were immersed in 10% and 40% CA as well as 15% EDTA, 2% NaOCl, 2% CHX, and 0.9% NaCl for 15 min, 1 h, and 24 h. ΔE values, representing the difference between the final and baseline values of the color components, were then determined using a VITA Easyshade Compact 5.0 spectrophotometer. Naked-eye evaluation of the changes in color and structures of the materials was performed using our own scale. Upon immersion of the materials in both 10% and 40% CA, there were statistically significant differences between spectrophotometric color measurement results for all CSCs (P < 0.05). However, CA does not cause dark discoloration, observable with the naked eye, of any of the materials, such as NaOCL and CHX. Significant statistical differences were also found between all CSCs in terms of submersion duration (P < 0.05). CA, which could be an alternative to EDTA use, caused greater CSCs discoloration and changed some of their structures. Unless required by the therapeutic procedure, clinicians should pay attention to the fact that the irrigant may affect the CSCs discoloration and minimize the contact time of irrigant with CSCs.
Calcium silicate-based cements are biocompatible materials for vital pulp therapy. However, they discolour the tooth tissue, which is important for the aesthetics of the anterior teeth. The aim of this study was to investigate the effect of calcium silicate-based cements on tooth discolouration. The study included 70 extracted bovine incisors. The crown of the tooth was cut off from the root, 2 mm below the cement–enamel junction. The pulp tissue was removed via a cervical cut with a barbed broach. The teeth were randomly divided into five experimental, one positive, and one negative control groups. The evaluated materials included Biodentine, Ortho MTA, Retro MTA, MTA Plus, MTA Repair HP, and in the positive group, ProRoot MTA. A VITA Easyshade Compact 5.0 spectrophotometer was used before the application, after 1 week, 1 month, 3 months, and 6 months. The significance levels were set at p < 0.05. All materials significantly changed the teeth colour (p < 0.05). However, Ortho MTA, ProRoot MTA, MTA Plus, and Biodentine (ΔE > 6) caused maximum colour change after 6 months. While the ProRoot MTA, Ortho MTA, and MTA Plus caused grey discolouration, Biodentine darkened the shade of the base colour. Thus, Retro MTA and MTA Repair HP can be safely used in the aesthetic dentition zone. According to these clinical results, the possibility of using Biodentine, due to its lack of gray discoloration, can be considered.
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