Crown discoloration promoted by materials used in regenerative endodontic procedures and effect of dental bleaching: spectrophotometric analysis

Abstract

Regenerative endodontic procedure (REP) has been proposed as a new approach to treat immature permanent teeth. However, materials used in REP for root canal disinfection or cervical sealing may induce tooth discoloration. Objectives To assess tooth crown’s color after intracanal treatment with triple antibiotic paste (TAP) or calcium hydroxide (CH); cervical sealing with glass ionomer cement (GIC) or mineral trioxide aggregate (MTA); and bleaching with carbamide peroxide.Material and Methods After pulp removal and color spectrophotometer measurement, 50 bovine incisors were divided into 4 experimental groups and one control (untreated). Experiments were performed in phases (Ph). Ph1: TAP (ciprofloxacin, metronidazole, minocycline), TAPM (ciprofloxacin, metronidazole, amoxicillin), DAP (ciprofloxacin, metronidazole), or CH treatment groups. After 1 and 3 days (d); 1, 2, 3 weeks (w); and 1, 2, 3 and 4 months (m), color was measured and medications were removed. Ph2: GIC or MTA cervical sealing, each using half of the specimens from each group. Color was assessed after 1d, 3d; 1w, 2w, 3w; 1m and 2m. Ph3: Two bleaching sessions, each followed by color measurement. Data were analyzed with ANOVA and post-hoc Holm-Sidak method.Results Ph1: Specimens of TAP group presented higher color alteration (ΔE) mean than those of TAPM group. No significant difference was found among TAP or TAPM and CH, DAP or Control groups. Ph2: cervical sealing materials showed no influence on color alteration. Ph3: Different ΔE means (from different groups), prior to bleaching, became equivalent after one bleaching session.Conclusions TAP induces higher color alteration than TAPM; color alteration increases over time; cervical sealing material has no influence on color alteration; and, dental bleaching was able to recover, at least partially, the tooth crown’s color.

Effectiveness and clinical implications of the use of topical antibiotics in regenerative endodontic procedures: a review

“…Bleaching was able to recover, at least partially, the shade of the crown (Santos et al . ). The ESE position statement on the use of antibiotics in endodontics concludes that taking into account the lack of solid evidence supporting the use of antibiotics in REPs, the use of calcium hydroxide should be preferred over triantibiotic paste (European Society of Endodontology ).…”

Características dos materiais utilizados como barreira cervical na revascularização pulpar: uma revisão integrativa

“…The osteogenic differentiation increased after exposure to Biodentine backs found in revascularization therapy, as shown in Table 2. [10][11][12][13][14][15][16][17][18] Regarding the analysis of discoloration, a total of 8 articles, 4 case reports and 5 in vitro studies were found. Regarding publication years and journals, three case reports, from 2010, 2011 and 2017, were found in the Journal of Endodontics 10,11,17 and one article, from 2016, in the Australian Dental Journal.…”

“…2,3,10,18 Among pulp revascularization stages, this study assessed the use of different materials used as cervical barrier. Of the materials evaluated in this study, articles were found using white and gray MTA, [6][7][8][9][10][11][12][13][14][15][16] Biodentine, 9,14,15,18 EndoSequence, 14,15 TheraCal, 9 and the Calcium-Enriched Mixture (CEM). 4,8,17 The materials used in cervical sealing act as physical barrier, protecting the clot and preventing possible recontamination.…”

“…This integrative review assessed the different materials used as cervical barrier and verified that they have bioactivity and reduced toxicity. [6][7][8][9] As a drawback to its use, coronal discoloration was verified, associated with the use of in vitro MTA and case reports, [10][11][12][13][14][15][16] and Biodentine 14,15,18 and En-dosequence in vitro. [14][15] Articles evaluating the discoloration of other bioceramic materials in vitro and in vivo were not found.…”

Changing the Color of Tooth Enamel in the Process of Orthodontic Treatment

“…Изменение цвета зубной эмали является относи-тельно редким феноменом, тем не менее, оно может стать причиной беспокойства пациента [7,8]. Также не исключены конфликтные ситуации между доктор-ом и пациентом.…”