Inflammatory markers IL‐1β and RANK‐L assessment after non‐vital bleaching: A 3‐month follow‐up

Abstract

Objective: This study assessed IL-1β and RANK-L levels in vivo and color stability of non-vital teeth bleached using hydrogen (35%) and carbamide (37%) peroxides 3 months after treatment. Materials and Methods: Fifty teeth were randomly divided into two groups (n = 25):35% hydrogen peroxide (HP) or 37% carbamide peroxide (CP). Four sessions of intracoronal walking-bleach procedure were performed. IL-1β and RANK-L levels were assessed from gingival crevicular fluid samples (from three vestibular and three palatines sites) at eight different time-points: at the beginning of the study (baseline), after four sessions of intracanal bleaching, and at 1 week, 1 month, and 3 months posttreatment. The color variations were visually detected using Vita bleach shade guide (ΔSGU). Results: Significant increases of IL-1β and RANK-L levels were detected at all timepoints (all P < .05) when comparing each time-point to baseline, and a high correlation (>0.8-Spearman) between variables. According the ΔSGU values, a color change of five for HP and four for CP were detected. Conclusions: Non-vital walking bleach technique promotes an increase in IL-1β and RANKL levels in periodontal tissues and also, it is maintained until the third-month posttreatment. Clinical Significance: The internal whitening of teeth increases the levels of cytokines associated with inflammation and bone resorption 3 months after the whitening procedure is finished; this should warn of possible harmful effects of this whitening technique. K E Y W O R D S biomarkers, double-blind study, hydrogen peroxide, RANK-L, tooth bleaching

Bleaching of severely darkened nonvital tooth case report—48 months clinical control

“…C, Bleaching agent in the pulp chamber F I G U R E 6 Sealing and maintenance of the bleaching agent internally the pulp chamber made with temporary material, inserted with the help of the centrix syringe was clinically found after internal bleaching or after 4-year postbleaching. We can speculate that the level of inflammatory markers could have increased, as in the study mentioned above, 17 however, perhaps our results demonstrate that this increase is not enough to promote cervical resorption. Nerveless, the presence of inflammatory markers were not evaluated in the present, study not allowing us to properly discuss this kind of influence.…”

“…Suggesting that individuals that had periodontal disease could be more susceptible to cervical resorption, mentioning that these bleaching treatments may not be recommended among them, because of their deficiency of inflammatory biomarkers balance. 17 In the present clinical case despite the initial periodontal condition presented by the patient, which was controlled before start the bleaching treatment no cervical resorption F I G U R E 5 A, Insertion of the bleaching agent into the pulp chamber. B, Accommodation of the whitening agent with a cotton ball.…”

“…They found an increase level of this markers when walking bleach technique with hydrogen peroxide (35%) or carbamide peroxide (37%) was done with persistence of 3 months post bleaching. 17 Although, this study does not respond to the clinical fact that root resorption could be produced by internal bleaching, it warns of possible harmful effects of this technique. Suggesting that individuals that had periodontal disease could be more susceptible to cervical resorption, mentioning that these bleaching treatments may not be recommended among them, because of their deficiency of inflammatory biomarkers balance.…”

“…39 Another fact that might have contributed to the nonappearance of cervical resorption is the favorable teeth anatomy according to Bersezio et al the anatomic variability must be considered, once anatomical defects could contribute to a superior dissemination of bleaching outside the root, what could conduct to a chronic inflammatory process resulting in cervical resorption. 17 The literature reports of color regression after long time followup in nonvital teeth are relatively high. Some studies observed after 2 years, color recurrence of 10%, after 5 years 25% and after 8 years 49%.…”

“…6,15,16 In addition, external cervical root resorption, which according to Bersezio et al is a quite rare side effect with a deficit in randomized clinical trials of patient follow-up, 17 however, this condition is consider as a potential negative effect that can cause significant biological risk thru periodontal changes, compromising the dental element. [17][18][19][20][21][22] Nevertheless, when the correct diagnosis of the color alteration is made, and the appropriate treatment protocol is defined, the clinician should consider dental bleaching as one of the first treatment alternatives, since it is more conservative than restorative or prosthetic procedures. 18 Among the existing techniques for bleaching nonvitalized teeth, the walking bleach is an option and it consists of the association of bleaching agents-sodium perborate (powder) and 20% hydrogen peroxide (liquid)-that are inserted into the pulp chamber and held for a few days.…”