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Pulpal Temperature Rise During Light-Activated Bleaching

Ayçe Unverdi Eldeniz,1 Aslihan Usumez,2 Serdar Usumez,3 Nilgun Ozturk 2

1
Department of Endodontics, School of Dentistry, Selcuk University, Konya, Turkey

2
Department of Prosthodontics, School of Dentistry, Selcuk University, Konya, Turkey

3
Department of Orthodontics, School of Dentistry, Marmara University, Istanbul, Turkey

Received 5 February 2004; revised 29 June 2004; accepted 2 July 2004


Published online 20 October 2004 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jbm.b.30144

Abstract: The purpose of this study was to measure intrapulpal temperature rise induced by
two kinds of bleaching gels when the tooth was exposed to a variety of light-curing units and
a diode laser in vitro. The root portions of 80 extracted intact human maxillary central incisors
were sectioned with a carborundum disk approximately 2 mm below the cementoenamel
junction perpendicular to the long axis of the teeth. Two bleaching agents containing heat-
enhancing colorant was applied to the labial surface. Light-curing units used were a conven-
tional halogen (40 s), a high-intensity halogen (30 s), a light-emitting diode unit (40 s), and a
diode laser (15 s). The temperature rise was measured in the pulpal chamber with a J-type
thermocouple wire that was connected to a data logger. Ten specimens were used for each
system and bleaching-agent combination. Differences between the starting temperature and
highest temperature reading were taken and the calculated temperature changes were aver-
aged to determine the mean value in temperature rise. Temperature rise values were com-
pared using two-way analysis of variance (ANOVA) at a preset ␣ of 0.05. Temperature rise
varied significantly depending on curing unit and diode laser used. The diode laser induced
significantly higher temperature increases than any other curing unit (11.7°C). The light-
emitting diode unit produced the lowest temperature changes (6.0°C); however, there were no
statistically significant differences among the curing units and there were no statistically
significant differences between bleaching agents. Light activation of bleaching materials with
diode laser caused higher temperature changes as compared to other curing units and the
temperature rise detected was viewed as critical for pulpal health. © 2004 Wiley Periodicals, Inc.
J Biomed Mater Res Part B: Appl Biomater 72B: 254 –259, 2005

Keywords: light-activated bleaching; temperature; dentin

INTRODUCTION sodium perborate, and carbamide peroxide are generally used


for bleaching.3,4 These materials are found effective for
Aesthetics, by definition, is the science of beauty, the partic- bleaching teeth, but side effects are changes in tooth struc-
ular detail of an animate or inanimate object that makes it ture,5,6 microleakage of restorations,2 external root resorp-
appealing to the eye.1 Tooth discoloration is becoming a tion, and pulpal irritation.7,8 The thermocatalytic, walking
greater concern as more emphasis is placed on esthetics. With bleach and mouthguard are the most popular bleaching meth-
the growing awareness of esthetic options, there is greater ods.9 In the thermocatalytic method, an external heat source
demand for solutions to such unsightly problems as food is applied to activate the bleaching agent.3 The energy of the
staining, fluorosis, and tetracycline staining. Bleaching sys- heat source is absorbed into all intermolecular and intramo-
tems have been received by the public as a more conservative lecular bonds and reaches maximum vibrations.10 The hydro-
and economical method of improving the appearance of the gen peroxide molecule falls apart into different, extremely
dentition.2 Bleaching is one of the corrective measures used reactive ionic fragments that swiftly combine with chro-
to treat discolored teeth. It can be performed internally on mophilic structure of the organic molecules, altering them
nonvital teeth or externally on vital teeth. Hydrogen peroxide, and producing simpler chemical chains.10 Cohen11 reported
on the histological effects of hydrogen peroxide and heat for
vital bleaching and concluded that vital bleaching utilizing
Correspondence to: A. Usumez, Selcuk Universitesi, Dishekimligi Fakultesi, Pro-
tetik Dis Tedavisi Anabilim Dalı, Kampus, Konya, Turkey (e-mail: this method is harmless to pulpal tissue.
asli_u@hotmail.com) Bleaching systems have offered easy-to-use bleaching
© 2004 Wiley Periodicals, Inc. agents, essentially using highly concentrated hydrogen per-
254
TEMPERATURE RISE DURING LIGHT-ACTIVATED BLEACHING 255

TABLE I. Visible Light Curing Units Studied

Applied
Activation
Brand Launch Year Type of Unit Time (s) Manufacturer
Laser Smile 2001 Diode laser 15 Biolase, San Clemente, CA, USA
Optilux 501 2001 High-intensity halogen 30 Kerr, Danbury, CT, USA
Hilux 1996 Conventional halogen 40 First Medica, NC, USA
Elipar Freelight II 2003 LED 40 3M Espe, St. Paul, MN, USA

oxide mixed with thickening agents or additional buffering Elipar FreeLight (3M Espe, St. Paul, MN, USA); and a diode
agents, catalysts, or heat-enhancing colorants.12 The energy laser (Lasersmile, Biolase, San Clemente, CA, USA). Man-
source can be derived from halogen curing units, high-inten- ufacturers’ names and addresses, applied time and other per-
sity curing units, and diode lasers.12 Laser devices have been tinent information are listed in Table I.
used in dentistry for soft tissue surgery, root end sealing and
sterilization, and for altering enamel and dentin surfaces to
Preparation of Teeth
increase resistance to decay or to facilitate the bonding of
composites and bleaching.13,14 Eighty maxillary central incisor teeth, extracted for periodon-
Conventional halogen usually operates at light intensities tal reasons, were selected. Each tooth was free of dental
between 400 and 800 mW/cm2. Halogen bulbs produce light caries or restoration. The teeth were cleaned and stored in
when electric energy heats a small tungsten filament to high deionized water at room temperature immediately after ex-
temperatures. Despite their common use in dentistry, halogen traction.
bulbs have several disadvantages. The basic principle of light The root portions of the teeth were sectioned with a
conversion by this technique is claimed to be inefficient as the slow-speed diamond saw (Isomet, Buehler Ltd., Lake Bluff,
light power output is less than 1% of the consumed electrical IL) approximately 2 mm below the cementoenamel junction
power and as they have a limited effective lifetime of ap- perpendicular to the long axis of the teeth, and stored in
proximately 100 h due to degradation of bulb components by deionized water until used. An opening was made into the
the high heat generated.15 pulpal chamber from the radicular portions of the teeth so that
A solid-state light-emitting diode (LED) technology was a thermocouple wire could be inserted. The pulpal chamber
proposed in 1995 for the polymerization of light-cured dental was cleaned of remnant pulpal tissues. The root stub was then
materials to overcome the shortcomings of halogen visible secured to an acrylic plastic base with an autopolymerizing
light-curing units.16 LEDs use junctions of doped semicon- resin. A hole was drilled through the acrylic plastic base to
ductors to generate light, instead of the hot filaments used in provide entrance for thermocouple wire into the pulpal cham-
halogen bulbs.17 LEDs have a lifetime of over 10,000 h and ber.
undergo little degradation of output over this time. LEDs The labial surfaces of the teeth were thoroughly pumiced
require no filters to produce blue light, are resistant to shock for 2 min, rinsed for 2 min in distilled water, and dried with
and vibration, and take little power to operate.18 LEDs’ clean, dry, compressed air. Each experimental group was
longer life span and more consistent light output compared treated with one of the following 35% hydrogen-peroxide–
with halogen bulb technology show promise for dental appli- containing bleaching materials: Opalescence XTRA (Ultra-
cations.19 Light curing with high-energy output causes sig- dent, South Jordan, UT, USA) or Quasar Brite (Spectrum
nificantly higher pulp chamber temperature changes as com- Dental, Culver City, CA, USA). Quasar Brite was mixed
pared to conventional halogen curing light.20 The purpose of according to the manufacturer’s instructions and both of the
this in vitro study was to measure the temperature rise in- bleaching agents were applied with a brush to the tooth
duced by selected curing units: conventional halogen (40 s), surface, in a layer approximately 1-mm thick.
high-intensity halogen (30 s), LED unit (40 s), and diode laser Light application time for conventional halogen light
(15 s) during activation of two different bleaching agents. (light intensity, 450 mW/cm2) and LED (light intensity, 380
The hypothesis tested assumed that there is no difference in mW/cm2) unit was 40 s. Laser irradiation was 15 s (under
temperature rise in pulpal chamber when bleaching material bleaching mode, 10 W, continuous wave) and high-intensity
was activated with these three curing units and the diode halogen (light intensity, 850 mW/cm2) application time was
laser. 30 s (under bleaching mode).

Temperature Measurement
MATERIALS AND METHODS
The temperature rise was measured in the pulp. The distance
The three curing units evaluated were Hilux 550 (First Med- between the emitting tip of the light source and the tooth
ica, NC, USA); Optilux 501 (Kerr, Danbury, CT, USA); surface was set at 10 mm. A silicone heat-transfer compound
256 ELDENIZ ET AL.

tion of bleaching material and curing unit or diode laser and


difference between start and highest temperature reading was
taken. Then 10 calculated temperature changes were aver-
aged to determine the mean value in temperature rise.
The results of testing were entered into an Excel (Mi-
crosoft威, Seattle, WA, USA) spreadsheet for calculation of
descriptive statistics. Statistical analysis was performed using
two-way analysis of variance (ANOVA) and then Tukey
HSD tests (SPSS/PC, Vers.10.0, SPSS, Chicago, IL, USA)
for comparisons among groups at the 0.05 level of signifi-
cance.

RESULTS
Figure 1. Schematic drawing of experimental set up showing the
temperature measurement during activation of bleaching material. Temperature rise values of the bleaching agents with the three
light units and diode laser tested are given in Figures 2 and 3
and Table II.
(ILC P/N 213414, Wakefield Engineering, MA, USA) was Temperature rise values with the same light source was
applied in the pulp chamber. This compound facilitated the pooled as no statistically significant effect of bleaching agent
transfer of heat from the wall of the dentin to the thermocou- on temperature rise values was detected with ANOVA (p ⫽
ple wire. A J-type thermocouple wire with 0.36-inch diameter 0.647). Pooled temperature rise values with three light units
(Omega Engineering, Stamford, CT, USA) was connected to and diode laser are given in Table III.
data logger (XR440-M Pocket Logger, Pace Scientific, NC, Temperature rise varied significantly depending on the
USA) during application of curing units and diode laser curing unit (conventional halogen, high-intensity halogen,
(Figure 1). LED) and diode laser used (ANOVA, p ⬍ 0.001; Table IV).
The sampling rate of the data logger was set to one sample The diode laser (11.7°C ⫾ 2.1°C) induced a significantly
every 2 s for a recording period starting with light curing for higher temperature increase than any other curing unit
approximately 60 –90 s until the temperature started to de- (Tukey, p ⬍ 0.001). The LED unit produced the lowest
crease. The collected data which was available in both tabular temperature increase (6.04°C ⫾ 1.0°C), however there were
and graphic form was monitored in real time and transferred no statistically significant differences among the curing units
to a computer. Measurements were made for each combina- tested (Tukey, p ⬍ 0.05).

Figure 2. Temperature versus time graphs of diode laser, high-intensity halogen, conventional halo-
gen, and LED during activation of Opalescence-Xtra.
TEMPERATURE RISE DURING LIGHT-ACTIVATED BLEACHING 257

Figure 3. Temperature versus time graphs of diode laser, high-intensity halogen, conventional halo-
gen, and LED during activation of Quasar-Brite.

DISCUSSION Light-activated, heat-enhancing colorant may increase in-


trapulpal temperature values.23 Two different bleaching
This in vitro study measured the temperature changes caused agents that contain 35% hydrogen peroxide with different
by the heat generated by three commercially available curing colorants [Quasar Brite (pink) and Opalescence Xtra (dark
units and a diode laser. Under the conditions of the present red)] were selected for the current study. Temperature rise in
study, the highest temperature rise was recorded using the the latter was higher but there were no statistically significant
diode laser for 10 s. The temperature rise during activation of differences between groups.
bleaching material was lower with the LED unit than the When using high-energy lasers in biological vital tis-
conventional halogen, high-intensity halogen, and the diode sues, the adverse effects must be considered. Histological
laser. This result is in accordance with the previous stud- reactions after laser treatment were investigated. Adrian24
ies21,22 which concluded that LED unit produces the least found a localized pulpal response in the region that,
thermal insult during polymerization process. through dentinal tubules, had indirect contact with the
Aqueous hydrogen peroxide has been used clinically at irradiation spot of an Nd:YAG laser in dentin. The rest of
30% to 35% levels to lighten teeth for many years, but the the pulp was unaffected.24 This finding was confirmed by
process has required multiple visits. Heat and light have Stelzel and colleagues,25 who found pulpal response when
been used empirically in attempts to catalyze hydrogen irradiating deep dentin layers. The current study focused
peroxide decomposition and speed tooth lightening.12 The on the intrapulpal temperature changes and no information
current study was planned to determine comparative ther- is given about histological evaluation.
mal risk to the pulp induced by these three light units and Pulpal changes caused by bleaching agents have been
diode laser. investigated by several authors. Seale and colleagues8

TABLE III. Pooled Intrapulpal Temperature Rise Values with


TABLE II. Intrapulpal Temperature Rise Values (⌬T, °C) with Light Sources
Various Light Sources
Mean ⫾ SD Tukey Grouping*
Light Source Quasar Brite Opalescence Xtra
Diode laser 11.75 ⫾ 2.07 A
Diode laser 11.5 ⫾ 2.2 12.0 ⫾ 2.0 High-intensity halogen 7.84 ⫾ 1.93 B
High-intensity halogen 7.2 ⫾ 1.9 8.5 ⫾ 1.6 Conventional halogen 6.35 ⫾ 1.80 B
Conventional halogen 6.3 ⫾ 1.4 6.4 ⫾ 2.2 LED 6.04 ⫾ 1.03 B
LED 5.9 ⫾ 1.0 6.0 ⫾ 1.0
Mean ⫾ standard deviation.
[Mean ⫾ standard deviation (n ⫽ 10)]. *Groups with different letters are statistically significantly different.
258 ELDENIZ ET AL.

TABLE IV. Two-Way Analyses of Variance intensity halogen, conventional halogen, and LED curing
Mode DF MS F P units. The maximal temperature increases determined were
viewed as critical for the pulpal health for any of the three
Bleaching material 1 6.14 1.95 .16 types of curing units and diode laser tested.
Light source 3 133.08 42.29 .00
Bleaching material† 3 1.72 .55 .65 The authors would like to thank Ultradent for supplying “Opal-
Light source escence” and Mr. Enver Atali for supplying Lasersmile unit.

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