Restor Dent Endod.  2023 May;48(2):e12. 10.5395/rde.2023.48.e12.

Effect of medium or high concentrations of in-office dental bleaching gel on the human pulp response in the mandibular incisors

• Roderjan DA
• Stanislawczuk R
• Soares DG
• Souza Costa CAd
• Favoreto MW
• Reis A
• Loguercio AD

• KMID: 2548215
• DOI: http://doi.org/10.5395/rde.2023.48.e12

Abstract

Objectives
The present study evaluated the pulp response of human mandibular incisors subjected to in-office dental bleaching using gels with medium or high concentrations of hydrogen peroxide (HP).
Materials and Methods
The following groups were compared: 35% HP (HP35; n = 5) or 20% HP (HP20; n = 4). In the control group (CONT; n = 2), no dental bleaching was performed. The color change (CC) was registered at baseline and after 2 days using the Vita Classical shade guide. Tooth sensitivity (TS) was also recorded for 2 days post-bleaching. The teeth were extracted 2 days after the clinical procedure and subjected to histological analysis. The CC and overall scores for histological evaluation were evaluated by the Kruskal-Wallis and Mann-Whitney tests. The percentage of patients with TS was evaluated by the Fisher exact test (α = 0.05).
Results
The CC and TS of the HP35 group were significantly higher than those of the CONT group (p < 0.05) and the HP20 group showed an intermediate response, without significant differences from either the HP35 or CONT group (p > 0.05). In both experimental groups, the coronal pulp tissue exhibited partial necrosis associated with tertiary dentin deposition. Overall, the subjacent pulp tissue exhibited a mild inflammatory response.
Conclusions
In-office bleaching therapies using bleaching gels with 20% or 35% HP caused similar pulp damage to the mandibular incisors, characterized by partial necrosis, tertiary dentin deposition, and mild inflammation.

Keyword

Hydrogen peroxide; In-office bleaching; Odontoblasts

Figure

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  Figure 1 (Control group) Dentin-pulp complex of a sound mandibular tooth. (A) A general view of coronal pulp tissue that exhibits normal histological features. (B) (High magnification of Figure 1A) The pulp tissue exhibits all defined histological zones. A continuous odontoblast layer (white finger point) is underlying the pre-dentin layer (asterisk). The non-inflamed subjacent pulp tissue shows pulp cells dispersed among a number of small blood vessels (black finger point) (hematoxylin and eosin., ×32 and ×125).

• 

  Figure 2 Dentin-pulp complex of mandibular incisors subjected to in-office bleaching treatment (“A-D” = HP35 and “e-h” = HP20). (A) The coronal pulp tissue exhibits a wide area of necrosis (white finger point) associated with notable deposition of tertiary dentin (arrows) (H/E [hematoxylin and eosin], ×40). (B) High magnification of Figure 2A. Note the transition border (black finger point) between the tubular dentin (De) and the necrotic pulp tissue (Ne) (×84). (C) The coronal and root pulp tissue exhibit continuous deposition of reactionary dentin (RD) (H/E, ×125). (D) Detail of the pulp area demonstrated in Figure 2C. The residual pulp tissue shows only a few inflammatory mononuclear cells among dilated and congested blood vessels (white finger point) (H/E, ×250). (E) RD (white finger point) adjacent to the partial coronal pulp necrosis. Note the residual pulp (Pu) tissue (H/E, ×40). (F) High magnification of the tip of pulp horn with necrotic tissue (Ne). Note the transition zone (black finger point) between the tubular dentin (De) and the necrotic tissue (H/E, ×84). (G) Detail of Figure 2E. Subjacent to the tubular dentin (De), a wide layer of RD is observed. Note the residual coronal pulp tissue (Pu) (H/E, ×125. (H) Detail of Figure 2G. Only a few mononuclear inflammatory cells among blood vessels can be seen (H/E, ×250).

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