Effectiveness and SEM–EDX analysis following bleaching with an experimental bleaching gel containing titanium dioxide and/or chitosan

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Abstract
The aim of this study was to evaluate the bleaching effectiveness and mineral alterations following the use of experimental bleaching gels that included 6% hydrogen peroxide (HP), titanium dioxide (TiO2) and/or chitosan in comparison with the routinely used 35% HP bleaching gel. Thirty-six maxillary anterior teeth were divided into three groups according to bleaching agent as follows: Group 1: 6% HP + TiO2, Group 2: 6% HP + TiO2 + chitosan, Group 3: 35% HP. Tooth colour was measured with a spectrophotometer before bleaching and after sessions one and two on days 14 and 30, respectively. Colour changes were assessed with the CIEDE2000 and CIELab formulas. Mineral analysis was performed with a scanning electron microscopy–energy dispersive X-ray (SEM–EDX) device before and 14 days after application. The enamel surfaces of randomly selected samples from each group were analysed by SEM. Two-way ANOVA was used to compare differences between groups. All tested materials resulted in significantly increased bleaching compared to the initial colour values (p < 0.05). Group 3 showed significantly more whitening compared to the other groups after the first and second sessions (p < 0.05). However, Group 2 presented prolonged whitening efficiency and reached a bleaching level similar to the 35% HP treatment after 14 and 30 days. The results of the CIEDE2000 and CIELab formulas were found to be correlated (r > 0.6). The increases in Ca were similar in Groups 2 and 3 (p > 0.05) and were significantly higher than that in Group 1 (p < 0.05). p was similarly decreased among all groups (p > 0.05). The combination of 6% HP, chitosan and TiO2 appears to constitute a promising material for tooth whitening, showing good bleaching efficiency and acceptable mineral alterations.

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