Академический Документы
Профессиональный Документы
Культура Документы
CRA
FIRST LOOK NEW GENERATION IN-OFFICE VITAL TOOTH BLEACHING, PART 2
This is the 2nd report (See CRA Newsletter Nov. 02 for Part 1) in an on-going evaluation of in-office vital
tooth bleaching products addressing what lights add to in-office bleaching. Report below addresses:
(1) Frequently asked questions; (2) Characteristics of 8 in-office bleach systems; (3) Clinical test
methods & results; & (4) CRA conclusions.
IN
THIS 1. FREQUENTLY ASKED QUESTIONS (SEE CRA WEBSITE FOR TEST METHODS & SUPPORTING DATA)
ONETOUCH Most light is emitted mainly in the visible spectrum. Biolase diode laser emits non- visible light in the near infrared, & Zoom
Topical anesthetic has a small portion of its emission in the ultraviolet.
Some lights are designed only for bleaching (Zoom, LumaArch, BriteSmile) while others serve multiple functions
Page 4
(LaserSmile - soft tissue surgery; Rembrandt - resin polymerization).
F. What are CRAs comments on the BriteSmile system & the JADA Feb. 03 report?
CRA has the following concerns: 1) Only one person performed all tooth color grading; 2) There was no indication that the
grader was trained or validation of the graders ability to judge colors consistently over time; 3) No prophy was performed
TM
prior to bleaching to remove extrinsic stains so accurate tooth color readings could be made initially; 4) The study was
funded by BriteSmile & the Director of the Forsyth Institute where the study was performed was on the BriteSmile Strategic
Since 1976 Advisory Committee of Industry Experts; & 5) BriteSmile requires all dental clinicians who wish to have a BriteSmile light in
3707 N. Canyon Road #6 their clinical facility to sign an extensive contract that includes a paragraph stating that the Client shall not, and shall not
Provo, Utah 84604 permit any person, to analyze or attempt to quote reverses engineer the BriteSmile System(s), Authorization Code, or the
801-226-2121 BriteSmile Materials while in their possession. A contract & stipulations of this type are infrequent in dentistry & beg the
question: Why?
www.cranews.com
CLINICAL SUCCESS IS THE FINAL TEST.
CRA Newsletter Page 2 March 2003
Cost of
$250 $49.95 $79 $169.95 $95.95 $110 $120 $85
B Whitening Kit
(1 patient) (1 patient) (4 patients) (5 patients) (2 patients) (3 patients) (2 patients) (1 patient)
(patients treated)
Storage Room
C Refrigerate Refrigerate Refrigerate Refrigerate Refrigerate Refrigerate Refrigerate
Conditions Temperature
Chemical
D Yes No Yes Yes Yes Yes Yes Yes
Catalyst
Yes Yes Yes Light Optional Light Optional Light Optional Yes Yes
Light Use
BriteSmile LaserSmile diode LumaArch If used, a standard If used, a standard If used, a standard Rembrandt Zoom
E Recommended Sapphire
by Company (Mercury Vapor laser with whitening (Halogen) resin curing light resin curing light resin curing light (plasma arc with (Metal-Halide)
Plasma Arc or LED) handpiece is suggested is suggested is suggested Whitening Crystal)
Light owned by $22,900
Cost of Light BriteSmile. Use $1,500
F included in patient (Soft tissue & $4,995 N/A N/A N/A $4,650
system bleaching laser)
UV meter $150
kit cost.
PRODUCT LABEL CLAIMS & CRA ASSAY RESULTS
% H202
Per Mfr. 15% 35% 35% 27% 38% 35% 35% 25%
(wt%)
Assayed conc. 17.8% 36.7% 41% 27.2% 41.5% 41% 35.7% 28%
Per Mfr. not available not available 5.5 5.5 7.0 5.0 8-9 7-8
Mixed
H
pH
6.1
CRA assay 4.0 5.6 4.0 7.5 3.0 5.9 7.9
MANUFACTURERS DIRECTED USE
Contact Time
I per Gel 20 minutes 8 minutes 8 minutes 15 minutes 15 minutes 4 minutes 60 minutes 20 minutes
Application
Gel
J Applications 3 3 3 3 4 4 1 3
per Visit
Total Gel
K 60 minutes 24 minutes 24 minutes 45 minutes 60 minutes 16 minutes 60 minutes 60 minutes
Contact Time
Estimated Total
M 90 minutes 51 minutes 54 minutes 73 minutes 90 minutes 45 minutes 90 minutes 100 minutes
Chair Time*
Method followed was: Hydrogen peroxide concentrate. United States Pharmacopeia XXII NFXUII 1990, pp 663.
2.0 *
1.8 1.8
KEY:
1.7 1.7 Light (Chroma) No-Light (Chroma)
1.6 1.6 * *
1.5 1.4 1.4 1.4
Light (Value) No-Light (Value)
1.3
1.2
1.0
1.1 1.1 1.1
* Products where light use is stated by
manufacturers as optional, & when
used a resin curing light is suggested.
(CRA used Optilux 500.)
0.5
BriteSmile is not included in this graph
because CRA clinical tests are not yet
completed.
0.0
Opalescence Rembrandt
Xtra Boost LumaArch Zoom PolaOffice Niveous Lightning LaserSmile
Plus
60 min. 24 min. 60 min. 16 min. 45 min. 60 min. 24 min.
41.5% 41% 28% 41% 27.2% 35.7% 36.7%
Product Name, Manufacturers Recommended Total Contact Time,
& CRA Assayed % H2O2 in the Mixed Gel
SUMMARY OF GRAPH:
The 3 systems where manufacturers designated light use as optional (Opalescence Xtra Boost, PolaOffice, Niveous) produced tooth lightening comparable to the
5 systems where use of light was mandated by the manufacturer.
Within each system individually, comparable lightening resulted whether or not light was used.
Although all systems lighten teeth an average of about 1 to 2 shades, proprietary chemicals now added to the H2O2 just before use allowed some bleach gels to
lighten teeth faster (LumaArch) & others to lighten teeth using less active ingredient (Zoom).
Statistically, LumaArch was among the 3 best performers & lightened teeth to the same degree as Opalescence Xtra Boost & Zoom systems, but achieved it in about
1/3 of the time (24 min. vs. 60 min.).
Possible reasons for less bleaching produced by 4 of the systems (see right to left in graph above):
LaserSmile gel is not activated chemically before application, & has a relatively short total contact time of 24 minutes.
Rembrandt Lightning Plus gel is activated chemically before application & its gel decomposition was so rapid that it may have dissipated much of its bleach
potential before it was applied to the teeth. In addition, it used a single gel application that stayed in place 60 minutes & was agitated, but not renewed.
Manufacturers newest directions now state: For best results, we recommend re-applying the gel every 15-minutes.
Niveous rate of gel decomposition after activation was lower than other activated gels, & the gel had less H2O2 at 27.2% & a little less contact time at 45 minutes.
PolaOffice was activated chemically before use & had good activity, but used 4 short contact times of 4 minutes each, for a total of contact time of only 16 minutes.
C. SENSITIVITY
Tooth sensitivity occurred with every system, & included teeth lightened with gel & light & with gel alone. These data suggest post treatment
sensitivity is due to the H202 gel, & not the current generation lights. All sensitivity resolved within 48 hours.
4. CONCLUSIONS
All systems tested lightened teeth & the degree of lightening depended on system chemistry & directions for use.
Opalescence Xtra Boost, LumaArch, & Zoom lightened teeth significantly more than the other 4 systems. Use of lights
according the manufacturers directions did not improve lightening for any system tested. Systems where light was stated
to be optional where any type of light could be used, lightened teeth as well as or better than, systems where light was
mandated & specific lights were sold as part of the system. The newest trend in in-office bleach gels is addition of chemical
activators to speed the lightening process (LumaArch) & reduce active ingredient (Zoom). Performance of LumaArch & Zoom,
respectively, exemplify these improvements. (CRA report on BriteSmile is forth coming.)
See CRA Website (www.cranews.com) for methods & complete data.
CRA Newsletter Page 4 March 2003
CRA
CONFIRMED NOTEWORTHY
USEFUL
SELF ADHESIVE CUSHIONS WRAP FILM EDGES FOR BETTER PATIENT COMFORT
EDGE EASE
Disposable cushions cover edges & wrap corners of x-ray film packs & digital
sensors. 2 styles (anterior-white, posterior-blue). Can be used with x-ray
alignment devices. Advantages: (1) Covers sharp edges & corners for
improved patient comfort & easier placement; (2) Easy to use; & (3) Works
with both conventional film & digital sensors. Disadvantage: Adds time to
place & remove.
of 20 CRA Evaluators stated this product would replace products
$42 / Box of 300
Strong Products
2725 Hidden Hills Way Corona, CA 92882 U.S.A.
61% they use currently, & 90% rated it excellent or good & worthy of
trial by colleagues.
909-371-5185 800-648-9729 Fax: 909-371-1468
Website: www.strongproducts.com
Products evaluated by CRA & reported in the CRA Newsletter have been selected on the basis of merit from hundreds of products under evaluation. CRA conducts research at 3 levels: (1) Multiple-user field
evaluations, (2) Controlled long-term clinical research, & (3) Basic science laboratory research. Over 400 clinical field evaluators are located throughout the world & 48 full-time employees work at the institute. All
professional staff volunteer their time. A product must meet at least one of the following standards to be reported in this publication: (1) Innovative & new on the market; (2) Less expensive, but meets the use
standards; (3) Unrecognized, valuable classic; or (4) Superior to others in its broad classification. Your results may differ from CRA Evaluators or other researchers on any product because of differences in
preferences, techniques, batches of products, & environments. Clinical Research Associates, Inc. (CRA ) is a non-profit educational & research corporation using a unique volunteer structure to produce objective,
factual data. All proceeds are used to support the work of CRA & the CRA Foundation, a tax exempt foundation. 2003 Clinical Research Associates, Inc. This Newsletter or portions thereof may not be
duplicated without permission of CRA. Annual English subscription $58 in U.S. & $60 (U.S. Funds) in other languages &/or countries, or $7 per issue.