Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

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Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : ZC01 - ZC04 Full Version

Effect of 3% Grape Seed Extract on the Bond Strength of Bleached Enamel with Natural and Commercially Available Bleaching Agents: An In-vitro Study


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/50966.17212
Yandra Lakshmi Suvarna, Garlapati Roopadevi, Bolla Nagesh, Vemuri Sayesh, Bandaru Pydiah Naidu, K VNS Sruthi, Mayana Aameena Banu, Shaik Aafreen Kamal

1. Postgraduate Student, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 2. Reader, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 3. Professor, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 4. Professor, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 5. Senior Lecturer, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 6. Senior Lecturer, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 7. Postgraduate Student, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India. 8. Postgraduate S

Correspondence Address :
Dr. Yandra Lakshmi Suvarna,
Postgraduate Student, Department of Conservative Dentistry and Endodontics, Sibar Institute of Dental Sciences, Guntur-522509, Andhra Pradesh, India.
E-mail: ylaxmisuvarna@gmail.com

Abstract

Introduction: Following bleaching with natural and commercial bleaching agents, to reverse the bond strength of enamel various antioxidants are used. The 3% Grape Seed Extract (GSE) has been more potent to be used as an antioxidant and has shown the immediate improvement in the Shear Bond Strength (SBS) values.

Aim: To evaluate the effect of 3% GSE as an antioxidant on the bond strength of bleached enamel with natural {Sweet Potato Extract (SPE)}, commercial {35% Hydrogen Peroxide (H2O2)} bleaching agents.

Materials and Methods: This experimental in-vitro study was conducted at Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India, over a period of one week in January 2021. According to the bleaching agent used, the labial surfaces of 40 extracted maxillary central incisors have been divided into two groups. Group I (n=20) include teeth bleached by SPE (natural) for about 30 minutes. Group II (n=20) included teeth bleached using 35% H2O2 (Pola office) for about eight minutes. Each group were again divided into two subgroups (n=10) based on the application of 3% GSE. After bleaching procedures, composite resin cylinders were bonded incrementally on the labial surface and stored in artificial saliva at 37°C for 24 hours. The samples were subjected to SBS under Universal Testing Machine. Data obtained were analysed using One-way Analysis Of Variance (ANOVA) and Tukey’s post-hoc test.

Results: On comparison of mean SBS values, statistically significant difference (p-value <0.05) was observed in all groups. The SBS values observed in 35% H2O2 bleached teeth were highly significant than the teeth bleached using 3% GSE application.

Conclusion: Application of 3% GSE immediately after bleaching the enamel surfaces, neutralises the deleterious effects of bleaching and increases SBS significantly.

Keywords

Antioxidant, Hydrogen peroxide, Shear bond strength, Tooth bleaching

In restorative dentistry, anterior teeth discoloration (intrinsic or extrinsic) is a major aesthetic concern, requiring an effective treatment (1). Vital bleaching is said to be a safer, popular, conservative and well-accepted treatment modality of treatment for discoloured teeth (2). For achieving rapid aesthetic results, bleaching agents in varying concentrations have been used. Various concentrations of H2O2 (Hydrogen Peroxide) from 5% to 35% and carbamide peroxide 10% are used to achieve lighter and more desirable tooth colour (3). The 35% H2O2 when applied on the tooth surface causes dispersal of peroxide into the organic matter of tooth structure. This depends on the factors like duration of application, diffusion coefficient and concentration of active bleaching agent (4).

Sweet Potato Extract (SPE) was used as a bleaching agent in this present in-vitro study. Gopinath S et al., formulated a bleaching agent obtained from plant tubers containing vegetative enzyme extract (sweet potato). They concluded that addition of SPE to H2O2 resulted in the retrieval of natural tooth colour and decreased the effects of bleaching on the enamel morphology, when compared to using H2O2 alone (4).

Sweet potato extract contains antioxidant molecules present either in enzymatic or non enzymatic in nature, such as Superoxide Dismutase (SOD), Catalase (CAT), peroxidase dismutase, polyphenol dismutase and ascorbic acid carotenoids, a phenolic compound (5). Teow CC et al., have observed that these phytochemicals have free radical scavenging activity (6). Nair M et al., showed that addition of 2% SPE in bleaching agent has reduced harmful effects on enamel and increases the bonding effect of composites to bleached enamel. Grape Seed Extract (GSE) with SPE might show synergistic effect in scavenging of free radicals (7).

Postoperative sensitivity, pulpal irritation, tooth structure alterations and microleakage are few complication of bleaching. One of the important complications of bleaching is decrease in the bond strength of composite to enamel (8). Vidhya S et al., and Lai SC et al., have suggested that, if bonding is undertaken immediately after bleaching, it adversely affects the SBS of resin composite to acid-etched enamel (2),(9).

The classic method of avoiding this is that the bonding procedure to be delayed for about 2-3 weeks after bleaching as the peroxide ions decompose and decreased Shear Bond Strength (SBS) is restored (10). To restore the decreased bond strength; various methods have been proposed, such as using alcohol treatment before the restoration to the bleached enamel, removal of outermost enamel layer and using adhesives containing organic solvents, such as antioxidants (11). Among all the above mentioned methods, usage of antioxidants has shown immediate improvement in SBS values (2),(9).

Naturally occurring antioxidants, like GSE, contains Oligomeric Proanthocyanidin Complexes (OPCs). These OPCs present in the natural antioxidants have the free radical scavenging activity. Vidhya S et al., and Lai SC et al., have suggested that the decreased bond strength can be reversed by the application of antioxidants such as proanthocyanidin and sodium ascorbate (2),(9). The 3% GSE has been shown to be more potent and safe to be used in various clinical applications (11).

Hence, this in-vitro study was conducted to evaluate the effect of 3% GSE as an antioxidant on the bond strength of bleached enamel with natural (SPE) and commercial (35% H2O2) bleaching agents.

Material and Methods

This in-vitro study was performed at the Sibar Institute of Dental Sciences, Guntur, Andhra Pradesh, India for duration of one week in January 2021. The study was undertaken after obtaining clearance from Ethical Committee of the Institutional Review Board (Protocol number 44/IEC-SIBAR/2021).

Inclusion and Exclusion criteria: Forty recently extracted human maxillary central incisors (extracted for periodontal reasons) were included in the study. The teeth with decay, fractures, cracks, severe attrition, erosion, dried teeth with developmental defects were excluded from the study.

Preparation of Solution

Sweet potato extract preparation: About 200 grams of purple colour sweet potatoes were washed, peeled and cut into cubes. A 25 mL of deionised water was used to smash the cubes in a blender and was filtered. A 100 mL of the filtered SPE was centrifuged at 2000 rpm for two minutes at 4°C. Thus, the clear liquid obtained is the SPE. Until use, the extract has been refrigerated at 4°C (4).

Grape Seed Extract preparation: Three grams of GSE powder (Ambe Phyto Extract Rx Ltd., Delhi) was dissolved in 100 mL of distilled water to make a 3% grape seed extract solution (1),(8).

Specimen preparation: All the samples were embedded in plastic moulds with self-cure acrylic resin, till the cementoenamel junction and the labial surfaces were cleaned with pumice slurry using slow speed hand piece. Until use, the samples were stored in 0.1% thymol.

Samples were divided into two groups (n=20), depending upon bleaching agents used.

Group 1 (n=20): A 30 mL of SPE solution was taken for the study. Gauze piece was saturated with 3 mL of SPE solution and placed on the labial surface of the sample for a period of 30 minutes with the SPE solution being changed for every 10 minutes (4). All the samples were washed under water for about one minute.

Group 2 (n=20): Labial surfaces of all the samples were treated with a 2 mm thick layer of 35% H2O2 gel (Pola office, SDI, Australia) at three intervals for eight minutes each, with a waiting period of three minutes between each session, as per manufacturer’s instructions. Using suction tip, the gel was removed and were washed under running water for about one minute.

Both the groups, were again divided into two subgroups, group 1A, 1B and group 2A, 2B (n=10) (Table/Fig 1), based on the application of an antioxidant agent, i.e., 3% GSE. Gauze piece was saturated with 3 mL of SPE solution and placed on the labial surface of the samples for a period of 10 minutes and rinsed (1).

Testing procedure: Immediately after the bleaching procedure, the samples were etched with 37% phosphoric acid (Ivoclar Vivadent, Schaan) for 15 secs and rinsed. Adper Single Bond (Dental Products, 3M ESPE, St Paul, MN, USA) was used for bonding the etched surface and cured for 20 seconds. Finally, composite (spectrum, microhybrid composites, Dentsply, Germany) build-up was done incrementally with teflon mould of 2 mm height and 2 mm diameter and cured for 30 seconds. Sample storage was done in distilled 2water for 24 hours. The SBS values were analysed under Universal Testing Machine (Instron Machine) (Table/Fig 2). The knife edge was targeted at interface between enamel surface and composite resin at a crosshead speed of 0.5 mm/min, till the dislodgement of the composite resin.

Statistical Analysis

The values were statistically analysed using software Statistical Package for Social Sciences (SPSS) version 16.0. One-way Analysis Of Variance (ANOVA) followed by the Mann Tukey’s post-hoc test were used to analyse the data. Statistical significance level was established at p-value <0.05.

Results

Total 40 maxillary central incisors were included in the study. (Table/Fig 3) shows the mean of SBS (MPa) of all the groups. Among the experimental groups, mean highest SBS was observed in group 2B, group 1B i.e., 14.77 MPa and 12.40 MPa respectively where 3% GSE has been used. Group 1A (p-value <0.05) have the lowest mean SBS value of 6.54 MPa than the group 2A. Group 1B displayed a significantly higher SBS of 12.40 MPa than the group 2A.

(Table/Fig 4) shows intergroup comparison of mean SBS values (MPa) of all groups. The mean SBS value of group 1A was statistically significant with that of group 1B (p-value <0.024) and group 2B (p-value <0.001). The mean SBS value of group 1B was statistically significant with that of group 1A (p-value <0.024). The mean SBS value of group 2A was statistically significant with that of group 2B (p-value <0.021). The mean SBS value of group 2B was statistically significant with that of group 1A (p-value <0.021) and group 2A (p-value <0.05).

Discussion

Tooth discolouration has always been an important factor in the recent times, due to growing concentration on the aesthetics. This growing awareness towards aesthetics has showed great demand to different treatment options in treating tooth discoloration. Of all these treatment modalities, most commonly used effective and conservative treatment options with minimal expense is vital tooth bleaching (8).

The SPE is a naturally obtained bleaching agent which contains a plurality of antioxidants, which act as scavengers (11). Vidhya S et al., have shown that proanthocyanidin application as a separate step, post bleaching resulted in immediate reversal of SBS of bleached tooth (2). In present study, 35% H2O2 (Pola office, SDI, Australia) was used thrice; each application was done for eight minutes. It has to be refreshed as the active ingredients of H2O2 are available for the first 15-20 minutes and has fast degradation action. It was applied thrice to attain same amount of bleaching obtained in the initial 15 minutes. The H2O2 being an oxidising agent, diffuses and dissociates into tooth structure to produce unstable free radicals such as hydroxyl (HO-), per hydroxyl (HOO-) and superoxide anions (OO-). These attack the organic pigmented molecules present between the inorganic salts of enamel and double bonds of chromophore molecules present in the tooth structure (12),(13).

Studies have stated that there will be less microhardness, surface alterations and reduced SBS of composite to enamel (13),(14). Upon storage, for 24 hours to three weeks, changes in structure caused by peroxide ions incorporation are eliminated, as peroxide ions decompose and replaced hydroxyl radicals re-enter the hydroxyapatite lattice (12). The reduced SBS in group 1A and 2A, compared to group 1B and 2B might be due to the following bleaching process residual oxygen layer left behind could have inhibited polymerisation of resin composite and interfered with infiltration of the resin into etched enamel. Lai SC et al., showed that by use of an antioxidant, i.e., 3% GSE, the presence of peroxide ions might be reversed (9).

The results in the present study showed that treatment with 3% GSE; group 1B and 2B increased bond strength significantly compared with group 1A and 2A. These observations were in accordance with study done by Subramonian R et al., who stated that this could be due to presence of OPCs in the antioxidant i.e., 3% GSE. OPCs have multiple donor sites which trap the superoxide radicals and epicatechin esterification by gallic acid enhances the free radical scavenging activity (15). Vidhya S et al., have shown that proanthocyanidin application as a separate step after bleaching resulted in immediate reversal of SBS of bleached enamel (2).

(Table/Fig 5) shows comparison of present study with previous studies (7),(15).

In recent years, it has been reported that utilisation of plant extracts i.e., natural antioxidants as a viable alternative to synthetic and chemical antioxidants. The GSE was chosen for this study since it has a greater degree of oxygen free radical scavenging potential and also yields a 10% higher concentration of proanthocyanidins. GSE contains oligomeric proanthocyanidins and free flavanol monomers. High molecular weight polymers, OPCs consist of (+)-catechin, monomeric flavan-3-ol and (-)-epicatechin (8). Other in vitro studies have shown that OPCs are 50 and 20 times more effective and stronger than vitamin E and C, respectively [8,16]. In order to reverse the reduced SBS of composite to the bleached enamel, 3% GSE was administered as an antioxidant right after the bleaching treatment.

According to Subramonian R et al., applying 10% pine bark extract after bleaching with 37.5% H2O2 showed better bond strength, whereas 37.5% H2O2 bleaching followed by treatment with 10% grape seed extract solution has shown better bond strength values compared to 37.5% H2O2 bleaching followed by treatment with 10% sodium ascorbate solution. It was determined from the results of the current investigation that, antioxidant use effectively restored the bond strength of bleached enamel (15).

In comparison to using hydrogen peroxide alone, Gopinath S et al., demonstrated that using 35% and 10% H2O2 containing SPE as bleaching agents not only produced better bleach, but also lessened the effects of bleaching on enamel morphology. These effects were more pronounced when using a higher concentration of H2O2. This excluded the additional step of applying antioxidants (4). Nair M et al., reported that compared to H2O2 and 5% GSE, usage of 2% SPE had shown significant bond strength. When applied after bleaching as a separate step, the effectiveness of 5% GSE was appreciated (7).

The molecular weight of the bleaching solutions employed in the present study appears to have high significance. Since, H2O2 which has a low molecular weight, permeates the dental hard tissues and decomposes into free radicals (17), any antioxidant surface treatment used to get rid of these free radicals should also have a low molecular weight for effective scavenging action.

Limitation(s)

The in-vivo environment cannot be replicated by the present study because it was conducted in-vitro. The restoration-tooth interface is subjected to a variety of stresses acting simultaneously in the oral cavity. A restoration is subjected to cyclic loading over the course of its existence; although no single stress is sufficient to cause a breakdown, over time it may result in the loss of the restoration and marginal deterioration. Thus, it is anticipated that fatigue testing of dental adhesive, would enable better in-vivo performance prediction.

Conclusion

The 3% GSE as an antioxidant increased SBS of bleached enamel with natural (sweet potato), commercial (35% hydrogen peroxide) bleaching agents. 35% H2O2 bleaching, followed by the application of 3% GSE as an antioxidant, has shown significant bond strength values. Treatment of bleached enamel surface with 3% GSE has reversed, the reduced SBS of composite resin. Additional studies are necessary to test higher concentrations of antioxidant agents, reducing time required to an efficient neutralising action and to improve SBS of composite resin.

References

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DOI and Others

DOI: 10.7860/JCDR/2023/50966.17212

Date of Submission: Jun 19, 2021
Date of Peer Review: Aug 17, 2021
Date of Acceptance: Nov 27, 2021
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 21, 2022
• Manual Googling: Nov 18, 2022
• iThenticate Software: Nov 24, 2022 (25%)

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