As a conclusion, considering the conditions tested, the changes in enamel were directly proportional to the treatment time and peroxide concentration. According to the methodologies used in these studies, higher concentrations of HP caused more Ca2+ loss than lower concentrations. The contact time of high concentrated bleaching agents may also be an important factor for Ca2+ loss. A recommendation to use activation methods which shorten the contact time of the highly concentrated bleaching agents can be used in the dental office. But it must still be mentioned that 10% CP would be the safest method. In addition, to avoid the unfavorable effects of bleaching treatments, it is recommended to use topical fluoride agents incorporation with bleaching agents to take advantage of remineralization process.
The findings of these in vitro studies may not be representative of the in vivo condition; in which the oral cavity is continually bathed with saliva that contains various minerals (i.e. fluoride, calcium phosphate), lipids, carbohydrates and proteins. They also do not represent unfavorable conditions where the deficiency of saliva or poor oral hygiene that might increase the caries risks. Further studies are needed to clarify the effects of these materials on Ca2+ loss of enamel and caries susceptibility.
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