The Effect of Various Remineralizing Agents on Post-bleaching Shade Stability: A Randomized Double-blind Clinical Study

Objectives: This study aimed to compare the effects of four remineralizing agents on post-bleaching shade stability and to evaluate the agreement between objective and subjective shade assessments. Methodology: Forty-eight eligible patients underwent in-office bleaching with 32% hydrogen peroxide, followed by one of the following: 1. potassium nitrate/sodium fluoride (After Whitening Mousse, AWM, n=11), 2. casein phosphopeptide-amorphous calcium phosphate/fluoride (MI Paste Plus, MI, n=13), 3. nano-hydroxyapatite/fluoride (Remin Pro, RP, n=11), or 4. PolyAmidoamine Dendrimer (PAMAM, n=13). Stability was assessed using ∆E, ∆SGU, ∆L*, ∆b*, and ∆WID at regular follow-ups over one year. Statistical analyses were performed using a Linear Mixed-Effects Model, Kendall’s W, and Cohen’s Kappa (α = 0.05). Results: Based on linear mixedeffects model, remineralizing agents did not significantly affect ∆E, ∆SGU, ∆L*, ∆b*, or ∆WID (p>0.05). The follow-up time had a significant effect on these color parameters (p<0.05). No post-bleaching shade relapse was observed in any of the experimental groups. There were slight to moderate agreements between the two evaluation methods (Kappa=0.106, W=0.504). Conclusions: None of the remineralizing agents compromised post-bleaching shade stability. Accurate post-bleaching shade stability assessment requires both objective and subjective methods. Clinical relevance: Bleaching stability was maintained with all remineralizing agents evaluated in this study.

Shade Stability Remineralizing Agents Enamel Remineralization Hydrogen Peroxide Bleaching