The Effect of Whitening Agents (Whitening Rinse and Carbamide Peroxide) on Stained Flowable and Packable Composite Aligner Attachments.

BACKGROUND: This study aimed to verify the effects of whitening agents on the color stability of aligner attachments made from flowable and packable composite resins after staining with coffee and wine. METHODS: Two composite groups were used for attachment preparation on epoxy resin master models: G-aenial Universal Injectable flowable (Group 1, N = 42) and G-aenial Posterior packable (Group 2, n = 42). Initial staining of samples was performed with coffee and red wine respectively, with a total period of 6 days representing 6 months of consumption. After staining, each main group was randomly divided into 3 groups related to distilled water as the control (Distilled Water (DW), n = 14) and whitening agents (Whitening Oral Rinse (WR), n = 14) (Carbamide Peroxide 22% (CP), n = 14) for a 14-day test period. Before staining (T0), after staining (T1), and after whitening (T2), color measurements were made with Vita Easy Shade V. DeltaE(00) formula was used to determine color differences between T0-T1 (DeltaE(001)), T1-T2 (DeltaE(002)) and T0-T2 (DeltaE(003)) color measurement periods. Also, attachments' whiteness change before and after whitening procedures was calculated using the Whiteness Index for Dentistry (WI(D)) formula considering as DeltaWI(D1) = WI(D)(T2) - WI(D)(T0) and DeltaWI(D2) = WI(D)(T2) - WI(D)(T1). RESULTS: After immersion in staining solutions, DeltaE(001) values of Group 2 were significantly higher than of values of Group 1 (p < 0.001). In Group 1, DeltaWI(D2) values in the WR and CP groups were found to be significantly higher than measurements in the DW group (p = 0.049 and p = 0.001). In Group 2, the value of DeltaE(002) for subgroup CP was significantly higher than that for DW group (p = 0.023). Also, the DeltaE(003) measurement of the WR group was higher than the measurement of the CP group (p < 0.001). In Group 2, the DeltaWI(D1) measurement of the CP group was lower than the measurements of the DW (p < 0.001) and WR (p = 0.014) groups. According to DeltaWI(D2) measurement in Group 2, CP measurements were higher than DW (p < 0.001) and WR (p = 0.024) measurements. Statistically significant differences were determined between the composite types for DW, WR, CP whitening types in terms of DeltaE(003) and DeltaWI(D1) measurements and between the composites for CP whitening type in terms of DeltaWI(D2) measurements (p < 0.05). For all significant differences, measurements for Group 2 were found to be higher than for Group 1. CONCLUSION: The color change of packable composite was more pronounced than that of the flowable composite after staining. Between whitening and staining stages, especially in packable composite group, carbamide peroxide whitening agent significantly effected the color and whiteness of the attachments compared to control distilled water group.