Does post-bleaching fluoridation affect the further demineralization of bleached enamel? An in vitro study

Background: Topical fluoride agents have been shown to be the most effective method in treating demineralized enamel after in-office bleaching treatments. Thus, this study aimed to examine the effects of two different post-bleaching fluoridation agents: 1.5% titanium tetrafluoride (TiF4) (9200 ppm) and 2.1% sodium fluoride (NaF) (9500 ppm), on the calcium loss of enamel after an acidic challenge. Methods: Ten maxillary premolars were sectioned into four pieces and then divided into the following four groups: Group 1: Control, kept in artificial saliva, no treatment; Group 2: 38% hydrogen peroxide (HP); Group 3: 38% HP followed by 1.5% TiF4; Group 4: 38% HP followed by 2.1% NaF solution. The specimens were subjected to demineralization for 16 days, refreshing the solution every 4 days; that is, on the 4th, 8th, 12th, and 16th days. Calcium ion (Ca2+) concentration was determined by an atomic absorption spectrophotometer. Data were analyzed using Friedman and Wilcoxon tests (p = 0.05). Results: The loss of Ca2+ in each of the test groups was compared with that of the control group, depicting that there was a statistically significant difference among the groups after 4, 8, 12, and 16 days and in total (p < 0.05). The calcium released from the fluoride-applied groups was lower when compared with the 38% HP and control group. At the end of the 16th day, the total amount of calcium released from the TiF4-treated samples (9.12 mg/mL) was less than from the NaF-treated samples (13.67 mg/mL) (p < 0.05). Conclusions: Regarding the results of our in vitro study, the risk of further demineralization was significantly reduced with the use of TiF4 and NaF after bleaching with 38% HP. TiF(4)was found to be more effective in preventing Ca2+ release owing to acid attack when compared with NaF. In the case of an intra-oral acidic exposure, the use of topical 1.5% TiF4 and 2.1% NaF agents might be beneficial after bleaching with 38% HP.