Influence of Antioxidant Agents on the Properties of Bovine Dental Enamel Subjected to Bleaching and Restorative Treatment with Composite Resin

ABSTRACT

Objective:  To evaluate the influence of two antioxidants on the fracture resistance of bleached enamel. It also assessed their impact on color change and surface microhardness.

Material and Methods:  Forty-eight bovine enamel samples underwent three bleaching sessions and were randomly divided into three groups (n=16): Control – No antioxidant application; Sodium Ascorbate – Application of sodium ascorbate for 30 min; DL-alpha-lipoic Acid – Similar to Sodium Ascorbate, but the antioxidant used was DL-alpha-lipoic Acid. Then, color was evaluated with a spectrophotometer, and microhardness was measured using the Knoop test, before the start of the bleaching treatment and immediately after the final application of the bleaching agent and the antioxidant. Afterward, the specimens were restored with composite resin. After seven days, the fracture resistance test was performed using an electromechanical testing machine. Fracture resistance and color evaluation data were subjected to one-way ANOVA, followed by Tukey’s post-hoc test. Microhardness was assessed using Kruskal-Wallis and Dunn tests (p<0.05).

Results:  Sodium ascorbate provided the highest fracture resistance compared to DL-alpha-lipoic acid and the control group after bleaching (p<0.05). The antioxidant agents did not interfere with the whitening effect of 35% hydrogen peroxide (p>0.05).

Conclusion:  Using sodium ascorbate reduced the deleterious effects on enamel microhardness and fracture resistance.

Keywords:
Tooth Bleaching; Antioxidants; Dental Enamel

Introduction

It is known that tooth discoloration can occur due to the biological process of dental aging, trauma, oral pathologies, the use of tetracycline, or biomaterials [¹]. Furthermore, discoloration can also result from extrinsic staining due to tobacco use and the consumption of pigmented foods [²].

Thus, it is understood that whitening treatment involves a chemical reaction aimed at wholly or partially removing extrinsic staining [³,⁴]. This procedure applies hydrogen peroxide or carbamide peroxide gels in different concentrations to the enamel surface of vital or non-vital teeth in the office, at home, or a combination of both [⁵].

Despite its benefits, dental whitening can have adverse effects [⁶]. These include changes in the mechanical properties of the mineralized tissues of the teeth, increased enamel porosity, dentin sensitivity, an immediate decrease in bonding capacity, and reduced fracture resistance of dental crowns [⁷,⁸,⁹,¹⁰,¹¹].

Previous studies have shown that bleaching gels interfere with the bond strength of restorative materials to the dental substrate when applied immediately after the whitening procedure [¹²]. This phenomenon is explained by the presence of a residual oxygen layer on the enamel surface, which can last up to four weeks due to the oxidative process of hydrogen peroxide, hindering the complete and adequate polymerization of resin monomers [¹¹,¹²].

Antioxidant agents have been extensively investigated as a potential alternative to reverse the compromised bond strength following whitening, given their ability to neutralize free radicals [¹³,¹⁴] to reduce waiting time and enhance the adhesive strength of dental elements. However, relatively few studies still examine their concurrent effects on fracture resistance, color of the bleached dental substrate, and surface roughness, highlighting the need for further research in this area.

Therefore, this in vitro study aimed to evaluate the influence of two experimental antioxidant agents (Sodium Ascorbate and DL-alpha-lipoic Acid) on the fracture resistance of bovine dental enamel bleached with 35% hydrogen peroxide (Whiteness HP 35%) and immediately restored using a universal adhesive (Scotchbond Universal) and nanohybrid composite resin (Opallis). It also assessed the influence of the antioxidants on the color of the dental substrate and the surface microhardness of bovine dental enamel bleached with 35% hydrogen peroxide (Whiteness HP 35%). The null hypotheses tested were: H0 – The use of the experimental antioxidant agents Sodium Ascorbate and DL-alpha-lipoic Acid will not influence the fracture resistance of bovine dental enamel restored with a universal adhesive (Scotchbond Universal) and nanohybrid composite resin (Opallis); H1 - The use of the experimental antioxidant agents Sodium Ascorbate and DL-alpha-lipoic Acid will not influence the color of the bovine dental substrate bleached with 35% hydrogen peroxide (Whiteness HP 35%); H2 – The use of the experimental antioxidant agents Sodium Ascorbate and DL-alpha-lipoic Acid will not influence the surface microhardness of bovine dental enamel bleached with 35% hydrogen peroxide (Whiteness HP 35%).

Materials and Methods

Forty-eight bovine incisors were selected for the study and sectioned at the middle third of the crown using a cutting machine (Isomet™ 1000; Buehler Inc., Lake Bluff, IL, USA) to obtain specimens measuring 3 mm in height and 3 mm in width. They were then taken to a precision cutter for transverse sectioning at the enamel-dentin junction, separating the bovine dental enamel. Subsequently, the samples were polished and standardized to a thickness of 1.5 mm. The surface hardness and color of the substrate were initially evaluated (Figure 1). During the experimental periods, the specimens were stored in an incubator at 37 °C and immersed in a distilled water.

Figure 1
Study design: (A) Sample preparation: 1 and 2 – Specimen collection; 3 and 4 – Sectioning at the enamel-dentin junction and obtaining bovine enamel specimens; (B) Hardness readings and Initial color analysis.

Whitening Protocol

After the preparations were completed, all specimens were subjected to the whitening protocol using 35% hydrogen peroxide (Whiteness HP 35%; FGM Dental Group, Joinville, SC, Brazil). The Whiteness HP product was mixed (three drops of hydrogen peroxide for one measure of thickener), and a whitening gel was applied to the surface of the specimens. The product was kept in place for 45 min, followed by extensive rinsing with water. Three whitening sessions were conducted at 72-hour intervals.

Immediately after the final whitening treatment session, the specimens were randomly divided into three groups (n=16) according to the antioxidant treatment:

• CO (Control): No antioxidant application;

• SA (Sodium Ascorbate): Sodium ascorbate powder (Now Foods Brasil, São Paulo, SP, Brazil) was mixed with distilled water in a 1:1 ratio and applied to the bleached bovine enamel using a microapplicator, remaining on the surface for 30 min. The samples were then thoroughly rinsed with distilled water;

• AL (DL-alpha-lipoic Acid): Similar to SA, but the antioxidant used was DL-alpha-lipoic acid (Sigma-Aldrich Corp., Oakville, Canada).

Color Evaluation

The color evaluation was conducted using a spectrophotometer (Ci6x, X-Rite Inc., São Paulo, SP, Brazil) with the CIEDE2000 system at two points before and after the whitening and antioxidant protocol. The color (∆E₀₀) change values for the CIEDE2000 system were obtained using the following formula [¹⁵]:

$\Delta E_{00}=\sqrt{{\left(\frac{\Delta L^{\prime }}{k_L{s}_L}\right)}^2+{\left(\frac{\Delta C^{\prime }}{k_C{s}_C}\right)}^2+{\left(\frac{\Delta H^{\prime }}{k_H{s}_H}\right)}^2+R_T\frac{\Delta C^{\prime }}{k_C{s}_C}\frac{\Delta H^{\prime }}{k_H{s}_H}}$

Microhardness Analysis

After the experimental period for each group, the specimens were subjected to microhardness testing using a microhardness tester (HV 1000, São Paulo, Brazil) with Knoop indentation (HK), applying a load of 25 grams for 15 s to obtain the outer surface of the lesion [¹⁶]. The microhardness measured was compared with the initial microhardness of each specimen.

Restorative Protocol

Subsequently, the specimens underwent the restorative protocol. Initially, the enamel was conditioned with phosphoric acid (Attaque gel; Biodinâmica Química e Farmacêutica, Ibiporã, PR, Brazil) for 30 s and rinsed with distilled water for 60 s. The entire surface was dried with an air jet, and the universal adhesive (Single Bond Universal; 3M ESPE) was actively applied for 20 s. The solvent was evaporated with air jets for 5 s and then photoactivated with an LED device (Valo Grand; Ultradent Products Inc., South Jordan, UT, USA) at a power of 1,200 mW/cm² for 10 s.

Next, the samples were restored with nanohybrid composite resin (Opallis; FGM Dental Group, Joinville, SC, Brazil), color EA1, in a single 1 mm increment and photopolymerized using an LED device (Valo; Ultradent Products, Inc., South Jordan, UT, USA) for 20 s.

Fracture Resistance

After 7 days of the restorative treatment, each specimen was positioned parallel to a vertical table, with the restored surface perpendicular to the load cell, and subjected to a vertical compression test using a universal testing machine (EMIC; São José dos Pinhais, PR, Brazil). The test was performed with a 500 N load cell at speed of a 0.5 mm/min.. The samples were subjected to an axial force, with the crosshead positioned at the center of the specimen. After the fracture occurred, the force (in N) required to cause the fracture was recorded.

Statistical Analysis

The statistical analysis was performed using the BioEstat 5.0 software (Sociedade Civil). The fracture resistance and color evaluation data were subjected to one-way ANOVA followed by Tukey’s post-hoc test (α=0.05). Microhardness was assessed using the Kruskal-Wallis and Dunn tests (P<0.05).

Results

Fracture Resistance

Sodium ascorbate provided the highest fracture resistance values (in N) compared to those demonstrated by DL-alpha-lipoic acid and the control group after the dental whitening protocol (p<0.05). There was no significant difference between the fracture resistance values (in N) demonstrated by the control group and the lipoic acid group after the dental whitening protocol (p>0.05). Table 1 shows the arithmetic mean and standard deviation of the fracture resistance values (in N) based on the antioxidant solution protocol (p=0.05).

Table 1
Mean and standard deviation of fracture resistance in N after seven days, according to the antioxidant solution protocol.

Statistics	Sodium Ascorbate	DL-Alpha-Lipoic Acid	Control
Mean	756.56a	578.66b	528.61b
Standard Deviation	199.23	109.51	96.87

• ^abDifferent letters in the same row indicate significant differences (p<0.05).

Color Change

The evaluated protocols resulted in similar color change values compared to the specimens before using the whitening agent. The antioxidant agents sodium ascorbate and DL-alpha-lipoic acid did not interfere with the whitening action of 35% hydrogen peroxide (p>0.05). Table 2 shows the arithmetic mean and standard deviation of ∆E₀₀ (CIEDE2000) based on the antioxidant solution protocol.

Table 2
Mean and standard deviation of ∆E00 (CIEDE2000) based on the antioxidant solution protocol.

Statistics	Sodium Ascorbate	DL-Alpha-Lipoic Acid	Control
Mean	5.69	5.19	5.62
Standard Deviation	0.86	0.43	0.88

• *No difference existed between the evaluated protocols (p=0.05).

Microhardness Change

Sodium ascorbate provided the highest microhardness values (in Knoop) compared to those demonstrated by DL-alpha-lipoic acid and the control group after the dental whitening protocol. There was no significant difference between the microhardness values (Knoop) demonstrated by the control group and the lipoic acid group after the dental whitening protocol (p>0.05). Table 3 shows the median, maximum, and minimum values and the first and third quartiles of the percentage change in microhardness values (in Knoop) of the dental crown enamel based on the antioxidant use protocol after the whitening protocol.

Table 3
Median, maximum, and minimum values, 1Q and 3Q, of the percentage change in microhardness values (in Knoop) of dental crown enamel, according to the antioxidant protocol used, after whitening.

Statistics	Sodium Ascorbate	DL-Alpha-Lipoic Acid	Control
Median	35.99a	7.69b	5.07b
Vmax – Vmin	98.89 – 0.36	9.09 – 0.14	9.72 – 0.06
1Q – 3Q	7.54 – 84.64	2.81 – 8.43	2.15 – 8.12

• ^abDifferent letters in the same row indicate significant differences (p<0.05); Vmax: Maximum value; Vmin: Minimum value; 1Q: First quartile; 3Q: Third quartile.

Discussion

Sodium ascorbate positively influenced fracture resistance and microhardness after the dental whitening protocol. However, it did not affect the color of the bleached bovine enamel. Therefore, the null hypotheses H0 and H2 were rejected.

Dental whitening, especially with 35% hydrogen peroxide, is known to cause enamel demineralization and alter its mechanical properties, such as fracture resistance, due to the release of free radicals that affect the tooth’s mineral structure [¹⁷]. Applying antioxidants post-whitening aims to minimize these damages by neutralizing free radicals and protecting the dental structure [¹⁸].

The results of this study demonstrate that sodium ascorbate provided the highest fracture resistance values (in Newtons) after the dental whitening protocol, compared to DL-alpha-lipoic acid and the control group. On the other hand, there was no significant difference in fracture resistance values between the group treated with DL-alpha-lipoic acid and the control group, suggesting that DL-alpha-lipoic acid was not as effective as sodium ascorbate in protecting dental enamel after whitening.

Sodium ascorbate is a water-soluble antioxidant [¹⁹] that neutralizes free radicals generated during the whitening process [²⁰], thereby protecting collagen and the mineral matrix of the enamel. Studies [²¹,²²] indicate the efficacy of sodium ascorbate in reversing the negative effects of whitening, such as reduced adhesive strength and structural compromise of the enamel. Furthermore, its ability to penetrate the enamel may contribute to better protection of the deeper layers of the dental surface, which could explain the higher fracture resistance values observed in this study.

On the other hand, DL-alpha-lipoic acid, although also a potent antioxidant, did not demonstrate the same efficacy as sodium ascorbate in protecting enamel. Studies suggest that DL-alpha-lipoic acid has efficient antioxidant action in other biological contexts [²³], but its effectiveness in remineralization or protection of dental enamel is still limited. Furthermore, its lower solubility may have reduced penetration into the enamel [²⁴], contributing to the observed results, as the fracture resistance values in the group treated with DL-alpha-lipoic acid were similar to those of the control group.

Additionally, it was observed that the whitening protocol, regardless of the use of antioxidants, resulted in similar color change values compared to the specimens before the whitening agent was used. Neither sodium ascorbate nor DL-alpha-lipoic acid significantly interfered with the whitening action of 35% hydrogen peroxide, suggesting that the antioxidants used, while effective in protecting the structural integrity of the enamel, do not affect the efficacy of the whitening process in terms of color change.

Dental whitening with hydrogen peroxide releases free radicals, such as the hydroxyl radical, destabilizing the pigment molecules in the teeth and promoting whitening [²⁵]. One of the concerns with using antioxidants after the whitening treatment is the possibility that these compounds may neutralize the free radicals and, therefore, reduce the effectiveness of the whitening process.

The fact that antioxidants do not interfere with the effectiveness of whitening may be explained by the timing and method of application. The present study applied the antioxidants after the whitening process, allowing hydrogen peroxide to act fully on the dental chromophores before the antioxidants neutralize the free radicals.

Finally, sodium ascorbate significantly increased dental enamel microhardness (Knoop) compared to DL-alpha-lipoic acid and the control group after the whitening treatment. A previous study suggested that free radicals, such as superoxide anion and hydroxyl radicals, are responsible for collagen matrix degradation and enamel demineralization during whitening [²⁶]. Sodium ascorbate, a potent antioxidant, acts by neutralizing these radicals [²⁰], which may contribute to preserving the mineral structure of enamel and, consequently, maintain or improve its microhardness.

On the other hand, despite being a recognized antioxidant, DL-alpha-lipoic acid did not show the same beneficial effect on enamel microhardness. Although this compound is effective in neutralizing free radicals in other contexts [²⁷], its action may be limited in dental enamel due to factors such as reduced penetration or lower interaction with the mineral components of the enamel. This may explain the similarity in microhardness values between the group treated with DL-alpha-lipoic acid and the control group.

Some limitations, such as the absence of real clinical conditions, should be considered. Although the study used bovine enamel as a substrate, it may not accurately replicate the conditions found in human teeth, particularly regarding structural composition and behavior during whitening. Additionally, there was a lack of stimulation of oral factors, as the conditions in the oral cavity, such as the presence of saliva, temperature variations, pH, and masticatory forces, were not simulated in the laboratory environment. These factors can influence the action of hydrogen peroxide and the effectiveness of antioxidants in protecting the enamel, affecting fracture resistance and microhardness.

Furthermore, only two antioxidants were tested (sodium ascorbate and DL-alpha-lipoic acid). Therefore, the study does not consider the effect of a broader range of agents that may act differently in protecting the enamel. Finally, we encourage further studies with long-term evaluations of these objectives to compare them with the results of the present study.

Conclusion

The use of sodium ascorbate after coronal whitening increases fracture resistance and enamel microhardness without altering the coronal coloration, compared to the use of DL-alpha-lipoic acid.

• Financial Support
  None.

Data Availability

The data used to support the findings of this study can be made available upon request to the corresponding author.

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Edited by

• Academic Editor:
  Alessandro Leite Cavalcanti

Publication Dates

• Publication in this collection
  28 Nov 2025
• Date of issue
  2026

History

• Received
  07 Dec 2024
• Reviewed
  11 Feb 2025
• Accepted
  13 Feb 2025