The Effect of a Bleaching System on Properties Related

to Different Ceramic Surface Textures

Amina A. Zaki, BDS, MSc, PhD,1 & Nadia Z. Fahmy, BDS, MSc, PhD2
1
Professor, Department of Fixed Prosthodontics, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
2
Professor, Department of Fixed Prosthodontics, Faculty of Dentistry, October 6 University, Cairo, Egypt

Keywords
Bleaching; LFC ceramic; roughness; color.
Correspondence
Nadia Fahmy, October 6 University—Fixed
Prosthodontics, 6 October City, Cairo, Giza
Governorate 11511, Egypt. E-mail:
nadiafahmy@hotmail.com
Early versions of this article’s abstract,
materials and methods section, and tables
were published in the Egyptian Dental
Journal (2007:53;2395,2407).
Accepted: February 22, 2008
doi: 10.1111/j.1532-849X.2008.00419.x
Abstract
Purpose: This study examined the effect of a manufacturer’s proposed bleaching
protocol on surface properties of a low-fusing ceramic.
Materials and Methods: Forty ultra low-fusing ceramic samples (Ducera LFC) were
constructed for this study. Half the discs were autoglazed, and the other half were
overglazed. The two main groups (autoglaze, overglaze) were further divided into
subgroups of four. Group I: autoglazed (control group I), bleached autoglaze, diamond
polished, diamond polished and bleached. The same division was applied to Group
II: overglazed (control group II), bleached overglazed, diamond polished, diamond
polished and bleached. The total number of subgroups was eight. Control groups I
and II (n = 10) were both immersed in distilled water, which was changed daily for
1 week. The other six subgroups (n = 30) were subjected to the following protocol:
2-hour bleaching using carbamide peroxide 35%, followed by six 8-hour bleaching
applications using 15% carbamide peroxide gel. Every two bleaching procedures were
interrupted by a 10-hour fluoride gel application. At the end of each bleaching step,
the treated specimens were washed under running water in readiness for the next
application.
Results: Bleaching did not significantly affect the surface roughness of the autoglazed
group; however, it significantly increased the roughness of the overglazed ceramic,
especially after polishing. Regarding whiteness, the overglazed group had significantly
increased values compared to the autoglazed group. It appeared that bleaching whitened
the overglazed specimens significantly, whereas polishing alone showed less whiteness.
There appeared to be a strong inverse relation between the roughness and the whiteness
of the autoglazed specimens as affected by the bleaching. On the other hand, a weak
inverse relation was found between the roughness and whiteness of the overglazed
specimens, as affected by the bleaching.
Conclusions: In-office bleaching with 35% carbamide peroxide, followed by home
bleaching with 15% carbamide peroxide and a fluoride gel may affect the roughness
and whiteness of overglazed and polished/overglazed Duceram LFC restorations. No
significant change in roughness or whiteness was detected by this bleaching system on
autoglazed Ducera LFC. Ceramic restorations should be protected before any bleaching
for fear of altering their roughness and whiteness. Patients should be advised that their
existing porcelain restorations may not match their natural teeth after bleaching.

The number of people seeking optimum esthetics is growing,
and patients often seek solutions for esthetic problems such
as discolored teeth. In-office and night-guard vital bleaching
are widely used because of their conservative approaches and
effectiveness in removing tooth discoloration.1
Modern bleaching agents used for tooth discolorations con-
tain hydrogen peroxide or carbamide peroxide as active ingre-
dients.2,3 These peroxides penetrate the dental hard tissues and
oxygenate both the dye substances (chromophores) adsorbed
to the enamel surface and those in the enamel and the dentine
tissues. In the process of bleaching, the peroxide attacks unsat-
urated double bonds of the chromophores, which results in col-
orless oxygenated molecules and particles. The chromophores
lose their coloring capacity, and the natural white tooth color is
restored.4
Vital bleaching using carbamide peroxide has been sug-
gested as a safe alternative to vital bleaching with hydro-
gen peroxide.5-7 Many of the systems available today use
10%, 15%, 20% or 35% carbamide peroxide as the active
ingredient.

Journal of Prosthodontics 18 (2009) 223–229 ⃝

c 2009 by The American College of Prosthodontists 223
Effect of Bleaching on Ceramic Surface
Carbamide peroxide solutions are very unstable and immedi-
ately dissociate into their constituents after clinical application
on contact with tissue or saliva.5 The 10% to 16% carbamide
solution breaks down into 3.5% hydrogen peroxide and 7% to
10% urea. The hydrogen peroxide further degrades into oxygen
and water, whereas the urea degrades into ammonia and carbon
dioxide.5,8 Treatment times for night-guard vital bleaching vary
extensively and depend on how much time per day the patient
spends applying the suggested technique.5
Numerous studies have shown bleaching to be effective in
whitening certain types of discolored teeth, but its effect on
enamel and restorative materials is not clearly understood.9-35
Conflicting data exist regarding the effects of bleaching on
enamel. Some authors report no alterations after exposure to
10% to 16% carbamide peroxide,9-11 while others observed
some modifications in enamel especially at lower pH.12-18
The changes recorded in bleached enamel include pitting and
erosion for lower pH solutions,12 increase in enamel wear rate of
bleached teeth,13 decrease in fracture toughness, and decrease in
hardness in the outer enamel.14 According to McGuckin et al,15
bleached enamel appeared to resemble acid-etched enamel. Ma-
tis et al16 and Leonard et al17 concluded that lower concentra-
tions of bleach procedures produced similar color changes as
higher concentrations if used for longer periods.
Regarding bleaching effects on restorative materials, several
studies show contradicting results. Hunsaker et al2 studied the
effect of seven brands of bleaching gels on dentine, enamel, and
restorative materials and concluded that no major changes were
observed with scanning electron microscope examination.
Türker and Biskin19 investigated the effects of three home
bleaching agents on the microhardness of various dental es-
thetic restorative materials. All the bleaching agents decreased
the microhardness of the porcelain and increased that of the
light-cured modified glass ionomer cement.
Türker and Biskin20 also recorded the surface roughness of
three restorative materials (Duceram, Ducera Dental GmbH,
Rosbah, Germany; Fuji II LC, GC Corp, Tokyo, Japan; 3M
Silux Plus, #M dental products, St. Paul, MN) after using three
brands of bleaching agent products (Nite White, Discus Den-
tal Inc, Beverly Dental Inc, Beverly Hills, CA; Opalescence,
Ultradent Products Inc, South Jorden, UT; Rembrandt Lighten-
ing Gel, Den-Mat Corp, Santa Maria, CA). Surface roughness
values increased significantly during the first two weeks for all
bleaching groups of each restorative material, with no signifi-
cant changes observed in the following periods.
Butler et al21 compared the surface roughness of three porce-
lains (feldspathic, low-fusing, and aluminous porcelains) when
exposed to two fluoride solutions, 10% carbamide peroxide, and
distilled water. They concluded that for low-fusing ceramic, the
autoglazed surface had a significantly high mean of 1.23% flu-
oride. The other two ceramics were affected after immersion in
the three solutions; however, the roughness of the three glazed
ceramics was unaffected.
Kamala and Annapurni22 tested the effect of three acidic
solutions (1.23% APF Gel, 16% carbamide peroxide, Coca-
Cola) and distilled water (control) on the roughness (Ra) of
two ceramics: a low-fusing ceramic (Ivoclar classic) and an
all-ceramic (Ivoclar IPS Empress 2). They concluded that acid
solutions etched ceramic surfaces of both ceramics.
224 Journal of Prosthodontics 18 (2009) 223–229 ⃝
Zaki and Fahmy
Roughness is an important surface property and is described
as the overall roughness of a surface. Surface roughness (Ra)
is defined according to measurement techniques as either the
arithmetic mean value of all absolute distances of the roughness
profiles from the centerline within a measuring distance (R2),
or is based on light reflection from the surface.23
The roughness of intraoral hard surfaces enhances initial
adhesion and retention of oral microorganisms and accelerates
maturation of plaque through increasing the area available for
adhesion by a factor of 2 to 3. A rough surface may as well
abrade opposing tooth or restorative materials.24,25 Thus for
optimum esthetics, the surface of dental restorations should be
as smooth as possible.
This study examined the effect of a manufacturer’s proposed
bleaching protocol on surface properties of a low-fusing ce-
ramic. This bleaching system was proposed by Ultradent (Ul-
tradent Products Inc, South Jordan, UT). It consists first of
in-office bleaching using carbamide peroxide 35%, after which
patients seeking lighter shades are sent home for further home
bleaching using 10% to 20% carbamide peroxide interrupted
by fluoride gel applications to decrease sensitivity.
Materials and methods
Forty ultra low-fusing ceramic specimens (Duceram LFC, De-
gussa Dental GmbH, Hanau, Germany) were constructed for
this study. The discs (12-mm diameter, 2-mm thick) were fab-
ricated using a split ring for standardization. The slurry was
packed and vibrated into the ring. The discs were fired in a pro-
grammable and calibrated vacuum furnace according to their
recommended firing cycle. Following caliper control, defective
specimens were adjusted by porcelain powder addition and cor-
rective firings. The fired discs were allowed to air cool to room
temperature then ground flat. Diamond stones (30 µm, Komet,
Lemgo, Germany) were used for corrective grinding to adjust
the disc dimensions, followed by progressively finer abrasives
(15 µm, Komet) using a slow-speed hand piece (Kavo Model
K9, Lake Zurich, IL) at 20,000 rpm. The ceramic discs were
sonicated in distilled water for 10 minutes, and then half the
discs were autoglazed while the rest were overglazed. Each
glazing procedure was performed according to the manufac-
turer’s instructions.
The two main groups (autoglazed, overglazed) were further
divided into subgroups of four. Group I: autoglazed (control
group I), bleached autoglazed, diamond polished, and diamond
polished and bleached. Group II: overglazed (control group II),
bleached overglazed, diamond polished, diamond polished and
bleached (bringing the total to eight subgroups) (Table 1).
The polished discs within each group were prepared by grind-
ing to remove the glazed surface using medium grit diamond
points followed by polishing using a special polishing kit (RA
320 EVE Diasynet, Diacera, Germany). The kit consisted of
rubber points formed of a unique blend of diamond grits inter-
spersed in a special synthetic rubber matrix.
In control groups I and II (n = 10), the discs were kept in
distilled water, which was changed daily.
Specimens (n = 30) were initially treated with 35% car-
bamide peroxide gel for 2 hours representing the first in-office
bleaching session. Specimens were then treated with 15%
c 2009 by The American College of Prosthodontists
Zaki and Fahmy Effect of Bleaching on Ceramic Surface

Table 1 Eight subgroups (n = 5 in each subgroup) Table 2 ANOVA test for roughness values (Ra) of surface treatments of
autoglaze
Group I : autoglazed Group II : overglazed
Bleaching +
i. Autoglazed—control group I i. Overglazed—control group II
Control Bleaching Polishing polishing
ii. Autoglazed and bleached ii. Overglazed and bleached
iii. Autoglazed and diamond iii. Overglazed and diamond Mean roughness (Ra) 139.715 135.281 134.854 135.143
polished polished Std. deviation 0.755 4.960 2.029 2.884
iv. Autoglazed/diamond iv. Overglazed/diamond N 20 10 40 24
polished and bleached polished and bleached p-value 0.35
Significance NS

The mean difference is significant if p-value < 0.05.

carbamide peroxide for 8 hours, (6 applications) interrupted

by three applications, each of 10-hour duration using Flor-Opal Results
(Ultradent, South Jordan, UT). At the end of each bleaching
step, the treated specimens were washed and cleaned under Roughness
running water in readiness for the next application. Bleaching did not significantly affect the surface roughness of
autoglazed or autoglazed and diamond polished Duceram LFC
ceramic (Ducera Dental GmbH, Rosbah, Germany) (Table 2);
Roughness testing
however, bleaching significantly increased the roughness of the
overglazed and polished overglazed ceramic (Table 3).
Roughness was measured using roughness software (Image J, By comparing the surface treatments within the overglazed
1.31 b, NIH, Washington, DC). The software uses an image group, it was found that bleaching of the overglazed group
captured by a CCD zoom digital camera (DP 10-Olympus, had no significance on its roughness; however, bleaching of
Tokyo, Japan) stereomicroscope at 20 × magnification. The diamond polished overglazed samples significantly increased
main idea is the placement mounting of the specimen on a the roughness of the ceramic (Table 4).
standardized site on the mechanical stage with the light source Group statistics showed that polished overglazed ceramic
at 90◦ . This angle is standardized by the use of a cool ring light was smoother than polished autoglazed Ducera ceramic, but no
mounted around the objective lens. It records a photo of the other statistical difference was found (Table 5).
tested surface and then interprets the roughness as shadows of
the peaks and valleys, with the lower values indicating higher
Color
roughness contrary to the profilometer. In the case of rough
surfaces, the Ra value indicates a low measure of gray scale Bleaching of autoglazed and polished autoglazed Duceram LFC
from a central baseline (i.e., towards the 0 value, as 0 value resulted in increased whitening of the ceramic (Table 6). The
indicates black, while 255 value indicates white). overglazed group had significant increased whiteness com-
Baseline surface measurements were made before the first pared to the autoglazed group. It appeared that bleaching
application and repeated after the final treatment. The Ra value whitened the overglazed specimens significantly, whereas pol-
is derived as the arithmetic mean of the departure from the ishing alone showed less whiteness. Whiteness increased in the
mean line of the reading. The initial and final Ra mean values entire bleached overglazed group (Table 7).
for each of the tested specimens were recorded and tabulated. There appeared to be a strong inverse relation between the
The mean Ra values for each group were recorded, tabulated, roughness and the whiteness of the autoglazed specimens as
and statistically analyzed. affected by the bleaching (Table 8). This suggests that bleach-
ing increased whiteness when roughening values were not sig-
nificantly altered. On the other hand, a weak inverse relation
was found between the roughness and the whiteness of the
Color testing
Color measurement was performed using image analysis soft- Table 3 ANOVA test for roughness values (Ra) of surface treatments of
ware (Image J 1.34, NIH, Washington, DC). The colored image overglaze
is transformed into an 8-bit image, grayscale being from 0 to
255 where 0 is black, and 255 is white. The color was measured Bleaching +
within five fields for the same specimen, and the means were Control Bleaching Polishing polishing
calculated. Mean roughness (Ra) 139.826 138.052 137.738 135.011
The results from roughness and whiteness testing were tab- Std. deviation 1.479 3.479 0.616 3.219
ulated and statistically analyzed using one-way ANOVA, post N 20 10 40 19
hoc (Bonferroni test) for multiple comparisons, and indepen- p-value 0.03
dent samples t-test. Spearman correlation was done to correlate Significance S
roughness and whiteness values after bleaching. A p-value <
0.05 was considered significant in all tests. The mean difference is significant if p-value < 0.05.

Journal of Prosthodontics 18 (2009) 223–229 ⃝

c 2009 by The American College of Prosthodontists 225
Effect of Bleaching on Ceramic Surface Zaki and Fahmy

Table 4 Multiple comparisons post hoc test (Bonferroni) for comparison of mean roughness

95% Confidence interval

Mean
(I) Overglazed II (J) Overglazed difference (I−J) p-value Significance Lower bound Upper bound

Control II Polished 2.088 0.443 NS −3.396 7.571

Bleached 1.774 0.466 NS −3.130 7.571
Bleached-polished 4.815 0.045 S 0.108 9.522
Polished Bleached −0.313 0.866 NS −4.059 3.432
Bleached-polished 2.727 0.120 NS −0.756 6.210
Bleached Bleached-polished 3.041 0.018 S 0.567 5.514

The mean difference is significant if p-value < 0.05.

overglazed specimens, as affected by the bleaching (Table 9). justments is mandatory to improve the esthetics, strength, and
This suggests that as bleaching altered the roughness of the longevity of the restoration.28 Additionally, a smooth surface
ceramic, it also affected its whiteness. texture is important for the color of the restoration, since it re-
flects a greater amount of light than a rough surface.31

Discussion
Dental porcelain is widely used in restorations, including all-
ceramic crowns, metal ceramic crowns, and fixed partial den-
tures due its excellent esthetic properties, durability, and com-
patibility.26 It is common practice to grind the glazed surface
of porcelain restorations for final adjustment to correct oc-
clusal interferences and inadequate contours and to improve
esthetics.27,28 This procedure removes the surface glaze and
introduces flaws.29
A glazed ceramic surface is generally considered favorable,
as it is thought to increase the fracture resistance and reduce
the potential abrasiveness of the ceramic surface by sealing the
open sores in the surface of the fired porcelain.30
Dental overglazes are composed of colorless glass powders
applied to the fired crown surface to produce a glossy surface,
while natural glaze (autoglaze) is a vitrified layer that forms
on the surface of the porcelain containing a glass phase when
the porcelain is heated to a glazing temperature for a specified
time.29 Intraoral adjustments break the glazed surfaces and cre-
ate rough surfaces, which promote plaque formation, irritate
soft tissues, and increase the wear of the opposing dentition or
restorative materials. Therefore, glazing or polishing after ad-
Roughness
Roughness was recorded using a photo of the tested surface,
which was then interpreted as shadows of the peaks and valleys,
with lower values indicating higher roughness.
Bleaching did not significantly alter the surface roughness
of the autoglazed ceramic group; however, it significantly in-
creased the roughness of the polished overglazed ceramic. By
comparing autoglazed to overglazed ceramic we find that even
though autoglazed and overglazed Ducera had the same rough-
ness values initially, bleaching appeared to significantly in-
crease the roughness of the overglazed ceramic.
This increased roughness may have been caused by a mild
etching of the ceramic caused by the carbamide peroxide agent
used along with the additive effect of the Flor-Opal gel (Ul-
tradent Products Inc, South Jordan, UT). Hydroflouric acid is
known to be an etchant of feldspathic ceramics as it causes
dissolution of glass-matrix-creating micro-irregularities. It is
used as a treatment to enhance resin adhesion. In addition,
in their study on the effect of bleaching on ceramics, Türker
and Biskin19,20 revealed a reduction in the feldspathic porce-
lain surface SiO 2 content of between 4.82% and 4.44%, which
probably contributed to the increased roughness detected.

Table 5 Independent samples t-test of autoglaze versus overglaze

roughness values

Std. Table 6 ANOVA test for whiteness of surface treatments of autoglaze

Surface treatment N Mean deviation p-value Significance
Control I:
Control–auto (I) 5 139.715 0.754 0.936 NS autoglaze Bleaching +
Control–over (II) 5 139.826 1.479 group Bleaching Polishing polishing
Bleach–auto (I) 5 135.281 4.960 0.167 NS
Bleach–over (II) 5 138.052 3.479 Grayscale of 135.625 138.641 137.111 140.175
Polish–auto (I) 5 134.854 2.029 0.035 S whiteness
Polish–over (II) 5 137.738 0.616 Std. deviation 5.397 21.473 5.533 10.879
Bleach and 5 135.200 3.065 0.404 NS N 8 40 8 40
polish–auto (I) p-value 0.86
Bleach and 5 134.284 3.248 Significance NS
polish–over (II)
The mean difference is significant if p-value < 0.05.

226 Journal of Prosthodontics 18 (2009) 223–229 ⃝

c 2009 by The American College of Prosthodontists
Zaki and Fahmy Effect of Bleaching on Ceramic Surface

Table 7 ANOVA test for whiteness of surface treatments of overglaze Table 9 Correlation between roughness and whiteness of overglazed
specimens using Spearman correlation
Control II:
overglaze Bleaching + Correlation Roughness Whiteness
group Bleaching Polishing polishing
Roughness 1 −0.300
Grayscale of 152.888 161.279 149.775 153.095 Whiteness −0.300 1
whiteness Type Inverse
Std. deviation 21.099 11.467 12.874 10.988 Strength Weak
N 8 40 8 20
p-value 0.021
Significance S
Canay and Cehreli39 also reported clinically noticeable higher
The mean difference is significant if p-value < 0.05. color changes following bleaching with 10% carbamide per-
oxide, for polyacid-modified composite restoratives than for
hybrid and macrofilled composites. They related the amount
of color change to the matrix content, filler amount, and type.
The removal of the overglaze layer from the ceramic surface They attributed this to the presence of strontium fluorosilicate
by diamond polishing must have modified the glaze layer ex- glass, which accounts for 72% of its composition (by weight).
posing the ceramic and further enhanced the etchant effects of It would seem that the reduction in the SiO 2 content after ce-
the bleaching system used. ramic bleaching reported by Türker and Biskin19,20 could have
This finding agrees with those of White et al,32 Rosen- caused this color change. Furthermore, increasingly roughened
tritt et al,33 De A Silva et al,34 and Moraes et al;36 however, surfaces would reflect the individual segments of the specular
Duschner et al37 reported no changes in surface morphology of beam at slightly different angles.32,37
porcelain exposed to bleaching. This could have been due to Change in whiteness induced in the overglazed group only
the lower concentration of the bleaching agents used in their and not in the autoglaze group may be due to the difference in
study. the heat treatment the ceramic was exposed to during the glaze
Clinically, this implies that if we expose diamond-polished cycle, rendering the autoglazed group more resistant to the
overglazed ceramic to bleaching, we significantly increase its etching effects of the bleaching system. Polishing of overglazed
roughness, causing more plaque retention, bacterial adherence ceramic alone, however, did not affect whiteness.
and soft tissue irritation. Since diamond polishing of ceramics
is often performed after occlusal adjustments of restorations,
these restorations should be protected by a barrier before any
bleaching procedure is performed. Correlation between roughness and whiteness
Spearman correlation was done to correlate roughness and
whiteness values after bleaching. A strong inverse relation was
Color found between the roughness and the whiteness of the auto-
glazed specimens as affected by the bleaching. This suggests
No significant difference in whiteness was detected by bleach- that the higher the Ra value of the roughness, in this case indi-
ing within the autoglazed ceramic group, even though numer- cating a smoother surface, the less the whiteness of the ceramic.
ically there was a slight increase in whiteness. This implies When the ceramic is bleached, the Ra value is numerically de-
that bleaching auotglazed Ducera LFC ceramic does not alter creased (meaning increased roughness), and the lightness is
its whiteness. This is in agreement with the negative effect of increased. This suggests that the more reactive the bleaching
color changes reported when bleaching with carbamide perox- agent is in causing dissolution of the ceramic, the more its
ide gel;38 however, bleaching of overglazed and polished over- whiteness will increase, suggesting it will appear whiter, as in
glazed Duceram LFC resulted in increased whitening of the etched frosted enamel. On the other hand, there is a weak in-
ceramic. This suggests that whitening occurs when overglazed verse relation between the roughness and the whiteness of the
and polished overglazed ceramics are exposed to bleaching. overglazed specimens, as affected by bleaching. This suggests
This is in agreement with the findings of Rosentritt et al,33 that as bleaching affects the roughness of the ceramic, it may
who reported color change in some restorative materials (com- increase its whiteness. The whitening effect of the bleached
posite, compomer, and ormocer) they tested after bleaching. ceramic is increased by the increased roughening (decreased
numerical value) of the overglazed ceramic.
Table 8 Correlation between roughness and whiteness of autoglazed A rough or irregular surface texture will reflect an irregular
specimens using Spearman correlation and diffuse pattern of light, which will modify the color of
the restoration.31 Kim et al40 stated that surface topography
Correlation Whiteness Roughness influenced the color of porcelain, especially the CIE L∗ value.
Whiteness 1 −0.728
The lightness induced by the bleaching gel and Flor-Opal
Roughness −0.728 1 used may come from the change in surface topography in ad-
Type Inverse dition to some chemical change that may have occurred by
Strength Strong unstable free radicals that are generated from these compounds
through either an oxidation or reduction reaction.41

Journal of Prosthodontics 18 (2009) 223–229 ⃝

c 2009 by The American College of Prosthodontists 227
Effect of Bleaching on Ceramic Surface
Further investigation is needed to correlate the exact mech-
anism and quantity of whiteness change as affected by the
bleaching system used before any treatment is undertaken.
Conclusions
(1) In-office bleaching with 35% carbamide peroxide, fol-
lowed by home bleaching with 15% carbamide perox-
ide and a fluoride gel may affect the roughness and
whiteness of overglazed and polished overglazed Duce-
ram LFC restorations.
(2) Bleaching whitens overglazed Duceram LFC.
(3) No significant change in roughness or whiteness was de-
tected by this bleaching system on autoglazed Ducera
LFC.
(4) Ceramic restorations should be protected before any
bleaching for fear of roughness and color change.
(5) Patients should be advised that their existing porcelain
restorations might not match their natural teeth after
bleaching.
Acknowledgments
Imaging and calculations were done in the Advanced Research
and Tumor Markers Unit, Oral Pathology Department, Faculty
of Dentistry, Ain Shams University, Egypt. Thanks are extended
to Dr. Ihab S.Abdel-Hamid for his technical help in the testing
and statistics of this study.
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