This study was undertaken to achieve a high bleaching efficacy with plasma, through longer application and reparative bleaching processes, by different shade evaluation methods. Extracted human teeth were divided into 6 groups (n=10). All teeth were treated in pairs. Low concentration of 15% carbamide peroxide (CP) was applied, with and without plasma, for 10, 20, and 30-min tooth bleaching, respectively. The bleaching procedure was repeated once daily for four days. The teeth were maintained in a moist environment provided by artificial saliva. The Vitapan Classical shade guide and Commission Internationale de L’Eclairage (CIELAB) color system were collectively used to measure the bleaching efficacy. Color evaluation was statistically analyzed using Student t-test and one-way analysis of variance (ANOVA) complemented by Tukey’s test. Combining the plasma with 15% CP showed significantly greater color changes compared to bleaching without plasma (p<0.05). A high bleaching efficacy with plasma is proportional to the repetitive application and the treatment time. A 30-min application with plasma provided the best bleaching. Repetitive bleaching showed lower probability of color relapse of the bleached tooth. The color change by shade guide correlated with the changes in CIELAB color system. A value of 1 color change units (CCU) conversion factor for overall color change (ΔE) values comparisons was 3.724 values. The two measuring methods provide a more accurate correspondence of color change. The repetitive and longer application for tooth bleaching, combined with plasma, has a strong bleaching effect and produces whiter teeth.

Nonthermal atmospheric pressure plasma has attracted great interest for biomedical applications. The plasma consists of charged particles, radicals, and a strong electric field as the fourth state of matter. This study evaluated the change in the surface roughness after tooth bleaching by plasma in combination with a low concentration (15%) of carbamide peroxide, specifically whether the application of plasma produced detriments, such as demineralization and structural change, with the goal of efficient and safe tooth bleaching. After being combined with plasma and 15% carbamide peroxide, the hydroxyapatite surface was significantly smoother with a low roughness average value. Tooth bleaching with 15% carbamide peroxide alone produced an irregular surface and increased the surface roughness with high roughness average value. Tooth bleaching with plasma resulted in no significant variations in hydroxyapatite in terms of change in surface roughness and surface topography. The application of tooth bleaching with plasma is not deleterious to dental hard tissue, implicating it as a safe tooth bleaching technique.