Triple-blinded randomized clinical trial comparing efficacy and tooth sensitivity of in-office and at-home bleaching techniques

Abstract

Triple-blinded randomized clinical trial comparing efficacy and tooth sensitivity of in-office and at-home bleaching techniquesObjective: Our study aims to compare the efficacy and tooth sensitivity following in-office (35% hydrogen peroxide) or at-home (10% carbamide peroxide) bleaching treatments both preceded by 2% potassium nitrate (2%KF) desensitizing gel. Methodology: 130 volunteers were randomly allocated to a) in-office bleaching and a placebo at-home protocol; or b) in-office placebo and at-home bleaching treatment. 2% KF was applied for 10 min before both treatments. Objective: color evaluation was performed (spectrophotometer CIEL*a*b* system and CIEDE2000) to calculate the color change (ΔE00). Subjective evaluation was performed using the VITA classical shade guide followed by shade variation (ΔSGU) at the beginning and end of bleaching treatment and 2 weeks post-bleaching. Tooth sensitivity was daily recorded using a Likert scale varying from 1 (no sensitivity) to 5 (severe sensitivity). Analysis was carried out using non-parametric tests.Results: Regarding the color change, at-home bleaching resulted in significant color improvement compared to in-office treatment for the parameters Δb* (p=0.003) and Δa* (p=0.014). Two weeks post-bleaching, the at-home treatment resulted in significant color improvement compared to in-office treatment for the parameters Δb* (p=0.037) and ΔE00 (p=0.033). No differences were observed in either ΔSGU parameters. Concerning sensitivity, patients treated with in-office bleaching reported more tooth sensitivity than the at-home group only on the first day after bleaching started, without significant differences in the other periods evaluated (p>0.05). Conclusions: At-home and in-office bleaching, preceded by a desensitizing agent, were effective for vital teeth bleaching and 10% carbamide peroxide produced a higher whitening effect than 35% hydrogen peroxide in the short time evaluation. Tooth sensitivity rates were similar for the two techniques tested.

Correlation between patient satisfaction and color changes after tooth bleaching

“…After undergoing two bleaching sessions, the b* values exhibited the most pronounced change, followed by the L* value, with the a * value trailing. This sequence corroborated the patterns observed in previous studies 42,43 . Researchers had found that alteration in b * values served as the most accurate indicator of color change 44 .…”

“…This sequence corroborated the patterns observed in previous studies. 42,43 Researchers had found that alteration in b* values served as the most accurate indicator of color change. 44 Conversely, another study revealed that shifts in L* values were superior indicators of tooth bleaching effectiveness.…”

“…Two researchers who were instructed in the use of the spectrophotometer were assigned to perform the color measurements. The L *, a *, and b * values of each tooth were recorded, and the average value was calculated based on three measurements per tooth 42–45 . Measurements were taken at multiple time points: baseline (T1), after the first bleaching session (T2), after the second bleaching session (T3), 1 week after the second bleaching session (T4), and 3 weeks after the second bleaching session (T5) 46 .…”

“…The L*, a*, and b* values of each tooth were recorded, and the average value was calculated based on three measurements per tooth. [42][43][44][45] Measurements were taken at multiple time points: baseline (T1), after the first bleaching session (T2), after the second bleaching session (T3), 1 week after the second bleaching session (T4), and 3 weeks after the second bleaching session (T5). 46 The assessment of tooth color change was performed using the CIEDE2000 color-difference formula (ΔE 00 ).…”

Effect of antioxidant on tooth sensitivity after bleaching

“…This agreed with a previous study, which reported moderate and more severe sensitivity on the day the gel was applied, and it virtually decreased after 4 days for the majority of individuals. 53 Another study noted that some patients experienced "severe shock-like pain" within 1 h of treatment. In the fourth to seventh day following the procedure, the tooth sensitivity was restored to normal levels.…”