Comparison of Two At-home Whitening Products of Similar Peroxide Concentration and Different Delivery Methods

SUMMARY Purpose This study compared the whitening efficacy, side effects, and patients' preferences/perceptions of two whitening systems of similar peroxide concentration but different formulation and delivery methods. Methods The tooth color change of 24 participants was measured using a shade guide (BSG) and a spectrophotometer (ES). Color difference was calculated: ΔE* = [(ΔL*)2 + (Δa*)2 + (Δb*)2]1/2. One whitening treatment was randomly applied to the right or left maxillary anterior teeth and the other was applied to the contralateral teeth, at-home with 35% carbamide peroxide in a tray (TW) or with 14% hydrogen peroxide in strips (WS). The tooth color was evaluated at baseline, 15 and 30 days (15 days postwhitening). Participants rated their tooth and soft tissue sensitivity (1–10 scale) and completed a questionnaire on their preferences. Results were analyzed by repeated measurement regression analysis/Tukey and Mann-Whitney (p<0.05). Results At 15 days, the teeth treated with TW and WS presented ΔE* = 7 and 6, respectively (ΔBSG=3 for both), and at 30 days, they presented ΔE* = 7.5 and 6.5, respectively (ΔBSG=3 for both). There was no significant difference in tooth and soft tissue sensitivity between treatments. No participant reported tooth and gingival sensitivity at the postwhitening appointment. Of the participants, 83% preferred the TW over WS. Conclusion Both ΔE* and ΔBSG showed no significant difference in tooth color change between TW and SW at either time point. By the end of the study no participants reported tooth and gingival sensitivity. Participants preferred TW over SW.

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The degree of color change, rebound effect and sensitivity of bleached teeth associated with at-home and power bleaching techniques: A randomized clinical trial

European Journal of Dentistry ◽

10.4103/1305-7456.120655 ◽

2013 ◽

Vol 07 (04) ◽

pp. 405-411 ◽

Cited By ~ 22

Author(s):

Fatemeh Velayati Moghadam ◽

Sara Majidinia ◽

Joseph Chasteen ◽

Marjaneh Ghavamnasiri

Keyword(s):

Clinical Trial ◽

Randomized Clinical Trial ◽

Color Change ◽

Rebound Effect ◽

Color Difference ◽

Chi Square ◽

Tooth Color ◽

Anterior Teeth ◽

Significant Difference ◽

At Home

ABSTRACT Aim: The purpose of the present randomized clinical trial was to evaluate the color change, rebound effect and sensitivity of at-home bleaching with 15% carbamide peroxide and power bleaching using 38% hydrogen peroxide. Materials and Methods: For bleaching techniques, 20 subjects were randomized in a split mouth design (at-home and power bleaching): In maxillary and mandibular anterior teeth (n = 20). Color was recorded before bleaching, immediately after bleaching, at 2 weeks, 1, 3 and 6 month intervals. Tooth sensitivity was recorded using the visual analog scale. The Mann-Whitney test was used to compare both groups regarding bleaching effectiveness (∆E 1 ), rebound effect (∆E 2 ) and color difference between the rebounded tooth color and unbleached teeth (∆E 3) while the Wilcoxon compared ∆E within each group. Distribution of sensitivity was evaluated using the Chi-square test (α =0.05). Results: There was no significant difference between groups regarding ∆E 1 and ∆E 3 (P > 0.05). Even though, ∆E 2 showed no significant difference between groups after bleaching as well as at 2 week, 1 month and 3 month follow-up periods (P > 0.05). Although, significant difference was found in ∆E 2 (P < 0.05 Mann-Whitney) between two methods after 6 months and a high degree of rebound effect was obtained with power bleaching. Within each group, there was no significant difference between ∆E 1 and ∆E 3 (P < 0.05 Wilcoxon). The distribution of sensitivity was identical with both techniques (P > 0.05).Conclusion: Bleaching techniques resulted in identical tooth whitening and post-operative sensitivity using both techniques, but faster color regression was found with power bleaching even though color regression to the baseline of the teeth in both groups was the same after 6 months.

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Photobiomodulation vs. Placebo on Post-Bleaching Sensitivity and Color Change: A Split-Mouth Clinical Study

The Open Dentistry Journal ◽

10.2174/1874210602014010267 ◽

2020 ◽

Vol 14 (1) ◽

pp. 267-274

Author(s):

Caroline C. de Silva ◽

Cristiane de M. Alencar ◽

Brennda L. F. de Paula ◽

Fernanda F. de A. Jassé ◽

Jesuína L. N. Araújo ◽

...

Keyword(s):

Hydrogen Peroxide ◽

Color Change ◽

Tooth Bleaching ◽

Low Level Laser Therapy ◽

Tooth Color ◽

Pain Evaluation ◽

Level Laser ◽

Significant Difference ◽

The Right ◽

Post Hoc

Objective: This study aimed to investigate the efficiency of Photobiomodulation (PBM) with low-level LASER therapy compared to placebo in post-bleaching sensitivity and color change during a three-week office bleaching treatment. Methods: A split-mouth model was used to evaluate 21 subjects. The right and left hemi-archs were randomized to one of two groups: GP (placebo): simulated LASER application followed by tooth bleaching with 35% hydrogen peroxide; and GL: treated with PBM followed by tooth bleaching with 35% hydrogen peroxide. A four-degree modified Visual Analog Scale (VAS) was used to assess tooth sensitivity after the application of an evaporative stimulus (stimulated pain). In addition, a daily questionnaire was used to measure unstimulated pain. The color change was measured using a spectrophotometer. The Friedman and Wilcoxon tests were used to analyze data sensitivity. Color results were statistically analyzed using Analysis Of Variance (ANOVA) followed by the Tukey post-hoc test. Results: There was no significant difference between GP and GL for stimulated pain evaluation (p> 0.05). However, there was a significant difference between the groups for unstimulated pain evaluation (p≤ 0.05). In addition, ΔE data did not reveal any significant difference in tooth color between groups at any time (p> 0.05). Conclusion: PBM prevented post-bleaching sensitivity compared to placebo, based on the daily pain assessment questionnaires. PBM did not compromise the quality of bleaching treatments.

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Laser Influence on Dental Sensitivity Compared to Other Light Sources Used During In-office Dental Bleaching: Systematic Review and Meta-analysis

Operative Dentistry ◽

10.2341/19-064-l ◽

2020 ◽

Vol 45 (6) ◽

pp. 589-597

Author(s):

BGS Casado ◽

EP Pellizzer ◽

JR Souto Maior ◽

CAA Lemos ◽

BCE Vasconcelos ◽

...

Keyword(s):

Randomized Clinical Trials ◽

Color Change ◽

Meta Analysis ◽

Present Review ◽

Cochrane Library ◽

Light Sources ◽

Eligibility Criteria ◽

Tooth Color ◽

Significant Difference ◽

Meta Analyses

Clinical Relevance The use of laser light during bleaching will not reduce the incidence or severity of sensitivity and will not increase the degree of color change compared with nonlaser light sources. SUMMARY Objective: To evaluate whether the use of laser during in-office bleaching promotes a reduction in dental sensitivity after bleaching compared with other light sources. Methods: The present review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and is registered with PROSPERO (CDR42018096591). Searches were conducted in the PubMed/Medline, Web of Science, and Cochrane Library databases for relevant articles published up to August 2018. Only randomized clinical trials among adults that compared the use of laser during in-office whitening and other light sources were considered eligible. Results: After analysis of the texts retrieved during the database search, six articles met the eligibility criteria and were selected for the present review. For the outcome dental sensitivity, no significant difference was found favoring any type of light either for intensity (mean difference [MD]: −1.60; confidence interval [CI]: −3.42 to 0.22; p=0.09) or incidence (MD: 1.00; CI: 0.755 to 1.33; p=1.00). Regarding change in tooth color, no significant differences were found between the use of the laser and other light sources (MD: −2.22; CI: −6.36 to 1.93; p=0.29). Conclusions: Within the limitations of the present study, laser exerts no influence on tooth sensitivity compared with other light sources when used during in-office bleaching. The included studies demonstrated that laser use during in-office bleaching may have no influence on tooth color change.

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Tratamento de trauma oclusal anterior com pino de fibra de vidro associado à coroa de dissilicato de lítio Anterior occlusal trauma treatment with fiberglass pin associated to lithium disilicate crown

RSBO ◽

10.21726/rsbo.v1i1.592 ◽

2018 ◽

Vol 15 (1) ◽

pp. 66

Author(s):

Raisa Carolina Hintz ◽

Rafaela Caramori Saab ◽

Eugenio Garcia ◽

Sergio Paulo Hilgenberg ◽

Leonardo Fernandes da Cunha ◽

...

Keyword(s):

Lithium Disilicate ◽

Tooth Color ◽

Anterior Teeth ◽

Aesthetic Appearance ◽

New Treatment ◽

The Aesthetic ◽

Aesthetic Dentistry ◽

The Right ◽

Dental Whitening ◽

Treatment Alternatives

Introdução: A aparência estética é uma das preocupações do ser humano, o que leva a uma busca constante por uma estética que expresse harmonia, naturalidade e expressividade. Sendo assim, os procedimentos restauradores têm contribuído positivamente para a resolução dos desafios odontológicos estéticos. Objetivo e relato de caso: Relatar um caso clínico com associação de clareamento dental, confecção de pino intrarradicular e coroa indireta em dissilicato de lítio em que foi devolvida ao paciente a estética desejada. Pacientede 23 anos de idade fraturou o incisivo central superior direito na infância; insatisfeito com a instabilidade de cor do dente, buscou novas alternativas de tratamento. Conclusão: A associação de diferentes tratamentos na Odontologia estética pode apresentar resultados satisfatórios para o restabelecimento estético e funcional de dentes anteriores.Introduction: The aesthetic appearance is one of the human being concerns, leading to constant search for an aesthetic that expresses harmony, naturalness and expressiveness. So, the restorative procedures have contributed positively to overcome the aesthetic dentistry challenges. Objective and case report: Report a clinical case in association to dental whitening, making of intraradicular pin and indirect crown of lithium disilicate when it was returned to the patient the desired aesthetic. A 23 years old patient fractured the right central incisor in the childhood, dissatisfied with the tooth color instability, he looked for new treatment alternatives. Conclusion: The association of different treatments in the aesthetic dentistry might present satisfactory results to the aesthetic and functional reestablishment of anterior teeth.

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Perbedaan efektivitas jus tomat (Lucopersicon esculentum Mill.) dan jus apel (Mallus sylvestris Mill.) sebagai bahan alami pemutih gigi

e-GIGI ◽

10.35790/eg.4.2.2016.13488 ◽

2016 ◽

Vol 4 (2) ◽

Author(s):

Enny F. S. Lumuhu ◽

Martha M. Kaseke ◽

Wulan G. Parengkuan

Keyword(s):

Apple Juice ◽

Color Change ◽

Human Interaction ◽

Tomato Juice ◽

Control Group ◽

Carbamide Peroxide ◽

Control Group Design ◽

Anterior Teeth ◽

Tooth Discoloration ◽

Significant Difference

Abstract: Teeth appearance plays an important role in human interaction. One of its problems is tooth discoloration which can affect personal self confidence and appearance. Chemicals for whitening the teeth can cause negative effects such as decreased enamel hardness and gingival iritaion. An alternative material that can be used for that purpose is natural substance inter alia tomato juice (Lucopersicon esculentum Mill.) which contains hydrogen peroxide and apple juice (Mallus sylvestris Mill.) which contains malic acid. This study aimed to determine the difference in effectiveness of tomato juice and apple juice as natural bleaching agents. This was a true experimental study with a pretest postest only control group design. There were 30 samples of post-extraction anterior teeth soaked in coffee for 12 days and were further divided into 3 groups, each of 10 samples. Group 1 was immersed in tomato juice; group 2 was immersed in apple juice; and group 3 as the positive control was immersed in carbamide peroxide 10%. Each group was observed after 1 day, 3 days, and 5 days. The color change was measured by using CIEL*a*b method. The results showed that tomato juice, apple juice, and carbamide peroxide 10% could whiten the teeth. However, tomato juice was more effective compared to apple juice and carbamide peroxide 10%. Apple juice and carbamide peroxide 10% did not show any significant difference in color change. Keywords: tomato juice, apple juice, carbamide peroxide 10%, tooth discolorationAbstrak: Penampilan gigi berperan dalam interaksi manusia. Masalah dalam penampilan gigi salah satunya ialah perubahan warna gigi yang dapat memengaruhi kepercayaan diri dan keindahan penampilan seseorang. Penggunaan bahan kimia untuk memutihkan gigi dapat berdampak negatif seperti penurunan kekerasan email dan iritasi gingiva. Bahan alternatif yang dapat digunakan untuk memutihkan gigi yaitu dengan bahan alami antara lain jus tomat (Lucopersicon esculentum Mill.) yang mengandung hidrogen peroksida dan jus apel (Mallus sylvestris Mill.) yang mengandung asam malat. Penelitian ini bertujuan untuk mengetahui perbedaan efektivitas jus tomat dan jus apel sebagai bahan alami pemutih gigi. Terdapat 30 sampel gigi anterior pasca ekstraksi yang direndam kopi selama 12 hari. Sampel dibagi menjadi 3 kelompok masing-masing terdiri dari 10 sampel. Kelompok 1 direndam dalam jus tomat; kelompok 2 direndam dalam jus apel; dan kelompok 3 sebagai kontrol positif menggunakan karbamid peroksida 10%. Setiap kelompok dilakukan pengamatan 1 hari, 3 hari dan 5 hari. Perubahan warna diukur menggunakan metode CIEL*a*b. Hasil penelitian mendapatkan jus tomat, jus apel, dan karbamid peroksida 10% dapat memutihkan gigi. Jus tomat lebih efektif memutihkan gigi dibandingkan jus apel dan karbamid peroksida 10%. Jus apel dan karbamid peroksida 10% tidak memiliki perbedaan memutihkan gigi yang signifikan.Kata kunci: jus tomat, jus apel, karbamid peroksida 10%, perubahan warna gigi

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Primary failure rate for 1680 extra-alveolar mandibular buccal shelf mini-screws placed in movable mucosa or attached gingiva

The Angle Orthodontist ◽

10.2319/092714.695.1 ◽

2015 ◽

Vol 85 (6) ◽

pp. 905-910 ◽

Cited By ~ 49

Author(s):

Chris Chang ◽

Sean S.Y. Liu ◽

W. Eugene Roberts

Keyword(s):

Stainless Steel ◽

Soft Tissue ◽

Failure Rate ◽

Alveolar Process ◽

Second Molar ◽

Initial Failure ◽

Attached Gingiva ◽

Significant Difference ◽

Insignificant Difference ◽

The Right

ABSTRACT Objective: To compare the initial failure rate (≤4 months) for extra-alveolar mandibular buccal shelf (MBS) miniscrews placed in movable mucosa (MM) or attached gingiva (AG). Materials and Methods: A total of 1680 consecutive stainless steel (SS) 2 × 12-mm MBS miniscrews were placed in 840 patients (405 males and 435 females; mean age, 16 ± 5 years). All screws were placed lateral to the alveolar process and buccal to the lower first and second molar roots. The screw heads were at least 5 mm superior to the soft tissue. Loads from 8 oz–14 oz (227 g–397 g, 231–405 cN) were used to retract the mandibular buccal segments for at least 4 months. Results: Overall, 121 miniscrews out of 1680 (7.2%) failed: 7.31% were in MM and 6.85% were in AG (statistically insignificant difference). Failures were unilateral in 89 patients and bilateral in 16. Left side (9.29%) failures was significantly greater (P < .001) compared with those on the right (5.12%). Average age for failure patients was 14 ± 3 years. Conclusion: MBS miniscrews were highly successful (approximately 93%), but there was no significant difference between placement in MM or AG. Failures were more common on the patient's left side and in younger adolescent patients. Having 16 patients with bilateral failures suggests that a small fraction of patients (1.9%) are predisposed to failure with this method.

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EFEKTIVITAS EKSTRAK STROBERI DAN JERUK MADU DALAM PERUBAHAN WARNA GIGI SECARA IN VITRO

Jurnal Ilmiah PANNMED (Pharmacist, Analyst, Nurse, Nutrition, Midwivery, Environment, Dentist) ◽

10.36911/pannmed.v16i1.1059 ◽

2021 ◽

Vol 16 (1) ◽

pp. 209-213

Author(s):

Nalem Rika Rahayu

Keyword(s):

Color Change ◽

Laboratory Research ◽

Carbamide Peroxide ◽

Tooth Color ◽

Sample Group ◽

Tooth Discoloration ◽

Significant Difference ◽

Experimental Laboratory ◽

Shade Guide

ABSTRACT Changing tooth color affects a person's aesthetics. Methods to restore tooth discoloration include the use ofagents bleaching. This study aims to understand the differences in the effectiveness of strawberry and honey orange extracts intooth discoloration in vitro. This type of experimental laboratory research used 45 premolar tooth samples divided into 3 groups (50% strawberry extract and 10% carbamide peroxide concentration, 50% honey orange extract and 10% carbamide peroxide concentration and 10% carbamide peroxide concentration). Samples were immersed in coffee solution for 5 days and recorded color with a shade guide, then samples were immersed in the extract of strawberries, honey oranges and carbamide peroxide for 7 days in an incubator, then recorded color again visually with a shade guide. Data analysis used thestatistical tests Oneway Anova and Posthoc LSD. The color change of the sample group immersed in strawberry extract with carbamide peroxide resulted in a significant difference (p <0.05). Likewise, the sample group immersed in honey orange extract with carbamide peroxide produced a significant difference (p <0.05), but strawberries and honey oranges did not. there is not significant difference (p> 0.05). From the results of the study it can be concluded that the extracts of strawberries and honey oranges were able to increase the discoloration of teeth to become brighter, there was no significant difference between changes in tooth discoloration soaked in strawberry extract and honey orange. ABSTRAK Warna gigi yang berubah mempengaruhi estetik seseorang, metode untuk mengembalikan perubahan warna gigi diantaranya dengan penggunakan bahan bleaching. Penelitian ini bertujuan untuk memahami perbedaan efektivitas ekstrak buah stroberi dan jeruk madu dalam perubahan warna gigi secara in vitro. Jenis penelitian eksperimental laboratoris menggunakan sampel gigi premolar sebanyak 45 buah dibagi atas 3 kelompok (ekstrak stroberi konsentrasi 50% dan karbamid peroksida konsentrasi 10%, ekstrak jeruk madu konsentrasi 50% dan karbamid peroksida konsentrasi 10% dan karbamid peroksida konsentrasi 10%). Sampel direndam larutan kopi selama 5 hari dan lakukan pencatatan warna dengan shade guide, kemudian sampel direndam ekstrak stroberi, jeruk madu dan karbamid peroksida selama 7 hari di dalam inkubator, lalu dilakukan pencatatan warna kembali secara visual dengan shade guide. Analisis data memakai uji statistik Oneway Anova dan Posthoc LSD. Perubahan warna kelompok sampel direndam ekstrak stroberi dengan karbamid peroksida menghasilkan perbedaan signifikan (p<0,05), begitu pula kelompok sampel yang direndam ekstrak jeruk madu dengan karbamid peroksida menghasilkan perbedaan signifikan (p<0,05), namun stroberi dan jeruk madu tidak ada perbedaan yang signifikan (p>0,05). Dari hasil penelitian dapat disimpulkan bahwa ekstrak stroberi dan jeruk madu mampu meningkatkan perubahan warna gigi menjadi lebih terang, tidak ada perbedaan signifikan antara perubahan perubahan warna gigi yang direndam ekstrak stroberi dan jeruk madu.

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At-home Bleaching With 10% vs More Concentrated Carbamide Peroxide Gels: A Systematic Review and Meta-analysis

Operative Dentistry ◽

10.2341/17-222-l ◽

2018 ◽

Vol 43 (4) ◽

pp. E210-E222 ◽

Cited By ~ 11

Author(s):

JL de Geus ◽

LM Wambier ◽

TF Boing ◽

AD Loguercio ◽

A Reis

Keyword(s):

Systematic Review ◽

Lower Risk ◽

Color Change ◽

Research Question ◽

Cochrane Collaboration ◽

Risk Of Bias ◽

Cochrane Library ◽

Carbamide Peroxide ◽

Significant Difference ◽

At Home

SUMMARY Objective: To perform a systematic review to answer the following research question: Is at-home bleaching in adults with more concentrated carbamide peroxide (CP) gels as effective and safe as bleaching performed with 10% carbamide peroxide gels? Methods and Materials: A comprehensive search was carried out in the MEDLINE via PubMed, Scopus, Web of Science, LILACS, BBO, Cochrane Library and SIGLE, without restrictions. IADR abstracts (1990 to 2016) and unpublished and ongoing trial registries, dissertations and theses (ProQuest Dissertations and Periodicos Capes Theses Databases) were also searched. The risk of bias of the included studies was analyzed using the Cochrane Risk of Bias tool from the Cochrane Collaboration. We meta-analyzed the data using the random effects model to compare 10% CP and more concentrated CP gels in terms of color change (ΔSGU or ΔE) and risk and intensity of tooth sensitivity (TS). The quality of the evidence was rated using the GRADE approach. Results: After the database screening, 182 articles remained, and this number was reduced to 17 after examination of the abstracts and/or full texts. Four articles were follow-ups of earlier studies, and thus we collected 13 studies. Ten studies were at unclear risk of bias, while three were at low risk of bias. Lower risk and intensity of TS was observed for 10% CP. The odds ratio for the risk of TS was 0.41 (95% CI 0.20 to 0.84, p=0.01), and the difference in means for TS intensity was 0.44 (95% CI 0.67 to −0.20, p=0.0003). No significant difference was observed in terms of color change in ΔSGU (difference in means 0.29; 95% CI 0.25 to 0.83, p=0.29) and for ΔE (difference in means −0.16; 95% CI 0.38 to 0.06, p=0.16). Except from the ΔSGU, for which the evidence was graded as low quality, the other outcomes were considered at moderate quality. Conclusions: At-home bleaching with 10% CP showed similar bleaching efficacy with lower risk and intensity of TS in comparison with more concentrated carbamide peroxide gels.

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Evaluation of staining and color changes of a resin infiltration system

The Angle Orthodontist ◽

10.2319/111615-777.1 ◽

2016 ◽

Vol 86 (6) ◽

pp. 900-904 ◽

Cited By ~ 2

Author(s):

Andrew Leland ◽

Sercan Akyalcin ◽

Jeryl D. English ◽

Eser Tufekci ◽

Rade Paravina

Keyword(s):

Red Wine ◽

Color Change ◽

Accelerated Aging ◽

Color Difference ◽

Human Teeth ◽

Point Pair ◽

Resin Infiltration ◽

Color Changes ◽

The Right ◽

Time Point

ABSTRACT Objective: To analyze the staining and color changes of a resin infiltrant system used for management of white spot lesions (WSLs). Materials and Methods: WSLs were artificially created on left buccal halves of 48 extracted human teeth. These sites were then treated with resin infiltration (RI) while the right halves of the teeth remained as nonresin (NRI) areas. Six groups were formed (n = 8 teeth/group) and were exposed to the following: red wine, coffee, orange juice, combined staining agents, accelerated aging, and distilled water for 1 week. The teeth were then polished with a prophy cup and polishing paste. Color properties were assessed using a spectrophotometer at baseline (T0), after each exposure (T1), and after polishing (T2). Color difference (ΔE*) was calculated between each time point for both halves of the teeth (RI and NRI). Data were analyzed with a two-way analysis of variance with presence of resin infiltration and staining agents as the main effects for each time point pair. Multiple comparisons were made with a Bonferroni post hoc test. The level of significance was set at P < .05. Results: The red wine and combined staining agent groups caused the greatest color change between all intervals (P < .05). Significant interactions were recorded between resin infiltration application and staining agents at all time periods (P < .05). The presence of resin infiltration as a main effect did not affect color change between T0 and T2 (P > .05). Conclusions: RI areas showed higher staining susceptibility than did NRI areas. However, prophylaxis had a strong effect on reversing the discoloration of both RI and NRI areas.

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A Clinical Study Comparing the Efficacy and Sensitivity of Home vs Combined Whitening

Operative Dentistry ◽

10.2341/10-159-c ◽

2011 ◽

Vol 36 (5) ◽

pp. 460-466 ◽

Cited By ~ 21

Author(s):

PFL Dawson ◽

MO Sharif ◽

AB Smith ◽

PA Brunton

Keyword(s):

Hydrogen Peroxide ◽

Clinical Study ◽

Color Change ◽

Carbamide Peroxide ◽

Anterior Teeth ◽

Randomized Clinical Study ◽

Custom Made ◽

Significant Difference ◽

Group A ◽

Change In Mean

SUMMARY This randomized clinical study assessed efficacy in terms of color change and production of sensitivity after home whitening alone and home whitening supplemented with in-office bleaching. Thirty-six subjects (aged 19 to 58 years) were randomly assigned to one of three different treatment groups: (A) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays; (B) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays supplemented with in-office bleaching with 9% hydrogen peroxide (in the same trays); or (C) home whitening for two weeks, with 16% carbamide peroxide in custom-made trays supplemented with in-office bleaching with 27% hydrogen peroxide (in the same trays). The efficacy of tooth whitening was assessed by determining the color change associated with the six upper anterior teeth using a value-ordered shade guide. Sensitivity was self-assessed with the use of a visual analog scale (VAS). Tooth shade and sensitivity were assessed at the following points: pretreatment; immediately after the home whitening phase; immediately after the in-office phase (groups B and C); and one week post active treatment. At the one week follow-up visit, subjects in group A had a mean (SD) color change of 5.9 (1.83) (teeth were lighter) immediately after cessation of treatment (p<0.01). Subjects in groups B and C experienced a greater change in mean (SD) shade immediately following their respective in-office treatments of 5.1 (1.53) and 5.4 (1.55). However, within one week, the shade of these teeth regressed to a similar degree to that achieved by subjects treated in group A. Overall, no significant difference in shade change or sensitivity was produced between the three groups. Investigators concluded that the in-office element of combined whitening produced no significant difference in tooth color or sensitivity when compared with home whitening alone.

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