Comparison of the Effect of Agitation on Whitening and Tooth Sensitivity of In-Office Bleaching: A Randomized Clinical Trial

SUMMARY Objective: This single-blind, split-mouth, randomized trial was aimed at evaluating the bleaching efficacy (BE) and tooth sensitivity (TS) of a 20% hydrogen peroxide (HP) bleaching agent used under active or passive application. Methods and Materials: Twenty-two patients with canines darker than C2 were selected. Teeth were bleached in two sessions, with a one-week interval between treatments. The bleaching agent was applied using active (HPactive) or passive (HPpassive) application. Each tooth in the HPactive-allocated hemiarch received bleaching gel with sonic activation after 10 and 30 minutes from the start of treatment, with rounded movements all over the buccal surface. The color changes were evaluated by subjective (Vita Classical and Vita Bleachedguide) and objective (VITA Easyshade Spectrophotometer) methods at baseline and 30 days after the second session. TS was recorded up to 48 hours after treatment using a 0–10 visual analog scale. Color change in shade guide units (SGUs) and ΔE was analyzed using a Wilcoxon test (α=0.05). The absolute risk and intensity of TS were evaluated using McNemar test and a Wilcoxon test, respectively (α=0.05). Results: Significant whitening was observed in both groups after 30 days of clinical evaluation. The activation did not significantly influence BE (ΔSGU HPpassive=5.6 and HPActive=5.8; p=0.98; and ΔE HPpassive=10.6 and HPactive=10.3; p=0.83). Absolute risk of TS (HPactive=36.4% and HPpassive=31.8%; p=0.94) was similar for both groups (Fisher exact test). TS intensity (visual analogue scale) was higher during the bleaching sessions and up to 24 hours thereafter for both groups, with no differences between groups (twoway analysis of variance and Tukey). Conclusion: The active application of a 20% HP gel did not improve BE and TS.

Download Full-text

Effectiveness of In-office Hydrogen Peroxide With Two Different Protocols: A Two-center Randomized Clinical Trial

Operative Dentistry ◽

10.2341/17-128-c ◽

2018 ◽

Vol 43 (4) ◽

pp. 353-361 ◽

Cited By ~ 3

Author(s):

IEB Martins ◽

S Onofre ◽

N Franco ◽

LM Martins ◽

A Montenegro ◽

...

Keyword(s):

Hydrogen Peroxide ◽

Color Change ◽

Absolute Risk ◽

Rank Test ◽

Bleaching Agent ◽

Tooth Sensitivity ◽

Peroxide Bleaching ◽

Color Changes ◽

Ph Values ◽

The Absolute

SUMMARY Objectives: The aim of this study was to compare the bleaching efficacy and tooth sensitivity (TS) of a 38% hydrogen peroxide bleaching agent used for in-office bleaching, applied under different time protocols: a 40-minute application or two 20-minute applications. Methods and Materials: Forty-four patients from Brazil and Colombia, with right superior canines darker than C2, were selected for this multicenter, single-blind, randomized trial. The teeth were bleached in two sessions, with a one-week interval between them, in a split-mouth design. The bleaching agent was applied in two 20-minute (2×20) applications or one 40-minute (1×40) application in each session according to the manufacturer's instructions. The color changes were evaluated by using subjective (Vita Classical and Vita Bleachedguide) and objective (Easyshade Spectrophotometer) methods at baseline and 30 days after the second session. Tooth sensitivity was recorded up to 48 hours with a 0-10 visual analog scale. Also, the pH values during the application of bleaching were recorded. Color change in shade guide units and ΔE were analyzed by using the Student t-test (α=0.05). The absolute risk and intensity of TS were evaluated with the McNemar test, the Wilcoxon signed-rank test, and the Friedman test, respectively (α= 0.05). Results: Significant whitening was observed in both groups after 30 days of clinical evaluation. The use of a 40-minute application did not significantly influence the absolute risk of TS (68%, 95% confidence interval [CI] = 53-80) as well as the intensity of TS compared with the acid bleaching gel (absolute risk of 82%, 95% CI = 68-91). The pH values did not differ significantly between groups and at the different assessment periods (p=0.42). Conclusion: The use of a 40-minute in-office bleaching agent gel application produced the same whitening degree and TS that the two 20-minute bleaching agent applications did. The former preferably should be applied because one 40-minute application does not require gel refreshing.

Download Full-text

Comparison of the Effects of In-office Bleaching Times on Whitening and Tooth Sensitivity: A Single Blind, Randomized Clinical Trial

Operative Dentistry ◽

10.2341/15-085-c ◽

2016 ◽

Vol 41 (2) ◽

pp. 138-145 ◽

Cited By ~ 23

Author(s):

C Kose ◽

AL Calixto ◽

JRO Bauer ◽

A Reis ◽

AD Loguercio

Keyword(s):

Color Change ◽

Absolute Risk ◽

The Other ◽

Bleaching Agent ◽

Tooth Sensitivity ◽

Anterior Teeth ◽

Verbal Scale ◽

The Absolute ◽

Shade Guide ◽

Single Blind

SUMMARY Objectives: The objective of the present study was to compare the bleaching efficacy (BE) and tooth sensitivity (TS) of in-office bleaching applied under different time protocols. Methods and Materials: Fifty-three patients were randomly distributed into three groups: the bleaching agent was applied in one (1×15), two (2×15), or three (3×15) 15-minute applications. The labial surfaces of the anterior teeth were bleached using a 35% hydrogen peroxide gel. Two bleaching sessions with a one-week interval between were performed. The shade evaluation was performed with a visual shade guide and spectrophotometer before and 30 days after bleaching. Participants recorded TS with a five-point verbal scale. Color change was analyzed by one-way analysis of variance and Tukey tests. The absolute risk of TS and TS intensity were evaluated by the Fisher exact and Friedman/Kruskal-Wallis tests, respectively (α= 0.05). Results: Significant whitening was observed in all groups, with statistically lower BE for the 1×15 group (p<0.05). The absolute risk of TS (95% confidence interval) was lower for the 1×15 group than for the other groups (p<0.05). The TS intensity of the 3×15 group was statistically higher than that associated with the other protocols (p<0.05). Conclusions: A single 15-minute application produced less TS but reduced BE. The protocol with 2×15 produced a degree of BE similar to that of the 3×15 group, but with reduced overall TS intensity.

Download Full-text

Correlation Among Methods to Measure Tooth Color in Clinical Trials Evaluating Tooth Bleaching

Current Dentistry ◽

10.2174/2542579x01666180416112018 ◽

2019 ◽

Vol 1 (1) ◽

pp. 46-52 ◽

Cited By ~ 1

Author(s):

André Luis Faria-e-Silva

Keyword(s):

Repeated Measures ◽

Color Change ◽

Correlation Coefficients ◽

Wilcoxon Test ◽

Tooth Bleaching ◽

Color Measurement ◽

Tooth Color ◽

Color Changes ◽

Assessment Time ◽

Shade Guide

Objective: This study aimed to assess possible differences in results provided by two shade guides and a spectrophotometer used to measure the color changes during tooth bleaching. Methods: Fifty-six patients underwent two sessions of in-office tooth bleaching with a 35% hydrogen peroxide with a week of an interval between them. The color evaluation was performed using shade match with two guide scales (Vita Classical, and Vita Bleach Guide) and a spectrophotometer providing CieLab data. The color was assessed at baseline and 7 days after each session, and 30 days after the last session. Data from scales were arranged in scores according to lightness (lowest to highest) and the color changes were calculated based on baseline data. For CieLab data, ΔL, Δa, Δb, and ΔE were calculated for each assessment time. Differences between the color changes observed in each session were assessed by Wilcoxon test (α = 0.05). Friedman`s test and One-way repeated measures ANOVA were used to analyze color changes among the assessment times. Spearman`s test was used to evaluate the correlation between the shade guide scores and data from Cielab. Results: All methods of color measurement demonstrated any additional effect of second bleaching session on color change, and stable color after 30 days (p < 0.001 for all methods). Both shade guide scales presented low correlation coefficients with ΔL, and moderate coefficients with Δb, Δa, and ΔE. Conclusion: Despite the weak/ moderate correlation among the methods used to measure tooth color, all methods showed similar results of tooth bleaching effectiveness.

Download Full-text

Administration of Ascorbic Acid to Prevent Bleaching-induced Tooth Sensitivity: A Randomized Triple-blind Clinical Trial

Operative Dentistry ◽

10.2341/12-483-c ◽

2014 ◽

Vol 39 (2) ◽

pp. 128-135 ◽

Cited By ~ 25

Author(s):

EA de Paula ◽

S Kossatz ◽

D Fernandes ◽

AD Loguercio ◽

A Reis

Keyword(s):

Clinical Trial ◽

Hydrogen Peroxide ◽

Ascorbic Acid ◽

Color Change ◽

Absolute Risk ◽

Tooth Sensitivity ◽

Parallel Design ◽

Color Changes ◽

The Absolute ◽

Similar Risk

SUMMARY This study evaluated the effect of ascorbic acid, 500 mg every eight hours, on bleaching-induced tooth sensitivity. A triple-blind, parallel design, and placebo-controlled randomized clinical trial was conducted on 39 adults. The pills (placebo or ascorbic acid) were administered three times per day for 48 hours; the first dose was given one hour prior to each bleaching session. Two bleaching sessions with 35% hydrogen peroxide gel were performed with a one-week interval. Tooth sensitivity was recorded up to 48 hours after bleaching. The color evaluation was performed before and 30 days after bleaching. The absolute risk and intensity of tooth sensitivity were evaluated by Fisher exact and Mann-Whitney U-tests, respectively. Color changes were evaluated by unpaired t-test (α=0.05). There were no significant differences in the absolute risk and intensity of tooth sensitivity and color change between the groups. Both groups showed a similar risk of tooth sensitivity (p>0.05). The perioperative use of an antioxidant, such as ascorbic acid (500 mg, three times daily) perorally, was not able to prevent bleaching-induced tooth sensitivity or reduce its intensity.

Download Full-text

Sonic Activation of a Desensitizing Gel Prior to In-Office Bleaching

Operative Dentistry ◽

10.2341/19-283-c ◽

2021 ◽

Author(s):

VP Lima ◽

LM da Silva ◽

A Nuñez ◽

A Armas-Vega ◽

AD Loguercio ◽

...

Keyword(s):

Sodium Fluoride ◽

Rating Scale ◽

Color Change ◽

Absolute Risk ◽

Potassium Nitrate ◽

Controlled Clinical Trial ◽

Significant Difference ◽

The Absolute ◽

Sonic Activation ◽

Shade Guide

SUMMARY This double-blind, randomized, and controlled clinical trial evaluated the effect of sonic activation during the application of a desensitizing agent (DA) containing 5% potassium nitrate and 2% sodium fluoride on the occurrence of tooth sensitivity (TS) associated with in-office dental bleaching. Treatment with or without sonic activation of the DA was randomly assigned to one-half of the maxillary teeth of 34 patients in a split-mouth design. On the side without sonic activation (noSA), the DA was applied and maintained in contact with the teeth for 10 minutes. On the sonic activation side (SA), the DA was activated 30 seconds per tooth. The DA application was followed by application of 35% hydrogen peroxide in two bleaching sessions separated by a one-week interval. The primary outcome was the absolute risk of TS, recorded using a numeric rating scale and a visual analog scale. Color was evaluated with a digital spectrophotometer and a value-oriented shade guide. No significant difference between treatments was observed in the absolute risk of TS, which occurred in 93% (p=1.00) of both noSA and SA groups. The TS intensity was higher in the 24-hour interval after sessions, for both treatments, without differences between them. There was no difference in the color change for the treatments, with the average change in number of shade guide units of the Vita Classical scale of 6.35 for both (p=0.87). Sonic activation of DA containing 5% potassium nitrate and 2% sodium fluoride did not reduce the absolute risk and intensity of TS associated with in-office bleaching.

Download Full-text

Preventive Use of a Resin-based Desensitizer Containing Glutaraldehyde on Tooth Sensitivity Caused by In-office Bleaching: A Randomized, Single-blind Clinical Trial

Operative Dentistry ◽

10.2341/17-020-c ◽

2018 ◽

Vol 43 (5) ◽

pp. 472-481 ◽

Cited By ~ 1

Author(s):

ACS Diniz ◽

SNL Lima ◽

RRdJ Tavarez ◽

AH Borges ◽

SCS Pinto ◽

...

Keyword(s):

Clinical Trial ◽

Color Change ◽

Absolute Risk ◽

Tooth Whitening ◽

Tooth Sensitivity ◽

Anterior Teeth ◽

Significant Difference ◽

Numerical Rating ◽

Shade Guide ◽

Single Blind

SUMMARY Objective: To evaluate the risk and intensity of bleaching-induced tooth sensitivity (TS) after in-office bleaching following topical application of a resin-based glutaraldehyde desensitizer. Methods: Thirty-three patients were randomly assigned to the experimental (Gluma Desensitizer Liquid, Heraeus Kulzer, Hanau, Germany) and placebo groups. The placebo or Gluma Desensitizer Liquid was applied for one minute prior to application of an in-office bleaching gel. Bleaching was performed with 35% hydrogen peroxide gel (three applications × 15 minutes each) over two sessions, one week apart. The color of the anterior teeth was evaluated before and 21 days after treatment using the VITA Classical shade guide, Bleachedguide 3D, and Easyshade spectrophotometer. TS during and after the bleaching was recorded according to the visual analog (VAS) and numerical rating (NRS) scales. All data were submitted to statistical analysis (α=0.05). Results: There was no significant difference in absolute risk or intensity of TS between the two groups (risk and VAS, p=0.93 and 0.31, respectively; NRS, p≥0.45). At the end of the bleaching protocol, tooth whitening was observed in both groups, as evident from color change in shade guide units (ΔSGU, 4.1-7.1; both guides) and overall color change (ΔE, 7.4-9.3 units); however, there were no significant differences in whitening between the two groups (p>0.11). Conclusion: Gluma Desensitizer Liquid was not able to reduce the risk or intensity of TS. Bleaching efficacy was not affected by application of the desensitizer.

Download Full-text

Efficacy of and Effect on Tooth Sensitivity of In-office Bleaching Gel Concentrations: A Randomized Clinical Trial

Operative Dentistry ◽

10.2341/12-140-c ◽

2013 ◽

Vol 38 (4) ◽

pp. 386-393 ◽

Cited By ~ 56

Author(s):

A Reis ◽

S Kossatz ◽

GC Martins ◽

AD Loguercio

Keyword(s):

Clinical Trial ◽

Hydrogen Peroxide ◽

Side Effects ◽

Randomized Clinical Trial ◽

Color Change ◽

Absolute Risk ◽

Tooth Sensitivity ◽

Bleaching Gels ◽

Shade Guide

SUMMARY With the aim of reducing the side effects of in-office bleaching agents, less-concentrated hydrogen peroxide (HP) gels have been released by manufacturers. We evaluated the tooth sensitivity (TS) and bleaching efficacy (BE) of two HP concentrations in this study. Gels containing 35% and 20% HP (HP35 and HP20, respectively) were applied on teeth of 60 caries-free patients. Color was recorded at baseline and one week after the first and second bleaching sessions using the Vita Classical shade guide. TS was recorded on a 0-4 scale. BE at each weekly recall was evaluated by Kruskall-Wallis and Mann-Whitney tests (α=0.05). Absolute risk of TS and its intensity was evaluated by Fisher exact and Mann-Whitney tests, respectively (α=0.05). After two bleaching sessions, color change of approximately eight tabs was obtained with HP35; whereas, with HP20 it was six tabs (p<0.05). Only 26.7% (HP35) and 16.7% (HP20) of the participants reported TS, and no statistical differences were detected among them. Both in-office bleaching gels showed similar TS intensity, but the 35% HP agent produced faster bleaching.

Download Full-text

Combined Bleaching Technique Using Low and High Hydrogen Peroxide In-Office Bleaching Gel

Operative Dentistry ◽

10.2341/15-266-c ◽

2016 ◽

Vol 41 (4) ◽

pp. 388-396 ◽

Cited By ~ 24

Author(s):

M Rezende ◽

L Ferri ◽

S Kossatz ◽

AD Loguercio ◽

A Reis

Keyword(s):

Hydrogen Peroxide ◽

Repeated Measures ◽

Color Change ◽

Absolute Risk ◽

Color Stability ◽

Fisher Exact Test ◽

High Hydrogen ◽

Significant Difference ◽

Shade Guide ◽

At Home

SUMMARY Objectives: The aim of this study was to evaluate the efficacy, color stability, risk, and intensity of tooth sensitivity (TS) of combined bleaching techniques performed with 20% or 35% hydrogen peroxide for an in-office protocol. Methods: Thirty patients were randomly divided into two groups and submitted to a single 45-minute in-office bleaching session with 35% hydrogen peroxide or 20% hydrogen peroxide. At-home bleaching was performed with 10% carbamide peroxide for two hours daily over the course of two weeks. The color was evaluated with the value-oriented shade guide Vita Classical at different periods up to 12 months after bleaching. Patients recorded the intensity of TS using a five-point verbal scale. Color change data were submitted to a two-way repeated-measures analysis of variance and Tukey test (α=0.05). The absolute risk and intensity of TS were compared with the Fisher exact test and Mann-Whitney test, respectively (α=0.05). Results: On average, an effective and similar whitening of three units in shade guide was observed for both groups, which remained stable for 12 months. When both protocols were compared, the one with hydrogen peroxide 35% showed a higher risk (p=0.02) and intensity of TS (p=0.04). In regard to the TS intensity, no significant difference was observed up to 48 hours after in-office bleaching (p=0.09) and during the at-home bleaching phase of the study (p=0.71). Conclusion: The combined bleaching technique using at-home bleaching associated with in-office bleaching was effective and stable over the course of 12 months, regardless of the concentration of the hydrogen peroxide used for in-office bleaching. However, the protocol with 20% hydrogen peroxide produced lower risk and intensity of TS.

Download Full-text

Is a Single Preliminary Session of In-office Bleaching Beneficial for the Effectiveness of At-home Tooth Bleaching? A Randomized Controlled Clinical Trial

Operative Dentistry ◽

10.2341/18-196-c ◽

2019 ◽

Vol 44 (4) ◽

pp. E180-E189 ◽

Cited By ~ 2

Author(s):

SC Vaez ◽

ACC Correia ◽

TR Santana ◽

MLC Santana ◽

AC Peixoto ◽

...

Keyword(s):

Color Change ◽

Tooth Bleaching ◽

Controlled Clinical Trial ◽

Fisher Exact Test ◽

Tooth Color ◽

Exact Test ◽

Color Changes ◽

Time Required ◽

Preliminary Session ◽

At Home

Summary Objectives: To evaluate the effect of combining in-office with at-home bleaching procedures in terms of the time required to obtain satisfactory tooth color, final color changes, and tooth sensitivity (TS) reported by patients. Methods and Materials: Twenty-six patients enrolled in this study used 10% carbamide peroxide in a bleaching tray for 1 h/d until satisfactory tooth color was obtained. One-half of the participants underwent a preliminary session of in-office tooth bleaching with 35% hydrogen peroxide for 45 minutes. The time in days for the patients to obtain satisfactory tooth color by at-home bleaching procedures was recorded. The color change of the maxillary canines was assessed using the Vita Bleachedguide 3D Master scale and a spectrophotometer at 1 week and after the end of bleaching procedures. Participants' satisfaction with their smile was recorded using a visual analog scale, and TS was determined throughout the entire treatment. Data were analyzed by t-test, Mann-Whitney test, or Fisher exact test (α=0.05). Results: The combined protocol reduced (by an average of 3.7 days) the time required to obtain satisfactory tooth color but increased the risk and level of TS. No difference in the final tooth color change (around 5.0 shade guide units; ΔE=11.6–14.9), or the level of patients' satisfaction with their smile, was observed. Conclusions: A preliminary session of in-office bleaching reduced the time necessary to obtain satisfactory tooth color with at-home bleaching but increased the risk and level of TS.

Download Full-text

Effectiveness of and Dental Sensitivity to At-home Bleaching With 4% and 10% Hydrogen Peroxide: A Randomized, Triple-blind Clinical Trial

Operative Dentistry ◽

10.2341/16-260-c ◽

2018 ◽

Vol 43 (3) ◽

pp. 232-240 ◽

Cited By ~ 9

Author(s):

K Chemin ◽

M Rezende ◽

AD Loguercio ◽

A Reis ◽

S Kossatz

Keyword(s):

Hydrogen Peroxide ◽

Rating Scale ◽

Color Change ◽

Absolute Risk ◽

Tooth Sensitivity ◽

Whitney Test ◽

Mann Whitney Test ◽

The Absolute ◽

Shade Guide ◽

At Home

SUMMARY Objectives: To evaluate the risk for and intensity of tooth sensitivity and color change of at-home dental bleaching with 4% and 10% hydrogen peroxide (HP). Methods: For this study, 78 patients were selected according to the inclusion and exclusion criteria and randomized into two groups: HP 4 (White Class 4%, FGM) and HP 10 (White Class 10%, FGM). In both groups, the at-home bleaching was performed for a period of 30 minutes twice a day for two weeks. The color was assessed by Vita Classical, Vita Bleachedguide 3D-MASTER and spectrophotometer Vita Easyshade (Vita Zahnfabrik) at baseline, during bleaching (first and second weeks) and after bleaching (one month). Patients recorded their tooth sensitivity using a numeric rating scale (0-4) and visual analog scale (0-10). Data from color change (DeltaE data) was submitted to two-way analysis of variance. The color change data in Delta SGU from the two shade guide units were compared with the Mann Whitney test. The risk of tooth sensitivity was evaluated by χ2 test and the intensity of tooth sensitivity from both scales was evaluated by a Mann-Whitney test (α=0.05). Results: The absolute risk and intensity of tooth sensitivity was higher in the group that used HP 10 than the one that used HP 4. Data from change in the number of shade guide units and color variation after one month of bleaching for both groups showed significant whitening, with no difference between groups. Conclusions: At-home bleaching is effective with 4% and 10% HP concentrations, but 10% HP increased the absolute risk and intensity of tooth sensitivity during at-home bleaching.

Download Full-text