Effect of Bleaching Gel Concentration on Tooth Color and Sensitivity: A Systematic Review and Meta-analysis

Abstract

SUMMARY Objective: The aim of this systematic review and meta-analysis was to evaluate a high concentration of hydrogen peroxide (35%) regarding tooth sensitivity and color change in tooth bleaching in comparison to low concentrations (6% to 20%). Methods and Materials: This review was conducted using the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and is registered on the Prospective Register of Systematic Reviews (CRD42017064493). The PICO question was “Does a concentration of hydrogen peroxide ≥35% using in-office bleaching procedure contribute to greater tooth sensitivity?” A search was made in PubMed/MEDLINE, Scopus, and the Cochrane Library. Results: Fourteen studies were selected for the qualitative analysis and seven for quantitative analysis. A total of 649 patients were evaluated (mean age: 36.32 years; range: 13.9 to 31 years), and the follow-up period ranged from one week to 12 months. The meta-analysis demonstrated that tooth sensitivity was higher in the patients submitted to treatment involving a high concentration of hydrogen peroxide (0.67; 95% confidence interval [CI]: 0.44 to 1.03; p=0.04; I2: 56%), and a significant difference was found regarding objective color ΔE (1.53; 95% CI: 2.99 to 0.08; p<0.0001; I2: 82%) but no significant difference was found regarding subjective color ΔSGU (0.24; CI: 0.75 to 1.23; p<0.00001; I2: 89%). Conclusions: This study indicated that a lower concentration of hydrogen peroxide causes less tooth sensitivity and better effectiveness in objective color change (ΔE); however, there is no difference between them related to subjective color (ΔSGU).

Influence of Hydrogen Peroxide on Mineralization in Dental Pulp Cells: A Systematic Review

“…The studies conducted so far indicate a process involving dentinogenesis and mineralization of pulp tissue or pulp cells after contact with HP. Although several systematic reviews have evaluated the adverse clinical effects of bleaching (16,24), only one recent systematic review assessed the impact of this procedure on the pulp tissue (12). Thus, the objective of this study is to carry out a systematic review to understand the immediate and long-term effects of bleaching agents on the process of mineralization of the pulp tissue.…”

Bleaching efficacy and quality of life of different bleaching techniques — randomized controlled trial

“…The rationale for those higher HP concentrations lies in obtaining faster results, thus being indicated for situations when immediate whitening is required [ 16 , 20 ]. However, HP’s oxidative properties prompted manufacturers and clinicians to search for in-office techniques with lower HP concentrations to prevent hazardous effects on biological tissues [ 6 , 21 – 23 ]. As a result, a wide range of bleaching products with lower peroxide concentrations have been developed over the years, and even an at-home paint-on varnish technique (VivaStyle Paint On Plus, Ivoclar Vivadent, Liechtenstein) was proposed for in-office use due to its fast-bleaching rate suggested by a fast HP release in approximately 10 min [ 18 , 24 – 26 ].…”

A Comparative Evaluation of Nanohydroxyapatite-Enriched Hydrogen Peroxide Home Bleaching System on Color, Hardness and Microstructure of Dental Enamel

“…Bleaching treatments consisting of the application of oxidizing agents, which directly break the double bonds of chromophores, correcting and reducing intrinsic and/or external discoloration resistant to mechanical cleaning [ 2 ]. The dental bleaching treatment can be performed by the dental clinician using bleaching agent with a high concentration of bleaching agent (in-office bleaching), or alternatively by the patient, dispensing a low concentration of bleaching agent into an individualized tray (at-home bleaching) [ 3 ]. Nevertheless, at-home bleaching has gained popularity among these types of bleaching treatments since it requires reduced chair-time, affords satisfactory outcomes, and causes less risk of tooth sensitivity than in-office treatment [ 4 ].…”