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A randomized clinical trial was conducted to compare the whitening effectiveness and tolerability of two daytime, professional, hydrogen-peroxide, vital-bleaching systems. Adults who had never bleached their teeth were randomly assigned to use either 14% hydrogen-peroxide whitening strips or a marketed 9.5% hydrogen-peroxide custom-tray-based syste…
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… for one case of moderate tooth sensitivity in the tray group, all of the adverse events were mild in severity and transient in duration. Severity days, a measure of symptom duration and severity and not just occurrence, generally favored the 14% hydrogen-peroxide strip ( Table 5). The mean (SD) severity days score (tooth sensitivity or oral irritation) was (852)3952 0100) with strips compared to (852)3952 0100) with the custom tray. …
OBJECTIVE AND BACKGROUND DATA: Photodynamic bleaching is a recently developed method that may be suitable for photo-oxidation of difficult internal stains. This study examined the outcomes of photodynamic bleaching for treatment of confirmed cases of tetracycline discoloration, when used as a single-appointment procedure. Digital analysis of standa…
This three-month, single-blind clinical study compared two whitening treatments, at-home with 10% carbamide peroxide and in-office with 35% hydrogen peroxide, for the degree of color change of teeth, color relapse and tooth and gum sensitivity. The degree of color change and color relapse was evaluated by using a colorimeter, shade guide and color…
To evaluate the effect of external bleaching on the color and luminosity of fluorotic stains and adjacent, normally mineralized enamel areas by means of CIE L*a*b* colorimetry. Eighteen adolescents with mild to moderate fluorotic stains were randomly assigned to either bleaching group A (n = 9) or control group B. Eligibility criteria were fluoroti…
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Regardless of the high success rate, patients commonly report the occurrence of tooth sensitivity during the in-office bleaching procedures. Recently, it has been demonstrated that using a customized tray (called sealed in-office bleaching technique) reduces peroxide penetration. The aim of this randomized clinical study was to evaluate tooth sensi…
… The characteristics of the 20 selected studies are listed in Table 2. The parallel study design was predominantly used in 19 studies, 9,15,17,19,20,[40][41][42][43][44][45][46][47][48][49][50][51][52][53] and only one study used the split mouth design. 16 …
… Eig hteen stu d ies had al re ad y b een p ublished, 9,16,17,19,[40][41][42][43][44][45][46][47][48][49][50][51][52][53] and two studies were abstracts of the IADR. 15,20 Color Evaluation Criteria …
… 40 The risk of GI was evaluated in 15 studies. 16,17,19,[41][42][43][44][45][46][47][48][49][50][51][52] Patient Satisfaction Evaluation Criteria …
Clinical Relevance Bleaching performed at home while under the supervision of a dentist provides greater color alteration compared with whitening strips when evaluated with a spectrophotometer, although the color alteration was undetectable by unaided human eyes. SUMMARY Objective: A systematic review and meta-analysis were performed to answer the following research question: Does the use of whitening strips (WS) lead to an equivalent color change compared with supervised dental bleaching in patients with permanent dentition? Methods: A search was performed on August 10, 2017 (updated on March 22, 2019), in PubMed, the Brazilian Library in Dentistry, Latin American and Caribbean Health Sciences Literature database, Cochrane Library, Scopus, Web of Science, and SIGLE, without restrictions regarding date or language. Abstracts from the International Association for Dental Research, unpublished and ongoing trial registries, dissertations, and theses were also searched. Only randomized clinical trials (parallel or split mouth) in patients with permanent dentition that compared WS with dentist-supervised dental bleaching performed at home (AH) or in office (IO) were included. The risk of bias (RoB) was evaluated using the Cochrane Collaboration tool. A meta-analysis with subgroup analysis (low and high peroxide concentration) was conducted for color change ΔE* (spectrophotometer) and ΔSGU (shade guide units), risk and intensity of tooth sensitivity (TS), gingival irritation (GI), and patient satisfaction using a random effects model. Heterogeneity was assessed with the Cochrane Q test and I2 statistics. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to assess the quality of the evidence. Results: After the removal of duplicates, followed by title and abstract screening, 20 studies remained. Only two studies were considered to have a low RoB; 11 had a high RoB, and seven had an unclear RoB. For WS versus IO, data were not available for the meta-analysis. For WS versus AH bleaching, a significant difference in ΔE* favoring the AH group was observed (standardized mean difference [SMD] = −0.50, 95% confidence interval [CI] −0.79 to 0.21), but the risk (risk ratio = 0.78, 95% CI 0.65 to 0.93) and intensity of TS (SMD = −0.30, 95% CI −0.56 to −0.04) were lower in the WS group. Color change in ΔSGU, risk and intensity of GI, and patient satisfaction were not significantly different between groups (p>0.20). The quality of evidence for ΔE*, risk and intensity of TS, and intensity of GI were graded as moderate. Conclusion: Although the risk and intensity of TS were lower in the WS group, dentist-supervised at-home bleaching led to a better color change when measured with a spectrophotometer, although the color alteration was undetectable by unaided human eyes.
… In the present study the time was adopted as recommended by the manufacturer. It is not surprising that a higher-concentration agents used for a longer period of time would produce better overall teeth whitening [18]. …
Background: Combining at-home and in-office vital teeth bleaching techniques has proven to be effective; however, the efficacy of combining at-home bleaching agents is still unclear. Objective: To compare the effectiveness of 10% and 35% carbamide peroxide at-home bleaching agents solo or in combination. Materials and Methods: Forty enamel samples from human premolars were divided into four groups (n=10) to receive different at-home bleaching protocols. The samples were bleached for two weeks as follow: G1 bleached with 10%CP for 8h/day; G2 bleached with 35%CP for 30 minutes/day; G3 starting with 35%CP for three days and continue with 10%CP for the last 11 days; and G4 bleached with 10%CP for the first 11 days and with 35%CP for the last three days. Teeth color measurements were recorded by a colorimeter in reference to the CIE L*a*b* at different periods. Student’s t-test was used to compare between the groups at each measuring period. Results: No significant differences were seen among the four groups neither in ΔE*1& ΔE*2 nor in ΔE*6 (p>0.05). Conclusion: Both 10% and 35%CP, used for two weeks, were effective in teeth whitening. Compared with 10% CP, combination treatments whether starting with 35% CP or ending with it produced no significant difference in teeth whitening during the treatment or one month post operatively.
… Some reports have mentioned tooth hypersensitivity and irritation of soft tissue as the most frequent side effects of tooth whitening treatments using both types of whitening materials. The use of a high-concentration tooth whitener to increase efficiency is believed to have an adverse effect on the state of the tooth structure [4,5]. It has been reported that some patients experienced side effects after dental treatment; 62.2% noted sensitive teeth, 45.9% had soft tissue irritation, 2.1% experienced systemic effects, and 18.8% had no side effects [6]. …
This study aimed to analyze the color change effect of the application of small starfruit extract gel on tooth enamel. Thirty specimens of bovine teeth were divided into 6 groups that would receive applications of gels with different concentrations of Aceh’s small starfruit extracts (70%, 80%, 90%) and of Bogor’s small starfruit extracts (70%, 80%, 90%). The application of the gel was performed 4 hours per day for 14 days. The measurement of the color changes was performed before application and after 7 and 14 days of application by using a VITA Easyshade®. The changes were calculated according to the CIEL*a*b* formula. Dependent t-tests showed that there were significant color changes after application of the gels containing 70% and 80% of small starfruit extracts for 7 and 14 days, but the gels caused discoloration instead of whitening of the enamel surface of bovine teeth.
… Los sistemas de tiras de blanqueamiento no requieren del uso de cubetas; están compuestos por una capa delgada adhesiva de gel de peróxido de hidrógeno en concentración de 5 %. Estas se colocan sobre la superficie vestibular de los dientes anteriores durante 30 minutos y esto se repite dos veces al día, hasta por dos semanas (1,20,21). …
strong>Introducción. El blanqueamiento dental es de los procedimientos más solicitados a los odontólogos. Desde los años 90 han aumentado las técnicas y presentaciones de los productos usados para este procedimiento. Por el aumento en la demanda del blanqueamiento dental, se puede encontrar gran número de estudios en la literatura, por lo cual es difícil sacar conclusiones válidas sobre la efectividad a largo plazo de las técnicas disponibles. Objetivo. El objetivo de esta revisión sistemática es determinar si el blanqueamiento dental es efectivo a largo plazo, cuál sistema de blanqueamiento es el más efectivo, cuánto perdura en el tiempo y cuáles son las variables que intervienen en el éxito. Materiales y métodos. Los artículos utilizados en esta revisión son ensayos clínicos aleatorizados, buscados electrónica y manualmente entre 1980 y el 2013, en diferentes bases de datos. Resultados. De 4.581 artículos encontrados, se seleccionaron 8 artículos para incluir en la revisión, ya que cumplían con los criterios establecidos. Después de seleccionar los artículos definitivos para la revisión, se hizo una evaluación metodológica de estos, por medio de la cual se encontró que el nivel de evidencia fue alto en tres artículos, medio en cuatro y bajo en uno. Conclusión. Teniendo en cuenta la buena ‘evidencia’ que se encontró, se concluye que: la efectividad del blanqueamiento a largo plazo no depende de la técnica del blanqueamiento empleada. El cambio de color registrado durante el blanqueamiento dental fue similar en todos los grupos evaluados. El blanqueamiento en casa, es un tratamiento efectivo. A pesar de que se mantienen los cambios de color logrados con el blanqueamiento, se presenta una recidiva de leve a moderada.
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… Higher concentrations of whiten ing gel cause greater tooth sensitivity while too low a concentration has less effect. 7,[15][16][17] The use of 10% carbamide peroxide may offer the best compromise between sensitivity and effi cacy. Deliv ery systems also have an effect on the outcome 15 with tray-based application having more favourable treatment out comes than paint-on or toothpaste tech niques. …
Tooth whitening has become a popular treatment regime but there is little quantitative evidence to compare techniques and so confusion may exist for the clinician as to which regime to prescribe for greatest efficacy. The aim of this study was to compare immediate and longer-term colour change on natural tooth colour in vitro, using five current tooth whitening techniques with blind matched control groups. A total of 100 human teeth of matched size were cleaned, stored in sterile deionised water at 4 degrees C then randomly allocated to one of the five active treatment groups or five matched control groups. The active treatments were: 10% carbamide peroxide (CP) x 60 min, 35% CP x 30 min or 35% hydrogen peroxide (HP) treatment x 30 min activated by one of three sources of energy (diode laser, halogen light, and plasma arc curing light). Tooth colour was analysed with a colorimeter before and after treatment: immediate, one week and nine months post-bleaching designed to generate tooth colour value (L(*)) according to the L(*)a(*)b system. The change in colour was determined as DeltaL (the difference in the value of the colour) for each tooth, then the mean differences were obtained for each group and compared. Tooth surface temperature was monitored. Comparing active treatments with controls it was found that 10% CP, 35% CP, 35% HP with halogen provided significantly greater tooth whitening. Comparing the different treatments showed that 10% CP was significantly more effective (P <0.05) than all other treatments except 35% HP with halogen activation. The effect of each treatment regime over time showed that the 10% CP gave a significant gain immediately and one week later (P <0.05), however, all the whitening effects were lost over time following these single treatments. The temperature rise on the tooth surface was greatest when using laser activation during power whitening. This study suggests that 10% CP is an effective technique for tooth whitening and can offer significant benefits over alternative regimes.
… A decrease of 3.35 units for the b * values was observed in the whitening strips compared to 1.67 for the tray where the study was intended to compare 14% hydrogen peroxide whitening strips to marketed 9.5% hydrogen peroxide custom tray based system for a period of 21 days. 10 Clinical trial carried out by Gerlach et al. on 43 subjects, observed a significant reduction of yellowness with a reduction in the b * value of 1.83 units using a 5% carbamide peroxide professional custom tray system in a period of 15 days. 11 Another study on 20 healthy adults randomised to two groups which was carried out by Gerlach et al. comparing 6.0% hydrogen peroxide strip-based bleaching system to a combination system (10% carbamide peroxide gel in a stock tray along with an anti-cavity whitening dentifrice and after-bleaching whitening mouth-rinse) with the same duration as the present study obtained a reduction in b * value of 2.23 for the whitening strips and 0.97 for the tray system. …
The study investigates the suitability of different whiteness indices and colour parameters in assessing changes in tooth whiteness using a digital-colour imaging system. Forty-six male and female subjects aged 18-70 years participated in the study and were divided into two groups. The control group was given a standard “non-whitening” dentifrice (Colgate Great Regular Flavour) and the test group received whitening strips (crest white strips). The latter contained 6% hydrogen peroxide and were worn for 30 min twice daily on the six maxillary anterior teeth. Digital images of teeth were captured using a Jai 3CCD digital camera with annular LED illumination array and the data obtained was used to calculate colour parameters (L*, a* and b*) and whiteness indices (WIC, WIO, W). Colour differences (delta L, delta a, delta b and delta E) and differences in whiteness indices were obtained and were compared between the test and control groups. Reliability and repeatability of the instrument were checked by comparing the digital data to the clinical data and also by comparing data obtained from different camera views for the same tooth. The test group showed significant changes in the colour parameters and whiteness indices over the 2-week period. It also showed significant correlation between the digital data obtained from lateral and central camera views for the same teeth. Digital data showed a similar trend to that of clinical data. The WIO index demonstrated the strongest discrimination between the test and control groups. The WIO index is appropriate for assessing changes in tooth whiteness. The digital imaging system is reproducible and reliable in evaluating changes in whiteness of teeth.
… Companies like Proctor and Gamble and Colgate offer non-tray whitening products that have been well researched and documented. 19,20 These include Crest Whitestrips, containing a 6.5% hydrogen peroxide, many different versions of Colgate Platinum whitening toothpaste, and Colgate Simply-White Whitening Gel, a paint-on gel containing 5.9% hydrogen peroxide. 21 …
Everyone wants to have a radiant smile with gleaming pearly whites – and today, practically everyone can! Sales of over-the-counter whitening products have been estimated to approach $1 billion a year in North America alone. 1 Tooth whitening has become a multi-million dollar industry, and there are literally hundreds of competing products to whiten teeth, be they in-office procedures or take-home systems. The more you know about tooth whitening, the better prepared you’ll be to help your patients make informed decisions about what system is right for them. How it all began The dental use of hydrogen peroxide, the basic ingredient in all tooth whitening products, has been documented for over 80 years. Initially, hydrogen peroxide was used for periodontal treatment and wound healing, because it was proven to prevent and retard the colonization and multiplication of anaerobic bacteria. 2,3 In 1966, Schneider et al. 4 documented the use of a peroxide-containing gingival strip to apply peroxides in periodontal tissue healing. It wasn’t long before an accidental side effect was observed -peroxide actually whitened the teeth. Later, a pediatric dentist, Dr. Jerry Wagner, used Proxigel in custom-fitted, vacuum-formed trays specifically for whitening teeth. These were FDA-approved oral antiseptics containing 10% carbamide peroxide. 1 The concept of tooth whitening was born. How it works Hydrogen peroxide releases the oxygen that breaks down the conjugated bonds in protein chains (stains) into a single bond, which increases the absorption of colour wavelengths resulting in the reflection of little colour (i.e. a whitening effect). 5 Extrinsic staining, which affects only the enamel surface, can be caused by tea, coffee, nicotine, chewing tobacco, blueberries, wine and natural aging. These stains are all relatively easy to treat with tooth whitening. The intrinsic stains that discolour the internal aspect of the tooth such as fluorosis, tretracycline, trauma, and systemic conditions are infinitely more difficult to treat. Even though peroxides in whitening materials have been shown to permeate intact enamel in just a few seconds 6 , changing the colour of the dentin requires long exposure to realize positive results.
This study examined whether an ultraviolet light enhanced the whitening efficacy of a peroxide gel containing a photo-Fenton activator. Fifty subjects were enrolled into the trial at two geographically separate sites. As directed by the randomization keys, teeth of half of the study subjects were concurrently exposed to the whitening lamp, while the gel was on their teeth, for a total light exposure of 45 minutes. The other half of the subjects received no light treatment. At each examination, clinical data were collected on the gingival index, shade score, and self-assessed dentinal hypersensitivity. Changes in tooth shade were significantly better (approximately 26% improvement; p < 0.05) for subjects exposed to the gel and dental whitening lamp (average = 7.7 shade changes) compared to subjects exposed to the gel only (average 6.1 shades) immediately after treatment. No reports of erythema, desquamation, ulceration of soft tissues, gross changes in teeth, gingiva, or restorations were documented. The relative changes in mean sensitivity scores were similar for both groups, with no significant differences between the Light and No-light groups at any interval. The whitening effect was improved by approximately 26% when the Zoom2 dental whitening lamp was used. It was demonstrated that the a photo-Fenton activator used with a bleaching light and 20% hydrogen peroxide gel is safe and effective for whitening teeth rapidly.
Tooth whitening products for use at home work over a short period of time but users should be aware of common side effects and note that long-term data on their use are not yet available. Products for whitening teeth at home are available ‘over-the-counter’ or from dentists. This review looks at whether such tooth whitening products work and, if so, which are more effective. The review focuses on products which have a chemical, bleaching action rather than an abrasive action. Results found that over a short period of time these products do work, and that there are differences between the products, mainly due to the levels of active ingredients, hydrogen peroxide and carbamide peroxide. People should be aware of common side effects such as tooth sensitivity and irritation to the gums and note that long-term data on the use of such products are not yet available.
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