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Comparison of efficacy of tray-delivered carbamide and hydrogen peroxide for at-home bleaching: a systematic review and meta-analysis

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Abstract

Objectives

The aim of the study was to compare the color change produced by tray-delivered carbamide peroxide [CP] versus hydrogen peroxide products [HP] for at-home bleaching through a systematic review and meta-analysis.

Materials and methods

MEDLINE via PubMeb, Scopus, Web of Science, Latin American and Caribbean Health Sciences Literature database (LILACS), Brazilian Library in Dentistry (BBO), and Cochrane Library and Grey literature were searched without restrictions. The abstracts of the International Association for Dental Research (IADR) and unpublished and ongoing trial registries were also searched. Dissertations and theses were explored using the ProQuest Dissertations and Periodicos Capes Theses databases. We included randomized clinical trials that compared tray-delivered CP versus HP for at-home dental bleaching. The color change in shade guide units (SGU) and ΔE were the primary outcomes, and tooth sensitivity and gingival irritation were the secondary outcomes. The risk of bias tool of the Cochrane Collaboration was used for quality assessment.

Data

After duplicate removal, 1379 articles were identified. However, only eight studies were considered to be at “low” risk of bias in the key domains of the risk bias tool and they were included in the analysis. For ΔE, the standardized mean difference was −0.45 (95 % CI −0.69 to −0.21), which favored tray-delivered CP products (p < 0.001). The color change in ΔSGU (p = 0.70), tooth sensitivity (p = 0.83), and gingival irritation (p = 0.62) were not significantly different between groups.

Conclusions

Tray-delivered CP gels showed a slightly better whitening efficacy than HP-based products in terms of ΔE, but they were similar in terms of ΔSGU. Both whitening systems demonstrated equal level of gingival irritation and tooth sensitivity.

Clinical significance

Tray-delivered CP gels have a slightly better whitening efficacy than HP-based products in terms of ΔE. This should be interpreted with caution as the data of ΔSGU did not show statistical difference between the products.

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References

  1. Xiao J, Zhou XD, Zhu WC, Zhang B, Li JY, Xu X (2007) The prevalence of tooth discolouration and the self-satisfaction with tooth colour in a Chinese urban population. J Oral Rehabil 34:351–360. doi:10.1111/j.1365-2842.2007.01729.x

    Article  PubMed  Google Scholar 

  2. Alkhatib MN, Holt R, Bedi R (2004) Prevalence of self-assessed tooth discolouration in the United Kingdom. J Dent 32:561–566

    Article  PubMed  Google Scholar 

  3. Haywood VB, Heymann HO (1989) Nightguard vital bleaching. Quintessence Int 20:173–176

    PubMed  Google Scholar 

  4. Haywood VB, Leonard RH, Nelson CF, Brunson WD (1994) Effectiveness, side effects and long-term status of nightguard vital bleaching. J Am Dent Assoc 125:1219–1226

    Article  PubMed  Google Scholar 

  5. Cibirka RM, Myers M, Downey MC, Nelson SK, Browning WD, Hawkins IK, Dickinson GL (1999) Clinical study of tooth shade lightening from dentist-supervised, patient-applied treatment with two 10% carbamide peroxide gels. J Esthet Dent 11:325–331

    Article  PubMed  Google Scholar 

  6. Alonso de la Pena V, Balboa Cabrita O (2006) Comparison of the clinical efficacy and safety of carbamide peroxide and hydrogen peroxide in at-home bleaching gels. Quintessence Int 37:551–556

    PubMed  Google Scholar 

  7. Demarco FF, Conde MC, Ely C, Torre EN, Costa JR, Fernandez MR, Tarquinio SB (2013) Preferences on vital and nonvital tooth bleaching: a survey among dentists from a city of southern Brazil. Braz Dent J 24:527–531. doi:10.1590/0103-6440201302152

    Article  PubMed  Google Scholar 

  8. Meireles SS, Heckmann SS, Santos IS, Della Bona A, Demarco FF (2008) A double blind randomized clinical trial of at-home tooth bleaching using two carbamide peroxide concentrations: 6-month follow-up. J Dent 36:878–884. doi:10.1016/j.jdent.2008.07.002

    Article  PubMed  Google Scholar 

  9. Auschill TM, Hellwig E, Schmidale S, Sculean A, Arweiler NB (2005) Efficacy, side-effects and patients’ acceptance of different bleaching techniques (OTC, in-office, at-home). Oper Dent 30:156–163

    PubMed  Google Scholar 

  10. Tay LY, Kose C, Herrera DR, Reis A, Loguercio AD (2012) Long-term efficacy of in-office and at-home bleaching: a 2-year double-blind randomized clinical trial. Am J Dent 25:199–204

    PubMed  Google Scholar 

  11. Mokhlis GR, Matis BA, Cochran MA, Eckert GJ (2000) A clinical evaluation of carbamide peroxide and hydrogen peroxide whitening agents during daytime use. J Am Dent Assoc 131:1269–1277

    Article  PubMed  Google Scholar 

  12. Giachetti L, Bertini F, Bambi C, Nieri M, Scaminaci Russo D (2010) A randomized clinical trial comparing at-home and in-office tooth whitening techniques: a nine-month follow-up. J Am Dent Assoc 141:1357–1364

    Article  PubMed  Google Scholar 

  13. Hasson H, Ismail AI, Neiva G (2006) Home-based chemically-induced whitening of teeth in adults. Cochrane Database Syst Rev:CD006202. doi: 10.1002/14651858.CD006202

  14. Alonso de la Pena V, Lopez Raton M (2014) Randomized clinical trial on the efficacy and safety of four professional at-home tooth whitening gels. Oper Dent 39:136–143. doi:10.2341/12-402-C

    Article  PubMed  Google Scholar 

  15. Ferrari M, Cagidiaco MC, Monticelli F, Kugel G, Barker ML, Gerlach RW (2007) Daytime use of a custom bleaching tray or whitening strips: initial and sustained color improvement. Am J Dent 20(Spec No A):19A–22A

    PubMed  Google Scholar 

  16. da Costa JB, McPharlin R, Hilton T, Ferracane JI, Wang M (2012) Comparison of two at-home whitening products of similar peroxide concentration and different delivery methods. Oper Dent 37:333–339. doi:10.2341/11-053-C

    Article  PubMed  Google Scholar 

  17. Bizhang M, Chun YH, Damerau K, Singh P, Raab WH, Zimmer S (2009) Comparative clinical study of the effectiveness of three different bleaching methods. Oper Dent 34:635–641. doi:10.2341/08-069-C

    Article  PubMed  Google Scholar 

  18. Delgado E, Hernandez-Cott PL, Stewart B, Collins M, De Vizio W (2007) Tooth-whitening efficacy of custom tray-delivered 9% hydrogen peroxide and 20% carbamide peroxide during daytime use: a 14-day clinical trial. P R Health Sci J 26:367–372

    PubMed  Google Scholar 

  19. Moher D, Altman DG, Liberati A, Tetzlaff J (2011) PRISMA statement. Epidemiology 22:128. doi:10.1097/EDE.0b013e3181fe7825, author reply 128

    Article  PubMed  Google Scholar 

  20. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods G, Cochrane Statistical Methods G (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928. doi:10.1136/bmj.d5928

    Article  PubMed  PubMed Central  Google Scholar 

  21. Gerlach RW, Barker ML, Karpinia K, Magnusson I (2009) Single site meta-analysis of 6% hydrogen peroxide whitening strip effectiveness and safety over 2 weeks. J Dent 37:360–365. doi:10.1016/j.jdent.2009.01.005

    Article  PubMed  Google Scholar 

  22. Berga-Caballero A, Forner-Navarro L, Amengual-Lorenzo J (2006) At-home vital bleaching: a comparison of hydrogen peroxide and carbamide peroxide treatments. Med Oral Patol Oral Cir Bucal 11:E94–E99

    PubMed  Google Scholar 

  23. Niederman R, Tantraphol MC, Slinin P, Hayes C, Conway S (2000) Effectiveness of dentist-prescribed, home-applied tooth whitening. A meta analysis. J Contemp Dent Pract 1:20–36

    PubMed  Google Scholar 

  24. Swift EJ Jr, May KN Jr, Wilder AD Jr, Heymann HO, Wilder RS, Bayne SC (1997) Six-month clinical evaluation of a tooth whitening system using an innovative experimental design. J Esthet Dent 9:265–274

    Article  PubMed  Google Scholar 

  25. Xu X, Zhu L, Tang Y, Wang Y, Zhang K, Li S, Bohman LC, Gerlach RW (2007) Randomized clinical trial comparing whitening strips, paint-on gel and negative control. Am J Dent 20(Spec No A):28A–31A

    PubMed  Google Scholar 

  26. Reid JS (1985) Patient assessment of the value of bleaching tetracycline-stained teeth. ASDC J Dent Child 52:353–355

    PubMed  Google Scholar 

  27. Nathoo S, Stewart B, Petrone ME, Chaknis P, Zhang YP, DeVizio W, Volpe AR (2003) Comparative clinical investigation of the tooth whitening efficacy of two tooth whitening gels. J Clin Dent 14:64–69

    PubMed  Google Scholar 

  28. Migliore S, Damiani MG, Faucher A (1991) Bleaching of vital teeth. Part one of a comparative study of two ambulatory methods. Inf Dent 73:1109–1114

    PubMed  Google Scholar 

  29. Dawson PF, Sharif MO, Smith AB, Brunton PA (2011) A clinical study comparing the efficacy and sensitivity of home vs combined whitening. Oper Dent 36:460–466. doi:10.2341/10-159-C

    Article  PubMed  Google Scholar 

  30. Arzt AH (1981) Updating tetracycline-stained teeth bleaching technique. Quintessence Int Dent Dig 12:15–18

    PubMed  Google Scholar 

  31. Haywood VB, Leonard RH, Dickinson GL (1997) Efficacy of six months of nightguard vital bleaching of tetracycline-stained teeth. J Esthet Dent 9:13–19

    Article  PubMed  Google Scholar 

  32. Wilson CF, Seale NS (1985) Color change following vital bleaching of tetracycline-stained teeth. Pediatr Dent 7:205–208

    PubMed  Google Scholar 

  33. Karpinia K, Magnusson I, Barker ML, Gerlach RW (2003) Clinical comparison of two self-directed bleaching systems. J Prosthodont 12:242–248

    Article  PubMed  Google Scholar 

  34. Lo EC, Wong AH, McGrath C (2007) A randomized controlled trial of home tooth-whitening products. Am J Dent 20:315–318

    PubMed  Google Scholar 

  35. Collins LZ, Maggio B, Gallagher A, York M, Schafer F (2004) Safety evaluation of a novel whitening gel, containing 6% hydrogen peroxide and a commercially available whitening gel containing 18% carbamide peroxide in an exaggerated use clinical study. J Dent 32(Suppl 1):47–50

    Article  PubMed  Google Scholar 

  36. Li Y, Lee SS, Cartwright SL, Wilson AC (2003) Comparison of clinical efficacy and safety of three professional at-home tooth whitening systems. Compend Contin Educ Dent 24:357–360, 362, 364 passim; quiz 378

    PubMed  Google Scholar 

  37. Gerlach RW, Gibb RD, Sagel PA (2000) A randomized clinical trial comparing a novel 5.3% hydrogen peroxide whitening strip to 10%, 15%, and 20% carbamide peroxide tray-based bleaching systems. Compend Contin Educ Dent Suppl:S22–8; quiz S42–43

  38. Donly KJ, Garcia-Godoy F, Segura A, Baharloo L, Rojas-Candelas E, X. Z (2002) Efficacy and safety of vital bleaching in teenagers using 6.5% hydrogen peroxide strips during the day or 10% carbamide tray system overnight. J Dent Res Sp Issue 1953

  39. Gerlach RW, Shahidi H, Zhou X (2002) Clinical trial comparing whitening strips to a carbamide peroxide potassium nitrate tray system. J Dent Res Sp Issue 1952

  40. Loyola-Rodriguez JP, Pozos-Guillen Ade J, Hernandez-Hernandez F, Berumen-Maldonado R, Patino-Marin N (2003) Effectiveness of treatment with carbamide peroxide and hydrogen peroxide in subjects affected by dental fluorosis: a clinical trial. J Clin Pediatr Dent 28:63–67

    Article  PubMed  Google Scholar 

  41. Schroeder M, Reis A, Luque-Martinez I, Loguercio AD, Masterson D, Maia LC (2015) Effect of enamel bevel on retention of cervical composite resin restorations: a systematic review and meta-analysis. J Dent 43:777–788. doi:10.1016/j.jdent.2015.02.017

    Article  PubMed  Google Scholar 

  42. Schulz KF, Chalmers I, Hayes RJ, Altman DG (1995) Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 273:408–412

    Article  PubMed  Google Scholar 

  43. Collins LZ, Maggio B, Liebman J, Blanck M, Lefort S, Waterfield P, Littlewood D, Naeeni M, Schafer F (2004) Clinical evaluation of a novel whitening gel, containing 6% hydrogen peroxide and a standard fluoride toothpaste. J Dent 32(Suppl 1):13–17

    Article  PubMed  Google Scholar 

  44. Matis BA (2000) Degradation of gel in tray whitening. Compend Contin Educ Dent Suppl:S28, S31-5; quiz S49

  45. Al-Qunaian TA, Matis BA, Cochran MA (2003) In vivo kinetics of bleaching gel with three-percent hydrogen peroxide within the first hour. Oper Dent 28:236–241

    PubMed  Google Scholar 

  46. Matis BA, Yousef M, Cochran MA, Eckert GJ (2002) Degradation of bleaching gels in vivo as a function of tray design and carbamide peroxide concentration. Oper Dent 27:12–18

    PubMed  Google Scholar 

  47. Frysh H, Bowles WH, Baker F, Rivera-Hidalgo F, Guillen G (1995) Effect of pH on hydrogen peroxide bleaching agents. J Esthet Dent 7:130–133

    Article  PubMed  Google Scholar 

  48. Sun G (2000) The role of lasers in cosmetic dentistry. Dent Clin N Am 44:831–850

    PubMed  Google Scholar 

  49. Chen H, Huang J, Dong X, Qian J, He J, Qu X, Lu E (2012) A systematic review of visual and instrumental measurements for tooth shade matching. Quintessence Int 43:649–659

    PubMed  Google Scholar 

  50. Ontiveros JC, Paravina RD (2009) Color change of vital teeth exposed to bleaching performed with and without supplementary light. J Dent 37:840–847. doi:10.1016/j.jdent.2009.06.015

    Article  PubMed  Google Scholar 

  51. Gurgan S, Cakir FY, Yazici E (2010) Different light-activated in-office bleaching systems: a clinical evaluation. Lasers Med Sci 25:817–822. doi:10.1007/s10103-009-0688-x

    Article  PubMed  Google Scholar 

  52. Ontiveros JC, Eldiwany MS, Paravina R (2012) Clinical effectiveness and sensitivity with overnight use of 22% carbamide peroxide gel. J Dent 40(Suppl 2):e17–e24. doi:10.1016/j.jdent.2012.08.009

    Article  PubMed  Google Scholar 

  53. Alsaleh S, Labban M, AlHariri M, Tashkandi E (2012) Evaluation of self shade matching ability of dental students using visual and instrumental means. J Dent 40(Suppl 1):e82–e87. doi:10.1016/j.jdent.2012.01.009

    Article  PubMed  Google Scholar 

  54. Alshiddi IF, Richards LC (2015) A comparison of conventional visual and spectrophotometric shade taking by trained and untrained dental students. Aust Dent J 60:176–181. doi:10.1111/adj.12311

    Article  PubMed  Google Scholar 

  55. Kielbassa AM, Maier M, Gieren AK, Eliav E (2015) Tooth sensitivity during and after vital tooth bleaching: a systematic review on an unsolved problem. Quintessence Int 46:881–897. doi:10.3290/j.qi.a34700

    PubMed  Google Scholar 

  56. Matis BA (2003) Tray whitening: what the evidence shows. Compend Contin Educ Dent 24:354–362

    PubMed  Google Scholar 

  57. Gerlach RW, Zhou X (2001) Vital bleaching with whitening strips: summary of clinical research on effectiveness and tolerability. J Contemp Dent Pract 2:1–16

    PubMed  Google Scholar 

  58. Swift EJ Jr (2005) Tooth sensitivity and whitening. Compend Contin Educ Dent 26:4–10, quiz 23

    PubMed  Google Scholar 

  59. Markowitz K (2010) Pretty painful: why does tooth bleaching hurt? Med Hypotheses 74:835–840. doi:10.1016/j.mehy.2009.11.044

    Article  PubMed  Google Scholar 

  60. Cooper JS, Bokmeyer TJ, Bowles WH (1992) Penetration of the pulp chamber by carbamide peroxide bleaching agents. J Endod 18:315–317. doi:10.1016/S0099-2399(06)80479-6

    Article  PubMed  Google Scholar 

  61. Costa CA, Riehl H, Kina JF, Sacono NT, Hebling J (2010) Human pulp responses to in-office tooth bleaching. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontics 109:e59–e64. doi:10.1016/j.tripleo.2009.12.002

    Article  Google Scholar 

  62. Cook SP, McCleskey EW (2002) Cell damage excites nociceptors through release of cytosolic ATP. Pain 95:41–47

    Article  PubMed  Google Scholar 

  63. Huynh MP, Yagiela JA (2003) Current concepts in acute pain management. J Calif Dent Assoc 31:419–427

    PubMed  Google Scholar 

  64. Rezende M, Loguercio AD, Kossatz S, Reis A (2016) Predictive factors on the efficacy and risk/intensity of tooth sensitivity of dental bleaching: a multi regression and logistic analysis. J Dent 45:1–6. doi:10.1016/j.jdent.2015.11.003

    Article  PubMed  Google Scholar 

  65. Soares DG, Basso FG, Pontes EC, Garcia Lda F, Hebling J, de Souza Costa CA (2014) Effective tooth-bleaching protocols capable of reducing H(2)O(2) diffusion through enamel and dentine. J Dent 42:351–358. doi:10.1016/j.jdent.2013.09.001

    Article  PubMed  Google Scholar 

  66. Soares DG, Basso FG, Hebling J, de Souza Costa CA (2014) Concentrations of and application protocols for hydrogen peroxide bleaching gels: effects on pulp cell viability and whitening efficacy. J Dent 42:185–198. doi:10.1016/j.jdent.2013.10.021

    Article  PubMed  Google Scholar 

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Acknowledgments

This study was conducted during the doctoral stage of Issis Luque-Martinez under the supervision of the Prof. Lucianne Cople-Maia. The authors of this study would like to thank the following authors who kindly provided information not available in their full texts: Bruce Matis, Alonso de la Peña, Kevin James Donly, Mozhang Bizhang, and Marco Ferrari. This study was partially supported by National Council for Scientific and Technological Development from the Brazilian Government, under grants 304105/2013-9 and 305588/2014-1.

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Authors and Affiliations

  1. Dentistry Academic Unit, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile

    Issis Luque-Martinez & Miguel Angel Muñoz

  2. Department of Restorative Dentistry, State University of Ponta, Grossa, PR, Brazil

    Alessandra Reis & Alessandro D. Loguercio

  3. Department of Dental Materials, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Marcos Schroeder

  4. Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Danielle Masterson

  5. Department of Pediatric Dentistry and Orthodontic, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil

    Lucianne C. Maia

  6. Departamento de Odontologia, Universidade Estadual de Ponta Grossa, Rua Carlos Cavalcanti, 4748, Bloco M. CEP, 84030-900, Ponta Grossa, Paraná, Brazil

    Alessandra Reis

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  1. Issis Luque-Martinez
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  2. Alessandra Reis
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Correspondence to Alessandra Reis.

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This study was partially supported by CAPES and National Council for Scientific and Technological Development (CNPq) under grant nos. 304105/2013-9 and 305588/2014-1.

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This article does not contain any studies with human participants performed by any of the authors.

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Luque-Martinez, I., Reis, A., Schroeder, M. et al. Comparison of efficacy of tray-delivered carbamide and hydrogen peroxide for at-home bleaching: a systematic review and meta-analysis. Clin Oral Invest 20, 1419–1433 (2016). https://doi.org/10.1007/s00784-016-1863-7

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