Clinical Oral Investigations

, Volume 11, Issue 4, pp 321–329 | Cite as

Efficacy and tolerability of two home bleaching systems having different peroxide delivery

  • Christian HannigEmail author
  • Dirk Lindner
  • Thomas Attin
Original Article


The aim of this study was to investigate tooth whitening efficacy and oral side effects during bleaching with Whitestrips® (WS) (6% hydrogen peroxide H2O2 gel) and Vivadent Vivastyle® (VS) (10% carbamide peroxide gel). Forty-seven subjects were included in this single blind, randomized, parallel group study. Application of WS was performed twice a day for 30 min. Trays filled with VS were worn for 60 min once a day. Tooth color was evaluated by measuring L*a*b* values before the study and after completion of the bleaching. Treatment tolerability was monitored throughout bleaching with an 8-week follow-up after completion of therapy. After 2 weeks both treatment groups demonstrated significant improvements in tooth color compared to baseline. A shift toward less yellow (−Δb) and brighter (+ΔL) tooth color was observed. Δb amounted to −1.69 ± 0.38 for WS and −1.20 ± 0.34 for VS (mean value ± SE). ΔL was +1.55 ± 0.41 for WS and +1.20 ± 0.37 for VS. There was no significant difference between the two systems. No significant differences between the two bleaching systems were recorded for clinically observed signs or reported symptoms. Gingival irritation was observed in 13%, reported tooth hypersensitivities in 22% and reported gum irritation in 20% of the total study population. At an 8-week follow-up visit no adverse effects were observed. Both WS and VS demonstrated significant and comparable levels of tooth color improvement after 2 weeks. Each treatment caused similar levels of transient oral side effects.


Bleaching Side effects Lab value Efficacy Hypersensitivities Gingival irritation Tolerability 



The study was sponsored by a grant from Procter & Gamble. We would like to thank Dr. Catherine Mahony and Mr. Ashley Barlow for their helpful comments, Sarah O’Mahony for monitoring the study according to Good Clinical Practice Guidelines, Kieran Brennan for statistical evaluation of the data, and Robin Harris for taking and helping to analyze the digital images.


  1. 1.
    Attin T, Paque F, Ajam F, Lennon AM (2003) Review of the current status of tooth whitening with the walking bleach technique. Int Endod J 36:313–329PubMedCrossRefGoogle Scholar
  2. 2.
    Barnes DM, Kihn PW, Romberg E, George D, De Paola L, Medina E (1998) Clinical evaluation of a new carbamide peroxide tooth-whitening agent. Compend Contin Educ Dent 19:968–978PubMedGoogle Scholar
  3. 3.
    Christensen GJ (1997) Bleaching teeth: report of a survey. J Esthet Dent 10:16–20CrossRefGoogle Scholar
  4. 4.
    Cohan S, Parkins FM (1970) Bleaching tetracycline-stained vital teeth. Oral Surg Oral Med Oral Pathol 29:465–471CrossRefGoogle Scholar
  5. 5.
    Commission Internationale de Léclairage (1971) Recommendations on uniform colour spaces. Colour difference equations. Psychometric colour terms. Bureau Central de la CIE, Paris, France, Suppl 2 to CIE pub 14 (E-13.1)/(TC-1.3), 1978Google Scholar
  6. 6.
    Cooper JS, Bokmeyer TJ, Bowles WH (1992) Penetration of the pulp chamber by carbamide peroxide bleaching agents. J Endod 18:315–317PubMedCrossRefGoogle Scholar
  7. 7.
    Da Costa Filho LC, Da Costa CC, Soria ML, Taga R (2002) Effect of home bleaching and smoking on marginal gingival epithelium proliferation: a histologic study in women. J Oral Pathol Med 31:473–480PubMedCrossRefGoogle Scholar
  8. 8.
    Douglas RD (1997) Precision of in vivo colourimetric assessments of teeth. J Prosthet Dent 77:464–470PubMedCrossRefGoogle Scholar
  9. 9.
    Dunn JR (1998) Dentist-prescribed home bleaching: current status. Compend Contin Educ Dent 19:760–764PubMedGoogle Scholar
  10. 10.
    Ferrari M, Kugel G, Cagidiaco MC, Barker ML, Gerlach RW (2004) Clinical trial evaluating the peroxide concentration response of whitening strips over 28 days. Am J Dent 17:291–294PubMedGoogle Scholar
  11. 11.
    Gegauff AG, Rosenstiel SF, Langhout KJ, Johnston WM (1993) Evaluating tooth colour change from carbamide peroxide gel. J Am Dent Assoc 124:65–72PubMedGoogle Scholar
  12. 12.
    Gerlach RW, Zhou X (2001) Vital bleaching with whitening strips: summary of clinical research on effectiveness and tolerability. J Contemp Dent Pract 15:1–16Google Scholar
  13. 13.
    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 29:22–28Google Scholar
  14. 14.
    Gerlach RW, Barker ML, Sagel PA (2003) Objective and subjective whitening response of two self-directed bleaching systems. Am J Dent 15:7A–12AGoogle Scholar
  15. 15.
    Gerlach RW, He T, Zhou X (2003) Safety and tolerability of vital bleaching with whitening strips: evidence from 32 clinical trials. J Dent Res 82 (abstract 0078)Google Scholar
  16. 16.
    Gerlach RW, Zhou X, McMillan DA (2003) Safety of vital tooth bleaching with 6% hydrogen peroxide whitening strips: evidence from 18 clinical trials. J Dent Res 83 (abstract 1045)Google Scholar
  17. 17.
    Gonzalez-Ochoa JG, Nordahl I, Matis BA, Mjor IA (2003) Histological assessment of the dental pulp after bleaching. J Dent Res 82 (abstract 2480)Google Scholar
  18. 18.
    Hannig C, Zech R, Henze E, Dorr-Tolui R, Attin T (2003) Determination of peroxides in saliva—kinetics of peroxide release into saliva during home bleaching with Whitestrips and Vivastyle in vivo. Arch Oral Biol 48:559–568PubMedCrossRefGoogle Scholar
  19. 19.
    Hannig C, Zech R, Henze E, Dreier S, Attin T (2005) Peroxide release into saliva from five different home bleaching systems in vivo. Am J Dent 18:13–18PubMedGoogle Scholar
  20. 20.
    Hannig C, Willenbücher S, Becker K, Mahony C, Attin T (2006) Recovery of peroxides in saliva during home bleaching—influence of smoking. J Oral Rehabil 33:533–541PubMedCrossRefGoogle Scholar
  21. 21.
    Haywood VB, Heymann HO (1997) Nightguard vital bleaching. Quintessence Int 20:173–176Google Scholar
  22. 22.
    Haywood VB, Leonard RH, Nelson CF, Brunson WD (1994) Effectiveness, side effects and long-term status of Nightguard vital bleaching. J Am Dent Assoc 125:1219–1226PubMedGoogle Scholar
  23. 23.
    Haywood VB, Leonard RH, Dickinson GL (1997) Primarily research. Efficacy of six months of Nightguard vital bleaching of tetracycline-stained teeth. J Esthet Dent 9:13–19PubMedCrossRefGoogle Scholar
  24. 24.
    Horn DJ, Bulan-Brady J, Hicks ML (1998) Sphere spectrophotometer versus human evaluation of tooth shade. J Endod 24:786–790PubMedCrossRefGoogle Scholar
  25. 25.
    ICH (1997) Harmonised tripartite guideline for good clinical practice. Institute of Clinical Research, Maidenhead, UKGoogle Scholar
  26. 26.
    Kugel G, Kastali S (2000) Tooth-whitening efficacy and safety: a randomized and controlled clinical trial. Compend Contin Educ Dent Suppl 29:16–21Google Scholar
  27. 27.
    Lange DE, Plagmann HC, Eenboom A, Promesberger A (1977) Clinical evaluation methods for analysis of oral hygienic conditions (text in German). Dtsch Zahnärztl Z 32:44–51PubMedGoogle Scholar
  28. 28.
    Leonard RH, Haywood VB, Philipps C (1997) Risk factors for developing tooth sensitivity and gingival irritation associated with Nightguard vital bleaching. Quintessence 28:527–534Google Scholar
  29. 29.
    Leonard RH Jr, Haywood VB, Eagle JC, Garland GE, Caplan DJ, Matthews KP, Tart ND (1999) Nightguard vital bleaching of tetracycline-stained teeth: 54 months post treatment. J Esthet Dent 11:265–277PubMedCrossRefGoogle Scholar
  30. 30.
    McMillan DA, Gibb RD, Gerlach RW (2001) Impact of increasing hydrogen peroxide concentration on bleaching strip efficacy and tolerability. J Dent Res 80 (abstract 1102)Google Scholar
  31. 31.
    Nathanson D (1997) Vital tooth bleaching: sensibility and pulpal considerations. J Am Dent Assoc 128:S41–S44Google Scholar
  32. 32.
    Niedermann 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 15:20–36Google Scholar
  33. 33.
    Pohjola RM, Browning WD, Hackmann ST, Myers ML, Downey MC (2002) Sensitivity and tooth whitening agents. J Esthet Restor Dent 14:85–91PubMedCrossRefGoogle Scholar
  34. 34.
    Sagel PA, Jeffers ME, Gibb RD, Gerlach RW (2002) Overview of a professional tooth-whitening system containing 6.5% hydrogen peroxide whitening strips. Compend Contin Educ Dent 23:9–15PubMedGoogle Scholar
  35. 35.
    Saxer UP, Mühlemann HR (1975) Motivation and instruction (text in German). Schweiz Monatsschr Zahnmed 85:905Google Scholar
  36. 36.
    Thitinanthapan W, Satomont P, Vongsavan N (1999) In vitro penetration of the pulp chamber by three brands of carbamide peroxide. J Esthet Dent 11:259–264PubMedCrossRefGoogle Scholar
  37. 37.
    Tipton DA, Braxton SD, Dabbous MK (1995) Role of saliva and salivary components as modulators of bleaching agents toxicity to human gingival fibroblasts in vitro. J Periodontal 66:766–774Google Scholar
  38. 38.
    Tung FF, Goldstein GR, Jang S, Hittelman E (2002) The repeatability of an intraoral dental colourimeter. J Prosthet Dent 88:585–590PubMedCrossRefGoogle Scholar
  39. 39.
    Zhou X, ML Barker, Gibb RD, Gerlach RW (2002) Impact of behavioral, clinical and demographic parameters on whitening response: evidence from 18 clinical trials. J Dent Res 81 (abstract 1965)Google Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Christian Hannig
    • 1
    • 2
    Email author
  • Dirk Lindner
    • 2
  • Thomas Attin
    • 2
    • 3
  1. 1.Department of Operative Dentistry and PeriodontologyUniversity of FreiburgFreiburgGermany
  2. 2.Department of Operative Dentistry, Preventive Dentistry and PeriodontologyUniversity of GöttingenGöttingenGermany
  3. 3.Clinic for Preventive Dentistry, Periodontology and CariologyUniversity of ZürichZürichSwitzerland

Personalised recommendations